ACL Replacement (HAMSTRING Graft) - Recovery of Speed?

Training Injuries
1

Hey all,

Quick story. I tore my left ACL playing basketball and had reconstructive surgery a little over six weeks ago. I had a hamstring graft and also had a small meniscus tear repaired.

My question is, what’s the likelihood that I’ll regain my speed once everything heals up and I get my hamstring strength back? I’m 26 years old, 6-3 and was ~200 pounds prior to this surgery (I’ve dropped to ~190 since). Anyone who has had this surgery (specifically hamstring graft) or who has worked with any athletes who have had this method of ACL replacement, please let me know your experience.

As a side note, I tore my other ACL back in college and had a patellar tendon graft. After that surgery I got very big into lifting, especially legs. I came back 120% from that surgery and was significantly faster and stronger, though I attribute that all to the weight lifting. Prior to this injury, my 1RM max was 295 back squat, 245 front squat and 355 deadlift.

Thanks for any input.

2

As long as there are no complications with surgery (excessive scar tissue, infection, etc), you should have no worries about returning to full function. As you stated with your other knee, you came back 120%, which can be explained by the starting of weight lifting which you hadn’t done prior to the injury/surgery.

I have worked with several athletes who have returned very well from ACL-R surgeries, both with hamstring and patellar grafts. My best advice is to focus on restoring full proper static and dynamic ROM at the hip, ankle, AND knee. At 6 weeks out, you should be well on your way with return to full knee ROM. Also, focus on glute activation, knee control/stability, and hamstring strength with knee flexion as well as hip extension.

Tons of other stuff, but that should be a good starting point and your therapists should be able to help you out along the way.

3

[quote]LevelHeaded wrote:
As long as there are no complications with surgery (excessive scar tissue, infection, etc), you should have no worries about returning to full function. As you stated with your other knee, you came back 120%, which can be explained by the starting of weight lifting which you hadn’t done prior to the injury/surgery.

I have worked with several athletes who have returned very well from ACL-R surgeries, both with hamstring and patellar grafts. My best advice is to focus on restoring full proper static and dynamic ROM at the hip, ankle, AND knee. At 6 weeks out, you should be well on your way with return to full knee ROM. Also, focus on glute activation, knee control/stability, and hamstring strength with knee flexion as well as hip extension.

Tons of other stuff, but that should be a good starting point and your therapists should be able to help you out along the way.[/quote]

seconded…

4

Thanks for the reply, that helps a lot. It’s very hard to find info on hamstring grafts relating to my particular goals, so it’s great to hear from someone who has worked with athletes coming back from this.

I was a little iffy about going the hamstring route with this tear because of how well everything went with the patella graft last time. My doc assured me that with how they do hamstring grafts now, I’d be better off in the short term with rehab and in the long term with the overall health of my knee. It’s just hard to find examples of athletes who have gone the hamstring route, so thanks for the input.

5

Not a problem. Keep us updated on your progress. Are you getting visits with a physical therpist/athletic trainer for rehab or doing it yourself?

6

Yes, I’m seeing my PT once per week and doing everything on my own on the other days. It’s basically just a checkup, and then she’ll watch me do my exercises and make sure I’m doing them correctly. She’s thrown in something new each week, and I’ve had no setbacks so far. I’m able to do everything I’m supposed to at my gym. I also work in a college athletic department and know a few of the athletic trainers, so they’ve been a good resource as well.

7

Definitely hit up the athletic trainers and see if they are willing to help out and let you utilize their facility. That would be a great resource for you. The 1 time per week PT stuff is what frustrates me the most with how insurance companies regulate PT visits. If you were a collegiate athlete and were injured, you would be getting daily treatment/rehab from your athletic trainers/therapists. This is one reason why I feel that collegiate/pro athletes (in addition to positive genetic traits) come back quicker and better than most people who do not receive the same level of care.

Best of luck with everything and like I said earlier, keeps us updated and feel free to ask questions.

8

hey bud, hope the rehab is progressing well.

You probably already know most of the drill with rehab from your first surgery - but the big difference will be getting that hamstring joint range and strength back - get it back to full strength before you play sport. For the simple reason ive seen ppl come back to early and either strain the “injured” leg hamstring or injure the opposite leg because they are over compensating. Ive found just stationary cycling can get the job done(nice co-contraction), also great for bringing up the quads - tie that with some deadlifts/ham curls in later stages and youll be sweet.

Also - Im not sure what the deal is where you’re from but PT’s and Physiotherapists are completely difference here. Physio > PT for your initial rehab.

9

Yes it is definitely not ideal only seeing my PT once per week. With my last surgery, I went 2-3 times per week for a little over three months and then cut let me loose. I’m lucky to have access to the university gym which has the equipment I need. The athletic trainers are good to go to when issues come up, when I need ice or a place to do some of my daily rehab.

I’m approaching seven weeks from surgery now and the knee and hamstring are feeling more and more normal. I still have some pain when squatting (in the knee), but that’s gotten better week-to-week. Walking is no problem, and going up/down stairs is barely an issue either. I can’t wait to start running and actually start squatting and deadlifting, but I know that’s still a ways away.

10

It occurred to me that when I say PT, some people may take that as Personal Trainer. I mean PHYSICAL THERAPIST when I say that, so sorry for confusion. I would definitely not see a personal trainer for rehab from knee surgery (no offense to any trainers). I think physical therapist is the same as a physio.

11

Just wanted to give an update and hopefully get some input on an issue I’m having.

I’ll be nine weeks out of surgery tomorrow (Oct. 11). My strength is coming along great and range of motion is ahead of schedule (-6 to -8 degrees extension, 142 degrees flexion). However, over the past three weeks I’ve developed really sharp pain during full extension. It happens when I push off of my surgery leg when walking, when I lay my leg on a flat surface (in extension) and when I flex my quad with my leg extended. The pain is located in the back of my knee and under the front of my kneecap.

Now I should mention that I had my medial meniscus REPAIRED along with my ACL. My doctor did not seem concerned when I saw him last week and said that the “discomfort” is easily explained by the method they used to repair my meniscus (they used three anchors to suture it back up). He said he expects it to last another month, but not persist. My PT also thinks that swelling, scar tissue, excess joint fluid and general tightness in my calf are all contributing as well. It gets much looser after she massages the area or after I ice it.

Anyway, I don’t know many people who have had a meniscus repaired so I have nobody to ask. Anybody have experience with this?

12

Hey triple C, I have the same pain in my knee after the surgery except mine extends further on my medial side (probably due to the work on my meniscus). I asked and got the same response. In general i think the bone bruising just takes a while to subside. After my first injury I had a similair problem but about 10 weeks later it started improving. So now I am just patiently waiting for the range to return again! -6 degrees is excellent, on a good day i can get -2 maybe after warmup most of the time i can’t even get 0. How is your hamstring strength doing? I tore mine twice after surgery but i think it’s finally starting to mend. Do you also find that it is hard to activate the muscles on your medial side? I think that the poor activation of my VM is due to the inflammatory inhibition in my semiT (graft site) causing the poor extension.

13

Just a quick OT: How long did you have to wait for the surgery, did you have to pay for it? I am just interested in how you have things sorted out in the States, because here in Europe it sucks. I have been waiting for my ACL surgery over a year and will be waiting for a few more months probably.

14

rehan -

My hamstring strength is getting there. All I’ve done so far is hamstring curls with a band, but I’m supposed to start on the hamstring curl machine this week. I at least feel like I can contract the entire hamstring, which is a far cry from where I was at around week 3-4. As far as strength and endurance, that’s coming along but it still gets tired during exercise. Sorry to hear you tore yours again.

As far as my extension problem goes, I feel like the pain under my kneecap is on the lateral side. Not sure why that is since I had my MM repaired. Nobody seems very concerned with it though, and there are some things I can do to help it which makes me feel better.

Once it’s “stretched out” or warmed up, it doesn’t hurt at all to go to -6 or -8 unless I flex my quad. That’s where the swelling is inhibiting quad activation.

I haven’t had any problem activating any muscles on the medial side or at all other than at full extension. My PT routine consists of stationary bike, one-leg press, 4-way hip with a band, single-leg squats to ~50 degrees, hamstring curls w/ a band, calf raises, wall sits and glute bridges, and I’m able to do all of that mostly pain free. No weight bearing past 90 degrees though b/c of the risk of re-tearing the meniscus repair.

Tinesterone -
I tore my ACL back in April but did not have surgery until August 10. I could have had it sooner, but had to put it off for family reasons. I have health insurance through my employer, so they pay for the majority of the surgery, PT sessions and all of the medicine and equipment you take home with you after the surgery.

The only downside is that they pay for 20 PT visits per year which in my opinion is not enough. I’m only able to go once per week so I can try and stretch it out to January when a new 20 visits will kick in. I’m left to do everything on my own for the rest of the week, though I’m lucky to have access to facilities where I can do what I need. I am sorry you’ve been waiting so long for your surgery. What is the holdup?

15

Just my two cents. If you tore both ACL’s without contact and just “fell wrong” I would really focus on proper glute activation. The G-max eccentrically controls valgus stress on the knee.

16

I tore my first one while landing on one leg from a jump (straight-legged, stupid) playing flag football, leading to a hyperextension. The second was also non-contact, but all I did was step wrong while chasing after the basketball.

I think a few things led to the second tear - I had a very intense leg day the day before, the hardest leg workout I’d had in probably a year. My quads and hamstrings were very sore that day, and I also didn’t stretch before playing. In hindsight (and I regret this every day), I should have absolutely stretched and probably shouldn’t have been on a basketball court to begin with when my legs were feeling like.

I also think I may have had a slight quad-dominant imbalance. I had been using an upper-lower routine for the previous four months that used front squats and Bulgarian split squats as the primary exercises on leg day. I also did RDLs and GHRs on the same day, but I went very very heavy on the front squats and made huge gains in that lift. My RDLs did not improve nearly as much, so you’re probably right about the glute activation being something I should focus on.

Also, for what it’s worth, my current issue with tightness/pain in the back of my knee has subsided for the most part. My PT put me on a stretching routine that involved negative extension while flexing my quad. Seems to have helped.

17

So just a quick update…

I saw my doc today for my 12-week follow-up, and the graft is solid. He said everything is coming along great. That is until I asked him about my meniscus repair, and he replied with, “Well I remember that your tear, I wasn’t sure if it was one that was going to be able to be repaired. But I thought there was a chance, so I went ahead and tried.”

So basically this meniscus repair may or may not take. If it doesn’t, I’ll have to go back in at some point to have a piece of it removed. He told me about a month ago in my last appointment that it was a “pretty lengthy tear,” so that has been a major downer today. Still, I’m glad he has felt good enough to even try to repair it. I’d rather not lose a piece of cartilage if I don’t have to.

In a related issue, I’ve had some recurring pain and tightness in the back of my knee and under my kneecap for about six weeks. It tightens up if I sit at my desk too long and gets better when I stretch my calf and do some static quad sets (basically just forced extension). I asked him about that and whether it was a sign of the meniscus repair failing, and he said it could be but the pain is most likely caused by tightness in my posterior capsule. I have no idea what that means.

18

i hope on your behalf that it all goes well man!

19

just been wondering how the rehab is proceeding. I am dying to get training again. 6 of december is when i should be cleared to start pushing the envelope so to speak, so i am just trying to keep busy till then

20

I ran for the first time today (it will be 13 weeks tomorrow). I was cleared to run last week, but had not been able to until today. I ran for .25-mile intervals three times. My knee got a little sore as I got to the third session, but nothing that was unbearable. Felt great, all things considered. Everything feels very stable.

I was also given the go-ahead from both my doctor and physical therapist to squat with (LIGHT) weight, so I’ve been using the bar for 3x10. I actually did 65 lbs. today and will probably be pretty sore. That’s only 225 pound lighter than what I was doing before the injury, haha.

Other than that, things generally feel pretty good. I have some occasional tightness in what I’m told is my posterior capsule. That usually sets in later in the day, I guess from sitting down at my desk for extended periods. Seems like the less I sit down, the better it is, or if I take two days off from rehab it doesn’t become an issue.

Last week, I was worried that my meniscus repair didn’t take, but after seeing my PT, she put me at ease. As I stated in a previous post, my doc told me that during surgery, he wasn’t sure if my meniscus would heal but decided to repair it anyway. I then noticed that I had some strange clicking when I went from +5 degrees extension into full extension and was SURE that was a sign of the tear. Apparently, that can be any number of things though from a tight IT band, scar tissue deep inside the knee or just a knot from the meniscus suture that’s rubbing. I have no pain that you’d generally associate with a torn meniscus, so I feel fairly confident that everything is good for now.

rehan - hope your rehab is going well. Looking back, it seems like I had major improvements at four-week intervals. From week 4 to week 8, I became much more comfortable walking and pushing weight, and from week 8 to week 12 I felt like my strength came back in a big way. Already now, from last week to this week (12), my knee feels almost normal for a good bit of the day.

Not sure if that makes sense to you. It’s like I’d be trudging along feeling like my gains were very slow and then BAM, I had a breakthrough. Walking went from cumbersome to normal. Pressing on a leg press went from weak to strong, and painful to smooth. Now I’m running, which I couldn’t picture myself doing normally two weeks ago (I even tried for about 10 yards, it was pitiful).