ACL Tear repair and recovery

[bcrrider]

Tore ACL in the first minute of a 3hr GNCC race. Finished the race and thought is was a sprain. I could still walk and do thinks but an unexpected twist would shoot me up with pain. MRI two weeks later confirmed torn ACL. Doctor recommends surgery repair. He is a sports doctor, working with professional athletes. I am in a brace he prescribed until the fall as I have work in need to do until then that requires walking. But he says I should not ride/race to avoid more damage. He was a dirt bike rider and says too risky with the chance to stab the foot and twist the knee.

He offered me options of patella or hamstring grafts. Saying if no preference he will go hamstring as most sports like soccer go that route. Patella could be an issue for any kneeling activities. (or landing on the knee) Anyone have any experiance advice on going either way with regard to healing and racing again? I have seen some posts that say patella is quicker, but have a friend that says hamstring was.

Also, the recovery plan is to be on crutches for 6 weeks with what sounds like a more restrictive brace before weight bearing back on my current brace and then on the bike at 6 months, fully race ready in 9 months if I hit the therapy hard. Does that sound consistent?

[DrMark]

Best graft for MXers is patella tendon and extraarticular back up. Accelerated rehabilitation crutchless and braceless. Return to riding at 3 months. We’ve done thousands.

 

 

[TGP]

Same injury to My left ACL along with serious bone contusions and meniscus tear. I’m going with the Patella graft per my docs suggestions for the same reason as given above....gotta get the sick time at work built up though so i can take the 6-8 weeks initial recovery off...could be awhile unfortunately. 

In the meantime, bracing and light PT style activity to strengthen the muscles around the knee again to build stability. The bikes got fuel drained yesterday and are going into the back of the garage.

 

[DonO]

bcrrider,

Let me give you some old man advice.

1. Prior to (like 2 months before your surgery) do "all" the exercises to strengthen your knee muscles (not just in shape but superior shape!!!)

2. Go with Patella graft

3. After surgery, continue to rehab with those same exercises!!!!!

What you say, why you think your an expert on this DonO????

Well Dr. Mark did my left knee with right knee patella graft in 2005 (I was 45 then), I was back to full racing (MX and HS) in 3 months. People (from the rehab center to fellow racers) were astounded by that feat. I have done just about everything (laid tile, all kinds of yard work, auto work, racing wrecks, etc.) you can imagine to that knee and never had a problem!!!!

btw, I was actually riding "lightly" in the woods next to my house 1 month after surgery (neighbor was shaking his head at me ?).

[298]

Torn ACL, LCL August 5th, 2018. Got Hamstring graft on September 14th (LCL was a high grade tear but able to heal without surgery). Returned to riding mid April with knee braces. 

Was on crutches for 3 days and walking without a brace at 4 weeks. 

[bcrrider]

I have heard lots a praises for Dr Mark, but I am far from Texas and working with a local Dr that does work on professional, college and high school level sports teams in the area.  He actually used to race dirt bikes and says there should not be difference in hamstring or patella for woods riding (but prefers hamstring).  What I am seeing is a large variation in the recovery time.  Many have experienced the 6 to 9 month recovery and then there are the Dr Mark patients saying they were back in 3.  Is it all based on how you push yourself in post op TP? 

[bcrrider]

Also, has anyone used Platelet-rich plasma (PRP) in their procedure to speed recovery?  It is being offered to me, but is not covered by insurance.

[298]

1 hour ago, bcrrider said:

I have heard lots a praises for Dr Mark, but I am far from Texas and working with a local Dr that does work on professional, college and high school level sports teams in the area.  He actually used to race dirt bikes and says there should not be difference in hamstring or patella for woods riding (but prefers hamstring).  What I am seeing is a large variation in the recovery time.  Many have experienced the 6 to 9 month recovery and then there are the Dr Mark patients saying they were back in 3.  Is it all based on how you push yourself in post op TP? 

3 months is playing with fire. I went to the top Doc in Canada. NBA, NHL, NFL, Olympic athletes are his main patients. His protocol is 6-9 months. Doesn’t matter the sport. 

You can have the muscle at 3 months, but the graft requires healing time as well. 

There is a reason even pro moto riders take 6 months. Even the ones who go to the top knee surgeon in the world in Sweden. 

Edited August 9, 2019 by 298

[298]

23 minutes ago, bcrrider said:

Also, has anyone used Platelet-rich plasma (PRP) in their procedure to speed recovery?  It is being offered to me, but is not covered by insurance.

Yes. Seemed to help. I graduated the 6-9 month protocol at 3 months. But still had to wait 6 to ride so the graft could heal. 

[Mundyba11]

I had my ACL repaired with patellar graft 8 years ago. I have no issues kneeling or any type of work on my knees. I know a few people who have had hamstring and cadaver and have re torn it. Take it easy after surgery follow all rehab and exercise procedures and expect 6 months recovery, with really trusting it around the 1 year mark 

[DonO]

bcrrider,

If you read my post reply.

DO the strengthening exercises like 2 months before surgery and I mean do them like you are serious enough to never think what you are doing is good enough (go above and beyond!!!!). I thought I was in pretty good shape, especially my legs until I "really" put the pedal to the metal in the exercises and found that I was not "top notch".

Guarantee you do that and your outcome will be fab!!! (unless your surgeon screws up?)

 

298,

You can believe what you want, I did my research, talked with Dr. Mark and Ed (was his PT guy at the time) many times before even deciding.

Best dam $1K (hotel and airfare and some on the procedure not covered by Ins) I ever spent in my life!!!

[298]

2 hours ago, DonO said:

bcrrider,

If you read my post reply.

DO the strengthening exercises like 2 months before surgery and I mean do them like you are serious enough to never think what you are doing is good enough (go above and beyond!!!!). I thought I was in pretty good shape, especially my legs until I "really" put the pedal to the metal in the exercises and found that I was not "top notch".

Guarantee you do that and your outcome will be fab!!! (unless your surgeon screws up?)

 

298,

You can believe what you want, I did my research, talked with Dr. Mark and Ed (was his PT guy at the time) many times before even deciding.

Best dam $1K (hotel and airfare and some on the procedure not covered by Ins) I ever spent in my life!!!

I believe you, and i’m sure Dr Mark is good. I’m saying 3 months is pushing it. If you are a pro that needs to be out there to make a living, sure, risk it. If not, take time to heal. A graft isn’t fully healed until 24 months. 12 months is the average for most stick and ball sports, with 6-9 months being accelerated programs. 

[bcrrider]

I have been doing the PT and the knee feels good.  I had my 6 month visit and was hoping to get the green light to get back on the bike for some casual riding, but instead told I can now jog/run, ride a bicycle on flat surface, but no dirt bike until 9 months.  This puts me out of the season for qualification for the year end overall in racing.  I feel like I am able to get back on the bike, doc even said the muscle looks good with nice definition.  (I am 19 and muscular from working out and sports)  The latest I can put off racing and still make a season of it is the first week of April.  This will be the 7 month point in recovery.  Would it not be a good idea to go against Dr's program?  What have others experienced?

[298]

7 hours ago, bcrrider said:

I have been doing the PT and the knee feels good.  I had my 6 month visit and was hoping to get the green light to get back on the bike for some casual riding, but instead told I can now jog/run, ride a bicycle on flat surface, but no dirt bike until 9 months.  This puts me out of the season for qualification for the year end overall in racing.  I feel like I am able to get back on the bike, doc even said the muscle looks good with nice definition.  (I am 19 and muscular from working out and sports)  The latest I can put off racing and still make a season of it is the first week of April.  This will be the 7 month point in recovery.  Would it not be a good idea to go against Dr's program?  What have others experienced?

Listen to your doctor because everyones protocol is different and everyone heals at a different rate. Your Dr. did your surgery so he has the best idea of how long until you can return. Like I said. 6-9 months is very typical for Moto. Look at Musquin. 9-12 for most other sports. 3-4 months is ridiculous because all it would take is 1 little mistake to destroy your graft since it’s still so weak at that point. 

[TGP]

Let it heal. 

[nytrainer]

"Pre-hab" is key. When you have regained the strength and ROM and are feeling like maybe you don't need the surgery, then you're ready for it.

I have rehabbed many ACL injuries and everyone heals at different rates. Many of the time athletes would be cleared to return at 4 months minimum post-surgery, but techniques are improving every year. How quickly you proceed through the rehab protocol depends on your level of healing/strength.

Many surgeons liked to do the patella graft for athletes and hamstring for non-athletes and older individuals. 

[bcrrider]

It feels good and strong, maybe even better than prior to the injury because of all the focused rehab exercises that was more than what I did for my legs before.   The doctor says it is biology that the body takes 9 months to heal the graph, but I would think at my young age and activeness I would be on the faster end of the range or what I can ramp up in the next month to get ready early.

[mikerides33]

Can you name some of the exercises?

[298]

20 hours ago, bcrrider said:

It feels good and strong, maybe even better than prior to the injury because of all the focused rehab exercises that was more than what I did for my legs before.   The doctor says it is biology that the body takes 9 months to heal the graph, but I would think at my young age and activeness I would be on the faster end of the range or what I can ramp up in the next month to get ready early.

It is biology. You can’t speed it up. I tore it last year at 19 years old. I got cleared strength wise at 3.5 months. I still had to wait until at least the 6 month mark to ride. 

[bcrrider]

So how did it feel riding at 6 months?  I am past the 6 months and wanting to ride at 7 months vs the 9 months stated by the doctor.