ACL Rehab/Recovery

[roll122]

Hi everyone,
I am about 6 weeks post op from ACL reconstructive surgery(i used a patellar tendon graft) Heres my question/situation.
I am a college lacrosse player, our season is in the spring and i am trying to be back/recovered asap. I have a very aggressive rehab/protocol since my doctor is the NY jets doctor. I do therapy 3x a week with a physical therapist. But i have been doing something rehab-like almost everyday(stationary bike,stairmaster, stretching,ice, electric stim, etc.) I was wondering if anyone in this forum has been through this rehab and if they have been even more aggressive on their own. I have a lot of information on this whole thing and i know lots of people who have had the same injury. But everyone is different. I am asking how u guys have done, advice, tips, whatever. Let me know.. I want to be playing ASAP!!!my doctor says i could be back playing 5-6 months.(5 is optimal for me!) Thanks!!
-Mike

[Bill Hartman]

ROM, strength, etc. are the easy part to get back. The concern would be how the graft will tolerate the activities. bryanc had a great post (he's quite the research guru) about how the graft will adapt to its new location and "duties". Do a search for it. It may give you an idea of what you're up against by coming back too soon.

The fastest I've ever seen anyone come back was 3 months. He played basketball at Purdue and was highly motivated (come to think of it, I think Rod Woodson came back after 14 weeks [couldn't miss the playoffs] but he was still in pretty sad shape). He also understood the risk of coming back so quickly. He decided that it was worth it. It was his last year and he had no intensions of playing pro ball.

How your laxity?

Have they established any return to sport planning for you as far as when you'll begin working on change of direction, deceleration, acceleration drills?

Another thing to keep in mind as to determining when you are fully rehabbed...you are not ready until you are ready mentally. What that means is that if you have even a passing thought about your knee during activities, then you are not ready no matter what the tests, your doc, or your PT say.

Bill Hartman

[bryanc]

You're a highly motivated athlete, and that bodes well for your outcome. However, the important thing to understand and accept at this point, is that there are many factors in ACL rehab that are out of your control. Gradual return to play should be an important part of your program, using clearly graded, task-specific drill criteria. Progression along this program should be flexible enough to address your eagerness to return to play (i.e. each grade is challenging) but should also allow you to step back according to your own symptoms (i.e. not too challenging). This, of course, seems like a common sense rehab approach, but is not always implemented. Additionally, depending on whether your ACL injury was contact related or not, you may want to consider adding proprioception drills as well as technique analysis (and alteration) to the way you approach your sport (specifically planting and cutting maneuvers).

At 6 weeks post op, your graft is still not fully integrated into the bone--it's actually questionable as to whether it's even mostly integrated. Being over-aggressive at this stage may actually make things worse. While doing nothing is associated with really bad outcomes, you do have to give the graft a chance to take. Early mobilization is necessarily to remodel the collagen in the graft to adapt to its new environment and task, but too much activity (while great for remodelling) may comprimise the "grafting" process since joints under constant repeated loading don't heal well.

The important thing to remember is that it's okay to be aggressive, but also equally important not to rush the process in favour of earlier return to sport. Be compliant with your program--don't be "over compliant". More is not necessarily better.