How long before I ski? (ACL post-op)

**SkiBrain** · 08-21-2008, 09:39 PM

Thanks for the great info folks. Been wondering this myself, although my new job is probably going to keep me so busy that there won't be much time for skiing this year even after rehab, which I need to get back on track with. Moving across the country, looking for a place to live, and starting a new job have made it very difficult to do PT exercises.

**Woodlandclown** · 08-22-2008, 09:25 AM

Originally Posted by Vinman

You could be on skis ~5-6 mo but for cruisers only. Aggressive skiing should wait a bit longer 9 mo to 1 yr. In short don't rush it.

Btw I posted this from my itouch....sweet.

what about waterskiing? I feel like i could right now. It would be fine if I didnt fall, but I usually always wipe out. I really want to go!!! I am just aroud 5 months.

**Steven S. Dallas** · 08-22-2008, 10:19 AM

Originally Posted by Woodlandclown

It would be fine if I didnt fall, but I usually always wipe out. I really want to go!!! I am just aroud 5 months.

That's exactly where I am- five months yesterday, actually- and it is taking a lot of willpower not to go and play tennis, jog, or do my best Phil Dalhausser impression on the beach volleyball courts. I feel fine, and therein lies the danger. Thinking about all the shitty PT sessions and what a drag it was limping around for a month brings me back down to earth, though. Staying mellow and getting stronger for another month not only really cuts down my chances of fucking it all up now, but in the future as well.

Stay strong, ACL sister.

**Vinman** · 08-22-2008, 06:42 PM

Originally Posted by Dexter Rutecki

Vin, is that true? The past two times I've had the pleasure of an ACL recon, when the docs released me at around six months they didn't tell me to avoid anything--so I didn't.

Is that dumb? I basically went right out and skied bumps, raced, and even aired it out more or less as I had been doing before the injury. Was I just lucky?

Dex, my last post is based solely on my opinion and not on and kind of hard data. But yes I think that 5 mo is pretty early for most peeps. Some can be back to almost 100% at that time while others won't be there for upto 9 mo or so. I also think that in general at 9-12 mo most skiers will have their confidence back enough to charge hard and be back to very close to pre-injury level. The mental stuff is always tougher than the physical stuff.

This also happens to be at a point in recocery where the graft is becoming more liagment like and gaining in strenght.

**Vinman** · 08-22-2008, 06:44 PM

Originally Posted by Woodlandclown

what about waterskiing? I feel like i could right now. It would be fine if I didnt fall, but I usually always wipe out. I really want to go!!! I am just aroud 5 months.

waterskiing would not be on my list of things to do after an ACL recon with only 3 mo til ski season......

**The SMP** · 08-24-2008, 01:57 PM

For those of us that will be in the 5-8 month ACL post-op range this season, has anyone considered changing their equipment? Maybe a shorter or easier to swing ski or chaning the din (pre-release vs. non-release fall on the new knee). Didn't find anything searching and this crowd seemed the right bunch to ask.

**splat** · 08-24-2008, 02:13 PM

Originally Posted by Vinman

Dex, my last post is based solely on my opinion and not on and kind of hard data. But yes I think that 5 mo is pretty early for most peeps. Some can be back to almost 100% at that time while others won't be there for upto 9 mo or so. I also think that in general at 9-12 mo most skiers will have their confidence back enough to charge hard and be back to very close to pre-injury level. The mental stuff is always tougher than the physical stuff.

This also happens to be at a point in recocery where the graft is becoming more liagment like and gaining in strenght.

Vinman - I was told that it takes 9 months for the new acl to graft to the bone, at least if it's a hammy that got screwed onto the bone, like mine. True dat?

**GoNads** · 08-24-2008, 05:39 PM

Maximal strength of the graft occurs at 18 months..

**FiveLarge** · 08-24-2008, 06:02 PM

Originally Posted by GoNads

Maximal strength of the graft occurs at 18 months..

is this independent of graft type? source? not so much doubting as just curious...

**Vinman** · 08-24-2008, 06:18 PM

Splat: all depends on graft type. PT graft has bone blocks so those will fuse/heal inot place around 6-10 weeks. The 9 mo timeline you refer to is probably where the graft is gaining strenght and starting to change its collagen structure to make it more like ligamanet tissue instead of tendon tissue.

graft strenght time line is definitly dependant on graft type. auto graft will be gain strenght 6+ mo on and not be done remodelling itself until 12-18+ mo. Allograft takes longer as the revascualrization take longer. 12-24 mo? not sure exactly.

**splat** · 08-24-2008, 07:13 PM

Originally Posted by Vinman

Splat: all depends on graft type. PT graft has bone blocks so those will fuse/heal inot place around 6-10 weeks. The 9 mo timeline you refer to is probably where the graft is gaining strenght and starting to change its collagen structure to make it more like ligamanet tissue instead of tendon tissue.

graft strenght time line is definitly dependant on graft type. auto graft will be gain strenght 6+ mo on and not be done remodelling itself until 12-18+ mo. Allograft takes longer as the revascualrization take longer. 12-24 mo? not sure exactly.

That's why I qualified my kind of graft, figuring a PT prolly healed sooner. Interesting...I asked my PT if my revascularizing was pretty much done and he said he thought so, but that the new lig grafting to the bone would take 9 months. Maybe he just said I could ski in 9 months, which, of course, is where my every question to him inevitably leads.

Do the docs place the bone blocks in PT procedure into the exact spots where your acl originally connected to bone?
GoNads - was your double bundle ever a PT graft? I assume not, but have to ask.

Originally Posted by SkiBrain

Thanks for the great info folks. Been wondering this myself, although my new job is probably going to keep me so busy that there won't be much time for skiing this year even after rehab, which I need to get back on track with. Moving across the country, looking for a place to live, and starting a new job have made it very difficult to do PT exercises.

We're still on parallel paths in different universes, Nat.

**Arno** · 08-25-2008, 03:27 AM

I first skied on groomers about 4 months post-op. Have similar feeling about it to Ty - looking back, it was probably a risky thing to do and I am not sure I'd encourage others to do it but the great thing was that I could still ski. I found that really encouraging and motivating for my rehab.

By the end of that season (about 8 months post op) I was doing fairly challenging skiing (for me) but taking it pretty steadily. I did have to bale on some hut to hut touring in the alps about 7.5 months post op - mainly because it was really warm and skiing boot deep slush when your ACL isn't quite there wasn't a great feeling.

Didn't really start pushing it until the following season but now I'd say I'm a much better skier than I was before I did my ACL so it's all good in the long run

**Vinman** · 08-25-2008, 04:07 PM

Originally Posted by splat

That's why I qualified my kind of graft, figuring a PT prolly healed sooner. Interesting...I asked my PT if my revascularizing was pretty much done and he said he thought so, but that the new lig grafting to the bone would take 9 months. Maybe he just said I could ski in 9 months, which, of course, is where my every question to him inevitably leads.

Do the docs place the bone blocks in PT procedure into the exact spots where your acl originally connected to bone?
GoNads - was your double bundle ever a PT graft? I assume not, but have to ask.

We're still on parallel paths in different universes, Nat.

revascualrization for a PT graft takes about 4-6 months.

They will try to place the graft as close to the original position as possible. The bone blocks are actually seated in tunnels, 1 in your femur and the other in your tibia with the tendon running though your knee as close to where your ACL used to be as possible.

**Woodlandclown** · 08-26-2008, 11:50 AM

Originally Posted by Steven S. Dallas

That's exactly where I am- five months yesterday, actually- and it is taking a lot of willpower not to go and play tennis, jog, or do my best Phil Dalhausser impression on the beach volleyball courts. I feel fine, and therein lies the danger. Thinking about all the shitty PT sessions and what a drag it was limping around for a month brings me back down to earth, though. Staying mellow and getting stronger for another month not only really cuts down my chances of fucking it all up now, but in the future as well.

Stay strong, ACL sister.

well then i guess i am not 5 months. i was at least a few weeks after you. i stayed strong. i wouldnt really have skied, i just wanted to hear what you gimps would say!

its just me and my bike this summer. i have one super strong leg and one thats coming, albeit very slowly.

**Buzzworthy** · 08-26-2008, 02:22 PM

Originally Posted by spthomson

Or is arcing hard turns through crud enough to cause a re-do?

One thing I would bet on is that the next day your knee would be the size of a volleyball.

Better safe than sorry is my motto in winter now.

**wolfelot** · 10-02-2011, 04:36 PM

Alright. I gotta bump this. I'm 15 weeks post op autograft patella ACL recon. I have been working out very diligently without over doing it. I still have not had the 'ski' talk with my ortho, but will be having an appointment very soon. My surgery was June 24th and my goal is to ski greens and blues over xmas which is a little more than 6 months post op.

When did you other guys start skiing after surgery? Or if yours was not during the season, at what point would you have been cleared to ski?

**Cedrik** · 10-02-2011, 07:50 PM

In my checkup two weeks ago I was cleared to ski groomers in mid-December, which is 8 months post-op. He seemed to stress that 8 months is the earliest he'd recommend (other than classic x-c, which I can do when there's enough snow). My leg strength is 80%+ vs non-repaired leg, all other functions (balance, lateral movement, etc) are 100%, quad and knee circumference is equal, so he of course took that into account.

**FiveLarge** · 10-03-2011, 12:12 AM

Heh. Interesting to see this bumped - my thread from about 3 years ago. Based on my own experience and that of several friends, it really varies person-to-person. So, you have to do the smart thing for where you're at recovery wise - and do listen to your PT & ortho. Time isn't the ultimate tell-tale for sure. Nor is hours spent in the gym or generally rehabbing.

But, here's how things unfolded for me:

Injury date: 6/19/08
Surgery date: 7/23/08
Patellar tendon autograft.

When I saw the dr the first time he said the knee looked ready that day for surgery - which is to say, pre-op I had minimal swelling and good strength/ROM.

Post op, I did have a cellulitis that made me pretty sick for several days and I had to go on antibiotic IV for a couple weeks. That made for a slow start on the rehab.

Rehab 2x per week for 3 months with PT. I think the sessions were supposed to be an hour - I was usually there a good bit longer - basically worked to fatigue each time.

I don't remember exact time frame, but before PT was over, I was doing some "light" hiking and riding the mountain bike on pavement. I did do Bierstadt (easy 14'er) on November 1.

I didn't necessarily get the "go ahead" from my PT or doc on all my activities, but I never felt like I was over-pushing. I'm just not a gym guy - I MUCH prefer to get my exercise from being outside, so that's what I did. I also felt like the best way to get back to doing the stuff I love was to do it - just scaled back a bit.

I had put January 1 in my head for skiing before surgery even. Didn't know if it would happen, but gave me something to work toward.

A good friend had a bday in mid-December, and wanted me to ski with her. I wasn't even interested in her

but I thought I could give it a very low-key go. I turned my DIN down - which ended up being a mistake. On about my 3rd or 4th run, I was picking up speed and confidence as everything was feeling MUCH better than I expected, and hit a patch of chunky snow on the edge of a blue groomer. One ski went flying off, and I was skiing on just my operative leg. I tried to ease into a controlled fall - I didn't want to be on that leg, and immediately got onto my back, leg in the air.

I decided that was enough for that day. Didn't ski again until Dec 31. Here's a brief ski log for when I started:
12/31 - 7 runs, green & blue groomers
1/8 - 9 runs, blue & blue/black
1/12 - first pow day (at Vail), 7 runs, skied the bowls
1/16 - first bc day - 2 laps off Mt Trelease - cream cheese type snow
1/21 - only 6 runs, but did a lap or two in the Lake Chutes - very firm - probably what led to the early fatigue
1/25 - 2nd bc day, a little more hiking this time at BP
1/29 - 2nd pow day (Vail), 12 runs
2/1 - Vail, firm, set up pow, cruddy - fatigued fairly quickly

Due to snow conditions/schedule, didn't ski again until 2/18, but I think by this point, I was feeling pretty solid and without much limit. Endurance probably not 100%, but not far off.

If I was feeling any pain/fatigue/instability, I was always willing to stop. Pow was friendlier than firm. Being on good pow skis helped that, too.

**Wolfmansbro** · 11-07-2011, 03:07 PM

Originally Posted by The SMP

For those of us that will be in the 5-8 month ACL post-op range this season, has anyone considered changing their equipment? Maybe a shorter or easier to swing ski or chaning the din (pre-release vs. non-release fall on the new knee). Didn't find anything searching and this crowd seemed the right bunch to ask.

Thought I would re-post this considering there wasn't a response. Maybe someone is better at searching than me, but I wasn't able to find any answers to this question.

I'm 6 months post-op after a left leg hamstring ACL repair and lost a good majority of the meniscus.
I mountain biked a ton this summer, 4-6 days a week, and just started trad climbing the last couple of months. Bouldering still seems too scary to land on the knee.
A lot of PT for the first 3 months of surgery. But my left quad is still considerably smaller than my good leg.

Thinking about selling the ARGs and Volkl Goats (190cm) this year and skiing on my smaller (180cm) Icelantics, or should I look at something even smaller? I'm 6' and 150#. Aggressive skier, normally put in 100 plus days in the Wasatch a year, although only 50 days last season (all without an ACL)
Will smaller skis be safer? Hopefully this will keep me from skiing things I shouldn't be this season.

Anyone with similar ideas or opinions?

**Cedrik** · 11-10-2011, 01:15 PM

Welcome to the ACL Class of 2011. I'm planning to ski on narrower, lighter skis for at least the first few months. I'm cleared to alpine ski in mid-December, which is 8 months post-op (ACL auto hammy + full MCL).

Normally I ski ON3P Billy Goats (140/115/120), but I'll start on Fischer t-stix 88 (124/88/112). Megaride boots and Dynafit Speed bindings on both.

I think less weight and torque on the leg is a good thing to start out.

**wolfelot** · 11-13-2011, 06:16 PM

I'm going to dial down my dins just a little bit. I won't be skiing as hard and do want to make sure I release if I fall.

**tone capone** · 12-02-2011, 02:36 PM

So I finally had a legit ski day yesterday, 9 months post op acl and 50% meniscus. ^^^I think it's a good idea to set your bad leg din lower, just to make sure you don't end up skiing on just the bad leg.

Happy to report that I skied a good amount of vert, over 20,000 feet on a progressively deteriorating groomer that was a mix of snow piles and ice patches.

I was pleasantly surprised that I could ski pretty smoothly and with good form, however:

Unlike Cedrik, I have this nagging kneecap pain and despite considerable effort, my operated leg is still quite a bit skinnier than the other. The pain was present but not debilitating, even made some decent turns in the cut up pow on the side of the trail. The thing that finally got me to quit though was that my good leg got completey fatigued and almost cramped up. No muscle fatigue in the operated leg at all, zero. Just knee soreness, which I completely ignored and just made sure to turn really hard on that side too.

It's super weird to me, cause I really felt like I was laying into both legs equally, skiing smoothly, consistently, with reasonable confidence and trust in the stability of the knee. I am hoping this kneecap pain is not going to permanently prevent the muscles from rebuilding properly. I really wish I could get better answers about this, as the doc and pt just keeps telling me it's nothing and it will go away with strength. I can even do 160# single leg presses now and it still feels the same, and is still just as skinny as it's been since surgery. I hope to God there isn't something wrong in there that I am just fucking up by continuing the weight lifting routine and skiing. It just doesn't seem right at this point, considering everyone else's muscles seem to come back just fine in 6, 8 months and they don't have kneecap pain every time they bend with weight on it.

Any insight you guys have would be appreciated. Did any of you have that deal where only your good leg gets tired even though you don't feel like you are compensating? Any one else get permanent knee cap pain after acl and or meniscus debridement? I have also tried all the other pt bullshit they prescribe for patella femoral pain, including constant patella mobilization, taping, strapping, streching, pushing through the pain to try and strenghten the vmo etc. Did any one have this issue and it just went away after a year or more?

**zion zig zag** · 12-02-2011, 09:15 PM

I can't answer much of the question since I'm only 4 months out, but the doc did tell me that I'll still be able to see the difference in legs up to, and possibly longer than, a year. The difference in strength between the 2 is only 16% but there is a big difference in size. As far as the knee cap pain, I've noticed I have to be super warm, like to the point of dripping sweat, before mine goes away.

**wolfelot** · 12-02-2011, 11:30 PM

Hey tone Capone, I am 5 months and a week out from acl surgery. I don't know what it is but the repaired knee doesnt get tired or have the lactic acid burn feeling the other does. It is pretty strong but still slightly skinnier than the other leg. I do leg presses and concentrate on not letting the good knee dominate, but the good leg still burns more.

**tone capone** · 12-03-2011, 12:44 AM

^^^ exactly. I do all my gym work with the operated leg only to get it fatigued, that seems to be the only way. It seems no matter how hard I concentrate biking or skiing, I just can't get the operated leg feeling any muscle fatigue. It's always only the good leg. The good knee even started achiing bad enough that I was kinda glad bike season was over and I could just work the hell out of the operated leg in the gym.

Well thanks dude, good to hear I'm not the only one and that it's still within the realm of normal.