Timeline to returning to climbing post ACL reconstruction & meniscus repair

I tore my acl and meniscus in a ski accident in late January. I have ACL reconstruction surgery (quad graph) and likely a meniscus repair scheduled for mid April.

I am trying to get a sense based on others experience (while definitely acknowledging everyone’s healing journey and timeline is different) how long it will take for me to return to at least chill sport top roping.

I know trad and leading sport are likely going to be out until the 2026 season. But I’m hopeful I might be able to do some easy TRing by late summer or fall.

Also if anyone else has been through this process and has any tips please drop them in the comments. I have a great PT, so will definitely be super committed to PT.

Thank you!

I also tore my ACL and medial meniscus skiing about four years ago. I had it repaired in June 2021. in terms of the meniscus. The recovery depends on whether they decide to shave it off or repair it if they shave it off you are generally weight-bearing within a few days after surgery, but if they repair it generally you’re in a locked brace For about six weeks to allow the meniscus repair to heal. My meniscus was fixable so he put a couple stitches in it and repaired it and I was in a brace that locked out motion for about six weeks after surgery. I did a ton of PT before I was cleared from the meniscus repair and after. I think I did PT for almost 6 months after the surgery because my insurance had a very good PT benefit. My surgeon also did a quad graph as well. As I said I had the surgery in June and I climbed a flat iron, which is easy climbing in November so I was back climbing easy stuff about five months after surgery, but that was probably a bit earlier than I should’ve. I got lucky and didn’t re-injured it, but in hindsight, I probably should’ve waited a little bit longer. I did ski that season and was skiing on it about six months after surgery but took it easy for most of the year the following climbing season felt pretty normal. I would guess if you have the surgery in April and you do a lot of PT and everything heals well you could be climbing by September of this year, but obviously it depends on one case to another one thing to keep in mind that my surgeon told me was that as the graft slowly gets rebuilt from a tendon into a ligament it’s actually at its weakest point for re-injury about 4 to 6 weeks after surgery, which is when people start feeling less pain the swelling goes down and they have better mobility so it’s really important to be very careful Around that point. he said that the soft tissue takes about three months to repair but that the stability of the knee is highly dependent on the musculature and so full recovery is more like six months to a year. Hope that helps. Last piece of information is I am a dedicated climber. I’m very active and I’ve been climbing for 30 years but I’m also 48 years old.

Curious if either of you know why they did/doing a quad graft?  I'm going in in two weeks scheduled for patellar autograft. Reason he gave (although he was open to discussion) was less quad atrophy post surgery this way, faster recovery. Especially curious if there's anything climbing related to this choice as that's basically the reason I'm getting surgery at 43. 

I am not a medical professional, so can only speak from my own experience. I chose quad primarily due to my surgeon suggested it due to the sports I do (backcountry skiing, climbing, backpacking, mtn biking etc) despite the potentially longer recovery time due to diminished quad strength. I also have had friends of similar fitness levels as myself, and similar outdoor goals have a successful recovery with quad graph. I also already have some slight arthritis in the knee likely due to genetics, which led me to select the quad graph. 

I have heard from friends there are some potential complications from a patellar autograph when performing kneebars, high steps and knee drops. But I would ultimately trust your surgeon's advice, but maybe if you can find a PT who is familiar with climbing mechanics and acl reconstruction they might have better insights. 

My surgeon said it depends a lot on how old your Dr is and who trained them. Patellar grafts were very common about 15-20 years ago but are less common now. Then the hamstring graft was to go to but both had problems with pain or injury to the patellar tendon and hamstring tendon respectively. My surgeon is younger (mid 40’s), US ski team Dr and everything he does is evidence based. He gave me some recent research that seems to point to the quad graft being the best for our kinds of sports and he said that a lot of younger drs are using the quad graft. Mine has healed great and I have climbed and skied hard on it for the last few seasons so no complaints from me.

I tore my ACL in a bouldering fall on Jan 2nd 2023.  I was recommended surgery by the sports doctor who I saw who I thought tried to avoid surgery.  I chose not to get surgery because I could walk with no pain and with limited mobility on a compromised gate, and because surgery was expensive and outcomes seemed life lasting at best and sketchy at worst.  

My knee was the size of a grapefrut for about six months, well into June/July.  I just put Arnica on it every day 2x a day and limited the mobility and weighting of it, using a brace 24 hours a day, and then 12 hours a day as it felt better.  Initially I avoided as much movement as possible, but after a few months as the weather warmed up I started riding my bike 2-3 times per week, just light rides to move the leg.

About 6 months out I started doing leg exercises again, slowly training pistol squats by holding onto a cable machine to take weight off, only pistol squatting about 20 or 30 pounds to start.  Up until this point I had been just campusing in the gym, so I began actually climbing again, just lowball bouldering on specific problems, traversing, TRing, and up/down circuits: things with small or no ground falls.  I wore approach shoes during this time since falls were overwhelmingly going to be feet first due to the feet cutting and therefore be straight down and controlled.  I also started doing leg mobility at this point, and FWIW I now have full mobility and can go fully straight and I can sit with my shins touching the ground with my toes pointed out straight and my legs folded under me with my butt resting on my heels, comfortably.  

By a year out I was back to bouldering in the gym with climbing shoes with some limitations (no big falls, no twisting falls, no suddenly trying to gain footing) and with a brace, and after 18 months I started climbing outside again regularly and bouldering more freely in the gym, always carefully and still with a brace.  Now, a bit more than two years out, I hardly notice it at all.  I don't use my brace anymore for anything, and no longer carry it 'just in case'.  I still avoid big falls and weird landings, but my comfort with those is growing slowly as the knee feels better and better.  I know it was not surgery, but a big injury to the knee and surrounding tissue just the same, so I hope that helps.  It is worth noting that the ACL grows directly out of the largest repository of stem cells in the adult human body, and if you get surgery they drill a hole in the bone where the ACL would grow out of so there is a guarantee your body wont repair itself and thus if there are any problems the only viable solution is another surgery.  You can always get surgery later down the road, too.

I am currently recovering from ACL surgery (almost 8 months out).

I tore my ACL and meniscus in May 2024 and had surgery in August. I had a Posterior Tibialis allograft (cadaver) with an internal brace. My surgeon initially recommended a quad graft but after some discussion decided that a quad graft could impact my mobility for climbing and I did not want the longer recovery associated with an autograft so we went the allograft route. My meniscus healed on its own before surgery so I did not have any meniscus work done.

I was able to start routesetting on a rope again at 2 months, toproping at 3 months, ice climbing (TR) at 5 months, and sport climbing at 6 months (after beginning agility training and single leg hopping at PT). My return to climbing was definitely faster because I was not recovering a harvest site.

The mental aspect of returning to sport climbing has been the hardest. My biggest tip would be to be patient with yourself and don’t try to rush it.

I tore my ACL and meniscus skiing in Jan 2024. I had surgery in early March 2024. The surgeon was able to repair my meniscus (as opposed to shave it) and I had a quad graft for the ACL. I was on crutches for 6 weeks because of the meniscus repair. I was able to start top roping really easy stuff again in the gym by July 2024. Was back to doing some leading outside by October 2024. I worked with a sports specific PT that did not take insurance (and I didn't have out of network coverage), so it was quite an investment, but for me, it was totally worth it. And I was seriously dedicated to my PT. Literally never skipped a workout or a session for 8 months. Definitely take it easy and listen to your body and your medical team and go slow as you get back into things. Know that it may seem like recovery is going to take FOREVER right now, but it goes faster than you think!

FWIW Natalia Grossman tore her ACL and is about one month post op. She’s posting about it a decent amount on IG. She was climbing basically right away (TR, one legged). She had a patellar graft. The applicability to mortals may vary. 

Tore ACL and meniscus Jan 2022 while bouldering in a gym. patellar graft surgery March 2022, back to TR in gym June 2022, leading in gym July 2022, leading outside August 2022.  Back to gym bouldering around December 2022 (no outside bouldering)

Def made sure I kept the grades lower and worked my way up, avoiding any falls til around October 2022 

Tore meniscus and had the surgery to it. Took about 3 months before I began to play around on it. Took a good 8 months before I was back to "normal", though I now watch for the warning signs a bit more than I used to. All in all, I wanted to get back to it as quickly as possible, but it's not worth it. just take the time it takes you to get back to full, don't rush it.

The curve on re-injury likelihood of an ACL reconstruction bends somewhere between 9-12 months.  Before that, there is progressively higher risk of re-injury, after that it decreases only a small amount out to about 2 years and then you're basically back to the same risk as anyone else.  If the surgery is successful, you're diligent about PT, and don't do anything to re-injure it for that first 9 months, your odds of a successful outcome are very good.  If you re-injure it, the success rates of revisions are less good but still ok.  Choose your activities accordingly.  

Choose your PT carefully.  Not all PT is return-to-sport oriented.  If you look around your PT and half the people there aren't other athletes also rehabbing sports injures, you have probably not found the right sports rehab clinic in your area.

My ACL reconstruction (hamstring graft) return to climbing was about the same as the actual injury: 3-4 months to bouldering. Heel hooks/pulling, or hyperextensive flagging took a little longer to recover fully.

When your physical therapist tells you it's safe to do so.

The issue is that your graft gets weaker before it gets stronger. So immediately after surgery, your graft is as strong as it’s going to be for a while, it will get weaker while it remodels, and then it will get stronger again. Unfortunately, peak weakness of the graft coincides with when you’re just starting to feel like you can do more. 

As much as it sucks to wait longer to go back to full activity, it will really suck if you have to go through it again.. Depending on whether or not you have a meniscal repair that will also affect the timeline. You don’t want to  tear your freshly repaired meniscus.   So I would ask your doctor, because keeping a good meniscus in your knee, and a solid ACL repair are your best chances of avoiding arthritis later on