Attempting rehab from complete ACL tear

Hi all

As the title says, I am attempting a return to sports following a serious knee injury, and I am hoping that some of you might have some experience or advise for me. 

I will try and provide as many relevant details below as possible. Feel free to skip as much as you like, any advise is highly appreciated!

23 year old male, 70 kg, 179 cm. Preinjury I had good mobility, comfortable asian squat, able to do about 3 sets 10 slow and controlled pistol squats on either leg, for some indication of strength. Had recently picked up foundations one and started working my way through, the lower body progressions in this course (note only F1) offering little to no challenge while upper body work was rather challenging. Main sports being skiing and kite surfing, no previous history of serious injury.

MRI following injury shows complete ACL tear, as well as partially torn MCL and LCL, but does not indicate any meniscus damage. Injury resulted from a freak ski injury, where my knee was hyper extended.

I am hoping to be able to recover sufficiently without surgery to be able to return to sports such as kite surfing and skiing, and my knee specialist seem to believe that this might be possible (see this study if interested: http://bjsm.bmj.com/content/47/15/980.long) – however I have the option to get the reconstruction if it proves absolutely necessary. In either case I will be using an extreme sports knee brace in the future when doing potentially hazardous activities.

I am now about 3 months out from the injury (January 30th) and progression so far has been as following:

First two weeks: complete immobilization and extreme swelling, perhaps 20 degrees ROM, no weightbearing. Lots of muscle atrophy, injured thigh circumference 5 cm above patella was 40 cm compared to 45 cm on non injured leg.

2-8 weeks: donjoy knee brace providing lateral stability, progressive weight bearing, from two crutches to one crutch to no crutches. Swelling and ROM slowly improving. Progressing through biking, machine leg curl and extensions and stifflegged and normal deadlifts, typical rep ranges of 3 x 10-15, with weight such that this is close to muscular failure, to regain muscle loss (this was the rehab advised by PT). Supplemented this with the most basic F1 lower body progressions.

10 weeks: followup with knee specialist. The MCL seems to be healing nicely, and should recover more or less fully. The LCL have recovered sufficiently to be outside the range for surgery, but is still some way from full functionality; hopefully this continues to heal and tighten up. ACL Lachman test shows 10 mm laxity in injured knee compared to 6 mm in non injured. Range of surgery is anything more than 2 mm laxity difference, however it is not clear to what extent inactive stability is related to active stability. Donjoy is now off.

Now (about 13 weeks): Full range of motion from cold in the morning, comfortable asian squat, can sit for extended holds in the bottom position of the pistol squat on the injured leg. Have tested on a couple of occasions, and have regained strength to do a slow and controlled pistol squat on the injured leg, however this is uncomfortable in the joint, so am staying away from those for now. Muscle volume is coming back nicely, 52 cm on the non injured leg, 50 cm on injured, so greater volume compared to preinjury, following the body builder-ish protocol advised by PT. At this point I have noticed slight pain in the injured knee following the strength sessions, am assuming this is likely due to the fact that I am now moving more weight than the knee can handle at this point (am up to 3 x 10 deadlift @ 110 kg). As such I have decided to lay off the resistance training and focus completely on the foundations lower body series for the time being. Plan is to go through all the progressions from the start, doing a master set daily (typically 5 x 15 + mobility), doing the same progression for 1 week, before moving to the next progression for the next week. At this point I am up to deck squats (PE5), can do these painless, and they still seem fairly easy strength wise. I will get the rest of the foundations series when I progress past F1. Knee is still somewhat swollen, continues to improve, albeit slowly. According to PT it is very unusual for the swelling to persist past the 6 month mark. Knee will get somewhat stiff after longer periods of inactivity, and will kind of creak when flexing/extending, more so when cold than when warmed up.

So this is my story. If any of you have any experience from yourself or other athletes missing an ACL, or any other advise that seems applicable, it would be highly appreciated!

Hi Erik , I have torn my ACL and partially the medial collateral ligament and a little strain in the meniscus. Surgery it is not an option. the ONLY one case it is for people having an impressive medial quad which can compensate for torn ACL a bit.

There is not a reason to think about building the medial quad now because the isolation of the medial quad with knee extension on the leg extension machine leads to forwarding instability of the knee with the probability of major problems than before. 

Also, injury to ACL usually leads to different bones cinematic during the walk, squat, run etc and the cartilage will begin to be reduced impact after impact, and then bone against bone, after usually comes to the necessity to prosthesis.

Hi Erik, I'll report you my experience. I've torn my ACL almost 2 years ago during a soccer match with my friends. Both Physiotherapist and orthopaedist said me the decision to have surgery or not was up to me, depending on my activities. So I asked some friends of mine and also here on the forum which could be the best decision for me, and I received the same suggestion: to have surgery, with no doubt (P.S. I definitely have no impressive medial quad, as Alessandro stated ). 

After the injury, I had to stop GST progressions for single leg squat, but also I wasn't able to walk, run, squat without feeling a sort of 'instability' on my knee.

After surgery I inevitably lost a significative amount of muscle mass and strength. Orthopaedist said me that rehab is important just like surgery, nothing less. So I strictly followed the rehab program, and after a while I've resumed GST.  Now I could say I've reconquered all the flexibility lost, little by little I'm regaining strenght too, and the feeling of discomfort on my knee has expired.

Hope my experience will be helpful for you.

Alessandro

 

 

Thanks very much for your imput, both of you! I know it is the common practice to have the surgery done, but it seems, to me at least, that this is a viewpoint that is more and more challenged. see for example the study i linked; here they showed that 60% of those who delayed surgery, ended up not needing it (though unclear what kind of athletisism these aspired to). I've also seen evidence to suggest that the risk for knee arthritis is the same irrespective of whether or not that the reconstruction is done. So far I have not experienced any real instability, although i have also been fairly careful. have begun working on light jogging and cutting movements with my PT.

Will report back on here how i am progressing, whether I end up having the surgery or not, for anyone interested. It is heartening to hear you've regained flexibility, this is something ive been quite nervous about for the surgery!