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I am a noobie; started riding this past October and I am hooked. I have already done a race and was training for my first Sprint Triathlon. I have been lurking around the discussion boards reading and learning as much as possible from the great feedback offered here. I am finally compeled to post my first thread, in search of more great advice and guidance.

I just got back from a spring ski trip that left me with a torn ACL this past Monday. I had an appointment with the Orthopedic Surgeon today and it is clear that we are looking at surgery. I certainly have a torn ACL and a good probability that my Meniscus may be torn as well. The MRI may tell us more, but that is what we have so far. While the surgery is intense, the rehab is even more critical from my discussion today and the research I've done so far. Many of the rehab programs I have researched so far call for stationary cylcing as part of the rehab. I am wondering if any of you have had to deal with an ACL reconstruction, and how soon you were able to get back on the bike. I am also looking for general advise and lessons learned on the rehab process. Thanks!
 

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I had a high grade tear of my PCL on Oct 30th. Fortunately it did not require surgery, but it kept me from riding on the road for 2 months. I was riding in the trainer after 4-6 weeks, so it is not so much the motion of the pedalling that will keep you from riding as much as all the things that can go wrong on a ride, specifically crashing and clipping in and out of pedals. My injury was about as bad as you can get and still avoid surgery (I did it 8 days after purchasing my first road bike... Go figure.)

I will say that the stationary bike at rehab as well as my bike in the trainer did immeasurable good for flexibility and restoring muscle mass after the atrophy of that DAMN immobilization brace. I still have pangs/twangs/twinges in my knee every once in a while that don't hurt as much as they remind me I am not 100% yet and to back off a little. I think most people will encourage you to not push too hard or you will have to start from square one if you reinjure yourself.
 

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My friend tore his 3 weeks ago, surgery 2 weeks ago. He was off crutches a week ago. I don't know the details of how bad it was, rehab, etc etc, but I don't think hes at the point of biking yet (he doesn't bike though). Good luck. out of curiousity, how'd it happen skiing? fall backwards/backseat?
 

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My daughter just had ACL surgery,done arthroscopically. She is recovering quickly with the help of a sports medicine therapist. She was lucky and did not have a torn meniscus. The ACL was replaced with a donar's ACL (from a person who no longer had a use for it).

Al
 

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Discussion Starter #5
I was coming down a run under thick snow conditions (not groomed). When I dropped into the last steep section of the run my down hill edge (left ski) got caught and I went for a nasty tumble and my ski refused to come with me at first. I felt the pull, then the loud POP!!! That was it...I was done. I wish I would have fallen backwards...I would still have a knee.
 

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Tibu said:
I am wondering if any of you have had to deal with an ACL reconstruction, and how soon you were able to get back on the bike. I am also looking for general advise and lessons learned on the rehab process.
Although I am far from the expert kpcw is, I did have a similar injury to you: partial tear of the ACL and meniscus damage skiing last February (14 months ago). I fell into the backseat as the ski twisted sideways (a pretty insignificant wipeout). My doctor suggested no surgery, just rehab, and see how things progressed. I rested fully for about 3 weeks, then started rehab and some easy biking. Recovery was OK, although I didn't heed his advise 100%, tried to start other sports too soon, and set myself back on the road to recovery.

14 months later, my knee is 90% OK. I believe the ACL is fine, its just the meniscus damage that hasn't recovered 100%. This was also a re-occurence of an earlier soccer injury. My doctor explained that the meniscus either sorts itself out, or needs to be removed - there is no real mendingper se. After about 8 months of niggling knee issues, I decided to start playing soccer again, and there was no deterioration. Every now and then I get a flare up but it is annoying rather than painful. I guess I may have bits of junk in there that sometimes move where they shouldn't.

I biked almost the whole time during recovery (docs recommendation). Remember also that the ACL is extended when the knee is straight, so don't try doing anything that will quickly straighten or possibly hyperextend the knee (eg kicking a soccer ball). Make sure your saddle is not too high on the bike, thus extending your knee.
 

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Recovering from ACL reconstruction and torn meniscus is how I got into road biking in the first place...so, that was one good thing that came out of the whole event.

And as kpcw said, don't slack on the PT even though you're starting to feel better. Biking was good, but my other (impact) activities took a while longer, I believe because I didn't continue to be as regimented about the PT.
 

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First, a torn meniscus is no big deal. I had surgery for this and was cross country skiing 4 days later. Fully recovered in about a month or two, if I recall.

I had ACL reconstruction just over 2 years ago (mid Jan 2004). It was about a week later that I could make the pedals go around on the stationary trainer. I rode outside (VERY slowly and carefully, and on a flat road) about 3 weeks PO. Did a flat race in late march (4th place?!) and managed to race the rest of the season.

On the bike the knee was fine, but doing other activities (running, basketball) it would get very sore and swell up again. The range of motion reached about 90% and then plateaued because I don't ever stretch enough. Now it's probably 98-99%.

I would suspect you are looking at least 4-6 months before you can start running again. In my opinion, that's probably a good thing. When my doc said I couldn't run, I thought "that's a relief!" ;-)

Last summer I crushed the same leg in a mountaineering accident (there was talk of amputation!), and was off the bike for over 3 months, and couldn't really train for about 5 months. It's coming around though. My only issue now is lack of strength, since the leg atrophied a LOT. I'm still pedalling a bit one legged.

I'm racing this year, and doing ok (I'm in a higher cat so mostly just hanging in there and happy to be able to ride).

At the beginning, listen to the doctor, but be careful because IMO they don't ever say much. Inform yourself, and ask a lot of questions. It's extremely important to get a good PT, and do what she says. But assuming you were fit to begin with, and know to listen to your body, you should be able to push yourself more than the PT will. How well and how quickly you recover depends on how much work you are willing to do during rehab.

As for the bike, once I could ride it, I loosened my clipless pedals so they released easily and put a 13-29 cassette on. I live in a really hilly area (every ride begins with a 12% grade hill) and so I tried to avoid the hills as much as possible, and use very easy gears.

Good luck with your recovery.
 

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Discussion Starter #9
kpcw,

WOW!! You did write the book. That is a scary history you have there. Thanks for the feedback. I am doing tons of research, making sure that I am as prepared as possible. As for your questions: I am about to turn 40 next month. I just scheduled surgery on April 28 and the MRI is tomorrow. The Doctor is reserving 3 hours for the procedure, which tells me that he expects a torn meniscus, not good. If it is a major tear of the meniscus, I will be in crutches for a month, versus a week if it is a minor tear. I am still debating the type of graft...but leaning towards an Allograft to help with speed of recovery. My doctor is helping me with the decision making process, and he is supportive of either a Patella tendon autograft or the allograft. He certainly recommeds those options over the hamstring or quad autograft options. As far a PT, the doctor told me to wait until the swelling goes down to start anything significant. I am doing leg raises since yesterday, and as soon as the swelling goes down I will start on the trainer...hopefully this weekend. I am pretty happy with the surgeon I have, so far. The good thing is that he's gone through this already, he tore his ACL skiing as well...so he has first hand knowledge of what I am going through. I am anxious to get the process moving, and start the road to recovery...who knows, I may be able to use this as a step up to my training regime. I am already in pretty good shape, but there is always room for improvement. Thanks for the links!
 

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In early January I completely tore my ACL and partially tore my LCL skiing. Surgery was held off untill they felt my LCL was going to be OK, wound up going under the knife March 7. Allograft (sp?), no meniscus damage. It's been 5 weeks and range of motion is almost fully back and I am working with my PT on strengthing. I was able to make the pedals go round at about a week and a half and have been on the trainer quite a bit. I have been cautiously on the road for about a week and a half now. My biggest hurdle has been making my quads work again, they are coming but its lots of work. I still have some swelling that I am told may be around for several more months. No running, jumping, etc untill I have a strength test at the 3 month mark according to my doc. It's frustrating, but at least I can ride.

Dave
 

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Choose a doc who does nothing but knees if you can.

Turns out there is an art to getting the new ligament to exactly the right length. Only by having the exact right length do you regain 100% of power. Finding the best knee guy is the best way forward, a part-time knee guy has less chance of doing a great job. Clearly, rehab is as important as the surgery. Brace yourself the PT will be cruel, but if you don't do it you will never recover.

The good news is that the stronger your leg is the less your knee will bother you. Set some written goals for leg strength 1 year after surgery and 3 years after. I benchmark on Nautilus machines (doing the stack with both legs and doing half the stack + 40 lbs with one was my goal), find something you can measure that will work for you.

You can come all the way back if you really want to and are willing work through the pain.

Good luck.
 

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like remy, i got into cycling to recover from ACL surgery.

if the meniscus is torn, be careful not to hurt it more before the surgery.

i agree with those who say get a doc who does knees only - i say find out who does pro athletes, even if you have to travel to them. At least one who does competitive college athletes.

also, ditto for the pt - get one who does pro athletes -- otherwise, they will not respect your athleticism and won't realize how quickly you will advance in rehab. they will suppose you are a weekend warrior and will give you the xeroxed rehab plan.
 

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tore my ACL

many moons ago, uh, 15 years ago or so. Waited 10 years to have it repaired (no MCL, meniscus, etc. damage). bought a bike to help with the rehab. I was on a stationary in 1 week, out on the road (not mountain biking) after 2 months. Careful with the cliping in and out. Wait about 6 months to do any mountain biking. Road riding is sweet therapy. Be prepared for a bit of atrophy. It'll never come back. I barely notice the difference in the size of my scrawny quads at this point. Either I'm used to the difference or perhaps the atrophied muscles have caught up.

Good luck, keep us posted.

BT
 

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I completely blew my ACL 35 years ago. Went to doc, and got misdiagnosed as meniscus (only)damage. Lived with the knee popping in and out for almost 20 years and went to doc again, because it "popped out" and stayed "popped out". He asked all the regular questions and did many flexability tests and then informed me that I had no ACL.. After much discussion pro and con, I decided not to have reconstructive surgery. I took up cycling after the initial PT that was RXed. Been cycling now for more than 15 years and knee is very stable. I don't do sports that require quick lateral movements, but I do ski as I am a PSIA level 2 instructor. The only skiing activity/condition that seems to bother me is heavy crud or wind slab. That causes too much extension and I start to get sore. BTW, if you heard the "gunshot" or dry limb "snap", you likely totally severed the ACL as I understand it. The 2nd doc informed me that's the classic sound of an ACL letting go. I was also told that I would likely have a very arthritic knee by now, but that has not occurred either. I guess the point is that IMO cycling has been a real saving activity for me. It has been responsible for the stability of the joint and the resumption of virtually all the activities that I formerly pursued, ie. skiing, hiking, running (I don't anymore but I could), skating, etc.

Birddog
 

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Discussion Starter #15
Just had the MRI this afternoon. The ACL is completely severed. Like Birddog said, the "gunshot" was indeed the ACL saying "hasta la vista baby, nice knowing you". I am in full blown pre-Op PT...thanks KPCW. The swelling is down considerably and I plan to give the trainer a go tomorrow morning. My preOp is this Wednesday and the surgery is set for April 28th. Thank you for all the feedback so far.
 

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Blew my ACL 26 years ago twisting my knee playing squash. Had arthroscope thinking it was meniscus and when they found out it was ACL they woke me up to see if I wanted it repaired at that time or not. My wife was pregnant and I was the sole bread winner and I needed to be mobile to make a living. Opted for intense PT and rehab instead, got fitted with a custom made brace and started playing squash again in about 9 months.

3 months later, because of the instability, I twisted the same knee again playing squash this time while wearing the brace.

Resulting injury was much worse than the original one which I found out about 4 months later after surgery. I had severed a major piece off the inner condile (ball of the femur that sits on the tibia and bears all the weight with the meniscus in between).

Surgeon said at the time the repair went well (patella tendon graft) but that the missing bone (size of a silver dollar he said) could/would cause problems.

There was a ton of pain (full bent knee cast for 10 days, followed by 6 weeks in a full hinged cast) and once PT started the lost bone was really sore.

Fast forward 25 years this December and I am more fit that I have ever been in my life (54 now). My main activity is cycling and spinning in bad weather/off season. I pretty much have given up sports where a twist might occur (squash, skiing etc.) Nobody told me I needed to do this, in fact I have played those sports since (no brace never need to wear one) without incident, however I know that I am one good twist away from an artificial knee so I can't say I miss any of the sports I have voluntarily chosen to abandon.

I have become an endorphine addict with my main source of cardio being cycling and sometimes swimming.

Things have turned out much much better than I was led to believe after going under the knife 25 years ago.

Good luck with your procedure and keep us posted on you progress.
 

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1 year and 4 months post ACL / Meniscus sx

The knee feels pretty good. Back on the bike about 4 months after surgery. The ACL was completely gone and had a "bucket handle" tear on the poaterior horn of the meniscus. The Ortho repaired the meniscus instead of removing it and that was really tough on recovery because I was locked in extension and was limited on how much I could flex for about the first six weeks. Once I was allowed to go for full flextion rehab wasn't too bad. Also very important to not just cycle during rehab, since your good leg can help out and try to get full extension asap. anyway, good luck. I know what your going through.
 

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Tibu said:
Just had the MRI this afternoon. The ACL is completely severed. Like Birddog said, the "gunshot" was indeed the ACL saying "hasta la vista baby, nice knowing you". I am in full blown pre-Op PT...thanks KPCW. The swelling is down considerably and I plan to give the trainer a go tomorrow morning. My preOp is this Wednesday and the surgery is set for April 28th. Thank you for all the feedback so far.
I've been through two ACL reconstructions/revisions and a number of other procedures on one of my knees since 1987. I last had an allograft revision in May 2006. For what it's worth, I was on my bike riding consistently before the surgery, and I even managed a 50 mile training ride the evening before my surgery.

In terms of rehab, I was off crutches and on my trainer doing ROM work in less than two weeks. I was riding on the trainer after 3 weeks, and I was on the road at four weeks. I was on my telemark skis (in a CTI brace) at just under 6 months. The allograft is a snap compared to the older autograft procedures.

One tip: Order a Donjoy Iceman cryotherapy unit (http://www.kneeshop.com/iceman.htm) and have it ready to go with lots of ice when you get back home from your surgery. You can find them on ebay for around $100. The iceman will really help with the swelling, and it works much better than regular cold packs.

The first few nights post-op are really miserable, and the iceman will help you get at least a few hours of sleep. I'd just fill the thing and leave it on all night.
 

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Tibu said:
Many of the rehab programs I have researched so far call for stationary cylcing as part of the rehab. I am wondering if any of you have had to deal with an ACL reconstruction, and how soon you were able to get back on the bike. I am also looking for general advise and lessons learned on the rehab process. Thanks!
Did my ACL ('00) at the age of 46 - repaired with a hamstring graft. I ski for a living in the winter, and bike 3500+ in the summer - no brace, just telltale scars.

Getting your range of motion is your #1 priority. Time and commitment.

Hope you like to train hard and are willing to move through discomfort. Welcome to rehab.

Getting back on the bike? As soon as you can - indoors.

Outdoors? My doc and pt's strongly discouraged me from going outside and riding for 4 months! Why? No control over the freak thing that could cause a re-injury. And there are many once out on the road - when you least expect. Control your environment in your rehab.

The days take forever to go by, but you'll be out soon enough.

In the meantime, get as much info as possible, make responsible decisions, be methodical and patient in your rehab, and do whatever you can to get strong for your surgery.

Rehab starts now.
 

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Discussion Starter #20
Just got back from an 18mi ride...just had to take it on the road today. Not very responsible, but had to be done. I spent the last week doing 45min. sessions on the trainer...I hate the trainer. I was starting to get a mild case of cabin fever...needed the wind in my face. I was very tentative the first 6mi., then I got a little more confortable. I kept it in easy gears and concentrated on spinning smoothly. I did not want to push it, it felt great!!

So far there is no pain (that will come in loads after the surgery), I am almost walking without a limp, and the swelling is almost all gone. This is the weirdest injury I've had so far. I think I'll be well prepared going into surgery this Friday. We'll see how it goes Post-Op, that is going to be the real challenge. My surgeon promised me plenty of pictures of the procedure; I'll post them for those of you with a morbid side...like me ;-).
 
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