Experiencing ACL Reconstruction and Meniscus Repair from a Physiotherapist's Perspective

The physio becomes the patient! And wow, is that ever a hard thing to do. Throughout this humbling rehab journey, I have learned big lessons in resilience, rolling with the punches, asking for help and trusting the process. Playing soccer on September 15/2024, I fully tore my ACL and MCL, and had two horizontal tears in the body and posterior horn of my lateral meniscus. It was the classic cork screw mechanism, where the lower part of my leg was locked in a tangle of another players leg, and the rest of my body just kept going. I felt a pop, or about a dozen pops and crunches. I tried to put weight on it and it gave out like a wet noodle. 

I was in a locked hinged brace for 7 weeks to get the full MCL tear to heal and to hope for some early healing of the ACL. Ultimately, the MCL did heal nicely, and did not require any surgical management. 

From the time of injury until early December, I had the hope to treat this injury conservatively without surgery. As a physiotherapist, I am definitely pro-rehab over surgery whenever possible. There is some amazing evidence emerging about the potential for the ACL to heal, especially if placed in a bracing protocol, but we just don't know who will be a "coper" and who won't. I read and analyzed every shred of evidence about conservative ACL management. Oh and here's a fun fact - back in 2010, I tore my ACL on my other knee, also playing soccer. I suspect it was a partial tear, and I had no other co-existing injuries. I always had a little laxity in tests like Lachman and Anterior Drawer, making me a fun test subject in any physiotherapy course. I was able to rehab it aggressively in the gym and return to all kinds of pivoting sports.

In December 2024, I felt my first big instability episode, where my knee shifted forwards and almost collapsed when I was just planting my foot down to open a heavy door. From here on, the instability would continue to get worse, usually happening when my knee was forced into a bit of unpredicted hyper-extension or uneven ground. It just feels awful, and weird, and not right.

Pre-surgically, the meniscus tear was also giving me lots of grief. Despite my best efforts, I could not regain full knee flexion. I could not crouch, squat deeply, or kneel. It's also probably largely changed my movement mechanics and muscle function. The research on meniscus tears shows that conservative treatment is often equal to surgery in long term outcomes, and therefore conservative options are recommended at first, except ... in some cases and certain types of meniscus tears (bucket handle tears, displaced fragments, large tears). 

So how did I make the decision to pursue surgical intervention? Originally, I felt like a bit like a failure, a physiotherapist who failed conservative rehab. However, I feel like I had all the information, the knowledge, the expert opinions, to make the right educated decision. Ultimately, my knee kept giving me episodes of instability, and the meniscus tear just wouldn't settle down. If anyone is going through this process, I would suggest you give yourself 6 months of high quality rehab, get lots of opinions, and see where you end up. Don't rush into anything.

At the end of the day, this injury has made me a better physiotherapist. One who sees both sides, when it's appropriate to rehab conservatively and when it's necessary to have surgical intervention. No two ACL injuries are the same, and there needs to be individualized decision making.

This injury has been the best professional development that I never asked for. 

After a couple of very frustrating rescheduled surgery dates, the day of surgery was quite smooth. I was the first case, and I was home by 1pm. It's an interesting thing, to work in a small town and see your patients, neighbours and friends in the halls of the hospital. Overall, it was a fantastic experience and the staff at Squamish General were amazing. I even happy cried in the recovery room, telling the nurse how amazing my experience was (let's blame the anaesthesia...). 

The first week was a blur. It was harder and more painful than I expected. My body did not agree with the heavy narcotics, I was dizzy, nauseous, constipated and a total zombie. 

Despite all that, I focused hard on regaining my knee extension immediately in the first 24 hrs. I slept with my leg propped up, with a pillow under my ankle to allow for passive extension. I also tried to fire my quad just about every hour. And the cryo-cuff ice machine was my best friend! 

Because of the meniscus repair, I am non weight bearing for 6 weeks. Had I only had an ACLR and/or a menisectomy, I would be able to weight bear as tolerated. So my recovery may look a little slower initially. I am also restricted to only move my knee to 90 degrees flexion for 6 weeks, which I am nearly there by the end of the 2nd week. So overall, it's going really well, but crutch life with two little kids is... challenging.

Helpful Tools for ACL Reconstruction + Meniscus Repair:

I have been using my NMES muscle stim to help fire my quad. After a major injury or surgery, arthrogenic muscle inhibition is very common. Think of it as your nervous system shutting off the quad muscle due to swelling, pain and damaged mechanoreceptors, which leads to muscle weakness and atrophy. The muscle stim can help overcome this, and get the quad to fire more effectively. Managing swelling and pain is also highly effective at returning the quad to a more functioning state. Regaining full knee extension and getting the quad firing with the goal of no quad lag, are the most important early goals of ACLR management.

I have also been using blood flow restriction (BFR). BFR is a technique that uses a cuff or band to restrict blood flow to a limb during exercise. This restriction allows for muscle growth and strength gains to be achieved with lighter weights and lower intensity training. This is often needed in the early days of ACLR, as we want to load the muscles to prevent atrophy and gain strength, yet we have to respect the healing timeframes of the ACL and meniscus repair. 

I have a few more weeks to go on crutches, and then the more exciting rehab can start! Stay tuned for my next update :)

Claire McDonald, BScKin, MScPT

Registered Physiotherapist

Squamish, BC