ACL tear, needing advice

I did patellar tendon graft as well.

The first few days post op were really easy for me pain wise, so I wouldn't worry too much about that.  I stuck to the recommended pill regiment for 3 full days and never had pain levels go above a 4/10 or so.  After the 3rd day I switched to normal amounts of advil and on day 5 I was completely off any sort of painkiller.  I'm just starting to regain feeling around the incision, and I can definitely feel the graft site when I make certain movements, but the pain is pretty minor.  The only way I can describe the pain from the graft site is that you definitely feel that they took something from the area, but nothing more than a reminder (I would rate it about a 2/10 on a pain scale).  My PT also told me that the pain will start to fade after about 6 months.  I can't see it getting in the way of me doing anything in the future, but it is nice to know that it usually goes away.

Based on talking to my doctor (Dr. ElAttrache @ Kerlan Jobe LA) and my independent research, patellar tendon grafts have been the gold standard for athletes for decades.  In my opinion, your better off going with what the doctor feels most comfortable doing, your less likely to have trouble with a successfully performed surgery than with an unsuccessful one.  I would much rather have the possibility a little bit of discomfort down the line than have to do another surgery and sacrifice more of my youth to surgery/rehab.  

caro toca roca wrote:I’m opting for the patellar tendon graft. How is your friend doing?

Hi! I'm Stich's friend with the BPTB graft. I'm 6.5 weeks from surgery and doing pretty well!  I ditched my last crutch about two weeks ago and I'm walking fairly well now. Yesterday I walked 3.15 miles and did a little over 1,000' of ele gain (on sidewalks; not hiking which is an activity for later in recovery). I'm a little sore today but that's mostly from just using muscles that haven't seen a lot of action for a few months! I had a minor scare where I was stalling on my flexion recovery but PT just had me do more heel slides and now I'm about 8* from symmetry with the non-op leg. OS told me not to worry too much about flex, that comes with time. Extension is what you need to worry about the most.

I'm off to the surgeon on Wednesday to see if I can get released to working in the kitchen part time - I'm a cook, but I've been working a cash register since about 2.5 weeks. My OS is pretty conservative so I'm trying not to be too hopeful. I have noticed that OS and PT recommendations with this surgery are all over the map. For example, I am supposed to wear a sport brace until I'm a year out, and still wear a straight brace to sleep! But some others have ditched all bracing much sooner.

The most important thing is to place trust in your OS and PT and do what they say. This is an injury that occurs most to active people; but the recovery also rewards active people. From what I can tell, you get out of it what you put into it. Try hard in PT, use lots of ice, and don't be afraid to have boundaries with others when it comes to your activities if you need to. I have several friends who have had ACL surgery (most of whom are skiers, climbers, or all-around active people) and if they have limitations, they sure as hell aren't obvious ones.

Good luck, shoot me a PM if you have any questions or need moral support!

Beth Caughran wrote:

Hi! I'm Stich's friend with the BPTB graft. I'm 6.5 weeks from surgery and doing pretty well!  I ditched my last crutch about two weeks ago and I'm walking fairly well now. Yesterday I walked 3.15 miles and did a little over 1,000' of ele gain (on sidewalks; not hiking which is an activity for later in recovery). I'm a little sore today but that's mostly from just using muscles that haven't seen a lot of action for a few months! I had a minor scare where I was stalling on my flexion recovery but PT just had me do more heel slides and now I'm about 8* from symmetry with the non-op leg. OS told me not to worry too much about flex, that comes with time. Extension is what you need to worry about the most.

I'm off to the surgeon on Wednesday to see if I can get released to working in the kitchen part time - I'm a cook, but I've been working a cash register since about 2.5 weeks. My OS is pretty conservative so I'm trying not to be too hopeful. I have noticed that OS and PT recommendations with this surgery are all over the map. For example, I am supposed to wear a sport brace until I'm a year out, and still wear a straight brace to sleep! But some others have ditched all bracing much sooner.

The most important thing is to place trust in your OS and PT and do what they say. This is an injury that occurs most to active people; but the recovery also rewards active people. From what I can tell, you get out of it what you put into it. Try hard in PT, use lots of ice, and don't be afraid to have boundaries with others when it comes to your activities if you need to. I have several friends who have had ACL surgery (most of whom are skiers, climbers, or all-around active people) and if they have limitations, they sure as hell aren't obvious ones.

Good luck, shoot me a PM if you have any questions or need moral support!

I am 8 weeks post op and impressed how much better you are doing. My balance is so off and I walk so slow that I don’t have a prayer of walking 3 miles. I am guessing age plays a big part in recovery timeline. 

I don't recall how soon after my ACL surgery it started, but my PT's had me doing a lot of balance exercises for the duration of the therapy, and of course I continued them afterwards.  (I had the surgery at 68 and it is now six years later.)  They explained that the surgery usually damages at least some nerves in the region of the knee, and that the proper sense of proprioception has to be retrained using the new (and perhaps more restricted) available data.  I did a lot of just standing on one foot, at first on the floor and then on a wobbly cushion.  When I seemed halfway decent at that, they threw balls at me and made me try to catch them without losing my balance.

Balance is something that declines with ageing as it is, so it can be hard to ascribe a particular cause to its diminution.  I think there is a decline in the number of cilia in the inner ear, making it harder to establish orientation.  Because of the exercises, I'm ok with my eyes open, and assume that there has been compensation in which the loss of inner ear data has been buttressed by visual cues.  But if I close my eyes its game over---I can only balance on one leg for a matter of seconds.

rgold wrote: I don't recall how soon after my ACL surgery it started, but my PT's had me doing a lot of balance exercises for the duration of the therapy, and of course I continued them afterwards.  (I had the surgery at 68 and it is now six years later.)  They explained that the surgery usually damages at least some nerves in the region of the knee, and that the proper sense of proprioception has to be retrained

Yea. I have no sensation around certain parts of my knee. I feel my PT is not giving me enough balance exercises. 

You have a few years on me but how long did it take you to get back to climbing? At this point I can’t even imagine doing approaches at any of my local craigs. This totally sucks!

normajean wrote:

I am 8 weeks post op and impressed how much better you are doing. My balance is so off and I walk so slow that I don’t have a prayer of walking 3 miles. I am guessing age plays a big part in recovery timeline. 

Just my observation as a layperson who is experiencing this first hand, there are a LOT of variables at play in recovery from this surgery. I'm no spring chicken at 37, but I'm sure my recovery would be a little slower if I had it 10 or 20 years from now. I think the most important thing are choosing a surgeon wisely (or as much as insurance can dictate; I read a meta analysis that showed that something like 75% of graft failures are due to incorrect placement of the graft. So I picked a guy that does dozens of these a month, instead of a dozen a year), and following PT protocol to the letter. 

I am also in a PRP and BMAC study. It's unknown how much that has played a role, but I'd guess it has to some degree. I saw the OS last week and the PA seemed to think it was a success point in their study, but the doc was quite a bit more reserved about it.

Time heals all wounds my friend. Some parts of my body will never be 100% again (shoulder, toe, hip, knee) but I still get by with them functioning at ~90%. After many injuries I never stopped climbing or skiing. the only thing that changed was the fundamental reasons I climb and ski.

There is no reason to rush the healing processing. Do your PT, take it slow, learn new things. And before you know it you will be back at it.