Ask Dr. Geier – Running after ACL surgery

Hi everyone! Thank you as always for all the great questions you send. While many of you use the Contact form on this site (which is great), please know that you can also use Facebook or Twitter. If you want to ask a question on Twitter, as Courtney did below, make sure you mention me so that I will see it. And I will do my best to answer it there or in an Ask Dr. Geier column or on The Dr. David Geier Show.

As always, please remember my disclaimer that I cannot and will not offer specific medical advice on my blog, on my show, on my social media pages, or by email.

David

Courtney Sanders asks on Twitter:

Hey! @DrDavidGeier just found out I have been running w/o an ACL for almost 10 yr and now have torn meniscus and arthritis stage 3. Will I run pain free again?!! I’m only 26. ;(

Thanks for the question, Courtney!

That is actually a more complicated question than you might think. First of all, it is certainly possible to run without an ACL. Sports like soccer, football, or basketball that involve rapidly changing directions, twisting, cutting, and landing from jumps are next to impossible without an ACL due to rotational instability. Running, however, is a forward motion. I have known several runners in their thirties who decided not to have surgery and were able to run without much change.

Having said that, if an athlete, even one who doesn’t play a cutting or pivoting sport, is having the knee give way or buckle, we usually recommended surgery to reconstruct the ACL. And having a meniscus tear probably makes sports medicine surgeons more inclined to treat the knee surgically, as the pain from the meniscus tear usually limits the patient’s activity. These are generalizations, so much of the decision is based on the specific symptoms.

Running on trailAs far as returning to sports and exercise after ACL surgery, it is a long process. As I have described elsewhere on this blog, the rehab process involves 5-6 months of physical therapy. First the patient and therapist work to restore full knee range of motion and then lower extremity strength. Gradually the therapist will allow the patient to start some exercise, such as stationary biking and then possibly an elliptical trainer. Jogging is usually withheld for 10-12 weeks to avoid repetitive stress on the ACL graft. Roughly around three months after surgery, the patient starts more functional training that involves plyometrics, balance, proprioception, and other skills that will get the athlete back to sports successfully.

Now unfortunately nothing is ever guaranteed with surgery, and that fact is especially true after ACL surgery. While most sports medicine surgeons do feel that return to sports is likely, there are some recent studies that show return-to-sports numbers closer to 60-70% instead of the 90% or so that we usually cite. I will discuss this data in an upcoming post, but many factors might be involved. Most important to these lower return-to-sports numbers seems to be psychological factors and apprehension about reinjuring the knee. Now these issues might not be as important in returning to jogging, which does not involve rapid twisting and landing from jumps. But it still must be remembered that return to a sport at the pre-injury level is never guaranteed.

Lastly, the presence of a meniscus tear and arthritis changes can be important. What specific treatment is needed for the meniscus can have a large effect. Most meniscus tears cannot be repaired (meaning sewn back together). The vast majority of meniscus surgeries involve trimming out the torn part, as the tear configuration and location is such that a repair would not heal. In theory, removing some of the meniscus, which acts as a shock absorber in the knee, could lead to arthritis changes down the road.

Also, the presence of arthritis changes at the time of surgery could suggest that the athlete will have some pain even after he or she has returned to full activity. As we have talked about in other posts, surgeons can look at the degenerative changes to the articular cartilage and try to smooth them out with a shaver. But this does not restore them to normal cartilage. While we have some treatments that might help small areas of cartilage damage, we have nothing reliable that reverses more diffuse changes back to normal cartilage. That doesn’t mean that the athlete cannot run, but it is important in a long-term sense.

20 Responses to Ask Dr. Geier – Running after ACL surgery

  1. Courtney says:

    Hi Dr. Geier,

    Thanks so much for your response to my questions. I had my ACL reconstruction and meniscus repair surgery on Friday! Have gone to PT once and am using the game ready ice system. I am really going to dedicate myself to PT for the next 6 months!!

  2. Henry says:

    Good luck with your rehab!
    I had my ACL reconstruction done two weeks before my 21st birthday due to a wrestling injury. After rehab I started running and two years later ran my first 5K in 19:41. That was 13 years ago and now I am training for a half marathon in August. I thank Senator Bo Watson for helping coach our wresting team and my rehabilitation.

  3. Nancy says:

    Thank you for your valuable comments. I had meniscus surgery and acl surgery last year. Is there a brace you would recommend to wear while running? I’ve looked on-line and there are so many types, but I hate to spend the money trying them out. I just wish I had something to sturdy the knee while running that was more than an elastic type band.

    • drdavidgeier says:

      Generally no brace limits the twisting movements that typically cause meniscus tears. And since the knee isn’t inherently unstable after surgery to trim out part of a meniscus tear, most orthopaedic surgeons don’t require patients to wear braces. Having said that, some people feel that knee sleeves or fancier versions of that provide a sense of stability and help them return to sports and exercise.

      • Nancy says:

        Thank you for responding. Although my last surgery for the acl was last mid-July, I feel apprehensive about putting weight on my knee to run. I walk and bike ride just fine. I’m just worried about the pressure. Maybe it still needs more time and strengthening. Thanks again.

  4. Colton Duncan says:

    Dr. Geier,
    I am 22 and had MCL reconstruction and meniscal repair 8 weeks ago. I have rehab protocol for 2x/day and seem to be progressing fast (full range of motion, body squats, brisk walking with no limp, etc.). I’m currently biking with resistance once a day as part of my rehab program and am curious if you have had a similar case-male in low 20′s, and how soon that patient began running again.
    Thanks

    • drdavidgeier says:

      Fortunately I have rarely had to perform MCL reconstructions as they heal on their own or just need a primary repair. I tend to hold patients who underwent a meniscal repair out of jogging for about 4 months, assuming everything is going well. I have concern that the repetitive impact from running could disrupt the healing of the meniscal repair. Having said that, the time is only one factor among many and have to be tailored to the particular patient and the surgery he or she had.

  5. Andy says:

    Hi I’ve recently had acl on my right knee. They used the pletellor tendon graft I had it on the 10th of January .. When I pull my leg (below the knee) forward and back there’s still a lot of movement ! I just want to know if this is normal because I’m itching to start running and would love to be able to have kick abouts with friends ..

  6. Luke says:

    Hi,

    I had an ACL reconstruction in November last year. I got a staph infection, had three wash out surgeries to remove it. Then had a drip in for two weeks and was on antibiotics for a month.

    I’ve been doing gym exercises and just started running.

    However recently i’ve been having problems with my feet swelling right on the bottom. Tonight my knee is really sore just above my knee cap, sore even to touch. Feels like bruising maybe?

    Regards,

    • drdavidgeier says:

      Sorry. I wish I could help, but without seeing you formally as a patient, I can’t really know the cause of your symptoms or give you any advice.

  7. kunu says:

    Hy Dr..
    This kunu.I did ACL surgery 1 year back,As per my doctor advice i did so many exercise.I always love to run but after 1 year when i start jogging i am getting pains in my knee(surgery knee).My questing is tht when i can start run as before and how much time to take relief from this pain and injury.Pls replay me.Your advice is very important to me.

    Thanking you

    • drdavidgeier says:

      Pain in the front of the knee can occur after ACL surgery, especially when the patient has not regained all of the strength of that lower extremity. Getting back into physical therapy can often help return to full activity. Your surgeon could give you more specific advice about anything else going on in your case.

  8. Abhi says:

    Hello Dr. Geiger,
    I am 31 yr old guy. I torn my ACL 3 yrs ago and had my surgery done (Hamstring graft). There was no meniscus tear or any other complications. I did physio and proper weight training and I never had any pain in the knee.
    I am currently getting into the long distance running and I usually run 12-15 km 3 times a week and there’s no pain. My question is; Is it okay if I go train myself for a marathon or that sort of long distance running? I see many doctors say that when I had my ACL done, I am already having an arthritis risk. They also say that if not now but I might get it after say 10-15 yrs. I wonder, I am completely fine now and don’t have any issues with the knee. If I control my weight and build muscle mass in the lower body, will I still be at the risk?

  9. Jared says:

    I had ACL reconstructive surgery on March 12th 2013 and am worried that I’m still unable to jog. I went to PT for the first 3 months after surgery and have since been riding my bike diligently 15 miles per day. I have strengthened my quads and other muscles in my legs and have regained full range of motion. I can walk normally without feeling any pain, however, I can’t jog at all. I can’t bare the pain from the impact when I land (even from a slow jog). I am 5 1/2 months out of surgery and am worried that my ACL didn’t heal correctly, or even worse, failed entirely. Are there such cases? Is it normal not to be able to job (even at a slow pace) at 5 months post surgery?

    • drdavidgeier says:

      Yes it is possible, although I can’t say if that is normal in your case. Your orthopaedic surgeon can examine your knee and review any necessary radiology studies to tell you if something worrisome is going on that is causing your issues with jogging.

  10. Charlotte says:

    Hi, I’m 19 and play soccer at a high level I had an ACL reconstruction and meniscus repair over 2 years on March 29th 2012 ago a year later after my surgery I ruptured my ACL again causing my meniscus to get fully torn. I had a emergency surgery to remove the meniscus and only a week ago I have just had my second ACL reconstruction using a donor ligament grath. I have been told by my surgeon to give up on soccer as I’ll never be able to get back playing again and the ACL might not hold, I would love your opinion if you think it’s possible for me to get back playing again I have gone round to different sports specialist to see what everyone’s opinion is to help me decide what to do.

    • drdavidgeier says:

      It is hard for me to give specific information or predictions without being involved. While it can certainly be more difficult to return to sports after a second ACL surgery than a primary one, many athletes can do it. The need for meniscus surgeries can be a complicating factor as well, though.

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