Following ACL reconstruction, athletes are always curious when they can ditch the crutches and brace and start working towards their previous activities. The graft type, the complexity of your surgery (i.e. if/what other tissues were repaired), and your overall healing capacity are factors that help determine your timeline. The following should give you an idea of what to expect whether you had your ACL repaired or your ACL and meniscus repaired.
If you had only the ACL repaired with crutches:
Initially use crutches & brace:
– You can expect to initially walk with the crutches and your knee brace locked in extension. Your knee lacks stability and strength as your new graft is healing, so one of the main goals for the first phase following surgery is to protect the graft.
– A bone-patellar tendon-bone (BPTB) graft is considered more stable than other options, so your surgeon may clear you to walk without crutches as long as you don’t experience an increase in pain. For many, this milestone is met in 7-10 days post-op – using crutches after ACL surgery.
– For those with a hamstring graft or allograft (harvested from a cadaver), your surgeon may prefer you to keep walking with crutches and partial weight-bearing progressing to weight bearing as tolerated for 4-6 weeks after surgery. In order to ditch the crutches, you’ll need to demonstrate proper gait mechanics and quad control. According to NHS website, your physiotherapist will advise you about what exercises to do.
– Performing a straight leg raise without a knee lag (shown below) is usually a good indicator that you’re ready to unlock your brace (from 0-90° knee bend). That is, laying on your back and lifting your leg towards the ceiling while keeping the knee in full extension throughout the entire movement. When the quads are weak, you’ll see a compensatory bend in your knee as you lift (aka extensor lag) which may straighten out at the end of the movement.
– Individuals are often cleared to stop wearing their brace while walking around the house 6 weeks after surgery if they’ve achieved appropriate quad control.
– Regardless of graft type, your MD may clear you walk without the brace slightly earlier if you demonstrate good quad control and can walk without asymmetry and abnormalities (like limping).
But what if I had my ACL & meniscus repaired?
Menisci are cartilaginous crescent-shaped rings between your femur and tibia that absorb shock, distribute force, increase stability of the knee joint, and provide lubrication to promote long-term joint health. Naturally, concurrent injury to the ACL and meniscus means that your recovery is more conservative.
Initially use crutches & brace:
– Similar to if you solely underwent an ACL repair, you will initially walk with crutches, partial weight bearing restrictions and your brace locked in extension.
Without crutches & brace:
– Protocols vary in their instruction based on surgeon preference and your progression through your recovery.
– It’s common to be restricted to walking with brace locked in extension, crutches and partial weight bearing for 6 weeks following surgery.
– Or you may get the okay from your surgeon between 2-4 weeks, to unlock the brace from 0-90° of knee bend (flexion) but maintain use of crutches.
– You may be instructed to begin weaning off crutches in 4 weeks. Again, this is usually dependent on appropriate quad control and gait mechanics.
**Please remember that your timeline can vary based on your recovery and the specifics of your surgery. Always consult your surgeon and physical therapist before discontinuing use of crutches or brace.