Day 1 – 6 – A Major Post Surgery Hurdle
ACL Surgery: The First Week Post-Op
The first week after ACL reconstruction surgery is one of adjustment, discomfort, and unpredictability. Some people bounce back with minimal issues, but many others find themselves surprised by how challenging the basics become. Most patients fall somewhere in between; coping with swelling, medication side effects, limited mobility, and emotional ups and downs.
Some people get home and barely even need their pain meds. Others have said it was about the most painful week of their life, and that includes people who have been injured before with broken legs, ribs and other issues. Again, most people will likely be someplace in between.
Getting Home and Settling In
Leaving the surgery center or hospital can feel like a small victory, but getting home safely is your first big hurdle. Many places won’t even let you leave unless you’ve got a family member or close friend or someone that’s already registered with them as being your safe ride home. The surgery center may get you to your ride via wheelchair. But you’ll have to make it into the vehicle. Remember that you’ll likely be in a full leg brace locked straight. Even with a car seat put all the way back, it may be challenging to get in. You may have to sit down sideways in the door, (watch your head!), and push yourself back before pivoting into the seat. Then bring your crutches in, seatbelt on etc.
If at all possible, someone should be staying with you once you get home. Ideally for a couple of days at least. Once inside, avoid stairs if possible. If not, take your time and move purposefully. You should have already been taught how to use crutches on stairs. Some may choose to sit and try to “scooch up” the stairs. If so, you’d have to be very careful of the bad leg. And the there’s how to get up once at the top of the stairs, which could be very challenging.
Set up a recovery space ahead of time with easy access to a bathroom, medications, water, snacks, your phone, and ice therapy equipment. Some may choose to do this if they have space in a room on a ground floor vs. going upstairs to their typical room.
Mobility: Crutches, Braces, and Simple Movement
Most people will be on crutches with a knee brace locked at zero degrees (straight) for at least the first few days, often longer. Getting to the bathroom, kitchen, or even just shifting position in bed can be difficult. Take your time and plan your movements.
If you’re unfamiliar with crutches, practice before surgery or ask your physical therapist to give you a quick lesson. Use a backpack or crossbody bag to carry small items. Keep everything you need within reach to reduce trips. Be careful with any kind of bag that goes to one side. You don’t want to be unbalanced on your crutches. Here’s more on mobility aids.
Pain Management: Staying Ahead of the Curve
A nerve block or spinal anesthesia may leave your leg feeling weirdly numb or tingly for the first 12–24 hours. When it wears off, expect a spike in pain. This is normal, but unsettling. Also note that nerve block works at a certain level and even after it wears off, there could be aftereffects in parts of your leg elsewhere than the surgery site.
Many suggest following your pain management plan proactively. That means taking medication on schedule, even before the pain ramps up. If you wait until you’re already hurting, it’s harder to catch up. Many doctors recommend a mix of prescription painkillers and over-the-counter options like Tylenol or ibuprofen (as directed). Some also prescribe daily aspirin more to avoid clotting vs. pain control.
Use cold therapy frequently, whether it’s a rented cryo cuff machine, gel packs, or a bag of frozen peas. Elevate your leg above heart level to reduce swelling, and don’t forget compression if recommended.
Food and Medication Side Effects
Your appetite may be low at first. Between anesthesia, narcotics, and general discomfort, food can be unappealing. Stick to light, easily digestible meals: broth, toast, rice, fruit, and electrolyte drinks. Avoid greasy or heavy food for the first few days. Have snacks and water available in your recovery room. You want to avoid getting up unless you really have to.
Pain meds often cause constipation. Don’t ignore it. Start stool softeners or gentle laxatives as soon as you’re home if your doctor approves. Drink plenty of water and include fiber when you can. It may still take several days before you feel you need to move your bowels, even if you’re eating well. More on Nutrition for ACL Recovery.
Sleep and Mental Fog
Sleep during the first week is often elusive. You’ll likely be stuck on your back with your leg elevated and brace locked. This is uncomfortable for most, especially side sleepers. Consider using a wedge pillow, bolsters, or rolled towels to make yourself feel slightly “turned,” even if you’re still on your back. Ice machines can be noisy, and pain may peak at night, so prepare for some restless hours.
Mentally, expect some fog. Whether from medications, disrupted sleep, or the general stress of surgery, many people feel groggy, emotional, or detached in the first few days. That too is normal. Give yourself a break and understand that no matter how tough you are, you’ve been beat up a bit here. It’s going to take some time to emerge from this.
Focus on Small Wins
Your job this week isn’t really to rehab your knee. It’s to keep it stable, manage your pain, avoid complications, and stay safe. Celebrate the small victories: getting to the bathroom without help, eating a full meal, reducing your pain meds, or sleeping for a few solid hours.
Take it one day at a time. This is the hardest part for many people, but it’s also the beginning of getting your life back.
And note that you may read about or hear of those who are getting up and about almost immediately whereas others aren’t really walking yet in a month or more. Everyone is different and may have had different experiences. That is, different ages, different injury levels, different surgical procedures, different amounts of time between injury and surgery with opportunity to prep for surgery, and so on. It’s natural to want to have some baselines and a desire to have some expectations. Just understand that your journey will be your own. You’ll do what you can when you can; just be sure to do so safety with guidance from your care team.