1 yr out from ACL surgery

[sbbeckett]

My leg is doing fine -- some soreness after workouts, but I assume that's normal -- and is even stronger than my uninjured leg. However, the size hasn't quite come back. The quad, especially that muscle on the inside side of knee, is still smaller than the uninjured leg.

Any mag advice on how to get the size back up?

[Arno]

I have the same thing 2 years out - both legs stronger than ever. Apparently it's not unusual for you never to regain the size

[Theodore]

My left leg is still a tiny bit smaller than the right one. My last surgery was November of '02. I justified it by saying that I got rid of ineffective muscle and replaced it with state of the art muscle...

[sbbeckett]

Apparently it's not unusual for you never to regain the size

Really? Bummer. I didn't know that. Maybe Vinman can write me a scrip for some 'roids. Hey Vinman, I only need enough for my left leg.

[Stikki]

The muscle you are referring to is the vastus medialis oblique or VMO, the teardrop part of the quad on the inside of the knee. It sounds like the other muscles of the quad are doing well but the VMO is still atrophied and may need specific work.

The VMO is targeted through either the last 20 degrees of knee extension or flexing the knee through full range of motion. In my experience I find full range exercises, especially single leg, to work the best. Warning; these may be contraindicated depending on your range of motion, talk to your doc or PT first if you haven’t been cleared. These exercises include full squats (calf to hamstring), reverse or regular lunges with front foot elevated, one leg squats off box, and Bulgarian dips. To target the VMO using the last 20 degrees of extension exercises such as terminal knee extensions with bands (TKE’s), 1 leg knee extensions, and partial leg presses will work.

If you have already tried all of the above your set and rep scheme may be something to look at. Hypertrophy or muscle building is best done through 3-4 sets if 8-12 reps, rehab tends to be much higher volume mostly in reps to build connective tissue and endurance and doesn’t do as much for pure size gains. Also make sure that when you do single leg exercises always work the smaller leg first.

Sample targeted program:

Workout A (early in week)

-Reverse lunge with front foot on 4” box
3 sets of 10-12 reps, smaller leg
2 sets of 10-12 reps, bigger leg
So: small, big, small, big, small

-Terminal knee extensions with band
Same set/reps scheme as above

Workout B (later in week)

-One leg squat off box
3 sets of 10-12 reps, smaller leg
2 sets of 10-12 reps, bigger leg
So: small, big, small, big, small

-1 leg knee extensions
Same set/reps scheme as above

I’d also do a ton of hamstring or knee flexion work to balance out all this quad and knee extension work.

Disclaimer: The above is what has worked in my personal experience, use at your own risk

[jenscats5]

I have the same thing 2 years out - both legs stronger than ever. Apparently it's not unusual for you never to regain the size

Ugh!! that would suck.......good to know however.....

[dogwonder]

What Stikki said. I'd reiterate single leg exercises. One thing that worked for me was one legged wall sits, although this does tend to hitter the upper quad more than the lower quad.

[Dexter Rutecki]

You can just do what I did and blow the other side too, problem solved, complete symmetry.

Actually, I had the same problem getting that VMO muscle back but at only 3-4 months post-surgery. Skating a lot is what finally got those smaller muscles back into shape for me (as far as I could tell, it was when I started skating a lot that they began coming back, I don't remember if it coincided with a change in PT exercises too). I think by 18 months the size seemed to be about the same.

[sbbeckett]

I've been doing most of the exercises you guys mention here but I've also stuck to the rehab set/rep schedule which was two sets of trying to get to twenty reps with whatever weight is appropriate. When I can do twenty, I up the weight. I guess I might switch to three sets with heavier weight and ten reps.

Thanks for the $.02.