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  1. #1
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    Post ACL Surgery and Riding

    Hello All,

    I was wondering if anybody could give some advice. I'm about 5 1/2 months out from surgery for a torn ACL and meniscus. I've finished physical therapy and have been in the gym on a regular basis trying to get the leg muscles back. I've also been doing quite a bit of road riding.

    I had a doctors appt. about a week ago and he basically cleared me for all activities (except for pivot-sports such as soccer and hoops). Anyway, I'm still nervous about hitting the singletrack. I'm just about to start using clipless pedals again (been on platforms since after surgery), and I'm nervous about that as well. Any words of wisdom from any folks who have gone through this before??

    Thank you all in advance!

  2. #2
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    What kind of graft did you have? I had a patellar tendon graft which takes a long time to recover from. There is a possibility to aggravate the harvest site and get tendonitis. Barring that most of your limits are psychological at this point. Just get back into normal activities and proceed with caution. Some good advice for bad knees is until you get your strength back spin small gears and don't mash. Oh, also warm up before and ice after each ride. Good luck.

  3. #3
    recovering roadie
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    I wore an ACL knee brace mountain biking for a while as a backup. I started doing easier rides 3 months post-op, but continued to take the knee brace with me on gnarlier rides for probably a year or more.

    Surgery was more than four years ago now, and things work pretty well.

    Keep up the good work, you're going to get there.

  4. #4
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    Thanks for the good words, guys. I really appreciate it! It's good to hear from people who have gone through this before and are now back to normal.

    Pogie - I had a hamstring graft. I'm actually finding that one of my trouble spots is a weak hamstring. Go figure!

    Anyway, thank you guys again for the advice!

  5. #5
    dru
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    dont sweat it

    Got the surgery in 90, got a black belt in karate in 97, boxed for two or three years after that. Have mountain biked for over ten years seriously. Have almost no meniscus on the inside of the repaired knee (tore the acl in 84-no good fixes till 90). Cant run, knee swells up. Can ride like a biatch though, and can still go a few rounds too.

    I am 43, the surgery is 17 years old. Take it easy for a few weeks and watch your saddle height. Patellar femoral syndrome is a common side effect of the surgery so monitor your discomfort. PFS is also caused by too much hammering at fixed rpms so mix it up a bit.

    You'll be fine, just make sure you get out of the pedals if you bail!

    Drew

  6. #6
    dru
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    You had the hamstring version? I don't know about the side effects of that! Sore hams? If so don't go for the single speed scene at first. I did a few rides in one gear just to see what it was like and I couldn't walk the next day!

    Anyways you will be fine!

    Drew

  7. #7
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    Dru is right - no good repairs until after 90....

    Both ACL's "redone" in late 90's Within 12 weeks of operation I was riding MX with Cti braces and riding XC at full capacity without braces. I had the cadavor (spelling) fix the last time. My knees feel as good as new. Now its my "back"

  8. #8
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    dru and mtrhead - thanks for the good words. it's really great knowing that there is longevity in getting the ACL fixed!! sounds like you guys have been there and done that. i'm definately steering clear of mashing big gears and going with the spinnning instead. i can't believe how much strenght i've lost (not saying i had any before the surgery!). but when it comes to goin' up...it's a struuuuggle!!

    anyway, thanks for good words of inspiration! glad to hear all is still going well for you guys!

    cheers.
    j

  9. #9
    sixsixtysix
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    I am 6 months out from surgery # 6 on my left knee. This is my 3rd torn ACL and this time they had to do a full meniscusoscopy on both the lateral and medial meniscus since I folded what was left into my knee joint and locked it at a 30 degree angle. Because of that I was unable to get a ACL graft done in the first surgery and do to post surgery complications I am looking at not having an ACL for at least a year.

    That being said. I went out and got myself a new brace and have been on the bike for the last 2 1/2 months, basically since 16 weeks post op I have been riding single track. Last weekend I did a 8 mile, 3000 vertical foot climb on my 50lb DH bike followed by a 15 mile downhill run which is my longest and hardest ride to date post op and had no problems.

    Get back on the bike and just take it slow, don't overstep your own bodies protect mechanism. I know for about the first 6 weeks I was on the bike everytime i would need to put my foot down I was very very mindful to make sure I went onto my good leg and actually let myself just tip over a few times rather than planting my bad leg.

    If you have a brace, wear it, if not get one and wear it. Don't look at it as a rehab device, look at it as a piece of protective equipment design to protect all the invested pain suffering and rehab you have gone through to get your knee repaired. It is no different than wearing shin guards or a helmet. If I had followed that bit of advice, I would have not have torn mine for a 3rd time, and I will not even throw my leg over a bike without my brace on.

    If you take care of yourself and protect that knee you will have no problems performing the tasks and participating in the sports you love to do for a long time, if you don't each time it gets injured, it gets a little worse and a little slower recovery time.

    Take care of yourself and good luck

  10. #10
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    six - thanks for the advice! wow! sounds like you've been there and done that when it comes to knee injuries. i'm sorry to hear about your issues; hopefully this will be the last go-around for ya!

    i'll definately take your advice this weekend, as i'm planning to head out on the trails for the first time since the injury. i'm contemplating on wearing flats/platforms for the first time out. also, you mention the use of a knee brace. sounds like you swear by it. i'll have to look into that. there seems to be differing opinions about the matter depending on who you talk to.

    at any rate, i wish you best of luck with your own recovery!

    cheers,
    j

  11. #11
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    I had an acl replaced with a cadaber graft in feb.It failed because it loose and now the doc wants to re do it with my hamstring next month.He said it is going to hurt worse than the first time[OUCH]! He could do a patillar graft too.What would you do?I also had a third of miniscus removed too.Sorry bout my spelling.Thanx RB

  12. #12
    sixsixtysix
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    I only ride platforms, I don't trust myself with clipless pedals, not just because of my knee, but because I have a tendency to do stupid things.

    As far as the brace, I do swear by wearing one now, because had I been wearing one last October, I wouldn't have been in the situation I am. My crash was a near 0 speed crash where I simply got my leg tangled up in the frame as I went over the bars, had I not got my foot caught I would have not had a single scratch on me. But because I had already had 5 knee surgeries over the past 15 years, my knee was far from perfect and susceptible to re-injury. I would talk to your doc, tell him very honestly what you intend on doing on your bike and ask if he feels it would be worth the extra protection to wear one. You see alot more DH guys wearing them these days as a preventative thing and 661 even makes a few different models of off the shelf braces/pads.


    As for the grafts:
    My doc wont use cadaver grafts because of the chance of rejection and infection, he only uses hamstring and patellar grafts. It is not to far off from when there will be synthetic ACL's, hopefully by the time I have my next one they will be available.

  13. #13
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    Thanks for the reply.I wear a donjoy brace now.But i still hyperextend .Thats why i have to it over again.Hopefully i will be on the trails in 3or 4 months.I just have to be more careful.

  14. #14
    sixsixtysix
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    Quote Originally Posted by rooftrash
    Thanks for the reply.I wear a donjoy brace now.But i still hyperextend .Thats why i have to it over again.Hopefully i will be on the trails in 3or 4 months.I just have to be more careful.
    Really? Which brace were you wearing? Were the hinge stops installed? If so, what degree stops? I have worn Donjoy's for the last 10 years and just bought a new Extreme Armor one for riding since it has the knee pad attachment.

  15. #15
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    It real nice!it is made by Donjoy.It is made of carbon fiber.10 degree stops and interchangeable also.It is so light i don't even know i have it on.It has a knee/chin pad that looks real cool to.and works.you put the pad under the brace so it aint goin no where.I wish i had another one for my other knee to match!looks like body armor.I feel a lot safer and confident while riding.Kind of spendy at 1,100 tailor made and completely built.comes in all colors to match our bikes LOL.The paint aint real good on carbon.tends to scratch.but i aint pretty anymore either.It does it's job .I love it .it is my first one.RB

  16. #16
    dru
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    get the patellar

    Apparently the Patellar tendon version is the 'gold standard' for acl repairs. The idea of using cadaver parts creeps me right out, and why would you want to do it anyways with anti rejection issues? The patellar version hurts quite a bit more than the hamstring apparently. It hurts, I'll tell you that! Go read up, and then find a good surgeon. My guy is down there somewhere, his name is Syd Schulman, and he had an excellent rep. when he was working up here in Canada.

    Good luck!

    Drew

  17. #17
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    I had ACL surgery (hamstring graft) and meniscus repair/trimming last April. According to my physiotherapist I was very lucky in that I don't seem to develop much scar tissue and am a fast healer. I only really used crutches for the first day after surgery and was back on the bike riding easy singletrack 3 weeks post surgery. Probably not the smartest thing to do, my surgeon said riding is good, falling again is bad. I seem to be the exception to the norm because I've sure heard some nasty recovery stories from others. I may have had an advantage by hitting physiotherapy hard for 2 month prior to surgery. I wore a G2 brace for about 3 months post surgery. Once I had regained full range of movement and about 90% strength back my surgeon said the brace was optional. I was back riding 100% within 4 months, and now over a year later the knee that was operated on feels better than the other one.

    I can only recommend to go to physio religiously and progress back into riding as it feels better.

  18. #18
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    ACL Grafts

    Quote Originally Posted by dru
    Apparently the Patellar tendon version is the 'gold standard' for acl repairs. The idea of using cadaver parts creeps me right out, and why would you want to do it anyways with anti rejection issues? The patellar version hurts quite a bit more than the hamstring apparently. It hurts, I'll tell you that! Go read up, and then find a good surgeon. My guy is down there somewhere, his name is Syd Schulman, and he had an excellent rep. when he was working up here in Canada.

    Good luck!

    Drew
    I just thought that I would chime in as well. I am a PT and had my ACL repaired last week along with both my Medial and Lateral Meniscus. My thouthts, and my surgical group's, on differents grafts are like this. Being that we, cylists, perform a very repetetive sport, the Patellar Tendon Bone graft is not the best option. There is a lot of lilterature that is coming out of Scandanavia that indicates what we have thought/seen for some time now in. There is a large number of post-op Patellar tendon grafts that end up with tendonitis and Patellar Femoral Syndrome after their surgeries. As cylclists, we are even more prone to this diagnosis.
    The Patellar Tendon graft gives the best fixation and arguably the best healing rate, however, at a cost of possibly problems down the road. I chose to go with a cadaver graft (got a younger guy with a 10 gauge Post Tib tendon harvest). You may have to baby the graft a bit more in the beginning, however the long term outcomes are arguably quite similar and without the greater risk of repetetive issues down the road.
    BoiseBoy

  19. #19
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    Thank you for the post.This will be my second surgery on this knee since feb 19th.The first one was an Alograft and it failed.[sucks].I just found out today i will be having a [hamstring graft] on June 4th:[ I'm a little worried about this one because i hear the [hamstring graft] hurts like hell.even more than the first one i had with the alograft and i thought my leg was cut off at the knee!The oxycodone was prescribed 20 mg every 4 to 6 hours for moderate to severe pain and i could only go 3 hours before i had to take 20mg's again.The pain was horrible!and i thought i could take alot of pain.It lasted a little under 48 hours before i could back off the pain meds a little.I must be a puss but it hurt severely.i couldn't even sleep.the pills made me sick as hell.I used an ice man too for swelling.My question is how bad did the hamstring part hurt,how bad on a scale of 1 to 10,what kind of pain meds were you taking?Is there anything i can do now to make this any easier?Last time i also went through mild withdrawals after i went off the meds too.because i had to take them for like 3 months prior to surgery because work mans comp couldn't get their shi- together and get me approved for surgery.[NIGHTMARE].God i hate this!I just bought a brand new Giant Trance 3 and now i just get to look at it.Sorry for the poor me.I just need to get it off my chest.Is there any non narcotic pain killer you know of ?I don't want to get the physical withdrawals again either.Thanx for listening.RB

  20. #20
    dru
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    Pain.....

    My acl operation was the worst pain I've ever endured. I was getting knocked out with Dermerol iv every 4 hours. I'd wake up two hours later and then last about an hour before *****ing for more. Brutal. Way worse than going over the bars with no shirt on pavement at 30 mph and breaking the collarbone too, in two places, on my motorcycle. The severe pain lasted about 24 hours. I am a bit of a suck I guess.

    As for pfs, I've been very lucky, that's all. I occasionally have my left knee, the good one, bother me because of the clutch on the 18 wheeler. I just favour the bad leg when this happens.

    Biking in general has been the best thing for my knee in general, despite the risk of pfs. I have to agree, the hamstring version might be the better choice for us cyclists.

    Drew

  21. #21
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    I tore my left ACL a year ago, had it replaced with donor tissue and was on the bike 3 mos after. Then I crashed again and had to have ACL surgery in the same knee.

    I've been back riding for tha last 5 mos and use a knee brace on every ride. I've though about using it only on the technical rides where I can do something stupid and reinjure it, but there's always that voice in my head that tells me not to do it.

    Just my 2 centavos

  22. #22
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    RT - i had my ACLr surgery about 5 months ago. had the hamstring graft. i don't really know what to say regarding the pain. it definately hurt...a lot. i don't really know how to compare it to anything. for the first few days, it was definately the worse pain i've ever had. but, it sounds (unfortunately) like you've kind of been through this sort of thing, so it may not be as bad as you think it's gonna be. i was tripped up pretty well on vicodin. probably stayed with it for a couple of weeks, if i recall. i was happy to get off of it, though. after the vicodin, i just did a steady dose of over-the-counter pain stuff. it was uncomfortable, but not unbearable. i have to echo the sentiments made before: just hammer on the physiotherapy. having a good therapist made all of the difference to me. it certainly hurt, but in the end, it worked out quite well.

    sorry to hear about your graft failing. but you'll get through this, no doubt. best of luck!

  23. #23
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    I wish I'd never even entered this forum. these threads are depressing me. i haven't had ACLs for around 10 years.

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