ACL surgery - How did you get back in the game?

[bhamtsd]

I am scheduled for ACL reconstruction in late July. Has anybody in here had this surgery? If so, how did you work your way back into fighting shape?

When did you start back working your punches and basic footwork?

I imagine that kicking is going to be out of the question for the first few months. What did you do to get your knee ready for the action of kicking?

[Yrkoon9]

A few questions:

Are you getting a cadaver ligament or a patellar? That will make a world of difference.

I have related my ACL reconstruction many times. It goes down as one of the worst periods of pain and suffering of my life. The short answer is that I had shitty physical therapy and that set me back. Those people with good phys ther recover quicker.

I was back in the gym doing basic stuff about 4 months later. I did not do weights because it was just too painfull. Maybe around 5-6 months I was doing some 50% kicking, pivoting, and twisting on the knee. I didn't start running again until after 6 months. Even then it felt like they cranked the screws in my leg a 1/4 turn after every workout. I don't remember exactly how many months went by, but I was competing again within a year. Probably around 9 months.

Rest assured this will be painfull. Physically, emotionally, and spiritually. You will wonder if you will ever be able to work out again.

If you are looking for solid answers about when you will be performing at 100% again - there are none. Each recovery is unique and individuals handle the transition back differently. Don't push it and go get yourself another ACL surgery because you came back too soon. That would be dumb.

[bhamtsd]

I've got a meeting with the surgeon July 3rd and I am going to ask about the ligament source.

My physical therapy is going to be done at this place that is connected to my gym (both owned by the same guy). I talked to the head therapists and met some people 3 months into their recovery. They all suggested to go cadaver if possible since it reduces recovery time.

One thing in my favor is that I live in Birmingham Alabama and we have the finest knee cutters in the world.

I wanted some MA perspective on rehab/recovery since most of the people they work with are football/baseball/soccer types.

How long ago was your surgery and do you still have any tightness/lingering pain?

[Yrkoon9]

Let me tell you a few more things about my ACL surgery.

First of all there is a risk of the cadaver ligament NOT being accepted by the body. In that case you get to go back in for another surgery. Fun fun.

A patellar graft is SOOOOOOO much more painfull. In case you don't know what they do I will describe it:

They cut 1/3 of the tissue that extends from your quadracep, stretches over your knee and attaches to your shin bone. They saw the bone chunks that attach that tissue out as well. Some of the bone from the femur, and some from the shin. Then they lace that new tissue through your knee and attach the bone ends down with stainless steel screws.

I can tell you that the pain from the bone chunks being removed and 1/3 of my patellar ligament constituted the majority of the pain for the first few weeks. Then I began to dwell on the pain of those screws being in my bones. You aren't going to get around the pain because those screws are going to remind you what happened for a long, long, long time.

After the surgery they put you on a machine that you take home. It moves your knee back and forth. Basically to keep blood flowing and keep the range of movement somewhat. This pain will be excrutiating as well. I did not have pain medication for the first 24 hours. I can only compare the pain with someone drilling into my leg every time that fucking machine made a bend. You will hate this machine.

Okay so now you are going to be in full leg brace. You will have to work your range of movement every day for many months. You will NOT be able to fully extend or fully pull back your leg for many, many months. Now because I had a patellar ligament the inability stemmed mostly from the sheer pain. With a cadaver you may have more range of movement earlier - in fact you probably will. But forget about sitting on your knees for a while.

So I got really shitty phys therapy from some guy just up from Argentina. I was running up and down stairs within a month. Possibly the most dangerous and counter productive thing I could have done. If I had fallen and stumbled and torn that ACL I might have actually had to kill that sombitch. Anyway you do closed chain excersizes for a couple months and work on range of motion. Isometric exercizes are good too.

Now it is 10 years later. My knee still creaks and pops and I can still feel those screws occassionally. But I still train and compete. It is structurally 100%. In my case I did not just tear my ACL. I did my MCL and much of my meniscus as well. They had to remove a lot of that. So that is where the creaking comes from. And some of the pain and arthritis.

10 years later my leg is still slightly smaller than my other. Other people probably don't notice. But I do. And I notice I favor my other a little bit especially when jumping or starting off on a sprint. Some of it is mental, and some physical. Yes there is a big ass scar on my knee. Yes it has a little more play in it than my other knee. Otherwise it is fine. I am very happy I made the decision to have it done. But I will not lie and say there were times during recovery I thought I would die, wanted to die, and would never train again. Hopefully with the cadaver option you won't experience much of this.

[Nubian Robodin]

As Yrkoon has said post-op is pretty fucking awful. Physical therapy is the worst part though. It's painful, tiring, and its dreadfully boring.

Due to the nature of my injury my knee will never be the same but it has nothing to do with my acl so I dont think you'll have to worry about that.

[Grashnak]

Well, my actual surgeries are all quite old and I'm told that both the surgery and post-op treatment has vastly improved, but for the record, I'll give you my story.

I fucked up my knee while I was in the service (Canadian Armed Forces - College Militaire Royale de St Jean if it matters). During a physical training session we were playing football and I ended up on the wrong end of a big pileup and completely severed my ACL and did extensive damage to the meniscus.

My first surgery was in Sept 1984, several months after the injury (yay military medicine) and was a version of the patellar operation described by Yrkoon. Unfortunately, it wasn't done very well (my later surgeons could never understand exactly what the first guy was trying to do) and the repair failed fairly quickly. Exit the military - 10% disability.

I had a basic arthroscopic intervention to clean up the dangling ends etc - second of three operations.

Anyway, back then they put you in a cast for months - by the time it came off, I had a stick leg - all the muscles had atrophied. Yech. Even today, 22 years later, you can see a difference in the muscle definition.

Physio was very painful, not helped by the months of inactivity.

In 1987 I had a more advanced surgery using a (at that time) very advanced experimental surgery using carbon fibre replacement for the ACL. Much better recovery because I was in a mobile brace and was working the knee from day one (I actually woke up from surgery attached to a machine that moved my knee automatically).

Seemed to work well, and although I had a fair amount of instability due to the general knee damage, the repair was sturdy and lasted until 2001 when I fell off some icy steps and ruptured the repair again.

I'm told that today, ACL reconstructions result in almost 100% recovery. Mine was never that good - at best I was only 75% and even then I was very careful with pivoting/twisting. Unfortunately for me, my current orthopedic surgeon is reluctant to do any more repairs because, according to him, everytime they do a major knee intervention it causes signifcant damage to the joint in general and speeds the arrival of arthritis - which I'm already starting to feel at age 40. Soooo, he won't open it up again unless it really becomes a life altering problem. So I live without an ACL and am VERY tentative when I train.

Anyway, your results almost have to be better than mine. Good luck!

[bhamtsd]

I had a meeting with the surgeon today. He convinced me that patellar tendon is the way to go. The group just returned from an ortho symposium where they received data that cadaver grafts have a much higher failure rate than patellar. Also cadaver grafts take longer to integrate into the body (if at all). So I've decided to go the more painful route (patellar) since it may be cheaper in the long run.

[Yrkoon9]

Life is going to suck for you. For a long while.

[Tom Kagan]

I know it's probably a little late in the game for you to consider, but seriously think about NOT GETTING THE OPERATION at all.

Many people - even some real athletes - survive and thrive with a severed ACL. If you were 10 years younger, there would be no question: get the operation. But since you are 35, you are at an age where not opting for reconstruction is viable. There are very good custom braces (read: expensive) for protecting an ACL-less knee in impact sports. The brace, along with diligent specific exercises, can possibly be enough. Frankly, most "normal" people would not even know they are missing the ACL in most situations.

While Yrkoon9's cautionary tale should definitely give you heed, I have to say my own personal experience was nowhere near as bad. I had the same B2B patellar ACL as he (along with a partial meniscectomy). I had full passive range of motion inside of four weeks, albeit painfully.

It is possible that our experiences differ because of what I suspect are two possible factors: 1) I had a continuous circulating cold therapy device wrapped on my knee almost every moment I was immobile, and 2) My doctor was aggressive in prescribing anti-inflammatories and pain medications. These two factors are somewhat new in post-op care for ACL reconstruction, and recent studies show dramatic improvements in outcomes.

Also, a major factor in your post-op routine will be whether your meniscus is repaired or partially removed. Ironically, a repaired meniscus will greatly increase the post-op hassle because you will not be able to bear weight on you leg at all for a couple of weeks until the repaired portion heals.


Some things they don't tell you but you may or may not experience, in no particular order:

- During and after the surgery, I bled internally down my calf making for one very large and very annoying bruise. Two years later, it still feels like I have permanently pulled my calf muscle, even though it's not. I catch myself limping from time to time because of it even though there is nothing wrong. It's just a phantom pain.

- Every eight or ten weeks or so, god reminds me how stupid I was in the injury by stabbing me with an invisible icepick directly under my kneecap. The searing and excruciating pain lasts maybe two seconds, then is gone.

- I have a numb spot on my skin directly below my kneecap where the graft was taken from about the size of half dollar.

- For about six months after the surgery, every so often, another small piece of scar tissue from the graft area worked its way up to the skin surface and broke out in a bleeding mess.

- it took a year before kneeling was comfortable. Some people who have the B2B patellar graft will never be comfortable kneeling ever again.

- My knee joint is still slightly tender at full extension after two years if I ignore stretching it in hyper-extension (not pleasant). I have to remember to do the stretching at least once a week. Also, if I don' stretch it, it feels "tighter" in that I cannot hyper-extend it quite as far as my other knee.

- You will not be able to put on a sock or shoe, or tie your shoe on the same side foot for a short while afterward. Make sure you have someone to help. (And, make sure they don't wiggle your foot/shin from side to side trying to put the shoe on unless they like hearing you scream.)

- Learning how to use crutches properly going up/down stairs before the operation is a good idea.

- Pray to any and all the gods your kids do not get it into their heads it's time to wrestle.

- Pay attention to where you put your crutches down. Getting up is a lot harder than sitting. If you can't reach your crutches (or someone who shall remain nameless decides there is a better place for them), you could be stuck in one spot for a while until help arrives.

- For anyone remotely athletic, good physical therapy is as much about stopping you from re-injuring yourself as it is strengthening. It may seem ridiculous when they put 10 lbs on a leg extension machine and ask you to do 3 sets of ten reps on the first post-op session. However, remember your patellar tendon has been significantly weakened by being the donor tissue for the graft. The last thing you want to do is to rupture this tendon because you got impatient and wanted to put up some bigger numbers.

- Eight months after the surgery, my knee swelled up very badly. The doctor said he gets many panicked calls around this time due to scar tissue break-up. He was right; my knee was fine otherwise after a week or so.

- Life has a very sneaky habit of encroaching into your downtime when you would otherwise have been training. It can be very hard to beat the real world back into submission after you are cleared to go harder. Don't underestimate the psychological impact of losing this repetition of training to be replaced by other forms of repetition. Plan for it so you can mitigate its effect.

- The popcorn effect of crepitus can be very distracting.



Good luck. Let us know how it goes.

[bob]

I'm amazed that people are still doing the patella tendon graft. In Australia it's gone well out of fashion. Almost all of them are done with hamstring grafts now(pulled through from the back.)
I've been a physio/physical therapist for over ten years and the results seem to be much better. Many of the younger surgeons don't even have their patients in a brace afterwards. No crutches, except for maybe a day or two. Still painful, but infinitely less so. The actual time to get back into contact sport doesn't really change - there's a fixed period to make the graft strong, but it's a lot less of a hassle.
The main thing is to progress your rehab. Most people don't do enough high level stuff in the latter stages - particularly dynamic work, power training and proprioception. I get my patients doing stacks of single leg dynamic drills, trying to make it as sport specific as possible. Too many people just do a generic rehab program - weights, bike, running.
Good luck.

[Tom Kagan]

Just a further note:


I spent two hours yesterday in a dimly lit, 130 degrees (F) tempurature, attic crawl space - all the while kneeling, crawling, hunching, squating, and duck walking.

Aside from losing 9% of my bodyweight (interesting what sweat will do when you are working on live knob and tube wiring) and nearly falling through the ceiling to the floor below, I gave nary a thought to my knee aside from the distracting snap crackle and pop of crepitus.

My knee was a little sore this morning - mostly along the patellar tendon incision. It was probably just more scar tissue breaking up because it's fine this afternoon already.

After this, I'm officially upgrading my surgery outcome rating from a B+ to an A-. If the damn crepitus just would shut up, I'd give it an even better rating.

[RunningDog]

I had a full reconstruction of my ACL, and some meniscal cartilage removed, nearly 2 weeks ago.


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Hopefully YrKoon's months of pain and suffering are a worst-case scenario, the worst symptom I've had so far is cabin fever from being stuck at home.

I found an hour-long Youtube vid of an identical operation here:

http://www.youtube.com/watch?v=_DkdOQSHYkY

Might be of interest to anyone getting surgery soon.

In my case the surgeon used tendon tissue from my hamstring tendon, and threaded and screwed it in in the usual way. Apparently all went well, no infections.

The physios gave me a hefty brace with a hinge to stop the leg from bending more than 90 degrees, or from twisting. I'm not wearing it as much as I should (they recommended I SLEEP with the bloody thing but fuck that, quite frankly). The wierdest thing is that there's a shitload of bruising and swelling around my ankle. WTF? they didn't even touch my ankle, as far as I know. But I phoned up the clinic and they said that was normal.

I will update this thread if my leg needs amputating at any point, or indeed as I see fit.

And to anyone who thinks state-run healthcare is shit, this was the view from my room:


And this was my lunch:


That's right. It came with doilies and a flower.

[Tom Kagan]

The physios gave me a hefty brace with a hinge to stop the leg from bending more than 90 degrees, or from twisting. I'm not wearing it as much as I should (they recommended I SLEEP with the bloody thing but fuck that, quite frankly).

Before it heals in place within 8 weeks or so, one eighth of an inch is how far the graft has to pull out of its screw tack before the graft will fail.

One eight of an inch! (3 millmetres) - That's all.

Wear the brace you moron!

[RunningDog]

Alright Dad. It's back on.

[Student]

I tore my acl/mcl & meniscus just about 7 months ago and had surgery about 5 months ago (cadaver graft and meniscus trim).

At just about 5 months I have already been given the OK from my doctor to start all light training again (including BJJ - I just have to be smart). Currently my knee feels great - my strength in the injured leg is closing in at close to 80% of my non-injured leg (once I reached 70% I was given the go ahead to start pivoting movements again). I don't plan on doing any aggresive training until I am closer to the 12 month mark (or maybe even beyond - I don't feel like going through this again!)

I won't kid you and say it has been easy but it's nothing like what I read in some of the posts above (Sounds like those were from years ago and I know things have come along way - both in the surgery and the PT - for example the largest scar I have is about 1/4 inch long) - for me it's been a ton of rehab and I expect to continue rehab exercises for a long time (some exercises I assume for life).

Good luck to anyone going through this - it's not fun, and it takes a while, but the end results should be worth it.

PS - Here is a great forum if you want to learn alot more about this or just read diaries of peoples recoveries -> http://www.kneeguru.co.uk/KNEEtalk/index.php