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Post-ACL reconstruction recovery - some quick questions

 Poster: A snowHead
Poster: A snowHead
Had my ACL reconstruction and partial meniscus removal last Thursday afternoon. The following day the physio got me to 90 degree passive flexion. Then I left the hospital and I can't see any physio until at least tomorrow, as today is a bank holiday in Belgium.

My first question is the following: how much flexion is safe / indicated? I've gone up to c. 100-degree and I feel I can push further but don't want to damage something! (I'm aware that I should push for full extension).

Second question: on kneguru, I saw that step-ups (on the bad knee) are indicated as an "early mobile phase" exercise, whereas leg raises (straight or bent) are in the intermediate phase. I'm happy about doing leg raises (straight raises while laying on the floor and bent raises either lying on the floor or sitting on the kitchen table) but not yet certain about step-ups - this would mean having all my weight on the bad knee. Any views?

Walking on crutches is getting better every day - I'm now doing two walks of 45 mins - 1 hr a day.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
horizon, they put a limiter on my brace so i couldn't flex too far. my advice - don't push the flexion until you have seen a physio

my rehab started on proprioception (?sp) before going too much on strength. lie on your belly with your leg flexed at the knee up behind you (knee stays on the floor) and try to move your foot back and forth by a very small amount

i'd start small with the step-ups. it's a pretty stable exercise. stepping down is another matter altogether!

good luck! you'll be off those crutches soon
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
horizon wrote:


Walking on crutches is getting better every day - I'm now doing two walks of 45 mins - 1 hr a day.



Blimey that's a lot - it was probably about 4 weeks before I could manage that. There are lots of rehab protocols and some that you read (particualrly on tgr) or in the US where people seem to get hooked up to passive ROM machines seem quite aggressive and have a tendency to make you feel like you're putting your recovery at risk. My surgeon was very experienced and not particularly aggressive telling me the biggest risk was at about 6 weeks where the graft is apparently at its weakest but you're itching to start putting the work in. The important results he said are at 5-6 months not in the interim which will make you just fine for some spring turns!
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At the moment don't do more than youre currently doing until you see the physio recommended by your surgeon. There is little hard and fast evidence about what's the right course of tx (other than not putting people in a cricket pad splint or cast like we used to do here 20yrs ago). Much of the belief re open/closed chain exercises are ritual in terms of that surgeon BUT it's often best to continue with that ritual as that's what they trust and believe in. Sorry if my reply is a clear as mud but inital post op rehab is a bit like that.
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Thanks guys. The surgeon had pretty much nothing to say about the rehab (except that while I was still under he flexed my knee more than 90 degrees to show mrs horizon - who was watching the operation - that the graft will hold up). He left it all to the hospital physio - who in turn said "you're welcome to come here, but you may find it easier logistically to go to someone near to your place".

Maybe because I only had 70% of the ACL torn (surgeon's estimate, not sure how that works), he and the first physio estimated recovery for light skiing at 4-5 months and for full contact sports at 5-6 months.

fatbob, I was also told that the graft gets weakest at 6-8 weeks and then strengthens again progressively. I don't have any plans of skiing or doing any other "hard" sports before March-April. (Well an outside chance of skiing blue runs with horizon jr in the second half of Feb, but only if I am fully cleared to do so. We'll see.).
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horizon, Glad to see you on the other side and working on the rehab.

Try these for reading purposes but do not do anything more than 90° until you have seen the physio.

http://drmillett.com/downloads/rehab-protocols/acl-rehab-protocol.pdf

http://www.kneeguru.co.uk/KNEEnotes/node/775

http://www.aclsolutions.com/rehab.php

http://www.oxfordradcliffe.nhs.uk/forpatients/090427patientinfoleaflets/100419acl.pdf

http://goortho.net/pdf/Rehab/ACL_Rehab.pdf

From this small and very unrepresentative selection, you will see that rehab programmes vary considerably. There are some commonalities in terms of exercises and general stages but that is about it. Each operation is unique and our reactions to the operation as well as how well our bodies react to that trauma and the post-operative healing are also unique.

If it helps, I was back skiing 5.5 months after a major revision surgery that took 6+ hours! Do your homework and discuss pushing the boundaries with your surgeon and a physio you trust and who makes the effort to get to know you!

Good luck and see you on the slopes later this season wink

Sue
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
There does seem to be loads of different thinking on this. I was told, like others have said, the graft gets progressively weaker to around 6 weeks postop as the graft dies and forms 'scaffold' for new growth. New growth takes over from there.

I had my knee done a bit earlier in the year (eek, I cant remember xactly), and I didnt ski the following season.

OK, I did ski in the March, but on 140 skis, on piste, for two days, with DIN set to 4 on recovering leg.
Read all about it here : http://snowheads.com/ski-forum/viewtopic.php?t=29849&highlight=

Hope it all goes well for u!
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Updating: Week 7 today, all is going well. On the trampoline I can do 2-3 bounces on the recovering leg only. Not allowed to run for another month+, but can do cycling and swimming. Surprisingly little pain through the recovery process...ok there are sharp pains every now and then when I step too hard, but I was expecting much worse.

The physio reckons I have a fair chance of skiing blue runs with my son in the last week of Feb Toofy Grin

Could a mod please move this to the new Ski fitness etc forum? Thanks!
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You'll get to see more forums and be part of the best ski club on the net.
horizon, that is really good progress well done. It shows to be honest that your initial fitness going into the op has played a good supporting role in your recovery. Very Happy snowHead snowHead
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horizon, great stuff sounds like you are flying keep it going but don't overdo it.

I made my comeback in Verbier a week ago after nearly two years out following ACL rupture and operation. Bit nervous to start with but skied one on one with a top coach who knows my skiing and we just hammered the drills to get back in the groove. I can honestly that technically I have never skied better. Now i'm back I am still having physio but really focussing on getting fitter and stronger it never stops!
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Horizon - I ruptured an ACL skiing in La Grave during February 2007. The following visits to doctors and consultants showed that I'd also previously ruptured my other ACL (5-a-side football). With the aid of a Donjoy brace I skied for a week in Tignes a few weeks later during late March, one week before undergoing ACL reconstruction on both knees. I have to say that the re-hab was pretty awful with lots of ups and downs, but I followed the physio advice to the letter. I found that cycling in particular was best for re-strengthening the legs, and was cycle racing by the end of August. Skied as hard as ever the following winter without the brace and without any issues and have done since. If you follow your physio's advice and do the necessary work, you should be good as new in 6 - 9 months.
Good luck with it.
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
Hi, I was searching for ACL postop information online related to skiing. I found this post and saw that the protocol link from Dr. Millett was outdated. I've included the new link below:

https://drmillett.com/rehab-manuals/

I have a link on my personal website with some basic functional progression after ACL reconstruction and normal milestones after ACL reconstruction surgery. There isn't much skiing related information on there.

However, I'd be interested in hearing the other side of things - when did you get back to certain skiing milestones? How long until you felt like you were skiing at the same level as you were before your ACL surgery? I would love to hear your personal experiences.
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