Responding to both you and rmt --

I was the polar opposite of rmt with instability. After the injury but before repair, I just twisted to the side to toss laundry on my bed one day and my knee popped out. I knew right then I was going to get the surgery.

As far as cycling goes, exercise will be secondary.

After surgery, your knee will be tight with limited range of motion. PT will work on making sure you slowly get back to full extension / flexion.

For me, some of the flexion exercise was to get on the stationary bike with the seat high, and try to pedal slowly. When that felt easy they'd lower the seat a notch, etc.

My first surgery was a patella graft which is a tougher rehab. If you're getting a donor graft, you'll be starting off better with less pain.

Last word of advice: don't try to "do extra". Just follow what PT tells you. Don't push too early as you don't want to damage your repaired ACL until it heals, as was mentioned above.

Thanks Spudone,

You've made me realise I probably need to check in with the physio before I meet up with the bike fitter. I hadn't thought about how tight things would be initially!

My surgeon hasn't given me a choice RE which kind of graft I get. He's made a judgement based on what he thinks is best for me as an individual. He did say that they used to do patella grafts but they don't anymore - something to do with side effects.

I know of some surgeons who do Quadricep grafts but he said there can be issues with some kind of excessive bleeding from where they take the graft from. He also said hamstring grafts were much stronger than Quadricep grafts. I haven't heard of surgeons in South Australia (where I'm from) routinely doing operations using a donor graft.

I have seen one YouTube video of an Australian woman who had donor graft after her first (quadricep) graft failed. I suspect if it's only offerred here when you've already used the best graft material you can get from your own body.

As you said I'll need to take the rehab slow especially to begin with. At least if I have some pain from my hamstring while that's healing it'll remind me to take things easy!

I'll be having weekly physio appointments for a while so I doubt I'll be given the time to come up with extra exercises! :-).

So given everyone was so nice and supportive I thought I'd check back in with an update. I am six weeks post op now. It's going well!

I think I was lucky that I had an excellent surgeon, my injury was a clean ACL rupture with no other damage inside the knee and I suspect being a relatively small person makes it easier to recover given I don't load a lot of weight through my ACL.

Initially I was quite frustrated at being back on crutches but I didn't need to take many pain killers.

I bought a cheap version of the Dr Tens machine that has helped me to reactivate all of the left quad muscles. I also had a large triangle pillow to elevate my leg so I could sleep with it up high and straight. I think that has helped me to get full extension back because I don't wake up having to encourage my knee to un-bend again.

I did / do the exercises my hospital physio gave me for range of motion 3 to 5 times a day. I have a program with my current physio I do every 2nd day which has just been upgraded to include weighted exercises.

To begin with he gave me an easy bodyweight program to do every 2nd day - which I did pretty much everyday. He also didn't want me to cycle every day but the surgeon told me I could get away with doing as much light, low resistance exercise as I wanted as long as it didn't include pivoting or open chain exercises.

My ACL graft is still solid - no laxity. When they compare it to my good leg it is actually tighter than my natural ACL. Hopefully that means if it does loosen a little as time goes on it'll still function well.

Still no really fun stuff like running or kicking in the swimming pool is allowed for another 6 weeks. I have just been allowed back into the pool with a pool buoy - before they were worried about the infection risk as the scars take a long time to close up.

My main challenge now is building up the strength in my left leg. It's visibly smaller than my right. I can get up out of a chair using my bad leg without the assistance of my good leg. I'm trying to remember to do that during the day as much as possible. The fear is that you keep the imbalance going out of the habit of relying on your good leg more.

I also have a very weak left hamstring. With my right leg I can easily tap my bum with my right heel while standing. I can only get about half way with my left. I think that is a bit of a trip hazard. I want to be able to lift that heel up quickly and easily to dodge obstacles I only spot at the last second - I do tend to be a daydreamer when I walk around sometimes so that's a SERIOUS requirement for me! :-)

I feel like the rehab has turned a positive corner now. I think the main thing is that I can walk normally again and aI can walk fast. Initially even after getting off of the crutches I had a really slow, stiff legged gait. So happy days! :-)

Oh - One more thing that may or may not be more interesting / applicable to non-injured people.

I have to learn to activate my glutes to prevent my knee fom collapsing inwards as I step up. Ironically I can do this quite easily on my injured leg but I really struggle when I step up on my right leg.

I have also always tended to roll inwards more with my right foot when running.

When I do Clam Shell resistance band exercises I feel like I can open up wider with my right side but I am using the glutes higher up than when I do the Clam shells with ly left leg on top controlling the motion.

So my aim is also to learn to use the correct region of my right glutes (of the non-injured leg) more accurately to prevent future ACL injuries. My surgeon did say that if his patients ae follow up ACL injuries they tend to be on the opposite leg to the one which was initially injured.

I guess that if my ACL was not forceably injured by another person doing BJJ but was to happen by accident it was more likely to happen to the other leg due to my glute disfunction.

So if anyone has references etc they can recommend on optimal glute funciton for running I'm keen to know! Thanks! :-)

Did you have an allograft or use your own tissue? Mine was cadaver tissue and never loosened up. The tightness prevents me from straightening my leg fully and it’s very painful in the knee if I try. I still get by just fine, but it has limited my mobility.

Mine was a hamstring graft. I'm ok with mobility luckily. I will need to do work on my hamstring strength. I wasn't given the option to choose anything different. I'm glad it wasn't up to me to be honest. I'd rather those decisions be made by a surgeon with a lot of experience treating others with similar body types etc.

Do you definately know it is the graft itself that is tight? I was told that the knee fluid is something like cement. If it's not straightened overnight while you sleep - regardless of the graft - it will kinda harden in a bent position. Ever since I was told that I've been sleeping with my leg up as straight as possible on a large triangle pillow. I try to avoid bending it while I sleep AT ALL.

I also sleep with recovery compression pants every night. I don't know how much difference that makes but I'll do anything to improve the rehab process!

Hopefully your graft will get looser over time if the tightness you feel is from that. I usually hear about increases in graft laxity as a problem but in your case it might be a good thing! I can't remember the time periods when it tends to occur but I remember hearing about it when I was looking for information online.

Someone I have heard of via a friend (their coach) still has their leg buckle occasionally post ACL surgery - I can only assume that is because the graft developed too much laxity.

How long post surgery are you? I hope things get easier for you over time!

Glad to hear a really positive update! Keep ‘em coming as you make more progress!

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD