Climbing Following ACL Reconstuction

[ericb]

So I'm two months out from ACL reconstruction (hamstring) and feeling pretty spry. I've been cleared by my surgeon for swimming, eliptical, bike (stationary and road).....no jogging until next visit (2-more months) and the original prognosis was no skiing/plant-pivot for nine months, with functional brace.

 

My surgeon said I was ahead of schedule. I've been aggressive working on ROM, and stengthening, and my hamsting/quad strength are coming back quickly.

 

The question is when can I start climbing again? I'm planning on picking up a fancy new brace ($$$ ouch!) for some added stability for some light hiking, and have been a trekking pole fanatic for several years already. My surgeon is very conservative, and his return to full activity is on the slow side at 9 months vs. ~ 6 months for others. Many folks are cleared to jog at 2-3 months, so he's on conservative side there as well - all that to say that I know that if I ask him, I won't like the answer so I'm looking to hear what some other folks have done and when. (In addition to Ryland, of course, who is superhuman)

 

I'm guessing that the approach is probably as dangerous as the climbing it itself, but trying to imagine the scenarious that could stress the ACL graft itself when climbing. Could I return to the gym or exit 38 on top-rope sooner rather that later? Easy trad climbs at 3-4 months post op???

 

 

Edited May 27, 2007 by ericb

[high_on_rock]

Full ACL reconstruct, on the indoor wall 8 days later (what an idiot, but she wasn't following instruction and said "you do it" and I had no choice left!); actually started real climbing at about 2-3 months, been climbing since.

[ericb]

did you have hamstring or patella graft

[high_on_rock]

patella I believe. I know it wasn't the hamstring.

[ericb]

From what I understand, the patella graft is stronger earlier due to the stronger anchorage (screw-bone-bone) and bone to bone healing takes place pretty rapidly. The hamstring graft is more susceptible to early rupture as it is soft tissue to bone healing.

[ryland_moore]

Can't comment on the hamstring version personally, but I did know a gal who had the hamstring and she did not start climbing until after about 5 months if I remember correctly.

 

It all depends on how strong your legs were previously. Regardless of the type of ACL surgery, the stronger your leg was going into it, the quicker your recovery, at least that was what my doc said. I bet if you have descent range of motion, you should be fine. The problem will be when you have to high step and place all of your weight on that leg. I was in Vegas for a bachelor party during the NFC playoffs January 14, 2006 so wsa about 1 month out from surgery. I had to get away from the strip so headed out to Red Rocks. We climbed easy stuff (5.8 and 5.9s) and I could definitely feel it when I stepped up on lead. It was more sore after climbing five pitches then when I was just jogging or riding the bike. I still did not have my full range of motion yet. I say this because it may put things into perspective for you when comparing how you feel on the bike.

 

As an aside, I wasn't doing PT but just a bunch of exercises my doc gave me. I went out fly-fishing for steelhead on the Kilchis River in early February and as I was walking down a really steep bank, I slipped in my wading boots and my leg got tucked up behind me as I fell. It hurt really bad because it was forced and happened so quickly, however, I think it broke up some of the scar tissue and increased my range of motion tremendously after that! Good luck in the healing. You'll be back soon enough. I would say with your schedule maybe toproping first where you can back off if need be. You can look at it as relying less on that leg and building up your finger strength or smear technique becasue you are forved to take smaller steps...

[chesterboo]

Eric, I had ACL reconstruction 5 years ago. Now both of my knees feel the same and I am happy. I followed the advice of the surgeon and did extensive pt for first 3 months. I started in doing my first long backpacking trip of 50 miles 6 months after the surg. I skied the next season but with a brace. After that it has been fine. You may be ok to do some of the activities that you are excited to get back into and odds are you would be, but studies show that your graph and musculature around it are not near 100% for 9-12 months. I was even told that full healing can take as long as 2 years from surg. The way I see it, you have put so much time, energy, frustration and general screwing up of your plans for the whole spring, why waste all that because you wanted to get out and push it early. My surgeon told me that every year you have those young fit hot shots (usually snowboarders) who get back at it after 3 months and screw up their graph and they are back for more. Think about how bad that would suck???? Chill brother and your time will come.

[high_on_rock]

Without any doubt, heal it right the first time and don't force yourself into a second rehab period. Once is enough.

 

 

[ken4ord]

For me it was 4 months, I was back on ice and in the climbing gym. The biggest concern is any falling or slipping. The stepping up (though high steps were out) and kicking did not present to much strain, though my knee still felt weak and unstable. I definitely wasn't out every weekend just every once and a while to curb my appetite. At 6 months I was back at it every weekend though.

 

BTW- I had a patella graft, stitched up meniscus.

[Ducknut]

I had a hamstring ACL rebuild 3 years ago at age 45. I went into surgery strong. I did the PT everyday and exercised in the gym everyday. I got the ok to run at about 2 or 3 months. At 4 months postop I climb up Hood via south side in 4 hours, on the 5 month anniversary I did Cooper Spur and at 6 months I did the three Sisters over 24 hours (bivy after doing North and Middle). I should have packed it in snow that night cause it was swollen the next day. I don't think I did any perm. damage to the graft or anchor points but I think I did build up some scar tissue where it passes through the joint cause it "pops" sometimes. The popping is caused by the scar tissue hanging up, it doesn't hurt, its just pops like a knuckle pop.

 

The one thing I have noticed is that my hamstrings still haven't regained full strength and that if I lift my leg high to step up I'll get a charlie horse. So make sure to do your hamstring strengthening exercises.

[hopper_62]

Hi All,

 

I took a skiing spill after hitting a hidden stump before the big dump last week and just got the MRI info back on Friday. Doc tells me I need a new ACL and is asking which one I want patellar tendon autograph or allograph. Any opinions from those that have had the surgery - from what little I've read on the web it seems the allograph is the way to go with the only draw back being a slight chance of post op infection. (the surgeon is recommending this as well)

 

And, I'm relatively new to Portland and went to Doc. Crawford at OHSU. Anybody get cut by this guy and have an opinion?

 

Thanks for any info.

[Pandora]

Bummer - sucks when the season ends before it begins, eh?

 

I had my ACL replaced in August with the hamstring graft. If I were to do it over again, I'd go with the allograft instead because of the quicker recovery time. As you mentioned, there's the ever-so-slight chance of infection or your body rejecting the foreign tissue, but my doctor pointed out that the donor graft tends to stretch less, and the operation for an allograft is less invasive. I believe it is the better choice as long as your doctor is experienced in that type of replacement.

 

Best of luck to you.

[ericb]

very few docs are doing allografts any more. The sterilization process necessary to negate the possibility of HIV/Hep transmission weakens the graft.

 

Orthopedic Physicians Associates Surgeons in Seattle are the knee docs for the Sonics (Zorn), Mariners (Holland) and Seahawks (can't remember) and to my knowledge none of them recommends cadaver tendons. I don't think you will see reference to many professional athletes using cadaver tendons. I went to Zorn - he recommends hamstring, and Holland favors patella (but does hamstring as well). I recall seeing a graph showing the % hamsting vs. patella vs. allograft done over time, and hamsting is becoming the preferred method with allograft dropping off to single digits. I guess I'd be a bit leary of a surgeon that's recommending allograft.

 

Either the hamstring or patella autograft will be stronger in the long term. Also, your body eventually revascularizes the autograph making it stronger in the long, long term. Patella used to be stronger than the hamstring, but now I think the composite hamstring graft (semitendinosis/gracillis) is stronger than the patella.

 

Most surgeons have a preferred autograph - either hamstring or patella, and you pretty much pick the method when you choose the surgeon. I chose the hamstring as there's lower incidence of patella tendonitis, and less long-term frontal knee pain. My wife had patella ~ 20 years ago from an excellent surgeon (Cal Berkeley athletics surgeon) and still can't kneel on hard surfaces without pain. Do a lot of asking around about surgeons, and be sure and talk to a really good PT. They will know a lot about reputation in the local area.

 

I'm nine months out now and feeling really good and strong.

 

 

Edited December 24, 2007 by ericb

[hopper_62]

Eric,

 

Thanks for the reply, I'm going to intensify my research!