Returning to cycling from a knee reconstruction (ACL)

[nickdos]

During this year's Scott 24 hr I had a pretty nasty crash (on the DH section) that put me out of the race. GP advised me to get a MRI which confirmed I'd snapped my ACL (anterior cruciate ligament). Had surgery a week ago and I'm now looking at a long slow recovery to returning to cycling. Focus ATM is to get full "range of motion" back in the knee, after which I can start on the trainer/ergo. Surgeon thought I'd be able to be back on the road bike after 8 weeks (from memory) but I'm not if is just with flats or with proper road shoes/cleats?

Just wondering how long it took others to come back from a knee reconstruction? Any tips or advice?

[CXCommuter]

Both knees ACLs replaced- recovery is also dependent upon whether hamstring or patellar graft used (i have had both). 8-10 weeks is okay but remember that the graft will be weakest around the 3 month period as it undergoes change from a tendon to ligament structure (I was told this). At surgery the graft is actually stronger than a normal ACL apparently.

Hamstring tendon grafts tend to recover quicker and have less side effects, patellar tendons tend to be a better outcome for the ACL, BUT patellar tendonitis/tendonosis is a problem, which I have in copious quantities and limited my recovery as I went too hard too soon and the patellar tendon never recovered.

Allow six months for full recovery but on the bike for easy spins at 3-4 months if no other issues (ie cartilage damage, quadriceps strengthening issues)

[nickdos]

Thanks for that. FYI I had a hamstring tendon graft, which seems to be the norm these days.

I've been doing my exercises to the letter as I'm motivated to get back on the bike ASAP. But I can see my quads shrinking before my eyes, which is pretty scary.

[racka]

I'm not if is just with flats or with proper road shoes/cleats?

Just wondering how long it took others to come back from a knee reconstruction? Any tips or advice?

It'll be flats only. You DON'T want to go twisting your knee after a knee reco. My girlfriend is just over 12 months out from her reco, and it wasn't til 10 months or so that she was allowed to wear cleats.

When I had mine done, I was on the exercise bike after two weeks, and could have got on the road after a month with flats only (I wasn't cycling at that stage though so it didn't matter). I probably wouldn't recommend it though purely because of the possibility of a crash again.

Bottom line...with a reco, any exercise that has your knee moving in a straight line is fine. Anything that has any sort of twist, jolt or sideways pressure should be avoided like the plague. Keep this in mind...you can rebuild your quads in a couple of months. Your knee takes a year.

[nickdos]

Thanks Racka, I figured as much (and surgeon will likely confirm tomorrow in my first post-op consult). I have a pair of combo SPD/flat pedals on my trusty commuter (flat bar roadie with 28mm/700c) so I might as well still to that bike to start with (I might have to remove mudguards to get it on the trainer

10 days out and physio is v. happy with my progress - I've got 0° (extended full flat) and 80° flex in the knee (unassisted and pre-manipulation). Using iOS reminders app to remind me to do exercises, which is working well.

[Eleri]

I had my ACL reconstructed with a hamstring graft about 10 years ago. I ran the City to Surf about 9 months later and while I could run well on the flat it was too early for the downhills I discovered.

A weaker hamstring has affected my running and cycling since. As a result I had a number of weird things going on in both legs, compensating for the weaker hammy including me favouring one leg on the bike and developing a very strange action. My knee appeared to stop at 2 o'clock and 10 o'clock when pedalling and I had one foot with a toe-point, the other heel down.

When people kept commenting on it, I decided to get it investigated further and went to a cycling physio. I really thought the ACL was tracking wrongly. In fact, it was a bunch of muscles around the leg and up into my lower back that were very tight. Got them loosened and then did lots more core work and re-taught myself to spin properly. This was exceptionally boring.

For the last year or so I've eliminated any difference of strength between my R and L legs and for the first time don't get weird leg pains when running.

On the basis of my experience, I'd recommend really trying to build up in strength in the affected leg and maintaining that. Plus building core strength.

[Roub]

I snapped my ACL and tore my MCL (Medial cruciate) in Jan this year snow skiing. After consults with my Ortho, I actually decided against reco for now. I'm happy not to ski anymore and I don't play twisting, turning type sport. I was back on the bike after 4weeks on the trainer only with the saddle raised a bit to prevent too much bend, I did stay with cleats, but I only twisted my ankle towards the bike as I didn't place strain on the knee.
Bike on the road after 6 weeks and was VERY careful with unclipping. Came good after 4 months or so and now glad I didn't have the surgery yet as It allowed me to complete my MTB race season and do Tour de Cure and secure a place on next years' tour too.

Now 10 months later I have full power and knee gives me no dramas on the bike at all - even unclipping in emergencies etc in either direction. Also off the bike is fne unless I twist it wrong and I get a short pain in the medial (rarely)

I may still get the surgery, but will look to fit it in to the schedule where I don't have a lot of riding and make sure its in the off season

[CXCommuter]

A quick note- many people don't need to get the ACL reconstructed as they have tight joints/ligaments (apparently a famous squash world champion didn't have ACLs and still won and I cannot think of a worse sport for knee instability). For me I have marked join laxity (loose joints) so with a torn ACL walking down stairs alone was of concern so not doing the surgery was not an option for me.

[nickdos]

Thanks for all those replies...

I was torn between getting/not getting the ACL repaired (bad pun) but a few things swung it for me. I had pretty loose knee joints (like CXCommuter pointed out) - so much so that both the physio and my GP (who specialises in sport medicine) both thought my ACL was OK prior to getting a scan done, based on manipulation of both my knees. Timing was also good to do it now (I actually had the cash to go ahead) and having paid for private health insurance for over 10 years I felt it my due to actually use it for once ). Also having young kids, the chance of mucking around with a football, etc., and further injuring my knee was worth considering. I was also told that _not_ getting the ACL fixed was a risk factor in getting bad arthritis later in life but I'm a bit dubious on that one. I also have a family history of snapping ACLs - 2 of my brothers have had 3 ACL reconstructions between them.

[Eleri]

Thanks for all those replies...

I was torn between getting/not getting the ACL repaired (bad pun) but a few things swung it for me. I had pretty loose knee joints (like CXCommuter pointed out) - so much so that both the physio and my GP (who specialises in sport medicine) both thought my ACL was OK prior to getting a scan done, based on manipulation of both my knees. Timing was also good to do it now (I actually had the cash to go ahead) and having paid for private health insurance for over 10 years I felt it my due to actually use it for once ). Also having young kids, the chance of mucking around with a football, etc., and further injuring my knee was worth considering. I was also told that _not_ getting the ACL fixed was a risk factor in getting bad arthritis later in life but I'm a bit dubious on that one. I also have a family history of snapping ACLs - 2 of my brothers have had 3 ACL reconstructions between them.

I also thought about not getting mine repaired and was fully prepared to work on strengthening the muscles around the knee - except ... I kept dislocating something (patella?) and was in excruciating pain. This happened most often on planes as I was shuffling sideways to get into the window seat. Given I was on several flights a week, this became somewhat of a problem fairly quickly. Then I thought about what would happen when I was older and less able to maintain the muscle tone.

I too have a brother who had done 2 ACLs.