Modern ACL allograft post-op Protocol? No brace? Whuhuh?

[ikkin]

Blew my right ACL last month. Same exact injury as my left leg, which I tore (and had repaired) five years ago. Clean ACL tear, torn all the way through, no other damage. Apparently I am "good" at tearing ACLs.

Having surgery on the 23rd to repair it. Allograft. Same repair as last time. Same graft type, same technique. Only difference is the surgeon as the last repair was in Boston, this one is in Bellingham, WA. New ortho says I'll walk out of surgery without a brace OR crutches post-op. Does this sound familiar to anyone? Last time I crutched out with a full leg brace, which was set at zero for a week. The prospect of having no brace immediately after surgery is scary as hell. Am i just out of date? Is this standard practice these days? Please advise!

[Cedrik]

Check out Dr. Mark's website http://www.sandersclinic.net/. His patients are very mobile right after surgery. Early mobility is supposed to really help recovery.

I was in a locked brace for a week initially and had to wear one for two months, but that was due to a full mcl repair, not the cal repair (April 2011).

Since you're somewhat concerned, seems like crutches might not be a bad idea, at least for the first several days (week?).

[Shogun]

I had surgery on my left ACL this past August. Was in a straight brace for a week post-op @ 0 then they unlocked it for the next 3 weeks... I needed the crutches to help get around for the first week but I also had a nerve block for a few days after surgery so I couldn't bare any weight.

I'm sure your surgeon knows whats best and from reading this forum it seems many peoples surgeries differ.

I know many doctors recommend a custom brace for skiing/pivoting activities and many members on this forum use them but my doc advises against them...

[HowieT2]

I had the surgery in May. knee was immobilized the day of the surgery and used crutches. next day, I was done with the immobilizer and when I wasn't icing, I was doing straight leg raises. stopped crutches after day 2. day 3 started on stationary bike. very limited but by day 5 was able to do 30 minutes a day.
have had a great result. mtn biking about 8 weeks post op.

[skioride]

My surgery was in June and I was advised to use my crutches as long as I limped.
I used them for a couple weeks but usually only as protection from jelly leg. I didn't have a leg brace post op because I had a machine to flex my knee for the first week. I'd be surprised if you didn't need crutches unless they've figured our a way for your quad not to atrophy post op.
As far as skiing? My knee brace has been ordered because at 6 months post op I would rather be safe then sorry and my knee is only about 75%. When professional football players take at least a year to be back at 100% I never thought I'd be at 100% in 6 months.
I'm very sure I won't need the brace next winter unless I have a major setback.

[bendtheski]

I had the surgery in May. knee was immobilized the day of the surgery and used crutches. next day, I was done with the immobilizer and when I wasn't icing, I was doing straight leg raises. stopped crutches after day 2. day 3 started on stationary bike. very limited but by day 5 was able to do 30 minutes a day.
have had a great result. mtn biking about 8 weeks post op.

Pretty much the same for me. Now at week 6 and just got a whole bunch of new bicycle candy from the UPS man!
Ortho says I'll be clear to ride (outside) by week 8 or 9, so for now the stationary bike will have to do.

This is all good news to me. I watched a buddy of mine pretty much destroy his mountain bike frame and most of his ski wardrobe mountainbiking and skiing with a brace on!

[wolfelot]

Man, the surgical techniques vary so much for ACL recon. I think I had the big hard brace on and locked at all times except exercise for like a month and then they opened it up. I was on crutches for two weeks. I had just a clean ACL tear with no other damage. I'm pleased with my results as I skied 6 months to the day after surgery.

[skioride]

Man, the surgical techniques vary so much for ACL recon. I think I had the big hard brace on and locked at all times except exercise for like a month and then they opened it up. I was on crutches for two weeks. I had just a clean ACL tear with no other damage. I'm pleased with my results as I skied 6 months to the day after surgery.

Did you use a brace wolf? I only have only skied one day and it was with a brace but I'm not sure I really need it. I think I'm using the brace as a crutch(no pun intended). I skied a few bumps today but I'm not sure I would have had the confidence if I didn't wear the brace.

[wolfelot]

^^^^I have an activity brace, a Don Joy. It is pretty low profile and I barely even know it is there. It fits under my ski pants without an issue and I don't have baggy pants. It is a neoprene sleeve with two hinged rods and then some velcro straps. I feel like it gives me some extra insurance that if I take an odd fall that I will be protected from tweaking it. They are never fail-proof though. I'll use it the rest of this year and then likely give my PT guy a call next fall to get his thoughts on using it.

[Shogun]

I'm 7 months Post-op and thinking about going skiing tomorrow for the first time... cruising some corduroy groomers in the morning seems do-able.

Wolfelot- How is your muscle tone on your operated leg compared to your good leg? I'm sure only 6 months out you weren't 100% yet? Do you have any popping/grinding? How did it feel skiing (and after) @ 6 months?

I feel like I can ski, but my muscle tone is still only about 70% compared to my good leg and I do have some minor popping and grinding from time to time (no pain though) My knee also gets a little stiff and I can still feel some stiffness in my hamstring were they took the graft... All these things seem pretty normal for 7 months out. I'm at the point were I feel confident in my knee and it feels fine on a day to day basis but skiing is very unpredictable on the knees and I don't have any sort of brace, my doc never recommended one....

I feel like I could get some good groomed runs in and see how it feels, but I still have that slight nervousness because I havent been on skis since last may and I don't really know what to expect from the knee...I've been riding my mountain bike almost everyday and that feels fine, but obviously way different than skiing...

[wolfelot]

Wolfelot- How is your muscle tone on your operated leg compared to your good leg?

Right now I would say that my operated leg muscle tone is 95% of the other leg. I can barely tell a difference between the two. The right outside of my quad on the un-operated leg has this small extra bit of muscle that the operated leg does not quite have as much off. I'm still doing some isolated single leg presses at the gym and I can still tell that the operated leg is still not quite as explosive as the other leg when I do the same weight. This is pretty slight though.

I'm sure only 6 months out you weren't 100% yet?

I don't think I was 100% at 6 months and now that I am just under 8 months, I still have a little bit of awareness in the operated knee. In the weeks leading up to skiing right at 6 months I was pushing pretty hard and my knee was not swelling, or getting overly stiff even after pushing it pretty hard for a few days in a row. I pretty regularly was running 3.5 miles outside at a decent pace and my knee was not really bothersome. I still iced and stretched including ROM after every workout.

Do you have any popping/grinding?

Yeah, it was/is weird. Just everyday things like getting off the couch and pushing off to walk would sometimes make my knee crack kind of like a knuckle. It did not hurt though. With regard to grinding, I really did not have this sensation after about 3 months. Overall, the popping has become less and less frequent.

How did it feel skiing (and after) @ 6 months?

It freaking felt fine while skiing! I had REALLY worked hard to be able to ski over xmas at 6 months post op. I really did not have a feeling like I needed to make a conscious decision to be sure to turn in one direction or another because the operated leg was noticeably weaker or more tired than the other leg. I skied 9 out of 11 days at Schweitzer skiing AT LEAST 20k feet of vertical each day. I would say all of the days were considered full days of lift-served skiing. I thought after 3 blue groomers that my quad might be in knots and give me fits but it was good to go all day. I was really surprised after the first day that my knee did not swell, get stiff, or my quad was not shot. Everyday I did ROM exercises and iced my knee. I ended up skiing pretty much everything Schweitzer has for terrain. I dialed it down by not doing any jumps at all, not taking as aggressive a line as I normally would in steeper off-piste stuff, taking it easy in steeper trees, not doing bumps, and not going out for that last run of the day. I was very, very pleased with my results. I was ultimately working out almost 2 hours a day about 6 days a week.

It sounds like you can be ready to ski some groomers with you want. I'm not sure how dedicated you have been with rehab, but when I skied at 6 months my muscle tone was definitely more than 70%. I personally would want a low-profile activity brace for a little more security. The brace just feels right for me.

I feel like I was pretty lucky in that I had only a clean ACL tear and didn't need anything else worked on in my knee.

Let us know how things go for you Shogun. Good Luck!

[Shogun]

Thanks for the detailed response! I decided to give it a shot today and I'm happy with the results. It's funny how like riding a bike the first day back on skis and everything feels normal. While skiing I was fairly conscious of my operated leg and I could feel it just wasn't up to par with my good leg, but I was still able to put weight into my turns and get good edge response. On the bumpy/skied out snow I could feel my leg was a little "wobbly" and I felt sometimes I would compensate with my other leg but this is definitely due to the muscle tone not being all there yet.

It sounds like you were/are a bit ahead of me in terms of leg strength, ect. and I wish I was a bit farther in my recovery... still, being able to ski pretty comfortably on trail @ 7 months is nice... The last month or two I have slowed down a bit on rehab and I hope to step it up again. I'm going to try and get up to the mountain around once a week and continue to see how it feels... After today I feel like I'll be pretty good on any groomed blues which is fine with me until it gets stronger.

[bendtheski]

^^^^I have an activity brace, a Don Joy. It is pretty low profile and I barely even know it is there. It fits under my ski pants without an issue and I don't have baggy pants. It is a neoprene sleeve with two hinged rods and then some velcro straps. I feel like it gives me some extra insurance that if I take an odd fall that I will be protected from tweaking it. They are never fail-proof though. I'll use it the rest of this year and then likely give my PT guy a call next fall to get his thoughts on using it.

That sounds like the donjoy my OS gave me right after the injury. It's not as burly as some of the carbon/aluminum braces I've seen, but I'll probably use it for at least the first couple of days returning to skiing just because I have it, although by now the velcro is pretty munged up with dog hair.

Hopefully I won't need too many of the other contraptions that I've acquired during this process, crutches, immobilizer, kneehab TEMS unit, etc., but I an NEVER getting rid of the Cryo-Cuff! That thing has been worth its weight in gold during the six weeks since surgery, and is probably going to continue to be useful as I work towards returning to full activity.

[spicy cha cha]

I got cut today and have the same instructions. I had the same reaction when I heard. I don't see how crutches for the first week could hurt though

here is a meta-analysis with the obvious limitations
http://www.udel.edu/PT/PT%20Clinical...%20ACL%20I.pdf
in a nutshell

[skioride]

Thanks for the detailed response! I decided to give it a shot today and I'm happy with the results. It's funny how like riding a bike the first day back on skis and everything feels normal. While skiing I was fairly conscious of my operated leg and I could feel it just wasn't up to par with my good leg, but I was still able to put weight into my turns and get good edge response. On the bumpy/skied out snow I could feel my leg was a little "wobbly" and I felt sometimes I would compensate with my other leg but this is definitely due to the muscle tone not being all there yet.

It sounds like you were/are a bit ahead of me in terms of leg strength, ect. and I wish I was a bit farther in my recovery... still, being able to ski pretty comfortably on trail @ 7 months is nice... The last month or two I have slowed down a bit on rehab and I hope to step it up again. I'm going to try and get up to the mountain around once a week and continue to see how it feels... After today I feel like I'll be pretty good on any groomed blues which is fine with me until it gets stronger.

It seems like we're in similar positions although I now have 6 days in. Not long days only 2-3 hours but I've made progress every day. I skied consecutive days Thursday and Friday and was able to ski a couple black runs and more bumps without any pain or swelling afterwards. I even got a little bit of air off a bump without any problem. What still scares me a little is falling. I don't want to fall and get my ski hung because I don't think the brace will help if I hyperextend my knee. I crank my bindings down pretty hard and I'm not sure if I should loosen my left binding up a bit but I don't want it coming off if I lose my balance. Anyone with binding advice I'm all ears.
I'm with you shogun. Happy to be out there again without missing a season and I expect to be 100% next year.

[skioride]

And I think Cha Cha's article is spot on. It seems like the progressive approach.
My only advice to everybody post surgery is carry your crutches even if you just walk with them under your arms and bring them to crowded places so you don't have an incidental contact that could make you fall. Believe me I knew when my leg was stable as you probably will too.
This injury takes time to heal don't be stupid and end up on the operating table again. That's what I keep telling myself.