ACL & Meniscus reconstruction - Rehab hints and tips....

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ACL & Meniscus reconstruction - Rehab hints and tips....
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flag jskiff
Posted: Jan 13, 2015 at 7:49 Quote
Hi all,

I managed to completely snap my ACL and shred the cartilage at the back of my knee. So I’m now in for an operation on the 27th of Jan.

Can’t say I’m looking forward to it but it’s a needs must type situation!

At 35 (nearly 36) I’m no spring chicken so I’m not expecting to be out hitting the trails in a matter of a few weeks, however I would like to do everything I can to speed up my recovery.

So my ask is to any of you budding physiotherapists, doctors, surgeons, previously ACL-less folk and other such experienced individuals out there to share any information, hints or tips that could help, I would be much appreciated any guidance. 

Another point that some advice would be welcome for is that I have a holiday booked to travel out to the Tatras Mountains for a 10 day gravity riding extravaganza in June, the question is what are my chances of my knee being sufficiently healed to take on the rigors of DH (by June 15th)?

Cheers,
John.
flag MongooseJage
Posted: Jan 15, 2015 at 8:26 Quote
Everyone's different but you should be able to ride, I was after that time, but no big jumps ☺️ Got a knee brace and started riding a lot harder think it was more confidence!
flag jskiff
Posted: Jan 15, 2015 at 8:32 Quote
MongooseJage wrote:
Everyone's different but you should be able to ride, I was after that time, but no big jumps ☺️ Got a knee brace and started riding a lot harder think it was more confidence!

Thing is you are a good 15 years younger than me, so you will heal a hell of a lot quicker. I'm really concerned if I go ahead with op now that my holiday will be scuppered.

They have said I can delay the op until after summer if I want.

Technically I've been riding on the same injury for 2 years, it's only ever caused me jip when I played footy. I've also got a knee brace but it's horrendously uncomfortable. Which knee brace are you using?
flag StueyStuey
O+
Posted: Jan 15, 2015 at 8:59 Quote
jskiff wrote:
MongooseJage wrote:
Everyone's different but you should be able to ride, I was after that time, but no big jumps ☺️ Got a knee brace and started riding a lot harder think it was more confidence!

Thing is you are a good 15 years younger than me, so you will heal a hell of a lot quicker. I'm really concerned if I go ahead with op now that my holiday will be scuppered.

They have said I can delay the op until after summer if I want.

Technically I've been riding on the same injury for 2 years, it's only ever caused me jip when I played footy. I've also got a knee brace but it's horrendously uncomfortable. Which knee brace are you using?

You talk like you are past it. 35-36 is no age and in a lot respects you are in your prime.
flag jskiff
Posted: Jan 15, 2015 at 9:09 Quote
StueyStuey wrote:
jskiff wrote:
MongooseJage wrote:
Everyone's different but you should be able to ride, I was after that time, but no big jumps ☺️ Got a knee brace and started riding a lot harder think it was more confidence!

Thing is you are a good 15 years younger than me, so you will heal a hell of a lot quicker. I'm really concerned if I go ahead with op now that my holiday will be scuppered.

They have said I can delay the op until after summer if I want.

Technically I've been riding on the same injury for 2 years, it's only ever caused me jip when I played footy. I've also got a knee brace but it's horrendously uncomfortable. Which knee brace are you using?

You talk like you are past it. 35-36 is no age and in a lot respects you are in your prime.

Haha very true fella, I'm just going off what the surgeon told me in relation to healing etc.....Peronally I feel sound mucker ;-)

If it wasn't for my 10 days of gravity action in June I'd just get it sorted now.

My thinking is if I delay until say September, I can have my holiday (albeit on a dodgy knee) and a good summer of riding then spend autum/winter recovering in time for spring 2016.

But in exactly the same breath I don't really want to delay if I could avoid it!!!!!!
flag StueyStuey
O+
Posted: Jan 15, 2015 at 9:15 Quote
You could use your holiday as motivation to get fit but you'd need to take some advice from you surgeon I guess. If it were me I'd want to get it sorted out.
flag MongooseJage
Posted: Jan 15, 2015 at 9:17 Quote
I rode without an acl for a year and really didn't notice it until I started playing football again!

I use a mueller hg80, really light, stiff and comfy, I use it for snowboarding too not as much on the bike now though!

Ye I'm 21 but you seem active and you're not exactly 70Wink the healing does take a long time tbh! It's completely your choice, personally I'd have it summer then you have winter to heal and chill. It's how I wanted to do it but i needed to sort it before starting UNi!
flag jskiff
Posted: Jan 15, 2015 at 9:26 Quote
Motivation to improve fitness is always welcome, it's more to do with what I will be allowed to do. From the reading I've done about the op it's a fairly long and arduous rehab process.

I'm in with the Specialist tomorrow so I'm going to see what they advise.

I have a feeling when I say DH riding they are going to laugh and tell me to give my head a wobble haha

@MongooseJage - Will look that one up, was it provided or did you buy it yourself?

I was given a Breg Fusion brace, I then had to spend about a hundred quid to buy a patella cup that fitted it from the US. It's horribly uncomfortable though, I've lasted about 10 mins then jibbed it off and put my normal pads and what not on.
flag ShantySpark
O+
Posted: Jan 15, 2015 at 9:32 Quote
I had the same surgery when I was 18, which was 11 years ago now so things should be better, but I was a full 6 months of recovery. I wasn't into riding at that time but I expect I would have been able to start some easier riding before then without much issue. Like one of the people above said, wear the brace and it should be ok. If your trip is the end of June, that will be 5 months post op and I would suspect riding would be good to go by then.

The biggest thing to do after the surgery is stick with the physio plan and ride a stationary bike every day once it loosens up enough that you can do revolutions. Not hard by any streach, just to keep it moving, begin streaching out the new ACL, etc. This will make a huge difference in the recovery and pain once healed. It will also help with not letting your legs muscles get weak while you are recorvering and not using the injured leg as much.

I still have some issues with mine due to injuring it again, having a second surgery 2 years ago and now my quad has shrunk due to me favouring it. In physio again trying to get it ready for next season of riding. Hope that helps you with some insight.
flag JasenK
Posted: Jan 15, 2015 at 9:42 Quote
Oh dear, ACL is a horrid op, recover time is quite long as body has to first bond in bone (assuming patella tendon....much better than hamstring reconstruction), so 4 - 6 weeks or so (the tendon is still strong), then your body converts it to a ligament, so that becomes weak 6 - 12 week stage, then just general recover and physio stuff.

I did my right knee and Meniscus back in 2010, approx. 10 months to playing football, but caused Cyclops legions, so second op, 2 years in total before back to full fitness. If you def need the Meniscus doing then they might put you in heavily angle restricted knee brace for 4 weeks, and this adds ages to the recover as first thing you need to do is get the movement back in the knee.

I did an enduro (trail riding) day in Spain approx. at just about 4.5 months after the op but was very scary and only footed on bad leg once in the whole three days of riding....so you hols is a big risk. I was back riding my push bike on roads from about 3 months or so from memory, but again, you need to be careful as this build muscle in certain areas that can then cause muscle changes and with a tightish ITB can cause knee cap mis-alignment ...that happened to me to (as was doing a good mix of cycling and football, so twisting and turning before the op, to just closed chain exercises for ages afterwards)...the misalignment grooves the underside of the knee cap, which is cartilage, and then it becomes squeaky....they re-profiled mine (shaved a bit off to smooth), but will then always be a bit fecked as never recover from this apparently?!
flag jskiff
Posted: Jan 15, 2015 at 11:53 Quote
Bloody hell..... nightmare stories guys. Hope you are both ok now.

Cheers for the info though, it gives me some real world scenarios Smile

I've heard similar stories elsewhere, when things go a bit tits up following the surgery. This is one of the reasons i was contemplating delaying until the summer was out.
flag jskiff
Posted: Jan 15, 2015 at 12:31 Quote
@jasenk its the hamstring that my surgeon has recommended. Will speak to him about the pros and cons tomorrow Smile
flag JasenK
Posted: Jan 16, 2015 at 4:12 Quote
jskiff wrote:
@jasenk its the hamstring that my surgeon has recommended. Will speak to him about the pros and cons tomorrow Smile

Mine was done by the guy who works for / looks after Brighton & Hove FC. Top reviews also (mine done via BUPA). He absolutely recommended patella tendon. My misses had a hamstring reconstruction. Think the pro/cons are as follows:

Patella Tendon

- Great fixation in tib and femur as is bone healing in bone (when they take the middle part of the tendon they take a segment of bone from knee cap and tib.,,,this is what screws into the holes they drill).
- Big plus is IF it fails again, they clear out bone when they drill again, much easier than clearing out ligament
- Only speculation, but wonder if they can achieve the "optimised" drill angle with a hamstring and still get it fixed in place?
- Downsized are, a) risk of housemaids knee in the future (mine is a tiny bit sensitive, but ok), and b) the traditional method involves a big incision to get the graft out....mine was done with key hole, no real scars at all

Hamstring

- Fixation strength always raise as a concern
- If it fails, bugger to drill out
- Work required to get over tight / painful hamstring
- Speculation again, but hear of plenty of cases where getting the installed load hasn't been enough (still instability) or too much (lack of full range of movement), so might be more difficult tension the graft spot on (bit like tying a knot in the end of very strong balloon....quite difficult)

The key thing is though, get it done, worth it to prevent longer term damage to cartilage, I don't bother with a knee brace and still play football, MTB'in, MX'in, off skiing, overall happy with the final outcome...but does take time to recover (don't rush either, plenty of horror stories about people snapping newish grafts by trying to do too much to soon)....best of luck, hope it all goes well :-)
flag jskiff
Posted: Jan 16, 2015 at 6:31 Quote
Cheers fella, will raise some of the points made with my surgeon.


Waste of time going the hospital today, the fella doing my surgery wasn't there so they wouldn't advise me on what's going on without his say so. Gonna have a word and see what he says.


Oddly the Specialist I seen today was the guy I first met and he told me I didn't need an operation. He initially gave me a brace and told me I'd be fine, in his words "if you were a 21 year old football superstar I would tell you now that your career is over".

I wasn’t exactly over the moon about this, so I seen another specialist who literally said nothing of any use or interest, plus 3 different physiotherapists after that I went to my own doctor. Luckily he was heavily involved in sports injuries in his former life, so he had a play and generally dragged my knee all around the surgery. In his opinion it was weird that my leg was so stable, he couldn’t get any movement that would indicate there was an ACL tear, despite the scan pictures clearly showing the damage.

So he recommended this fella call Ash........It's only once I seen this new guy that it was decided the op was the best course of action due to the rupture in my cartilage. In his opinion I would end up with arthritis after about 10 years if I never had the procedure. Oddly he was able to pop my knee in and out with little effort, a task no one else had be able to replicate.

Mad how they have such varying opinions, the new chap does BUPA and all that jazz, reviews of him look pretty good and he does some major surgery, hip, knee replacements, etc...
flag mattygee020671
Posted: Jan 16, 2015 at 6:42 Quote
jskiff wrote:
Hi all,

I managed to completely snap my ACL and shred the cartilage at the back of my knee. So I’m now in for an operation on the 27th of Jan.

Can’t say I’m looking forward to it but it’s a needs must type situation!

At 35 (nearly 36) I’m no spring chicken so I’m not expecting to be out hitting the trails in a matter of a few weeks, however I would like to do everything I can to speed up my recovery.

So my ask is to any of you budding physiotherapists, doctors, surgeons, previously ACL-less folk and other such experienced individuals out there to share any information, hints or tips that could help, I would be much appreciated any guidance. 

Another point that some advice would be welcome for is that I have a holiday booked to travel out to the Tatras Mountains for a 10 day gravity riding extravaganza in June, the question is what are my chances of my knee being sufficiently healed to take on the rigors of DH (by June 15th)?

Cheers,
John.

Hi mate. well i know how you feel.
i did mine at the age of 26, took a year to get the op done in germany ( was based there) and i was initially told 10 months to a year before i would be back to 100 percent ish.
well after pulling my finger out with lots of effort, 3 months rehab at hedley court i was running better than i did before after 6 months. 18 years later the repair is still holding up. good luck dude and heal well and soon.
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