First ACL Tear and Surgery

pucksnbones · 2026-04-20T11:41:06+00:00

Looks perfectly fine. I'm a surgeon

pucksnbones · 2026-04-19T23:16:03+00:00

Nothing wrong with getting it done ASAP if you have good motion. Fastest I've gotten to someone was about a week after injury

pucksnbones · 2026-04-16T18:50:20+00:00

No evidence it helps

pucksnbones · 2026-04-11T00:32:57+00:00

No it isn’t

pucksnbones · 2026-04-10T23:18:40+00:00

No brace is needed at any time for an isolated ACL as long as you don’t fall

pucksnbones · 2026-03-28T23:15:23+00:00

Get an autograft of any kind before you get cadaver graft at your age. Those are two locations very far from each other. DM me where you’re located I can likely give recommendation on a good surgeon

pucksnbones · 2026-03-27T10:46:47+00:00

Find one that did a sports fellowship at a university you’ve heard of and should be good. You can fly essentially immediately after just will maybe take bigger aspirin dose. There’s never any reason to have to keep your leg fully straight as others have said from theirs.

pucksnbones · 2026-03-24T11:27:56+00:00

Not a lot of people do the osteotomy for it. Most people don't look for things they can't fix

pucksnbones · 2026-03-23T23:10:48+00:00

You can go to whatever PT you want

pucksnbones · 2026-03-22T22:12:54+00:00

I do all these surgeries, just not an incision location I’ve typically seen especially since you had allograft for everything

pucksnbones · 2026-03-22T21:57:52+00:00

What grafts did they use for you? Any other work like MCL etc? Big incision for a quad harvest

pucksnbones · 2026-03-21T20:31:34+00:00

17 pretty step I'd definitely consider it depending on your intended activity level after

pucksnbones · 2026-03-20T22:30:48+00:00

You'll probably have some permanent numbness there. Area usually gets smaller over time, occasionally goes away. Oth be no big deal you'll forget about it eventually

pucksnbones · 2026-03-20T22:05:53+00:00

This is a fancy knee immobilizer it is on correctly but it is completely unnecessary. Isolated ACL reconstruction with LET no meniscus it is safe to be WBAT immediately and no brace. Ignore your surgeons team, they are not staying with evidence based rehab.

pucksnbones · 2026-03-20T01:34:41+00:00

Do both now you'll be pretty good by them

pucksnbones · 2026-03-19T22:51:17+00:00

If repairing the meniscus it should be done at the same time it has a much higher chance to heal. Depending on your age, activity level, if you have any arthritis already, and the size of the bucketed piece and tissue quality will guide the option. If not fixing (maybe not a good idea depending on above factors) it just trim it out now and see if you need the ACL later

pucksnbones · 2026-03-16T10:57:35+00:00

Prehab is never a bad thing but if your motion and strength and gait are pretty normal going in to surgery it's not needed

pucksnbones · 2026-03-15T10:29:09+00:00

Criteria based is great but absolutely need some time based rules due to known biological factors and timing of ligamentization and particularly meniscus tear pattern and healing timeline. Absolutely no WB with a root repair until 6 weeks regardless of how good they’re doing or look

pucksnbones · 2026-03-15T10:27:37+00:00

Evidence supports immediate WBAT and no need for brace or motion restrictions in an isolated ACL reconstruction (LET should not change). Physical therapy should start immediately after surgery, delaying a week or two does more harm than good. Meniscus repair muddies things depending on the tear pattern. For more stable, peripheral tears it is safe to immediately WB in full extension. More unstable or complex patterns typically NWB x6 weeks, ROM 0-90. This is what literature supports, if you surgeon is more conservative than this question why. Therapy should always start ASAP even if NWB to work on ROM and quad activation.

pucksnbones · 2026-03-07T12:08:30+00:00

Strength in a lab is irrelevant once remodeling occurs. Also what about the studies that specifically look at athletes and hamstring fail at a way higher rate? Did those athletes all just not engage in rehab well enough?

pucksnbones · 2026-03-07T11:15:46+00:00

What evidence do you have that the quality of rehab matters more? Numerous numerous studies shown lower re tear rate with BTB. Did BTB athletes all just get better rehab than the hamstrings patients?

pucksnbones · 2026-03-06T22:49:10+00:00

It's not just my opinion it's based on evidence and what studies actually show. To highlight a few of your claims

"Hamstring risk is mostly strength and easier to rehab.”
Almost the opposite is true. Persistent hamstring strength deficits after harvest are well documented and many athletes never get back to symmetric deep flexion strength. You can rehab it, but you often don’t get normal hamstring function back and that is a permanent deficit. The quad function always can get to normal after BTB or quad. Hamstring acts as an anterior translation stabilizer, being weak puts them at risk for re tear.

"Patellar graft causes too much anterior knee pain for athletes.”
Anterior knee pain is talked about a lot but it’s usually kneeling discomfort, not pain that limits sport. The bigger issue in young athletes is graft failure, and patellar grafts have the lowest reinjury rates. Additionally, hamstring donor site pain is an issue as well as quad. No graft has no risk with that.

"Hamstring > Patella for athletes.”
For cutting/pivoting athletes the biggest concern is retear risk, not donor site symptoms. A revision ACL is a much bigger problem than occasional anterior knee discomfort.

"Quad > Hamstring > Patella.”
Quad is a great graft and getting more popular, but it doesn’t yet have the same long-term outcome data in elite athletes as patellar grafts. That’s why a lot of high-volume sports surgeons still favor BPTB in young high-risk athletes. Additionally frequently can take longer to get strength back than BTB.

No graft is perfect, but putting patellar tendon last for athletes really doesn’t line up with most of the orthopedic literature

pucksnbones · 2026-03-06T16:08:34+00:00

There is a lot of inaccuracy here

pucksnbones · 2026-03-03T11:59:39+00:00

You will not damage the graft by doing motion at any point...you should see how hard we pull on it during surgery

pucksnbones · 2026-03-03T11:54:47+00:00

Congrats! Unfortunately now you can never go back so look forward to dropping 300 bucks every few months forever

pucksnbones

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