Squatting/deadlifting heavy after patellar tendon autograft ACL reconstruction

[onthemend]

Hello Coach Rippetoe,

Before I launch into my question, I just want to say that the Starting Strength program laid a fantastic foundation for my lifting career and I am extremely glad that I picked it up.

I am having ACL reconstruction surgery next week. I have decided against the hamstring graft since it requires harvesting the entire semitendinosus and possibly gracilis tendons. I cannot decide on an allograft at this point in time and I am also not keen on that option. The patellar tendon looks like my best choice at this point.

My question is: Is it a legitimate concern that the patellar tendon could rupture, after losing its inner third, while squatting or deadlifting heavy weights (i.e. 400+)? How did yours hold up? How heavy did you go? Do you know strength athletes who have gone on to lift heavy weights with the patellar tendon graft?

Thank you and all the best to you.

[Mark Rippetoe]

Mine seems to be fine, but if I had it to do again I'd use the allograft. It wasn't an option in 1994, and the pain was significant. Significant.

[onthemend]

Mine seems to be fine, but if I had it to do again I'd use the allograft. It wasn't an option in 1994, and the pain was significant. Significant.

Thank you very much for the quick response.

I have noticed your advocacy for the allograft on these boards. There are a few different reasons which I won't get into here about why I don't think it is a viable option for me at this point in time.

I have been made aware of the pain associated with the patellar tendon autograft. As for patellar vs hamstring, I figure I'd rather endure the pain than sacrifice my semitendinosus and or gracilis function.

What kind of weights did you squat/deadlift postoperatively?

Thank you again.

Anyone else who has been through it, would love to hear about your experiences.

[Mark Rippetoe]

To back up a bit, I would NEVER allow a hamstring-tendon repair. Never ever. I was back to squatting partial ROM in a couple of weeks, very carefully, full ROM was at about 8 weeks, I think. But the goddamn thing hurt for about 2 years.

Two fucking years.

[Dan Miller]

I had an allograft ACL reconstruction in 2011, still gets sore whenever I layoff lifting for a while. Do my squats, keep the muscles around the knee strong, and it feels better. Go figure.

[Nermin]

I think you're good, OP. I had patellar tendon ACL repair done in 2008 (at age 26). The cause of the injury was an awkward landing playing basketball. Up until then I knew nothing of performing squats correctly (and I did not perform them, nor did I follow a rational strength program of any kind). e, I began to squat after about 2-3 weeks of post-op ROM work, quarter depth. I have talked to friends who didn't push through the extension/flexion work with the PT in the first couple of weeks, and they still have poor range of motion. This is anecdotal, of course, but my suggestion is to make sure you put the work in from the very start despite the pain. With the novice effect, I was able to get this ugly, uncoached squat to like 185-200lbs, thinking that was pretty good. It allowed me to resume recreational sports after about a year. No pain, no issues - couldn't be happier with the repair.

Fast forward to 2013 and the Starting Strength book, video, seminar (in that order). I worked up from ~185 to currently 335x5 (not heavy in absolute terms, but pretty heavy for me) and have never had any issues with that knee. Also, that tendon fills in over time so I'd imagine your risk of rupture decreases with time. I suggest: start light, proceed carefully, and practice impeccable form.

[onthemend]

To back up a bit, I would NEVER allow a hamstring-tendon repair. Never ever. I was back to squatting partial ROM in a couple of weeks, very carefully, full ROM was at about 8 weeks, I think. But the goddamn thing hurt for about 2 years.

Two fucking years.

I think that's not the norm. Although many people do experience pain. Graft site morbidity appears to be the main reason why the hamstring tendon autograft has become popular in recent years.

Hopefully I can avoid a bit of it! Thanks for your time and assistance.

[onthemend]

I think you're good, OP. I had patellar tendon ACL repair done in 2008 (at age 26). The cause of the injury was an awkward landing playing basketball. Up until then I knew nothing of performing squats correctly (and I did not perform them, nor did I follow a rational strength program of any kind). e, I began to squat after about 2-3 weeks of post-op ROM work, quarter depth. I have talked to friends who didn't push through the extension/flexion work with the PT in the first couple of weeks, and they still have poor range of motion. This is anecdotal, of course, but my suggestion is to make sure you put the work in from the very start despite the pain. With the novice effect, I was able to get this ugly, uncoached squat to like 185-200lbs, thinking that was pretty good. It allowed me to resume recreational sports after about a year. No pain, no issues - couldn't be happier with the repair.

Fast forward to 2013 and the Starting Strength book, video, seminar (in that order). I worked up from ~185 to currently 335x5 (not heavy in absolute terms, but pretty heavy for me) and have never had any issues with that knee. Also, that tendon fills in over time so I'd imagine your risk of rupture decreases with time. I suggest: start light, proceed carefully, and practice impeccable form.

Thanks a bunch for the response. Didn't see this. Appreciate the anecdote and glad to hear it worked well for you! Definitely an impressive squat as well.

[MPhelps]

I tore my ACL, MCL meniscus in 1999 while skiing (telemark, yeah, I'm cool). Had patellar tendon graft in 2000. I followed the PT for however long they gave me. I was back working in the woods in 3 months. I haven't had any issues with the knee since as far as instability or ROM. Since then I've skiied, run, hiked, and squatted. Rip's right though, it hurt like hell for a month and hurt less like hell for another 2-3 years. It was probably 2005 before I didn't have any sensation of the injury and surgery on my knee. The only thing I wish I had in 2000 was good advice about lifting. Instead I had a lot of high rep isolation BS and mobility crap from PT. At least you have SS to run whenever you're able to get back into things.

[onthemend]

I tore my ACL, MCL meniscus in 1999 while skiing (telemark, yeah, I'm cool). Had patellar tendon graft in 2000. I followed the PT for however long they gave me. I was back working in the woods in 3 months. I haven't had any issues with the knee since as far as instability or ROM. Since then I've skiied, run, hiked, and squatted. Rip's right though, it hurt like hell for a month and hurt less like hell for another 2-3 years. It was probably 2005 before I didn't have any sensation of the injury and surgery on my knee. The only thing I wish I had in 2000 was good advice about lifting. Instead I had a lot of high rep isolation BS and mobility crap from PT. At least you have SS to run whenever you're able to get back into things.

Thanks for sharing that. Good to hear so many guys coming back from the same surgery. And yeah, really hoping my lifting experience will come in handy in the rehab. It's definitely come in handy in the pre-hab, as I'll be going into the surgery already squatting and deadlifting heavy, which apparently helps the outcome.