Torn ACL...anyone with experience?

[dwalt]

Tore my ACL a few weeks ago. The knee is still a good bit swollen, which is making the pre-op physical therapy a bit more difficult, but I'm starting to get my ROM back.

I've opted for the allograft surgery. I'm young and certainly not a professional athlete, so the allograft seemed like the least painful and easiest (albeit longer) recovery.

Just curious if anyone here has any experience with the surgery, recovery, etc.

 

[AcroBoy]

Allograft is OK, but the long term results would suggest that they do not stay tight as long as say patellar tendon or even hamstring tendon reconstructions. They all have their own advantages and disadvantages.

The bigger question remains as to why you might even need surgery. If your knee is stable and you have a good ROM after PT, there is no documented urgency to having an operation. Just because it's torn doesn't necessarily mean you need to have surgery right away, if at all.

Before people start chiming in about how great their own surgery went or how well their aunt did after a similar operation, nothing matters except your own symptoms. At the very least you should be asking your orthopaedic surgeon: what are the relative advantages of hamstring versus patellar tendon versus allograft reconstructions. And, why does surgery have to be done now if I have a full range of motion and no other symptoms. There is some evidence that with an unstable knee, ACL reconstruction might help to prevent the development of arthritis, but this is more in the case when the knee is unstable and symptomatic.

As a caveat, it is not uncommon to tear your meniscus when damaging the ACL, but perhaps simply debriding the meniscal tear might be adequate in relieving your symptoms, which is a lot less surgery than an ACL reconstrution.

I'm sure you will get a lot of anecdotal advice from people who have undergone the surgery, but this is an N of 1 ("I had this done thirty years ago and I've been great/terrible, so you should do the same as I did back then").

My background is as an academic orthopaedic surgeon and knee specialist with 20 years of experience. Even with this experience, I am not suggesting a course of action, but rather questions that you might consider asking of your surgeon.

Good luck.

 

[dwalt]

Allograft is OK, but the long term results would suggest that they do not stay tight as long as say patellar tendon or even hamstring tendon reconstructions. They all have their own advantages and disadvantages.

The bigger question remains as to why you might even need surgery. If your knee is stable and you have a good ROM after PT, there is no documented urgency to having an operation. Just because it's torn doesn't necessarily mean you need to have surgery right away, if at all.

Before people start chiming in about how great their own surgery went or how well their aunt did after a similar operation, nothing matters except your own symptoms. At the very least you should be asking your orthopaedic surgeon: what are the relative advantages of hamstring versus patellar tendon versus allograft reconstructions. And, why does surgery have to be done now if I have a full range of motion and no other symptoms. There is some evidence that with an unstable knee, ACL reconstruction might help to prevent the development of arthritis, but this is more in the case when the knee is unstable and symptomatic.

As a caveat, it is not uncommon to tear your meniscus when damaging the ACL, but perhaps simply debriding the meniscal tear might be adequate in relieving your symptoms, which is a lot less surgery than an ACL reconstrution.

I'm sure you will get a lot of anecdotal advice from people who have undergone the surgery, but this is an N of 1 ("I had this done thirty years ago and I've been great/terrible, so you should do the same as I did back then").

My background is as an academic orthopaedic surgeon and knee specialist with 20 years of experience. Even with this experience, I am not suggesting a course of action, but rather questions that you might consider asking of your surgeon.

Good luck.

Thank you for this reply...lots of good info and questions to bring to my surgeon. One of the main reasons I'm opting for surgery is because
I'm young (24) and enjoy playing basketball, golf, and skiing and want to make sure I can do those activities. That being said, I am not planning on getting the surgery for at least a month or 2 so that I can 1) continue PT and see how I'm healing (it seems that either way - surgery or not - the PT now is good to being now), and 2) get more info/opinions regarding the surgery options.

Thanks again for the great reply.

 

[X3 Skier]

I have torn both my right and left ACL many years ago. Fixed the right and not the left.

Wish I would have not had the right repaired as the left leg is better than the right. I have skied for 50+ days a year every year since the left tear with only very minor swelling if any on both knees after a hard day on the hill.

Just one example but the advice to make sure you really want to do surgery is excellent. Like many others, I have arthritis in both knees and will get them replaced eventually, but that's to be expected on anyone 70+ years old, no matter what happened to my ACL in the past since I have been an active athlete all my life including being a part time ski patroller for 25+ years on both good and bad knees.

Cheers

 

[AdamZ]

Geezer, do you use a knee brace when you ski?

 

[X3 Skier]

Geezer, do you use a knee brace when you ski?

I did for the first year or so after the tears but now it's just a neoprene sleeve on both knees. Mostly for warmth and whatever psychological benefit it may offer. :wink2: I don't even know where the braces are anymore. Of course I don't pound through the moguls, but I do ski pretty fast on the groomers. :wink2:

Another minor issue for pilots is the operation will have to be reported to the AME and while it is no problem, who knows what the FAA might think if there are complications.

If you need it, go for it but in my case, and it is only one case, no cutting was better.

Cheers

 

[dwalt]

Another minor issue for pilots is the operation will have to be reported to the AME and while it is no problem, who knows what the FAA might think if there are complications.

This is something that I assumed would not prevent me from getting a new medical when mine expires; however, it is also something to consider. Does anyone think it could be an issue?

 

[docmirror]

I'm almost afraid to post in this thread after all the repair bashing. Here's my story.

I tore my right ACL when I was 38. I waited almost 6 months to have it repaired. It was done 17 years ago, and they used cadaver tissue. I was concerned at the time about getting bad ligament tissue but went ahead with it. The rehab is at least 50% of the successful outcome, either way.

I tore my left ACL when I was 50, which was 6 years ago. I had that repaired after about 2 months, this time I used my own hammy I think it came from. Again, rehab is at least 50% of a successful outcome. After a few months, I was getting swelling in my calf and some tingling in my toes on the left, which was diagnosed as a moderate case of blood clot in the vein just above my left knee(I don't know which one). I took Coumadin for about 8 months, and recovered fully from that.

I'd like to say I ski 50+ days a year, but that would not be true. I still get about 30+ days in, and in summer I am active in golf, windsurfing, and various household jobs, plus I restore cars as a hobby.

The ortho advised a brace for only the first few weeks of skiing, and told me that continued use of a brace would only inhibit the joint from fully recovering strength and ROM. He said to ski carefully, and work up to the prev activity without a brace unless you want to use the brace forever.

I'm happy with my results, despite the blood clot, and would do the same again. I have a ski buddy who did not repair his ACL from 4 years ago, and he could not ski at all last year. He's about 40Lbs overweight which makes a difference as well, but his knee would not support the impact and flexing needed to control skis.

IIRC, John Elway played his entire career without ACLs in both knees, or maybe it was just one. He wasn't much of a runner, but it didn't seem to affect his play much at all. My thinking is that the ACL is there for a reason. when it isn't there, I felt like I couldn't trust my knee to operate exactly the way I wanted it to operate, and that is darn critical when going down the slopes(I ski very fast).

 

[docmirror]

This is something that I assumed would not prevent me from getting a new medical when mine expires; however, it is also something to consider. Does anyone think it could be an issue?

I had the blood clot after the ACL repair. I reported the ACL repair and the blood clot. You have to keep track of your PT/INR values for the duration of the blood clot and get a clean bill after it's over, but it was pretty much a non-issue in the eyes of the FAA(from 6 years ago).

 

[X3 Skier]

I'm almost afraid to post in this thread after all the repair bashing.

No bashing here since it really is a personal decision.

I just wanted to show it is not an automatic given as some may think based on what Pro or College athletes typically do. With the stress they place on their knees it is a no brainer to get the repair. For make believe athletes like me, different situation and it really is a choice of no cutting and hope for the best or an operation and hope nothing bad happens on the table or afterward which is a small but not zero possibility.

I agree rehab is at least 50% of the equation. If you slack off, it will definitely be less than optimum.

BTW 30+ days isn't a bad season.

Cheers

 

[Seanaldinho]

I haven't done anything to my ACL but just before I turned 16 I expierenced a "tibial tuberosity avulsion". Essentially the tendon that runs from the quad muscle to the patella to the shin bone (it is what helps your knee bend) tore a chunk of bone off my shin. I was "lucky" and didnt require surgery. Almost a year later I still have problems with my knee, no full range of motion, cracking whenever my knee goes past 90*, and occasional pain under heavy weights. Prior to this I was a soccer player and in very good shape. I could squat almost 250 pounds. Now Im 16 and can squat 100 pounds, partially because of the pain and partially because of the atrophy.

In other words knee problems suck.
Wish Id had the surgery...

 

[zaitcev]

I tore my right ACL by landing on extended leg at sparring. Unfortunately it pulled a bit of cartilage, so surgery was necessary anyway. At the time I was not aware about different types of surgery, and I do not know for sure which one this was, except that it used a cadaver tissue. I reported it at the exam form.