How to tackle ACL reconstruction so I can go back to Judo and BJJ?
October 18, 2014 6:18 AM   Subscribe

Whoot, 1st question on MetaFilter. I tore an ACL, and I'm looking at reconstruction so I can go back to my two favorite things, Judo and Brazilian jiu-jitsu. My question: Any professionals with insight? Any protips or questions I should ask? Any thing I should be cautious or wary about? (More detail under the fold if that's helpful.)

I compete, and I love these sports, so "Drop it and take up knitting" is not an option I want to look at.

I'm concerned because my first surgical consult was with someone with no experience with grapplers/wrestlers. Combine that with my being totally new to the "find a surgeon" game; my last surgery was getting my wisdom teeth removed 15 years ago.

The doc did an MRI to rule out a partial ACL tear, but he was pretty sure it was a meniscus thing. So, a bit of a surprise when radiology found a complete ACL tear.

The thing that made my alarm bells ring is that this doctor's protocol is no weight bearing for 2-3 weeks after surgery. I'm comparing that my folks' hip replacements, where they oh, break the biggest bone in your body and stuff a metal stick in it. They were up and walking out of the OR. And other friends who have done the deed elsewhere say the doctor says get off the crutches as soon as possible. Yes, I'm a fidget, but it's always been my understanding that weight-bearing ASAP is important for your legs.

Halp. Thank you.
posted by aaxelrod to Health & Fitness (8 answers total) 1 user marked this as a favorite
I'm concerned because my first surgical consult was with someone with no experience with grapplers/wrestlers.

This isn't really a legitimate criteria IMHO. You can decide that you prefer a surgeon experienced with athletes but the surgery is the surgery -- the is no special ACL technique for surgical repair on athletes vs any other kind of patient. The difference will come in rehab, so I'd look at what your physio options are and find the best physio you can. Sports medicine physio is a thing. I recommend rehab that includes water, like at least a tank.

The thing that made my alarm bells ring is that this doctor's protocol is no weight bearing for 2-3 weeks after surgery.

No weight bearing is not no movement. Patients are often on a passive motion machine, and you'll be on crutches. There is so much pain and so much swelling and so little joint rotation I can't imagine bearing weight for the first two weeks. Like, mechanically: you knee is bent and stays bent for a good long while; there is no way to bear weight on it unless you are a tilting tripod.

My initial physio consisted of my AMAZING physio flexing my foot for me and trying to encourage my knee to bend in slow, painful increments of what felt like 1 degree a day. Then I graduated to the stationary bike with short pedals. It was probably three weeks before my toes even touched the floor and that was not for lack of trying, let me tell you.
posted by DarlingBri at 8:01 AM on October 18, 2014 [1 favorite]

Anecdata: Mr. Apparently tore ACL, MCL, and meniscus doing judo three years ago, in his mid-forties. He had surgery at Hospital for Special Surgery in NYC with amazing results -- one year out he was stronger and a better athlete than he had ever been before, doing a lot of heavy long distance trail running. He credits his surgeon, who works with many professional athletes and dancers, and a very athletic and vigorous physical therapy regimen for his recovery. He was up and moving, doing physical therapy the day after surgery. He did not return to martial arts.

My personal trainer, a crazy-fit recent college athlete in her mid-twenties, had her ACL repaired locally, and did not start physical therapy for some time after the surgery. Her recovery took much longer.

Good luck, and be sure to max out your physical therapy sessions!
posted by apparently at 8:33 AM on October 18, 2014

Best answer: I got my ACL reconstructed about 3 years ago. Obviously, you want a good surgeon, but the most important part of the recovery is the physical therapy both before and after the surgery. Hopefully you're already seeing a PT and strengthening the supporting muscles now. If not, get a recommendation for a PT specializing in working with athletes and get started.

You won't be bearing any weight on that leg for 2-3 weeks after surgery, trust me. The graft has to heal before the leg can bear weight, and yes, you will be moving the leg during those 3 weeks, starting to get your range of motion back.

I was back to bike-commuting after about 14 weeks and started running at about the same time. Before that, I was swimming with a pull buoy and using an upper body ergometer to stay in shape.

One question for your surgeon is whether you'll get cadaver tissue for the graft or use your own hamstring tendon or patellar tendon. My surgeon recommended that I use my hamstring tendon based upon my age (early 40s) and level of athletic activity (very high). He said it would last longer that way. But, the recovery took longer and was more painful because my hamstring also had to heal.

I run, bike, play softball, swim, and do HIT workouts regularly, and don't notice any difference between my repaired knee and the other one at this point. Good luck!
posted by outfielder at 9:09 AM on October 18, 2014 [2 favorites]

See a sports medicine guy! I transcribe for a sports orthopaedist and he does these surgeries all the time, and people go back to doing what they do (football, basketball, tennis, martial arts, standup paddle boarding, etc.), with great success. And these are people of all ages - high school through 60 or so.

Ask for a referral to a sports guy. Then make sure you also get a sports-oriented physical therapist for your rehab.

I would say that this pretty accurately describes what the nice doctor I type for tells his patients:

Including: Will I need to be on crutches after surgery?

Yes, but only initially and only for comfort. Full weight bearing is gradually increased as tolerated by the patient. It typically takes seven to 10 days after the procedure, until the patient is comfortable without the assistance of a crutch. An exception to this rule is if the patient also underwent a meniscal repair or other reconstruction of an additional ligament. In these cases, weight bearing may be restricted for several weeks.

If he thought you'd need a meniscal surgery of some sort, that would account for the no weightbearing thing.

Go see a sports guy.
posted by AllieTessKipp at 9:29 AM on October 18, 2014

It's okay to shop around for doctors. I had a similar experience to yours with my hip injury; the first doctor I saw had a waiting room full of senior citizens who were just happy to be able to walk again/not be permanently bedridden/etc with no further recovery goals. I too, as with the comment above, had excellent results from going to HSS and finding a doctor who was familiar with my injury as something caused by dance and gymnastics, and she was able to not only (temporarily, alas) sort it out but also give me the kind of feedback I missed from the first doctor, such as when I could start actually working out/participating in athletics again.

tl;dr sports medicine doctors exist for a reason.
posted by poffin boffin at 9:31 AM on October 18, 2014

oh and also: everyone's surgical recovery experiences are going to be different because really, no one 100% injures themselves in the same way, and everyone's pre-injury level of fitness is different, everyone's body is different, etc etc, so basing your own future recovery progress on someone else's timeline is only going to frustrate you in the long run.
posted by poffin boffin at 9:32 AM on October 18, 2014 [1 favorite]

My experience: My replaced ACL tore itself just a few years later. I wasn't doing judo at the time, or anything that athletic.
posted by Obscure Reference at 10:10 AM on October 18, 2014

Having both had hip surgery to repair a torn labrum and having given birth, my experience of both is the same: you really can't judge how your own recovery will go based on other people on the internet. Some people bounce back from these things incredibly quickly. Others take longer to heal. You will probably not know which you are until after the surgery has happened. I was a very fit, strong person who did PT religiously and my hip still took longer than I had hoped to heal (and I still have to treat it carefully). I was also a very fit person who took care of herself throughout her pregnancy, and still had a terrible childbirth and a very hard time recovering physically. I guess I'm just not a good healer.

I definitely think getting a great surgeon is valuable (I also used HSS here in NYC and it is top-rate), and even more important is a good PT for pre- and post-surgical recovery. FWIW I don't think I was that much weight bearing immediately post my hip surgery although I was definitely on a continuous motion machine immediately.
posted by ch1x0r at 10:54 AM on October 18, 2014

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