ACL Reconstruction - Patellar Tendon Autograft

Hello,

Seven months ago I suffered a ruptured ACL while playing soccer. Five weeks ago I underwent an ACL Reconstruction via Patellar Tendon Autograft. Last week I resumed going to the gym to test out what I can do, and also to train upper body movements. Barbell squats are a definite no-go yet, but I can do deadlifts (with considerable discomfort/moderate pain). I have not noticed any injury as a result of deadlifting, but I am worried about what is the wise course of action.

My physiotherapist has advised against continuing with deadlifting, and also to refrain from barbell squats. The physio recommendations are several low-resistance/high-reps air squats, and other assistance exercises + stretches. Aside from regaining range of motion (which I have nearly 100% regained already), I am not really in agreement with the physio recommendations. In my opinion those guidelines would just lead to reduced strength levels. I would like to resume training as soon as possible, while minimising risk for injury. Here are my main worries listed below along with some more info for context:

- Overcompensating with the non-operated leg leading to either form breakdown and/or injury.
- Causing damage to the graft / operated knee.
- Slowing the healing process.

Other info for context:
I am 33 years old, 6' 0" - 214lbs.
Several years on and off dicking around in the gym. Three months LP + some intermediate programming (Heavy/Light/Medium).
PRs (these were set late summer 2019 - I was stronger than that just prior to injury and the subsequent pandemic lock-down):
Squat: 345lbs
Deadlift: 435lbs
Bench: 260lbs

Do I follow the physio guidelines for lower-body and focus on training upper-body? Or should I just push on through some pain with deadlifting and resume squatting as soon as I feel that I can?
Any advice would be greatly appreciated.

I’m as aggressive as you will ever find in a physical therapist, and even this is too much for me to be comfortable with. You are five weeks post-op....five more weeks is needed. Upper body stuff is good as long as it is things like Larsen press, seated press, etc. single leg leg press and anything you can do single leg is helpful. Working the uninvolved leg heavily can reduce the atrophy on the involved leg.

Thanks for the reply Will. Do you mean to completely avoid squats and deads, or to just not go heavy yet?

Prior to reading your reply I went to the gym and tested out squatting again. Squatting with 135lbs - 3 sets x 5reps felt fine. Only minimal discomfort and no knee pain or swelling afterwards. I did not go heavier than that.
Regarding deadlifts, the heaviest I had gone was a single set 5 x 275lbs (which was definitely painful, but resulted in no injuries/swelling, etc). If I were to continue I could lower deads down to 185lbs.

Just want some clarification to make sure ,thanks!

I’d have to recommend avoiding them all together.

Got it - Thank you! I will give it another 4 weeks or so, and then go from there.

Now, truth in advertising, I started bench pressing after Tommy John Surgery 2 weeks post-op. Where I was at the time, there were no other PTs that could manage a post-op Ulnar Collateral Ligament Reconstruction and anterior transposition of the ulnar nerve, so I was given the task of performing rehab on myself. I followed a linear progression with the post-operative valgus block brace on. I benched pressed twice per day until I got back to 135, once per day until I hit 205, then every other day when I got back to 255. At 8 weeks to the day, I hit 315, with the brace, for an easy single. I then dropped back to 245 (without the brace) and have been progressing since then. Any PT or orthopaedic surgeon in America, or the world for that matter, would be absolutely horrified about how I treated myself.

Yeah I get that. We tend to be more aggressive with ourselves than we would feel okay with recommending to other people.
Its fine though, setting myself back a few weeks, where training wouldn't even be optimal anyway is preferable to risking injury or other problems.