Other/Mixed ACL reconstruction? ACL rehab without surgery

[Max.Sehr]

Hi All,

a week ago I have injured my anterior cruciate Ligament (ACL) during a soccer game. I went to the doctor and got an MRT, who diagnosed either a severe partial rupture of my ACL or a complete rupture which is not that clear looking at the pictures. My orthopedist said that the knee is somewhat stable, not like a usual complete ACL rupture. The anterior drawer test showed a little bit of movement but not excessive. So we went with the option of a conservative therapy, which means i decided to get no surgery (no ACL reconstruction) at the moment. We decided to check the stability of the knee again after a few weeks and then discuss the options again.

So my question is, whether some of you had similar experiences of a partially torn ACL and went without a surgery? Also, did some of you even rehab your knee with a completely torn ACL? I am very interested to hear your experiences and if some Strongfirst principles might help to rehab the knee.
Do you have any recommendations/experiences for stabilizing the knee in the future?
I am thinking about OS Resets, narrow GSQ, Single Leg DL and maybe Pistol Squats in the future to Bulletproof the knee again. Is this a reasonable approach and can this help to have a painfree knee without surgery?
By the way i am relatively pain free at the moment and working on the last bit of extension and flexion right now. Of course i will re-check with my orthopedist again.
Thanks a lot and kind regards,
Max

 

[rickyw]

You may find some interesting info from Ben Patrick, known as the kneesovertoesguy
If I remember correctly, he doesn’t have an ACL

 

[Aidan14389]

I had a partial tear about 6 years ago and engaged in physical therapy for about 4-6 weeks. After full compliance with what my physical therapist told me to do I was as good as I was before the injury. I went back to BJJ and lifting and I still feel great.

I strongly urge you to try the conservative route. It worked great for me.

 

[jozko]

I did not tear my ACL, but all my ligaments were seriously messed during my complete patella dislocation. I believe this greatly helped me:

Should You Train Your Slow Twitch Fibers? | StrongFirst

Cutting-edge Russian research tells us every type of athlete, from marathoner to powerlifter, has a lot to gain from training slow twitch fibers.

www.strongfirst.com

And the rest of this series:

How to Build Your Slow Fibers, Part I | StrongFirst

Slow fibers take slow movements to train them. Consider the “Golden God” dance by the famous Soviet Chechen dancer Mahmoud Esambayev.

www.strongfirst.com

How to Build Your Slow Fibers, Part II | StrongFirst

Pavel Tsatsouline present you with a plan that will increase your pressing strength and endurance by building up slow muscle fibers in your triceps.

www.strongfirst.com

How to Build Your Slow Fibers Part III | StrongFirst

Combining fast twitch and slow twitch hypertrophy training for all major muscle groups is a challenge. Before you jump in, here's what you need to consider.

www.strongfirst.com

But before I was able to do full bodyweight squat, I started with simple isometrics (horse stance) and a lot of walking.

 

[jozko]

I know I forgot something important.

Romanian deadlifts and back extensions. It was a game changer in my rehab period - hamstrings are surprisingly important in knee stabilization and health. I noticed it on my own after weeks of experiments, but I can google too:

The Role Hamstrings Play in Protecting Knee Ligaments - Body Gears

At Body Gears located in Chicago, Oak, Wheaton, and Winnetka, our physical therapists use techniques to turn on these weak muscles and then teach you how to do exercises to maintain this activation and to strengthen the hamstrings.

bodygears.com

 

[JamesPTA]

A negative anterior drawer test or Lachmans test does not mean there will not be anterior shear of the knee in functional movements. You want to compliment and fortify the ACL with exercises that will aid in addressing the instability.

I’d address this by seeking PT to determine your deficits and also as a way to educate yourself on the proper exercises versus just guessing with goblet squats and pistols.

 

[ClaudeR]

To give another point of view, My wife partially tore her ACL in a ski accident
She went through all the rehab etc successfully without surgery, then she stumbled on a downhill walk and caught herself with that knee which did tear it fully… then she had to go for surgery afterall.
Maybe unlucky, maybe the previous injury made it weaker, who knows

Recovery / rehab from the surgery took the better part of a year, don’t do it if you can help it

 

[godjira1]

Hi All,

a week ago I have injured my anterior cruciate Ligament (ACL) during a soccer game. I went to the doctor and got an MRT, who diagnosed either a severe partial rupture of my ACL or a complete rupture which is not that clear looking at the pictures. My orthopedist said that the knee is somewhat stable, not like a usual complete ACL rupture. The anterior drawer test showed a little bit of movement but not excessive. So we went with the option of a conservative therapy, which means i decided to get no surgery (no ACL reconstruction) at the moment. We decided to check the stability of the knee again after a few weeks and then discuss the options again.

So my question is, whether some of you had similar experiences of a partially torn ACL and went without a surgery? Also, did some of you even rehab your knee with a completely torn ACL? I am very interested to hear your experiences and if some Strongfirst principles might help to rehab the knee.
Do you have any recommendations/experiences for stabilizing the knee in the future?
I am thinking about OS Resets, narrow GSQ, Single Leg DL and maybe Pistol Squats in the future to Bulletproof the knee again. Is this a reasonable approach and can this help to have a painfree knee without surgery?
By the way i am relatively pain free at the moment and working on the last bit of extension and flexion right now. Of course i will re-check with my orthopedist again.
Thanks a lot and kind regards,
Max

hi Max,

here's a hopeful story for you. I tore my right ACL in Jul-17 during a judo training session. I was distracted, got my foot planted wrong, then it twisted and there was a loud pop. lost all strength in the leg for a few mins, but recovered enough to hobble home. next day MRI confirmed the worst - acl was gone, but luckily mcl + meniscus were ok. i BOOKED an acl-recon surgery for Oct-17 and embarked on a pre-hab routine.

i was pretty religious about the pre-hab, and about a week before the surgery my physio told me if she were me, she would skip the recon because I looked like I had 90+% function in the knee. why take a chance for marginal improvements? so i cancelled the surgery, and added a battery of leg accessory exercises that I do as a warmup first thing I wake up... have been doing that for about 5 years now.

OK the bad news. there are some stuff that I can probably do but have chosen to stop: soccer/futsal + judo + badminton. They require quite a bit of cutting motions and I can do it if I am not fatigued but I get the sense that as I tire I increase the injury risk. I am careful when sprinting as well because it is not the sprinting that hurts, but if i try to stop suddenly sometimes the knee gets sore.

YMMV.

 

[Max.Sehr]

All of you, thank you very much for your experiences and recommendation! I really appreciate it.
@JamesPTA I already have PT in the moment and will check and discuss this with my PT and orthopedist. Just wanted to hear about your experiences here on the Strongfirst community.
@jozko Thank you for the recommendation. I have read the article before and was also thinking about to implement it in the future as Pavel mentioned somewhere that it can be helpful in the case of injuries.
I will also check out the Kneesovertoesguy as the first impression of his story looks really inspiring. But i am still a little bit skeptical
Also, very inspiring to hear your stories! I will try to stabilize the knee and see what the next weeks will bring. If possible i will go without surgery as i dont want to play soccer at any cost and just want to do weight training, cycling, swimming and climbing.

 

[offwidth]

All of you, thank you very much for your experiences and recommendation! I really appreciate it.
@JamesPTA I already have PT in the moment and will check and discuss this with my PT and orthopedist. Just wanted to hear about your experiences here on the Strongfirst community.
@jozko Thank you for the recommendation. I have read the article before and was also thinking about to implement it in the future as Pavel mentioned somewhere that it can be helpful in the case of injuries.
I will also check out the Kneesovertoesguy as the first impression of his story looks really inspiring. But i am still a little bit skeptical
Also, very inspiring to hear your stories! I will try to stabilize the knee and see what the next weeks will bring. If possible i will go without surgery as i dont want to play soccer at any cost and just want to do weight training, cycling, swimming and climbing.

If your ACL is torn beyond a certain point it will not heal without surgery. That being said, there are, as many of the other replies have mentioned lots of opportunities to avoid surgery (or at least postpone it) by various strengthening methods and intelligent training.

I don’t know what type of climbing you are talking about but some types of climbing can be extremely problematic for ACL’s

 

[s f]

I partially tore my ACL (MRI confirmed) over 15 years ago.At first,the knee felt unstable on uneven surfaces.Did some basic PT for a few weeks.I used ankle weights for knee extensions,hamstring flexion and lateral raises working up to 25 pounds.Seated wall squats working up to 5 minutes,KB swings,turkish get-ups,step climbing and deadlifts were next.As the knee became more stable,I mixed in lunges and running up a hill(to this day,I avoid downhill running).I can do whatever I want to--glad I didnt go for reconstruction.Just take it slowly and be persistent.Good luck.

 

[godjira1]

I partially tore my ACL (MRI confirmed) over 15 years ago.At first,the knee felt unstable on uneven surfaces.Did some basic PT for a few weeks.I used ankle weights for knee extensions,hamstring flexion and lateral raises working up to 25 pounds.Seated wall squats working up to 5 minutes,KB swings,turkish get-ups,step climbing and deadlifts were next.As the knee became more stable,I mixed in lunges and running up a hill(to this day,I avoid downhill running).I can do whatever I want to--glad I didnt go for reconstruction.Just take it slowly and be persistent.Good luck.

running very long downhills or running on the treadmill at 0% incline makes my knee sore!

 

[Cearball]

Almost complete tear of my right ACL.

Are you looking at trying to return to football?

I did mine in martial arts & don't have the stability to return to that type of training.

However I can do most gym stuff fine though I was advised not to do long distance running.
I have a full range of motion & not much pain when performing exercises.

Saying all this the knee never feels the same as my good one & I get a bit of tightness & soreness first thing in the morning.
Always feel like I need to "wake" that leg up & get the muscles firing.

 

[Starlord]

You may find some interesting info from Ben Patrick, known as the kneesovertoesguy
If I remember correctly, he doesn’t have an ACL

Beat me to it.

 

[alinaradinsky]

I would say it depends on what activities you'd like to go back to once it feels good again. I had a 60% tear of the ACL years back and went about 5 years without surgery. It felt completely stable until fight camp, during which I tore it fully. It wasn't strong enough to sustain strikes. After the full rupture of the ACL, I couldn’t go back to kicking or light sparring. However, strength training and anything in which I had full control felt fine. I had surgery because didn’t want to be limited in what I could do, whether it be fighting or skiing. I really liked single-leg deadlifts and standing banded fire hydrants on an unstable surface, for knee stability.

 

[Max.Sehr]

Thank you for your insights, really appreciate it!
I will try to stabilize the knee in the next 4 weeks and then i have the next evaluation at the doc. From there we will decide if we are going for surgery.
At the moment im implementing the exercises from the Kneesovertoesguy and it feels really good. Especially the backward sled seems to improve knee stability and muscle activation. Of course, i am using progressions which are aprropriate for me in the moment.
However, i am leaning a bit more to ACL reconstruction as it just gives you the mental safety to do all sorts of things in the future and be not limited by the knee. Also, i have heard a lot of stories now where people went without surgery and after a while decided to do ACL reconstruction because they had some problems over the long haul. So similar to @alinaradinsky's story.

 

[GaryT]

Thank you for your insights, really appreciate it!
I will try to stabilize the knee in the next 4 weeks and then i have the next evaluation at the doc. From there we will decide if we are going for surgery.
At the moment im implementing the exercises from the Kneesovertoesguy and it feels really good. Especially the backward sled seems to improve knee stability and muscle activation. Of course, i am using progressions which are aprropriate for me in the moment.
However, i am leaning a bit more to ACL reconstruction as it just gives you the mental safety to do all sorts of things in the future and be not limited by the knee. Also, i have heard a lot of stories now where people went without surgery and after a while decided to do ACL reconstruction because they had some problems over the long haul. So similar to @alinaradinsky's story.

I’ve been so very grateful for reconstructive surgery in my 30’s from a complete sever of my acl. I’ll be 64 next week and never an issue with basketball, in-line skating, amateur competive bodybuilding in early 40’s or anything else.

I literally have to check for what’s left of some scarring sometimes to remember what leg it was on because of other injuries such as a broken leg, etc. I had a great military surgeon. I found him and thanked him some 20 odd years post-op.

 

[Cearball]

I can say the reason I didn't have surgery is because I felt when I was checking statistics about people returning to sport at the same level they were before it wasn't the +90% figure you see bandied about in regards to successful ACL repairs.
Those figures include sedentary OAP that don't do anything more physically taxing then a walk to the shop.
I didn't want to have the op & end up worse in terms of pain/range of motion then when I started.

I would be very specific about what you're physical goals are going forward & super clear with your doctor what you want to achieve then ask what the likelihood is of the repair successfully allowing you to do that.

 

[mprevost]

Hi All,

a week ago I have injured my anterior cruciate Ligament (ACL) during a soccer game. I went to the doctor and got an MRT, who diagnosed either a severe partial rupture of my ACL or a complete rupture which is not that clear looking at the pictures. My orthopedist said that the knee is somewhat stable, not like a usual complete ACL rupture. The anterior drawer test showed a little bit of movement but not excessive. So we went with the option of a conservative therapy, which means i decided to get no surgery (no ACL reconstruction) at the moment. We decided to check the stability of the knee again after a few weeks and then discuss the options again.

So my question is, whether some of you had similar experiences of a partially torn ACL and went without a surgery? Also, did some of you even rehab your knee with a completely torn ACL? I am very interested to hear your experiences and if some Strongfirst principles might help to rehab the knee.
Do you have any recommendations/experiences for stabilizing the knee in the future?
I am thinking about OS Resets, narrow GSQ, Single Leg DL and maybe Pistol Squats in the future to Bulletproof the knee again. Is this a reasonable approach and can this help to have a painfree knee without surgery?
By the way i am relatively pain free at the moment and working on the last bit of extension and flexion right now. Of course i will re-check with my orthopedist again.
Thanks a lot and kind regards,
Max

I had what was almost certainly a complete tear of my ACL nearly 30 years ago. I was playing football on the beach and I planted my left foot and heard a loud pop. I had tons of swelling the next day and my left knee was very unstable for three years. I was in college at th time without medical insurance so I never went to the doctor. I started doing leg extensions and leg presses as soon as the knee was good enough to do those. Eventually transitioned to barbell squats. But still the knee was very unstable. At some point around the three-year mark the knee started to tighten up. I have run many thousands of miles on that knee since then. It’s just as good as my right knee. I had a discussion about this with the orthopedic surgeon for the Baltimore ravens. He said that in about 25% of cases the knee will stabilize on its own even without surgery. I guess I was in that lucky 25%.