ACL reconstruction and Partial Meniscectomy Rehab

[Photostic]

5 days ago I had surgery to reconstruct a completely torn ACL and remove a partially torn medial meniscus in my left leg. I hurt myself playing basketball about 6 months ago and finally had the surgery after an MRI showed that the meniscus was damaged. I had an allograft tendon put in for the ACL and, for the meniscus, part of it was removed. The surgery went great, but I have a couple of questions on my rehab.

My doctor has me on an extremely conservative recovery protocol. He wants me using a CPM (continuous passive movement) machine with flexion from 0-30 degrees and no further in the 1st 2 weeks. By week 4 he wants me up to 60 degrees and by week 6 he wants me up to 90 degrees. In addition, I was advised not to do any rehab exercises during the first 2 weeks: just extending range of motion to 30 degrees.

I am concerned because this protocol is a lot slower than anything I've read online by far. Most of the protocols I see have patients reaching 90 degrees flexion in the first week and doing strengthening exercises immediately.

Does anyone have any experience with this that could possibly reassure me that this rehab will be effective? Also any helpful resources you have on ACL recovery and rehab would be helpful.

[Photostic]

bump

[rick_3e8]

bump

Find another doctor. Make sure he does 50-100 acl's / year.
You should be in physical therapy within a few days post op.
You should be getting close to full range of motion at 6 weeks.
Scar tissue is the reason you don't want a slow recovery.

I pushed very hard and was playing ball again in less than 6 months
(with brace).

good luck

[Photostic]

Thanks for the response. I am not sure I want to switch doctors a week after surgery. I just want to make sure that I am going to heal correctly. I'm not in an extreme hurry to get back to action. So a few extra weeks of rehab is np, as I don't play any sports.

What type of graft did you have and any meniscus damage? did you completely tear the ACL? Are you back to 100% now? And when was your surgery?

[rick_3e8]

Sorry didn't realize you'd already had the surgery.

Hamstring graft for me, though I'm not sure I would recommend it.
If I had to do over I would try the donor graft. My doc said the patella
graft was prone to cause tendonitus pain.

Volleyball injury (landed with too much upper body rotation).
Played with a brace for a year or so and then started playing without it.
Got roped into a sand tournament (it was supposed to be on grass) and
since I didn't have my brace AND I was playing on sand I partially tore my
reconstruction with a little cartlidge damage to boot (can't remeber if it was meniscous).
Had bad pain after second surgery which was to clean up cartilidge and severed part of reconstruction. I laid out for a few years and got fat I regret doing that.

Got back in shape and have been back playing (indoors) now without a brace for awhile.
I wish I could say as good as new but that would be a lie. Damaged knee
is weaker and probably always will be.

My Doc says that Braces are of limited value in terms of reinjury.

[orthodoc]

This is slower than my typical ACL rehab protocol (and slower than most surgeons I know). The ACL is actually under max stress with the knee closer to full extension, and isn't really stressed as you flex deeper (PCL gets stressed with greater knee flexion). But your doc may have reasons for it based on what he found intra-operatively or he may just use this protocol based on the past experiences he's had with ACL reconstruction. You trusted him enough to operate on you, so I would recommend continuing to trust that he's doing what he thinks is in your best interests post-op.

Are you sure you had a menisectomy? This protocol is similar to what I'd recommend for someone who had their meniscus repaired (and it would trump the ACL rehab protocol).

5 days ago I had surgery to reconstruct a completely torn ACL and remove a partially torn medial meniscus in my left leg. I hurt myself playing basketball about 6 months ago and finally had the surgery after an MRI showed that the meniscus was damaged. I had an allograft tendon put in for the ACL and, for the meniscus, part of it was removed. The surgery went great, but I have a couple of questions on my rehab.

My doctor has me on an extremely conservative recovery protocol. He wants me using a CPM (continuous passive movement) machine with flexion from 0-30 degrees and no further in the 1st 2 weeks. By week 4 he wants me up to 60 degrees and by week 6 he wants me up to 90 degrees. In addition, I was advised not to do any rehab exercises during the first 2 weeks: just extending range of motion to 30 degrees.

I am concerned because this protocol is a lot slower than anything I've read online by far. Most of the protocols I see have patients reaching 90 degrees flexion in the first week and doing strengthening exercises immediately.

Does anyone have any experience with this that could possibly reassure me that this rehab will be effective? Also any helpful resources you have on ACL recovery and rehab would be helpful.

[Buick55]

That is pretty slow. I had a dislocation which tore my ACL, MCL, PCL and meniscus and I was back in therapy 7 days after surgery doing stretches mainly. It seemed to progress a lot faster than what your doc is telling you, and I had a major tear and was bed ridden for the first month or so before surgery. The biggest thing that my therapist said was to make sure to work on extension. If that stiffens up it is a lot harder to recover than your flexion. I worked on both, but concentrate on extension. No weight though, that was painful for me for a long time. I have been dealing with this problem for a long time, surgery was on Oct. 1st. I have been working with a great therapist and seems to be doing well for my injury, but don't push it too fast. I tried to push harder than my therapist wanted at home and ended up with a little tendonitis in the patella which set me back the week I had to take off for that. Hit me up if you have any other questions. My therapist is great and I still see him twice a week.

[S1XM4N]

This actually sounds like an old school doctor who has had good success with the way he has always had his client’s rehab. Not necessarily a bad thing but it would be worth asking him the reasoning behind his approach for your knowledge (as well as ours). There is a good chance that with using an allograft he is worrying about you trying to do too much to quick. When you have an ACL replacement with a hamstring or patella graft most of your recovery is literally from where they took the graft healing and needing to be worked out. With an allograft you don’t have to heal from a graft or cut from other parts of your leg/knee so the recovery is much faster.

This is good and bad especially for those young and active. The ligament starts out strong from the day of surgery but for the next 6 months actually gets weaker as it acclimates and fuses to your body. The problem with allograft is that you can feel significantly better in 3-5 months with intense rehab and gain back most of the muscle loss in that time frame. So the common problem is you feel back almost too normal and get back out on the court or field and you re-tear your ACL because it is still weak. After about 6 months it progressively gets stronger if it is not damaged.

Your doctors rehab methods might be much slower than normal to help prevent this from happening. Since you are not a competitive athlete (assuming here) there really isn’t a huge need to for an insane recovery time. It’s also important for your other good leg to have time to recover because you will be over compensating and over using it a lot at first.

Reconstruction of the knee is one the things medically that has changed pretty dramatically in medicine. I have had both ACLs replaced with cadaver (allograft) ligaments as well as surgery to clean up MCL/LCL/Meniscus. My doctor actually gave me the choice of how I wanted it replace out of Hamstring, Patella, or Allograft (he doesn't agree with synthetic use yet).

My Dr and Physical Therapist wanted me on my leg as fast as possible and working to get ROM and strength back as quickly as possible. I did a lot of weighted leg lifts and resistance bands and that started about 6-7 days after surgery just long enough for the swelling to go down enough to start moving. Check with your DR and Physical Therapist to see what the goals are for your recovery and why they are using the methods they are. They should have no problem explaining it to you. Keep up the hard work of the PT and you will get there man. Best of luck! Keep me posted on your progress.

[Photostic]

Thanks for the responses

Sorry didn't realize you'd already had the surgery.

Hamstring graft for me, though I'm not sure I would recommend it.
If I had to do over I would try the donor graft. My doc said the patella
graft was prone to cause tendonitus pain.

Volleyball injury (landed with too much upper body rotation).
Played with a brace for a year or so and then started playing without it.
Got roped into a sand tournament (it was supposed to be on grass) and
since I didn't have my brace AND I was playing on sand I partially tore my
reconstruction with a little cartlidge damage to boot (can't remeber if it was meniscous).
Had bad pain after second surgery which was to clean up cartilidge and severed part of reconstruction. I laid out for a few years and got fat I regret doing that.

Got back in shape and have been back playing (indoors) now without a brace for awhile.
I wish I could say as good as new but that would be a lie. Damaged knee
is weaker and probably always will be.

My Doc says that Braces are of limited value in terms of reinjury.

How old were you at your first injury?

I think that the brace really adds a lot of stability. I can walk a lot more normally when I use the brace, than without it. Without the brace I just limp around. I am hoping to be able to play sports again, but I'm also beginning to realize that this is a lifelong injury.

This is slower than my typical ACL rehab protocol (and slower than most surgeons I know). The ACL is actually under max stress with the knee closer to full extension, and isn't really stressed as you flex deeper (PCL gets stressed with greater knee flexion). But your doc may have reasons for it based on what he found intra-operatively or he may just use this protocol based on the past experiences he's had with ACL reconstruction. You trusted him enough to operate on you, so I would recommend continuing to trust that he's doing what he thinks is in your best interests post-op.

Are you sure you had a menisectomy? This protocol is similar to what I'd recommend for someone who had their meniscus repaired (and it would trump the ACL rehab protocol).

Meniscus repair was the plan going into surgery. But my doc made me aware that there is a slim time-frame that the meniscus can be repaired in (6 weeks). So I missed that window and it had to be removed during surgery. I am definitely trusting the doc to do what's in my best interest, but I am getting very restless and want to get going on PT already. It's been 2 weeks since surgery. I have my first post-op appointment tomorrow, and I am looking forward to getting a lot of my questions answered. I will update tomorrow.

That is pretty slow. I had a dislocation which tore my ACL, MCL, PCL and meniscus and I was back in therapy 7 days after surgery doing stretches mainly. It seemed to progress a lot faster than what your doc is telling you, and I had a major tear and was bed ridden for the first month or so before surgery. The biggest thing that my therapist said was to make sure to work on extension. If that stiffens up it is a lot harder to recover than your flexion. I worked on both, but concentrate on extension. No weight though, that was painful for me for a long time. I have been dealing with this problem for a long time, surgery was on Oct. 1st. I have been working with a great therapist and seems to be doing well for my injury, but don't push it too fast. I tried to push harder than my therapist wanted at home and ended up with a little tendonitis in the patella which set me back the week I had to take off for that. Hit me up if you have any other questions. My therapist is great and I still see him twice a week.

Did you have a meniscus repair or a menisectomy? I have been doing some mild stretching and flexing just to test out the knee. I can't fully extend my knee yet without extreme pain, but I'm working on it.

This actually sounds like an old school doctor who has had good success with the way he has always had his client’s rehab. Not necessarily a bad thing but it would be worth asking him the reasoning behind his approach for your knowledge (as well as ours). There is a good chance that with using an allograft he is worrying about you trying to do too much to quick. When you have an ACL replacement with a hamstring or patella graft most of your recovery is literally from where they took the graft healing and needing to be worked out. With an allograft you don’t have to heal from a graft or cut from other parts of your leg/knee so the recovery is much faster.

This is good and bad especially for those young and active. The ligament starts out strong from the day of surgery but for the next 6 months actually gets weaker as it acclimates and fuses to your body. The problem with allograft is that you can feel significantly better in 3-5 months with intense rehab and gain back most of the muscle loss in that time frame. So the common problem is you feel back almost too normal and get back out on the court or field and you re-tear your ACL because it is still weak. After about 6 months it progressively gets stronger if it is not damaged.

Your doctors rehab methods might be much slower than normal to help prevent this from happening. Since you are not a competitive athlete (assuming here) there really isn’t a huge need to for an insane recovery time. It’s also important for your other good leg to have time to recover because you will be over compensating and over using it a lot at first.

Reconstruction of the knee is one the things medically that has changed pretty dramatically in medicine. I have had both ACLs replaced with cadaver (allograft) ligaments as well as surgery to clean up MCL/LCL/Meniscus. My doctor actually gave me the choice of how I wanted it replace out of Hamstring, Patella, or Allograft (he doesn't agree with synthetic use yet).

My Dr and Physical Therapist wanted me on my leg as fast as possible and working to get ROM and strength back as quickly as possible. I did a lot of weighted leg lifts and resistance bands and that started about 6-7 days after surgery just long enough for the swelling to go down enough to start moving. Check with your DR and Physical Therapist to see what the goals are for your recovery and why they are using the methods they are. They should have no problem explaining it to you. Keep up the hard work of the PT and you will get there man. Best of luck! Keep me posted on your progress.

The doc is pretty young, but he did tell me that his protocols are very individualized. I hope that I will get some more answers tomorrow and will probably start PT as well. So I'll have more info then. Thanks again for the replies.

[taf1968]

OP, I can't speak to the ACL side . . . but I did have a partial menisectomy in my right knee about 7 years ago. I was in much the same boat as you were on that one. I had hurt my knee when I was in 5th grade (slipped on wet grass while kicking a ball and landed in a hurdler stretch--tore meniscus) but back then they did not think surgery was needed. I lived with it locking up on me every now and then . . . finally got it in the wrong position during martial arts and the sucker wouldn't unlock at all.

The surgeon went into it intending on repair . . . but post-op he said that it was injured so long ago that repair was impossible. He tried to do what he could but in the end he said it just had to come out.

Anyway . . . my recovery went pretty well. I was riding a stationary bike within a few weeks and a regular bike a few weeks after that. Took things slow to get back into lifting, but got back to full speed fairly quickly I thought. It hasn't kept me from doing any sports and feels fine for the most part.

Good luck with the rehab!

[rick_3e8]

Thanks for the responses



How old were you at your first injury?

I think that the brace really adds a lot of stability. I can walk a lot more normally when I use the brace, than without it. Without the brace I just limp around. I am hoping to be able to play sports again, but I'm also beginning to realize that this is a lifelong injury.



Meniscus repair was the plan going into surgery. But my doc made me aware that there is a slim time-frame that the meniscus can be repaired in (6 weeks). So I missed that window and it had to be removed during surgery. I am definitely trusting the doc to do what's in my best interest, but I am getting very restless and want to get going on PT already. It's been 2 weeks since surgery. I have my first post-op appointment tomorrow, and I am looking forward to getting a lot of my questions answered. I will update tomorrow.



Did you have a meniscus repair or a menisectomy? I have been doing some mild stretching and flexing just to test out the knee. I can't fully extend my knee yet without extreme pain, but I'm working on it.



The doc is pretty young, but he did tell me that his protocols are very individualized. I hope that I will get some more answers tomorrow and will probably start PT as well. So I'll have more info then. Thanks again for the replies.

....

I was around 34..

I did wear a brace for about a year and half while I regained full strength.
Past that point my Doc said there was not much point. As he explained it, the condition in which you really need the brace to do its thing, will also be the condition in which the brace will slip. It made sense to me because to feel like the brace wouldn't slip I had to tighten it too much. Flexing the quad was uncomfortable with the brace really tight. I sort of knew when I didn't need it anymore. The doc also said build up the hamstring to help protect the ACL.

[Buick55]

I had a meniscus repair with a donor tendon for the ACL. The extension for me took about two months to get it fully extended and it was painful to deal with the stretching, but no pain no gain I guess. I still can't do a full squat with out a little patellar tendon pain, but my therapist says it will come with time. I'm finding not going to deep and keeping extremely good form isn't as painful, but I am 4 months after surgery. They are still telling me it will be another month or two before I am able to run again. So don't get discouraged, but I feel the same way. I feel like I should be farther along, but the PT says tendons take a long time to fully heal. I also did a ton of damage to the knee, so hopefully yours wasn't as bad.

[Fresch]

5 days ago I had surgery to reconstruct a completely torn ACL and remove a partially torn medial meniscus in my left leg. I hurt myself playing basketball about 6 months ago and finally had the surgery after an MRI showed that the meniscus was damaged. I had an allograft tendon put in for the ACL and, for the meniscus, part of it was removed. The surgery went great, but I have a couple of questions on my rehab.

My doctor has me on an extremely conservative recovery protocol. He wants me using a CPM (continuous passive movement) machine with flexion from 0-30 degrees and no further in the 1st 2 weeks. By week 4 he wants me up to 60 degrees and by week 6 he wants me up to 90 degrees. In addition, I was advised not to do any rehab exercises during the first 2 weeks: just extending range of motion to 30 degrees.

I am concerned because this protocol is a lot slower than anything I've read online by far. Most of the protocols I see have patients reaching 90 degrees flexion in the first week and doing strengthening exercises immediately.

Does anyone have any experience with this that could possibly reassure me that this rehab will be effective? Also any helpful resources you have on ACL recovery and rehab would be helpful.

Very conservative management indeed. Can't understand why it would be so slow.

Therapy should still start the day post surgery.

The meniscal component will slow the recovery, but should not explain such a slow rehab process.

[csabatka1]

Here are the first 3 months of rehab post ACL/MCL/meniscus. I had a very aggressive physical therapists and very aggressive in my own strength training.

Personal advice, stay aggressive on it, but listen to your body. If it hurts don't do that exercise. Start high reps and work on balancing.

http://csabatka1.blogspot.com/

[Cat11937]

I just had the same surgery August 8, 2013, and I been unable to weight bear and in tremendous pain being on bed rest. I am on several pain killers that don't work as I can't top crying. I went to my first post op appt on August 21, 2013, the other surgeon who was in surgery with me manipulated my knee and told me being in this much pain was abnormal. With his help I could bend my knee 40* and straighten to 10* but I could not hod my leg up on my own. My primary surgeon came in without even checking me and told me I retore my acl. How could I do that on bed rest???? I feel like he s covering up for messing the surgery up. I feel like I should be in physical therapy bc I'm scared I'm going to me in a wheelchair for a long time if I cat strengthen my leg. Can someone help me so I can feel less pain

[Fresch]

I agree, how you can re-tear an ACL reco in bedrest is beyond me, and how you can diagnsoe it without examination / investigation is a total mystery!

[fabienzan]

Thanks for the response. I am not sure I want to switch doctors a week after surgery. I just want to make sure that I am going to heal correctly. I'm not in an extreme hurry to get back to action. So a few extra weeks of rehab is np, as I don't play any sports.

What type of graft did you have and any meniscus damage? did you completely tear the ACL? Are you back to 100% now? And when was your surgery?

Hi Photostic,

I am having the same operation as you in 1 week. ACL recow with Hamstring and medial and lateral meniscus partial menisectomy. I am curious to know how you are going after 10 years this is normally when you start getting osteoarthritis.
Is your knee fully functional with no pain ?

Thanks

[fabienzan]

I just had the same surgery August 8, 2013, and I been unable to weight bear and in tremendous pain being on bed rest. I am on several pain killers that don't work as I can't top crying. I went to my first post op appt on August 21, 2013, the other surgeon who was in surgery with me manipulated my knee and told me being in this much pain was abnormal. With his help I could bend my knee 40* and straighten to 10* but I could not hod my leg up on my own. My primary surgeon came in without even checking me and told me I retore my acl. How could I do that on bed rest???? I feel like he s covering up for messing the surgery up. I feel like I should be in physical therapy bc I'm scared I'm going to me in a wheelchair for a long time if I cat strengthen my leg. Can someone help me so I can feel less pain

Howe did you go with that ?

[fabienzan]

5 days ago I had surgery to reconstruct a completely torn ACL and remove a partially torn medial meniscus in my left leg. I hurt myself playing basketball about 6 months ago and finally had the surgery after an MRI showed that the meniscus was damaged. I had an allograft tendon put in for the ACL and, for the meniscus, part of it was removed. The surgery went great, but I have a couple of questions on my rehab.

My doctor has me on an extremely conservative recovery protocol. He wants me using a CPM (continuous passive movement) machine with flexion from 0-30 degrees and no further in the 1st 2 weeks. By week 4 he wants me up to 60 degrees and by week 6 he wants me up to 90 degrees. In addition, I was advised not to do any rehab exercises during the first 2 weeks: just extending range of motion to 30 degrees.

I am concerned because this protocol is a lot slower than anything I've read online by far. Most of the protocols I see have patients reaching 90 degrees flexion in the first week and doing strengthening exercises immediately.

Does anyone have any experience with this that could possibly reassure me that this rehab will be effective? Also any helpful resources you have on ACL recovery and rehab would be helpful.

Hi,

I am having this operation this week. I am wondering how you are going 10 years after this operation ? Have you got any sign of OA , is your knee still bothering you or is it full functional again ?

[fabienzan]

OP, I can't speak to the ACL side . . . but I did have a partial menisectomy in my right knee about 7 years ago. I was in much the same boat as you were on that one. I had hurt my knee when I was in 5th grade (slipped on wet grass while kicking a ball and landed in a hurdler stretch--tore meniscus) but back then they did not think surgery was needed. I lived with it locking up on me every now and then . . . finally got it in the wrong position during martial arts and the sucker wouldn't unlock at all.

The surgeon went into it intending on repair . . . but post-op he said that it was injured so long ago that repair was impossible. He tried to do what he could but in the end he said it just had to come out.

Anyway . . . my recovery went pretty well. I was riding a stationary bike within a few weeks and a regular bike a few weeks after that. Took things slow to get back into lifting, but got back to full speed fairly quickly I thought. It hasn't kept me from doing any sports and feels fine for the most part.

Good luck with the rehab!

Just wondering how you are going now ? Any sign of pain , OA or anything else on your repair knee ?

[fabienzan]

5 days ago I had surgery to reconstruct a completely torn ACL and remove a partially torn medial meniscus in my left leg. I hurt myself playing basketball about 6 months ago and finally had the surgery after an MRI showed that the meniscus was damaged. I had an allograft tendon put in for the ACL and, for the meniscus, part of it was removed. The surgery went great, but I have a couple of questions on my rehab.

My doctor has me on an extremely conservative recovery protocol. He wants me using a CPM (continuous passive movement) machine with flexion from 0-30 degrees and no further in the 1st 2 weeks. By week 4 he wants me up to 60 degrees and by week 6 he wants me up to 90 degrees. In addition, I was advised not to do any rehab exercises during the first 2 weeks: just extending range of motion to 30 degrees.

I am concerned because this protocol is a lot slower than anything I've read online by far. Most of the protocols I see have patients reaching 90 degrees flexion in the first week and doing strengthening exercises immediately.

Does anyone have any experience with this that could possibly reassure me that this rehab will be effective? Also any helpful resources you have on ACL recovery and rehab would be helpful.

Hi,

How are you going now with your knee ?

Cheers

[Photostic]

Hi,

How are you going now with your knee ?

Cheers

Hey - It's closer to 5 years post op. But the knee is doing great as far as the stability. Arthritis is definitely present and is hurts a lot of the time.