Gym while MCL heals pre ACL surgery and how long to wait for ACL reconstruction?

[Vasilako]

Hi everyone, so glad I have found this site, and reading some of the post op diaries has made it seem like alot of people have had great success once getting their knees reco'd.

I recently had a nasty collision in the first game of the soccer season where two players landed on the outside of my knee whilst it was grounded (and I was playing bloody goalkeeper!).

Anyways long story short, the MRI came back wit a large joint effusion, with a grade 3 tear of the ACL, a high grade 2 strain of the MCL, luckily nothing done to the medial meniscus, but a complex tear involving the lateral two-thirds of the posterior horn of the lateral meniscus. I have also a low grade strain of the proximal fibular collateral ligament.  Add to that some bone bruising and all in all, my knee is stuffed :-)

I've been lucky enough to be waering a irom domjoy knee brace from my wife's cousin who had his knee reco'd a few years ago to assist in keepin the leg straight to allow hte MCL to heal. My physio has set the range of movement to 90 degrees flexion and 30 degrees extension and given me some exercises to do to help strengthen the quad around the kne

I have two quesitons, firstly, is it ok to be doing other types of exercises at my gym e.g. for upper body obviously being careful in what strain i do on my knee in the meantime? I hate just feeling like I can't do anything other than flexing my quad about 100 times a day!  Also, given that my left leg has been doing alot of the work over the past week, it is starting to get a bit tired and would like to focus on some exercises to do on that leg to keep it strong.

Also, I would like to know how long i can go between doing my ACL surgery.  The reason for asking this is that my wife and I have planned our proper honeymoon in July and it's a 6 week round the world trip.  The OS told me that the brace should be worn for 6 weeks for the MCL which shouold give me plenty of time prior to my trip for the MCL to heal.  I would just like to know that if I waited till say September which would be about 5 months post injury if that would be pushing it too long not do to the ACL surgery?  I obviously would be very careful on the trip not to do anything that would involve pivoting or turning, and just be taking it a bit easier than I normally would.

Any comments would be appreciated.

Cheers
Vas

[Vasilako]

I spoke to my PT and did do some exercises at the gym for the upper body.  Just some bicep curls, shoulder presses and chest presses.  Also did some one legged leg presses on my left leg.  Needless to say was getting a few odd looks from people at the gym walking around in my brace. 

I've been trying to keep a positive mindset through all this.  Things can be worse and reading some of the stories on here, i feel like my knee problems are relatively minor and will (hopefully) get back to normal within about 12 months of hard work.

I'm still curious to find out if people think that waiting so long between the MCL healing and doing the ACL would be problematic.  Would like to hear other people's experiences if they had similar injuries.

Cheers
Vas

[Rothera]

Hello Vas
Well this sounds very similar to my situation last year. I was skiing (April last year) and had a very silly, slow twisting fall. MRI showed ruptured ACL, grade 2 MCL sprain and large LM tear.

The plan was to brace me for 2-3 months to enable MCL to heal and then have surgery to reconstruct ACL and repair or remove LM tear.

I was doing physio twice a week to strengthen quads and maintain ROM but at the same time protecting the MCL from damage and providing a healing environment.

All was going well (although MCL was not tightening up) but in late May my knee dislocated out of the front of the brace while walking down stairs. The decision was taken to do surgery straightaway on ACL and LM tear.

We didn't do anything with the MCL at the time and unfortunately this continued medial laxity meant the ACLr failed and by Sept the graft had almost completely ruptured and the MCL was now grade 3 tear! Back to surgery to redo ACL and MCL at same time. More bad news....expanded bone tunnels and soft bone meant I had to have a bone graft first and wait 5 months for main event.

I've just had this done and am recovering well with new MCL and ACL.

So, your question about how long to wait is not easy to answer. Ideally you should wait until your MCL is well healed and able to support the ACLr. However, if like me, your MCL doesn't tighten up you may want to think about earlier surgery. You need to really discuss the plan with your physio and surgeon. Certainly between injury and first surgery I was encouraged to keep fitness up and go to the gym (wearing brace all the time). And between the bone grafting and final operation I have been using the gym a couple of times a week....and longing to get back to running!

Good luck and if there are any questions you have do ask. We really sem to have similar injuries.

[JintsLady]

Hi Vas,
Suffered similar injury except while I was sparring in karate.  Bigger guy and I were struggling for a take down, my R foot was planted behind his and he won the struggle, sending me over his leg while my foot stayed planted.  Went to OS next day, as I previously tore my L acl and knew what it felt like. 

OS sent me for MRI which diagnosed the dreaded "Unhapppy Triad" injury.  Torn acl, torn mcl and some probable meniscus tearing.  After speaking with OS decided to have surgery as soon as I could.  Am scheduled for hamstring autograft in early May, which is about 5 weeks post injury.  OS said he will take a look at how mcl is healing and determine if that needs to be repaired and will see what needs to be done with the meniscus. 

I asked what I can do to prepare and I have started pre-hab with my PT (2x a week).  We are not only working the injured leg but also working the supporting leg.  PT also said I can do upper body work as long as it doesn't strain knee.  I'm doing what I can and even trying to learn some new routines. 

Good Luck with everything, I hope you get to enjoy your trip.  Let us know what you decide. 

[Vasilako]

Hi Rothera

I'm glad to see you are recovering well with your new ACL and MCL, hopefully i don't have to go through all that painful bone graft situation. I guess my only worry is that it's been almost two weeks since the injury, and whilst I can weight bear on my injured leg fully, and almost walk normally with a little bit of a limp with the brace on, the swelling around the knee doesn't seem to want to go down at all, even tho I am still icing and using a compression bandage on the knee 24/7.  Sleeping with the brace on is also a pain...hopefully it does strengthen up in the next few weeks.

JintsLady, the waiting time was suggested by my OS, I will be seeing him in the next few weeks hopefully once the MCL has healed.  Tomorrow I'm going to my PT so hopefully he would of seen some improvement in my knee. In the meantime, I think I will be like you and do as many new routines as possible.  I just hate the feeling of sitting/lying around not doing anything!

Goodluck with your surgery and recovery.  I'll keep you posted on how I am travelling along!

Cheers
Vas

[Rothera]

Hi Vas

I know the brace is a pain, but really, it must be used. That's a bit rich coming from me as I hated it too and occasionally took it off for sleeping!!! The swelling could take months to go fully though so just carry on with what you're doing. Are you elevating the leg when you ice? Try and get it elevated as much as you can. When I was working I would sit at my desk with the leg propped up.

Hope things go well.
R

[JintsLady]

Vas,
Just curious, does your OS or PT have you working on full extension/flexion?  I know you said your PT locked the brace at 30/90.  I'm just comparing the protocols we are following.   My OS has my PT working on both for me.  I have full extension but still shy of full flexion. 

Rothera,
I see you went through so much but now seem to be recovering, can you tell me what your OS/PT has you doing with the revision of the ACL and repair of the MCL?  I may be in same boat in a few weeks.

Thanks and Good Luck with your recoveries!
Jo

[Vasilako]

Hi Rothera

Yeah I am elevating when I am icing it on the couch, also I do prop it up at my desk.  I started getting a reaction to the Voltaren 50's the doctor had prescribed for me so I stopped taking them and just am on Panadene Forte every now and then when the pain kicks in, which is usually at the end of the day after walking around on it.

JintsLady,
At the moment they don't have me on full extention/flexion.  I'm going to see the PT later on today so will let you know if he changes the lockout on my brace.

Goodluck with the recoveries!

Cheers
Vas

[Vasilako]

So I went to my PT on Friday and he said that my MCL is definitely feeling a bit tighter, and gave me some additional exercises to do, including squats and heel slides within the ROM of the brace.  He also said he noticed the swelling has come down considerably. I guess cause I see my knee every day it always looks the same to me lol.

He also increased my ROM to 20 degrees from the previous 30.  I have noticed however in the past few days that my right calf is extremely sore, and i know it's from mainly walking on the front part of my foot, so need to concentrate on putting my weight through the whole base of my foot.

Also my GP gave me a referral to see another knee specialist which I am excited about, as my PT told me that he is one of the best in Australia.  Get to see him in a next Thursday so my PT said we will just continue doing  exercises till then.

Today at the gym I did those additional exercises and I also added a few more in myself including single leg presses on my bad leg with very low weight (40 pounds)..not like the old 240 I used to do on both legs! and I also rowed within the ROM of the brace for about 1000 meters and all felt great.  Just getting quad soreness rather than any knee pain at all.  I can't believe how much the muscle deteriorates within such a short space of time!

Hope everyone is going well with their recoveries!

Cheers
Vas

[Rothera]

Hi Vas

The muscle deterioration is so sad! As I had 5 months between operations whilst waiting for the bone grafts to take, I got myself pretty fit back at the gym....cycling, x-trainer plus weight, so I went into surgery 4 weeks ago with good leg muscles and good overal strength.

4 weeks on my bad leg looks pathetic! A little stick with a huge knee!

Oh well, I can start muscle building exercises this week. So far it's just been ROM exercises.

All the best
R

[Vasilako]

Hi Rothera

I know how bad it feels when you look at your leg and just realise that all the muscle is gone...it is depressing but i guess it just motivates you more to keep at it and make the muscle strong again.

Glad to see that you can start doing weight bearing exercises on the leg. Hope that your recovery is tracking as it should!

Also i know never to roll my eyes when my wife complains about wearing heels again...my calf is absolutely shattered from walking on my forefoot for 2 weeks lol

Cheers
Vas

[JintsLady]

Hi Vas,
Glad to here they are increasing your ROM.  That's a good thing.  Definitely keep up whatever other exercises you can.  It is depressing to see your leg after surgery, how weak it is, so it helps if the rest of you is feeling strong. 

My PT has added a bunch of strengthening exercises to my ROM exercises, so my leg is as strong as possible going in to surgery.

I can't wait to get to the other side and start the long journey back!!   I'm two and half weeks out until my surgery. 

Let us know what the other knee specialist says. 

Good Luck and keep strengthening that leg. 

Yes, heels are killer on the calves!

J

[Vasilako]

Well what a difference with Orthopaedic Surgeons!!!!

I just went and saw the second specialist yesterday, and he was so much better than the first. He actually took his time to look at all my MRI scans rather than just rely on the report and also had me take X-Rays of my knee to ensure no bone issues which luckily was all good.

He told me I am no longer in need of wearing a brace, so Robocop is now dead! 

I just need to follow his training regime for pre-habilitation, and will see me again in a month's time to see how I am progressing.  He also agreed that I shouldn't do the ACLr until after my trip which put my mind at ease. 

All in all, since my last post, have found the knee is getting a lot more stable, have increased my ROM too, but still some nagging swelling that just won't go away and is restricting my movement, but slowly it is getting better.  Just have to keep at the exercises and physio.

Hope you are all doing well with your knee injuries :-)

Cheers
Vas

[JintsLady]

Vas,

That's great news.  Glad to hear you're doing better.  Just keep working the surrounding muscles and make that knee as strong as possible before your surgery.  Glad you can enjoy your vacation with peace of mind about the surgery.

I'm less than a week out to my surgery and had my last PT session yesterday.  My PT says my leg is strong and as ready as it will ever be for surgery.  I have complete ROM with a little bit of pain when in full flexion but none with extension. 

Looking forward to being on the other side.

Good Luck!

J

[Rothera]

Hi J

Sorry for late reply. I guess you're asking about rehab?

Well I've been taking it very easy the first six weeks. The line was "brace for 6 weeks 24/7" set originally at 90-30 and have gradually adjusted it so that now  it is open. We have been focusing on ROM rather than muscle-building but have just started that this week. I can drive now but have to wear the brace all the time during the day, not at night now. Im expecting to step up rehab now so that in 10 weeks I am back to gentle running.

I feel really good. Very little pain now. Mainly associated with the tightness of grafts when I try to bend and straighten. I think the operation has been very successful and I'm planning on getting back to full per-accident levels ASAP!

What surgery are you having?

Best
R