T Nation

Hamstring Weakness After ACL Graft


#1

I am about to have ACL surgery. The surgeon will be using a graft from my semitendonisus and gracilis hamstrings to create an new ACL. I am getting pretty worried about the results. I can expect not to be deadlifting again until 6 months after surgery. And as if that weren't bad enough, there is a VERY strong potential that the affected hamstring will never be as strong as my other one.

Who else here has had this type of surgery before? What were your results?


#2

Every athlete I have worked with who was intelligent regarding their rehab came back with equal strength in both legs. It depends on the physician doing the surgery, but generally they want to wait about 3 months before significant hamstring strengthening is done to allow for the semitendinosus and gracilis to properly heal. If you rush it, you risk tearing the tissue since it won't be completely healed. You can do plenty of glute activation exercise, such as bridges, hip thrusters, etc once your leg/knee is able to handle the load. Then once that 3 month period hits, you can start training that hamstring with more focus and intensity.

Will the hamstring tendon be the same after surgery? No. Are you capable of getting it as strong as the other one? Yes.


#3

Hey dharok,

Sorry to hear about your injury, but rest assured that you'll be on the road to recovery after surgery.

I had the same surgery almost seven months ago - ACL reconstruction using a hamstring graft, as well as a meniscus repair. My hamstring is already close to full strength compared to my other leg. The first two months or so after surgery, your hamstring feels basically like dead weight. I couldn't pull my foot up behind me more than 12 inches for a while. It's pretty amazing though that soon enough with basic rehab, the rest of your hamstring begins to compensate for the missing piece, and you begin to get your strength back.

It obviously requires a lot of hard work and diligence to get everything back, but it is possible. The only difference I can tell now, even at just seven months out, is that the hammy on my surgery leg tires out quicker than the other one. If I do any kind of isolation work, like one-leg hamstring curls, I can do more reps with my healthy leg than the surgery leg. Strength-wise though, I can do the same weight on both legs for all unilateral exercises (mainly single-leg RDLs and Bulgarian split squats).

I started deadlifting (very light weight) at around three months once I was cleared to run. The big compound lifts take some getting used to though since you will probably have been using your other leg more since your injury. I will say it's still a bit of a battle to consciously make myself distribute the weight equally on both legs at various points of the big lifts (squats and deads).

I notice it more with deadlifts and DL variations, but that may be because I have spent way more time squatting since surgery (2x week back squatting, 1x time DLing), so I'm a little more used to that movement. I have recently changed my routine and am now squatting and RDLing twice per week with an upper/lower/upper/lower split.

Not to start throwing numbers around, but I was able to squat 245 for one rep past parallel about three weeks ago. I had never 1RM'ed more than 290 before my injury, so I'm considering that my pre-injury max. I'm pleased with 245 for now. I haven't tried to max out my deadlift, but the most I've even tried to pull since surgery was 235. I had gotten up to 355 before the injury, so I have a ways to go with that.

All that said, I've also found my lower back to be weaker and had a pretty bad strain about 1.5 months ago. Just a heads up that the supportive systems involved in those heavy lifts also weaken, more than you may realize.

Anyway, I don't want to start rambling about my recovery any more than I already have. If you have any questions, I'm glad to help. rehan_bl is also on this board going through the same thing, and he's at around the 5-6 month mark I believe. He would also have some good insight to the recovery process.


#4

Thanks for the responses. I guess I am very leery about the surgery b/c I was hoping to compete in a PW competition in January 2012, and I was hoping to get a least a 1600 lb total.

My injury is very old--about 16 months--because Canadian Health Care sucks, so my knee has become quite stable at this point. I am currently pulling over 600 lbs, and from what I hear from everyone I ask, I would not be able to do that in 10 months if I go ahead with the surgery. I guess I wouldn't be able to do much of a squat either.


#5

i pulled 465 (very low rack pull) for a double today 6months post op. You will be just fine


#6

its hard but dont look too far ahead of yourself mate - get your rehab done and youll be just fine...I found after my ACL surgery both my knees were a hell of a lot more stable with all the balance work etc...

I had "rest ice compress and elevate you C**T" over a picture of franco columbu in my room - a little crude, but it worked wonders for my motivation haha :stuck_out_tongue:


#7

So here's what my surgical consult with a knee specialist said:

There are two reasons to fix an ACL: (1) instability, and (2) joint degeneration.

Re: (1) I currently have no instability while deadlifting or squating, and I have no instability on a day-to-day basis. Heavy workouts have strengthened my hamstrings and quads enough to overcome the lack of an ACL. I have solved my own instability problems with heavy lifts.

Re: (2) My original scans showed that my joint was a "real mess"--as my GP stated. I had early signs of arthritis, my ACL had been dissolved and was no longer there, and my menisci where both damaged--one severely. 8 months later, after performing my own rehab on my knee, the early signs of arthritis are gone, so the concerns about the ACL and menisci are less urgent.

As a result, the specialist said that whatever I am currently doing is having better results that surgery is likely to have. As long as I don't take up a pivoting sport without using a brace, there is no reason to get the surgery at this point.


#8

Amazing work there. There is a lot of non sense going around ACL surgery these days.
Practically everyone with a broken ACL is referred for surgery.
And boy, is the Recovery hard !
I am 7 weeks postop. Still walking with a limp.
My quads are like 1/3rd in mass and strength and still homebound practically. If I go around too much then swelling comes back.
Hams are taking me to 90 degrees only to get past I need more time.
I will gain strength in a couple months or more. Lot of work and patience man!
Somedays, I feel I should have not gotten the surgery.