# Riding after an ACL/meniscus injury?



## beastmaster (Sep 19, 2012)

I am contemplating throwing some gears on my SS. In January I had a total tear of my ACL as well as a minor tear of the meniscus and will have surgery next Thursday for repair. I won't be on the bike for a bit afterwards, but when I can ride I am thinking the SS will be too much on my knee. I will put the gears back on sometime in September or October (7-8 months post surgery).

I am also considering another bike as my SS is rigid and has no dropper post. In this case the other bike would be less focused and allow more room for riding errors.

Anyone here have an experience with this injury and single speeding afterwards? Or for that matter, experience with riding any mountain bike post ACL reconstruction?

Thank you!


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## prj71 (Dec 29, 2014)

Have had the ACL done on both knees. Right knee in 1997 along with torn meniscus and left knee in 2013. 


No problems riding at all...I ride year round...mountain bike, winter fat biking and road biking.


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## beastmaster (Sep 19, 2012)

prj71 said:


> Have had the ACL done on both knees. Right knee in 1997 along with torn meniscus and left knee in 2013.
> 
> No problems riding at all...I ride year round...mountain bike, winter fat biking and road biking.


I am glad your results were so good!

I am 8 days out now from the surgery. Good news is that the meniscus tears were significantly less and problematic than the MRI showed. My surgeon was able to leave them alone basically. He threw on stitch into the lateral side (which appeared less damaged in the MRI) and the medial side wasn't really damaged at all (this side appeared more damaged in the MRI).

I worked hard to gain mobility of the joint in the first 6 days. I have an amazing 90+ degrees of flex and can get the knee totally flat with just the slightest hyperextension. All of this sort of shocked the doc. He still wants me on crutches until the first of April, but he gave me an Rx for PT, which I begin 3x/week tomorrow. I still am working on getting the swelling down, but things are definitely pointed in a better direction now.


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## Forest Rider (Oct 29, 2018)

What was your ACL repair?


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## beastmaster (Sep 19, 2012)

Forest Rider said:


> What was your ACL repair?


The ACL is the abbreviation for anterior cruciate ligament. This is one of four ligaments that hold the knee joint together. The ACL controls how the femur moves over the tibial plateau and prevents hypertension. I tore mine completely which requires surgery to gain full athleticism. That surgery involves replacing the ACL with a graft, which comes from two primary sources-the injured's own body (removal of portions of either the hamstring or patella tendons) or a cadaver donor ACL. Mine came from my hamstring. This type of surgery is generally preformed with arthroscopic techniques-meaning it is considered minimally invasive. That said, the instruments used do go all the way into the middle of the knee joint and involve boring holes into both the femur and tibia.

Soccer and basketball players as well as skiers (and many other sports too) can injure this ligament in so much as these sports involve quick lateral moves in a stop and go environment.

My surgery was a total ACL reconstruction with a single stitch thrown into my medial meniscus too. Very frequently ACL tears involve meniscus damage as well. The meniscus are the cartilage pads between the femur and tibial plateau. There are two of them.

I will be "toe weight" bearing for a few weeks, which means crutches. I hate crutches. 20 years ago I broke my ankle and was on them for 8 weeks with no weight on that leg at all. At least I can put a small amount of weight on that leg! Haha!

It takes up to 9 months to fully recover from this injury. But that means being where I was prior to the accident. Last time I did PT (the broken ankle) I came back stronger than pre-injury. I will do that again. I hope to be riding by the end of April on my road bike and end of May on easy single track. Back to technical riding by the end of summer or early fall. And skiing next year (which is my one true love) by first of December.

Hope that explains your question thoroughly!


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## Forest Rider (Oct 29, 2018)

Wow, much more background than expected.

I've had the surgery, but thanks for the description.

You said 'tore' your ligament and I didn't know if you meant it was 'severed'.
I too had the hamstring allograft. 

I say you need to listen to your PT as far as recovery. It sounds to me like you are overdoing it at home without direction.
I was never an athlete prior to the ACL reconstruction, however since surgery I've run marathons, shorter races. Road and mountain bike, softball and still dirt bike. Because I took time and patience to properly heal I am in a great position to continue pain free for hopefully the rest of my life. One thing I do not want to happen is to destroy the graft. Surgery #2 to repair #1 is not pleasant, so I'm told.

I think the #1 cause of re-injury is going back to activity too early. In my opinion, being on a bike in 2 months is a pipe dream.

Best of luck to you in your recovery. I was injured for 15 years before having the surgery performed. So glad I did finally have surgery!


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## beastmaster (Sep 19, 2012)

Forest Rider said:


> Wow, much more background than expected.
> 
> I've had the surgery, but thanks for the description.
> 
> ...


Having just had my first visit with the PT, we went over the rehab protocols, I think you are correct about my riding ambitions that early. (Damn!)  While I have a deep and long athletic background, I am not the best at being injured. (I played NCAA Division 1 basketball for NAU in the 1980's, skied professionally in the 1990's, and have ridden bikes competitively for about 7 years now, not to mention racing factory Ducati's for about 10 years in the early 2000's as well.)

It was explained to me that the allograft undergoes a change in its physical structure--going from tendon to ligament physiologically. This change happens slowly over time, but the most critical portion happens in a 4 to 8 week period during week 8 through 16 of recovery. It is during that period of time that most re-injuries happen because people start to feel considerably better and do too much, too early.

Besides all of this, I will most likely be using crutches for at least another month to help aid the meniscus tear which had a single stitch put into it. Putting weight on the knee now will cause the stitch to fail.

I have been warned and will listen. Thank you for sharing your experience too. Good to know you had a good result.


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## Forest Rider (Oct 29, 2018)

beastmaster said:


> Having just had my first visit with the PT, we went over the rehab protocols, I think you are correct about my riding ambitions that early. (Damn!) While I have a deep and long athletic background, I am not the best at being injured. (I played NCAA Division 1 basketball for NAU in the 1980's, skied professionally in the 1990's, and have ridden bikes competitively for about 7 years now, not to mention racing factory Ducati's for about 10 years in the early 2000's as well.)
> 
> It was explained to me that the allograft undergoes a change in its physical structure--going from tendon to ligament physiologically. This change happens slowly over time, but the most critical portion happens in a 4 to 8 week period during week 8 through 16 of recovery. It is during that period of time that most re-injuries happen because people start to feel considerably better and do too much, too early.
> 
> ...


I am happy to hear the comments from the PT at least in terms of how people get moving when they 'feel better'. In my experience, my PT wanted me to easy into our prescribed activity....for one, because there is protocol for rehab for ACL reconstruction, but also because it allows our mind to understand that despite feeling good, we are not healed.
It's pretty important too that the bone grows around your pins so that they do not pull out.

Very true about meniscus. I didn't have to worry about that as much of mine was cut out due to the amount of tears I had going on. I had it worked on 3 times in total for scoping and meniscus trimming, the 3rd time being during ACL work.

I was on crutches for a while, can't recall exactly how many weeks but it was at least 3 or 4 weeks. Then starting out by walking/standing with 50% weight on the repaired side. Then moving to a single crutch. I went in to PT without my crutch. He wasn't sure how to react, but I figured I'd fall over trying to figure out how to walk with a single. ha He watched me walk and did some examining (poking and prodding) and said I was fine as long as I walked per our discussions.

I cannot recall how long it was, but it was a very long time. He had me doing box jumps. He first showed me what he wanted. So I jumped up on top of the 18" box and stood there. He told me to jump down. I said I needed a second as I could envision myself collapsing when I jumped off since it had been so long doing anything like that.
Keeping in mind I would routinely jump over the side of a 4" lifted full size pickup and think nothing of it, prior to surgery. I was amazed in myself to jump down from 18" with success. haha Finally I am getting to be normal again. But yeah, that was quite a bit into the recovery.

I have a fair bit of arthritis in that knee now so I can't run as much as I used to. It does ache from time to time when I run. I can get past that, but I have a lot of years left and I want to be able to walk normally when I am older.

Just today I was dirt bike riding, a lot of up on the pegs. There is a bit of joint soreness when I finished, but a few hours later after cleaning the bike and getting it all put away, I feel perfectly normal.

The hardest part is listening to the doctors orders, well the PT I mean. When I was incorporating jump rope, and box jumps -impact activity, I started taking the stairs harder at the office I work at. If a little is fine, more must be okay too. After a few days of doing the extra work of stairs at work, my IT band was hurting so bad. I tried to mask it until PT saw me landing on my toe differently on that leg. When they asked, I told them where it hurt (it was IT but I had no idea what he heck that was at that time). No impact for a week. Healed right up and I was back to it, but this time I did't over do it.

I feel like I am definitely one of the ones with a very positive experience all said and done. I have raced either 3 or 4 half-marathons. Two marathons and a crap ton of fast shorter races. I got down to low 6 minute pace. My first marathon was 3:35. I climb forever on the mountain bike, have put in countless road bike miles. I was one of the fastest guys on the softball teams I was on. Like I mentioned earlier, aside from running through the neighborhood when I was younger, I was never an athlete. About 15 years of being injured, then finally getting fixed is when I found the world of sports and I am glad I have the capabilities I do.

Hang in there and don't let it get your down. The best thing about the ACL surgery is they are common and you will heal as good as new. I never feel anything as a result of the hamstring graft. I have a very very tiny spot on my knee with no feeling. PT told me eventually the area would probably be the size of a quarter with no sensation. I think it's at least that size or smaller. The quad muscle on that side won't grow as much as the other leg, and I was warned of that. It is plenty strong, but doesn't have the size as proof that they are (assumed) equal in strength. Being as athletic as you are, you will bounce back perfect with less effort than others will take. I was 2 weeks behind a cadaver patient in PT and that person complained of pain and was well behind me. She didn't want to do the work.....And wasn't very athletic.
All I had going for me prior was just working out in a gym.

Looking forward to hearing some of your progress over the next couple months.


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## Jim Beam (Dec 22, 2003)

Couldn’t have happened to a nicer guy. 🤪


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## Jim Beam (Dec 22, 2003)

tl;dr. Cliffs note version?



beastmaster said:


> The ACL is the abbreviation for anterior cruciate ligament. This is one of four ligaments that hold the knee joint together. The ACL controls how the femur moves over the tibial plateau and prevents hypertension. I tore mine completely which requires surgery to gain full athleticism. That surgery involves replacing the ACL with a graft, which comes from two primary sources-the injured's own body (removal of portions of either the hamstring or patella tendons) or a cadaver donor ACL. Mine came from my hamstring. This type of surgery is generally preformed with arthroscopic techniques-meaning it is considered minimally invasive. That said, the instruments used do go all the way into the middle of the knee joint and involve boring holes into both the femur and tibia.
> 
> Soccer and basketball players as well as skiers (and many other sports too) can injure this ligament in so much as these sports involve quick lateral moves in a stop and go environment.
> 
> ...


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## milehi (Nov 2, 1997)

I had the same injury racing Bootleg Canyon February 11, 2011. I went off course. One of my pedals released, the other didn't. I remember being on my back with the bike above me twisting my knee. I stood up and my knee bent laterally. It made me sick to my stomach as my adventure lifestyle ending flashed before my eyes.

Luckily I worked in orthopedics and had one of the docs fix me up. The surgery was held off for a month and a half until the swelling went down. It wasn't until the beginning of July that I was able to get back on the bike which is a single speed but only rode flat bike paths. I was back to racing the single speed class by mid October.

I didn't go to formal PT. The doc gave me paper with the movements she wanted me to do, and that was it. I saw her everyday in the OR anyway.


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## beastmaster (Sep 19, 2012)

Jim Beam said:


> Couldn't have happened to a nicer guy. ?


Really? Wow! Showing your true colors again?


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## FlyBoy (Dec 23, 2003)

I've been looking for some recent threads of recovery time to cycling post ACL surgery. So it's good to see others having success at going through the process.I had my ACL repaired with a Hamstring graft at the end of March. At 1 week I didn't think I would ever walk again...a bit dramatic but I had forgotten how hard the recovery was from my previous ACL repair from 17 years ago. But...

I was able to complete a complete revolution on one of those stationary recumbent bikes at the Physical Therapist office on day 12. That was a big step for me to at least see there was a light at the end of the tunnel.

On day 19, I went to REI and bought a Wahoo smart trainer. I went home and hooked it up to Zwift and got on the bike (30 min per my PT's recommendation). At first the knee was stiff and it was a bit of work to make a complete revolution but once I warmed up a little I had a great 30 min ride. 

Over the next week I rode every day and progressed to an hour. I gained strength each day. It was awesome.

Today was 4 weeks and 1 day. I rode for one hour and 38 minutes with an average of 155 watts. It felt awesome. I could have kept going but didn't want to over do anything. It's amazing how good this is for your leg and how it speeds up recovery by not only building strength but by building your motivation to get back out on the road.

I haven't had my 6 week follow up with the Dr. yet but my PT tells me that the 2 month mark is about the soonest he would recommend cycling outside on a flat bike path. He said 4-5 months for mountain biking on single track. Obviously I'll back up his recommendation with the Dr's when I have my next appt. Does this time frame sound about right for what you all have experienced? Until then, I plan to keep chugging away on the trainer and building my fitness.


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## Forest Rider (Oct 29, 2018)

I trust the PT before the Doctor estimates.


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## beastmaster (Sep 19, 2012)

FlyBoy said:


> I've been looking for some recent threads of recovery time to cycling post ACL surgery. So it's good to see others having success at going through the process.I had my ACL repaired with a Hamstring graft at the end of March. At 1 week I didn't think I would ever walk again...a bit dramatic but I had forgotten how hard the recovery was from my previous ACL repair from 17 years ago. But...
> 
> I was able to complete a complete revolution on one of those stationary recumbent bikes at the Physical Therapist office on day 12. That was a big step for me to at least see there was a light at the end of the tunnel.
> 
> ...


My surgery was February 28th. Yesterday was 8 weeks out. My PT says I am considerably ahead of where most people are at this point. BUT! He also keeps reminding me about the rehab protocols and how important it is to be careful not to re-injury myself.

From weeks 8 to 12 the hamstring graft undergoes a complex process. In essence, the new graft doesn't have the blood supply it had (when it was part of the hamstring) or will have when the recovery reaches 12 to 16 weeks. During this period we are at the greatest risk of either re-tearing it or stretching it.

My Doctor's protocol says no outdoor cycling until 12 weeks, no standing on the pedals until 14 weeks and at 16 weeks I can go full gas. In the meantime I am working out in the gym, riding my road bike on the trainer, and doing PT 3x/week. Good thing I have a lot of work to do otherwise the waiting would seem impossible to endure.



Forest Rider said:


> I trust the PT before the Doctor estimates.


I would trust the physician who did the work first and let them determine the time table. PT's are very important in the process, but they shouldn't (and ethically cannot) take the lead in creation of the protocols.


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## FlyBoy (Dec 23, 2003)

Thanks for sharing your timeline Beastmaster. It's good to hear how your process is going and the recommendations from your people. I'm anxiously looking forward to what the surgeon says at my next appt in a week and a half. The bike feels great, but I'm not going to push it too hard until he gives me the green light.


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## beastmaster (Sep 19, 2012)

FlyBoy said:


> Thanks for sharing your timeline Beastmaster. It's good to hear how your process is going and the recommendations from your people. I'm anxiously looking forward to what the surgeon says at my next appt in a week and a half. The bike feels great, but I'm not going to push it too hard until he gives me the green light.


Are you riding your bike off the trainer, as in on two wheels only, as in outdoors? If so, be careful! Shearing forces can damage the fresh graft and it is way easier to damage it than you might imagine.


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## FlyBoy (Dec 23, 2003)

I’m not. Like I was saying in my first post, I got a smart trainer and have been riding indoors. Unfortunately I’m not expecting the doc to clear me for outdoor riding until sometime in June. 


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## beastmaster (Sep 19, 2012)

Sounds like you're being smart. What do they say, "absence makes the heart grow fonder?" I, for one, can't wait to get back on my bike, my real bike, outside, on pristene single track in the high country!


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## beastmaster (Sep 19, 2012)

First post-ACL reconstruction outdoor ride is in the books. First off, I had to change my pedals to flats. This was the first time I have ridden on flats since I was a child. (Riding clipless is not advisable, as the knee can have some twisting movement and I would likely pull up on them, as I normally do.) I was super slow and very careful. No need to re-injury the surgical repairs.

Boy did this feel great!


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## FlyBoy (Dec 23, 2003)

beastmaster said:


> First post-ACL reconstruction outdoor ride is in the books. First off, I had to change my pedals to flats. This was the first time I have ridden on flats since I was a child. (Riding clipless is not advisable, as the knee can have some twisting movement and I would likely pull up on them, as I normally do.) I was super slow and very careful. No need to re-injury the surgical repairs.
> 
> Boy did this feel great!
> 
> ...


Beastmaster. Awesome news. Looks like your first ride outside was right at or a little after 2 months from your surgery. How has it been going since then? Have there been any issues with the dismount from the bike?

Have you mostly stuck to paths and roads or have you ventured onto some tame single track?

How long before you are cleared or are going to try riding with your clip ins?


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## beastmaster (Sep 19, 2012)

FlyBoy said:


> Beastmaster. Awesome news. Looks like your first ride outside was right at or a little after 2 months from your surgery. How has it been going since then? Have there been any issues with the dismount from the bike?
> 
> Have you mostly stuck to paths and roads or have you ventured onto some tame single track?
> 
> How long before you are cleared or are going to try riding with your clip ins?


I saw my orthopedic surgeon today. Tomorrow is 3 months out from surgery. My physicians protocol states seated outdoor cycling can begin at 10 weeks; standing hill climbing at 16 weeks--on June 20th (he modified it today); and easy single track at this point too.

He wants me to stop PT at the end of my Rx (7 more sessions) in favor of hitting the gym hard. I have no swelling anymore and full range of motion.

In August he will fit me for a knee brace for this upcoming ski season. At that time he will most likely give me the go-ahead to begin the easier high mountain single track with my clipless pedals. In the fall he will give me permission to hit the more technical terrain.

The things he wants me to avoid (until August) are running, dynamic twisting movements, or sudden hits (like extending my foot to catch myself if I have a big front end slide on the bike.

In the fall I will begin dynamic exercises, like box jumps, running drills, and other stuff to increase lateral motions.

It turns out there is a lot to come back from after an injury like this. The main thing I need to work on now is overall strength and developing my cardio again. The front side of this recovery is slow and lingering. The backside will be steep and hard. The middle (where I am now) is the approach to the hard stuff.


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## Forest Rider (Oct 29, 2018)

I remember when I was started on box jumps and running drills. Best days ever! It took a lot of mental capacity to box jump. I was shown how to do it. I then jumped up on the box and just looked at the ground like "are you kidding me". After doing it a couple of times I can't even describe how I felt.

Good luck with your continued recovery. Sounds like you're progressing nicely!


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## beastmaster (Sep 19, 2012)

14 weeks post-ACL reconstruction surgery under the belt and I am riding again on single track! According to my doctor and PT, I am in the 99th percentile of patients at this stage of recovery. I have two more weeks before I can stand up while climbing (as well as on descents). It is so great to ride bikes in the dirt again. I have about a month and a half before I can ride clipless and on serious technical terrain. But for now, it is good to be out there!


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## Forest Rider (Oct 29, 2018)

What was your confidence level like for the first ride?


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## beastmaster (Sep 19, 2012)

Forest Rider said:


> What was your confidence level like for the first ride?


Pure terror! Haha!

My first rides were paved and dirt roads. A few of these rides later I went on a some super mellow connector trails between the dirt and pavement. From there I progressed to easy single track that parallels some railroad tracks. Each of these rides were between 12 and 15 miles with about 300-500 vert. 10 or 12 days ago I began riding some more challenging single track (still in the 12-15 mile range with about 1000 vert). My first foray into these trails I was super careful not to push traction in the slightest. If I felt uneasy about anything I just popped off the bike and walked past the scary thing. The past week I have been on some true moderately technical trails (less mileage--8 to 10 but more vertical in the climbs: 1000 to 1500). Again, I have been very careful not to push any limits.

I am still not standing on pedals while climbing or descending (June 20th is 16 weeks and when I can begin out of saddle climbs and descents). On the downhill sections I balance my feet and weight between them. I am right handed (and footed) but I rode goofy most of the time. When I switch my feet position I am noticing the lack of strength in my right hamstring (the injured leg), so I have a lot of gym work to do.

Proprioceptively, I am feeling very good. My balance is good and my total range of motion is 99.8%. The balance of power between the two legs is about 70% of normal. On the bike I have more than enough strength to power up almost anything. In the gym it is a different situation.

In August (6 months) I will begin advanced work (box jumps, one legged lunges, etc). When I was told it would take 9 months I thought to myself, why? I now know. Taking all that time off will require an equal amount of time to get back to full strength.

Biking (MTB) is part of the quiver of physiotherapy, but it isn't the only arrow to use. Recovering comprehensively from ACL reconstruction means the whole kitchen sink of exercises. Good thing, this all said, is that if you commit to it thoroughly, you will be a beast in the end!


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## Forest Rider (Oct 29, 2018)

Sounds like you and I have had similar recovery strategy. 

I've had a few injuries over the years and each time, it's a mental challenge to believe in myself. Depending on what I am doing and/or the consequence.

Glad you are back out there and glad you understand what can happen if things go bad. That keeps you motivated too. And keeps one from becoming overconfident too quickly. I think 15 miles and 1000 gain is quite a bit, so good for you. I mean for where you are in recovery, that's good strength.

My leg strength is not 100% balanced. Not since my 2nd injury, I can't mentally force myself to treat each leg equally for some reason. 
You'll love the day you do your first box jump.
I used to jump out of the bed of my full size truck, over the size rails onto the ground like it was nothing. After surgery, and going through recovery I couldn't bring myself to jump off the 20" box (or 24" maybe?). As soon as I did it, my brain went into happy mode.


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## FlyBoy (Dec 23, 2003)

Can you speak to the restriction of standing while you are pedaling? I assume your surgeon has told you that because there are enhanced strains on the ACL while standing and pedaling? I haven’t received that restriction from my surgeon or PT. I’m just curious if it’s that or if it’s for something else. Thanks!


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## beastmaster (Sep 19, 2012)

Forest Rider said:


> Sounds like you and I have had similar recovery strategy.
> 
> I've had a few injuries over the years and each time, it's a mental challenge to believe in myself. Depending on what I am doing and/or the consequence.
> 
> ...


My "normal" rides are between 15 and 30 miles with between 2000 and 7000 vertical. So these first rides are small in comparison.

Learning to trust the newly repaired ACL takes time. It is advised by basically everyone not to begin dynamic drills until at least 6 months post-op. The new ACL graft takes time to regain blood supply and nerve growth to it.

(Think about it, the hamstring graft comes from a location where there was blood direct blood supply and it was connected to the nerve block. When the old ACL was removed, along with it went all the old blood vessels and nerve endings. it takes a minimum of 12 weeks for the blood supply to come back. It takes longer for the nerves endings to grow back. In the between 8 and 12 weeks the new ACL is at its weakest and must be protected. The worst possible thing that can happen is sudden shearing forces. This happens in two ways; first is leg extended and the tibial plateau moves quickly past the end of the femur, or second is dynamic twisting forces with knee bent or straight.)

Box jumps, lateral side stepping, lunges, single leg jumping, and many other drills create the exact sort of force you want to avoid until the graft is completely healed. At this point however, the total knee/leg/core strength is significantly less. When you jump over the rails of the full size pick up onto the ground you are using way more than just your knee. You must build up your core strength (abs and back), gluts, quads, hamstrings, cavs, and upper body in order to be dynamic. If you take this seriously, you will be stronger than before the injury 9 to 12 months out.

I rode mountain bikes and alpine skied competitively. It is my intention to be back at that level or more. Patience while being a patient is difficult. You have to use your time and efforts correctly and not overdue it, setting you back, and yet at the same time push into it. It is a delicate balance to be sure. That is why working with a good PT and taking your physician's protocols is so important.



FlyBoy said:


> Can you speak to the restriction of standing while you are pedaling? I assume your surgeon has told you that because there are enhanced strains on the ACL while standing and pedaling? I haven't received that restriction from my surgeon or PT. I'm just curious if it's that or if it's for something else. Thanks!
> 
> Sent from my iPhone using Tapatalk


When we stand on the bike (climbing especially, but descending to a lesser degree as well) before 16 weeks we are creating shearing forces on the joint. You probably won't tear the new ACL from these forces, but you might stretch it, which isn't good. Once stretched, the new ACL will not function correctly. (Once properly healed, the new ACL isn't prone to stretching anymore than the old ACL was.)

As I wrote above, total muscular control (not just of the knee) must be achieved. It is the muscle system which controls the joints not the ligaments. When we lack strength we are significantly more likely to re-injury ourselves because we rely on the ligaments to control the joint more than the muscle system. At 20 weeks we can really start to push it harder. At 24 weeks (6 months) we can begin the "return to sport" protocol. That doesn't mean we return to sports at 6 months, that means we train to begin returning to sports. At 9 months, if you are fit enough, than you can return to sports.

Professional athletes do this whole timeline in significantly less time because they are paid to do nothing but train and play. But they also experience higher failure rates because the soft tissues are pushed to their limits rather than allowed to heal properly. They are paid to be possibly injured and when they injured again and again, they are replaced. We, on the other hand, are not paid to go to PT. So remember, time is our friend, but for the paid professional athlete, time is their enemy.


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## Forest Rider (Oct 29, 2018)

If you are asking me about standing restrictions, I don't have an answer.
I didn't ride bikes when I had surgery, not until I was almost recovered did I start riding. Conversation never came up for me.


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## BujiBiker (Jun 7, 2019)

I’m 2 weeks in from having surgery. Reading everything here it looks like 9 months out for me. ACL was replaced, miniscus was a bucket shaped tear, underside of the patella was smoothed out, and finally a cracked tibia. 

I blew my knee out 5 years ago, after buying a used fsr xc comp, my first FS bike. Got one ride on the trails, blew out my knee. Took a 1 year and a half to pedal circle again. Rode all summer of 17. Didn’t ride in 18 at all. Rode for two weeks in April and felt great. Ordered a new bike, 5 days later blew out my knee hard at the dojo. 

I squeaked out 3 rides on my new Abajo Peak. Then had surgery. I’m allowed to "walk" with my crutches at least. Can’t start pt for 4 weeks. 

Any other advise or wisdom?


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## Forest Rider (Oct 29, 2018)

Sounds odd to have to wait 4 weeks for pt.

Advice/wisdom as far as recover -basically what is mentioned in the thread I think is some good stuff.

Sorry about the injury. Find yourself a sports medicine PT to work your rehab. You'll be happier being sports trained than not.


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## BujiBiker (Jun 7, 2019)

I thought so to after reading different threads on here. I’ll just have to suck it up and press on. 

The ACL was only supposed to be repaired. Apparently they tried to stitch it but it wouldn’t take and hold. The Dr had to replace it with one from a cadaver. I honestly thought it was synthetic looking at the pictures. It has a diamond weave to it like a cord or rope. 

Interesting in the least. The pictures of the miniscus looks like the planet Jupiter.


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## jsard85 (May 31, 2019)

4 weeks is pretty long to start physical therapy. I had an allograft (cadavers acl) and also was made to wait 4 weeks. I ended up having to get manipulated a few months later as i "healed to fast" and couldnt get full range of motion. My physical therapist said it was most likely because my Dr had me wait so long before starting pt.

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## beastmaster (Sep 19, 2012)

Forest Rider said:


> Sounds odd to have to wait 4 weeks for pt.
> 
> Advice/wisdom as far as recover -basically what is mentioned in the thread I think is some good stuff.
> 
> Sorry about the injury. Find yourself a sports medicine PT to work your rehab. You'll be happier being sports trained than not.





BujiBiker said:


> I thought so to after reading different threads on here. I'll just have to suck it up and press on.
> 
> The ACL was only supposed to be repaired. Apparently they tried to stitch it but it wouldn't take and hold. The Dr had to replace it with one from a cadaver. I honestly thought it was synthetic looking at the pictures. It has a diamond weave to it like a cord or rope.
> 
> Interesting in the least. The pictures of the miniscus looks like the planet Jupiter.





jsard85 said:


> 4 weeks is pretty long to start physical therapy. I had an allograft (cadavers acl) and also was made to wait 4 weeks. I ended up having to get manipulated a few months later as i "healed to fast" and couldnt get full range of motion. My physical therapist said it was most likely because my Dr had me wait so long before starting pt.
> 
> Sent from my SM-G950U using Tapatalk


Everyone has a different trajectory and recovery from surgery. One isn't better than the other in terms of final outcome. There are too many variables involved. This said, there are established protocols for ACL rehab.

Trust your physician's timeline and protocol (unless they are incompetent which isn't likely). PT is required for a proper outcome. Generally speaking, physicians wait for 4 weeks following surgery for the patient to begin PT. They want the surgical entry points to be healed enough to manipulate without opening them accidentally.

Once PT commences, it is hard work and can be quite painful, as range of motion, strength, proprioceptive movements, breaking down scar tissues, etc, etc are all challenging to move past.

MY advice is to work hard on the things you are allowed to do, take your physician's direction first and foremost, and do the work with your PT. Follow the protocols and be a good patient by having patience.


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## BujiBiker (Jun 7, 2019)

This will be the third time learning to walk again, all on the left leg. 91 I tore the ligaments in my ankle in the SP Academy in the USAF. 5 years ago I blew out my knee playing tug of war at a church camp. Insurance wouldn’t even get an mri for 6 months. 

Took a year and half to pedal a circle. Left knee would pedal a violent square and try to wreck me to the left in the driveway. Got one ride on my first fs bike before I blew it out. Rode all summer in 17. Didn’t ride agin till April of this year. Rode 3 times a week for 2 weeks. Felt great. Ordered my first new bike since 02. Fezarri Abajo Peak. 5 days later blew out my knee. Bike arrived about a month later. 

I made 3 rides between my knee and all the rain before surgery. Had zero pain by that point, just no stability. Rode seated the whole time. Was blown away by the whole modern 29er thing. 

Sorry for the rambling, just bored to tears. 

The real pain will definitely start when I do pt. It didn’t even feel like like I was cut/drilled/screwed or ground on for a week after. Strongest pain meds was Tylenol 3. Only take one of those at night. Sure didn’t need them every four hours. Maybe after pt starts.


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## beastmaster (Sep 19, 2012)

Ride report 4 months out from surgery.

According to my doctor's protocol for my rehabilitation, I was able to begin seated outdoor riding on paved and gravel roads at 3 months and slowly advance towards more challenging terrain all while in a seated position.

At 3 1/2 months I was able to begin climbing out of the saddle and ride single track, including moderately technical features. Yesterday marked the first full ride without any issues whatsoever (4 months + 1 day). While I have yet to ride really big terrain and features, I have gone on countless 15 to 25 mile single track rides.

Last Sunday I began experimenting with out of the saddle climbs (four months), which was really strange because while seated I had great power and movement, but the moment I stood up, all of that went away. I couldn't push my foot over top dead center without a slight delay at first and I had significantly less strength while standing. I did all of this work on the road the first day or two. By yesterday (Thursday) it was all transformed. I can crank hard out of the saddle without any rotational lag or delay anywhere through crank rotation and have good power (for where I am in my strength training).

I have a good bit of work to do and have to be careful not to push the front end of the bike too hard which could result in an unrecoverable slide (I don't want to fall down!). But it sure is good to ride single track, go up high (I live at 7K feet and we have mountains up to 13K), climb lots of vertical, and log some real bike time again.

By the middle of next month I will report back on the progress being made. It is going really well right now. I am very pleased.


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## BujiBiker (Jun 7, 2019)

Friday was one month out of surgery for me. Go see the doc next week. Hopefully I can start rehab soon after. 

Did go out and shoot my bow. Hard to stand without the crutches but it was doable. Waiting to start a stationary bike at least.


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## beastmaster (Sep 19, 2012)

I am entering my 22nd week post ACL reconstruction and meniscus repair. I am riding about 100 miles/week now. Strength is coming back. Today was my first ride on clipless again—I don’t care for flats whatsoever, as they make controlling the bike more challenging. It is good to feeling as strong as I am. Most of my rides are about 2500 vertical and 20 miles. Next month I begin advanced proprioceptive training. I am doing three days a week in the gym with weights too. Knee feels great overall. Occasionally there are strange sensations, but never painful. I am very happy with how things are progressing.


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## BujiBiker (Jun 7, 2019)

I’am at 9 weeks from acl replacement/miniscus repair/patella/re-grind/cracked tibia. The knee joint is solid. Wasn’t expecting that. The quads are beyond jello. With my leg flat on the floor in front of me I can’t raise my heal off the floor. With the leg half bent standing up I can move all over the place. 

Good news the doc told me today I can ride basically unlimited mileage on the stationary bike. I rode 1.15 miles the other day, equivalent to a 1/2 mile climb here in the flat lands pushing about 70 rpm for cadence. I normally push about 80-90 in a "lesser " gear. 

I did ride my old fsr xc comp for about a mile in a parking lot. It was easy, just had to be VERY careful getting off the bike on the "strong" (read right) side. Doc told me when the left quad is 90% of right side in strength he will clear me for "sports" again. 

Figure I have 7 months to go.


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## beastmaster (Sep 19, 2012)

BujiBiker said:


> I'am at 9 weeks from acl replacement/miniscus repair/patella/re-grind/cracked tibia. The knee joint is solid. Wasn't expecting that. The quads are beyond jello. With my leg flat on the floor in front of me I can't raise my heal off the floor. With the leg half bent standing up I can move all over the place.
> 
> Good news the doc told me today I can ride basically unlimited mileage on the stationary bike. I rode 1.15 miles the other day, equivalent to a 1/2 mile climb here in the flat lands pushing about 70 rpm for cadence. I normally push about 80-90 in a "lesser " gear.
> 
> ...


Funny how quickly we loose the strength and how bloody long it takes for it to come back! Keep pushing. You'll make it. You had a very significant injury and taking your time coming back from it is advisable. Take direction from the professionals--your doc and the PT. All I can say is with the right mentality and hard work it is possible to come out stronger than before the injury.


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## BujiBiker (Jun 7, 2019)

Oh I plan to. I’m just shocked that the knee joint is solid, but the quad is jelly. I thought it’d be the other way around. It’s amazing a major muscle group can atrophy so fast. Even with all the walking I do at work and home, it’s crazy.


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## beastmaster (Sep 19, 2012)

BujiBiker said:


> Oh I plan to. I'm just shocked that the knee joint is solid, but the quad is jelly. I thought it'd be the other way around. It's amazing a major muscle group can atrophy so fast. Even with all the walking I do at work and home, it's crazy.


If I remember correctly, you had a sustained period of injury as well. Correct? I remember you said something about damaging the tibial plateau and patella in different accidents/injuries. So your overall leg strength (not to mention your overall strength) would be compromised as a result of this extended period. You can redevelop your quad strength, but don't forget your hamstring as well. In order to have proper control of the joint, all of the muscles involved must be strong or you risk re-injury. And your core muscles (back and abs) must be strong as well to control your body over the leg. When you get the OK from your doc, time to hit the gym and hard. Its not much fun, but the benefits are substantial. The final phase is the dynamic strength stuff--the proprioceptive work. This stuff matters a lot. At some point it might be a good idea to go a "boot camp" type of workout. That will secure all of your hard-earned efforts and bring you not only back to where you were when you were injured, but quite possibly further. Good luck!


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## BujiBiker (Jun 7, 2019)

Anything upper body is good to go. The dr wants the entire quad at 90% of the right (strong) leg. 

Once I get the required strength back, mountainbiking/ and slow re-integration of martial arts will bring back the coordination/nervous system, muscle/strength. At 48 years old I’m not going to push it. 

At the same time martial arts brought back the coordination, while mountain biking brought back the fitness. I couldn’t walk downstairs without a limp, or even cross step until 3 months back to dojo. That was 4 years after the initial injury. Riding was ok, but we don’t exactly have mountains around here to begin with. 

Staring at my new Abajo Peak trail bike everyday, longing to get dirty isn’t helping though. Pounding on Bully Bob from Century Martial Arts Supplies certainly helps!


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## 69tr6r (Mar 27, 2007)

About 5 weeks ago I suffered a Tibial Plateau fracture, and torn ACL. The fracture needed surgery to install a metal plate and screws. My surgeon said we need to repair the fracture before we can determine if the ACL needs to be repaired. 

The fracture is healing nicely, and I am full weight bearing 4 weeks post-op. My knee is very stiff and sore, and of course the muscles are atrophied, but I've begun PT and I'm making progress.

The surgeon said I will need to be fully recovered from the fracture, and have my strength back to 100% to determine if I need ACL, approx 4-6 months until that happens.

Has anyone had a torn ACL and lived a normal life in terms of cycling? I fear the worst and that I will have to go under the knife again and take another 9 months to recover from an ACL surgery.

Healing vibes to you all!

Thanks.


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## BujiBiker (Jun 7, 2019)

I won’t say normal. I originally tore my acl 5 years ago. Insurance made me get x rays and go through therapy for 6 months before I could get an mri. By that time it only showed micro tears in the acl. 

It blew out "mildly" 10-12 times, until April of this year. My knee blew out 90* horizontal to the inside and dropped me. When I couldn’t get up by myself I knew it was bad. 

I’d ordered my new Fezarri Abajo Peak trail bike 5 days before. It arrived about 3 weeks later and I put it together. Stared at for 3 days and said screw it. Rode it 3 times for about 23 miles in the flatlands. Last ride was 2 days before the surgery. 

I had zero pain by then just zero stability without a piddly neoprene brace. I did it, but wouldn’t recommend it. I’m 10 weeks out from surgery. Still looking at mid February before I’m comfy pushing it totally.


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## beastmaster (Sep 19, 2012)

7 months (29 weeks) this coming Thursday for my ACL Reconstruction/lateral meniscus repair. I am riding the way I did before the injury now--with the sole exception that I lost a good bit of fitness. I am back to riding 20-30 miles with over 5K to 8K of elevation on a regular basis. Knee feels fairly normal. It doesn't hurt at all, but it can feel a little tight after riding longer distances. I normally take a day off after bigger rides but rides of 10-15 miles (2-3K of vert) I don't take time away. All rides are on single track and some of them on very technical terrain. Twice I have had full leg extension get-offs without any unusual movement (sort of like a big power lunge). I fell once directly on that knee once too. So I have gotten these episodes behind me now. Ski season is fast approaching and I will need to step up my game with box jumps. I figure by the time ski season is back in late November I will back to normal.

Now as for ripping it up on skis, that is an entirely different aspect. I have an Rx for a ski-specific knee brace to help prevent hyperextension. I plan to take that very slowly at first. I will be super smooth and not allow my skis to just run. Its all about the transitions. I think by March I will be able to let 'em rip a bit more.

Skiing is very isometric while riding is very anaerobic/aerobic. Skiing begins from the core, and strangely enough, I find riding technical terrain to be the same. Core strength is what I am working on now. Without it, our upper bodies apply considerable leverage to our legs.

That is the update! Good luck with your rehabs everyone!


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## BujiBiker (Jun 7, 2019)

Doc cleared to ride a few weeks ago. Started out 4.5 miles on a bike path. We have some new trails about 30 miles away that are flat. Like 5 feet elevation difference. I’ve ridden about 20 miles there in a handful of rides. Feels good to be on dirt again. 

The doc gave me new athletic brace that feels solid. However it pinched a nerve on the outside of my calf. My lower leg and foot went numb. Wore it twice, and my foot is still numb 3 weeks later.


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## beastmaster (Sep 19, 2012)

Saw my orthopedic doctor this morning and was told my knee is ready for anything I want to do. I am now officially released! He gave me an Rx for a ski knee brace and I was fitted for a custom unit this morning as well. Damn, custom knee braces are expensive! $900 for this one! Wow! It will arrive in 2 weeks time and well before Thanksgiving, our traditional opening weekend of the ski season if mother nature cooperates.

Woohoo! Feels good to have this whole ordeal behind me finally! I am bilaterally as strong with one leg as the other. I have no strength, power, or endurance deficits of any kind. I am totally back to normal. Feels good. Riding a ton of miles and climbing a ton of vertical. In August I really started to ramp things up. I ramped them up again in September and so far in October I am crushing it. Now if mother nature helps, this ski season will be great!

This all said, I do plan to start the ski season conservatively. I will not let my skis just haul ass as I would normally. I am going to be Mr. Smooth, bending my skis for maximum energy and pop, as well as picking my early days carefully. "Go in slow so you can come out fast" is going to me my maxim, just like I did with the bike.


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## Forest Rider (Oct 29, 2018)

Good for you. Seems a little early to resume 100% normal activity but he's the pro.

You've been doing well with your recovery and now it should pay off for the lifetime work you give it.

I'd suggest the brace only for those types of activity that allows things to go bad. Yes, that can be anything, but wearing it skiing would be good.
I wore my brace snowboarding. I were it dirt bike riding. That's about all. If I were to wear the brace, and rely on it, stabilizing muscles wouldn't become strong.

Happy to hear you were giving an all-clear.

Be careful out there.


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## beastmaster (Sep 19, 2012)

Forest Rider said:


> Good for you. Seems a little early to resume 100% normal activity but he's the pro.
> 
> You've been doing well with your recovery and now it should pay off for the lifetime work you give it.
> 
> ...


There are many factors involved in recovery from ACL reconstruction. I exceeded all of the criteria for release from care and oversight. I am both lucky and determined. I didn't want the injury to be a pivot point in my life's activities. I worked hard to prevent that outcome.

Emory Hospital, the Mayo Clinic, and Steadman all state that 9 months is the normal return to sports timeline for an athlete. The brace is often prescribed but not always. It is mostly given for psychological support over physiological need.

If I rode dirt bikes (I did years ago), I would definitely wear the best knee braces possible (and I did in those days)!


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## buggravy (Sep 12, 2018)

beastmaster said:


> Saw my orthopedic doctor this morning and was told my knee is ready for anything I want to do. I am now officially released! He gave me an Rx for a ski knee brace and I was fitted for a custom unit this morning as well. Damn, custom knee braces are expensive! $900 for this one! Wow! It will arrive in 2 weeks time and well before Thanksgiving, our traditional opening weekend of the ski season if mother nature cooperates.
> 
> Woohoo! Feels good to have this whole ordeal behind me finally! I am bilaterally as strong with one leg as the other. I have no strength, power, or endurance deficits of any kind. I am totally back to normal. Feels good. Riding a ton of miles and climbing a ton of vertical. In August I really started to ramp things up. I ramped them up again in September and so far in October I am crushing it. Now if mother nature helps, this ski season will be great!
> 
> This all said, I do plan to start the ski season conservatively. I will not let my skis just haul ass as I would normally. I am going to be Mr. Smooth, bending my skis for maximum energy and pop, as well as picking my early days carefully. "Go in slow so you can come out fast" is going to me my maxim, just like I did with the bike.


Thanks for starting this thread, and documenting your recovery so methodically. It's very helpful for me, as I'm 3 months and a couple days out from surgery for a seemingly identical injury. I'm also fortunate in that I'm well ahead of schedule in my PT, and am fortunate to have a really stellar PT that works with a lot of pro athletes and is well versed in getting people back to a high level of activity. My question is, am I reading correctly that you've been doing all of the riding/activity described without any sort of bracing? The bulk of my riding buddies that have had ACL surgery were fitted with their custom brace shortly after surgery, and were using it any time that they rode. My surgeon typically doesn't prescribe the brace until 6 months. I've twisted his arm to get mine sooner, though I don't have it yet. I've been pretty salty about being hindered from doing activity because I don't have a brace, but it sounds like perhaps your surgeon subscribes to the same thinking as mine. That said, I did my first ride yesterday, obviously without any kind of brace. Just fire road, fitness type riding. I know better than to try anything techy where I may need to plant my foot unexpectedly. The knee gave me no issues whatsoever, and I'm grateful to now have at least that type of riding back so I can get my fitness back. I was a little wary of doing even that without a brace, but it sounds like you did without issue. Am I reading that correctly?


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