What You Should Know About Recovering From ACL Reconstruction Surgery

I'm not a doctor, so you definitely shouldn't treat this as medical advice. This is just me reflecting on my experience and listing things I wish I knew before and after my ACL reconstruction surgery.

Whether to get the surgery or not?
Get it! The people - both patients and doctors - I spoke to were divided into two camps: those who recommended the surgery and those who advised against it. Luckily, the majority opinion was the right one. Unless you're older or unable to give adequate time to post-op recovery, it's a no-brainer. Get the surgery.

What should I do before the surgery?
Strengthen your muscles! People warned me that the quadriceps and hamstrings in the affected leg would atrophy, but I was unprepared for the extent to which my thighs lost mass and strength. My consulting ortho recommended a few exercises even before the surgery, and I wish I had done more of those. Of course, this advice depends on your unique situation. Since I only had a 3-week gap between my injury (which included a medial meniscus tear) and the operation, I could only do the exercises for about a week or so. But in general, the stronger your thighs are before the surgery, the better prepared you are for recovery post-surgery.

What should I ask my doctor about the surgery?
From my research, it appears that the surgeon's main decision is to pick between one of three types of grafts: hamstring, patellar tendon, or an allograft (from a cadaver). If you're young, you should definitely choose the hamstring graft.

What should I know about the recovery process?
Not discounting the importance of a skilfully executed surgery, but most outcomes are eventually determined by the quality of the physiotherapy that follows. I happened to be on a sabbatical and was able to dedicate significant time to physiotherapy, which hastened my journey back to normalcy. Here are the rough milestones my surgeon and physio set for me:

Week 1 & 2 - Full extension: The first goal for rehab was to fully extend my knee. Since I had torn my meniscus too when I tore my ACL, the surgeon was a little conservative in the first two weeks. In most other cases, the doc is likely to encourage you to start flexing your knees too from day 2 or 3.

Week 3 & 4 - 90° flexion: The exercises were still fairly mild at this time, focusing on sitting on a chair with knees flexed at right angles.

Week 5 & 6 - 130° flexion: It felt like I hit a wall by the time I reached 90 degrees, as arthrofibrosis had set in. The regime intensified, and this was the most painful part of the process. The physiotherapist applied force to increase flexion by about 5 degrees daily. The knee would be inflamed and needed icing, but the next morning, there was no pain. This is when I realized the value of a good physiotherapist. The force applied should be calibrated to make daily progress while allowing recovery for the next day's session.

Week 7 & 8 - Full range of motion: The physiotherapist focused on rebuilding lost strength in the thighs and worked on reaching full knee flexion. Sitting in vajrasana and in the Indian toilet squat positions, each for about 20 minutes a day, helped ease the knee into its full range of motion. It was still painful, though. I also started cycling in this period, which helped introduce cardio back into the mix and kept the knees oiled for physio.

Week 9 & 10 - Strengthening: Therapy shifted to the gym, focusing on strengthening all muscles in the thigh and calf. Seated and laying leg curls, squats, leg press, and workouts on the hip abductor machine were emphasized.

Week 11 & 12 - Balance: Balance and stability exercises were added, involving catching a medicine ball while standing on a wobble board and later on a hedgehog balance pod. We continued all exercises from weeks 7 to 10.

Week 13 & 14 - Running: I felt comfortable trying to run by week 13. The first few runs were painful. Even beyond that, I always had to endure discomfort during the first kilometer and then slowly ease into a rhythm. Running was the most effective in bringing back strength, although all gym exercises helped bring back muscle tone in the leg.

At this point, I feel confident about working my way back into sports drills like soccer ball dribbling or basketball layups. It will take a few more weeks before I can fully take my knee for granted and go back to contact sports, but the journey so far, like all arduous ones, has been totally worth it, most of all for the mindfulness it has brought to my physical activities.

Ellora

There are few man-made structures that have made me feel as if the air was sucked out of my lungs —the first sight of the Taj Mahal or the Brihadeshvara temple at Thanjavur, or when, at the end of walking through a narrow canyon in Petra, the Al-Khazneh suddenly comes into view. I had that same feeling when I saw the Kailasha temple at Ellora. But more on that later.

Ellora has a series of rock-cut excavations built over a period of nearly 500 years, starting around the 6th century CE. The end result is a series of 34 caves representing three great traditions of pre-Islamic India—Buddhism, Jainism, and Brahmanism—that were healthily jostling for civilizational mindspace in that period. The first twelve caves, also the oldest ones, are Buddhist in nature and reminiscent of the Ajanta caves. The last five represent Jainism, somewhat similar to the Buddhist ones, but most Indians will identify the Jain motifs in the exquisite details. Almost as a symbol of the hegemony that Brahmanism eventually claimed in this land, the middle caves are dominated by the Hindu excavations.

Most of the 16 caves in the middle section are special in their own way, and I realized the single day I had budgeted for Ellora was woefully inadequate. Cave 15, for instance, depicts the Dashavatara, and each carving is a story unto itself. But the real showstopper is cave 16, the Kailasa temple.

Michelangelo said this about his most famous creation in marble: “I created a vision of David in my mind and simply carved away everything that was not David.” The unnamed architects of the Kailasa temple, commissioned by the Rashtrakuta kings, did something similar to a whole temple. They took a whole rock mountain and chipped away everything that wasn't a temple and left us a wonder that stands at 32m at its highest. I had read quite a bit about the temple before visiting it, and yet that didn’t prevent the feeling of awe from descending on me. It’s not enough to “see” the Kailasa temple. Monuments that combine scale and aesthetics have this way of modifying the very nature of space-time around them. It’s important to soak in that atmosphere, and that’s what I did.

Ajanta

Picture a horse-shoe shaped valley thick with vegetation enclosed by a near-vertical rock face. One end of the horse-shoe is a seven-stepped waterfall that then leads to a stream running right through the valley. On the cliff are caves that have been engraved into the rock which served both as viharas - resting areas - as well as places of worship and ceremony. The caves still have intricate carvings inside and at their peak, over a millenium and a half ago, would also have contained spectacularly executed wall paintings, some of which have survived even to the present day despite being exposed to the elements. The setting seemed like the work of an overzealous art director working in a big-budget south indian movie, and yet there it was before my eyes. 

It made me think about what this valley would have looked like in its heyday. It made me contemplate the power of a school of thought that drove people to literally reshape mountains. It made me wonder about the level of scientific knowledge and sophistication that enabled people to plan and execute such architectural marvels that look set to last a few more millenia. 

I came away also with the appreciation of how well the monuments have been preserved too. Their designation as UNESCO heritage sites may have something to do with the level of preservation. Visiting the monument on a cloudy day with only a thin weekday crowd in attendance, and the previous week's rains having fed the streams and perked up the vegetation, may have heightened my experience but very few places compare with Ajanta.