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ACL and meniscus, pushing pre op too far?

post #1 of 19
Thread Starter 

So I tore my ACL as well as grade 2 MCL and "extensive Meniscus damage" on the 1st of March.

I hung around in Canada for a while but am now back in NZ and have booked a consultation with surgeon on the 19th (earliest I could get).

What I am a bit worried about is the state of the meniscus and possibly damaging it further, Im sure the surgeon can answer all these questions but that is 3 weeks away....

 

My physio in Whistler convinced me that I should start rebuilding muscle as soon as it feels comfortable, so I have been all in, hitting up the bike, long walks, squats and numerous exercises. If it was just ACL I'm sure this would be fine, but I have read a bit about possible repair of the meniscus, as opposed to cutting it out, and am now a bit worried I could be reducing the possibility of repair with all this exercise? 

Or seeing it is "macerated" does that mean repair is impossible?

 

My range of motion has come along well but now plateaued for a couple of weeks, approx 45 degrees, I cant quite get my calf to touch my thigh/hamstring....

 

Below is the full description from the MRI.

 

 

A complete ACL tear is present, nio residual fibers are noted to be intact.

 

The PCL is buckled, and intact. Mild increased signal is identified at the superior aspect of the PCL, indicative of strain.

 

The MCL is thickened, and heterogeneous in signal intensity, adjacent to the femoral attachment. Fluid is noted both deep and superficial to the ligament.

 

Trace fluid is noted adjacent to the IT band. The LCL is intact.

 

The extensor mechanism is intact.

 

There is extensive bone contusion at the lateral femoral condyle and tibial plateau. No discrete fracture line is identified, however I do believe that there is a small impaction type fracture involving the subcortical region of the lateral femoral condyle. No focal cartilage defect is identified.

 

A small to moderate joint effusion is present.

 

An extensive tear of the lateral meniscus is present, involving the posterior one third of the meniscus, extending to the meniscal root. The posterior horn appears macerated. The medial meniscus is intact.

 

FINAL IMPRESSION

  1. Complete ACL tear. No residual fibers are noted to be intact.
  2. Grade 2 strain of the MCL.
  3. Mild PCL strain.
  4. Extensive tear of the lateral meniscus posterior horn, and meniscal root.
  5. Extensive bone contusions.

 

 

If you can help in anyway it would be much appreciated.

Tom

post #2 of 19

tlw,

 

I have no medical training so read this knowing that.

 

I'm currently recovering from ACL surgery and have too many drugs lingering in my noggin to be much help.  Not sure I would be much without them either.  Here is the link to the wiki on acl injuries.  The folks that set it up did a great job and it should help get you started.  There are also lots of links.

 

http://www.epicski.com/wiki/acl-injury-for-skiers

 

 

"...I could be reducing the possibility of repair with all this exercise?  Or seeing it is "macerated" does that mean repair is impossible?"

 

I don't know the answer to this but I don't think doing ROM only exercises until you find out will cause any problems.

 

 

My range of motion has come along well but now plateaued for a couple of weeks, approx 45 degrees, I cant quite get my calf to touch my thigh/hamstring....

 

Though the injury happened in a split second (I guess), it could take several months to get to normal ROM.  Be persistent & patient (no pun intended).

 

Heal well,

Ken


Edited by L&AirC - 4/5/11 at 3:49pm
post #3 of 19

YOu should consult your physician and physical therapist rather than rely on the internet.  That being said, it sounds like your menisicus is torn sufficiently that a repair is not likely to be possible.  Further, I doubt that cycling or squats is going to do much damage to it even if it might be salvagable.  What my PT and physician told me was that gaining/maintaining strength in the quads was really important pre-op.  Of course, I had my surgery 10 days after my tear, so I didn't lose that much strength.  I did, however, immediately get on the bike and was cycling 45 minutes a day prior to surgery.

 

I also had a grade 2 MCL tear and torn meniscus.  Mine was not repairable.  I asked the surgeon about this and the issue is that there is inadequate blood supply to the meniscus, so if it is torn, they have to trim it.  Leaving it untrimmed causes irritation and arthritis as you age. 

 

I'm now three weeks post-op, and riding an hour a day, doing the leg press, and quad sets/straight leg raises.  I bought a neuromuscular stimulator for the quad sets/straight leg raises, and it has really helped to get the quad refiring.

 

Also, a key issue is to work on getting your leg extension.  You want to be able to get to zero degrees pre-op.  In fact, that's a great way to tell if you are overdoing your training.  If you overdo it, the knee will swell and you won't be able to get full extension. 

 

Mike

post #4 of 19
Thread Starter 

Yep sounds good, I was going on physios advice, but I dont think im going to see a physio until post op now (or maybe just before so I have a game plan sorted), swelling has gone, and I have a pretty fair idea of what I need to do.

Made some big strides recently, can get full extension no worries, and getting close to full flexion. I probably have better fine balance on my bad leg now due to all the practise.

I was aware of the blood supply issue, but have seen how they can stitch it up if its a nice clean tear, hence the worry about damaging it further, but I think I'll just push ahead with aggressive rehab.

Cheers for the advice.

 

 

post #5 of 19

 

If your physician allows pre-op training, do as much as you can. I've been told (im no doc) that you can't cause much further injury in the short term (long term there is risk of cartilage abrasion) 

 

My first ACL injury was catastrophic - so unstable I couldn't walk without a locked out brace. My 2nd went undiagnosed for a few months (and several ski trips). I used the time post season and even post-DX to hit the gym hard. Quads, hams and hips. It made a world of difference in my recovery time post surgery. 

 

That said, every ortho I've spoken with agrees - its a 6 month no-skiing sentence. Even when your quad is back to full strength in 4 months, the bone graft is still healing along with the nerve reaction times. I've been told you just can't cheat it. 

 

Best of luck - speedy recovery! 

post #6 of 19

It always sounds worse in print so hang in there.

This is very much similar to my left knee which I popped in 2007 see other post re ACL partial tear. I'd be guessing that the meniscus will be the part that’s probably restricting your rage pre surgery. Mine got in the way and I wasn’t able to get my heel to my but until it was repaired. Get as strong as you can prior to going under the knife is always good. Be ready for lots of physio and hard work but it will pay off.

All the best on your recovery!  Just know this that many  racers, coaches and instructor  all have been there too so you not alone, I’ve done both and still  go as hard & fast out on the edge! 

post #7 of 19

Stay w/ in your comfrot zone & let you physio guide you.  Any work you do now will pay back later! best wishes!

post #8 of 19
Quote:
Originally Posted by tomlynchwatson View Post
 

So I tore my ACL as well as grade 2 MCL and "extensive Meniscus damage" on the 1st of March.

I hung around in Canada for a while but am now back in NZ and have booked a consultation with surgeon on the 19th (earliest I could get).

What I am a bit worried about is the state of the meniscus and possibly damaging it further, Im sure the surgeon can answer all these questions but that is 3 weeks away....

 

My physio in Whistler convinced me that I should start rebuilding muscle as soon as it feels comfortable, so I have been all in, hitting up the bike, long walks, squats and numerous exercises. If it was just ACL I'm sure this would be fine, but I have read a bit about possible repair of the meniscus, as opposed to cutting it out, and am now a bit worried I could be reducing the possibility of repair with all this exercise? 

Or seeing it is "macerated" does that mean repair is impossible?

 

My range of motion has come along well but now plateaued for a couple of weeks, approx 45 degrees, I cant quite get my calf to touch my thigh/hamstring....

 

Below is the full description from the MRI.

 

 

A complete ACL tear is present, nio residual fibers are noted to be intact.

 

The PCL is buckled, and intact. Mild increased signal is identified at the superior aspect of the PCL, indicative of strain.

 

The MCL is thickened, and heterogeneous in signal intensity, adjacent to the femoral attachment. Fluid is noted both deep and superficial to the ligament.

 

Trace fluid is noted adjacent to the IT band. The LCL is intact.

 

The extensor mechanism is intact.

 

There is extensive bone contusion at the lateral femoral condyle and tibial plateau. No discrete fracture line is identified, however I do believe that there is a small impaction type fracture involving the subcortical region of the lateral femoral condyle. No focal cartilage defect is identified.

 

A small to moderate joint effusion is present.

 

An extensive tear of the lateral meniscus is present, involving the posterior one third of the meniscus, extending to the meniscal root. The posterior horn appears macerated. The medial meniscus is intact.

 

FINAL IMPRESSION

  1. Complete ACL tear. No residual fibers are noted to be intact.
  2. Grade 2 strain of the MCL.
  3. Mild PCL strain.
  4. Extensive tear of the lateral meniscus posterior horn, and meniscal root.
  5. Extensive bone contusions.

 

 

If you can help in anyway it would be much appreciated.

Tom


I am going for this operation next week with knee reco and medial and lateral meniscus repair. How old were you at time of injury ?

post #9 of 19
Quote:
Originally Posted by habacomike View Post
 

YOu should consult your physician and physical therapist rather than rely on the internet.  That being said, it sounds like your menisicus is torn sufficiently that a repair is not likely to be possible.  Further, I doubt that cycling or squats is going to do much damage to it even if it might be salvagable.  What my PT and physician told me was that gaining/maintaining strength in the quads was really important pre-op.  Of course, I had my surgery 10 days after my tear, so I didn't lose that much strength.  I did, however, immediately get on the bike and was cycling 45 minutes a day prior to surgery.

 

I also had a grade 2 MCL tear and torn meniscus.  Mine was not repairable.  I asked the surgeon about this and the issue is that there is inadequate blood supply to the meniscus, so if it is torn, they have to trim it.  Leaving it untrimmed causes irritation and arthritis as you age. 

 

I'm now three weeks post-op, and riding an hour a day, doing the leg press, and quad sets/straight leg raises.  I bought a neuromuscular stimulator for the quad sets/straight leg raises, and it has really helped to get the quad refiring.

 

Also, a key issue is to work on getting your leg extension.  You want to be able to get to zero degrees pre-op.  In fact, that's a great way to tell if you are overdoing your training.  If you overdo it, the knee will swell and you won't be able to get full extension. 

 

Mike


Hi Mike,

 

That is an interesting statement "Leaving it untrimmed causes irritation and arthritis as you age" . Triming it will do exactly the same as far as I know.

How much of your meniscus did they trim and which one ? How old were you at time of injury ?

I am going for meniscus and knee reco next week - 4 months from injury

I am 43

 

Fabien

post #10 of 19
Thread Starter 

Hey mate, I was 2 months from turning 26 at the time of injury.

29 now...

 

I had the surgery late August I think? after 1st March injury, as mentioned this gave plenty of time for pre hab...

Anyway it seemed to pay off well, I had really good flexion within 24 hours and made a really quick recovery, I only ended up making 3-4 physio visits because everytime I went they pretty much said its going great, keep it up, so I figured I would stop going untill I had any issues.

I had even saved up dozens of frozen meals expecting to be crutching around for a week+, but ended up walking within a couple of days.

And 3+ years later I have no pain, no side effects, and nothing holding me back in skiing, (except me being a bit of a girl...)

I'm not saying this will always be the case, I'm aware I got lucky, and had a nice neat tear in the end according to the surgeon, not a messy overly damaging one, with not as bad meniscus damage as the MRI suggested, but with good pre hab and re hab I have ended up probably stronger than I have ever been. Hope that helps motivate you!

post #11 of 19

That's amazing. So you mean your surgeon managed to repair meaning suture your meniscus tear 3 years after the injury ?

I am 43 and I have to say I am pretty worry about going to this knee reco. This is my first big operation. My medial meniscus tear is a posterior horn root tear typical of ACL injury but not

good to be trimmed as it sets you up for arthritis.

If you managed to save your meniscus you will be find . I have a friend who has been living for 20 years with no ACL and he doesn't notice it.

post #12 of 19
I read he got injured three years ago in March, had the repair done three years ago as well, but in August. He's been recovering three years.
post #13 of 19
Quote:
Originally Posted by L&AirC View Post
 

tlw,

 

I have no medical training so read this knowing that.

 

I'm currently recovering from ACL surgery and have too many drugs lingering in my noggin to be much help.  Not sure I would be much without them either.  Here is the link to the wiki on acl injuries.  The folks that set it up did a great job and it should help get you started.  There are also lots of links.

 

http://www.epicski.com/wiki/acl-injury-for-skiers

 

 

"...I could be reducing the possibility of repair with all this exercise?  Or seeing it is "macerated" does that mean repair is impossible?"

 

I don't know the answer to this but I don't think doing ROM only exercises until you find out will cause any problems.

 

 

My range of motion has come along well but now plateaued for a couple of weeks, approx 45 degrees, I cant quite get my calf to touch my thigh/hamstring....

 

Though the injury happened in a split second (I guess), it could take several months to get to normal ROM.  Be persistent & patient (no pun intended).

 

Heal well,

Ken


Hi Ken,

 

How are you recovering from your injury ? I am interested to know if 8 years after your accident you have pain related to your meniscus tear or operation. I am going for a knee reco and meniscus repair tomorrow.


Cheers

Fabien

post #14 of 19
Quote:
Originally Posted by sibhusky View Post

I read he got injured three years ago in March, had the repair done three years ago as well, but in August. He's been recovering three years.


ok so does that mean he waited 8 months from injury and still got his meniscus repaired ?

post #15 of 19
Quote:
Originally Posted by fabienzan View Post


Hi Ken,

How are you recovering from your injury ? I am interested to know if 8 years after your accident you have pain related to your meniscus tear or operation. I am going for a knee reco and meniscus repair tomorrow.


Cheers
Fabien

Fabian,
It's been 6 years since my first ACL injury and 4 years since I did the other side. I'd say I'm doing pretty good. My knees don't bither me much and when the do, it could be more from arthritis than the injuries. For a while, they seemed to swell at the drop of a hat. Not hurt, just swell. This has diminished quite a bit.

I do yoga now and I do notice them being tight but that is more because doing yoga requires more than what most doctors would consider normal ROM. Kneeling with my butt on my heels is challenging and that is when I usually feel it in my knees. No pain just very tight. It's coming along.

The two things that do seem to bug me is running and standing still for long periods. I haven't tried running again for about three years. My knees would swell right afterwards. Standing still (walking and hiking are fine) seems to do the same. Again, no pain, just swell.

I would also point out that I didnt have a lot of meniscus work done. Just done trimming. Both surgeries were really about the ACL.

Good luck and hope you have a speedy recovery,

Ken
post #16 of 19
Quote:
Originally Posted by fabienzan View Post

Quote:
Originally Posted by sibhusky View Post

I read he got injured three years ago in March, had the repair done three years ago as well, but in August. He's been recovering three years.


ok so does that mean he waited 8 months from injury and still got his meniscus repaired ?

Not sure where you get 8.

But he did indeed have time pass between the injury and the repair.
post #17 of 19

I completely agree with the above on the listening to your doctor and physio, and also that seeking internet advice as your primary guide for dealing with an injury is a terrible idea. And that the work you put in now will be very helpful for after. 

 

Three key points from my perspective (as someone who as trained lots of clients while waiting for or recovering from knee surgery:

1. Listen to your body. If what you're doing makes your knee hurt, then don't do it. Either adjust your form, adjust your range/load/volume, or pick a different exercise.  

2. You should be aiming for almost vertical tibia, which means bilateral squats are not your best bet right now. I would suggest rear foot elevated split squats (regular split squats can bother the knee when it is the back leg), or if you're strong enough, single leg squats to a box (and limit the ROM - don't aim for pistols here). Even with these options - pay attention to the shin angle on the front leg: it's like skiing - more vertical is better. 

3. Do more hip dominant work (the deadlift family) than knee dominant work (the squat family).

 

Good luck.

 

Elsbeth

 

(oops - I just saw this is a super old thread that's re-opened. So my comments are probably less useful.)

post #18 of 19
Quote:
Originally Posted by L&AirC View Post



Fabian,

It's been 6 years since my first ACL injury and 4 years since I did the other side. I'd say I'm doing pretty good. My knees don't bither me much and when the do, it could be more from arthritis than the injuries. For a while, they seemed to swell at the drop of a hat. Not hurt, just swell. This has diminished quite a bit.



I do yoga now and I do notice them being tight but that is more because doing yoga requires more than what most doctors would consider normal ROM. Kneeling with my butt on my heels is challenging and that is when I usually feel it in my knees. No pain just very tight. It's coming along.



The two things that do seem to bug me is running and standing still for long periods. I haven't tried running again for about three years. My knees would swell right afterwards. Standing still (walking and hiking are fine) seems to do the same. Again, no pain, just swell.



I would also point out that I didnt have a lot of meniscus work done. Just done trimming. Both surgeries were really about the ACL.



Good luck and hope you have a speedy recovery,



Ken

 



Hi Ken,

Did you get any meniscus damage the first time ? What % did they remove and where ? Having arthritis after only 6 years is very short. I would be worry about that.
My knee surgeon is is one of the best here in Melbourne left 2 small lateral meniscus tear untouched in my knee and one of 1.2 cm in my medial meniscus because they are asymptomatic. I suppose this is better for the long term health of the joint than trimming it.
post #19 of 19
Quote:
Originally Posted by fabienzan View Post

Quote:
Originally Posted by L&AirC View Post



Fabian,

It's been 6 years since my first ACL injury and 4 years since I did the other side. I'd say I'm doing pretty good. My knees don't bither me much and when the do, it could be more from arthritis than the injuries. For a while, they seemed to swell at the drop of a hat. Not hurt, just swell. This has diminished quite a bit.



I do yoga now and I do notice them being tight but that is more because doing yoga requires more than what most doctors would consider normal ROM. Kneeling with my butt on my heels is challenging and that is when I usually feel it in my knees. No pain just very tight. It's coming along.



The two things that do seem to bug me is running and standing still for long periods. I haven't tried running again for about three years. My knees would swell right afterwards. Standing still (walking and hiking are fine) seems to do the same. Again, no pain, just swell.



I would also point out that I didnt have a lot of meniscus work done. Just done trimming. Both surgeries were really about the ACL.



Good luck and hope you have a speedy recovery,



Ken

 



Hi Ken,

Did you get any meniscus damage the first time ? What % did they remove and where ? Having arthritis after only 6 years is very short. I would be worry about that.
My knee surgeon is is one of the best here in Melbourne left 2 small lateral meniscus tear untouched in my knee and one of 1.2 cm in my medial meniscus because they are asymptomatic. I suppose this is better for the long term health of the joint than trimming it.

There was meniscus damage both times, but it was minimal both times. IIRC, the surgeon said he just cleaned it up so it would be smooth. He didn't really remove any.

I had arthritis before the ACL injuries and not because of them, though the ACL tears don't help.
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