ACL Recovery

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#1
Well tomorrow is the day. My 15yo dabbed his foot when he shouldn't have and completely tore his ACL, and some meniscus too. I have researched it alot and feel pretty good about full recovery, but would like to hear from those of you who have been through it. He is going to have the patella tendon autograph, which I think is the the right choice for him. I know what all the doctors say about recovery milestones, but I would like to hear what the real world says. When did normal walking start? When did it become pain free? How bad was the post surgery pain? Could you really ride a Bicycle, and swim at six weeks? Is racing again at 4 months braced realistic? Is 6 months good as new? Thanks so much for your replies, they will help a nervous parent alot
 
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#2
I had the same exact surgery Nov 5th, which was a Wednesday. I went home the same day and felt great. I received a shot of novocaine in my hip that numbed my leg for about 48 hours, so pain post op was not bad. In total I have taken 3 pain pills. By Sunday I was able to walk with out crutches. Started P/T the Monday after, returned to work Tuesday, a week after surgery had >90 degrees range of motion. About a week and a half later normal walking, with slight pain.

Its going to be sore and go through different pains, at least mine has. I would say that biking and swimming at 6 weeks is possible.

Fastest recovery I've heard of was 3 1/2 months.
 
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#3
I had a left knee injury on the 2nd of August in which I broke a little piece off the tibia head, tore both mensicus and the ACL.
Surgery with a new ACL was in mid august. Into hospital on wednesday, out of hospital friday afternoon.

Don't worry about pain. Right after surgery they will give you pain killers (I had a cool fully-automatic electronic pump attached to my upper tigh which constantly delivered the stuff into my venes). When I left hospital they supplied me with pain killer pills, which I didn't need anymore after three or four days and before that only during night time.

The doctor told me to walk on crutches for 14 days and to wear a brace (limting movement to 0°/90°) for six weeks. He said I should put only little weight on the left leg and support mywalking with the crutches.
After 8 days I put the crutches away and after 3 weeks I stopped wearing the brace.

A very slow walk, without limping, was possible after 14 days or so, and constantly getting better. Very light jogging after 4 or 5 weeks.

Right after leaving the hospital I started visiting a physio-therapist three times a week for the duration of six or seven weeks. There I went on Step-Machine, Training-Bicycle, Massages, gymnastics, electro-shocks - all the torture stuff. These training-sessions were the only occasion on which real pain occured.

After 2 months I had nearly complete movability again. I forced myself to wait another month and then went riding again yesterday. All fine so far.
 

James

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#4
I had mine done on Monday.

Very little pain and it only hurts when I let it get stiff or if I move way past my current range of comfortable movement. I got the nerve block and only took pain pills the first three days because they told me that would help with the swelling.

I currently have full extension and well over 90 degrees bend. I think the swelling is most of what keeps me from moving it better than I do. Swelling isn't terrible but it is a little puffy. I can walk without crutches and it almost appears like I am walking normal after my leg is exercised and stretched a bit. Those first few steps are tough after I have been sitting for a while though. I can also drive my truck (work the clutch - left knee) if I wanted to.

I started the recumbant bike at PT on Friday and I can see bike riding and swimming at 6 weeks.

From what I understand...it is NEVER good as new. I think you end up with about 90% of new. I have heard of people riding after 1 month braced but I am not going to be that ambitious about it. SUPPOSEDLY, the graft goes through a vunerable period in months 4-6, otherwise the only concern would be that the bone doesn't fill around the graft completely until about 6-8 weeks (2 months). Other than those two things, its just about getting the swelling down and getting your muscles to work again.
 
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#5
Thanks or the replies. The nerve block/novicane seems like a good idea. Since he doesn't have to work or anything like that I think he should be pretty comfortable. I am encouraged that your experiances seem to all say that moving around normally is coming at a pretty fast pace. Its funny that yesterday while watching the discovery channel they did an ACL surgery right on TV. It was pretty gnarly how they did it, and it was an Allograft which is a bit less dramatic then the Autograft from what I hear. Its going to be a tough road to recovery for a antsy teenager. Even though I know it will never be the exact same I do have an expectation of 100% pre-surgery performance. The Dr. said that because he is young his recovery will be very good, and with poor diligence toward PT he would still get to 90%. He thinks with a diligent PT program he will get to at least 98%, and believe me I will be pushing his PT to the limit.
 

James

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#6
To clarify, the strength of the actual ACL graft is never better than 90% of what your body grows on its own from what I have been told. Now your leg muslces, flexibility, strength, endurance, etc etc can all be 100% or better than previous depending on your workout routine and the quality of the surgeon's work. So my interpretation is that is will take a bit less of an impact to the ACL graft to re-tear it than it would to tear the orginal...all other things being equal.

I must have misunderstood your "6 months good as new?" question....sorry. :thumb:

Good luck!!! Let us know how the recovery goes.
 
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#7
I tore my MCL and severed the ACL back on July 6th. I had acl reconstructive surgery on 8/11. I was back on my bike for the first time this weekend 11/22 with the help of a CTI2 brace. The recovery period has been up and down to be honest. I was in PT the day after surgery, by day two was off of pain meds but kept taking the advil for swelling. Within a week I was walking with the aid of crutches and without at about the two week mark. For the first six weeks my recovery was fast and I gained most all my flex and alot of strength back.

I was walking around fine without any kind of post-op brace at the five week mark. I started having problems with the patella at around week 7 or 8 and that set me back awhile. The problem was resolved and I'm now at 15 weeks and recovering strong.

Like I said, I went riding this past weekend and meant to take it easy. Well, that didn't happen and I put the knee through a test and it survived just fine. No major swelling of any kind and only a little sore the next day. Mainly meniscus issues. I don't feel I'm ready to go racing again at this point or play sports yet. But, I should be good to go at the 6 to 9 month mark. Keep in mind I'm a bit older than your son to. He should do just fine. Just don't let him slack on the PT.
 
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#8
Thanks for the replies! The surgery went well for the most part, and by that I mean the Dr. had hoped that the meniscus would have healed on its own (which I guess is very possible for kids, but not for us adults) and it did partially, but he still needed to use a few sutures on it. He also put an extra screw in the tibia which he wrapped the ACL sutures to as an additional anchor. I am a little fuzzy on why and how of this, but he did say it was not something he would do to a normal Recon. but he felt that it would give a little more safety factor to someone like us MXers.

I am glad I posted this because I did not know about the vulnerable stage of the graft that you guys described, and it made for interesting comments. I did know that there are quite a few grafts that fail within 5 years, but I didn't know that 15% of the people whose grafts hold past 5 years will have the surgery again. This is kind of depressing, but I guess there is no use sweating it.

Another thing that he said was that surprised me was that he felt that the partially torn meniscus was of more concern to him than the ACL itself. He said the long term effects of it had in his opinion greater consequences. I guess you can actually live a pretty normal (non-sports) life with a torn ACL, but a damaged meniscus is a different story.

He has the straight leg brace plus crutches this week, looses the crutches next week, and should return to an ACL brace the week after. He doesn't want him in PT until after he sees him again on Monday because he wants to make absolutely sure that everything is as it should be before he starts messing with it. He is at this point ok with riding braced at 3 months, but I will probley make him wait until 5 to be sure. My son is a pretty fast "B" rider, but not fast enough to where I think it is worth the risk. He did tell him to enjoy this week because the PT he is going to put him through is going to be grueling.

James- I also misunderstood what you were saying, and I agree 100% that the graft itself will always be a bit weaker.

Carnage- I am interested about the Patella issues you had, please do tell.

Finally I really hate to go here as its been beat to death on this site, but I had to ask if a brace would have prevented the injury. He said it MAY have prevented the ACL damage, but not the meniscus injury. He sited a recent study of a thousand athleats (no MX), half braced, half not, and there was no difference in injury rate. He did admit though that we are subject to greater forces than other sports, and as long as we trained without the brace so the knee could strengthen, he felt they couldn't hurt. He said the bottom line was that odds are, even braced he would have still been in the same place. That really helped out a parent who has been beating himself to death about being too cheap to drop the 500 on braces. I will be buying them now though!
 

oldguy

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#9
Glad to hear the surgery was a success. I had the ACL, MCL and lat replaced as well as screws in the femur and tibia head last year in November and concur with the above posts. Mine was done with a piece of hamstring as the replacements. I had a set back during mine as I was allergic to the screws used and this delayed the calcium replacement. I had a second surgery to remove the screws 1 1/2 months after the first. From this point on recovery went fast. I still had trouble kneeling on the patella until about 7 months after the first surgery ( remember I was 48 yrs old at time of surgery). I did experience some depression that the healing was not progressing at the rate I expected but Firecracker confirmed I was close to hers which made me feel better.
Pain after surgery was nothing compared to before it and I really think the motion machine helped immensely. PT especially on a recumbant bike also was vital in recovery.
Good luck and keep a close eye on him to make sure he is doing all the PT and also not adding his own program without checking it out first.
 
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#10
As far as my patella goes, I developed an inflamation right under the center of it. This was a result of my patella not tracking properly. What we later found out was that the quads were not firing properly so my patella wasn't being pulled evenly for lack of better words. After a couple of painful deep tissue massages of the quad right above the patella to break up the scar tissue everything started working normally again and I haven't had a problem since.

As far as a brace goes you'll get many different view points. Personaly, I'll wear mine when I ride until my knee is fully healed. I might even stretch that out to a full year post-op. After wearing it all day last Saturday I'll say that it gives plenty of support for hyper-extension and side impacts. However, would it have prevented my injury in the first place, doubt it. My foot had gotten stuck and the knee twisted pretty violently about 180 degrees. If, and I do stress the if, it would have prevented the knee from going then something else would of had to have given. If that other injury is a simple break then that would be worth it. A complicated spiral fracture or even a femur break and I'd start second guessing the brace. I think the brace will prevent minor force twists of the knee and the side impacts and hyper-extensions. Any major twisting force to the knee area and I'm not so sure it would have helped. Just my opinion.. others vary.
 

James

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#11
I agree with carnage about the brace. I wasn't wearing one when I injured my leg. About two weeks after injury, I could walk and ride about like normal except for the occassional over extension that caused considerable pain. I bought the braces and had no more problems while riding. Obviously does something.

I also think they provide additional protection to the ligaments by preventing the side to side and hyperextension and my assumption is that you will avoid injuries up to the point of failure of the brace or your leg bones. I further rationalized that I'd rather avoid many ligament/knee injuries from smaller hits as opposed to leaving my knees vulnerable to prevent a femur break in case I had a big hit.

I think a major twist with or without the brace is going to do damage.
 
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#12
I tore my MCL earlier this year and started wearing Asterisks. I've hear it said that they weaken the knee, etc, but that's rubbish. I've caught my foot several times in a rut and felt the brace torque on my leg--thank goodness I had them on!!! It takes only a little while to get used to wearing them, and once you do you'll feel naked without 'em. I'm not saying they will prevent all injuries, but hey--you can still have a head injury while wearing a helmet, too.
 
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#13
I think we all agree that braces can help, but they like all other safety equipment has its limits.

Well now that we are a few days post-op the pain is really starting to appear. The Dr. gave him a stronger pain medication because the original one was not cutting it. I just hope the pain decreases soon like is expected. I know that ice is good for the swelling but man he has him frozen like a popsicle. The Dr. wants him iced pretty much constantly for the next week.

You guys have encouraging recovery stories he had all but given up on making it to a local Loretta qualifier, but it looks like we will make one. The one we would like to make it to is about 16 weeks post-op, but if he is not ready we can always travel a bit. Thank you all for the info you provided.
 

zero_it

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#14
I wasted my ACL and tore the medial meniscus back in '94. They did the hamstring tendon for my ACL and sewed up the meniscus. Since there is very littel blood supply to the meniscus, it takes a long time to heal. With that procedure I wasn't to full weight bearing for two months. I was able to ride a bicycle about 3 months post-op and was back on my motorcycle in 5 1/2 months wearing a brand new CTi2 knee brace. It was a long haul, but I'm really glad they didn't carve any of the meniscus out, I'll be really thankful the older I get! Shortly after getting back on the bike I opted to buy a CTi2 for my other knee because I want to cut the chance of that ever happening to me again. They are expensive knee braces, but worth it. The only problem is getting MX pants & boots that fit properly over them and then dealing with your pants tearing out at the knee where the braces rub. It's still cheaper than surgery.

Good luck with the kid's recovery! Do all the prescribed physical therapy and then some.
 
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#15
Zero It: YOu say your glad they did not carve out any of your meniscus, why do you say that? trying to find out what I can be hopeful for...

Im at 6 weeks post op on an ACL debreadment (cleaning up a partially torn ACL, about 25% remains) and partial torn lateral and medial meniscus where Dr. shaved about a grand total of 5% between the lateral and medial. I can stretch to -5 degress extension (shoulod be +5 degree) and about 115 degrees flexion so range of motion is decent, but still improving.

My pain is in the meniscus area when i am squatting or doing a lunge as well as the fact that the Knee POPS. I am hoping continued PT can keep improving the situation but was wondering what kind of complications and/or limitations you (as well as anyone else) may suffer from with your knee injury.