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Returning to climbing after ACL surgery

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 SteveJCox 10 Jan 2021

Hi everyone,

Next weekend I’m having an ACL reconstruction with a hamstring graft in my right knee after rupturing my ACL back in March.

I’ve been given a rough estimation by the physio of 9-12 months for recovery to full strength, at which point I’ll be able to ski again, but I wondered what anyone else’s experiences of recovery are? Is it realistic to aim to be hill walking in the spring and trad climbing, or seconding routes in the summer? It goes without saying that I’ll be following the direction of my physio and surgeon before returning to sports.

Thanks in advance, Steve

 rgold 10 Jan 2021
In reply to SteveJCox:

I had ACL surgery, but with a cadaver tendon, nine years ago at age 68.  I did PT religiously, and as soon as I could started short hikes at a local preserve.  I chose a place with relatively short loop trails (~2 miles) so that I would never be far from quitting if things didn't feel right.  The trails were hilly, which seemed helpful.  I started using poles to mitigate stress and protect against missteps.  My impression is that these walks contributed to recovery as much as the more targeted PT.  After about 7 months I was ok leading easy trad, and was fully back at whatever I could do at that age (I think HVS-E1 in your system) in about a year. 

That said, I think is might have been more like two years before I fully emerged from the mostly---perhaps entirely---psychological strain of worrying about the knee, and I suspect that subconscious favoring of it has lead, over nine years time, to the "good" knee being more problematic than the repaired knee.

You do need to be careful about early overdoing.  I don't know if this is true of autografts, but the cadaver tendon actually weakens before it strengthens, and there is a period, about three months in if I remember correctly, when it is more fragile than the day it was installed.  Meanwhile, you are feeling better and want to push just when you shouldn't.  I'm told that if you mess up a graft, you are probably in for a lifetime of more trouble with the joint.  In this regard, you'll be hearing from and perhaps meeting people who have pushed the envelope and returned to full activity much more quickly.  I think it is worth understanding that they have chosen risks that, as with all such things, may have worked out just fine, but that doesn't mean you should strive to imitate them; the downside is not attractive.

I don't ski, and the rotational loads on the knee imposed by skiing are more severe than climbing and trail-running loads.  I'd be very conservative about returning to skiing; there I think appropriate strength exercises would be critical, and a brace would be a good idea.  (I wore an expensive custom brace for a short while; it was uncomfortable on the trails and more or less impossible on climbs and I soon gave up on it.  I did use a stiffened mostly neoprene brace for a while but stopped that three years ago or so.)

Best of luck with the surgery.  It seems reasonable to expect to be pretty fully back in the game in a year.

 smithg 10 Jan 2021
In reply to SteveJCox:

Yes, that's realistic. As you're relatively young you should recover fairly quickly. 

Just take it one day at a time, build up gradually and avoid anything which could risk shock loading the leg. Get some hiking poles if you don't already use them. I used a knee-brace for all activities for ages, even after both legs were performing the same in gym physio tests.

I was surprised how soon I was comfortable toprope/auto-belay climbing. Just kept it in control and only landed on the good leg.

Good luck. 

 SteveJCox 10 Jan 2021
In reply to rgold:

Thanks both for the encouraging insight and good to know that getting back to full fitness just takes a bit of time. As I understand it the really risk is tearing the graft in the early stages so I'll have to be super careful in the early stages. I've got a feeling I'll be spending a lot of time on Zwift before venturing outdoors again! 

 JIMBO 11 Jan 2021
In reply to SteveJCox:

I had a hamstring autograft, and two years after getting back to full climbing it failed whilst walking... no trauma required... had patella tendon autograft after that and four years on it's great 👍

I was surprised how much the reduced hamstring bothered me,  especially heel hooking.  I also still don't like egyptian manoeuvres. 

Good luck with it and as you say stick to the physio and make sure you work on the range and not just strength 💪

 lanky and weak 11 Jan 2021
In reply to SteveJCox:

I had mine October 2018 (hamstring graft):

Cycling within 2 weeks.

Gentle jogging after 1 month.

Leading indoors 2 months.

Bouldering 3 months.

Bouldering was the scariest with the falling and additional heels/toes etc. Heel hooks sometimes still feel weird and I won’t do the move. Took me a good 6 months of bouldering before I committed to doing the problems like before.

Now running marathons and have no issues whatsoever, not even niggles.

Good luck, stick with the PT! 

 SteveJCox 11 Jan 2021
In reply to lanky and weak:

Thanks guys, really encouraging to hear that you've all had good outcomes and more importantly, thanks for the kind words of support! 

In reply to SteveJCox:

I had ACL reconstruction using hamstring about 12 years ago, aged 50, before I really started climbing. Indeed one of the reasons for the op was so I could start climbing properly.   I also had experience of my daughter having a reconstruction, doing lost of post-op work but then after 9 months the graft failed and she had to have a second one ( fingers crossed, fine so far!) 

I did lots of exercise before the op  but, even so, was surprised how much it affected my muscle strength.  I was doing gentle hill walking after 3 months, cycling to work after 6 months ( could have done so ealrier but my surgeon didn't like risk of me falling off bike and damaging graft) and skiing afte 9 months.  After 12 months I started climbing, but  carefully.  With the experience I have now I would not think of climbing till at least 6 months after op.  My recommendations
- Get a good physio and listen to what shehe tells you. 
- Don't push too hard too early.  If the graft fails you could be set back another 6-12 months, even if you can get an op quickly. 
- Don't underestimate the psychological effect, it can take a long time to trust the knee again.  I wore a proper brace while skiing for 3 or 4 years after the op which helped me feel secure. 

The good news is my knee has been fine and gives me no problems.     Best of luck.

 Liz Lowe 11 Jan 2021
In reply to SteveJCox:

Best of luck with it, it's not a nice thing to come back from.   I had surgery in Jan '20 for ruptured ACL, part ruptured MCL and torn lateral meniscus, aged 54, reasonably fit etc.  Didn't get much physio March-June due to the first lockdown, although I was (and still am) quite obsessive with rehab - I could do reasonable distance (so c.10km +), easy hill walking by about July, and could just about ride a bike by then too.  I tried running too soon (October), and it put me back about 6 weeks, so beware of too much (of anything) too quickly.  I've not yet climbed, but physio has given the go ahead for easy stuff.  So with *just* (!) an ACL injury, you should be good to go more quickly.  With the rehab, you'll need to focus from the outset on getting full extension, which is crucial for a successful ACL repair.  Just do everything the physio tells you to!  And as others have said, don't underestimate the mental challenge of trusting your knee again.  Hope it all goes smoothly...   

 Rob Oram 12 Jan 2021
In reply to SteveJCox:

Had a hamstring repair close to 20 years ago now due to a rugby injury.  I had some complications due to some hyaline cartilage damage as well. I was back to playing rugby after about 15 months and still playing (occassionally) today.....I was able to get back to climbing a bit earlier than the rugby...I think about 9 months or so after the op doing gentle stuff. As long as you're careful and follow the physio's advice you should be as good as new before long.

 Rockchild 13 Jan 2021
In reply to SteveJCox:

I had an ACL reconstruction on my right knee with hamstring autograft at age 22 but was neither climbing nor skiing at the time so can't say much about returning to those in the short term. What I can say is:

- 1 month post-op I could go for a casual bike ride. I could do a light jog (but only because I was about to miss a bus/flight) which felt fine but made me nervous

- Hillwalking was fine in the "spring" time-frame that you are looking at. Besides that the only sport I did in the year following the operation was cycling. Like the other responders I spent plenty of time on the physio, like Liz Lowe said above I remember that regaining full extension/mobility was a big deal.

- I took up climbing a year post-op and in the 5 years that I've been bumbling around (bouldering/sport/easy trad) I have never felt any negative effects from the surgery and my repaired knee always feels as competent as my "good" one

- I took up skiing 3 years post-op, got confident fairly quickly and have never had any knee trouble over a range of terrain such as black runs/moguls/occasional unpisted snow. When I started out I took a neoprene knee brace with me out of prudence but very quickly sacked it off.

Best of luck with the surgery and your recovery, hope you're able get back out there as soon as possible (and safe)!

 SteveJCox 13 Jan 2021
In reply to Rockchild:

Good to know you were able to get back on the bike so quickly. Cycling was one of the activities suggested to me to build up quad strength prior to surgery and it's quickly become one of my favourite things to do! 

In reply to SteveJCox:

re cycling, I was on a cycle machine in the gym a week or so after surgery ( very high seat because could hardly bend the knee!).  It was great for both strengthening muscles and mobility of knee.  However, my surgeon was very insistent I didn't start cycling on the road until 6 months bpost op ecuase of risk of coming off the bike, twisting knee and damaging the graft.

btw great you are working on quads pre-op.

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