ACL & MCL torn, but MD wants to wait 2-3 months for surgery: Is that reasonable?

#1

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5/9/06 at 10:52pm

kwbc
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OK, so I'm new here on EpicSki, but for some reason I doubt you guys will JONG me too bad...

As posted in my Once is Enough thread on TGR, I happened to tear my ACL & MCL. It seems odd to me that my MD wants me to do physical therapy for a couple months and then (maybe) do surgery. Should I be pushing for surgery ASAP? Or is it OK to wait a while? And is there any way to know who a good surgeon is? (limited to Kaiser Permanente in California, so I probably don't have much choice)

I'd really like to get surgery soon so that I can still take my New Zealand trip. The plan was to spend July and August there with my girlfriend (a student at University of Otago, Dunedin) and get quite a bit of skiing in... But now I'd still like to spend those two months in Dunedin... And I can get PT from the instructors at their PT school for $30NZ or from the (supervised) students for $10NZ, so I'd be all set for the recovery process...

Thanks for the advice!

#2

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5/10/06 at 5:52am

volklgirl
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WAIT!!!

They need to wait min 6-8 weeks for the swelling to go down before they can effectively perform surgery. They also want you to build up all the other muscles, tendons, and ligaments to support your knee post-surgery. The pre-surgery PT will make post-surgery recovery way easier!!

#3

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5/10/06 at 10:35am

Maddog
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Well, 2-3 months is a long wait. The doc should be tailoring your surgery time to the soonest time where you are physically capable of handling surgery.

Right now you need to work dilligently on strengthening your hamstring and thigh muscles as you will loose muscle mass and tone post surgery and recovery will take longer if this loss is significant.

You might want a second opinion on surgery timing. But asking here is foolish for any real answers to your question.

Mark

#4

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5/10/06 at 10:39am

Philpug
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Quote:

Originally Posted by volklgirl

WAIT!!!

They need to wait min 6-8 weeks for the swelling to go down before they can effectively perform surgery. They also want you to build up all the other muscles, tendons, and ligaments to support your knee post-surgery. The pre-surgery PT will make post-surgery recovery way easier!!

My wife was in surgery 2 weeks after her accident and now is recovering quite well. There was no way that she could even move her knee let alone try to stregthen the muscles around it.

Click. Point. Chute.

#5

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5/10/06 at 10:42am

GarryZ
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You don't like the advice of your Doc ? See another , make it three and you can get a concensus. Like a board vote. Good luck to you, Don't rush because you want to push this for an outing . There can be another time for that , Be smart you will need those knees for alot of skiing yet to come.

#6

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5/10/06 at 10:57am

Trekchick
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Mid March one of my friends ripped up her knee in the half pipe. 1 1/2 weeks later she was in surgery. Physical therapy soon after. She's got a long road ahead, but she'll be on the slopes with us for the opening day!

6-8 weeks before surgery? Maybe different doctor opinions or maybe different patient situation.

Surviving is essential, thriving is incredible!
EpicSki Academy

#7

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5/10/06 at 11:58am

volklgirl
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Tore my ACL on St Patrick's Day. Had surgery Memorial Day weekend. Was walking (without crutches, but in much pain) in 2 weeks, gentle biking in July, running in August, skating in September, and back on skis in December. Of course, that WAS 10 years ago, so maybe things have changed significantly since then.

#8

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5/10/06 at 12:07pm

spdskr
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My surgeon was willing to perform surgery as soon as swelling subsided (4 weeks). My knee was quite loose and "buckled" several times in the interim. Had my surgery January 14, 1996 and was back on skis November 1996. Before that I had resumed biking, hiking, tennis and racquetball...all with the assistance of a custom brace. But as volklgirl mentioned, YMMV.

#9

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5/10/06 at 2:07pm

Atomicman
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They definetly want you to get as much range of motion back & strength before surgery.

Very often if your meniscus is damaged they have to operate sooner since you will only gain some range of motion back if the meniscus is catching or locking your knee.

Results are far improved by regaining as much strength as pssobel and as much range of motion and reduced swelling as possible before surgery.

But with all that said , get a 2nd opinion, it can't hurt. Just make sure whoever wants to hurry up & cut, isn't looking for a down payment for the the 911 Carrera 4 Turbo, they'll order as soon as you say go ahead!

#10

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5/10/06 at 5:17pm

breckview
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The reason I had to wait 2-3 months before ACL surgery was to rehab my MCL tear.

#11

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5/10/06 at 5:32pm

dchan
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every case is different. One friend had a ACLMCL tear (turns out it was only partial) and after waiting for the swelling to go down and starting PT right away it turns out she didn't need Surgery. There was enough still hanging on to get the tear to scar and heal.

It took almost a month to get a clean MRI so they could make a decision. They can always go in later and do surgery. Listen to your Ortho. If you are Kaiser, the one thing you can do is request that you get refered to a sports specialist. If they can't find one in network they will refer you to someone outside Kaiser and they will cover the cost. (as long as it's your primary or a kaiser ortho that sets up the referal)

#12

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5/10/06 at 7:49pm

SNPete
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Quote:

Originally Posted by kwbc

OK, so I'm new here on EpicSki, but for some reason I doubt you guys will JONG me too bad...

As posted in my Once is Enough thread on TGR, I happened to tear my ACL & MCL. It seems odd to me that my MD wants me to do physical therapy for a couple months and then (maybe) do surgery. Should I be pushing for surgery ASAP? Or is it OK to wait a while? And is there any way to know who a good surgeon is? (limited to Kaiser Permanente in California, so I probably don't have much choice)

I'd really like to get surgery soon so that I can still take my New Zealand trip. The plan was to spend July and August there with my girlfriend (a student at University of Otago, Dunedin) and get quite a bit of skiing in... But now I'd still like to spend those two months in Dunedin... And I can get PT from the instructors at their PT school for $30NZ or from the (supervised) students for $10NZ, so I'd be all set for the recovery process...

Thanks for the advice!

Got no advice beyond get a second/third opinion. Also this forum is a not one where people will "JONG" you. Unlike some other forums.

#13

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5/11/06 at 5:38am

kwbc
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Thanks, everyone for all the advice. My take-home points from everyone I've talked to seem to be that waiting is good to (1) ease swelling, (2) heal up a bit first, and (3) restore some ROM. Definitely will try to get a second opinion, though.

Oh, and I am seeing a sports medicine specialist at Kaiser... so hopefully she knows what she's talking about--Not that additional opinions could hurt.

Curious about this idea of meniscus damage inhibiting ROM--as I bend my knee it gets to a certain point at about 35 degrees where it just stops as though it is catching on something. No way I could possibly bend it further. Will definitely converse with my doc further about this.

thanks again!

#14

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5/11/06 at 6:29am

2-turn
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Quote:

Originally Posted by kwbc

I'd really like to get surgery soon so that I can still take my New Zealand trip. The plan was to spend July and August there with my girlfriend (a student at University of Otago, Dunedin) and get quite a bit of skiing in... But now I'd still like to spend those two months in Dunedin... And I can get PT from the instructors at their PT school for $30NZ or from the (supervised) students for $10NZ, so I'd be all set for the recovery process...

Thanks for the advice!

We've all "been there done that" and you've already received good opinions. Sucks about your plans for NZ.
Not to bring you down any more, but think about the timing, assuming you're from the northern hemisphere, that waiting 3 months is going to kill next year. Not sure you know what you're in for, but rehab is a long and arduous process. I went to rehab 3 days a week for a solid 6 months, not to mention the workouts I did at home.
I tore my knee on March 1, had surgery on April 1, and skied the middle of October (2 days later my PT said I was ready, he was surprised since he didn't realize K-mart opened). It's already May, so if you wait 1 month, that potentially will have you ready for mid-December....
Of course, it'd be nice to wait and find out you don't need surgery, but I wouldn't count on that...
Good Luck

#15

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5/11/06 at 12:19pm

T-Square
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You pay the Doctor for his/her expert opinion. I'd go with that. If you want a second or third opinion, get them. Remember Doctors have invested a hell of a lot of time, energy, and $$$$ in learning their profession. That's why they are the experts in that field. (Don't listen to me when I give out heath advise, I'm an engineer, not a doctor.)

If you aren't sure about the Doctor, talk to some ER nurses. They'll tell you the skinny on the good vs. bad docs.

None of us is as smart as all of us.

#16

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5/12/06 at 7:16pm

BigE
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Do the exercise. There is not a lot of opportunity for the doctor to know exactly how much is torn. Severed is different. In my opinion, it is never better to allow invasive surgery when none MAY be warranted -- no matter how "non-invasive" they claim it is......

#17

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5/13/06 at 4:59am

kwbc
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Doing the exercises as much as possible--and icing 4+ times a day and keeping it elevated most of the time. Still very swollen 15 days post-injury (18" circumference compared with 12" for other knee) and really painful, which is why I'm still awake at almost 5am.

When I crashed I did hurt both knees... but the left was much worst than the right, and I've never complained about the right, despite the pain, since the left has been much worse. The left knee is what the ortho said I tore an ACL, MCL, and possibly meniscus in. The following is my radiology report from Kaiser that arrived today. Considering that they removed the knee immobilizer based on these results (which they saw but I didn't see until now) and replaced it with a hinged brace, I'm definitely a bit concerned....

Radiology Examination Report:
RIGHT KNEE

** HISTORY **:
Patient Skiing Friday.

** FINDINGS **:
There is no fracture or dislocation seen. Knee joint spaces are well preserved without osteoarthritis. There is suggestion of a small knee joint effusion. Consider MRI to check for any internal derangement as indicated.

** IMPRESSION **:
No fractures seen. Probable small knee joint effusion.

I hope this doesn't mean they imaged the wrong knee. My X-rays from Kirkwood (of the LEFT knee) showed fractures and my X-rays from Kaiser did not, so Kaiser assumed that the Kirkwood ones were flawed and consequently replaced the knee immobilizer with the hinged brace.

If so, however, that would at least explain why 15 days later I'm still in such pain.

Just got off the phone with the advice nurse a little while ago. She said I should call ortho Monday morning since they don't work weekends and try not to move around too much this weekend. Too bad I'm moving tomorrow to a new apartment...

If you read this far, first of all you rock, and second, do you have any advice? I don't care if you're a doctor / nurse / video rental clerk...

Thanks all, peace, and have a great weekend. Oh, and Shasta is looking spectacular, BTW... Sure wish I could ski right now!

On a positive note, this is definitely the best time of day weatherwise in Sacramento as far as I'm concerned. All the windows open, 57 degrees F, no shirt and just shorts... Too bad tomorrow looks to be 90+

L8

#18

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5/19/06 at 3:59pm

Cirquerider
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It sure looks like an error. You had potentially bilateral damage. The results you posted above clearly say RIGHT knee, while your understanding is that the principal injury is in the left knee. The fact it took over a week just to be seen doesn't give me much confidence that Kaiser is infallible. Have you been referred to an orthopedic yet; or are the diagnotics based on a radiologic exam referral by your primary physician and interpretation by a radiologist? Also, what gives with X-Rays, you need an MRI to visualize soft tissue damage.

You need to get way more assertive with Kaiser, or this is going to drag on all summer.

You're taking a poll on when to do surgury, and you don't even have a diagnostic MRI yet, and the Xray is of the wrong knee!
Obviously the poll is flawed!!

BC's Video of his ride on Once is Enough is here: http://www.snowpics.net/view_single.php?medid=16482

Its almost here.

#19

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5/26/06 at 10:07pm

whtmt
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whtmt

I'm sure you'll get as many different answers as there are skiers here that have had repaired ACLs. So, go with what your Doc says or get a second or third opinion. Every torn ACL condition has a variety of variations on this injury theme. I was made to wait one month, to get the knee ready for surgery with pre-op PT and to let swelling go down. I had a full ACL tear and some minor meniscus tears and a strained MCL. I followed my surgeon's instructions to the letter and I'm stronger today then I was before my injury. Good luck.
whtmt & Mackenzie 911

#20

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5/28/06 at 7:08am

duke walker
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former surgeon speaks

as one who took the longest detour possible to becoming a ski bum-i was a surgeon-i was about to say that you had found a really honest professional who advised waiting.

after all, he gets paid for surgery, not for waiting. and some folks dont need an acl. but the bias is the opposite when the surgeon is on salary, as in government medicine , where the employee tries to do as little as possible. in some managed care settings, the surgeon gets a bonus for doing nothing and saving the system money.

once you are convinced that you need the procedure, schedule the time of the proceedure and the time needed to recover at your convenience.

#21

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7/10/09 at 11:37am

Roxy
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Hi,

I am just replying to this thread. I am glad to hear about waiting is good and helps for a better recovery from surgery. I recently tore my ACL, MCL about a grade 3 so it will need to be repaired along with some cartilage in the knee. This happened on the 4th of July and I am starting PT 2 weeks from now and set for surgery on July 29th. I could not imagine doing the PT before surgery becasue I am in so much pain right now, but I want to do things right so I guess that's what I will be doing.
Thanks for the informtion.

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ACL & MCL torn, but MD wants to wait 2-3 months for surgery: Is that reasonable?