ACL tear - looking for thoughts on recovery time - Page 10

55 days out from surgery, and I can finally walk down stairs without acute pain.  (Without warming up first through exercise.)  Yippee.  :)

 

 

That's what I was thinking, too, but then heard from someone else who had ACLs done on each leg that the acute one was easier than the previously damaged one, so I'm not sure.

 

Anyway, he got the all-clear yesterday. Three months and 1 week after surgery. He hasn't even hit the pt hard in the past few weeks. He still has some atrophy, but it's completely normal, according to doctor, even less than most people. I don't think he's going to start playing squash again tomorrow, or anything like that, but he's been golfing for about 6 weeks already with no ill effects. (He is right-handed, and it's his right knee, so not the main torqued leg, but...)   I would like to say he was in fabulous shape before surgery, but he doesn't even work out, really. Freak. 

 

 

I haven't read all the posts here either, but figured I would throw in my two cents anyways.

 

History:

 

Two ACL reconstructions on right knee- first was a double bundle 2.5 years to the day before the 2nd (which they call a "revision") which was 3 weeks ago (traditional single bundle).  First included a meniscus trim, the second meniscus repair. 

 

Got some conflicting recommendations but first Doc seemed to have a more aggressive protocol and had initially said it was possible to get back to skiing in 6 months with a single bundle reconstruction and as little as 4-4.5 months with a double bundle (which he later pushed back a bit).  For a while this doc had gone from doing all single bundles to all double bundles (which he thought superior at the time of my surgery) but is now using both, depending on the patients anatomy. 

 

Recovery and skiing seemed mostly fine (170 days the past 2 season) until I took an unusual fall last month at A-B and felt a dreaded pop.

 

2nd Doc (who is the doc for the US Women's ski team) said that although they originally used the same 6 month protocol with cadavers as your own tissue, that they have switched to a 9 month protocol as the cadaver graphs take longer to incorporate and get back to full strength (when compared to using own tissue).  He also said after operating on me that my ACL had been compromised BEFORE  the recent fall at A-B.  (RE 1 vs 2 bundles, his opinion was that while the double bundle seemed better in the lab, the failure rate in practice has been higher than single bundle). 

 

The possibility that my double bundle graph failed earlier raised some serious questions as to when this happened as I had no swelling or apparent injuries the past 2 years (and only a few, what I had thought minor, instability issues).

 

My bottom line thinking is to favor the more conservative protocol- while the knee may feel pretty good, I think the graph and the leg get stronger during that 6 mo to 18 month post op period. 

I was wondering how you were doing ... a question: could dr tell how "compromised" the graft was before the latest injury? Just wondering about the "pop" -- surely you had some sort of whole graft if it popped? Or maybe it was something else?

 

I asked DH if his was single or double but he didn't know, so I will assume it's single -- don't know, though. It's a hamstring graft. 

 

 

 

To hear the Dr tell it, it was likely completely gone anywhere from 30 days to 2.5 years before, but I am not 100% convinced...I suppose the pop could have been the meniscus (a "bucket handle" tear folded over on itself on the inside along with a smaller tear on the outside), but it felt pretty similar to the first one (but no MCL tear this time).

 

My Doc did indicated that hamstring (and other autographs) do incorporate quicker (which is where they came up with the original 6 month protocol from), but said another cadaver was the only one that made sense for me as he wanted to make it big (my first surgery had 8 & 7 mm bundles while this one was a single 11 mm graft).
 

 

Haven't made any updates recently - but then there hasn't been much to update about.  Progress continues but is slow.  Still enough pain I can't do full flexion, still some muscular atrophy, but its better week upon week.  I tried jogging - holy toledo that hurt.  It's the patellar tendon - I guess it's just irritated and maybe not sitting right because I still have a touch of swelling.  Sigh.  At least the bike riding is just fine.

 

Oh, and I got to see the orthoscopic pictures of my knee - glad to report I really do have a 100% perfect meniscus.  The donor tendon looks like the silvery bit of a pork loin, and they really rear things up to get the new tendon in there don't they.

 

Just thought I would put down my experience down to paper, for others to read but equally just for myself to remember. Enjoy.

Im exactly one week out of hamstring graft repair on my left knee (which means I can drive thank god) 

Tore it in Whistler on March 1st + MCL & 1/3 med meniscus & PCL strain but now back in NZ. helmet cam footage here (Explicit Language ;) ): http://www.youtube.com/watch?v=yk-0v_kQEc8

Have done plenty of gym work, balance, rowing and cycling  to pre-hab which seems to have paid off.

Things are going so much better than I ever would have dreamt which is great, I had prepared for the worst, with plenty of time off work organised and meals cooked and frozen etc etc but it all seems a bit uneccessary now.

I was awake for the op but pretty sedated, I remember watching the athroscope footage on tv, talking to the surgeon and asking questions but cannot remember any of the answers, all a bit dream like, but once I came too fully in the bed afterward I started playing around with my leg, the knee and below was still unresponsive from anaesthetic but I could already fire the quad so that was a good sign. Physio gave me a rundown on basic exercises and how to use crutches etc, but my time using them in whis on snow and ice and living on 4th floor got me pretty pro at that!

Thankfully NZ solely uses forearm crutches not the 50's style armpit things they hand out in Canada.

Left hospital at around 8pm with a leg immobiliser as I still didnt really have control of the joint, everything else felt good though, apart from my stomach, which had felt a bit off for a few hours and had had to eat very slowly. Anyway the walk downstairs and to the pharmacy was too much for it and i proceded to throw up at least 2 litres into a plastic bag that was handed to me only just in time, after that hiccup i felt great though, just had to get it out of the way.

Slept fine that night, and in the morn took my pills, filled the cyro-cuff and got started on my exercises. after some gentle warming up i managed to get 90 degrees flex and more or less full extension out of it, was so stoked! could also pull off straight leg raises so the quads were going well.

I kept the immobilser and crutches for most of the day, but by the end of it i found myself full weight bearing on the leg anyway so ditched the crutches round the house that day, and completely by the next day. The immobiliser also seemed fairly pointless by this stage as I had pretty good control of all my muscles so all it was doing was holding me back really, as long as i was careful.

By day 4 I thought I would try out the bike, set it nice and high and all went fine, the only problem by this point was that I had pretty much reached all the goals on the surgeons guideline sheets for week 1-2 so I was a little worried about trying to push anything too far, especially the weakened hamstring, so for the rest of the week I eased up a bit and just repeated the exercises given.

Those being quad contractions, foot pumps/circles, co-contraction (quad and hamstring, pushing heel down), heel slides, knee extension on chair, abduction, adduction, straight leg raise and glute contractions oh and occasional situps.

Finally saw the physio today and he basically told me to go for it which was what I needed really, someone to tell me it was safe to do so, he said as long as I dont aggressively stretch the hamstring or do any quick fire work with it like sprinting(obviously not) or weights im good to go. Measured my flexion at 126 in bad leg and i think about 138 in good leg if that sounds right?

So as of today Im going to ramp up the cycling especially and add a fair bit of resistance. Just ten mins in morn and night today to get used to it and build from there. and adding elastic band work and other resistance to the exercises I was already doing like the foot pumps, ab & ad-duction, pulling my knee to my chest and pushing the straightened knee down to try and go form 0 degrees extension to a bit of hyperextension like my good leg.

So all in all im in a really good mood today, and some targets and events I had completely ruled out prior to surgery dont seem so immpossible all of a sudden, like a 160km bike race around lake Taupo at the end of november. Obviously its still a long road ahead but its a great start, and its good to have some goals to work towards.

One downside has been the painkillers, although the pain has been less than from the original tear, the meds Ive received in NZ havent seemed to work much at all, first prescription from surgeon was tramadol, but i went back 3 days later to switch to something else that would actually relieve pain and not just make me nauseous, next up was gabapentin (neupentin) which doesnt seem to do anything at all. I even up'd the dose significantly after checking out some info online but still nada.

Pain is ok now so im not bothering to go back again but man I wish they had just given me some percocet (oxycodone) from day one like in canada when I tore it, that stuff really worked! and made me pretty happy despite the fact I had just ruined my season :)

It may seem like I bit of a brag haha, but Im just stoked at the result and I guess it goes to show what good prep, a good surgeon (did a lot of asking round on that too, to try and get NZ's best, Mark Clatworthy, great website too, with loads of info pdf's and explanation videos, the works... http://www.markclatworthy.co.nz/ ) and I guess a young (26) and pretty fit body can acheive.

One of my goals is to get down to the snow here before the end of the season to try a few days in a sit-ski, ironically I had a 2 hour introduction sit-ski lesson organised for Whistler staff the day before I blew my knee, and really enjoyed it, so as long as the knee isnt to tender and well wrapped up would be fun to try again and get on the slopes. I did also manage to go down the weekend before my op and give some friends some lessons on the green slopes, but i fought the temptation to head up higher even though the conditions were perfect, be pretty embarrasing to reinjure myself 4 days prior to surgery skiing again....

Might update this in a couple of weeks once im back at work and start hitting the gym etc.

Hope it wasnt too long and boring,

Tom

Edited by tomlynchwatson - 8/11/11 at 7:58pm

 

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Elistan, just remember to focus on yourself and not other peoples recovery time. You can use others for a reference, but don't dwell on it. Focus on yourself & the things that you can control. Keep doing and enjoying the things like bike riding that you can do. Keep doing and enjoying the things like bike riding that you can do. Keep doing and enjoying the things like bike riding that you can do. 

 

+1

 

And always do what your PT tells you to. Don't over do it and don't slack off either.

 

We all heal differently. You will get better.
 

 

Excellent advice. I slacked off a little but I was wakeboarding (carefully) within nine months. My mother was up and going again within 6 months, it was the fastest recovery for someones age that the doctor had ever seen. By the way the post about pain walking down the stairs earlier just reminded me of the experience, must have been a repressed memory, man that was annoying.

Tom

Sounds like you are doing great. I had my acl reconstructed 5 months ago. I was fortunate and had virtually no pain. I was riding the stationary bike 5 days subsequent to surgery, and was up to an hour on the bike 2 weeks out. I was released to ride outdoors (with platform pedals) at 5 weeks, and rode my first metric century 2 months out.

I've steadily built my training volume, and am up to riding 220 miles a week. Recently, though, I've been experiencing swelling in the knee, so I've had to back the volume off a bit.

What seems to irritate my knee is several days of high intensity training followed by a big day (85 miles, 5kof climbing).

That being said, my power numbers are close to where they were last year. I just don't have the resilience yet to recover from a big volume of work.

Perhaps you will be different. But my advice is to error on the side of caution. There's little point in setting your recovery back by overdoing it. And at your stage of rehab, that'd probably be by over stressing the hamstring. If you pull that, it purportedly takes a very long time to recover from.

Also, your graft actually is at it's most vulnerable from 8-12 weeks after surgery. Baby it a bit, listen to your body and your pt.

I was fortunate that my pt was a serious cyclist like me who had acl reconstruction a week before me. She let me push the envelop because I was ready. But I also had unreasonable expectations of what I'd be able to do.

I had hoped to ride the bicycle tour of Colorado in June a bit more than 3 months after surgery. The btc is a 6 day 430 mile stage ride with lots of climbing. While I'd risen several metric centuries by the time that the btc came around, there was no way I was going to be able to string those days together, let alone handle some of the tough climbs on the tour.

So, take it as it comes. Focus on getting the quad to fire. Work on the bike, but don't overdo it. There's always next season.

From someone who doesn't do things halfway,

Mike

Waaw this forum is still going on, I was posting about my ACL surgery last year in jun 2010

good luck guys just be patient and listen to your orto. and PT

ACL surgery is not fun but the knee can be back in a pretty good shape

I am getting ready for a winter season again :)

Be careful out there

giga

Bump! 

 

For what it's worth, in Jan this year, just less than a year after my ACL tear and 11 months after the surgery, I was back on the slopes.  No issues to report.

 

In general, the knee exhibits some irritation at times - mostly the patellar ligament in my decidedly non-medical opinion (it likes to pop and crackle at times too) - and I can only get complete flexion if I work up to it with stretching, but for the most part I hardly every think of the knee.

 

The nerve damage can be really annoying at times though.