Torn ACL and meniscus

He wrestles and plays football.This happened at wrestling practice.....he is a better football player. Thought wrestling would help with his agility and leverage.

Well it’ll be a while until he gets back to fully playing sports. It should anyway

Right after surgery, pain will depend a lot on exactly what’s done and what graft is picked. Patella tendon autograft was initially thought to be the “gold standard” but research is showing hamstring autografts can be just as effective and both really have super low retear rates. If he’s an athlete and young, don’t get a cadaver allograft. Retear rates are much higher and really they’re only used for older people that probably aren’t going to be returning to any sport.

Right after surgery, patella tendon grafts can be a little more painful because they’re gonna be harvesting some bone to help with healing as the new ACL. Hamstring grafts are usually going to be similar to if you pulled your hamstring.

Meniscus repair will probably be performed if it’s viable but that depends on the type of test and where it is because different areas of the meniscus have varying blood supply. Low to no blood supply means no healing, so that’s when they would just clip out the tear.

Meniscus repair is better for the long term health of the knee which is why the doctor will do it if he can, but usually that will slow down early rehab. Again depending on where the tear is and also the doctor’s preference, weight bearing might be limited or at least in certain positions (usually you’re ok to weight bear if you’re in full extension) and they might also limit how much he can bend the knee for the first month while that heals.

Right after surgery, the first goals are to get full extension (the knee all the way straight), get swelling under control, and just to get his quad back firing because there will be a good bit of inhibition from swelling and surgery. Usually, people are back on their feet and moving around relatively quickly feeling more “normal” with just basic walking, but that depends so much person to person and also based on the procedure.

But yea, the first couple of months can be boring. By that point, it will be a bit more focusing on getting most of his strength back along with proprioception and stability. So it goes a lot beyond the knee, but includes ankle, hip, and core control.

Research is changing a lot more on when people should return to running and sports and that kind of stuff. Everyone started super conservatively, then they sped things up a bunch, but now they’re going a bit more conservative again. He’s looking likely at waiting 3-4 months out of surgery until he can start straight line running. That also depends on how he’s doing functionally. So basically, if he’s still super weak, doesn’t have full motion, still has a lot of swelling, etc. then no running.

By that point, he should start working on some plyometrics and will work up to some “agility” type work and getting used to changing directions, acceleration and deceleration type work at about 6 months. Honestly, that’s when a lot of people start to feel really good and they think they can get back to sports, but really more research is showing it’s better to wait. He’s probably looking at least at 9 months until he’s back to sports, and sometimes with younger kids, to get full function on that leg, it can take up to a year if not longer.

Some doctors just go by timeline of when they clear people, but really he should be cleared with a lot of functional testing so making sure his strength is truly 100% back to normal and not just 95%. This also includes different jump tests like his vertical, broad jump, triple jump, etc.

And just FYI, we’re starting to see more and more people have an increased risk of tearing their opposite ACL from the one that was operated on when they get back to sports. Some of that can be due to favoring the operative leg, but also we’re thinking it can come from de conditioning and just focusing on the operative leg, so as he’s doing all this stuff working on the surgical leg, it’s always good to do both sides. Gotta keep things symmetrical

I think that’s about it. Let me know if you have any other questions or anything.

We are going for the hamstring graft. I thought 6-9 months as well. He's bummed about it because he knows what all this entails.

The meniscus tear was pretty severe and really caused the most attention from the doctor.

How old is he and what grade?

Yep, bummed out because he was looking at significant playing time this upcoming year on the OL.

Told him not to pull a Jerry Rice and rush it. Good advice though on the opposite knee and overcompensation once cleared....makes sense though.

I tore my ACL/Meniscus at age 18 playing basketball.

I had the Patellar Tendon surgery and it was by far the most serious surgery I have had. The few days after were very intense pain and I was loopy due to so many drugs (oxycontin, etc). After that, Physical Therapy was laborious and I ended up being on crutches for a significant amount of time (4+ months).

The good news is 13 years later I have no issues w/ my knee and I am 10x more active now than I was at 18. I lift weights multiple times a week and go on mountaineering trips several times a year without issue.

Only advice I would give to him is to ensure he takes the PT seriously. I took it about 70% seriously and still have mobility issues in my left leg to this day. It is hard to take something serious at that age for 6+ months several times per week.

My kid had surgery end of Mar 19th.
We chose cadaver based on our surgeon and what he recommended. It was from a 16 yo boy.
He is one of the better surgeons in FL- work with colleges, Detroit Tigers etc.

She was out of school about 2 weeks but we followed all the directions carefully. He was a no ice/no brace Dr. She never used them.

She did Therapy 3 days a week for about 4 months, then it went down to 2 days until December. She still goes to her PT one day a week. Around November she went to working with D1 etc as her PT recommended she work out. We used them pre injury.

It wa sa long process but they did not want her to rush back to RTS. We heard all the 6/7 months and she can play again. We decided to take our time. They tested her all the way thru to make sure her left leg(acl) was stronger or equal to her right.

She hasnt had any issues as she slowly returned to volleyball in December (practice 2 times a week). She has played in a few tournaments in 2020. We arent letting her overdo it. She has been playing year round doe 3 years- beach and indoor so she was in great.

All I can say is research the Surgeon and Therapist- make sure they on same page. Our PT was familiar with the Dr.

And to drive my point about rushing back- we know a vb player who tore her acl about 2 months prior to my kid. Not sure who they used- bt was made aware they tried rushing back and ended up tearing the acl in her opposite knee.

I think Clay Thompson tore his acl a month later- so if it will take him 10-12 months with the training he will get being a Pro Player- I know we were going to take our time in getting her straight.

patients that return prior to a year and without functional testing have a 26% reinjury rate whether it be the same or contralateral knee.

make sure his PT performs functional return to sport testing prior to returning to sport.

also, most private insurance companies cap therapy visits in a year and unless you plan on doing some cash pay then i'd try to save some visits in the beginning when the rehab protocol is relatively basic and the focus is quad activation and achieving full ROM.

Mike and Lenny provide good content, I like their instagram accounts.

I need breaks from that Boston accent though lol.

Zaba, are you a PT or ortho doc?