My 3-Month ACL Surgery Recovery Journey - Patellar Pain, Progress, and Patience

My 3-Month ACL Surgery Recovery Journey: Patellar Pain, Progress, and Patience

Recovering from ACL surgery has been a ride I wasn’t quite ready for. Three months ago, I had my ACL reconstructed with a Bone-Patellar Tendon-Bone (BPTB) graft and a Lateral Extra-Articular Tenodesis (LET). I thought I’d done my research, but the reality of recovery has thrown some unexpected challenges my way. For anyone about to undergo the same procedure, here’s an in-depth look at what my experience has really been like.

Looking back, there are three main points that sum up my recovery so far: the surprising pain at the graft site, the journey of regaining full range of motion, and the mental battle of slow progress.

Graft Site Pain: The Unexpected Limiter in Rehab

The most surprising part of this process? The pain at the graft site. Going in, I assumed the new ACL itself would be my biggest pain point. But it turns out the patellar tendon area—where they took the graft—has been way more painful and limiting. Every time I try to train my quads, this nagging pain from the graft site reminds me of its presence.

The BPTB graft is strong and often recommended for people who are active, especially athletes. But what’s often glossed over is that taking a slice of your patellar tendon to replace your ACL means a unique kind of recovery challenge. This graft site pain has lingered long past the surgery pain I’d prepared for, and it’s taken over as the main obstacle in my rehab journey.

How Patellar Pain Has Held Me Back

Quad strength is absolutely essential in ACL recovery. The quads help stabilize the knee, which is critical for protecting the new ACL and preventing future injury. But this graft pain has forced me to pump the brakes. Simple exercises like squats or leg extensions are tricky because they aggravate the graft site. I had hoped to progress quickly through the basic strength-building exercises, but the pain at the graft site often stops me.

Finding that balance between working the quads to help my knee and respecting the pain has been one of the biggest lessons so far. It’s not just about “pushing through,” because that’s almost guaranteed to make things worse. I’ve had to listen to my body more carefully and be more strategic in how I train.

Pain Management Tips that Work

Ice has become my best friend. I can’t count the times I’ve reached for an ice pack after a session, but it genuinely helps keep the pain down and lets me stick to a consistent routine. Rest days have also been crucial to my sanity, especially when I’ve overdone it. In the beginning, I didn’t want to slow down—I was too eager to see results. But after pushing through the pain too often, I learned to build in rest days.

I’m learning to work with my body, adapting my workouts so I don’t lose momentum while staying pain-aware. For anyone going through this, I’d say: don’t ignore your body’s signals. Respect the pain, and find the pace that lets you keep making progress without overdoing it.

Regaining Range of Motion: Flexion and Extension Wins

From the very beginning, getting my range of motion back has been a huge focus. Luckily, I was able to achieve full extension right away, which was key for walking and day-to-day activities. My physical therapist was adamant about the importance of full extension. Without it, I wouldn’t be able to walk properly, and my knee would develop a limp that would be hard to fix later on. Achieving that early was a huge win, but regaining flexion was a different story.

The Battle for Full Flexion

The path to full flexion wasn’t as straightforward. Bending my knee felt incredibly tight and unnatural, and each degree felt like a mini-battle. For the first few weeks, every small gain in flexion was a cautious, careful improvement. My physical therapist encouraged me to push for more flexion each session, but I had to walk a fine line between progress and pain. There’s nothing quite like feeling your knee slowly bend more than it could the day before.

My go-to exercise? Wall slides. With wall slides, I could control the depth of the bend by sliding my foot down the wall. This made it possible to go slow and ease into a deeper stretch, which was less painful but still effective. Little by little, I worked my way up, and by six weeks, I finally had my full flexion back.

Each extra degree felt like a victory, and not just physically. Mentally, getting those extra degrees back felt like a win I could hold onto.

Why Regaining Flexion and Extension Matters

Range of motion is foundational to all the other progress that follows. If you don’t regain your full range of motion, every other part of recovery becomes harder—walking, building strength, even basic stability. Achieving full flexion and extension early on meant I could focus on other areas without limitations from stiffness or a shortened range. For anyone preparing for ACL recovery, this is one of the most important aspects to prioritize. The more you can focus on these foundational elements, the easier the rest of recovery becomes.

The Mental Struggle: When Progress Slows Down

I expected the early weeks to be physically tough, and they were. Pain and stiffness were constant reminders of the journey ahead. But what I didn’t fully anticipate was how much of the struggle would be mental, especially after those initial weeks.

The Highs and Lows of Early Wins

In the beginning, things were actually a bit exciting. Every small gain felt like a huge step forward—moving from crutches, getting full extension, bending my knee a bit more each day. I felt motivated and even optimistic, thinking I’d be one of those people who beat the odds and progressed quickly. I’d read stories of people who pushed through ACL recovery in record time (Hello r/ACL), and I had it in my head that maybe I could be one of them.

But that optimism started to fade as progress slowed. There’s a honeymoon phase in recovery, where each win feels big, and you’re constantly seeing improvement. But after the first month, the wins became fewer and further between.

Plateaus and the Mental Toll

After about two months, the gains became less obvious. It wasn’t like the early days, where each session had a visible result. Instead, some days my knee felt stiffer, or I’d hit a pain wall that stopped me from going further. Mentally, that was tough to accept. The lack of visible progress made it easy to question if I was doing enough or doing things right.

It’s incredibly hard to stay motivated when progress seems invisible. Sometimes I would even feel like I was going backward. On bad days, my knee would swell more than usual, or I’d have a tightness that wasn’t there the day before. Those were the days when self-doubt would creep in, and I’d wonder if I was making a mistake or if I was pushing too hard.

Refocusing on Small Wins

To keep myself going, I started looking for the tiniest signs of progress. Maybe my knee felt slightly less stiff, or I was able to push one more rep. I started journaling my recovery to remind myself of these “wins,” and it’s been surprisingly helpful. Flipping back to see even small improvements gives me a sense of progress when it doesn’t feel obvious. I know now that recovery isn’t about drastic change from one day to the next—it’s about those small victories that add up over time.

Embracing Setbacks as Part of Recovery

One of the hardest lessons has been learning to accept setbacks as part of the process. Some days are just tougher than others, and I’ve learned not to beat myself up for needing extra rest or for not hitting a new milestone every week. On those days, I focus on gentler movements like light cycling or walking, trusting that rest is as important as the workouts. In the beginning, I thought taking a day off was almost a failure, but I know better now.

It’s also important to keep a broader perspective. When you’re in recovery, every setback feels like it could erase the progress you’ve made. But looking back on the past three months, I realize that those tough days didn’t actually slow me down long-term. They were just part of the journey.

Reflecting on Three Months of Recovery

Three months in, this recovery has taught me a lot—about my body, patience, and the ups and downs of real progress. The graft site pain has been more challenging than I expected, but I’m figuring out ways to work around it and still train my quads. Getting my range of motion back, especially full flexion, felt like a major win, thanks to trusty wall slides and a lot of persistence.

Mentally, this journey has been an even bigger challenge, but I’m finding ways to focus on small victories, set realistic goals, and embrace patience. ACL recovery is no straight line, but with the right mindset and a bit of self-compassion, each step forward feels like a step closer to being back to normal. It’s a long road, but every small victory is worth celebrating, and every challenge teaches me something new.