Are you experiencing anterior knee pain after an ACL reconstruction?  

ACL reconstructions are a very common surgery/injury in athletics. It is not uncommon to have anterior knee pain (or pain on the front of the knee) after surgery. This type of knee pain typically sets in around 1-2 months after and can persist for periods of time if not addressed appropriately.

Of course, ACL injury prevention is the best way to avoid knee pain and ACL injuries, and athletes should incorporate preventative exercises to their training for overall knee health and longevity.

There are many reasons someone may have anterior knee pain after an ACL surgery, but in this post, we’ll go over a couple of reasons why and what to do about it.

1. Optimize Ankle, Knee, and Hip Mobility

I have had two ACL reconstructions and was dealing with anterior knee pain after the second one. I didn’t know this then, but my intense anterior knee pain contributed to my hip and ankle mobility.

Lack of ankle dorsiflexion mobility, AKA knee going over toes, lack of hip rotation (internal and/or external), and lack of hip extension mobility (bringing leg behind your body), can all play a role.

When an area of the body lacks mobility, then the body will have to compensate and move more somewhere else. This may not be painful immediately, but over time, it can increase the stress on one area, i.e. the patella tendon, which can become irritated. This, in turn, can create pain in the front or back of the knee after ACL surgery.

Ways to improve your ankle and hip mobility are through:

• Self Myofascial Release Rectus Femoris

• Self Myofascial Release Lateralis and TFL

• Soleus SMR

• Self Myofascial Release or some form of hands-on soft tissue mobilization by a licensed medical practitioner.

Self Myofascial Release or some form of hands-on soft tissue mobilization by a licensed medical practitioner.

SMR Rectus Femoris

SMR Vastus Lateralis & TFL

Soleus SMR

Some mobility drills that can also help with that are:

1. 1/2 Kneeling Couch Stretch

2. 90/90 Hip ER/IR

3. 90/90 Hip Switches

4. Knee to Wall Ankle Mobilizations

½ Kneeling Couch Stretch

Key Points:

• Pain-free

• Maintain a straight line from your ear to your shoulder, hip, and knee.

90/90 Hip ER/IR

• Pain-free

• Front knee at 90 degrees, back knee at 90 degrees.

• The stretch should be felt in the hip when leaning forward or back.

90/90 Hip Switches

Key Points:

• Slow and controlled

• Pain-free

Knee to Wall Ankle Mobs

Key Points:

• Keep the foot straight ahead

• Lean forward and hold for 5 sec

• Perform for 8-10 reps

2. Well-Structured Strength and Conditioning

Often times after a patella tendon graft after an ACL reconstruction, a well-structured strength and conditioning program needs to be in place to strengthen all areas, specifically the quadriceps, glutes, hamstrings, calves, core, etc.

If an athlete has deficiencies in these areas, it can delegate and compound stress to the patella tendon across multiple muscles and joints.

A well-structured strength and conditioning program would consist of the following:

• Bilateral Knee Dominant Movements

• Squats

• Bilateral Hip Dominant Movements

• Deadlifts, Rackpulls

• Unilateral Knee Dominant Movements

• Reverse Lunges

• Unilateral Hip Dominant Movements

Slow Eccentric Goblet Squats

Front Squat with Pause

• Bilateral Hip Dominant Movements

• Deadlifts, Rackpulls

Trap Bar Deadlift

KB Deadlift from the Floor

Rack Pulls from Knee Caps

• Unilateral Knee Dominant Movements

• Reverse Lunges

Slow Eccentric Reverse Lunges

Step-Ups

Unilateral Hip Dominant Movements

Single Leg Deadlifts

Single Leg Bridges/Hip Thrusts

Stability Ball Rollouts (Core Stability)

Suitcase Carries

Anti-Rotation Press (Pallof Press)

Handling Pain Post ACL Surgery

Make sure to optimize hip, knee, and ankle mobility and perform a well-structured strength and conditioning program. Those are just two areas to look at if someone is experiencing pain in their patella tendon after an ACL reconstruction. With the proper guidance from a physical therapist, your knee after ACL surgery can make a complete recovery, pain-free.

Are you still trying to figure out what to expect post-ACL surgery? Be sure to read our early stages of ACL rehabilitation guide. It dives into different planes and ranges of motions and various body parts that should be worked for a full recovery.

For more information, read Knee Pain After ACL Surgery Part II, where we discuss two other areas that are very important to addressing patella tendon pain after an ACL reconstruction!