I would post this in the main forum. More people over there and I guarantee there are a bunch of guys that can give you good answers.

Jodi

Agree with Jodi, you will get more responses in the main forum

My daughter tore her ACL her junior year in HS. They did the repair 3 weeks after the injury and used a piece of her hamstring (not sure about this) as a replacement. She was on crutches for 3 or 4 weeks after the surgery. She was very dedicated in the rehab and was able to participate in track in the spring (her main sport is volleyball). In late spring (6 months after surgery) she was released to play VB if she wore a brace. She wore the brace for 3 months then took if off and has been brace free since then.

It has been 6 years and she says her knee still bothers her occasionally, but she still rehabs regularly and is able to participate in all the sports she wants.

So sorry to hear about your injuries! Rehab times for recovery are pretty variable. I do see many people returning to their impact sports at about 6 months, however that being said - recovery is about quality of return to sport, not just returning. As a physical therapist, often people who are athletes CAN return faster - they are stronger going into surgery, more motivated to work through the initial discomfort after surgery (especially gaining range of motion back!), etc. BUT - just because you are an athlete does NOT mean your tissues heal any faster than anyone else! I am 8 weeks post-op of a shoulder reconstruction, it is frustrating, but I keep reminding myself that if I take the time now I will be better upon my return. Cycling can actually be great for the knee after surgery - the things I would consider are the torque to clip in and out (ouch!) and the what if - what if you hit the ground soon after surgery?

Things that improve ACL surgical outcomes:
1) decreased inflammation in the knee prior to surgery - if you go into surgery and your knee is a balloon, sore, red, weak your surgical outcome may not be as good
2) Regaining range of motion, especially knee extension (straightening) quickly after surgery
3) Strong quads prior to undergoing surgery - less atrophy during recovery
4) Improved hip, hamstring, core strength during rehab - changing the movement patterns that inevitably develop when injured
5) Following the protocol - with minor adjustments for individual differences. This stuff has been studies out the a$%. It is pretty standardized at this point. Find a good surgeon in your area and the best, sports minded PT out there.

Good luck! If I can help in any way let me know!

Dana

---

________________________________________________
Don't Just Live, Thrive!
Thrive Kinematics Physical Therapy - http://www.facebook.com/...8178667572974?ref=hl

Thank you! I think that is exactly what I wanted to hear :).

It's such a common injury for sports that are actually hard on the knees (skiing, ultimate, soccer...) and I feel like the 8 month ''return to sport'' plan is for people who want to go *back* to skiing and other twisty sports. I just want to be allowed to do cycling training again (ie not gentle rides but interval training and hill repeats) and maybe some jogging on a flat path.

I hadn't thought about the clipping in and out... perhaps I can go old school with some clips and straps for a summer ;).

Ultimately though I'll just do what my physio tells me to (I've heard plenty of horror stories by now of people who went through the same surgery at my age, didn't take it seriously enough, and then impacted their sports life forever). It's just helpful to know that with the right attitude (following the rehab protocol and not skipping any of the work) I may be fixed in less than a year...

I'm a Certified Athletic Trainer and I've had two ACL repairs. One on each knee. I'll be honest, they aren't fun, but you'll get through them.


Strength before surgery will totally help your outcome after surgery, especially quad/VMO and hamstring strength. You will atrophy no matter what you do, but everything you can do prior will help. Finding a good doctor who pretty much only does knees is important, don't go with just anyone. I had different doctors for each knee and the second guy was much better. He was more sports oriented. As I had injured mine playing soccer.


I used my hamstring as my graft for both knees. It was the right choice for me personally because I had some other knee problems prior to my injuries. However the patella tendon graft can work well also. I'm personally a little more iffy about cadavers, but they seem to work alright, although most doctors do not prefer them and some insurances will not cover them. Rehab post hamstring graft is a little slower, and should be because your hamstring has to heal also. So you can't start hamstring strengthening as quickly and some doctors like the use of crutches for longer than with patella grafts. Nevertheless I'm happy to have gone that route. Just talk with your ortho. Ask a lot of questions and set up all of your follow up appointments ASAP so that they stay up to date with how you are doing and may let you progress faster. If you want any more info on which route to take just ask, I have done a lot of research.

PT is also important, get in as soon as allowed by your doctor. You'll want a more aggressive doctor if you want to return to biking sooner and get off the crutches sooner. Stationary riding will happen pretty quickly as you'll need to work on ROM, but it won't be the same a a hard workout for a little while. There are other ways to stay fit though. You can use arm bikes for cardio and still do upper body strengthening. Eventually you can get back in the pool too.


No matter who you go with and how you have things done, it'll take time. The healing process isn't fast. It'll be a few months before you start feeling "normal" and have your full ROM back. ROM is crucial you will need to work both bending and straightening. Do it whenever you have the time, morning, afternoon, night, whenever.

I'll be honest. I went back to playing collegiate soccer after each of my knee injuries. It's a process. I didn't feel 100% normal for about 1 year after. It took me that long to comfortably kneel again, lol, but I was still very active throughout my recovery. At 5-6 months you should be able to return to a good amount of activity and some jogging. There will always be both good and bad days, but you'll make it back to what you love to do. I did.

Here's my perspective as a sports med PT that sees ton's of ACL's. I probably do 25 a year, and currently have about 10 on my caseload right now. Regarding physician choice, make sure you get somebody that does a lot of ACL repairs, not just an ortho guy that does the occassional one. Look for somebody that has gone through a sports medicine fellowship. Regarding choosing your PT, ask your doc. He probably has a group that he works closely with. From there, go talk to them and ask them to explain their philosophy and what to expect. If they start talking about different machines you'll be using, RUN AWAY!! Machines don't improve movement. Single leg strength training does. Regarding graft choice (hamstring vs. patellar tendon): the research is still out. Both have their ups and downs, but long term the results are about the same. The docs that I work with almost exclusively do hamstring grafts because of the fact that complications of patellar tendonitis are significantly reduce. With a patellar tendon graft, the PT is essentially managing two injuries: patellar tendonitis (which is essentially what happens when they harvest the patellar graft ) in addition to the ACL. With a hamstring graft, you occassionally have a bit more post op pain, but even still I have my patients single leg deadlifting usually within the first 3 weeks.

Regarding progression: What I usually tell my patients is that they'll be using crutches for the first week to week and a half. They will be braced with the brace locked in extension for generally 2 weeks. They will continue to use the brace with it hinged for another 4 weeks, approximately. They start using a stationary bike 1-2 days after surgery for range of motion, and can generally perform a full revolution at around 5 days. At about 8-10 weeks, they'll begin running as long as their strength scores are adequate. By this point, you could be back on the bike, but I would personally prefer it if you used toe clips, as the graft is going through a healing process where it's the weakest. As an endurance athlete, I would work very closely with a gradual return to running program at this point. The one thing you have to be careful of is developing muscle imbalances with returning to full run training too soon. At 4 months, you would begin a jump training and agility program to further improve your athleticism and your movement capability. Realistically, you're good to go around 6-7 months. I just discharged a girl yesterday that I worked with for the past 7 months and she was able to jump farther (and land better) on her involved leg when compared to the uninvolved.

Good luck, and let me know if I can be of any help.

I actually had my first visit with a physio yesterday!

The full story is that I actually tore my ACL 6 years ago, and never got it repaired. I used to collapse fairly regularly (with a painful crunch) and it all went away when I stopped being a couch potato and started bike commuting. Now I race road bikes (And track, although I'm a bit weary of heavy gears and sprinting at the moment). I tore my meniscus running two months ago (because of the torn ACL and inattention) and that has been causing all the pain. Until now I had no trouble racing on a torn ACL.

I had wanted to be able to run, snowshoe and maybe cross country ski this winter, and try a couple triathlons next summer. My physio, who is aware of my level of involvement with bike training and racing basically said "You're doing everything right, there are no further exercises I could give you. Don't stop riding your bike.". I have no ROM issues, and the pain is bearable (it mostly feels like a bruise). From what I understand, I can manage the meniscus tear by laying off the running for another couple moths, and make sure I keep biking and swimming and strengthening tons. Apparently I can reintroduce some gentle jogging (in a flat straight line) and even a bit of snowshoeing, be completely fine to race (my bike, not triathlon) next summer, and postpone getting an ACL repair until the fall (or later). As someone in my early 20s, he actually recommend I not get the meniscus repaired as it will cause more harm in the long run??

Is it actually possible to do some running races, or shorter distance tris on a torn ACL?

If possible I'd rather just try and postpone the ACL repair to a more convenient time in my life (or at least in my season).

It is definitely possible to continue to race and participate in what you do without getting the ACL repaired. Based on what you've written here, I wouldn't even worry about getting it done. I've had this conversation with a few of my colleagues since we see so many ACL's and are all personally in the same situation as you are. At this point, the only real reason to get it repaired would be if you wanted to return to playing highly competitive tennis/soccer/basketball. I compete in tris, race bikes, and take the occassional downhill ski trip, and I wouldn't consider getting it done as it's possible to do all those activities extremely well without an intact ACL. Granted, you should be doing some strength training specifically for your lower body to address the dynamic stability factor that the muscles provide (I like single leg deadlifts, single leg squats, and rearfoot elevated split squats if you want just a few ideas).

There was some interesting discussion in our primary professional journal about this specific issue about a month ago and I would be happy to send it along if you PM me your email address.

The meniscus is another story. Depending on the location of the tear, it may not be possible to repair it. I 100% disagree with your PT regarding getting it repaired (as does the research) because the long term success of a repaired meniscus is much more beneficial than just going in and shaving it down. If it can be repaired, do it as your long term joint health will potentially be significantly improved. It will require a slightly longer recovery, but only by a few weeks. If it can't be repaired, the surgery is relatively simple and you could potentially be back out running within 4-6 weeks, but as I noted there is the increased potential for arthritis.

I had a hamstring graft for an ACL ten years ago and the surgeon was so good that when I went home I actually though he decided not to do the operation.The only pain I had was the drain in my leg and was able to walk with just a brace two days after the op.I was on the bike four days after and my physio was so concerned about my super aggressive rehab he sent me back to my surgeon for a stern talking to.My surgeon said " there is nothing wrong with your knee anymore,you are recovering from two torn hamstring tendons from where I harvested the grafts".I continued my very aggressive rehab and recovered very quickly.

My surgery was on Sept 14th,my first triathlon back was a sprint the following January 6th and I did a Double Ironman the following July..

As someone else said, strong legs before the op means for a faster rehab.I am due for an operation to repair some meniscus damage and I have delayed it in order to get as strong as possible.

Oh and the ligament damage was done years before I needed the operation.I tore it playing social soccer and managed to do four Ironmans,one Ultraman and one Deca Olympic Tri without it.Surgery was required when my knee collapsed on the tennis court.My surgeon said that the ligament reconstruction wasn't absolutely required but that while he was in there fixing everything else he might as well fix that too.

Good luck to you.

----

I'll throw my ACL reconstruction story onto this thread....

I tore my ACL when I was almost 19, back in 1996. The ACL was "flapping in the breeze" as my Ortho called it, and I had some tears to the meniscus and minor tears to the MCL as well. I quite honestly don't remember if anything was done with the meniscus, nothing was done for the MCL (they said it would heal naturally), and the ACL I had replaced with a patellar graft. (for you med types out there, I do not know if all my lingo is right, so don't flame me!)

I tore my ACL over xmas break (January), and went into PT right away to strengthen up my legs (dr's orders). Then, on spring break in March, I had the surgery done. I was in PT within days of surgery (there is nothing more cruel than that, let me tell you!). My doctor told me to get off the crutches one week afterwards (I had a pretty solid knee brace on). I was in PT through the end of August, and I remember they had me running on a treadmill and biking on a stationary bike as part of PT by around May. With that said, at the time I was nowhere near as athletic as I am now (I pretty much just sat around... I tore the ACL skiing), so my leg muscles started from a really weak base.

Good luck with whatever you do. I know for me, it was a no-brainer to get the surgery. I didn't have a ruined season to worry about, and I was "popping" my knee out on a regular basis (probably 3-4 times a week), and that is the most excruciating pain I can ever remember experiencing. If I found myself in the same boat now, I'd get the surgery, and just plan to do some late-season sprints.

Oh, and definitely find yourself a sports-oriented rehab place.