ACL tear - looking for thoughts on recovery time

I feel your pain.  I have had both ACLs done and I am missing most of the cartilage in my left knee.   Hopefully you only have a partial tear that will heal.   If you do need surgery, they really have improved the procedures and rehab since I had mine done.  Just get it done and work at the rehab and you should recover fairly quickly.   Best of luck.  

Sorry to hear about your accident. The biggest problem I've seen with ACL recoveries is getting back decent range of motion. The biggest inhibitor to ROM is usually swelling. Don't push things any harder than your doc(s) and PT(s) recommend.

You should be ready for next year, but there is a lot of work ahead of you. Biking has always been my primary sport in the summer which has worked well with my ACL injury recoveries (2 ACL reconstructions, plus many meniscus repairs). In the mean time, do what you can to reduce swelling with elevation and ice. Keep your leg elevated as much as possible. You can also massage the fluids towards your core to actively reduce the build up of fluids around your injury. Draw your hands along your leg from below the knee to above the knee and 'pull' the fluids towards your core. Any reduction of swelling you can do before you visit your doc will aid the diagnosis and speed the recovery.

Good luck!

A lot is dependant on how the rehab and ROM goes. You can get full ROM as soon as a month or two after an ACL reconstruction (my experiences). If you have meniscus repairs to be done, which is common with an ACL injury, you may be delayed depending on whether your surgeon wants to fix the meniscus before doing the ACL. Sometimes they are done at the same time. Meniscus repairs typically require a non-load bearing period of up to 6 weeks. My ACL injuries have always resulted in reconstruction so I don't have any means to speculate on what a partial tear may ensue.

All we can give you here are guesses. Be patient and do what you can to reduce swelling. Be gentle with the massage, it sounds like you have tremendous swelling going on.

The first thing to do is find out if the ACL is complete or partial tear.  Let us know what your doctor says.  It has been a long time since I had my knees done.  They are around 1988 and 1990 vintage reconstructions, along with some more cartilage tweaks in 1998.   My left knee was immobilized for 4 weeks to try because they tried to repair some of the cartilage.  You loose a lot or range of motion when immobilized for 4 weeks.  For my right knee, I woke up from surgery in a machine bending my knee to 90 degrees and they were much more aggressive with the early range of motion and exercises.  My guess is that is how things will be now, particularly if your cartilage is in good shape. They had me on an exercise bike very early, so I would expect that any cycling type activity would certainly be part of your rehab starting by the end of the first month after surgery at the latest.  Cycling and swimming are both great and will greatly aid in any rehab. 

Sorry about your accident.  I tore my left ACL skiing in late Dec 08 and had surgery in mid-February 09.  I also had a meniscus tear.  For me, receovery time was about 12 months to be close to back to normal.  Clearly, if you don't have a tear (and thus don't need surgery), recovery time should be considerably shorter.  If you get surgery, don't let anyone tell you that you can be close to 100% in 6 months as muscle strength (especially speed strength- very important for skiing) and proprioception do not return that quickly.  I was riding a stationary bike as soon as ROM allowed- for me this was about 2 weeks after surgery.  I did not want to get on my road bike until probably 4 months out from surgery mostly due to a concern of a fall on the repaired knee..  I did a lot of squats and lunges with weight before the surgery to maintain strength/muscle mass, as well as after surgery (without weight and then adding weight) as soon as ROM allowed (I also cleared this with my PT).

You've gotten some good advice already in the posts IMO.  Here are some additional thoughts.  My ortho told me that an ACL tear (for adults) is like getting pregnant- it is usually torn (100% tear) or it is not.  That is not to say you did not strain the ACL (I'm keeping my fingers crossed for you)- I'm just passing on what I was told .  Bottom line is to get an ortho  who speciallizes in knee injuries to check you out ASAP.  He will do a lachman test among others and he will likely recommend an MRI if he thinks there is ligament damage.  Also be aware that an MRI does not always reveal everything.  In my case, the MRI showed the ruptured ACL but did not reveal the meniscus tear.

In the meantime, try to maintain/increase ROM and keep the swelling down as earlier posts have noted.  My ortho also told me that expected ROM after the surgery (after all the rehab/recovery) is normally about the ROM (maybe a little less) that you have going into the surgery.  So, I'm saying to increase ROM, subject to ortho and PT concurrence of course, as much as you can now if it looks like you need surgery and to carefully rehab/strengthen the muscles around the affected knee without delay in any event.

I had deep tissue massages along with accupuncture treatments before and after the surgery, both of which I found very effective.  For me the accupuncture really helped reduce swelling after the surgery.  I had my first massage and accupunture 4 days after the surgery and began rehab with a PT approx 7 days after surgery. 

I have 11 days skiiing so far this season, with first day in mid-Dec 2009  where I took it moderately easy (no bumps, med speeds) and my most recent trip last week (March 2010) included heavy powder, fast groomers, moguls (ie, pretty much back to normal skiing).  I'm a 49yo, 200lb, atheletic, level 8 skier FYI.  I'd say I'm about 95+%  now and I'm stronger now than before the surgery.

Sorry if I was overly-detailed and good luck with your knee.

Sorry to hear about the knee.

I had a partial tear in '83 playing football in high school, two scopes and a lot of meniscus. Then in '85 I blew it out completely and had the ACL reconstruction, using the then fairly new, less invasive patellar graft procedure. I had a buddy who had one a couple years before that and he had a track from below the knee half way up the thigh and was in a cast for 6 weeks. With the "new" method, if it does go that way for you, they really work at ROM, fast...I mean right after surgery, as one poster said, you're in the passive motion machine. I can't add a lot more than the good stuff others have offered, but PT is the key. It sucks (and I sucked at it), but in the end, following instructions from the medical  and PT people and being vigilant with PT is the surest way to a quick recovery.

If swimming and biking are your things, you're in luck, because these are the first activities you can get back into, no pounding or lateral movement. You'll start on a stationary bike to protect the leg, but that motion is what they used for me to start getting back in shape and increasing strength and ROM. I never learned to ski before injuring my knee and then was too fearful to learn for the next 25 years. When I went back to my ortho this year to see what I needed to do to start, his belief was that braces are primarily a psychological aid the most important factor was muscle tone and strength in the bad leg.

Good luck!

How is the meniscus?

That is an extremely long time to wait to get on the mend. 4-5 months just to find out for sure that the ACL is completely gone?

I've been from tobogan to OR to PT in a month or so. At 100% in 6 - 8 months.

That said, you can ski with a missing ACL. I did it for about 15 years. You just need a properly fitting brace.

Really sorry to hear about your knee, but unbelievably appalled by the wait time.  This will be the hardest part, at least it would be for me.  The knee is pretty easy to fix.  My wife and I have both had ACLs replaced with great success and skied again 9 months later.  My wife tore hers the last week of March 2009 and she's skied 4 days this year (1st day 1/8/2010), she skis without pain and no subsequent swelling or soreness so that's good.  She's always been in good shape (she's 40) could probably go harder and wants to ski more but she's being smarter than I would. 

If you have the surgery in the 1st 1/4 2011 you'll be able to ski in 2012 if you do everything right.  Her doc said no brace  Don't slack on the range of motion.  My doc said the strength will return, they range of won't unless you work hard.  My wife's schedule went like this, tore last of week march, saw ortho 4/6 and had the surgery 5/5.  We hoped for 4/29 but the doc wanted a little less swelling. 

Biking is great for rehab but the open road will have to wait awhile.  The doc doesn't want you to have to do anything on reflex to catch your balance or stop quickly, no unplanned foot plants with force.  Swimming I think was fine, no whip kicks though.  Both will have to wait awhile after surgery but you'll get going quickly as the doctor prescribes.

I'm sad about the wait you may have to endure, that sucks!!!!!

My experience with my first ACL was the following. Torn ACL, 100% gone. Surgery to remove remaining pieces to avoid the 'tail ends' impinging on the proper fucnction of the knee. I also had meniscus repairs done at the same time. Soon I was doing PT in a pool: pool walking, then flutter kicks, etc. Stationary bike followed by road then trail riding. Skiing next season. This was back in the late '80s.

I don't believe that you should have to forego exercing such as cycling or swimming prior to surgery. I know plenty of people that get PT and resume active lives prior to any surgery. It is mostly a matter of letting the swelling reduce and getting ROM back as well as strength. A PT, under your doc's guidance, will be able to give you a test to determine your strength and release you to normal activity.

When you have laxity in the knee due to the absence of an ACL, a brace can help and can be prescribed subsequent to your obtaining full ROM and strength.

If you haven't gotten any PT yet, you should. There is no guarantee you will have improvement in ROM or reduced swelling in 4 - 5 months unless you are given professional advise NOW and immediately begin a plan of action to mitigate the impacts of the injury.

I'm not a doctor, nor do I pretend to be one; ever!  All of my replies have related to personal experience and/or second hand knowledge of how athletes and friends have dealt with injury.

Best of luck with your recovery. You will be better off to be as strong as possible for the surgery, whenever it occurs. Insist that your care givers provide you with a plan that will let you begin recovering now, regardless of when the MRI and/or surgery are going to take place.

Wow, sorry about the wait times.  That ads insult to injury.  Is that a Canada thing?  Are those wait times typical?  My opinion is that sooner is better for the surgery if you know you have to get it done.

Way back when I hurt my left knee, they didn't really have MRI's and did exploratory surgery to confirm that my ACL was gone.  It was, so they cleaned things up a bit and said if I was just a weekend warrior, I would probably be fine.  Unfortunately, that sounded good to me and I took their word on it.  Well, over the course of the next year, my knee went "out" 4 times.  Every time it would swell for a while, but then "heal" up and I would go about my life until I put it out again.  The downside to all this is that I did a lot of additional damage to the soft tissue, knee capsule, meniscus, etc...  That damage gives me aches and pains now.  Lessons learned -- when I blew out the ACL in my right knee, I did not hesitate to get it fixed as soon as the swelling went down and I could line up surgery.  I wanted to get it back to 100 percent and move on with my life.

My ortho said I had a general laxity in my knees and I would fail the physical for any professional football team.  My knees naturally hyper extended.  For me, if it weren't for balanced muscle strength in my hamstrings and quads and a good ACL, my knees would be just looking for an opportunity to come apart (I cringe at the thought).  So, I would not want to ski without my ACL rebuilt and ROM and muscle strength were it should be. 

That said, I have read about plenty of people that really never missed their ACL, have great knee stability without it, and can do whatever activities they want including skiing (brace wearing recommended).  For me, I had instability and lots of trust issues (after my left knee went out a couple of times), so I needed to have it rebuilt and tightened up.

In your situation, only you can make that call.  Once your swelling subsides and you can work it again, you will have to come to your own conclusion. If you are able to get surgery in early 2011, you will be ready to go for the 2011/2012 ski season.  There are many "ifs" in surgery and rehab, but you could be cleared for skiing 6 months after a successful surgery with aggressive rehab.  Best of luck.

I'm glad to hear that you have a PT and are already working on things. The one thing that a brace does work very well on is preventing hyperextension. I know this from first hand experience. Leg strength is also essential to compensating for the ACL, too, so working to get back on pace, ACL or no, is excellent.

Wow.  I was bumming until I heard the wait times for your treatment.  I tore my left ACL and meniscus about 7 days before you.  I am having surgery the day after tomorrow so I can definitley give you some insight into what to expect.  I have been working like crazy to get the ROM prior to surgery.  I've been able to ride a stationary bike, and am doing quad sets and 1 leg step  ups.  I can get my leg out straight, but can't quite get all of the ROM the other way.  I think I'm missing about 5 deg.  I can't quite get to a squat position.  Should I expect to never get this back after surgery?  I am also planning to see my chiropractor ASAP after surgery for K-laser treatment to speed healing and reduce swelling.  Anyone have any experience with it?

I'm having the hamstring graft.  Surgery is tomorrow.  I also have some meniscus damage, but I'm not sure yet if that's going to be a repair or a cleanup.  I'm sure it will have an impact on how fast I'm up and about.  When my Dr. told me I was having the surgery, he said I'll walk out and be back to work in a week.  When I picked up the paperwork from him yesterday, it said 6 weeks.  I think that sounds more like it anyway.  That should give me enough time to focus on rehab.  Feel free to drop me a note anytime if you have any specific questions and I can let you know how its going.  I should put some kind of ongoing post on here for people to see an example of how the rehab goes.  Maybe if I'm ambitious enough I will.  I did some research and printed off a good milestone tracker to see how I'm progressing and compare it with what the PT says.  My goal is to do whatever I am capable of each day to stay ahead of those milestones.  (Except maybe for the first couple days.  My plan there is to take pain pills, watch movies an surf the net.)  The last one of course being 'go skiing in December'.  I'm even going to follow a strict anti-inflammatory diet for as long as possible

Both my grafts were patellar tendon. I've fortunately had no patellar tendonitis which is not uncommon with this type of graft.

I've skiied 15 years without an ACL and don't miss it.  Every knee is different.

When I lived in Fernie it seemed people got into surgery in Cranbrook without much wait and had good results.  Check your options and be sure to make them know you can be available.  It seems people are always told to expect the long wait and then end up getting right in.

I was back in the office full time in 9 days. I did therapy at home a couple times a day, and with the therapist 3 mornings a week before work.   I had a graft from a cadaver.  By the time I was back in the office I had gone as far as I could with the range of motion machine you start with the day after surgery.  The best thing was the ice water circulator that I used.  The ice circulator was packed in my bandaging when I awoke after surgery.  They delivered a cooler with a pump for the ice water to my house before the surgery.  This provided more relief than any medication.  Good luck with your surgery and recovery.  I had my surgery last april, and skied 25+ full days this season as a patroller. 

Thanks for the well wishes.  Surgery went well according to the Dr.  I was planning to get the epidural and was actually going to watch the surgery on the monitor, but when they started, I could feel it so they knocked me out.  I had a femoral nerve block which made the front of the leg completely numb.  When I went to get up from the recovery room, I definitely felt pain in the hamstring where the graft came from.  I can bear weight already, but am using crutches just because it was awkward from being numb and felt weak at first.  They put me in a brace that I need to wear for weight bearing that limits the knee to 10 degrees, but I can already bend it to about 90 degrees.  I don't have the strength right now to flex the quad even.  Overall though its not very uncomfortable as all the meds are doing their job.  Just focusing now on icing and getting some rest. I'm told I have to wear this brace with this limited ROM during weight bearing for about 10 day.  Start PT Monday.  So far so good I guess.

 Vermonte, kcxd,

Here is my experience for what it's worth. Complete ACL tear and partial meniscus tear in April 2 years ago.  I had surgery in June, skied in December. I had a graft from a cadaver so no additional pain from the harvest site. Great advice I got: move your butt!  The only thing you are building by not moving is scar tissues.  Was it easy? no  was it very difficult? no it takes persistence...let me say that again: persistence.  A little bit everyday... but most of us who have had this did recover and skied again at the same level if not higher.
Funny stories: I had to was my hair in the kitchen sink  it was way easier because of the detachable shower head at the right height!
My daughter tried to fix some lunch and she confused cucumber for zucchinis.  Steamed cucumbers are great!
money saver: for therapy if you want to wear pants instead of shorts, buy one or two size bigger than yours (stretchy pants), undo the seem on the side, sew a ribbon on one side and use sticky velcro (little round shape work fine), this way you can open the side when needed.
Keep posting your progress, the laughs, the difficult moments - it helps...and you will get a lot of support from all of us!

Good luck!

snownat

I'll second the move it part, but make sure it is authorized/prescribed movement. I was in a ROM machine immediately after my first reconstruction as they kept me overnight. That was the first reconstruction, the second I crutched my way out within an hour or so and passing the pee test.

And elevate whenever possible. Swelling is the anti-ROM. Anything you can do to prevent loss of ROM and reduce swelling will always be good.
Edited by MastersRacer - 4/1/10 at 1:54pm

How soon before you could walk after the second one?  Were you weight bearing right away?