It is not uncommon for your knee to make strange grinding and clicking noises after ACL surgery. The first thing people think is that there must be something wrong with my new ACL graft! This is rarely the case. Pain, swelling, and strange noises your knee makes after ACL surgery are all usually normal after surgery. Watch this short video to learn all about the grinding and clicking sounds your knee makes.
Watch this short video to find out why your knee makes grinding and clicking noises after ACL surgery and why this may be completely normal!
As you saw in the video above, there can be normal sounds your knee makes and abnormal sounds your knee makes after ACL surgery. I have summarized them below.
Clicking of your kneecap or cracking sounds when you bend or straighten your knee is usually normal.
If the joint chatters, makes a grizzly or grinding sound and is accompanied by a shift in the joint, this may be abnormal. These sounds will usually make you feel like your knee is giving way or feels unstable, and this can be a problem. In this case, it is best to have your knee joint assessed for stability by a healthcare provider.
Most people need to worry less about the noises their knee makes after ACL surgery and focus more on their daily rehabilitation exercises. You can focus on your daily ACL rehabilitation by downloading Curovate from the links below. Curovate is a physiotherapy app that provides daily video-guided exercises for each day of your recovery. Curovate also tracks your progress and gives you the ability to measure your knee’s range of motion using just your phone.
If you need more tailored help after your ACL surgery or ACL injury, check out our Virtual Physiotherapy page to book your 1-on-1 video session with a physiotherapist.
I started my company, Curovate, with a very simple vision, to make physiotherapy accessible to everyone worldwide. That was in 2015. Our physiotherapy app Curovate was originally released on the Google Play Store on August 1, 2016. When we first released the app, it provided rehabilitation for people after anterior cruciate ligament (ACL) surgery. Seven years later, Curovate provides rehabilitation for all of the following physiotherapy-related issues on both iOS and Android devices:
The video below gives a short preview of everything Curovate can help you with in your daily rehabilitation. The main purpose of our physiotherapy app is to help you stay consistent with your daily rehabilitation exercises at home after an injury or surgery.
Curovate is a physiotherapy app for recovery before or after knee replacement, ACL surgery, knee osteoarthritis, knee strengthening exercises, hip strengthening exercises or hip replacement. Curovate has been developed and supported by physiotherapists.
To learn more about our app and how it can help you with your recovery, visit our website here. Or download Curovate from the links below and get started on your recovery!
If you need more tailored help during your surgery or recovery from your injury, check out our Virtual Physiotherapy page to book your 1-on-1 video session with a physiotherapist.
Are you recovering from a knee injury or knee surgery and are you asked to complete a questionnaire, the so-called Knee Injury and Osteoarthritis Outcome Score (KOOS)? This blog highlights the purpose of these questionnaires and explains what the KOOS is and how it is relevant to you and your recovery process. The first part discusses the purpose of these questionnaires in general and why you should care about them. The second part looks specifically at the KOOS and explains who it is designed for, what it measures, how it is scored, what it tells you about your knee and how it is relevant to you.
Why should I give feedback and are there any benefits for me?
Do you ever wonder why smartphones keep getting bigger or why your favorite website keeps changing its homepage? Well, it all comes from asking people what they want and then incorporating some or all of this feedback into the design of products and services.
For example, if you use our Curovate app for your knee replacement, ACL injury, or surgery recovery or hip replacement recovery, you’ve probably seen this one!
Curovate app review screenshots. Curovate is a physiotherapy app for knee replacement, ACL injury or surgery, knee osteoarthritis and video-guided hip replacement recovery.
The purpose of this is to understand how you experience the app so we can make changes to improve your recovery at home after surgery and injury. You may think, “If the product works, I’ll be happy with the results,” or “giving feedback only helps the makers and doesn’t help me,” but that’s not the case. For example, a water bottle may be advertised as the perfect insulated bottle that can keep liquids cold for 42 hours. Even if you love the insulated feature of the bottle, you may not buy it because you simply hate the look or because the design of the bottle makes it impractical to carry around. By giving your feedback you not only help the creator of the product, but you also help create something for yourself.
What is a patient reported outcome measure or PROM and why should I worry about it?
The same concept of feedback is important in healthcare. For example, if you are a weightlifter recovering from ACL reconstruction surgery, there are a few important factors to consider as it relates to your recovery. First, you want to be sure that the surgery was successful in repairing your ACL. Secondly, as a weightlifter you also want to be sure that you can continue to lift heavy weights and do what you love.
To measure both aspects and determine the effectiveness of the treatment, two different outcome measures are used. Objective physician-based outcome measures (CBOMs) typically include clinical data such as range of motion, knee laxity, or knee strength, which are objectively collected by your healthcare provider.[1] CBOMs can be useful in determining whether your ACL reconstruction surgery is successful from a clinical perspective.
Patient-reported outcome measures (PROMs), on the other hand, allow you to report your symptoms, your level of disability, and your health-related quality of life, all from your perspective.[2] So PROMs can be used to let your doctor know about any limitations you may be experiencing that may be hindering your ability to lift weights. PROMs can also help you better understand whether you are making progress while recovering from injury or surgery.
Although CBOMs are defined by a standardized outcome from a physician’s perspective,[3] PROMs are intended to help you achieve the outcome you want by allowing you to report symptoms that are most relevant to you and your lifestyle.[4]
What exactly is the KOOS, who is it intended for and what does it require?
Since different conditions require different treatments, there are therefore also specific outcome measures to assess a specific treatment. A reliable and valid PROM, specialized for people with various knee conditions, including ACL injuries, ACL surgery, meniscal injuries, focal cartilage lesions, knee osteoarthritis, knee replacement and various other knee conditions, is the Knee Injury and Osteoarthritis Outcome Score (KOOS). .[5][6] The KOOS is used by people in their twenties to people in their eighties.[6] The KOOS is a self-reported questionnaire that takes approximately 10 minutes to complete. You will be asked to complete the questionnaire once before the treatment or surgery begins, and again after the treatment or surgery has taken place.[5]
In terms of questions, the KOOS assesses five of the following dimensions: pain (nine items); symptoms (seven items); activities of daily living (17 items); sports and recreational function (five items); and knee-related quality of life (four items).[5] For reference, here is an example of the entire KOOS questionnaire.[5]
How is the KOOS scored?
Each item on the KOOS is scored on a 5-point Likert scale, with 0 representing the least severe and 4 the most severe.[4] A 5-point Likert scale allows you to show how strongly you feel about a particular question and gives you five options from which to select the one that best represents how you feel.[7] An example question from the symptom dimension of the KOOS and the 5-point Likert scale can be found in the image below:
KOOS question #1 relates to a person’s symptoms. The Likert scale shown above provides options to rate your symptoms from ‘Never’ to ‘Always’.
Each answer is associated with a score and each item score is then summed to give a total for that specific dimension. For example, the scores of all nine items from the pain dimension are summed to give a total score for pain. The total scores for each of the five dimensions are then converted to a scale of 0-100, with zero representing extreme knee problems and 100 no knee problems.[5]
What does the KOOS tell me about my knee and why is this important for me and my recovery process?
A KOOS is usually performed after an injury, after treatment, before surgery and after surgery. The KOOS can provide insight into the course of your knee injury or knee surgery and also allows healthcare providers to monitor the effect of the treatment over time.[8] It is important and necessary to have tests that can measure both short- and long-term outcomes, as traumatic knee injuries often result in damage to multiple structures such as ligaments, menisci, or cartilage.[8] and can ultimately lead to knee osteoarthritis, a degenerative joint disease characterized by pain, stiffness, swelling and limitations in joint function.[9] Given its ability to monitor both short- and long-term effects, the KOOS is therefore an effective tool to measure improvements or identify deterioration over time for people recovering from traumatic knee injuries.
As a person who has had a knee injury or surgery, it is valuable to compare your own KOOS scores with other people who have had a similar injury or surgery. Doing this can help you determine your level of functioning, progress, and limitations at any given time compared to others who have undergone the same injury or surgery.[10] In part 2 of the KOOS blog we discuss normative values for the KOOS and how to interpret these scores so you can compare your progress and understand what normal progress is.
Conclusion
A PROM is a patient-reported outcome measure. Typically, people complete these questionnaires after the injury, before surgery, after treatment, after surgery, and when they have completed treatment or rehabilitation. These questionnaires provide some insight into how the person is doing and can show progress or lack of progress. PROMs are important for you and your healthcare provider to better understand your current capabilities and limitations. One such PROM is called the Knee Injury and Osteoarthritis Outcome Score or KOOS. The KOOS asks various questions about pain (nine items); symptoms (seven items); activities of daily living (17 items); sports and recreational function (five items); and knee-related quality of life (four items). The KOOS only take 10 minutes and can provide a lot of insight into how your knee is doing. Read the blog above for more information about PROMs and the KOOS. Stay tuned for our second part of the KOOS blog, which will provide normal values for various knee injuries and surgeries.
If you have had a knee injury or surgery, try our Curovate app for your daily recovery. Curovate offers video-guided daily exercises, progress tracking, the ability to measure the range of motion of your knee and hip, and the ability to complete the KOOS outcome measurement, all within the app.
If you need more tailored help during your surgery or recovery from your injury, check out our Virtual Physiotherapy page to book your 1-on-1 video session with a physiotherapist.
As my daughter continues to process the injury, I would do my best to gauge where she is mentally. Is she still focused on the injury itself, or has she opened a window to talk about the recovery process? If I feel like a window has opened to talk about the recovery process, here’s what I want her to know.
5. Throughout your life you will realize that life is not about what happens to you, but about how you respond to it. This is one of those moments.
6. Recovering from an ACL injury involves the same principles that made you such a great athlete. You will apply the same hard work, discipline, focus and mental strength to get back to full health.
7. At some point you will decide whether or not you want to put the same energy you put into your sport into this recovery. If you choose, you can come back from this bigger, faster, stronger (and smarter, too).
The more technical article will come at some point (I still have my list of 20+ items). For me at least, it is my natural instinct as a parent to help my daughter through difficult moments in life (in my case, at 19 months, it is telling my daughter: “It’s okay, no problem” right after she falls is ). I suppose this is why I moved so quickly to technical information in my first approach.
But for now, in these first 1-7 days after my daughter was injured, I just want her to know that she is supported, and that ultimately it is her choice what perspective she has on the recovery process. Once she comes to the conclusion that she is ready to put her full mental and physical energy into the recovery process, the technical information awaits… and we get to work.
A patient-reported outcome measure (PROM) is a self-reported questionnaire that you typically complete before and after surgery or treatment.[1] It allows you to report your symptoms, level of disability and your health-related quality of life, all from your perspective.[1]
The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a PROM specifically designed for people with various knee conditions, including those with ACL injuries, meniscal injuries, focal cartilage lesions, knee osteoarthritis, and many others.[2][3] It takes approximately 10 minutes to complete and rate five of the following dimensions: pain (nine items); symptoms (seven items); activities of daily living (17 items); sports and recreational function (five items); and knee-related quality of life (four items).[2]
By completing the KOOS you will gain insight into the course of your knee injury and you and your healthcare provider can monitor the effects of the treatment over time.[4] For example, if you have just had total knee replacement surgery or ACL surgery, to help gauge your recovery progress and your level of disability at any given time, you can compare your preoperative KOOS scores to your postoperative scores. compare your KOOS scores with those of others who have undergone the same injury or surgery.[5]
For more information about PROMs and the KOOS, check out our blog where we explain what a PROM is and what the KOOS is.
Learn what a patient-related outcome measure or PROM is and why it is important for you to complete this form. Also learn what the Knee Injury and Osteoarthritis Outcome Score or KOOS is in this YouTube video presented by Joey Wong, kinesiologist.
Accelerate ACL clients are designed to optimize all facets of the recovery process. Yes, the technology and training you have access to through the AACL program can deliver breakthrough ACL repair results. But if you don’t give the body the things it needs to recover between workouts, you’ll limit how efficiently you can recover. If your goal is to look back on the recovery process and say, “I did everything possible to have an efficient recovery,” then you need to focus on three important lifestyle factors: nutrition, hydration, and sleep. This article and others to follow will focus on the nutritional side: what to eat after ACL surgery.
If you’re reading this article before ACL surgery, consider yourself lucky: In fact, it’s better to start on these recommendations NOW.
Please note that these are general guidelines based on conversations with our athletes’ nutritionists and dietitians across the country over the years. While they are suitable for most, they are not suitable for everyone. If you really want personalized recommendations, it can be a smart idea to work with a nutritionist or dietitian during the recovery process.
More than 200,000 anterior cruciate ligament (ACL) surgeries are performed in the US every year.[1] The anterior cruciate ligament or ACL is one of the four major ligaments in your knee.[2] Aside from a direct blow to the knee, injuries most commonly occur in sports that involve sudden movements, such as a quick stop or changes in direction. Common sports that cause ACL injuries include but are not limited to soccer, American football, basketball and volleyball. ACL reconstruction surgery is surgery that replaces a torn ACL.[2] The torn ligament is removed and replaced with a tendon; a band of tissue that connects muscle to bone. Regaining full extension of the knee, also called range of motion of knee extension or ROM, is one of the most important goals after ACL surgery.[1] Many studies show that people can fully extend their knee and have good results after ACL surgery.[1] However, this does not mean that straightening the knee is easy. That’s why I want to help you answer some frequently asked questions about knee straightening after ACL surgery.
When can I fully extend my knee or knee stretch again?
The goal for full extension or straightening of the knee after ACL reconstruction surgery is usually 8-12 weeks or between months 2 and 3 after your ACL surgery. For most people, the first four weeks are focused on allowing the tendon to regrow and hypertrophy or become larger, while the next four weeks are focused on strengthening the tendon.[4]
Timeline and possible recommended exercises
Please use the following as a guideline and understand that this is based on research-based ACL protocols, but it may not be suitable for you if you have not had standard ACL surgery. Also check with your doctor to make sure these exercises are safe and appropriate for you. You can also learn about a general ACL recovery timeline by reading our previous blog.
The suggested knee extension exercises below should be performed daily if you have had standard ACL surgery.
Immediate Postoperative ACL Surgery Weeks 0-1
Purpose: To control pain, swelling and inflammation. Place weight on the surgical leg if your surgeon gives you permission to do so.
Assignments:
Muscle setting exercises – contract and relax your leg muscles without moving the leg, just squeeze and relax your leg. These are also called isometric exercises.
Single pumps
Straight legs go up
Heel slips
Knee extensions or knee stretches. Normally you will not be able to fully straighten your knee in the first week. When your leg and knee are flat, this is called 0 degrees of knee extension. In the first week you have no knee extension. Your knee may remain bent when you try to straighten it and this is normal in week 1. Typically people lack 10 to 20 degrees of knee extension and this will be ‘-10’, ‘minus 10’ or ‘-20’, called ‘minus’. 20″ degrees of knee extension. The “-” or “minus” indicates that you have not yet reached 0 degrees of knee extension.
Lie on your stomach and bend your knee, unless you have had a hamstring tendon transplant for your ACL
Other tips: cryotherapy, which is the use of ice or other cold therapy, postoperative compression wrappings such as a tensor bandage, and elevation using ice and compression.
ACL surgery Weeks 2-3
Goal: full weight bearing without crutches with a normal gait or gait pattern
Assignments:
Continue with the exercises from phase 1, may increase from -20 or -10 to 0 degrees of knee extension. It’s hard in the second and third weeks, but you have to work hard to reach 0 degrees of knee extension.
Gait training – walking on a treadmill or a flat surface without crutches
Stationary cycling and DO NOT cycle outside
Usually swimming from week 3, as long as the stitches are removed and the scars are healing properly.
ACL surgery Weeks 4-6
Goal: Near full range of motion, double-leg squats, single-leg calf raises
0 degrees or knee extension
Climbing or climbing stairs from week 4
Assignments:
Step-ups – stand in front of a staircase or step stool, place your foot on it, stand up and shift your weight to the thigh and contract your quadriceps muscles
Step-downs – same process as step-ups, but start with your leg on the step and lower your body and leg in a slow and controlled manner.
Calf goes up
Hip extensions
Hamstring stretch
ACL surgery Weeks 7-8
Goal: Near full range of motion or full range of motion, full weight bearing during normal gait
0 degrees or more knee extension. Many people have knee extension of more than 0 degrees. This means that your knee bends backward more than in a straight line, which is normal. Extension greater than 0 is called “plus” or “+” degrees of knee extension. If a person’s knee bends 5 degrees more than a straight line, this is called “+5” or “plus 5” degrees of knee extension.
Assignments:
Continuation of exercises from phase 1 and weeks 4-6
Exercises that place more strain on the surgical leg and exercises with one leg, such as the step up, lunges and single leg sit to stand from a chair.
How can I improve my knee extension ROM after ACL surgery?
Loss of knee extension is a common complication after ACL reconstruction surgery.[5] Before your surgery, it is helpful to know that being able to fully extend your knee will reduce the chance of loss of extension after your surgery. Loss of extension can also lead to abnormal articular cartilage and poor quadriceps movement. These are the muscles in the front of your thigh, making it important to stick to your rehabilitation exercises.[5] Articular cartilage is the tissue that covers the ends of bones where joints form, making it easier for the joints to move. Recommended treatment strategies to achieve full extension include exercises such as extended low-load stretching and calf stretches.[1] Rehabilitation with knee extension often involves weekly progression. Progress in ROM should be monitored and continually assessed to ensure you are achieving your knee extension goals, based on your rehabilitation protocol and the advice of your healthcare provider.[4] In this blog you will also find some practical tips for improving your knee extension and knee flexion after ACL surgery.
Conclusion
ACL reconstruction surgeries are quite common and therefore the rehabilitation process and timeline are very well understood and researched. However, people often worry about the progress of their rehabilitation and especially whether they are achieving their knee’s range of motion at a normal pace. Following or adhering to your rehabilitation protocols or programs is critical to the success of regaining full knee extension. It’s important to remember that not everyone’s timeline will be the same, but 8-12 weeks is the average time to regain full knee extension after ACL surgery.
If you have had ACL surgery and want clear daily, weekly and monthly guidance for your knee extension and daily exercises for your recovery, try our Cuorvate app. Curovate offers video-guided daily exercises, weekly range of motion goals and exercises, progress tracking, the ability to measure your knee and hip range of motion, and in-app chat with a physical therapist.
If you need more tailored help during your ACL recovery, check out our Virtual Physiotherapy page to book your 1-on-1 video session with a physiotherapist.
Last winter I connected with another NFL player who was going through an ACL recovery.
Before meeting him, he had been working as hard as he could to recover efficiently from the ACL injury. But he had just been to his doctor, who had taken him through several to test to determine how well his recovery was going.
The score on the test wasn’t pretty. So much so that his head coach later told me it caused him to have a panic attack in the parking lot. Despite doing everything possible to keep this player’s recovery on track, they were… well behind.
Fortunately, the player received a referral to call Accelerate ACL. After just a few training sessions with our team and technology, he started seeing steady progress.
After a few weeks he went back to the doctor for further follow-up to test again. His score doubled. The head coach was relieved and sent me a text saying, “I believe his scores have gone up in large part because of your work with him.”
Today, that player is on track to return to the field for the start of the NFL season. During a recent workout at his home, another player was visiting him, and I told him that the technology used in Accelerate ACL workouts is similar to his “cheat code.”
Had this player settled and not sought additional help, his recovery likely would have been delayed, putting his 2021 season in jeopardy. Instead, he’s back on the field and eager to make an impact… we can’t wait to see how it turns out.
Knee injuries can be very scary and quite painful. If you have suffered a knee injury, you may wonder if your anterior cruciate ligament or ACL has been torn. You may have heard about ACL injuries from friends or family members or from the many professional athletes who have suffered ACL tears. In this video blog, you will learn the 5 most common signs that you may have an ACL tear. As the video below from Aleesha Uthup explains, there are some common symptoms to be aware of when it comes to ACL tears. The 5 symptoms mentioned in the video are: 1. hearing a pop, 2. knee pain, 3. knee swelling, 4. knee instability, 5. loss of knee flexion and extension. Keep in mind that you will usually have more than one sign of an ACL tear and that a single sign rarely confirms an ACL tear. If you think you have signs of an ACL tear, we strongly recommend that you have an examination by a healthcare provider to confirm your suspicion. If you have a confirmed ACL tear, here is an ACL recovery timeline that can help you understand your recovery process.
Watch this short video and learn about the 5 most common symptoms that indicate you may have an ACL tear. Aleesha Uthup, a physiotherapy student at the University of Toronto, talks about common symptoms of an ACL injury.
To read the full blog and learn more about the signs of an ACL tear, read Aleesha’s blog: “The 5 Most Common Signs and Symptoms of an ACL Injury | Curovate.”
You can download the Curovate app from the links below to get started on your ACL injury recovery. Curovate is a physiotherapy app that provides daily video-guided exercises for each day of your recovery from your ACL injury or specific knee strengthening exercises to prevent an ACL tear. Curovate also tracks your progress and gives you the ability to measure your knee’s range of motion using just your phone.
If you need more tailored help after your ACL injury or just want knee strengthening exercises to prevent an ACL injury, check out our Virtual Physiotherapy page to schedule your 1-on-1 video session with a physiotherapist books.
A few months ago, a woman who had recently torn her ACL scheduled a time on my calendar for a phone call (you can do the same here). She initially said she just wanted to know more about the program and its costs, but when I got her on the phone it was clear she was looking for something else…
She didn’t know exactly what she was looking for, but knew she wanted something MORE in her ACL recovery.
Surprisingly (or maybe not?) we hear this often. An active, competitive person is normally not satisfied with the “status quo” of ACL recovery. Physiotherapy 2-3x/week, relatively simple exercises at home… is this really all there is to ensuring your recovery is as efficient as possible?
Anyway, this particular woman had even taken the time to read our blog and implement the exercises we recommended on top of her at-home physical therapy routine (you can do the same through the links below. Just make sure you do so) approved by a PT or doctor).
Mastering the isometric wall squat after ACL surgery
How to straighten your knee after ACL surgery
How to get the most out of your quad sets
Back to the story…
She said the exercises had helped tremendously, but she STILL felt like she could do more. The exercises definitely expanded her range of motion, but the next morning she felt like she had to start all over again because the knee was super stiff when she got out of bed. When I dug a little deeper, I realized it Why she was determined to make her recovery as efficient as possible.
Her ultimate goal was to compete for Team USA in the international skydiving competition, and that was just it 3 months away.
After talking to her about the Accelerate ACL program and technology, she joined in – feeling like this could be something to really take her recovery to the next level.
During the 30 days we worked together, we saw progress every day. In the morning, she made a habit of measuring her own range of motion (pretty cool, right?) to determine if the program had been effective for her. On day 1, her range of motion was 118 degrees of flexion. On day 30 it was 155 degrees!!
She felt like she made enough progress over those 30 days that she could handle the rest of the recovery from that point on her own (with the help of her PT and doctor) – we were so proud of her!
Then last week I received the following email:
The e-mail
“I just got back from Russia and I’ve been jumping all the time. One of my teammates got Covid the day before we left, so she couldn’t go. So at that moment I was no longer a substitute. I hated it for her, but it was good for me. I had no problems and just slid in on my butt with each landing. :)”
We were PUMPED. This is exactly the kind of impact we envisioned when we started Accelerate ACL, and we’re excited to see it happen every time.
Anyway, I just wanted to share that story, along with the articles she found super helpful (above).
I know there are many people like you who are looking for “a little more” in their ACL recovery. It’s probably hard to put your finger on what exactly that “something more” is. Keep searching and keep trying. Remember that ultimately YOU are your biggest fan and advocate. Don’t settle for anything less than finding the best.
I hope this story inspires you and that the information in the articles above is useful. Feel free to check out everything on the blog… and let us know if you’d like to see us write about other topics.
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I had no problems and just slid in on my butt with each landing. :)”