Riding after an ACL/meniscus injury?- Mtbr.com
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  1. #1
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    Riding after an ACL/meniscus injury?

    I am contemplating throwing some gears on my SS. In January I had a total tear of my ACL as well as a minor tear of the meniscus and will have surgery next Thursday for repair. I won't be on the bike for a bit afterwards, but when I can ride I am thinking the SS will be too much on my knee. I will put the gears back on sometime in September or October (7-8 months post surgery).

    I am also considering another bike as my SS is rigid and has no dropper post. In this case the other bike would be less focused and allow more room for riding errors.

    Anyone here have an experience with this injury and single speeding afterwards? Or for that matter, experience with riding any mountain bike post ACL reconstruction?

    Thank you!

  2. #2
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    Have had the ACL done on both knees. Right knee in 1997 along with torn meniscus and left knee in 2013.


    No problems riding at all...I ride year round...mountain bike, winter fat biking and road biking.

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    Quote Originally Posted by prj71 View Post
    Have had the ACL done on both knees. Right knee in 1997 along with torn meniscus and left knee in 2013.


    No problems riding at all...I ride year round...mountain bike, winter fat biking and road biking.
    I am glad your results were so good!

    I am 8 days out now from the surgery. Good news is that the meniscus tears were significantly less and problematic than the MRI showed. My surgeon was able to leave them alone basically. He threw on stitch into the lateral side (which appeared less damaged in the MRI) and the medial side wasn't really damaged at all (this side appeared more damaged in the MRI).

    I worked hard to gain mobility of the joint in the first 6 days. I have an amazing 90+ degrees of flex and can get the knee totally flat with just the slightest hyperextension. All of this sort of shocked the doc. He still wants me on crutches until the first of April, but he gave me an Rx for PT, which I begin 3x/week tomorrow. I still am working on getting the swelling down, but things are definitely pointed in a better direction now.

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    What was your ACL repair?

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    Quote Originally Posted by Forest Rider View Post
    What was your ACL repair?
    The ACL is the abbreviation for anterior cruciate ligament. This is one of four ligaments that hold the knee joint together. The ACL controls how the femur moves over the tibial plateau and prevents hypertension. I tore mine completely which requires surgery to gain full athleticism. That surgery involves replacing the ACL with a graft, which comes from two primary sources—the injured’s own body (removal of portions of either the hamstring or patella tendons) or a cadaver donor ACL. Mine came from my hamstring. This type of surgery is generally preformed with arthroscopic techniques—meaning it is considered minimally invasive. That said, the instruments used do go all the way into the middle of the knee joint and involve boring holes into both the femur and tibia.

    Soccer and basketball players as well as skiers (and many other sports too) can injure this ligament in so much as these sports involve quick lateral moves in a stop and go environment.

    My surgery was a total ACL reconstruction with a single stitch thrown into my medial meniscus too. Very frequently ACL tears involve meniscus damage as well. The meniscus are the cartilage pads between the femur and tibial plateau. There are two of them.

    I will be “toe weight” bearing for a few weeks, which means crutches. I hate crutches. 20 years ago I broke my ankle and was on them for 8 weeks with no weight on that leg at all. At least I can put a small amount of weight on that leg! Haha!

    It takes up to 9 months to fully recover from this injury. But that means being where I was prior to the accident. Last time I did PT (the broken ankle) I came back stronger than pre-injury. I will do that again. I hope to be riding by the end of April on my road bike and end of May on easy single track. Back to technical riding by the end of summer or early fall. And skiing next year (which is my one true love) by first of December.

    Hope that explains your question thoroughly!

  6. #6
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    Wow, much more background than expected.

    I've had the surgery, but thanks for the description.

    You said 'tore' your ligament and I didn't know if you meant it was 'severed'.
    I too had the hamstring allograft.

    I say you need to listen to your PT as far as recovery. It sounds to me like you are overdoing it at home without direction.
    I was never an athlete prior to the ACL reconstruction, however since surgery I've run marathons, shorter races. Road and mountain bike, softball and still dirt bike. Because I took time and patience to properly heal I am in a great position to continue pain free for hopefully the rest of my life. One thing I do not want to happen is to destroy the graft. Surgery #2 to repair #1 is not pleasant, so I'm told.

    I think the #1 cause of re-injury is going back to activity too early. In my opinion, being on a bike in 2 months is a pipe dream.

    Best of luck to you in your recovery. I was injured for 15 years before having the surgery performed. So glad I did finally have surgery!

  7. #7
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    Quote Originally Posted by Forest Rider View Post
    Wow, much more background than expected.

    I've had the surgery, but thanks for the description.

    You said 'tore' your ligament and I didn't know if you meant it was 'severed'.
    I too had the hamstring allograft.

    I say you need to listen to your PT as far as recovery. It sounds to me like you are overdoing it at home without direction.
    I was never an athlete prior to the ACL reconstruction, however since surgery I've run marathons, shorter races. Road and mountain bike, softball and still dirt bike. Because I took time and patience to properly heal I am in a great position to continue pain free for hopefully the rest of my life. One thing I do not want to happen is to destroy the graft. Surgery #2 to repair #1 is not pleasant, so I'm told.

    I think the #1 cause of re-injury is going back to activity too early. In my opinion, being on a bike in 2 months is a pipe dream.

    Best of luck to you in your recovery. I was injured for 15 years before having the surgery performed. So glad I did finally have surgery!
    Having just had my first visit with the PT, we went over the rehab protocols, I think you are correct about my riding ambitions that early. (Damn!) While I have a deep and long athletic background, I am not the best at being injured. (I played NCAA Division 1 basketball for NAU in the 1980's, skied professionally in the 1990's, and have ridden bikes competitively for about 7 years now, not to mention racing factory Ducati's for about 10 years in the early 2000's as well.)

    It was explained to me that the allograft undergoes a change in its physical structure--going from tendon to ligament physiologically. This change happens slowly over time, but the most critical portion happens in a 4 to 8 week period during week 8 through 16 of recovery. It is during that period of time that most re-injuries happen because people start to feel considerably better and do too much, too early.

    Besides all of this, I will most likely be using crutches for at least another month to help aid the meniscus tear which had a single stitch put into it. Putting weight on the knee now will cause the stitch to fail.

    I have been warned and will listen. Thank you for sharing your experience too. Good to know you had a good result.

  8. #8
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    Quote Originally Posted by beastmaster View Post
    Having just had my first visit with the PT, we went over the rehab protocols, I think you are correct about my riding ambitions that early. (Damn!) While I have a deep and long athletic background, I am not the best at being injured. (I played NCAA Division 1 basketball for NAU in the 1980's, skied professionally in the 1990's, and have ridden bikes competitively for about 7 years now, not to mention racing factory Ducati's for about 10 years in the early 2000's as well.)

    It was explained to me that the allograft undergoes a change in its physical structure--going from tendon to ligament physiologically. This change happens slowly over time, but the most critical portion happens in a 4 to 8 week period during week 8 through 16 of recovery. It is during that period of time that most re-injuries happen because people start to feel considerably better and do too much, too early.

    Besides all of this, I will most likely be using crutches for at least another month to help aid the meniscus tear which had a single stitch put into it. Putting weight on the knee now will cause the stitch to fail.

    I have been warned and will listen. Thank you for sharing your experience too. Good to know you had a good result.
    I am happy to hear the comments from the PT at least in terms of how people get moving when they 'feel better'. In my experience, my PT wanted me to easy into our prescribed activity....for one, because there is protocol for rehab for ACL reconstruction, but also because it allows our mind to understand that despite feeling good, we are not healed.
    It's pretty important too that the bone grows around your pins so that they do not pull out.

    Very true about meniscus. I didn't have to worry about that as much of mine was cut out due to the amount of tears I had going on. I had it worked on 3 times in total for scoping and meniscus trimming, the 3rd time being during ACL work.

    I was on crutches for a while, can't recall exactly how many weeks but it was at least 3 or 4 weeks. Then starting out by walking/standing with 50% weight on the repaired side. Then moving to a single crutch. I went in to PT without my crutch. He wasn't sure how to react, but I figured I'd fall over trying to figure out how to walk with a single. ha He watched me walk and did some examining (poking and prodding) and said I was fine as long as I walked per our discussions.

    I cannot recall how long it was, but it was a very long time. He had me doing box jumps. He first showed me what he wanted. So I jumped up on top of the 18" box and stood there. He told me to jump down. I said I needed a second as I could envision myself collapsing when I jumped off since it had been so long doing anything like that.
    Keeping in mind I would routinely jump over the side of a 4" lifted full size pickup and think nothing of it, prior to surgery. I was amazed in myself to jump down from 18" with success. haha Finally I am getting to be normal again. But yeah, that was quite a bit into the recovery.

    I have a fair bit of arthritis in that knee now so I can't run as much as I used to. It does ache from time to time when I run. I can get past that, but I have a lot of years left and I want to be able to walk normally when I am older.

    Just today I was dirt bike riding, a lot of up on the pegs. There is a bit of joint soreness when I finished, but a few hours later after cleaning the bike and getting it all put away, I feel perfectly normal.

    The hardest part is listening to the doctors orders, well the PT I mean. When I was incorporating jump rope, and box jumps -impact activity, I started taking the stairs harder at the office I work at. If a little is fine, more must be okay too. After a few days of doing the extra work of stairs at work, my IT band was hurting so bad. I tried to mask it until PT saw me landing on my toe differently on that leg. When they asked, I told them where it hurt (it was IT but I had no idea what he heck that was at that time). No impact for a week. Healed right up and I was back to it, but this time I did't over do it.

    I feel like I am definitely one of the ones with a very positive experience all said and done. I have raced either 3 or 4 half-marathons. Two marathons and a crap ton of fast shorter races. I got down to low 6 minute pace. My first marathon was 3:35. I climb forever on the mountain bike, have put in countless road bike miles. I was one of the fastest guys on the softball teams I was on. Like I mentioned earlier, aside from running through the neighborhood when I was younger, I was never an athlete. About 15 years of being injured, then finally getting fixed is when I found the world of sports and I am glad I have the capabilities I do.

    Hang in there and don't let it get your down. The best thing about the ACL surgery is they are common and you will heal as good as new. I never feel anything as a result of the hamstring graft. I have a very very tiny spot on my knee with no feeling. PT told me eventually the area would probably be the size of a quarter with no sensation. I think it's at least that size or smaller. The quad muscle on that side won't grow as much as the other leg, and I was warned of that. It is plenty strong, but doesn't have the size as proof that they are (assumed) equal in strength. Being as athletic as you are, you will bounce back perfect with less effort than others will take. I was 2 weeks behind a cadaver patient in PT and that person complained of pain and was well behind me. She didn't want to do the work.....And wasn't very athletic.
    All I had going for me prior was just working out in a gym.

    Looking forward to hearing some of your progress over the next couple months.

  9. #9
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    Couldn’t have happened to a nicer guy. 🤪

  10. #10
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    tl;dr. Cliffs note version?



    Quote Originally Posted by beastmaster View Post
    The ACL is the abbreviation for anterior cruciate ligament. This is one of four ligaments that hold the knee joint together. The ACL controls how the femur moves over the tibial plateau and prevents hypertension. I tore mine completely which requires surgery to gain full athleticism. That surgery involves replacing the ACL with a graft, which comes from two primary sources—the injured’s own body (removal of portions of either the hamstring or patella tendons) or a cadaver donor ACL. Mine came from my hamstring. This type of surgery is generally preformed with arthroscopic techniques—meaning it is considered minimally invasive. That said, the instruments used do go all the way into the middle of the knee joint and involve boring holes into both the femur and tibia.

    Soccer and basketball players as well as skiers (and many other sports too) can injure this ligament in so much as these sports involve quick lateral moves in a stop and go environment.

    My surgery was a total ACL reconstruction with a single stitch thrown into my medial meniscus too. Very frequently ACL tears involve meniscus damage as well. The meniscus are the cartilage pads between the femur and tibial plateau. There are two of them.

    I will be “toe weight” bearing for a few weeks, which means crutches. I hate crutches. 20 years ago I broke my ankle and was on them for 8 weeks with no weight on that leg at all. At least I can put a small amount of weight on that leg! Haha!

    It takes up to 9 months to fully recover from this injury. But that means being where I was prior to the accident. Last time I did PT (the broken ankle) I came back stronger than pre-injury. I will do that again. I hope to be riding by the end of April on my road bike and end of May on easy single track. Back to technical riding by the end of summer or early fall. And skiing next year (which is my one true love) by first of December.

    Hope that explains your question thoroughly!

  11. #11
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    I had the same injury racing Bootleg Canyon February 11, 2011. I went off course. One of my pedals released, the other didn't. I remember being on my back with the bike above me twisting my knee. I stood up and my knee bent laterally. It made me sick to my stomach as my adventure lifestyle ending flashed before my eyes.

    Luckily I worked in orthopedics and had one of the docs fix me up. The surgery was held off for a month and a half until the swelling went down. It wasn't until the beginning of July that I was able to get back on the bike which is a single speed but only rode flat bike paths. I was back to racing the single speed class by mid October.

    I didn't go to formal PT. The doc gave me paper with the movements she wanted me to do, and that was it. I saw her everyday in the OR anyway.
    Ripping trails and tipping ales

  12. #12
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    Quote Originally Posted by Jim Beam View Post
    Couldn’t have happened to a nicer guy. 🤪
    Really? Wow! Showing your true colors again?

  13. #13
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    I've been looking for some recent threads of recovery time to cycling post ACL surgery. So it's good to see others having success at going through the process.I had my ACL repaired with a Hamstring graft at the end of March. At 1 week I didn't think I would ever walk again...a bit dramatic but I had forgotten how hard the recovery was from my previous ACL repair from 17 years ago. But...

    I was able to complete a complete revolution on one of those stationary recumbent bikes at the Physical Therapist office on day 12. That was a big step for me to at least see there was a light at the end of the tunnel.

    On day 19, I went to REI and bought a Wahoo smart trainer. I went home and hooked it up to Zwift and got on the bike (30 min per my PT's recommendation). At first the knee was stiff and it was a bit of work to make a complete revolution but once I warmed up a little I had a great 30 min ride.

    Over the next week I rode every day and progressed to an hour. I gained strength each day. It was awesome.

    Today was 4 weeks and 1 day. I rode for one hour and 38 minutes with an average of 155 watts. It felt awesome. I could have kept going but didn't want to over do anything. It's amazing how good this is for your leg and how it speeds up recovery by not only building strength but by building your motivation to get back out on the road.

    I haven't had my 6 week follow up with the Dr. yet but my PT tells me that the 2 month mark is about the soonest he would recommend cycling outside on a flat bike path. He said 4-5 months for mountain biking on single track. Obviously I'll back up his recommendation with the Dr's when I have my next appt. Does this time frame sound about right for what you all have experienced? Until then, I plan to keep chugging away on the trainer and building my fitness.

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    I trust the PT before the Doctor estimates.

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    Quote Originally Posted by FlyBoy View Post
    I've been looking for some recent threads of recovery time to cycling post ACL surgery. So it's good to see others having success at going through the process.I had my ACL repaired with a Hamstring graft at the end of March. At 1 week I didn't think I would ever walk again...a bit dramatic but I had forgotten how hard the recovery was from my previous ACL repair from 17 years ago. But...

    I was able to complete a complete revolution on one of those stationary recumbent bikes at the Physical Therapist office on day 12. That was a big step for me to at least see there was a light at the end of the tunnel.

    On day 19, I went to REI and bought a Wahoo smart trainer. I went home and hooked it up to Zwift and got on the bike (30 min per my PT's recommendation). At first the knee was stiff and it was a bit of work to make a complete revolution but once I warmed up a little I had a great 30 min ride.

    Over the next week I rode every day and progressed to an hour. I gained strength each day. It was awesome.

    Today was 4 weeks and 1 day. I rode for one hour and 38 minutes with an average of 155 watts. It felt awesome. I could have kept going but didn't want to over do anything. It's amazing how good this is for your leg and how it speeds up recovery by not only building strength but by building your motivation to get back out on the road.

    I haven't had my 6 week follow up with the Dr. yet but my PT tells me that the 2 month mark is about the soonest he would recommend cycling outside on a flat bike path. He said 4-5 months for mountain biking on single track. Obviously I'll back up his recommendation with the Dr's when I have my next appt. Does this time frame sound about right for what you all have experienced? Until then, I plan to keep chugging away on the trainer and building my fitness.
    My surgery was February 28th. Yesterday was 8 weeks out. My PT says I am considerably ahead of where most people are at this point. BUT! He also keeps reminding me about the rehab protocols and how important it is to be careful not to re-injury myself.

    From weeks 8 to 12 the hamstring graft undergoes a complex process. In essence, the new graft doesn't have the blood supply it had (when it was part of the hamstring) or will have when the recovery reaches 12 to 16 weeks. During this period we are at the greatest risk of either re-tearing it or stretching it.

    My Doctor's protocol says no outdoor cycling until 12 weeks, no standing on the pedals until 14 weeks and at 16 weeks I can go full gas. In the meantime I am working out in the gym, riding my road bike on the trainer, and doing PT 3x/week. Good thing I have a lot of work to do otherwise the waiting would seem impossible to endure.


    Quote Originally Posted by Forest Rider View Post
    I trust the PT before the Doctor estimates.
    I would trust the physician who did the work first and let them determine the time table. PT's are very important in the process, but they shouldn't (and ethically cannot) take the lead in creation of the protocols.

  16. #16
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    Thanks for sharing your timeline Beastmaster. It's good to hear how your process is going and the recommendations from your people. I'm anxiously looking forward to what the surgeon says at my next appt in a week and a half. The bike feels great, but I'm not going to push it too hard until he gives me the green light.

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    Quote Originally Posted by FlyBoy View Post
    Thanks for sharing your timeline Beastmaster. It's good to hear how your process is going and the recommendations from your people. I'm anxiously looking forward to what the surgeon says at my next appt in a week and a half. The bike feels great, but I'm not going to push it too hard until he gives me the green light.
    Are you riding your bike off the trainer, as in on two wheels only, as in outdoors? If so, be careful! Shearing forces can damage the fresh graft and it is way easier to damage it than you might imagine.

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    I’m not. Like I was saying in my first post, I got a smart trainer and have been riding indoors. Unfortunately I’m not expecting the doc to clear me for outdoor riding until sometime in June.


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    Sounds like you're being smart. What do they say, "absence makes the heart grow fonder?" I, for one, can't wait to get back on my bike, my real bike, outside, on pristene single track in the high country!

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    First post-ACL reconstruction outdoor ride is in the books. First off, I had to change my pedals to flats. This was the first time I have ridden on flats since I was a child. (Riding clipless is not advisable, as the knee can have some twisting movement and I would likely pull up on them, as I normally do.) I was super slow and very careful. No need to re-injury the surgical repairs.

    Boy did this feel great!

    Riding after an ACL/meniscus injury?-img_5035.jpg

    Riding after an ACL/meniscus injury?-img_5034.jpg

  21. #21
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    Quote Originally Posted by beastmaster View Post
    First post-ACL reconstruction outdoor ride is in the books. First off, I had to change my pedals to flats. This was the first time I have ridden on flats since I was a child. (Riding clipless is not advisable, as the knee can have some twisting movement and I would likely pull up on them, as I normally do.) I was super slow and very careful. No need to re-injury the surgical repairs.

    Boy did this feel great!

    Click image for larger version. 

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    Beastmaster. Awesome news. Looks like your first ride outside was right at or a little after 2 months from your surgery. How has it been going since then? Have there been any issues with the dismount from the bike?

    Have you mostly stuck to paths and roads or have you ventured onto some tame single track?

    How long before you are cleared or are going to try riding with your clip ins?

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    Quote Originally Posted by FlyBoy View Post
    Beastmaster. Awesome news. Looks like your first ride outside was right at or a little after 2 months from your surgery. How has it been going since then? Have there been any issues with the dismount from the bike?

    Have you mostly stuck to paths and roads or have you ventured onto some tame single track?

    How long before you are cleared or are going to try riding with your clip ins?
    I saw my orthopedic surgeon today. Tomorrow is 3 months out from surgery. My physicians protocol states seated outdoor cycling can begin at 10 weeks; standing hill climbing at 16 weeks--on June 20th (he modified it today); and easy single track at this point too.

    He wants me to stop PT at the end of my Rx (7 more sessions) in favor of hitting the gym hard. I have no swelling anymore and full range of motion.

    In August he will fit me for a knee brace for this upcoming ski season. At that time he will most likely give me the go-ahead to begin the easier high mountain single track with my clipless pedals. In the fall he will give me permission to hit the more technical terrain.

    The things he wants me to avoid (until August) are running, dynamic twisting movements, or sudden hits (like extending my foot to catch myself if I have a big front end slide on the bike.

    In the fall I will begin dynamic exercises, like box jumps, running drills, and other stuff to increase lateral motions.

    It turns out there is a lot to come back from after an injury like this. The main thing I need to work on now is overall strength and developing my cardio again. The front side of this recovery is slow and lingering. The backside will be steep and hard. The middle (where I am now) is the approach to the hard stuff.

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    I remember when I was started on box jumps and running drills. Best days ever! It took a lot of mental capacity to box jump. I was shown how to do it. I then jumped up on the box and just looked at the ground like "are you kidding me". After doing it a couple of times I can't even describe how I felt.

    Good luck with your continued recovery. Sounds like you're progressing nicely!

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