Expectations Afer ACL Reconstruction

Bigger Stronger Leaner Injuries and Rehab
1

Hi guys,

Long time lurker here; lots of fantastic stuff and I like that most threads appear to remain on track.

I am hoping that anyone who has been through this before, knows someone who has been through this, or otherwise has relevant knowledge can possibly shed some light on my situation.

I tore my ACL almost exactly 5 years ago. I will be having surgery at the end of February. I have not decided on a graft yet, but will likely go with the hamstring graft at the suggestion of my surgeon. My meniscus appears to be torn in the MRI image (taken roughly 4 years ago), but manual tests recently (not sure of the name) indicated that my meniscus may have healed. So, as of now, I am not expecting any meniscus repairs or removal.

My initial tear was misdiagnosed as a strain and it was recommended to me to do physio and rehab my injury through conservative treatment; this is why it has taken until now for me to get surgery. I did a bit of physio and then a decent amount of strength training over the years between the tear and now. I have a bit of instability in the knee while playing sports, but lifting is fine. I want to get the knee fixed because I’m only 26 and would like to get back into playing recreational sports.

Currently, I’m maxing out around 315 squat, 435 DL. Not sure of the measurements, but my legs are muscular and strong.

MY ISSUE IS: a lot of what I read online about ACL recovery is for people who are going through the initial trauma of learning to live without an ACL again - people who tear their ACL and undergo surgery relatively quickly after it. For me, though, this is something I’ve already gone through. I believe my proprioception is as good as it can get without an ACL. I’m wondering if I’ll be able to recover ahead of normal timetables due to my strength and “prehab”, and also curious if anyone has been through a similar situation, where they didn’t undergo surgery for quite a while after their tear?

And of course, how long before I can lift again? What will be the limiting factor?

Any input is appreciated. Thank you!

2

Hi there,

11 weeks post ACL op here (but I booked in 9 days after tearing it - private health insurance finally paid off!).

I was in the best shape of my life when I tore my ACL. The atrophy was astounding post op - within 24hours you will lose start losing muscle. Off crutches within 4 days. etc…

It takes 6 weeks for the grafts at each end of the replaced ‘hamstring to ACL’ ligament to bond to the bone. You can’t really push things during this period. Lots of rehab at home… stretching the ligament a little more each day to get it moving. Lots of ice and rest.

And now I’m back to doing light leg curl and extension work since week 8 ish. light DB squats etc…

Not sure if even with a great base on strength, you will be able to rush things. The body takes time to heal.

In saying that I am just working upper body a lot more. But I miss DL’s and Squats.

Rehab blows but its worth it. Lots of ice and rest between. Swelling starting to subside here over the past month, some definition returning to the quad.

Rate of improvement slows over time, so for me now it seems like a snails pace. I can kneel but can’t quite let my femur come back onto my shin on my operated side just yet.

There are a number of other good threads on TN on ACL tears.

I went the hamstring version which I believe is the most suitable for most people.

I guess it generally takes Aussie Rules footballers a solid 12 months till they are back playing professional level sport again. They have the best docs, physios, supplements, etc available to them here in Oz, and it STILL takes 12 months.

Weights (DL’s and Squats) being a close chain exercise may be able to back up to your previous peaks slightly quicker, as long as the knee is strong and stable (knee travelling over big toe and not caving in). Caving in would be the worst result as I understand. Would not want to reinjure it after going thru the operation and xx months of rehab.

Good luck! Any other Q’s post here, will answer what I can.

Oh did I mention the rehab? So much rehab…

3

Minimum 6-8 weeks for tissue healing, up to 16 weeks to reach baseline (appropriate for life) strength, and however many months it takes to get back to the level you want.

You definitely have good proprio based on how long its been torn, which is great. Do you need the surgery? Does it stop you from playing your sport? That aside, you should have a quicker recovery based on the strength and condition youre in.

4

[quote]raven78 wrote:
Hi there,

11 weeks post ACL op here (but I booked in 9 days after tearing it - private health insurance finally paid off!).

I was in the best shape of my life when I tore my ACL. The atrophy was astounding post op - within 24hours you will lose start losing muscle. Off crutches within 4 days. etc…

It takes 6 weeks for the grafts at each end of the replaced ‘hamstring to ACL’ ligament to bond to the bone. You can’t really push things during this period. Lots of rehab at home… stretching the ligament a little more each day to get it moving. Lots of ice and rest.

And now I’m back to doing light leg curl and extension work since week 8 ish. light DB squats etc…

Not sure if even with a great base on strength, you will be able to rush things. The body takes time to heal.

In saying that I am just working upper body a lot more. But I miss DL’s and Squats.

Rehab blows but its worth it. Lots of ice and rest between. Swelling starting to subside here over the past month, some definition returning to the quad.

Rate of improvement slows over time, so for me now it seems like a snails pace. I can kneel but can’t quite let my femur come back onto my shin on my operated side just yet.

There are a number of other good threads on TN on ACL tears.

I went the hamstring version which I believe is the most suitable for most people.

I guess it generally takes Aussie Rules footballers a solid 12 months till they are back playing professional level sport again. They have the best docs, physios, supplements, etc available to them here in Oz, and it STILL takes 12 months.

Weights (DL’s and Squats) being a close chain exercise may be able to back up to your previous peaks slightly quicker, as long as the knee is strong and stable (knee travelling over big toe and not caving in). Caving in would be the worst result as I understand. Would not want to reinjure it after going thru the operation and xx months of rehab.

Good luck! Any other Q’s post here, will answer what I can.

Oh did I mention the rehab? So much rehab…[/quote]

Thanks for the response. Hope it works out well for you - sounds like you’re on the right track!

What were your lifts like before the injury?

5

[quote]dzmendon wrote:
Minimum 6-8 weeks for tissue healing, up to 16 weeks to reach baseline (appropriate for life) strength, and however many months it takes to get back to the level you want.

You definitely have good proprio based on how long its been torn, which is great. Do you need the surgery? Does it stop you from playing your sport? That aside, you should have a quicker recovery based on the strength and condition youre in.[/quote]

Thanks for weighing in.

Not sure I “need” the surgery. I do not have a sport that I call my own. I play recreational softball and golf, but would be playing ice hockey as well if I wasn’t injured. Also want to get in to rec football or frisbee. Basically, I’m 26 now and figure that I want to get involved in a number of rec sports now with the hope of playing them for the rest of my active life. I really just enjoy playing casual sports with friends.

The instability is increasing for sure, albeit only slightly. Sometimes I will tweak something and my knee will swell and be painful for 1-2 weeks following the event. During this time, I am usually unable to trian legs and I am really just getting tired of the setbacks. Also, in the winter, I have to be very careful when walking across ice.

Basically, as I get older, I want to: (1) begin competing in powerlifting as best I can, and (2) be involved in several sports at a recreational level. My rationale for having the surgery is that I will hopefully be rid of setbacks in my training and will once again be able to play sports with more running / pivoting. I figure that I’m young now, too, so my chances of making a full recovery are still high. Lastly, I’m worried that without an ACL I am constantly exposed to a greater risk of a meniscus/MCL tear.

6

[quote]sadACL69 wrote:

[quote]dzmendon wrote:
Minimum 6-8 weeks for tissue healing, up to 16 weeks to reach baseline (appropriate for life) strength, and however many months it takes to get back to the level you want.

You definitely have good proprio based on how long its been torn, which is great. Do you need the surgery? Does it stop you from playing your sport? That aside, you should have a quicker recovery based on the strength and condition youre in.[/quote]

Thanks for weighing in.

Not sure I “need” the surgery. I do not have a sport that I call my own. I play recreational softball and golf, but would be playing ice hockey as well if I wasn’t injured. Also want to get in to rec football or frisbee. Basically, I’m 26 now and figure that I want to get involved in a number of rec sports now with the hope of playing them for the rest of my active life. I really just enjoy playing casual sports with friends.

The instability is increasing for sure, albeit only slightly. Sometimes I will tweak something and my knee will swell and be painful for 1-2 weeks following the event. During this time, I am usually unable to trian legs and I am really just getting tired of the setbacks. Also, in the winter, I have to be very careful when walking across ice.

Basically, as I get older, I want to: (1) begin competing in powerlifting as best I can, and (2) be involved in several sports at a recreational level. My rationale for having the surgery is that I will hopefully be rid of setbacks in my training and will once again be able to play sports with more running / pivoting. I figure that I’m young now, too, so my chances of making a full recovery are still high. Lastly, I’m worried that without an ACL I am constantly exposed to a greater risk of a meniscus/MCL tear.
[/quote]

Fair enough, best of luck I am sure it will turn out well. Hamstring graft is your best option, I believe. Interesting question you pose, Im unaware of research on ACL deficiencies leading to increased mensicus and MCL risks… neat.

7

RE: further susceptibility to further knee injuries with torn ACL. Not sure of the credibility/reliability of these sources, but…

CONCLUSIONS:

Medial meniscal tears, especially bucket handle tears, increased steadily in frequency more than 1 year after ACL injury. Timely ACL reconstruction may be warranted to reduce the risk of further medial meniscal damage even in patients whose original injury occurred more than 1 year before.

http://www.hss.edu/conditions_knee-arthroscopy-acl-meniscal-other-problems.asp#.VOOLK8YmRJg

Injuries to both the ACL and the menisci are common, particularly in athletes. (Torn menisci are also seen in older patients as the result of a degenerative process.) Moreover, surgeons often see them in conjunction with one another. This may be the result of injuries suffered at the same time, or in sequence; that is, a person with a torn ACL is at greater risk of injuring the menisci. Statistics show that more than 60% of patients diagnosed with an ACL tear also have a torn meniscus. A gender specific difference in ACL injuries among young female athletes has been demonstrated in recent years. Females are 2 to 6 times more likely to tear their ACL than their male cohorts, depending upon the sport (2).

The statistical analysis demonstrated that the earliest point of significantly higher incidence of meniscal tears was in patients undergoing ACLR more than 3 months post injury. Therefore, ACLR should be carried out within the first 3 months post injury in order to minimise the risk of secondary meniscal tears.

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[quote]sadACL69 wrote:
Thanks for the response. Hope it works out well for you - sounds like you’re on the right track!

What were your lifts like before the injury?
[/quote]

No worries.
3 Months post op now for me.
Surgeon happy with ligament movement (same as other knee).
125 deg bend in operated compared to 130 on other knee. getting there…

Started leg specific weight programme with a PT this week. Plus my own upper body lifts in there too. It’s all light weights though. 15 - 20kg on the leg extensions with holds at the top, etc. 10 reps etc…

My lifts prior - only been hitting the weights solid for 2 yrs after a long layoff since uni days. And I never deadlifted prior to finding TN.

Rough numbers (without checking my log) were:
DL 120kg ish
Sq 70kg ish
ohp 50 ish
bench 85 ish

(BW 68)

But DL and Sq were certainly continuing to improve. Plateaued out on bench and ohp though a while back.

9

3.5 Months on here post op.

Under careful watch from a PT, Leg press increased to 60kg (my BW 68kg) so getting up there again somewhat.
Walking weighted lunges.
Single leg squat work.

It will take time, but consistent effort on the rehab works wonders.

Any news from your end sadACL69 ?

10

Hey man, glad things are going well for you. Leg extensions though, eh? I’ve read in other places that they place a lot of force on the ACL. I know that once I tore mine, I could no longer do them without a lot of pain.

One week post-op today. Almost walking without a limp now. Standing knee flexion back to normal on operated leg. Sitting flexion (pulling foot toward myself on ground) is still a few degrees off non-operated leg. Quad seems to be firing pretty well, but swelling is holding it back a bit. Full passive extension on OP leg, short of active extension by probably 3-4 degrees. Can do a bodyweight squat to 90 degrees but not trying beyond that until I see my surgeon and PT next week.

All in all, pretty happy with my progress. Once the rest of the swelling goes it seems like I should be able to progress a bit more.

Keep me posted!

11

I’ve only been doing gym work after having it cleared by Physio - so yeah extensions are ok now (after the graft heals).

BW Squats, I was not doing those until month 2-3 I think, and not down to parallel either (on Physio’s advice).

Keep on with the rehab!

12
13

[quote]raven78 wrote:
I’ve only been doing gym work after having it cleared by Physio - so yeah extensions are ok now (after the graft heals).

BW Squats, I was not doing those until month 2-3 I think, and not down to parallel either (on Physio’s advice).

Keep on with the rehab![/quote]

Hey man, hope things are still progressing well for you! Keep on going!

14

Quick update on my ACL fwiw:

5months post op.

Started box jumps up (not down)
Some side to side jumps
Increasing stability in the knee

Light Deadlifts ok
Light to medium Squats ok
Front squats pushing my previous PR’s already
Bench and OHP little change - but main focus has been on leg days 3 times a week.
Plenty of leg extensions, leg curls.
Iso holds for the above to increase TUT.
Single leg work 50% of rehab on the legs too.

It’s hard work but worth it.