I had a 9am PT session this morning which meant an early start. We added some new exercises today. Squats and standing knee raises were both on the list for the first time, and they felt a little unstable at first since my knee is still relearning how to handle load and balance. By the end of the session they were starting to feel more controlled. Squats are important at this stage because they introduce functional weight bearing through the knee in a range that mimics real movement patterns, which starts retraining the joint and the muscles around it to work together. Standing knee raises challenge single leg stability and hip flexor strength, both of which are essential for eventually getting back to any athletic movement. My range of motion hit 107 degrees by the end of the session which I was really happy with.
At 11am I had an interview with my surgeon’s PA as part of my ACL research, and I came in with a lot of questions and left with a lot more to think about.
Starting with my own surgery, I learned more about the specifics of my graft and hardware. The size of the titanium screw is determined by the size of the graft itself, and the larger the screw, the more foreign material is in the joint, which can increase the risk of scar tissue forming. Quad grafts also inhibit the quad pathway even more than patellar tendon grafts do, which is something I hadn’t known before. Graft selection generally comes down to a combination of factors including the surgeon’s preference, the patient’s age, and their activity level. For younger female athletes soft tissue grafts are often preferred. The Q angle, which is the angle between the quad muscle and the patellar tendon, is naturally wider in female athletes due to hip anatomy, and it’s one of the biomechanical factors that contributes to higher ACL injury rates in women. It also plays a role in graft selection and surgical planning.
Recovery timelines were a big part of the conversation too. The standard return to sport benchmark is around nine months, and you really can’t speed up the biological process of the graft integrating with the bone. Clearance to return is based on strength testing, specifically whether the quad on the surgical side has recovered to at least 90 percent of the strength of the other leg, as well as demonstrated stability during dynamic movement like pivoting and jumping, which are the exact movements that stress the ACL in sports like gymnastics. At six months athletes are typically around 90 percent cleared for single leg movement, but full return is closer to nine months and depends heavily on the individual athlete and their surgeon’s assessment.
She also talked about PRP injections, which stands for platelet rich plasma. It’s a treatment where a small amount of the patient’s own blood is drawn, the platelets are concentrated, and then injected back into the injury site to try to accelerate healing. PRP is not FDA approved and not covered by insurance, so it’s considered experimental, and it’s generally more relevant for patients who are struggling to heal rather than those who are already progressing well.
On robotic assisted surgery, robots are not currently used for ACL reconstruction the way they are for knee replacement or abdominal surgery. Robotic systems increase precision but also significantly extend time under anesthesia, so the risk-benefit calculation doesn’t currently favor their use for ACL procedures.
On the menstrual cycle and injury risk, the research is still genuinely limited. There’s evidence suggesting that hormonal fluctuations across the cycle may affect ligament laxity, but the data is inconsistent and there aren’t enough large scale female specific studies to draw firm conclusions yet. That’s exactly the kind of gap that HERcovery exists to talk about.
After the call I finished my homework for the weekend and then headed to the gym to see my teammates, which was the best part of the day. I’m so excited to watch them at states next weekend!
