Has anyone been through an ACL/MCL repair/reconstruction?
Length of rehab? Were you active (running) before injury? Auto/Allo graph?
Length of rehab? Were you active (running) before injury? Auto/Allo graph?
ACL/MCL repair?
- Thread starter Bruce B
- Start date
I assume we're talking about an adult? It also will make a difference whether the injury occurs in a male or female.
Different physicians will use different methods including allografts (the most common), cadavers (started by the 49ers team doctor years ago), hamstring (second most common?) and most recently taking a piece of the Achilles tendon (proposed and done by a leading surgeon at The Hospital for Special Surgery in NY). The rationale behind the latter three approaches is that you don't mess up a perfectly healthy knee taking a graft (ergo, many people with the allograft develop tendinitis in the "good" knee).
Length depends upon condition person (especially quad strength) was in when the ligament was torn and if anything else was injured eg. MCL, meniscus (the "Unhappy Triad"). Orthopods though will usually prescribe a month or so of pre-surgical PT to speed up recovery time. Usually though the guidelines call for at least six months of rehab until multi-directional motion is allowed (eg as opposed to linear). PT usually begins right after surgery (babying the graft actually leads to more issues) with the knee being placed in a machine that passive flexes the joint.
And Mark is correct in that doctors sometimes will just pass on the surgery (called ACL-deficient) if someone is not active. OTOH, having worked with several people with ACL deficient knees, I'm not sure this is the right thing to do because I find these individuals often have a lot of knee pain, arthritis (either due to the injury, rehab or life activities) and a lot of knee instability in just everyday activities.
There are also a lot of other considerations and things to watch out for in PT that are beyond the scope of writing here. If you want, PM me and I'll give you my number and we can speak further.
Myles is correct. One of the keys after an ACL injury is to strengthen the medial support structures. After an ACL tear, the medial meniscus is a primary medial stabilizer. If the medial meniscus is also torn in addition to the ACL & MCL ("O'Donoghue's unhappy triad"), all the major medial supporting structure are injured. Rehab is focused on strengthening the muscle groups in the medial leg/knee, especially the VMO.
We've done quite a few of the athletes around here. The last time I did anesthesia for an ACL reconstruction was about 10-12yr. ago. I've got a few journal articles that some colleagues sent me. Guess I have time to read them now!
Strength is in some ways IMHO overrated. I think one of the things that PTs overlook is restoring correct movement patterns. Too often Pts fixate/judge progress based on joint ROM and strength -- and then the person goes out and reinjures the knee. Once you have micro-or macro-trauma, the brain shuts down some muscles, activates others and adopts the easiest, not the best movement pattern.
Plus there's the question how do you "isolate" the VMO when all the quad muscles are innervated by the same nerve?
3 years ago I had a Grade 2 MCL STRAIN...took almost a year to be pain free....it was a bitch.
I had residual bruising of the meniscus too, which also healed.
BTW, I work out 6 days a week which includes 4 days of tennis ( I play tournament level), biking, functional, med ball, and weights.
Strength is in some ways IMHO overrated. I think one of the things that PTs overlook is restoring correct movement patterns. Too often Pts fixate/judge progress based on joint ROM and strength -- and then the person goes out and reinjures the knee. Once you have micro-or macro-trauma, the brain shuts down some muscles, activates others and adopts the easiest, not the best movement pattern.
Plus there's the question how do you "isolate" the VMO when all the quad muscles are innervated by the same nerve?
I think strength cannot be overrated. Without over compensating with muscular strength, a bad knee is just a bag of bones. But I understand what you are saying.
Also, when you say "correct" movement patterns, many sports require very unpredictable and esoteric movements...like tennis, field hockey etc.
I suggest reading
Vladamir Janda
Pavel Kolar
Gray Cook
Mike Boyle
Craig Liebenson
Greg Rose
Then you will understand the relationship between neuroendocrine and muscular adaptions to stress. Unfortunately, the bodybuilding/meathead world has led us down the garden path.
In order of importance:
1. Functional Movement
2. Functional Performance
3. Functional Skill
For example, core strength is useless without proper hip and shoulder mobility.
And when you talk about strength, what type are you referring to? There is by definition at least eight types.
I'm familiar with Liebenson and Boyle.
One of my best friends here is a trainer. He does indeed stress Hips, hips, and more hips!
I guess when I talk about strength I really mean a hybrid of the different types, but stressing elastic strength if you play a sport requiring quick movements, jumps, and change of direction. I think its horses for courses. A sedentary person is going to rehab different than an athlete.
I can tell you I went from walking with a limp, to winning a tennis tournament by doing a dreadful program consisting of dead lifts, Romanians, lunges, squats, sled pulling, and basic stuff like bird dog, planks, and a ton of glute and hamstring works. I still do a preventative and maintenance routine 3 times a week which I continually vary.
At this point am careful not to make my quads too strong in relation to my hamstring and glutes.
I think his was the LCL and another repair of the ACL. Since 2 ligaments are involved, they're saying he might not be ready for opening day.
Well, had the surgery last week. I have done some weight bearing and went back to work today. Now I'm icing it down every night. Looks like it's going to be a long road. Start PT again latter this month. I have a brace that goes from upper thigh to ankle and having to wear TED hose to try and keep the swelling down.
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