Riding after ACL replacement?

[modoc]

I'm a Training level rider. Injured my knee in Jan, '08 and had my ACL replaced in Feb. I'm back riding the past couple of weeks in an Osser ACL brace without a medial hinge, but posting is agony even though I can do full squats and lunges and have tried to approximate posting on the ground.

I haven't yet been able to find a PT or personal trainer in my area (Daytona Beach) who rides. Is there anyone here who has been through this and can offer suggestions? So far I am only walking and sitting the trot. Haven't tried cantering, yet. I can't run longer than about ninety seconds, either, which is a disappointment because I like to run to get things done faster at the farm!

Back in June, I was still thinking I might be able to squeeze in a Novice event towards the end of the year, but I'm thinking now that's gonna be a no-go :-)

Ideas?

[beeblebrox]

I have donor graphs on the PCL (sister to ACL)

As well as donor graphs on my LCL

[Badger]

I had ACL surgery in early Sept '99 and was back in the saddle in Oct and hilltopping by
Christmas. I don't remember pain posting in particular. I pretty much did every single rep of every single exercise assigned by the PT until the day I got permission to ride again, then I just got on with riding and quit the PT. I didn't have any special exercises for riding, but I do know that a lot of people skimp on doing their reps and that slows their recovery. 8 months post surgery I was foxhunting, eventing, and showing in reg dressage shows at second level. I did wear my titanium brace for a full year, including at shows. The eventing TDs didn't care, the dressage TDs required me to check in with them and get riding in it okayed because it was unusual equipment. When foxhunting, I wore a polo knee pad over my knee to protect it from impact from branches and bumping other horses.

Sounds like you need to keep cranking on the PT for a while. Maybe ride without stirrups at first. Consider the Herm Springer jointed stirrups for the time being. Sucks going through this, but it WILL get better.

[ZEBE]

Skiing accident 2000-- Age 50
complete rupture/tear of ACL
total ACL replacement ( cadaver graft) March 2000
Back in saddle July
No jumping till following March
7 years later... never a problem

My knee was very unstable when it happened- tried to use the brace for a couple of weeks, but knee would blow out when I tried to put a leg in stirrup when I mounted up... couldn't stand it... so did 3 weeks of heavy duty major PT and then surgery and more heavy duty PT and was able to start riding in July.

[ryansgirl]

Yes it's beyond painful. I had my ACL replaced and my meniscus trimmed off a little over three years ago. I did PT for months and a lot of stuff at home. When I did finally start riding again almost ten months later (completely tore my ACL in June and had surgery in July - then winter came and I have no indoor so I had to wait until all the snow and ice melted before I could get on again) the pain was horrible. I immediately ordered some MDC Ultimate stirrups with the flexible sides - helped a ton... but it still hurts when I post or land from a jump. If I'm in the saddle too long, it hurts. I find myself leaning more to the left when I ride since it was my right knee that had surgery - just trying to take pressure off of it. I hadn't ridden in over a year now (due to having my mare diagnosed w/ Kissing Spines) but I know when I do start riding again, it's going to hurt - I think part of that is because my meniscus which almost acts like a shock absorber is gone.

My advice - buy some jointed stirrups and keep at the PT as much as you can - even a non-riding physical therapists should be able to give you instructions for doing PT at home. I do hope you are able to do the event at the end of the year :).

[artienallie]

I really messed up my left knee in a fall off Allie in April - tore the ACL, strained the PCL and MCL, tore the meniscus and cracked my tibia.

I had ACL reconstruction surgery (hamstring tendon autograft) in June, and started riding again last month. I'm sticking with the longer dressage stirrups for a while, but I don't seem to be having any issues at any gait. In fact, I'm planning on a dressage show in November.

I only wore a brace for about a week after the injury. Once they discovered I hadn't seriously injured my MCL, they took me out of it. I didn't even wear one after my surgery. Both my surgeon and physical therapist are big believers in movement being very necessary for rehabilitation.

I did PT twice a week from May - August, then was able to drop to once a week for September, because I was religious about doing my exercises every day. Yesterday was actually my last day of PT.

[silver pine]

Sorry to hear about your injury. I'm a PT and Novice level event rider, so I have some idea what your going through!
I'm not too surprised that you have pain with posting if you cannot yet run without pain. squatting an lunging are great exercises to begin the process of returning to posting and 3point position work, However, The difference is a stable base of support. When your end point (the stirrups) are essentially unstable points of support your hip knee and back are required to work that much harder to create stability. As a result increased compression force is transmitted through your knee causing discomfort. Assuming the rest of your PT is on track- full knee flexion and extension, good and strong contraction of the quads without contraction of the hamstrings, Good dynamic balance-can you stand on one leg with a slight bend in your knee and reach overhead? catch a ball? Things like this will replicate all the dynamic activities required for posting, jumping and gallop work. Any good sports PT should have the tools to help in this process, you do need to be diligent with your stretching, quad work and dynamic balance exercises. The running and posting will come, the body wants to heal itself- most of the time we just have to get out of our own way!!!
Good Luck!!!

[MustangSally00]

I demolished my ACL about 6 years ago.

My first bit of advice is to completely lose the brace. After my surgery my surgeon (who is is some Orthopedic hall of fame) would not allow me to use cruches or a brace. And it was the best thing for it.

Secondly, I wouldn't worry about finding a PT who is knowledgable about riding. The whole point of PT after ACL surgery is to build up all the muscle that you have lost during recovery and to regain your range of motion quickly so that you don't end up with a super stiff joint.

Personally I didn't have any pain problems when I got back to riding. The only issue was feeling a bit off balance when my stirrups got shorter.

I think you need to really take a close look at where you are strength and mobility-wise with your knee. If your surgery was in Feb. you shouldn't be having these issues. I was told 6 months of PT and up to a full year for 100% recovery (and by recovery I mean feeling 100% being able to run, plant a foot, and make a quick turn without feeling uncomfortable).

Good luck!

[medical mike]

Medial knee pain can have several causes so to help pin point a cause......

How much single leg strengthening have you done?
ARe you riding "heels down"?

What is your range of motion? Do you have full extension or are you short a few degrees?

If you can't run more than 90 seconds, is that due to pain? Feeling unstable?
If it is pain, where is it?

Do you have residual swelling? A click/pop with any specific motion?

Test:
Get in front of a full length mirror, shorts on. YOu will be evaluating knee position/lower extremity control.

Place a 2x4 face down on the floor
Place a chair next to the 2x4 as an "in case".
Place the balls of your 5 toes across the edge of the board
Elevate the sole of the foot until parallel with the ground

YOu are looking for some degree of the following...note how much of each.
Knee cap to squint inward, or whole knee to move inward
opposite leg to touch leg you are standing on
Stance leg hip to shift to the outside
ARch of the foot to collapse

If you are unsure, grab the chair with the hand opposite the stance leg.

You are seven months out so IMO running should not be giving you that much difficulty.

Regards,
Medical Mike
equestrian medical researcher
www.fitfocusedforward.us

[Equa]

My story's pretty similar to Mustang Sally's. Got back on a quiet dressage horse 3 weeks after surgery. Physio was amazed/pleased at my recovery. (Didn't tell the surgeon I was riding that soon).

For a few years, I didn't do any jumping - only because I didn't have a suitable horse. When I started eventing again a few years ago, I did find shorter stirrups gave me some pain - as did walking XC too fast - nothing that a good ole ice boot couldn't fix!. I don't run, but I ski quite comfortably.

[modoc]

Arrgghh! Lost my other reply- suffice to say, yes, long, hard PT, did every rep. Am still doing every rep and stretch every day, twice a day plus the gym 3xwk :-) I'm in the best shape I've been in in six years.

Thank you very much for sharing ya'll's experiences with me. I'm seeing that I need Springer or equivalent stirrups to cut the compressive forces silverpine mentioned. I'm certain from ya'll's comments that I need to do more single-leg standing work. We did a little at PT, on mini-tramp, throwing ball, but not much, don't know why. I can stand on just the one leg, knee slightly bent with hands up, but it hurts cold- better when it's fully warmed up. I still think my side-to side is weak, and the muscle on the front of my shin. My 'chronic' pain is medial, when I'm tired and have worked my leg hard. The meniscus wasn't torn. Had an achilles tendon allograft to replace ripped ACL.

I'm a little scared after reading the thread that I should have chucked the doc's advice and started riding waaaay earlier in my PT.

The pain on posting, running, and when my leg is not *completely* and throughly warmed up and stretched and I try to squat, lunge, whatever, is immediately above my knee cap and extending about halfway under the knee cap. (lunges and squats, ect are non-painful when I'm completely stretched and warmed up). The cap does slide downward with a non-audible and non-painful pop when I do my quad sets at full extension. I have full extension and very nearly full flexion at 148 degrees. It still hurts to fully flex , but I do it anyway- it's that achy-it's-okay-to-push-it-pain, not sudden ow, ow, shooting pain I get running and posting at the trot. I cantered today, that felt fine, yay! The downward transition was a little sudden/rough and I posted once, ow.

My position is good, heels down and stable- I'm an experienced rider and my horse is 12 with good gaits- I bred her and backed her, so she's one less thing to worry about. I have no intention of riding my sensitive QH who has a ton of suspension anytime soon :-) I only wear my brace riding - and I'm supposed to if I run outside, but since I'm not faring well on the treadmill, I haven't tried that yet.

Thank you, Med Mike, I'll do your check! I spoke to my surgeon about my pain at my six month check when he released me for running and riding. He wasn't happy about the riding. Regarding the pain, he just said it'll take a year to feel recovered and two to be fully healed. He's an excellent surgeon, and the PTs are housed within the clinic. He worked with pro football teams. He's conservative- maybe more so than I thought after reading this thread. Maybe I should see him again, I haven't talked to him about not actually being able to do that running he said I could start doing :-) (and maybe your suggestion will give me something more to go on) or get a second opinion. Does anyone have a rec for an ortho in Daytona area? ...Ocala, Orlando, Jacksonville...

JEBE, did you not jump until nine months after you started riding again for pain reasons or medical advice? I tore mine skiing, too- I'm 42. After skiing eighteen years and thirteen of those on a partial tear, this year will be weird not skiing at all. :waxessnowboard: :-)

ryan'sgirl- I hope we can figure all this out so we can both ride again painfree!

Mustang Sally, are you the same Mustang Sally as in Buffy fandom?

Oh, Badger! Thanks for the equipment heads-up at the shows- and wow, did you re-bound!

[medical mike]

that can have several causes. Most likely is a lack of extension. Could also looke for an impingement due to a secondary lesion.

You really need to stop going heels down. It wreaks havoc with the lower extremities mechanics. Most of all, you need the soleus to add the extra muscular stability lacking from the graft. Not to say the graft is not stable, but it is not the original ligament and the capacity to compensate through the altered mechanics that heels down is just not the same.

Good luck with the test.....

REgards,
Medical mike
equestrian medical researcher
www.fitfocusedforward.us

[modoc]

The lack of extension comment is right on, Mike :-)

On the test, it's very obvious that although technically, as far as PT and the doc was concerned, I have full extension,and I've been saying all along that I don't, because I have hyperextension on my 'good leg', I definitely am no where close to the extension on the good leg. My knee cap squints over inward, the good one actually pointed out a little. My daughter says my good leg was locked, and it was, but so was the other, it just didn't 'look' like it to her, though I could feel it. Except for my floor work with quad extensions, and when I do my hamstring/calf stretches, nothing I do involves locking it. Will my stretches ever recover my original hyperextension?

I had to jut my hip out (and lean :-))to keep my balance on my 'healing' leg. I do calf work, raises from the ground and balls of feet on a stair or step up so that I can have heels down and do full raises from there. Is there anything to do that specifically targets the deeper soleus and not the gastrocnemis? I can see that strengthening the soleus would be beneficial since it wraps along the tibia at midpoint where I think I'm lacking strength.

On the 'good' leg, my arch stays stable and on the healing leg, it collapses right onto the board. I've complained frequently throughout the months about my ankle aching and sometimes it feels tight, like I can't bend it up as much as the other. Standing on the board it seemed really weak, collapsing inward.

I shouldn't ride heels down? Is that possible after all these years? Can I balance with a flat foot? Do I put my stirrups as long as possible while still being able to touch them, or put my foot further through them than the ball of my foot? I can (well, *could*, anyway) post and maintain jumping position at speed without stirrups, should I maybe just ride without stirrups since I don't particularly have to worry about open chain stuff now? What do you think? I absolutely am talking anything you, Mike, or anybody else who responds, as helpful advice and not medical advice, so please feel free to talk away, and I will take everything and mull through it and check with my doc or bug my PT until he calls me back. I won't be stupid with it, but I do want all your thoughts and tips.

Do you have exercise ideas? If this is getting out of range of forum rules, please PM or email me :-) landrews8@gmail.com with COTH in the subject line. Thank you, thank you.

[artienallie]

The lack of extension comment is right on, Mike :-)

On the test, it's very obvious that although technically, as far as PT and the doc was concerned, I have full extension,and I've been saying all along that I don't, because I have hyperextension on my 'good leg', I definitely am no where close to the extension on the good leg. My knee cap squints over inward, the good one actually pointed out a little. My daughter says my good leg was locked, and it was, but so was the other, it just didn't 'look' like it to her, though I could feel it. Except for my floor work with quad extensions, and when I do my hamstring/calf stretches, nothing I do involves locking it. Will my stretches ever recover my original hyperextension?

Sounds like you have full extension - you're just used to the extra that's beyond the normal range of motion. My understanding is that hyperextension is not a good thing - the joints are less stable, and more susceptible to injury.

I understand - I hyperextend in my joints enough that there was initially some concern using my own tissue for my ACL reconstruction, although the final decision was to go ahead with the autograph. I no longer hyperextend on the 'repaired' leg.

I did TONS of proprioception work in PT - lots of time on the bosu ball and single leg balance. Enough that I'm actually better balanced on my repaired leg, and I'm a little bit stronger on that leg as well. I'm no expert, but I think that was some of the key work to getting my leg strong and stable enough that I'm confident in riding my flighty mare.

[silver pine]

There is actually huge debate in the ACL universe over weather or not "full extension" is 0 degrees of knee extension or equal to the opposite side (in your case hyper extension). some surgeons believe that stretching the new graft into hyper extension decreased it's stability and increases laxity, other believe the knee should be restored to it's pre-injured state.

Either way the lack of hyper extension should not be causing medial knee pain with weight bearing flexion (posting). Poor knee cap mechanics and general instability from poor muscle imbalances are a more likely culprit.

Working extension is crucial but in your case it sounds like an issue of dynamic knee stability. I would work with your PT on some dynamic stability ex.
for example:
one legged stance (slight bend in your knee) with ball toss/ on uneven surfaces for a progression
Bosu squat/lunges/unilateral stance
plyometric work- only if your PT feels you have the baseline stability to perform these safely.

Good luck!

[Cinnybren]

I know this is a little older thread, but all the same the feedback is helpful. I had ACL reconstruction (Patellar autograft) Oct. 21st. This thread is very interesting and helpful in the timing and such to riding again. I am already missing it like crazy.

I am lucky, my PT is going great. Did 2-weeks pre-surgery PT and started post surgery PT 3 days after my surgery. On day 3, I was already at 0 to 90 degrees flexion. Now two-weeks later I am out and about in the brace with no limp and without brace in the house and in PT and have 0-126 degrees flexion. My PT gal wants me fully out of the brace sooner than later. My surgeon is also of the mind the sooner you are moving around and resuming flexion the better. I am hoping for full clearance to ride within 6 months. As others mentioned, following your PT daily to the letter appears to make a HUGE difference in recovery.

Someone mentioned using a brace for a little extra support when you did start riding, would you post a link to the kind you are referring to? Also on the jointed stirrups, I've tried them before and hated them because they felt unstable to me, has anyone had that experience?

[smilton]

After first ACL (left knee) reconstruction, I just started without stirrups and then with longer stirrups and worked my way from there. I did notice I put more weight onto the good side especially over 3ft+ landings. Unfortunately a little over a year ago I did away with my good knee. ACL (right knee) reconstruction surgery went much better and I was walking normally much fast post surgery. Unfortunately complete return to activities has been difficult. Jogging for exercise is out of the question. I usually ride without stirrups and I haven't tried jumping again over anything more than 2ft but hopefully time will help.
I did all the single leg medicine ball tossing, trampoline balancing and band work. I really think it did help tremendously. Simple quats and leg lifts helped but the rest really improved muscle reactivity and balance. (AKA relearning to catch yourself when you stumble or get knocked off balance)
Everyone I've talked to say no matter what you go it still takes a year minimum for muscles to relearn response and nerves to regrow.

[imissvixen]

I found the best thing for my knee after ACL surgery was a heavy neoprene sleeve under my breeches. It can be hot as hell in the summer but it helps with both pain and proprioception. And I think it helps stabilize the knee cap. I don't need it now. My long term issue has been with my IT band I think because I never got my mechanics back.

[imissvixen]

Also, don't rush and don't forget ice. Take an anti-inflammatory before you ride. Put a neck strap on your horse and give yourself a little help in your posting to start out.

You will find it gets better.