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Partial ACL Tear-looking at options

post #1 of 8
Thread Starter 

I partially tore my ACL and meniscus at the end of January. On my dr's advice I've been going to rehab every week, and haven't skied the rest of the season. But my knee still feels weak and buckles fairly often while walking. I guess the hope was that I could build up enough muscle to stabilize my knee with a damaged ACL, but I'm a fairly active person, and I need a knee that's functional for intermediate level skiing, hiking, running, etc, without the concern that it will give out on me. Should I go for the surgery? 


post #2 of 8


BCpoweder - really sorry to hear about the injury! 

I feel your pain, literally. I tore my right ACL on the 1 year, to the day, anniversary of my left tear. My left (2009) was pretty bad. Swelled on the spot, instantly unusable and meniscus tear in two places. I had it repaired within 3 weeks of the injury. I wasn't even sure I had torn the right until well after ski season. It wasn't unstable under flexion. During recovery for the 2nd ACL, I re-tore the meniscus in the left. I've yet to get it scoped. After some cortisone injections, its actually been relatively pain free….mostly… sorta. 

The good news is that I had an awesome (although thanks to recovery time, an abbreviated) season this year. Both knees did fine, even the one with the currently torn meniscus. 


Before I get into what I've learned - here's the good news: you can be as active as you want depending on treatment. If you want to ski, hike, run, etc then my non-clinical opinion is that should be a very reasonable goal. 


Worth stressing again, I am not a physician, although I work closely with many professionally - my opinion is based solely on my experience and what I've read and learned.


last year there was an interesting European study that found rehab to be as effective, in the long run, for ACL tears as surgical treatment; with one caveat: the patient had no stability issues. The college of orthopedic surgeons still recommends surgical repair for instability issues for anyone who wants to resume normal activities (consult your physician, your milage may vary). I've not regretted either surgical repair. I will candidly say the post surgical pain and recovery is manageable but the rehab stinks - mostly from a time perspective. 3 days a week, a few hours each time for up to 3 months… its a lot to commit to and it is a commitment you have to make. 


The second time around (2010), I knew what to expect which made it both easier and harder. It was easier in terms of pain management and expectations. It was harder in terms of the time. I had the advantage of some stability - enough that I was in the gym for 3 months before survey (and diagnosis). I really worked my quads hard (b/c I was gearing up for the season) and it paid off. My rehab time was much shorter. So if you doctor ok's it, you might work on some quad, hamstring and hip strength before you have surgery, if you decide to have it. 


Finally, everything I've heard and read is that there is not really such thing as a partial tear. The ligament pretty much disintegrates upon injury. Again, I'm no doc, I've seen plenty of ACL MRI scans and have been told that partial tears are a misnomer - its more like my 2nd injury where its totally gone but the swelling and gross instability are not as pronounced. Again, your experience could be different. 


I guess my best bit of advice would be to research as much as you can. Get as many facts and ask as many questions as you need to feel sure that the decision you make is the right one. While surgeries were the right choices for me, you have nothing to lose by trying rehab and PT - if the instability doesn't improve, you know what the next move is. 


Good luck - speedy recovery!

post #3 of 8

Like Nick I too have blow my ACL's in both knees 1997 right knee 2007 left knee, 10 years and 2 weeks to the day, so I can fully relate to your dilemma.  Earlier one was simple ACL 2nd one was epic to say the least, an total ACL tear, MCL grade 2 and posterior meniscus tear that required trimming & stitching. The big thing about skiing especially these days with shaped skis and the torque that gets created is the stress to your joints. If your knee is unstable bad things can happen, braces help but I found they restrict you and I only used one for 1 season each time post surgery. I did load or research on the subject had both knees MRI’d and had 2 different surgeons look at the results before I went under the knife. Here’s what I did pre & post. I worked out as much as possible to get my muscle mass up each time because until they get in there you don’t see everything, and yes there can be surprises. The bigger and stronger you can get the quicker you will rebound post surgery. My right knee rebounded very fast 3 months @ 100% post surgery. Left knee took much longer due to damage and meniscus which meant no weight for 30-40 days post surgery that’s where you lose lots of muscle.  Get into a good physio clinic same as your surgeon research them get one who works with athletes in the same sport fields as above and check out their facility, get in there as much as possible and hit the gym too. The good news is the surgery works you can be stronger than before and very little side effects, my right knee was better because it tightened up the joint, my left knee is good too but it will always be a bit noisy due to the extent of the damage and my age, however I have never looked back and rip it up as much as I can every day I’m on snow.  Two procedures I know about are patella tendon, most basketball payers get this one, and hamstring tendon, I had this in both cases. Hopefully some medical experts will chime in about post side effects from each.  The hamstring means you have to stench your hams a bit more, and you have a small scar on your leg where the harvest the tendon. The patella procedure is taken right from your kneecap area big strong tendon however big scar, right on your knee cap and I’ve heard some issues with tendonitis later on. The other post op issues can be patella femoral pain. I had this a bit on my left knee until I got the strength up and tracking back. This happens when you knee cap becomes misaligned from muscle atrophy and thus grinds out of the groove and yep it hurts!   Lastly remember you’re not a car and who every you get to fix this has to be THE BEST. Check out sports surgeons who work on skiers, soccer players, hockey players, as all these sports roll the knee in and put lots of pressure on the joint laterally, plus they will understand your needs and ask you what you want to do post and will help you get back to 100%. I hope this helps you decide but at the end knowing all your options and getting mentally prepped for the next move will get you back in the saddle and ripping it top to bottom with confidence .

 Best of luck and get back on the snow!

post #4 of 8

There's something wrong with my knee right now and I don't know what it is.  Never went to the doctor after my "sprain" in January.  I have an appointment next week.  It pops and hurts while trying to lift/bend it backwards.  I thought it was a mild sprain but it seems to have seized improving.  I can't do surgery though with these 3 month recover times though because I can't work/pay bills without my knee :(

post #5 of 8

Seeing a trend - pre-surgical strength training really seems to help. 

I went with the allograft in both knees (donor grafts). The choice of graft seems to be a very personal decision and one well worth researching. 

post #6 of 8
Originally Posted by FujativeOCR View Post

  It pops and hurts while trying to lift/bend it backwards.  

Good luck Fujative! Fingers crossed that it is something minor! 

post #7 of 8

I tore my ACL about 4 years ago while skiing, and it was anything buy epic.  In fact, it was quite embarrassing as I was giving a friend some pointers on an intermediate hill...essentially, I got cut off, tried to avoid a collision, ski got caught in some pretty gnarly snow, twist, pop, off into the woods I went.  A few hours later I almost passed out b/c my knee had gone from numb to, in crazy pain.


That being said, I had the surgery:  My orthopedic surgeon was also the surgeon for the NY Rangers, so I felt like I was in good hands.  I think my experience was different however in that I felt it took a true two years to fully recover.  At the time I was working 60 hrs a week, and while I never missed a PT appointment, I feel that in order to recover quickly, you need to be in a gym frequently. Also as other people have said, it is a really good idea to be in very good shape going into the surgery (if that's the route you go). I found that I made tremendous progress following the surgery for about a month, plateaued, and then it was a grind to get back to where I was.  Since then, my knee has been fine.  It still hurts for no reason, it never feels "right" and I fund that I definitely lost a first-step, but I have ran 2 marathons in the last two years, and I'm skiing great...point: I'm glad I had the surgery.  I waited about a month to have it, and that month sucked....walking down steps was scary b/c it kept buckling...if you do the surgery, the Cryo Cuff will be your best friend- make sure you get one.  I still have mine and love it!

post #8 of 8

I haven't read the other responses and am not a doctor, but here are my thoughts, FWIW.


Go see another doctor (orthropedic surgeon) and get another opinion.   I really don't think you should still be experiencing instability issues if your tear was only partial.  I suppose it is possible that the tissues were stretched and it healed with too much laxity, but, if that is the case, you probably still will need surgical intervention to resolve the issue.


I have had both ACL's surgically repaired, and I did feel instability before the repairs.  I went a year before having my left knee repaired, and it never really felt normal and I did not trust it.  I have injured both knees several times and many ways (not only ACL's).   I really only had stability and trust issues with the knees when the ACL's were missing.


Best of luck.

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