Latest / The ACL Athlete Podcast / 094 | Is Numbness Normal after ACL Surgery? Part 2

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094 | Is Numbness Normal after ACL Surgery? Part 2 · The ACL Athlete Podcast

• 0:19
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:23
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:33
  SPEAKER_00: I'm your host, Dr.
• 0:34
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:38
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:46
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:57
  SPEAKER_00: Thanks for joining.
• 0:58
  SPEAKER_00: Now let's dive into today's episode.
• 1:03
  SPEAKER_00: What is up, guys?
• 1:05
  SPEAKER_00: Welcome back to the ACL Athlete Podcast.
• 1:08
  SPEAKER_00: Today is episode 94.
• 1:11
  SPEAKER_00: We are continuing the two-part series answering the question, is numbness normal after ACL surgery?
• 1:19
  SPEAKER_00: So today is part two, and we are building off of part one.
• 1:23
  SPEAKER_00: So if you are listening to this and you have not listened to part one, stop everything you're doing and stop this episode.
• 1:31
  SPEAKER_00: And go and listen to part one because it will be so key for you to listen to that episode, to get the full story, to understand more of the background.
• 1:41
  SPEAKER_00: So you can get the most out of this part two, which we're gonna hammer home this whole entire concept of numbness and more of the answers that you are wanting from this specific question.
• 1:53
  SPEAKER_00: And now I am going to give a little overview of part one where we talked about the definitions where numbness is a loss of sensation.
• 2:01
  SPEAKER_00: We have sensory and motor nerves.
• 2:03
  SPEAKER_00: Sensory gives us input and the sensations from our environment.
• 2:07
  SPEAKER_00: Motor gives us output or the movement and the function of our body, the anatomy of the lower extremity nerves, understanding the network of nerves of the lower extremities is key.
• 2:19
  SPEAKER_00: And that is something that looks basically like a tree with the trunk and the roots and roots from those.
• 2:26
  SPEAKER_00: So that is a very good way to visualize this, and how the femoral nerve branches into the saphenus nerve and into the infra patellar branch of the saphenus nerve.
• 2:37
  SPEAKER_00: This is key here, and that infrapetellar branch of the saphenus nerve is the key item here that we are focusing in on mostly.
• 2:45
  SPEAKER_00: And when you look at the saphenus nerve in general and that infrapatellar branch of it, that gives sensation from the inside of the front part of the knee and then down further the inside of the leg.
• 2:58
  SPEAKER_00: See the first pick in the show notes, and that'll help you give a good idea, especially of that infrapetellar branch.
• 3:04
  SPEAKER_00: You can think about where your bottom button or that screw is, and if you were to take just like your palm and put it right on top of it, that will give you a relatively good idea of the area that a lot of people feel with that numbness.
• 3:18
  SPEAKER_00: And this can also happen to other surrounding areas around the knee, but that infrapetellar branch of the saphenus nerve is the main player in this, and that's been one of the most research and studied that has impacted the numbness that people feel.
• 3:34
  SPEAKER_00: It makes sense based on the anatomy of the nerves and the way the ACL surgery goes.
• 3:39
  SPEAKER_00: And when we dive into what happens in the surgical process and also our anatomy and the surgical incisions, the procedure itself, the graph type that is chosen, it's not 100% preventable to avoid some of those, especially superficial nerves and those branches.
• 3:56
  SPEAKER_00: So either some of them get cut or they get stretched, oftentimes a little mix of both.
• 4:02
  SPEAKER_00: And so, how common is this numbness that we feel, especially around the knee?
• 4:08
  SPEAKER_00: Ranges from 40 to 80 percent, with many studies referencing somewhere around the 80s, and then some improve over time.
• 4:15
  SPEAKER_00: It varies in the literature, but the one thing that we basically know is that it shows how normal it is.
• 4:23
  SPEAKER_00: Basically, most ACLers feel some type of numbness or change in sensation.
• 4:28
  SPEAKER_00: And this is the common question that I get if this is normal, and is this something that you can expect, and also what are the outcomes related to this?
• 4:38
  SPEAKER_00: And so today we're gonna dive into the graph types impacting that, what's normal versus what's not, some of the anatomical variations that play into this, nerve regeneration and healing, and your recovery of the numbness.
• 4:53
  SPEAKER_00: So, the first thing I want to dive into in this part two episode is how do the graph types themselves play a role and how common the numbness and feeling is.
• 5:04
  SPEAKER_00: And so, as we break down graph types, we have the big buckets of allograph, which is a cadaver, and autograph, which is taken from your own body.
• 5:13
  SPEAKER_00: And the most common places are your patella tendon, your hamstring tendon, or the quadriceps tendon.
• 5:21
  SPEAKER_00: Those are the main three that you'll see in majority of ACL reconstructions with autographs taken from your own body.
• 5:28
  SPEAKER_00: Now, in general, allographs tend to have less numbness just because we are not cutting another part of the body or impacting another part of where some nerves go because the allograph and the harvest of it has already been done because it's taken from a cadaver.
• 5:44
  SPEAKER_00: Now, if we look at autographs, that's taken from your own body.
• 5:48
  SPEAKER_00: So we're having to go into the specific area and cut in order to create your new ACL graft, and that's either going to be on the inside part of the hamstring, the hamstring graft, the patella tendon, which is gonna be below your kneecap, and usually part of the bone below that, and above that, a part of the kneecap is taken.
• 6:08
  SPEAKER_00: And then if you take your quadriceps tendon, then that's gonna be above your kneecap where your quadriceps is inserting, and a lot of the times there's not bone taken from that, but sometimes there will be.
• 6:19
  SPEAKER_00: There are currently no studies that really show the comparison of all three, as well as really targeting in on numbness or those types of sensations, but what we can tell is basically that people with a quadriceps tendon are probably going to benefit from less numbness just because of the harvest site and the way that the nerve innervations work.
• 6:42
  SPEAKER_00: But then, if you were to put a hierarchy of maybe it is going to be the quadriceps tendon, the patella tendon, and then the hamstring tendon, with the hamstring tendon typically relaying a little bit more of that numbness than the patella or the quadriceps.
• 6:58
  SPEAKER_00: And these are based on the regions that they're taken from, and if you combine that with the surgical techniques as well as with the anatomy, and that is my own personal thought on that putting those pieces together.
• 7:09
  SPEAKER_00: In terms of what the research shows us, there is comparison between the patella tendon and the hamstring tendon with a lot of the infrapatellar branch of the saphenus nerve comparisons with hamstring tendon autographs, and this will make a lot of sense because of where the hamstring tendons are taken.
• 7:27
  SPEAKER_00: And it is more common to hear about more numbness because of where this hamstring graph is harvested from.
• 7:34
  SPEAKER_00: And when we think about the inside of that knee and the medial side of that knee, that's where we're gonna take it.
• 7:42
  SPEAKER_00: So usually it is the semitendinosus, and sometimes it's bundled with the gracilis.
• 7:49
  SPEAKER_00: And so the gracillus is one of the groin muscles, and then the semitendinosus is one of the inner hamstring muscles and tendons.
• 7:57
  SPEAKER_00: And when you look at the anatomy of the saphanus nerve and also the inferior branch of that saphenus nerve, and you see that come across from those tendons into the front side and the inside of that knee, this makes a lot of sense of okay, these are where these nerves travel.
• 8:15
  SPEAKER_00: And so if the incision is going to be basically where that front part of it is on the inside, then it makes a ton of sense because they have to cut through that nerve or parts of that nerve in order to get to the hamstring tendon.
• 8:30
  SPEAKER_00: And just as a reminder, just remember that these nerves are sensory nerves, so it's not going to typically impact any type of function, but it might impact that numbness feeling because when a nerve is cut, that is going to impact what you are feeling and the sensory of what that nerve is connected to.
• 8:49
  SPEAKER_00: And so that's where the numbness comes from, and that could be either from that incision, from the drilling, maybe from the tools, but this makes a lot of sense, especially when we're talking about harvesting a hamstring autograft.
• 9:03
  SPEAKER_00: And now to compare also my own personal ACL surgeries.
• 9:08
  SPEAKER_00: So I had hamstring autographs on both of my knees, and so on my right side, what's very interesting, my right side was the first one in high school, and we chose a hamstring tendon because the surgeon was like, You need a hamstring tendon.
• 9:24
  SPEAKER_00: We didn't know there were options then, but that's what we went with.
• 9:27
  SPEAKER_00: And the interesting part about this is where my incision was to take my hamstring tendon, and it's actually exactly where that sapphinous nerve, the inferior branch of it, actually crosses across towards the front of the knee.
• 9:42
  SPEAKER_00: And what's really interesting is that my sensory for my right knee, when I touch in that area, it's fairly numb.
• 9:50
  SPEAKER_00: And probably like a, you know, a half of a palm size, it feels a little off.
• 9:56
  SPEAKER_00: And then when I touch in that area, I actually feel a lot of weird sensory input into the other side or the lateral outside part of the outside of my knee, kind of lower onto my shin muscle.
• 10:09
  SPEAKER_00: So it's very interesting anytime I touch it, and that has been the same for the past, you know, years and years and years, and it hasn't changed at all.
• 10:18
  SPEAKER_00: And that's where it kind of is.
• 10:20
  SPEAKER_00: It doesn't bother me really.
• 10:21
  SPEAKER_00: If I kind of put my finger on it, and you know, when I was working on my scar tissue, I can notice how weird it felt, but I do notice more numbness on my right side, and now let's compare this to my left side where I had a hamstring tendon, and this incision is different.
• 10:38
  SPEAKER_00: Instead of the incision being on the front inside, it's actually right where my hamstring crease is, towards the back side of my knee.
• 10:48
  SPEAKER_00: And you know, if I could go back and ask these surgeons, like, hey, why'd you do it this way?
• 10:53
  SPEAKER_00: I wish I could, but um, this is very interesting in terms of my left side because I actually have not really much numbness at all, and I don't have as much of a weird sensory feel compared to my right side.
• 11:07
  SPEAKER_00: And my speculation is that when they did the right side and the incision point and where they cut, they had to go through more of my saphness nerve of that inferior branch of it compared to my left side.
• 11:20
  SPEAKER_00: It's pretty cool, and this is pretty anecdotal, who knows, but it makes a lot of sense to me, and especially with the anatomy and the surgical procedures themselves.
• 11:30
  SPEAKER_00: So I just wanted to share that anecdotal experience of my own ACL surgery and what I feel specifically from that.
• 11:38
  SPEAKER_00: Now let's talk about what's normal to feel and what's not.
• 11:41
  SPEAKER_00: And there's a few things to consider here.
• 11:44
  SPEAKER_00: One of the things I want you to think about if you're listening and you're close to surgery, is the timing of the surgery.
• 11:50
  SPEAKER_00: If you are immediately post-op, the anesthesia and the type of anesthesia is going to play a role.
• 11:55
  SPEAKER_00: You have general anesthesia that puts you to sleep, then there's the local anesthesia.
• 12:00
  SPEAKER_00: The nerve blocks are a part of the local anesthesia.
• 12:03
  SPEAKER_00: So if you have a femoral or maybe an adductor nerve block, that might play a role into some of the extra numbness you feel, and you can reference the first picture to see how that plays into that.
• 12:14
  SPEAKER_00: It shows the femoral nerve block and the areas that it should affect.
• 12:19
  SPEAKER_00: It'll be a little different with an adductor nerve block, but that can also play a role as well.
• 12:24
  SPEAKER_00: But these are things that are going to play into that general numbness.
• 12:28
  SPEAKER_00: The thing is that you're also fresh out of surgery.
• 12:31
  SPEAKER_00: Your body is like, what the heck just happened?
• 12:34
  SPEAKER_00: So it's not sure really how to process that new sensory information from the incisions to the healing to the bone tunneling to the new graft, especially if there's an autograph.
• 12:44
  SPEAKER_00: Your body is like, what the hell just happened?
• 12:47
  SPEAKER_00: And it is fair for it to feel that way because it's basically like another trauma, right?
• 12:52
  SPEAKER_00: That's what we usually call it and say, it's basically like we're gonna have to go back in there and redo a lot of work to make it right.
• 13:00
  SPEAKER_00: Now it's in that healing process, and the one thing that you want to think through is like once you're out of this acute phase or this early post-op phase, then you'll notice more of the numbness area kind of normalizing to what it'll normally be.
• 13:15
  SPEAKER_00: And then it's a little bit of a waiting game to see does it regain its normalcy and touch and feel?
• 13:21
  SPEAKER_00: Does it only get part of it?
• 13:23
  SPEAKER_00: Does it get all the way back, or maybe not at all back?
• 13:26
  SPEAKER_00: And now this is gonna come back to the nerves that were either cut or maybe stretched, and now it's playing that game of healing just like the rest of the knee.
• 13:37
  SPEAKER_00: This is because of that infrapatellar branch of the saphenous nerve and other potential superficial sensory nerves that branch off of that or around that, what we call superficial nerves or close to the surface, have been cut or impacted.
• 13:53
  SPEAKER_00: And like I mentioned earlier, most ACLers have some type of weird numb spot post op.
• 13:59
  SPEAKER_00: For some, it might be small, some it might be a little patch near the incision site, and for some, it might be more of something like a palm size, or sometimes it'll run a little further down the leg or the shin.
• 14:10
  SPEAKER_00: It's different for each person, and again, after you listen to this series and kind of see all these different possibilities, which we haven't even talked about, some that are coming, it makes a lot of sense.
• 14:23
  SPEAKER_00: Now, this last point of some of the what's normal to feel and what's not.
• 14:28
  SPEAKER_00: One of the things with this that if you think about the anatomy of this inferior branch, it crosses across the knee, and there are different variations of different branches and people have with their anatomy.
• 14:42
  SPEAKER_00: This can also lead to that kneeling pain and that anterior knee pain and sensitivity that a lot of people feel.
• 14:50
  SPEAKER_00: And I think that this gets missed a lot, and we kind of you know shake this up to maybe it's just the patellar tendon graph, but this still happens with people outside of patellar tendon graphs.
• 15:02
  SPEAKER_00: But when you think about the harvesting of a patellar tendon graph, you're still impacting the inferior branch of that saphenus nerve.
• 15:10
  SPEAKER_00: So that is something to keep in mind.
• 15:12
  SPEAKER_00: So if you are someone who has been dealing with kneeling pain and anterior knee pain and some of that sensitivity, there isn't as much research on this specifically testing it, but we do see some, and it's more common in patellar graphs, but there's a combination of things maybe related to the pressure of the incision, to the graph taken.
• 15:33
  SPEAKER_00: But I do think that there is something related to the safness nerve that plays a role into this.
• 15:39
  SPEAKER_00: And when we talk about expectations, what's the recovery of the numbness at your knee?
• 15:45
  SPEAKER_00: And will it get back to feeling normal?
• 15:48
  SPEAKER_00: Will you get your normal sensation back?
• 17:55
  SPEAKER_00: This is the ultimate question and really will depend on so, so many factors.
• 18:01
  SPEAKER_00: And it's honestly no one can give you a solid answer to this, but let's talk about what we do know and some of the expectations surrounding this.
• 18:10
  SPEAKER_00: So, nerve regeneration is a very slow game.
• 18:14
  SPEAKER_00: I want you to think about a turtle sprinting, they don't sprint, it's basically what's going on here, and so this is the way that you have to visualize basically any type of nerves healing around the joint or in general in the body.
• 18:28
  SPEAKER_00: Now, if you look at the third picture that's posted in the show notes, the link, it's an image of an actual cadaver of the inside of the knee.
• 18:37
  SPEAKER_00: And you can actually see kind of how that inferior branch of the saphenus nerve comes on the inside of the knee and kind of spreads towards that front side of the knee.
• 18:47
  SPEAKER_00: And it's pretty cool to see that, and it can actually give you a solid visual of okay, if we make incisions there, maybe there's drilling around there, the patellar tendon graph taken, the hamstring graph taken if it's on the front side incision.
• 19:01
  SPEAKER_00: So many things that can factor into this.
• 19:04
  SPEAKER_00: And look at how tiny that nerve is.
• 19:06
  SPEAKER_00: I remember in PT school when we went through anatomy lab, I was so obsessed, and it was so fun to basically, you know, look at the cadavers, dissect our own cadavers, and be able to really see the intricacies of the human body.
• 19:21
  SPEAKER_00: It was one of my favorite things in PT school, and it was cool how someone honestly donated their body, and we were able to learn from that.
• 19:30
  SPEAKER_00: But you can look at all the pictures you want.
• 19:33
  SPEAKER_00: There's something that is so unique about actually touching it, dissecting it, seeing how there's anatomical differences person to person, and this cadaver image kind of gives you a little bit of insight of maybe what you see from pictures of oh, here's the show of what nerves and anatomy looks like, and then there's the actual cadavers in human individuals, and they look very different, and can look like just basically hairs or strings, and this cadaver picture basically shows that, and it's pretty cool.
• 20:05
  SPEAKER_00: So the thing that I want to bring to light here is what happens in each situation in terms of okay, so there's been a cut to the nerve.
• 20:14
  SPEAKER_00: If the nerve has been completely cut, either end will slowly grow and try to find each other.
• 20:20
  SPEAKER_00: If the two ends meet, the nerve will likely rejoin and therefore sensation will return.
• 20:25
  SPEAKER_00: Can't say 100% that it will or that it'll be 100% the same, but there are a lot of times where these types of things can happen.
• 20:33
  SPEAKER_00: The main thing here to point out is that with physiology and research, it shows us with peripheral nerves or nerves that are in our extremities, they grow at a rate of one to four millimeters per day.
• 20:47
  SPEAKER_00: So if you're looking at 30 days, it's 30 millimeters or 120 millimeters, and that's not really a ton, it's probably more on the slower side of that one millimeter.
• 21:01
  SPEAKER_00: It's not a lot of distance, so you got to give it a lot of time, and sensory nerves tend to be a bit better with the growth capacity and can possibly recover over months or over years in some cases.
• 21:14
  SPEAKER_00: And this has been shown in the study by Hoke in 2006 mechanisms of diseases.
• 21:20
  SPEAKER_00: What factors limit the success of peripheral nerve regeneration in humans?
• 21:25
  SPEAKER_00: So that's a little insight on a cut and basically the nerve regenerating, if it can.
• 21:32
  SPEAKER_00: And then another factor to consider here is if they're stretched.
• 21:35
  SPEAKER_00: So maybe with the tools in there or the way that the graft is put in, that the nerve is stretched because of just moving around in the joint and trying to put it all together.
• 21:46
  SPEAKER_00: So that is a very big possibility as well.
• 21:48
  SPEAKER_00: And so if the nerve is stretched during the surgery, there is a much better chance of the sensation that it will improve.
• 21:55
  SPEAKER_00: During the stretch, the outer part of the nerve will typically squeeze down and is impacting the blood supply inside the nerve.
• 22:03
  SPEAKER_00: And that's the example that I mentioned in the first part of this series where sleeping on your arm, but you're probably thinking of a little bit more of a stretch and extreme example here via surgery.
• 22:15
  SPEAKER_00: And then sometimes during nerve healing, it could be normal to feel some of the tingling here or there, some of the electric feeling, maybe burning, pins and needles, all are normal and indicate that your nerve is somewhat trying to heal.
• 22:31
  SPEAKER_00: Now, this can vary so, so much.
• 22:33
  SPEAKER_00: And the thing that I want to make sure that you think about with that last point I made is that you just want to make sure that this isn't a long-standing feeling or impacting your function.
• 22:43
  SPEAKER_00: To me, this might also help explain some of those weird funky sensations throughout the ACL process.
• 22:50
  SPEAKER_00: You know, I'll get questions about hey, I feel this or this sensation or this pain.
• 22:56
  SPEAKER_00: Now, again, multifactorial and depending on what you're doing, where you're at in this process.
• 23:01
  SPEAKER_00: But I do think that sometimes some of this can potentially be attributed to maybe that nerve regenerating in this process.
• 23:09
  SPEAKER_00: Now, each person has their own individual case, so take that for what it's worth.
• 23:14
  SPEAKER_00: But some of those weird aches, pains sometimes that can pop up and then they just disappear.
• 23:20
  SPEAKER_00: Who knows if that's just that saphenous nerve, that inferior branch of it trying to heal and recover?
• 23:26
  SPEAKER_00: I know that I had tons of those throughout the process, not only early on, but middle to late.
• 23:32
  SPEAKER_00: You're just like, what is this sensation?
• 23:34
  SPEAKER_00: And then it just goes away, or maybe it'll come and go.
• 23:37
  SPEAKER_00: Who knows if that is the nerve trying to regenerate, or it's just the ACL process.
• 23:44
  SPEAKER_00: Now, last few points here I want to make anatomical variations, and this is going to be the last pick that you'll see in the show notes.
• 23:53
  SPEAKER_00: But this is a pretty cool image, but also goes to highlight how people can respond differently.
• 24:00
  SPEAKER_00: So when you think about the different factors that play into Everyone's experience.
• 24:06
  SPEAKER_00: You got a human body, you have genetics, you have different types of pain and sensations based on your experiences because pain and sensory is all multifactorial.
• 24:19
  SPEAKER_00: We talk about the graph types, we talk about the surgical incisions, the techniques, the way the tools are navigated, the holes are drilled, anything that is being cleaned up.
• 24:30
  SPEAKER_00: There are so many different pieces and moving pieces to this.
• 24:33
  SPEAKER_00: The other thing that I want to add here that is part of our anatomy is anatomical variation.
• 24:39
  SPEAKER_00: So when we talk about the anatomy of nerves or the anatomy of really anything in our body.
• 24:45
  SPEAKER_00: So for example, when you think about the sciatic nerve on the back side of the body, and usually that'll be where people will point to in their glutes if they have some like type of pain there, and especially nervy, then your sciatic nerve is going underneath that piriformis muscle.
• 25:02
  SPEAKER_00: Now there are a certain percentage of people who actually have that sciatic nerve pierced through the middle of that muscle as opposed to behind it, and then there are some people who have bifurcations or pieces that branch off of it.
• 25:16
  SPEAKER_00: This is anatomical variation.
• 25:19
  SPEAKER_00: The same thing can be said when you look at this image of the infrapatellar branch of the saphenus nerve.
• 25:25
  SPEAKER_00: When you look at the different types of variations of that nerve and its branches, and then you gotta think about the little mini branches that come off of that, it's just going to be innervating different parts of the knee, of the skin, all these different pieces, and that is going to impact your sensation and your sensory and that numbness.
• 25:45
  SPEAKER_00: So this is a big one that I want you to just kind of take with you to know it's going to be different person to person, and then talking about the different factors of okay, did they cut through that?
• 25:55
  SPEAKER_00: Was that just stretched?
• 25:57
  SPEAKER_00: You know, was part of it stretched?
• 25:59
  SPEAKER_00: So a lot of things to just kind of think about and some food for thought in terms of the anatomical variations.
• 26:06
  SPEAKER_00: And one of the last things here that I want to talk about is basically just the expectations and the recovery, and basically you walking this journey and figuring out okay, is this going to recover and heal?
• 26:18
  SPEAKER_00: Is this going to be something I'm stuck with?
• 26:21
  SPEAKER_00: And the big thing that I want to really provide for you, because it's important to be practical and set the expectations and really just the transparency of this process, the further away from post-op you are and you still have that numbness, the less likely it is for that to really and truly come back.
• 26:40
  SPEAKER_00: And that's just something that I've noticed after working with hundreds of ACLers.
• 26:43
  SPEAKER_00: Our team has noticed that when you look and talk to other people who work with ACLers, surgeons, PTs, you know, all my friends who are also a part of and in this community, we all talk about it, and it's very common for that to happen.
• 26:59
  SPEAKER_00: And as we pointed out in the statistics earlier, that a lot of people do feel that.
• 27:17
  SPEAKER_00: Most ACLers would agree with me here, and that research supports it.
• 27:21
  SPEAKER_00: Think it's important to know that, and so then that way you can understand, okay, I've just had my ACL surgery.
• 27:27
  SPEAKER_00: All right, the nerve block has worn off.
• 27:29
  SPEAKER_00: If you got that, I'm feeling a little bit of numbness, and maybe it's on the inside of my knee, maybe it's towards the outside, maybe it's down the leg a little bit.
• 27:38
  SPEAKER_00: Now, we want to make sure that doesn't impact function, and we want to make sure that that does hopefully improve, but there is also a chance that some of that won't improve, or maybe it's something where it reduces in size more than anything.
• 27:52
  SPEAKER_00: The one thing I'm here to tell you is that you really have nothing to worry about.
• 27:56
  SPEAKER_00: It shouldn't affect the healing of your joint, it shouldn't affect your ACL graft healing, it should not affect your function, it should not affect your pain for the most part.
• 28:08
  SPEAKER_00: Now there that can get a little complicated, but for the most part, hopefully it's just some of that numbness and weird feeling, but not coming off as pain, and it should not affect your overall recovery and healing of this process.
• 28:22
  SPEAKER_00: They did studies on this looking at people with and without numbness 24 months after ACL surgery and showed no differences in range, pain, or function, and that was for people who had injury to the infrapatellar branch of the saphenus nerve in anterior cruciate ligament using vertical skin incision for hamstring harvesting, risk factors and the influence of treatment outcome.
• 28:47
  SPEAKER_00: This was a study by Ochaya in 2017.
• 28:50
  SPEAKER_00: I apologize for that long title, but I want to make sure that you guys have the data supporting all these things that we're basically talking about and claiming, right?
• 29:00
  SPEAKER_00: And there are similar findings in people with total knee replacements, so you can find that research as well.
• 29:07
  SPEAKER_00: Most times it's just numbness, and a lot of the times people get used to it.
• 29:12
  SPEAKER_00: Majority of the ACLRs I work with all get used to it.
• 29:16
  SPEAKER_00: Now, the kneeling pain, you know, this is going to be a future topic that we talk about.
• 29:20
  SPEAKER_00: But in terms of that like general numbness feeling, as long as it's not impacting the function or your overall process, then most likely we're good to rock and roll.
• 29:30
  SPEAKER_00: Now, if you are worried about this, when in doubt, talk to your medical professional you're working with.
• 29:35
  SPEAKER_00: Make sure that it's not affecting your function and make sure that you have nothing to worry about.
• 29:41
  SPEAKER_00: But for the most part, you're pretty good to go.
• 29:44
  SPEAKER_00: But just check with your medical professional if that is bothering you and you just want to be on the safe side.
• 29:50
  SPEAKER_00: So that is the two-part series on is numbness normal after ACL surgery part one and part two.
• 29:58
  SPEAKER_00: Thank you guys so much for listening to this two-part series.
• 30:01
  SPEAKER_00: I hope that it was helpful.
• 30:03
  SPEAKER_00: And don't forget to check out the show notes where we have some of the images if you want to kind of geek out, but it'll also make so much sense.
• 30:11
  SPEAKER_00: I know for me, I'm a big visual learner.
• 30:13
  SPEAKER_00: So seeing the nerve and the anatomy, the variations, and even like that cadaver picture of the knee joint and that nerve, it helps to really hit home of understanding all of this and the process.
• 30:25
  SPEAKER_00: If you have any questions at all, please send me an email, hit me a message on theacelathhlete.com or a message on Instagram at ravipatel.dpt.
• 30:39
  SPEAKER_00: And I would love to answer any questions that you have or any thoughts you have about this podcast series.
• 30:46
  SPEAKER_00: But other than that, I just want to say I appreciate all of you.
• 30:49
  SPEAKER_00: Thanks for hanging out with me, for giving your time and your attention.
• 30:54
  SPEAKER_00: It is always so, so valuable.
• 30:56
  SPEAKER_00: If you feel like you got value out of this or the podcast is giving you some value out of your own process or your own experiences, please do me a favor and rate the podcast.
• 31:09
  SPEAKER_00: Give us a five-star review.
• 31:11
  SPEAKER_00: My goal is to be able to share as much education so we can equip all of you to make informed decisions.
• 31:18
  SPEAKER_00: And so then that way, this could be something where, hey, like if you are experiencing numbness and you came to this episode and you're like, man, I feel at peace because of this episode and I understand what's going on, not just being told, oh, it's normal and a part of the process.
• 31:33
  SPEAKER_00: No, we're gonna give you the why behind it and the practical pieces, and that's the main thing with this podcast.
• 31:39
  SPEAKER_00: We want you to be able to be in the driver's seat in control.
• 31:42
  SPEAKER_00: So if you can give us some love, that will be so appreciated, whether you're on Spotify, Podcasts, Apple, or any other platform, you guys are the real MVP.
• 31:54
  SPEAKER_00: Now I'm gonna go drink some water, stop talking because my voice is going hoarse from recovering from sickness.
• 32:02
  SPEAKER_00: But hey, we're here, we're good.
• 32:04
  SPEAKER_00: I hope you guys have a good rest of whatever daytime, whenever you're listening this.
• 32:10
  SPEAKER_00: And until next time, this is your host, Robbie Patel, signing off, and I'm gonna be able to do it.