ACL reconstruction with meniscus repair

BigTam

Über Member
Location
North Shields
Had my op on the 27th July, seen physio a few days later, was given some rehab exercises to do and told to start on static cycle after stitches were removed.
That was just over a week ago, set up bike on turbo, very little resistance, finding it tough, really sore when on bike, only doing 10 minute sessions twice a day, knee still quite swollen, know it's still early days but quite frustrating.
Anyone else have any experiences of post ACL rehab and issues ?
 

vickster

Legendary Member
You can connect with folks who’ve had knee op on

http://www.kneeguru.co.uk/KNEEtalk/index.php

@PK99 had his done last year

Sounds like you’re doing pretty well less than a month after major knee surgery. Was your meniscus actually repaired with stitches or torn bit trimmed?

ACLr is a 12 month+ rehab generally, need lots of patience. Be aware graft weakest and most vulnerable at 6-12 weeks...
 

vickster

Legendary Member
Not great for the longer term. How old are you?

My lateral meniscus is shredded, having menisectomy in January. Knee arthritic. Ligaments good tho!
 

vickster

Legendary Member
I'm 58, was extremely fit before accident, just worried now recovery time and age will take its toll.
How did you tear it?
You can join a gym for upper body, swimming with a float between legs etc
Is there arthritis too?
Recovery does always take longer when you are older unfortunately
Getting a private Physio with expertise in
ACL rehab would be advised too
 
I tore both my ACLs. The GP just told me to go home and put my feet up.

When I found a GP that gave a shoot I was put in weekly rehab at Badsley Moor Lane at Rotherham. Then it was balance, hip, step, rowing, squats (with ball) - just all round strengthening type stuff.
 
OP
BigTam

BigTam

Über Member
Location
North Shields
Just went over on my knee when trying to turn, heard a pop.
Yes using gym at work for upper body and core, starting swimming this week, though told just to water walk initially.
Consultant said there was some arthritis present.
Going to get intense physio through work, have access to rehab centre, so going there on a residential basis but not till October as they wont touch me until 12 weeks after op as graft still susceptible to damage till then.
Just frustrated and impatient, accident happened in April and op 3 month later, missed a whole cracking summer of cycling.
 

midlife

Guru
Just went over on my knee when trying to turn, heard a pop.
Yes using gym at work for upper body and core, starting swimming this week, though told just to water walk initially.
Consultant said there was some arthritis present.
Going to get intense physio through work, have access to rehab centre, so going there on a residential basis but not till October as they wont touch me until 12 weeks after op as graft still susceptible to damage till then.
Just frustrated and impatient, accident happened in April and op 3 month later, missed a whole cracking summer of cycling.
Just curious are you in the police?
 

PK99

Legendary Member
Location
SW19
Hi,

As Vickster said I've got direct experience....

Snapped ACL skiing in Feb '16. Minimal meniscus damage. Age 60.

Did not want to bugger up plans for the summer, so after consulting surgeon privately to get rapid diagnosis and advice I decided to delay op till October '16.

In the meantime I rehabbed and prehabbed under the guidance of a sports physio and cycled around Provence and up Ventoux sans-ACL in September '16.

Op in October '16 and back cycling with my CTC group in April '17

By sods law I got an unrelated DVT in the non operated leg just after starting back, that laid me up for a while then in September '17 I got a chest infection that morphed into something nasty and I only began to feel semi human but grossly unfit again in April/May '18.

So my time line is unusual, but apart from a little early morning stiffness (quiet at the back please!) the ACL knee is fine and I am back cycling hard but limited by lost general fitness.

D2 snapped her's in Feb '17, operated on within a month. Had a few minor setbacks with internal scar tissue, but she is back in the gym deep squatting 65kg and her PT says he cannot tell which is her damaged knee.

So, have confidence you will get back - but is does take time, and during that time of rehab the one key mantra is "protect the graft" do not do the wrong exercises or even too much of the right exercises.

I don't know how much you know about ACL surgery and rehab, so pardon me if I'm teaching you to suck eggs...

The ACL is a taut, non stretchy ligament in the knee that controls twisting motions. The surgeon takes the stretchy tendon from one of the 3 hamstring muscles, twists it together as an ACL lookalike and fixes it with screws into the middle of the knee joint - there are loads of YouTube videos showing the op, and it is pretty brutal surgery - the whole knee will be very sore for quite some time post op simply because of the surgery.

Key point to note, is that you currently do not have an ACL you have a piece of dead tendon screwed across the middle of your knee. Over a period of months, the body will first vascularise (provide a blood supply to) the dead tendon, it will then recognise it is stretchy tendon tissue where there should be non stretchy ligament tissue and will lay down collagen to convert tendon to ligament. Clever things bodies! So, over a period of months, the new ACL will first get weaker and weaker and then, as it converts, stronger and stronger. 12 weeks post of is identified by many sources as the weakest point for the graft - some sources vary on that, saying 5-6 weeks.

Hence the mantra I mentioned above "protect the graft" Stretching the graft before conversion is complete can lengthen it permanently and leave you with a floppy joint.

Early stage rehab is about regaining mobility of the post op joint, building up muscle to support the knee while it heals and as far as possible preventing complete atrophy of other muscles.

Also in early stage and continuing, a focus will be on proprioception - that uncanny thing that allows you to close your eyes and touch the end of your nose ie the body knowing where its various bits are. The ACL is a key part of the proprioception circuit for your lower leg and the body has to fine workarounds to give you back that original ability.

Later stages will look at regaining previous strength - in particular building the remining 2 hamstring muscles to do the work of the one that no longer had a tendon.

So what do I advise?

1. Do what your surgeon tells you.

2. Find a good sports physio with ACL experience and who you feel you can work with and trust. Do what they say you should - no more and no less.

3. Hire a game ready machine. A combination Compression and Cryotherapy device and works on both pain relief (cryotherapy) and swelling (compression)
It is magic. Used by all top sports people, coaches and physios.
http://www.gameready.co.uk/How_it_works.html

4. Hire a compex machine - your physio may have one - this is an electro stimulation device that allows you to exercise muscle around the knee without using the knee joint and risking the graft. Hurts like hell as it is putting more work through the muscles than you could in the gym!

5. Watch this video:
http://www.physiorehab.com/you-tube-videos/acl-reconstruction-rehab-program-essentials-seminar


and if you are as impressed as I was, buy his ACL rehab program.

http://www.physiorehab.com/rehab-programs-acl-knee-surgery-rehab

Your sports physio, should be happy for you to work with you on this, providing checkups on progress and giving the OK to move on to the various stages.

I found it in invaluable.

6. Accept the rehab is a long slow and often frustrating process - unlike training you are not aiming to push the limits, you are working well within capacities to aid recovery. Training to regain fitness will come later, but if you follow a good protocol the progress through rehab will be speedy and have its own rewards as difficult exercise become easier.


Items 2-5 are not cheap but together cost less than a new bike.

Good luck and if you want 121 advice drop me a PM.
 
Last edited:
OP
BigTam

BigTam

Über Member
Location
North Shields
Cheers all for the advice and in particular PK99, looking to run before I can walk, literally, bourne out of frustration, I am keeping to advice from physio.
The basic exercises are not a problem, was concerned however that the pain I am getting on the turbo may cause graft to fail but physio says no and to keep it up.
 

vickster

Legendary Member
Cheers all for the advice and in particular PK99, looking to run before I can walk, literally, bourne out of frustration, I am keeping to advice from physio.
The basic exercises are not a problem, was concerned however that the pain I am getting on the turbo may cause graft to fail but physio says no and to keep it up.
Make sure you ice the knee after exercising, be it on tne turbo or just the physio ones
 

bobinski

Legendary Member
Location
Tulse Hill
I hope the OP doesn’t mind me jumping on ha thread.
I tore my right knee ACL 35y ago skateboarding. I have coped without it. How we over last 2 years a couple of crashes and using m knee to ram the rear of a car left me with residual knee pain and likley associated ITB issues. Also a growing lump on outside of my knee, 2x2 Cm. A recent mri confirms lateral tear to meniscus. Fluid from the rear has produced the lump. Surgery on 23/10. Surgery lite is remove and clean up the lump, repair or snip the tear. Surgery heavy is ACL reconstruction using hamstrings etc. Surgery will be day after my 56th birthday. Consultant says I am a coper and surgery lite is probably as much as I need. I am inclined to agree. Anyone else had to make the live and if so anything I should consider before making a decision?
 

vickster

Legendary Member
How bad is the arthritis in the joint if you’ve been without an ACL for so long? Did the MRI show the state of the bones and joint space

At 56, it’s unlikely your meniscus is going to be able to be repaired with stitches, rather degenerate and just trimmed to a stable rim

@PK99 offers great insight above into ACLr in more mature years
 
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