[Andy Reed]

Hi Keith – sorry to hear about your knee.

It sounds like you are still very acute. Typically we hold off surgical reconstruction until the knee has settled down, swelling resolved, and you have regained a lot of function in the quads etc. Most patients are typically looking at surgery 8-12 weeks post injury (unless you’re in the NFL/NBA etc) so in terms of what to do right now – a good PT is gold, and can help you maintain quads strength and mass, hip and hamstring strength. Stationary cycling can be initiated as soon as you can pedal a circle. PT will advise on the use of a muscle stim, cold therapy etc, and in fact you can maintain mass and strength in the injured leg by exercising the uninjured side (muscle cross education).

After surgery you will be able to begin linear activities like stationary cycling almost immediately. Once your wounds have healed swimming and pool running can begin. In terms of Nordic skiing, many patients can begin classic skiing on the flat at around 12 weeks, usually in a brace, but obviously it depends on strength, balance, pain/swelling etc, and a brace would be advised to minimise re-injury. Every knee is different though and these timelines would simply be a guideline. We run our patients through a battery of functional testing before we clear them for return to sports. The biggest risk when classic skiing is actually having to step out of the tracks on a hill to snow plough so it  makes sense to stay flat and non-technical.

Because skate skiing involves more rotation through the knee, as well as a higher risk of catching the ski tip etc, I typically don’t allow my patients to skate ski until around 6 months, and even then, I would recommend a brace. For downhill skiing, 12 months minimum (and in general, the longer the better) to allow the graft to fully integrate/heal/vascularise. It is never wrong to go slow after ACL reconstruction and you can get creative with linear activities to avoid re-injury, maintain fitness and to stave off the boredom. Hope that helps!