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ACL tear - looking for thoughts on recovery time - Page 2

post #31 of 358

For ACL #2 I had already had a meniscus repair 6 weeks prior, so I was weight bearing after the reconstruction pretty much right away.

I'm not a doctor and I don't play one on TV either. Your results may vary.

post #32 of 358
The doc wanted me walking on the leg right away.  I did use the crutches for 4 or 5 days since I wasn't confident with my balance, but did put weight on the leg.  I used one crutch for another week or two when walking outside.
post #33 of 358
Thread Starter 
Glad to hear all went well! Hope you're still doing okay 24 hours on. What was your ROM like before the surgery? Were they insistent that you were able to bend the leg fully before they operated? 
post #34 of 358
Glad to hear all that.  It seems like it is different for everybody depending on the total damage to the knee and the procedure used.  My ortho was insistent on getting the leg straight before surgery.  I was able to do that, but couldn't quite bend it all the way the other way.  I could almost squat fully but not quite.  Today was pretty good.  I moved it quite a bit and iced it consistently and kept it up most of the day.  The nerve block lasted about 24 hours and it was real easy up til then.  The pain started kicking in after that, but I feel like I was on it alot today and definitely tested it.  Seems to be a good sign that I could bear weight on it so easily the day after surgery.  We'll see tomorrow how it goes without the nerve block in effect.  I have PT Monday and I hope to be able to walk by then.
post #35 of 358
Day 3 and starting to see a little progress.  Day 2 felt like a step back, but it was just because I was fooled into thinking I was better than I was the first day with the residual drugs from surgery and the nerve block.  One that wore off, I had intense pain for about 12 hours and it stiffened up alot.  I managed to do some exercises and bend it some, but I didn't have the ROM that I thought I had the first day either.  I had no quad muscle control and could not raise the leg lying flat without help.  Today, the pain is manageable, I can do quad sets and feel the muscle and I can raise it.  the pain is much more bearable.  When I get up to walk, I'm moving slow but using the crutches to walk and put weight on the knee.  I had some slight swelling in my foot yesterday, but that's subsided.  Pretty good start I think. 
post #36 of 358
Picked up some Prophet 100's online today from REI.  Skis and bindings under $500.  That seemed to help with my recovery also.
post #37 of 358
Thread Starter 
That would definitely help with any recovery, I think!

Glad to hear that it feels like it's making progress. Did you take anything for the pain, or just grit your teeth and struggle through?
post #38 of 358
kcxd; allow me to offer two more bits of unasked for advice for your consideration.

1) take pain medicine as prescribed/recommended by your doctor; there is imho no good reason to suffer or " just grit your teeth and struggle through" the pain

2) When it comes time for your surgery, be aware that there are different types of grafts and harvesting techniques for ACL reconstruction. Your orthopod may have a preference for one type over another, but in addition to his advice, consider that there are higher failure rates post-op with allografts ( ligament reconstructed with tissue harvested from cadavers) compared with autografts (your own tissue). For that reason, in a recent review it was recommended that  allografts should be avoided in young athletes when possible in favor of autografts.


In general, there appear to be similar functional outcomes with either the patellar tendon or hamstring tendon autograft, though the former is (surprise, surprise) associated with more pain upon kneeling and a higher rate of residual anterior knee pain. So overall, a reconstruction from your own hamstring tendon might be worth considering. Ask your doctor.


There's another ACL reconstruction technique that is now offered known as the "double bundle", but its long-term outcome remains unknown.

Wishing you a speedy recovery,


post #39 of 358
Oh no doubt.  Take the meds.  This would be unbearable without it.  I am using oxycodon.  Once that nerve block let go, I had to increase the dosage to deal with it for about 12 hours, but it's much better now and I'm ramping down on the oxycodon.  Most of its has been quite manageable so far.  The gave me a good brace that really helps keep it from moving some way it shouldn't and I am icing it frequently which really helps with pain and swelling which go hand in hand.  I'd rather be skiing or golfing, but it could be worse also.
post #40 of 358
Thread Starter 
I'm looking out my window at all the fresh snow on the North Shore mountains, and feeling pretty down. Wish there was some way I could move through the surgical wait list faster.

Dr. Rick, thanks for the advice. I have a history of chronic anterior knee pain (very persistent bilateral PFS) so I'm feeling like the patellar tendon graft wouldn't be a good choice for me. I'm a little wary of allografts from the reviews I've read, so I'm guessing the hamstring autograft will likely be my best option. I won't be seeing the surgeon for my initial consult till July, so at the moment I'm really basing my thoughts on the research I've done online and the feedback from folk who have been through it themselves. My OS might have a different opinion once he's actually taken a look at my knees.

Vermonte - glad to hear you're doing okay. In some ways I envy where you are right now, because at least now you've had the surgery and can move forward toward a final recovery. I feel stuck in a bit of a holding pattern; the work I'm doing now to rehab the injury will all have to be repeated after surgery, and with no real idea of how far away that might be it's all pretty frustrating.

On the plus side I did manage to complete a 100k road race on my bike yesterday, a month to the day after blowing my knee. I almost cancelled my registration after the accident, but I'm glad I held onto it now. It was pretty hard going and my time was way slow (5:02), but it was such an achievement to be out there that I didn't mind the slow time at all. Knee was quite sore toward the end of the ride and swelled a little afterwards, but mostly handled it well. And I'm sure it did wonders for my poor atrophied quad muscle! It's funny; 6 weeks ago I wouldn't have thought twice about a 100k ride, but now it feels like a huge achievement.
post #41 of 358
Congratulations on the ride.  I'm in OK shape for 39 years old, but you are far better off than I was.  I was going to say, having a month of prehab was definitely helpful in recovery.  I already notice that I am getting my muscle control back after the surgery it seems more quickly that when I hurt it to begin with.  Getting as much leg strength as possible certainly won't hurt anything since you have to wait for the rehab anyway.

I went to PT today for the first time.  5 days after surgery.  Pretty positive.  PT said the goal in the first 2 weeks of PT is to get 90 deg. of bend to the leg and get it straight.  I was almost there already in both cases.   I went in walking on 2 crutches since it was the first time I've really left the house, but after therapy and some adjustments to the brace,I walked a little bit and walked out feeling solid with one crutch. 
He unwrapped the dressing and cleaned the leg up a bit.  It looked good.  Very little swelling and the incisions were extremely small and healing well.  He heated it up and after some quad sets and leg lifts, I got on a bike and pedaled slowly backwards with the seat very high so I didn't have to bend to much.  Once I could pedal backward completely a little bit I started forward and pedaled slow for about 6 - 7 min.  Iced it and that was it.

Still some pain but its getting better and PT said I can start to pedal a little like that each day.  Good start I feel, but  helluva lot of work to go.
post #42 of 358
Thread Starter 
That does sound like very good progress! Just think of every step as one step closer to those new skis. How does the post-surgery swelling compare to the post-injury swelling? (Sorry, I'm very curious as to how things are going, so the questions are likely to keep coming!) Did the pedaling hurt at all?
post #43 of 358
the swelling looked similar.  I think I got it down quicker.  It seems a bit less this far from the surgery as compared to the injury.  and yes the cycling hurt, but it wasn't unbearable.  I couldn't pedal forward when I fist started because it was painful.  I could just make a revolution backward.  Once I got it going a little bit backward, I tried again forward and I could do it.  Then I kept pedaling for a few minutes.  Not very smooth, but I was surprised to already be doing it.  No problem with the questions.  I can certainly understand your curiosity.  I hope it proves helpful.
post #44 of 358
You both sound like you are on a good road to recovery (pun unintended kcxd). Congratulations. You are both demonstrating the benefits of listening to your PTs and working on ROM and reduction of swelling. Too many people I know either can't (must work) or don't (frustrated at inactivity) and suffer through prolonged recoveries that in the long run end of leaving them weaker than if they had followed directions to the T.

kcxd, I've been in your shoes; don't be discouraged by the delay. You are getting out and doing stuff now that will help with a speedy recovery when you do get the surgery.
post #45 of 358
Thread Starter 
Vermonte - it's very helpful, and I very much appreciate your taking the time to answer. It's great to have an idea of how things are progressing for you, and what I should prepare for/expect post-surgery. How's the graft site feeling?

MastersRacer - thank you - that does make me feel a bit better about it. It's just so frustrating knowing that I'll probably lose the whole of next ski season because of the long wait for surgery. I just have to keep reminding myself to focus on the things I can do something about (like the state of my quad muscles!) rather than the things I can't.
post #46 of 358
Good attitude.  then again, that's easy for me to say because I'm probably not missing a ski season.   Great day today.  Exactly 1 week out.  More progress.  I went to PT without crutches.  We didn't check on my ROM, but its better.  I rode at a slightly quicker pace for 15 min.  I did some step ups.  That caused the most discomfort and was the most difficult.  Only 20 on the bad leg.  Pushed a little weight for the first time.  Did presses with both legs and with only the bad leg. Finished with some machine that was like a recumbent stair stepper with some resistance.  Did that about 10 min. Slowly.  Finished with some ice and felt pretty good.  I walked around all day after that running errands.  There is still a little bit of swelling that causes some pain.  When I walk or exercise I notice the pain around the area where the largest incision is or where the surgery was done from.  I don't necessarily notice the graft site.  My hamstring feels weak also.  At one point today, I didn't have the brace locked and I was walking pretty well.  I looked down and noticed it was unlocked.  The PT told me that its just there to make sure the knee doesn't buckle.  I could see that happening.  It does feel very weak at times, but again, I'm happy with the progress.
post #47 of 358
Thread Starter 
Congrats - sounds like you're making really good progress. Must be nice to be off the crutches and walking around. Sounds like you're doing really well for just a week after surgery.

Did they get you using one of those continuous passive motion machines at all? Initially it sounded like they were pretty standard but I'm running into a few more people who haven't used them, and don't seem to have suffered any ill effects.
post #48 of 358
No didn't use the passive motion.  Dr. said I didn't need it.  Maybe because I am weight bearing and walking.  my girlfriend had a tibial plateau fracture two years ago and she had to use it a lot.  He definitely stressed moving it a lot and right away.  I can take the brace completely off and extend it over and over again while watching TV or lying in bed.  Just a lot of that along with leg raises, quad sets and extensions over a ball.  PT has me doing more.  I went to the gym on my own today and did a circuit of upper body machines along with about 15 min. slow pedaling.  I was getting the knee to about 100 degrees while pedaling.  Did a few leg presses and walked up a flight of stairs normally, but while holding the rail.   Less pain today and more strength.  I'm much more confident and stable walking and the pain is diminishing.  Very tolerable today.
post #49 of 358
Thread Starter 
Wow - it does sound like things are coming along really well so far. 

I got some bad news today which I'm still trying to digest. Wait times for an initial consult with an orthopedic surgeon in Vancouver are at 18-24 months; even worse than I thought. I'm desperately trying to come up with some options, because that's insane.
post #50 of 358
I remember the first stationary bike turns - I found that starting with the heel on the pedal was easier, then I worked my way to the ball of the foot.
kcxd, 18-24 months?! wow..Do the PT, it helps.  It does build muscle mass (which you'll loose with surgery).  Balance exercise can actually train you to control your knee better and be more stable (less prone to reinjury before surgery). Follow your PT advice - they know best and it's custom advice.
Good luck!
post #51 of 358
kcxd, I'm sorry to hear about the extraordinary delay. The good news is that when you have strength and ROM you can ski without an ACL. I'm living proof, or was before having the reconstructions. I went 15 years without one and since the surgery, I am racing strong and capable. The delay prolongs the ordeal, but doesn't mean an end of skiing for the duration of the wait.

Chin up, keep the pedals spiinning.
post #52 of 358
Good luck with your recovery! For me, I had a cadaever graft, PCM machine, and worked hard in PT gradually building up. In 7 months the beginning of the ski season came (November) and I was signed off to start skiing. I did so for the first 14 days in very soft boots (80 Lange) as rehab boots, and then switched out to regular medium stiff boots, and Kneebindings. Last season I skied a total of 61 days and this season 55 so far - so 116 on the graft so far.
post #53 of 358
Originally Posted by kcxd View Post

Wow - it does sound like things are coming along really well so far. 

I got some bad news today which I'm still trying to digest. Wait times for an initial consult with an orthopedic surgeon in Vancouver are at 18-24 months; even worse than I thought. I'm desperately trying to come up with some options, because that's insane.

Sorry to hear about the long wait.  Do they offer any private supplementation insurance that could speed things up?  I have an uncle from Australia and he said they have something like that, and many people get it.  Do other providences in Canada have shorter wait times?  If so, can you go there?  Is the system corrupt?  Can your bribe someone (er -  grease the wheels)?    

Best of luck.  In my mind, a two year wait seems like a high price to pay (I guess free isn't always "free").
post #54 of 358
Originally Posted by MastersRacer View Post

...good news is that when you have strength and ROM you can ski without an ACL. ..keep the pedals spiinning.


ACL out end of last season, this season skied 40+ days without it, and still going strong(er). As MastersRacer put it, strength and ROM are key - and sounds like both of which you are working very hard to increase. Keep up with the good progress!
post #55 of 358
Thread Starter 
Thanks, guys. If there's one thing that's guaranteed to make me feel better, it's the thought of skiing again.  The good news is that PT is going really, really well - my quad is building up again (that 100k bike ride seemed to kickstart it), the knee is stable, and ROM is within 10-15 degrees of the other leg. I got fitted for my ACL brace earlier this week and the physio is pretty confident that if I keep progressing as well as I have been, a few gentle turns before the end of the season (May 24th at Whistler) are a realistic goal.

With regard to the wait time, I've got a couple of options to pursue. My mother-in-law works at the hospital over in Victoria, and she's going to check on their wait times - she thinks they're much faster than Vancouver, and I could stay with the in-laws while I had surgery. My doctor also suggested that I call the orthopod I saw after my last knee injury in 2006 and try and convince them to treat me as an existing rather than new patient. Officially it's not really a followup if it's longer than 6 months, but given that it's an injury to the same area of the same knee she thinks it's worth a try.

Too bad that I had to get injured in the city with the longest OS wait times in Canada, but I'm not giving up just yet. Apparently being a squeaky wheel can work wonders, so I'm just going to squeak as loud as I can and hope for the best. 
post #56 of 358
Thread Starter 
A quick question: for those of you skiing minus an ACL, have you had to modify your style at all? Is there anything you avoid? I'm sure my first few days out will be pretty cautious, but if I do end up going through a couple of seasons without an ACL I'm just wondering what the longer-term limitations might be.
post #57 of 358
Just ski well. Don't huck anything; stay clear of the trauma park. Enjoy the weather and the easier trails that you probably eschewed for more challenging terrain in the past.

You will be more reliant on your muscle strength to maintain good control. Stay strong while skiing, don't get sloppy or lax. Be aware of your deficieny, but ski with the confidence that you are in good shape and can handle anything in reason.

Have fun!
post #58 of 358
I strongly considered skiing minus an ACL but with a brace to finish the season I got hurt, and while waiting the couple months for my surgery. The physical therapist, surgeon, and my sister-in-law who is an ortho OR nurse all urged me strongly against it because the only problem in my knee was my ruptured ACL (everything else was unharmed as proved by the MRI), and without the ACL's stabilizing influence there was a greater risk to injuring the MCL, PCL, and almost certainly the meniscus. I was told that at a minimum I would also be at much greater risk of osteo-arthritis down the road. I gave up the season and waited...
post #59 of 358
Some docs will tell their 'victims' that they will never ski again. A new doc and the right repairs and the 'never ski agains' are tearing it up on the slopes. I have heard first hand of these stories. Not all docs share the same opinions or knowledge of what is good and what is bad.

I had a meniscus tear, surgery and PT and was racing within 3 weeks of the surgery. My doc was supportative. He also was a US Ski Team traveling doc and understood my committement to skiing and racing. I'm sure other docs would say 'out for the season'.

You will know if you are comfortable with your condition. My test is to jump and land from about 2 - 3 feet up; like off a low wall onto a sidewalk. If I can jump and land in a tele stance with equal stability and comfort regardless of the leg that I'm leading with, I feel good to go for strenuous athletics. If not, then I work harder at PT. Your PT is able to evaluate your condition and help you make an informed decision.
post #60 of 358
Thread Starter 
I have good news - I talked to the OS I saw four years ago and explained the situation, and I have an appointment for May 19th! Fortunately they were sympathetic and willing to treat me as an existing patient as it's a reinjury of the same site. Feeling much better now. :) The OS has about a 4 month median wait for surgery after the initial consult, which is fairly standard. 

I'm only going to ski again this season if my PT gives the all-clear, which will depend on me having enough muscle tone and strength to not be at risk of further damage. If he says no I'm not going to push it; he's steered me very well indeed so far, and I trust his opinion. I imagine that whenever I next get out on the slopes - this season, next season, or the one after - I'll be taking it very easy on the groomers for a little bit. My partner (a beginner) is quite excited that we might be going at the same pace for a while. :)
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