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Going for ACL Reconstruction. Tips?


#1

It looks like this is the route I will be taking in all likelihood. Has anyone here ever gone through this ? I am looking for tips on training and rehab


#2

When did you tear it? Any other structural damages? What type of graft?

There is another post in the Injury forum regarding ACL rehab that was really good, so check that out. Short version - listen to your docs and therapists. If you are looking to get back into athletic type activity, try to find a therapist that has a background working with athletes. Make sure you get to full extension of your knee and don't slack on concentrating on ROM at the start. Don't rush through what you might consider the "small things" in rehab. Prepare for the long haul.


#3

I tore it about 2 weeks ago playing rugby. I'm due for a further inspection on tuesday


#4

rehanb_bl,
Just had my right acl reconstructed using a cadaver allograft including meniscus repair on Tuesday June 15. Sustained the injury in early April during a takedown drill in brazilian jiu-jitsu. I interviewed three doctors and researched replacement ligament type and pre-habbing leading into the procedure. Going through week 1 post-surgery now. Fire away with any questions and happy to share what I've learned on my "journey" thus far.


#5

get access to a pool that is relatively empty. If you're gym doesn't have one, try local hotels as they will sometimes cut you a deal to use theirs. Walking progressing to drills and running in the pool will speed up your rehab quite a bit.


#6

Thanks for the advice. What did you do for pre-hab? I will find out today what course of action will be taken. My knee is very unstable but there was almost no swelling. It was said that there is a partial tear the only thing that wasn't sure was whether it was big enough to require surgery (which it looks to be in all likelihood). I am doing a lot of quad dominant exercises as of now.


#7

I prehabbed for about 6 weeks. For weight training, I focused on barbell deadlifts (stopping when my form became even slightly questionable) and a machine squat (I think it was called the icarius). Stay away from open-chained exercises where your feet are not either planted on the floor or pushing against a plate.

I also focused on balance on the operative knee in the weeks leading up...everything from brushing my teeth to shaving to just standing on it as long as I could, as often as possible. I was told by my PT that this would aid with gaining proprioception post-surgery.


#8

ok thanks i will try that! I also found out today that there might be damage to my meniscus which is preventing me from fully extending my knee. All in all not a fun time.


#9

Pedal backwards on a bike to get ROM back in your damaged leg, you'll have to use your good leg to force the ROM, it will hurt but it works.
Get hamstrings, VMO strong again. Learn to absorb force eventually. Focus on proper gait/muscle activation/recruitment. Give it time, and be diligent with your rehabilitation.


#10

I have had an ACL reconstruction on my left knee and fully returned to sports and weightlifting. I did it in college and can say that I am so much stronger now than I was then. I have no pain in that knee at all, but I do occassionally have some soreness the day after playing basketball for 1.5 hours or so. As far as weightlifting goes though, I have never had any negative effects with that knee.

I had a patellar graft on that knee and have no complaints. That was back in 2005 though, and supposedly there have been a lot of advances with the hamstring graft option.

I recently tore the ACL in my other knee, however, and am having surgery in early August. My doc prefers the hamstring graft, but I'm still undecided as to which direction I'll go with it. Everything went so well with the patellar graft on my left knee that I'm skeptical about doing things differently this time.

I can give you more information if you want, just PM me.


#11

thanks for all the advice. How was your mobility leading up to the surgery? I am really mobile, they said my leg strength going in had helped me a lot


#12

The first time around, I had to wait seven months before the surgery so I was walking around with the torn ACL for that period of time. I tried to play basketball and football (recreationally) a couple times and wrenched my knee after a few minutes both times. It was pretty bad pain and swelled up each time. Both times were from trying to stop and cut in another direction.

As far as just walking around though, I was almost normal and most times didn't even think about the injury. I was able to run up stairs with no problem. There were a few times where my knee buckled backwards (just walking) but it never really hurt, just a scary feeling of instability. But that was not often. I did not lift legs AT ALL prior to that injury, however, so take that for what it's worth.

This time around, I am currently 2+ months post-injury (again, I tore the ACL in my "good knee" in April) and will not have surgery until August 10. Prior to the injury, I was squatting 290 max and deadlifting 355 max which I feel is pretty strong considering I'm 6-4, 200 lbs. I still get in the weight room 4 times per week, splitting 2 upper body and 2 lower body days. I also have a torn meniscus from the injury, so traditional squatting REALLY aggravates my knee, especially the day after. I have stuck to deadlifts and dumbell split squats (Bulgarian split squats), along with one-leg leg press, hamstring curls and calf raises. That's really all I can do. I haven't tried any cutting actions and don't plan to based on my first injury back in 2004.

Not sure if this helps you, but that is my experience. I will say again though that my left knee (first tear) is fine after a patellar graft. Rehabbing from that injury is what got me hooked on lifting.


#13
  1. ask your doc about lars surgery
  2. im bias but patella tendon graft is ancient technique and most surgeons will do hamstring(semiten/gracilis tendon graft)
  3. train your hammy before you get surgery so your tendon is FUCKING MAMMOTH!
  4. suck up the first few weeks in bed and eat a LOT of fibre haha or youll be shitting bricks from the pain meds
  5. weeks 1-4 are pretty gay but after that its easy sailing, strength/proprioception/ROM then youll start running and agility etc etc and 6-9 months is usually the period people can get back to sport but optimally should wait 12 months for the graft to be at its strongest before return to sport.
  6. NO knee extensions.
  7. Dont overdo it after your surgery, ICE the shit out of your knee if its swollen and just enjoy getting massive upper body :slightly_smiling: i gained 10kg's during my post-op period.

edit i found cycling on stationary bike was the BEST thing to do, but thats just me. and dont forget to train your uninjured leg to get the neural strength crossover.


#14

that is the one thing that kind of gets me, my legs have always been my strong suite, due to my position i do not want to add too much upperbody mass since my lean body mass is already around 93 ish kg. I've been doing heavy squatting and deadlifitng (without any pain) I can't make it ass to grass but i make it a fair bit below parallel.

I always do a lot of single leg. I have also been looking at various reconstruction measures. There is a very cool new technique that is double bundle with single tunnel, anatomically very correct and not very invasive at all.


#15

I wouldn't call the patellar method "ancient," as it is still widely practiced and very effective. Statistically, both types of graft have the same retear rate. The differences between the two come down to how they treat your rehab the first 3-6 months and the potential long-term tendonitis that comes with the patellar graft.

With a patellar graft, they remove the central 1/3 of your patellar tendon AND pieces of bone at each end. The graft then fuses bone-to-bone, which is a stronger connection INITIALLY. The hamstring graft is fixated with a screw that holds the soft tissue to the bone. That takes longer to fuse to the bone, but again we are only talking about the first 3-6 months post-surgery.

Really, you can dig around the internet and find people/websites arguing one way or the other, but the person you want to ask is your doctor. If he's more comfortable using one graft over another, go with his advice.

I am partial to the patellar graft because that is the method used during my first surgery, and the results from that could not have been any better. Also, I'm just not too keen on having 17% of my hamstring removed because that tissue does not grow back. The other muscles that make up your hamstring will eventually compensate for that loss but asthetically I'd just rather have my hamstring intact.


#16

Also what I was trying to say about hamstring vs. patellar is that they are essentially the same after that initial 3-6 month phase. Long-term, patients who opt for the patellar graft have a higher tendency to develop patellar tendonitis.

The patellar graft is still considered the "gold standard." (You will see that everywhere. I contacted the surgeon who did my first surgery and he used the exact same phrase). HOWEVER, there have been a lot of advancements made with the hamstring graft. The double-bundle video you posted is a great example. The hamstring graft used to be considered a "weaker" option, but that has been debunked with new procedures.

The bottom line is that both options are sound. There are pros and cons with each. Go with what you and your doctor are comfortable with.


#17

100% agree with that. BUT also talk to your physio, if you think about it they're the one's doing most of the work to fix you up.

I havent looked at any stats and not sure what the retear rates are, so you coulda plucked that figure and id be none the wiser lol - however from my studies Id say hamstring graft is slightly better for a few reasons;

Stands to reason if you fuck around with your patella youre much more likely to get knee problems down the track,

No direct knee pain

Semitendinosus is apparently a muscle in evolutionary decline (tendon/muscle length ratio) which makes it good for grafting (& no massive loss of function without it).

The muscle that gets cut and reflected back is still functional once it joins to the bulk of the hamstring, and you can strengthen your hammys back up 100%. (which youre going to have to do anyway because of the atrophy from being in the leg brace)

If youre getting pain in your knee your ability to get to full extension might be compromised.

This is just my opinion but as you said do what you feel comfortable with and theres a plethora of evidence to go either way....Your results will be more dependent on how much diligence you place on your rehab

Also there isn't a gold standard anymore.


#18

TripleC223 is correct as in both grafts have roughly the same re-tear rate and it mostly comes down to what path you want your rehab to take.

I agree with some of what you said here krsoneeeee. But here is the other point of view that is against hamstring grafts.

The only significant increase for knee problem down the road with a patellar graft is patellar tendonitis. There are minor chances of patellar bone issues, but generally those are held with more elderly populations or those with a co-current bone density issue.

Hamstring grafts do get knee pain, but it just won't be anteriorly. There will be a decrease with hamstring function with a hamstring graft as well. You will be able to get it back close to 100%, but that takes a significant timeframe of upwards to 22 months. For the first 2-3 months post-op with a hamstring graft, you will generally not be allowed to perform exercises directly addressing the hamstring. One could make the argument that since the hamstring won't be fully restored until 22 months post-op and you can't/shouldn't be training the hamstrings for the first 2-3 months, that if you try to come back to activity too soon, you will be at higher risk of an ACL re-tear. This would be due to the fact that the hamstring directly prevents anterior translation of the tibia, which is what will stress/tear the ACL.

Also, unless you have had additional ligament damage, meniscal repair, or micro-fracture done along with the ACL-R, the straight leg immobilizer knee brace will be allowed to be removed once comfortable, which I have seen within 48 hours of surgery. This is to promote and encourage regaining proper ROM.

The issue with regaining knee extension is present in both hamstring and patellar grafts. Patellar grafts generally have an easier time in regaining passive extension from my experiences working with ACL-R's. With the hamstring graft, there tends to be a lot of scar tissue build up in the posterior knee in addition to the hamstring guarding/spasming due to the damage done to it during the surgery, so the passive extension is harder to obtain. In both cases though, you need to worry about a cyclopes lesion which can permanently restrict knee extension.

As you said, it comes down to what your doctor and you prefer, but there is a lot to consider when making that decision. I have been hearing a lot of success with the double bundle technique as well.


#19

I have had both a patellar tendon graft and hamstring graft and prefer the hamstring graft hands down! The patellar tendon graft made my knee cap super sensitive to point where I could not put pressure on that knee cap (ie kneel on it) for quite sometime and even to this day it still feels weird/hurts to kneel on that knee.

listen to your docs and do all the lame post surgery stuff. Work on getting full ROM back asap then work on strength, slowly. pool work is good, riding bike is good, and squats helped me a lot. Leg extentions are a no-no and KILL my knee, even to this day


#20

yeah its a very interesting topic - i remember hoping that by the time i finished uni there would be a miracle cure but not yet! although LARS seems to be getting some good reviews here in Aust. - i actually had a small cyclops, but they are fairly rare...about 10-20% ?? i dunno.

Also, Im gonna say it doesnt take 2 years to get your hamstring strength back up though - Id be more worried about flexibility and retears.

As for knee pain, well that's fairly circumstantial and depends on how you treat yourself post op. The area of Px is obviously going to be different for each...

Imo, it only matters what surgery you have if youre a competitive sportsperson. anyone else can suck it up for a year or 2 and come back full strength from either operation.