Knee Pain after ACL Surgery?

Knee pain after an ACL reconstruction?  

ACL reconstructions are a very common surgery/injury in the athletic population .  Once someone has had a surgery like this, it is not uncommon to have anterior knee pain, or pain on the front of the knee after the surgery.  This type of pain typically sets in around 1-2 months after and can persist for periods of time if not addressed appropriately.

There a multitude of reasons why someone may have pain after a knee surgery, but in this post, I will go over a couple different reasons why and what to do about it.

1. Optimize Ankle, Knee, and Hip Mobility

I personally had 2 ACL reconstructions and was dealing with anterior knee pain after the 2nd one.  I didn’t know this at the time, but my intense anterior knee pain had contributing factors from 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 roll.  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, ie. the patella tendon, and in turn it can become irritated.

Ways to improve your ankle and hip mobility are through:

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

Some mobility drills that can also help with that are:

½ Kneeling Couch Stretch

Key Points:


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

90/90 Hip ER/IR


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

-Stretch should be felt in the hip when leaning forward or back.

90/90 Hip Switches

Key Points:

-Slow and controlled


Knee to Wall Ankle Mobs

Key Points:

-Keep 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 in order to strengthen all areas, but specifically the quadriceps, glutes, hamstrings, calves, core, etc.

If an athlete is presenting with deficiencies in these areas, it can delegate and compound stress to the patella tendon vs across multiples muscles and joints.

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

Bilateral Knee Dominant Movements


Bilateral Hip Dominant Movements

Deadlifts, Rackpulls

Unilateral Knee Dominant Movements

Reverse Lunges


Unilateral Hip Dominant Movements

Single Leg Deadlifts

Single Leg Bridges/Hip Thrusts

Core Stability

Stability Ball Rollouts

Suitcase Carries

Anti-Rotation Press

Those are just 2 areas to look at if someone is experiencing pain in their patella tendon after an ACL reconstruction. Make sure to optimize hip, knee and ankle mobility as well as be performing a well-structured strength and conditioning program.

Check out next week for part II as we will discuss two other areas that are very important to addressing patella tendon pain after an ACL reconstruction!

Andrew Millett