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ACL and MCL injury - To have surgery or not? - Page 2

Poll Results: Surgery for ACL and MCL tear?

 
  • 100% (4)
    For Surgery
  • 0% (0)
    Against Surgery
4 Total Votes  
post #31 of 45

Good points.  I went with the double bundle the first time because of the hope that it would reduce the chance of AO, which has pretty high rates among regular single bundle ACL recon patients.  Intuitively it seemed to make sense to me, but I think my single bundle revision actually feels more solid- kinda wish I didn't have those extra holes now.

post #32 of 45
Thread Starter 

Thanks for all the advice. Pretty sure i'm going to go ahead with the surgery in a few weeks once the swelling has gone down. 

 

Cheers again, Serena 

post #33 of 45

Best of luck with it!  I've been through two- the anesthesia kicks in, then you wake up and its done.  (Unless you are like one of my PTs who decided to stay awake)

post #34 of 45

Haven't read all the other posts, but typically, the opinions go both ways on the issue.

 

My suggestion is do your own research and see multiple doctors (specialist - check their experience and track record) to get their advice, then make a decision.

 

I have had an allograph on the right knee and an autograph on the left knee for my ACLs.  Without ACL's my knees were unstable and I could not trust them. If I wanted to have any type of an active life style, I needed to do the surgeries.  I regret that went a year without getting my left ACL fixed.  It led to substantial additional injury to my meniscus and surrounding tissue that really did not need to occur.

post #35 of 45

yeah, hope you are doing well now. Your experience is exactly why I am doing the surgery this March. Although I was told by my NJ dr I don't need surgery there's not one serious skier /active person I have spoken to so many who have had he surgery and feel great now. Since I have had meniscus surgery on the same knee and the MRI showed "fraying" of other aspects of the meniscus in the knee, I can't imagine that the wear won't end up causing me TNR over time. This is the difference between what I call practicing medicine by couch potato. and getting a dr who will actually take into consideration your lifestyle, goals and what's best for you over time.

post #36 of 45


 

Quote:
Originally Posted by Finndog View Post

yeah, hope you are doing well now. Your experience is exactly why I am doing the surgery this March. Although I was told by my NJ dr I don't need surgery there's not one serious skier /active person I have spoken to so many who have had he surgery and feel great now. Since I have had meniscus surgery on the same knee and the MRI showed "fraying" of other aspects of the meniscus in the knee, I can't imagine that the wear won't end up causing me TNR over time. This is the difference between what I call practicing medicine by couch potato. and getting a dr who will actually take into consideration your lifestyle, goals and what's best for you over time.


Yes, doing OK now.   I need to do a little compensating and favoring, but the knees are very functional and much more functional than it would be if I had not had the surgeries.

 

I was young when I blew out my left ACL.  Doctor said, if I was not an athlete, just a weekend warrior, it would be no big deal to get along without it.  Lots of people do.  I am young and think this sounds reasonable and get artho surgery to have the torn bits cleaned out, but nothing is repaired.  Over the next year, I put the knee "out" on four occasions resulting in much swelling.  The swelling would go down, I'd start to feel better, and then put it out again.  I put it out hiking down a steep incline, playing tennis, and with a girl on my shoulder for a chicken fight in a pool (remember, I was young).  The fourth time was more of a slip.    Anyway, I did additional damage and it was obvious to me that I needed to the knee surgically repaired.  When I blew out the right ACL several years later, I did not hesitate to schedule surgery to get it repaired.

 

Note that the surgical ACL repair of the left knee was done in 1988.  What they are doing today, seems to be about the same, but I am sure the rehab and technology are better now.  My nephew, who is an athlete and currently playing college baseball, had his ACL rebuilt from his hamstring his senior year in high school, and he thinks it was a blessing.  Due to the rehab and his focus on training, he said he is stronger and quicker than he has ever been and he doesn't think he would have been as dedicated to strength and conditioning without the injury. 

 

Feel free to PM me if you want any more details about my ACL experiences and opinions.

 

post #37 of 45
Thread Starter 

Thanks for all the replies!

 

Just wondering how long people were generally on crutches/using a brace before surgery as I'm feeling pretty confident without (25 days after initial injury), however have to wait till mid feb for an appointment with the specialist so not sure whether to carry on using them. 

post #38 of 45

You should not use crutches or brace.  You need to get the leg as strong as possible and have as much range of motion as possible before the injury.

I used crutches and tried not to put much weight on the injured knee for two weeks after the injury.  My leg was so stiff that the surgeon wanted 4 weeks of PT before the surgery.  On the day of surgery I could only get it straight when it was being pushed down and could only bend it to 105 degrees.

 

I just had my left ACl reconstructed on Friday.  I used the Patela tendon.  I went with Dr. Micheal Ciccotti who is the head physician for the Phillies.  I liked that he was very aggressive in his methods ( he said he wanted me off crutches 2 days after surgery) and if he works on million dollar athlete he can work on me.

 

I am really sore and the pain meds have made feel pretty bad.  My worst part of the surgery was post op feeling horrible from the general anesthesia.  I have also had awful pain in my shin since walking on it with my brace.  I have been using the CPM machine 8 hours a day and am up to 70 degrees.

post #39 of 45

 

Beanielp- what cdmess says is usually correct BUT it depends.  In my case, I was mostly off crutches and left them in the car when I first saw the Dr 9 days after my injury- he thought this was fine until he got the MRI back and saw that I had a bucket handle tear of the meniscus (folded over on itself meaning I was potentially doing damage each step I took).  He then recommended I go back on the crutches and scheduled me for surgery the next day. 

 

If you have your meniscus repaired (not trimmed, but sewn), then generally you will be told to use crutches 4-6 weeks post op to let it properly heel before going weight bearing.  Other exercises are done during this time to get range of motion back.  

 

Best of luck to both of you!

post #40 of 45

Crutches should really be for comfort only because you need to get the strength back in your leg before surgery. The best indicator (according to peer-reviewed studies) for a successful ACL reconstruction is the condition of the leg BEFORE surgery (this is assuming the operation is performed properly by a highly qualified surgeon).

 

Secondly, there is no evidence to indicate that a CPM (Continuous Passive Motion) machine provides any benefit after ACL reconstruction. It's true that it is a nice fancy piece of equipment but it is not at all necessary. Although, if you have insurance that will cover the cost then go for it. When CPM's first became available in the late 80's they were the new big thing for knee rehabilitation and then (like everything else) studies showed negligible  benefit in using them. 

 

And last but not least, if you have a meniscus repair at the same time as an ACL reconstruction there is no need to be on crutches for 4-6 weeks like would be necessary if you only had a meniscus repair. The reason being is that the ACL reconstruction causes a nice, strong blood flow to the knee that aids in the meniscus healing. Also, a contracture of the ACL graft is also very possible if you are on crutches protecting a meniscus repair that was done at the same time as the ACL reconstruction. The only thing that really needs to be avoided when you have both a meniscus repair and ACL reconstruction done at the same time is squats. Squats are a little too stressful for any repaired meniscus.

 

Again, this is from my own med school research and you should always follow your doctors instructions.  

post #41 of 45


I'll continue contributing to the thread drift here.

 

BGS- could it be that there is a correlation to the condition of the leg BEFORE surgery and how diligent someone is with the rehab AFTER surgery?  Put another way, isn't it likely that those who pre-hab best also rehab best?

 

I think what makes it hard for the patient and why a proper database would be useful is that different qualified medical professionals have different opinions about proper treatment of Meniscus, ACLs (and lots of other things, I imagine).  I was clearly told by my doctor not to be weight bearing (feather toe only) for the first 4 weeks and then gradually go to full weight bearing over the next two weeks.  I was also restricted to 0 to 90° meaning only limited exercises and no stationary bike the first 6 weeks.  My PT has said getting some traction was a good thing and one of my most common ROM exercises had me dangle my leg from a table letting it fall naturally to 90° and then lifting it with the other leg to straighten it- maybe this helped to prevent the graft from contracting??  Sure, there is a chance my Dr was wrong, but he is the head team physician for the US Women's Alpine Ski Team, so he is advising some pretty high level athletes.

 

Quote:
Originally Posted by BadGalSkier View Post

Crutches should really be for comfort only because you need to get the strength back in your leg before surgery. The best indicator (according to peer-reviewed studies) for a successful ACL reconstruction is the condition of the leg BEFORE surgery (this is assuming the operation is performed properly by a highly qualified surgeon).

 

Secondly, there is no evidence to indicate that a CPM (Continuous Passive Motion) machine provides any benefit after ACL reconstruction. It's true that it is a nice fancy piece of equipment but it is not at all necessary. Although, if you have insurance that will cover the cost then go for it. When CPM's first became available in the late 80's they were the new big thing for knee rehabilitation and then (like everything else) studies showed negligible  benefit in using them. 

 

And last but not least, if you have a meniscus repair at the same time as an ACL reconstruction there is no need to be on crutches for 4-6 weeks like would be necessary if you only had a meniscus repair. The reason being is that the ACL reconstruction causes a nice, strong blood flow to the knee that aids in the meniscus healing. Also, a contracture of the ACL graft is also very possible if you are on crutches protecting a meniscus repair that was done at the same time as the ACL reconstruction. The only thing that really needs to be avoided when you have both a meniscus repair and ACL reconstruction done at the same time is squats. Squats are a little too stressful for any repaired meniscus.

 

Again, this is from my own med school research and you should always follow your doctors instructions.  



 

post #42 of 45

A little late to the party, but I'll add what I can.

 

a tale of two knees ---

 

I've blown both ACL's over time. The right knee in '73 and the left in '94.

 

The left knee was terrible after the injury and my surgeon recommended repair (cadaver method). After about 12 months, it got back to about 80-90% original strength, but still has some lateral weakness. Not enough in be an issue skiing. Sadly, club soccer is no longer really possible.

 

The right knee, even though it was the older injury, has never been repaired. My surgeon kept asking a basic question - is the injury stopping me from doing what I want to do? So long as the answer is "no", he recommends against surgery. He prescribed a good brace (Breg) for skiing (doc is also an avid skier) and recommended serious low stress training (cycling/swimming) to help build muscle support for the knees. I chose cycling and put in a fair number of road miles prior to the 2010-2011 ski season.

 

Managed 20 days skiing last season - 10 in Colorado - and the knees held up pretty well. I can tell the difference between them, but it's not as big a difference as you may think.

 

5 days skiing in PA this year and headed to Tahoe in a week for 6 days on the slopes. After a second year of cycling, I'm expecting no problems from the knees.

 

Regardless of your personal decision - surgery or no surgery - do the PT and training. It really does pay off.

 

post #43 of 45

I'll jump into this thread.  I am 40 years old and have been skiing since age 13.  I tore my right ACL on 12/10/11 skiing nasty, frozen solid, man-made crap and is the first major injury to my knees.  I wasn't able to get a MRI until just after the holidays that confirmed the tear and a bruised bone.  I pulled myself up and began doing PT and exercises to strengthen the knee.  Yesterday I had my first visit with the OS and spent a good deal of time in the exam and discussing options.  Fortunately, I had no meniscus damage and the bone cartilage was in great shape.  Stability was good for the injury and the pivot test did well.  After discussions we landed, with his blessing, to try my normal activities for the next 6 weeks, including skiing, then come back and determine if I keep going without surgery.  He ordered a custom Bledsoe brace for skiing and other activities and a rigorous PT schedule begins Feb. 6th.  He is one of the top sports medicine OS in my area.  He stated that if it were him and he had the stability I have, he would try it without surgery first.  I will let every one know how it goes but as mentioned earlier, listen to the docs and hammer on PT.  Being healthy and strong (lifting weights) has allowed me a quick recovery with full ROM to date and some pain from the bone bruise.  I worked dead lifts back into my lifting routine this morning and did 5 sets of 5 at 315 pounds.  Prior to the injury, I was at 365 pounds so I am lifting a little less but not a lot and I had no issues with the knee. 

 

Good luck to each of you and keep positive.  A torn ACL sucks, there is no other way to put it but it is an injury that can be recovered from.  Just be smart in the choices you make and again, follow the advice of your doctor.

post #44 of 45

I'm strictly talking about a meniscus repair and an ACL reconstruction performed at the same time. If you had only a meniscus repair then you would have to be practically non-weight bearing for about 6 weeks. If you had an ACL reconstruction as well then non-weight bearing status is not necessary. In fact it can be far more damaging to be non-weight bearing on an ACL reconstruction for that length of time. 

 

MEfree30, 

 

If you had your ACL done at the same time as your meniscus repair I find it hard to believe that your doc had you virtually non-weight bearing for 4 weeks. That approach is not supported in the literature (it used to be years ago). However, it sounds like you had a good outcome so it's really irrelevant now. Things have changed so much in the past 10 years but so many docs are still following outdated protocols. This is not to say that these outdated protocols will not work but surgeons who consider themselves to be top notch should be up to date with rehabilitation methods. 

 

Now, if you had microfracture done then can understand the 4 weeks of non-weight bearing but otherwise it's really not necessary. 

 

Again, follow your doctors orders. 

post #45 of 45

Yes, I had my ACL construction (revision) at the same time as as the Meniscus repairs (both medial and lateral).  No micro-fracture.  

 

With a google search http://www.google.fr/search?aq=0&oq=acl+and+meniscus+repair&sourceid=chrome&ie=UTF-8&q=acl+and+meniscus+repair+protocol

 

I just found http://www.gcbj.com/content/PT_Sou_ACLWithMeniscus.pdf from a different DR, but the protocol looks mostly similar.  My PT, who trys to keep up with things (and who pushed me much more the first time around) agreed with the conservative approach and told me how fragile the meniscus is.

 

This one http://oansportsmed.com/athlete/forms/ACL_Protocol.pdf looks a little more aggressive but still talks about using crutches to walk between weeks 4-6.  Same with http://orthoncforms.com/forms/kirby/ACL_Reconstruction_With_Meniscus.pdf

 

You have to go to about the 5th result before you find one as aggressive as you are saying (and they don't make much mention of the meniscus) http://www.iasm.com/pdfs/ACLReconstruction.pdf

 

I'm not saying you are right or wrong, but it certainly tells me different DRs have different protocols- without good record keeping and statistics, it is hard to know which one is superior.

 

 

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