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Diagnosis confirmed: complete ACL tear

post #1 of 25
Thread Starter 
I just got the report from my MRI. The good news is that the menisci and other collateral ligaments are intact. The bad news is I have a full ACL tear where it attaches to the thighbone.

I'm getting two surgical opinions; one from a major teaching center and another from the local ortho. I'm in a big skiing area so probably either is good.

How painful is the aftermath of the surgery? Does it take a while to be able to walk again? It doesn't sound pleasant. I do want to ski again.

I've started PT to strengthen the quads.

post #2 of 25
I just had a patella graft done on Feb 18, you're out during the surgery and the pain block they gave me was effective for about 24 hours. I think they may have administered some pain medication via IV during my overnight stay.

Took a couple of percoden for the trip home though. My doc ordered a Continuous Passive Motion (CPM) machine and a cooling machine that circulates cold water around the knee to keep the swelling down. They both work very well.

The pain isn't too bad, although I do take a perc when I get on the CPM cause it does stress the knee to break up scar tissue. I'm on it about 6 hours a day in 2 hour segments and am up to 90 Degrees of motion. Also doing 3-4 sets of straight leg raises for quads and heel slides for the hamstrings, still somewhat painful on the heel slides though.

There is life after ACL and I intend to ski again. I plan to be back on the road bike by the end of March too. Just do your rehab faithfully and listen to your body. Look at all the professional athletes that have come back stronger after ACL repairs.

The post op pain wasn't as bad as my rotator cuff repair in 2001. The leg does throb a lot for a few seconds when I first stand up in the am or after having my foot elevated above my heart for a while. It feels really strange for a few seconds when all that blood rushes to the injured area.

One suggestion an Ortho friend made was to get as much extension with the injured leg as you can before surgery. Also after the surgery be sure to keep your injured leg above your heart when resting. I did and my doc was surprised at the lack of swelling at the 5 day post op appointment. Do your PT before the surgery too, straight leg lifts to keep the quads strong help a lot. My doc was also surprised that I could do straight leg lifts 5 days after the repair. I'm supposed to work on weighting the repaired leg more and I hope to be able to put full weight on it in a couple of days. I can take a couple of steps without crutches but knee is still weak. I'm still on crutches for most of the time but an spending a lot more time trying to walk around, but it takes us 60 year olds longer to recover than you younger folks.

I probably won't ski this year and will not ski at much above 50-60% for the first 12-18 month after the repair since complete biological replacement of the graft isn't complete till than. My sources say that the graft will be the weakest at around four months and full strength isn't reached until 12 to 18 months after the repair. I'm going to be somewhat conservative with my skiing until the ligament is completely strong since I want to be making turns in my 80's like Ott is.

Get the second opinions and go with the doc you are most comfortable with. Most of the docs around here do patella grafts, but the there are pro's and con's to each method of repair. Go with what makes the most sense for you and your doctor.

Good luck with your repair and let us know how it comes out.

If you have any other questions regarding this, pm me. I'm going to go spend a couple of hours on the CPM now.

post #3 of 25

My understand is that the sugery today is less painfull and more productive.

I am positive that you will not go through the pain that I did. Sounds like Bong had a very positive reconstruction of the ACL.
post #4 of 25
Thread Starter 
Thank you for your input. How long did you have to wait for surgery after the injury? I still have alot of swelling around the knee.

I'm trying not to freak out. It seems the mental challenge is as great as the physical, at least for me. I've never done more than stub a toe, more or less, in my life....

post #5 of 25
ouch. That's too bad. Get well soon. listen to your PT and orthopod.
post #6 of 25
Edited for double post.
post #7 of 25
My injury was Jan 30, repair was February 18, I had very little swelling and was walking with a brace 2 days after the tear. It was a complete tear with no meniscus damage. Need crutches after the surgery though.

I think the challenge is very mental. Pain is a given, but you have to use your mind to work through it during recovery and rehab. You can do it! [img]graemlins/thumbsup.gif[/img]

Deep breathing exercises help me work through the pain. Meditation works too, check out "WHEREVER YOU GO THERE YOU ARE" by Jon Kabat Zinn for help with controlling the pain through meditation.

Good luck with your repair and use your mind to get through the pain. Learn deep breathing as they teach in Lamaze.

post #8 of 25
Jane: Looks like you came to the right forum (what does that say about our skiing?). I had my acl replaced Wednesday, Feb. 25. My experience was much like Bong's, except that I had meniscus damage as well. I tore it On Dec. 12, at the ETU at Stowe. It wasn't Epicski's fault -- our group had stopped at the side of the trail, and as I slowed to join them, someone chopped me down from above, hitting me in the chest, and I did a slow backward twisting fall. Your surgeon will probably make you wait at least a month, so the swelling goes down. I didn't have PT before the surgery, but with my MD's approval I went back to the gym and did stationary bike for 20 min/ day, at about half my ordinary effort (I'm a cyclist) and machine leg extensions and hamstring curls at a weight that allowed me to do sets of 15 reps. I was in the hospital overnight, with regular use of the morphine button, and started using the passive motion machine and ice circulator the next am. I'm using them about six hours a day now (with percocet) with my range of motion up to 50 deg. The doc wants itup to 60 within one week. I'm allowed to weight-bear with a leg immobilizer. I expect to start PT after the second week, and I hope to be back on my road bike after six. After the first day it's really not too painful at all. I think the pain was much worse when they first started doing this repair, because they used to put patients in a full-length cast for about six weeks. When they took it off, your knee was just as stiff as it was with the cast on, and a big PT guy had to lean on your shin to break it loose. Now it's all range of motion immediately. Also, I had a cadaver tendon put in. This makes for quicker recovery because you don't have a donor site to heal as well, and my doc says it's just as strong. Good luck.
post #9 of 25

The damage to my knee was more sever then yours, I had surgery right away (3 days) after the injury.

I had more than ACL damages. Glad your not going to have as much as I did. I had reconstruction of the ACL (transplanted from another), Cartilage, and repair of the ligaments of the inside part of the knee. I only had two side of ligaments(MCL & ligaments on the outside of knee) holding my knee together.

The therapy had also changed with the times (over 17 yrs ago), and better I believe. At the time I injured my knee, one was not supposed to move it at all. But because the muscles was so well toned and developed, my doctor learned that my knee healed faster than most (5 yrs point shoe Ballet). I started Therapy early and it that helped it heal faster. My senior (injured summer before Junior yr) year I played soccer (against my doctors wishes) and skied that winter (with a brace of course).

Heck.. I still have screws in my knees today.

Good luck and keep us up-to-date. [img]smile.gif[/img]
post #10 of 25
Thread Starter 
I'm just back from my first surgical consult at a big medical center. The feedback was to wait several weeks until the swelling goes down, keep increasing ROM in PT, and reassess at that time. My impression is that I have to weigh the options; he didn't automatically recommend surgery. I'm 50 but an active 50 and want to continue to ski (and ride horses). I guess some people do ok without the repair but I'm skeptical.
Opinions? Do you know people who've gone without and have been able to ski?
post #11 of 25

You have lots of skiing and horse riding years left. Don't mess around, get it fixed.

I was able to ski with a full ACL tear, due to lots of hard work biking, weights etc. The problem is without an ACL, you are more susceptible to menisci damage which is much harder to repair. Without menisci, arthritis develops and you may need a knee replacement which limits the activities you can do.

I evenutally tore both my lateral and medial menisci requiring surgeries and 1 month of total non-weightbearing. I am sorry I did not have the ACL reconstruction sooner.
post #12 of 25
Four weeks ago my 21 year old daughter had a complete ACL tear similar to yours repaired. The first few days after sucked. Even with medication she was in some pain. When the medication wore off she was in a lot of pain. We had to rotate people to make sure she got her medication ever three hours, 24 hours a day.

After the first few days things got better. She had to hobble around on crutches for a week but was able to resume walking (with a limp) the second week. It has not been a pleasant experience but she is happy she got it over with and is looking forward to having a healthy knee by summer.

As for going without the surgery, my daughter tried using a brace and ended up reinjuring herself. Luckily, she didn't do any permanent damage to her knee but chances are she would have eventually.
post #13 of 25
Chalk up another one. I had a complete ACL tear, as well as a severe bucket handle meniscus tear in the 2000-2001 season. (Stowe's trail, chinclip got me)

I'm now comletely 100% over my injury both physically and mentally. Unfortunately, I still experience some pain and inflamation of the patella, but its just part of the deal of pushing myself each day on the hill or on a long run.

I had the patella tendon surgery (from my knee not a cadaver), and it has worked out well. I went to an outstanding doctor in the boston area.

I would say the biggest thing is to make sure you take the after surgery physical therapy more than serious. I did about 80-90% of what I was told to do, and probably didn't get my leg back to full strength (and confidence) for an additional season than if I'd really focused on rehab. Expect next season to possibly be just getting yourself up to where you were before the injury, therefore making yourself 100% physically and MENTALLY the following season.

As for pain, no good news here. I remember waking in the recover room and it was the worst pain ever. Spent the night in the hospital continually getting demeral shots, and left the following day (around noon) with a couple of prescriptions (percasset and tylenol w/ codeine) which were greatly needed the next few days....but then it wasn't so bad.

Hang tough, its a long and tough battle, but before you know, you'll be working out your leg, and focusing on the upcoming ski season.
post #14 of 25
I should add that from the point of view of someone who continued to ski hurt (I heard and felt several "pops" before I was in the hospital), that you shouldn't mess around and shoudl definitely get it fixed ASAP. Chances are if I hadn't messed around, I would not have torn the crap out of my meniscus which is THE reason why I continue to expreince pain, discomfort, and make occasional visits to the doc because of knee issues.

Aso someone says above, SAVE YOUR CARTILIDGE!
post #15 of 25
I had my third knee operation in December (never any ACL, though, knock on wood), and during rehab I found this to be a fairly informative site for knee info:
post #16 of 25
I recently rode a lift with a man whose ACL was torn beyond repair, in a motorcycle accident last summer (he said the only hope of repair was by a transplant and graft of tissue from another part of his body; and he's hesitant).

He was skiing well with a large brace on the outside of his knee, and said he felt fine.
post #17 of 25
i totally tore my acl about 8 or so years ago out in snowbird-out of control on the moguls,the last day of my vacation. i did not have the surgery, probobly because i had no more pain.went to physical therapy. did not ski for the next year, did and still do workouts with weights on my ankles , got a knee brace out of a ski catalog, decided to ski that next year and if i hurt myself again then i would go for the knife. i am still skiing and thoroughly enjoying myself on the slopes!!!!! pain and scar free.
post #18 of 25
53 days so far this year 8 in utah the rest in killington
post #19 of 25
Jane -
As many have said, listen to your docs..but also make sure that they know about your desire to return to the slopes AND the horses. Additionally, talk to your rehab guru about riding and stirrup length. After non-ACL injury, I had a local rehab guy come and evaluate my leg position in the saddle with great results - I now ride without knee pain during or post.

Best of luck for a strong and speedy recovery!
post #20 of 25
Hi, I have read many comments on this subject so its kind of hard to decide if you should have surgery or not. I injured my right knee about 7 years ago trying to do a martial arts kick, I heard a loud pop and severe pain, went to emergency room next day, they refered me to a specialist.I had no insurance so didn't go. Anyway, I wore a full leg brace and walked only with crutches for several months. I kept working my leg though ( i couldn't bend it for quite some time) When i finally got rid of the crutches and could walk I had a terrible limp for over a year, I ride horses too but didn't even try to ride for almost two years, I kept doing my own "therapy" by just exercising and bending and bending my knee until It finally got better ( It is probably 99% well now but it took over two years ) I am still careful with it though, every now and then I get a little twinge (or reminder) so, its hard to say on surgery or not, If you have the patience to wait it out and just do therapy, I'd suggest that, I've had three surgerys on my lower back and wish I'd never let them cut on me the first time....I am a very determined person though and don't let it get me down. I train and break my own horses and starting skiing last year and have had no problems. Good luck to you but weigh your choices carefully. Sincerely, Leisa
post #21 of 25
I had a similar experience to Loveski's as a kid although in my case I was told that , at that time. there was nothing they could do for it. The terrible limp I suffered after getting off crutches was mainly due to the lack of weight bearing excercise of that leg while I was on the crutches and it took quite a while to get rid of. I've been fine although I've been told I may have little or no ACL left in my right knee. I have no idea if your condition is comparable and would not dream of advising you beyond encouraging you to seek expert physical therapy whether you opt for the operation or not.
post #22 of 25

To Repair or Not to Repair - Is that the Question?

Even though Jane may no longer even be reading this thread, I can't resist jumping in here.

While there's no question that you can find plenty of anecdotal stories of people who've torn or severed ACL's and then chosen not to get the repair, that's a route that ought to be *very* carefully considered.

First off, I'm convinced that many of these stories are told by people who have probably torn, but not *severed*, their ACL. A severed ACL leaves the knee unstable, period. The ACL is there for a reason and if it's gone, that knee won't withstand the stresses a normal knee will. While strengthening will certainly help, there are certain movements that will threaten the soft tissue of that knee if the ACL isn't there.

The decision depends on your age, physical condition. level of activity, your willingness to go through rehab, and how concerned you might be about the risk of cartilage damage (and related arthritic pain later in life). While we hear these stories about people who have chosen not to repair, isn't it interesting that elite-level athletes who tear an ACL overwhelmingly undergo the repair? People whose livelihoods depend on physical strength and structural stability almost invariably choose repair.

My experience with an ACL replacement is almost identical to Bong's (same graft, same CPM, same cold water circulation, same drugs, same rehab - Bong, you didn't have yours done at Duke University by any chance, did you?). What pain I experienced was easily manageable and the rehab is rapid enough that you can feel things constantly getting better.

While I have no desire to do it again, I wouldn't hesitate an instant to repair an ACL again if I tore one. I skied without an ACL for a season. I guarantee you that post-repair I skied with more stability, confidence, and strength than I did before the repair (even though I had a fancy brace before the repair).

Sorry for the rant, but I think people who are waffling about having the surgery might latch onto these stories about people who have "successfully" chosen not to repair. In most cases, a repaired ACL is going to yield far better results later in life than an attempt to faith-heal it.

post #23 of 25

My repair was performed at Centennial Medical Center in Aurora, CO by Dr. Robert Rokicki. As you said, repair depends on the factors you listed and how stable you want your knee to be for ones chosen level of sports participation. I'm now 61, an active bicyclist and ski instructor. I am also willing to put up with significant discomfort during the rehab process to regain my prior activity levels. Based on my wish to continue skiing at a high level and continue bicyling, repair was the only option.

I agree that for a complete tear you need a repair if you want to participate high intensity sports and lead an active life.

post #24 of 25

to cut or not to cut

I agree with Bong. As you can see from my earlier post, my early recovery was succesful, and now that I'm three months post-op, I'm very glad I had it done. I've been allowed back on my bike for a month now, and expect to ski by December. Like Bong, I'm 61, and an avid cyclist, but very much a ski instructee rather than an instructor. But even if you never want to ski or do any sport with lateral motion again ( I think I could probably cycle without an ACL), if you don't have a graft, every time you twist your leg a little, or step wrong, you'll feel some pain (a little or a lot) that tells you that you're damaging your meniscus. I got mine fixed to avoid a knee replacement in 10 years as much as to be able to ski again.
post #25 of 25
Time back on the slopes differs for different people and doctors.

I blew out my ACL and slightly tore my meniscus Feb 2003. I had surgery May 31 2003.

I skied about 20 days this past season and was fine. This includes doing bumps.

I just ran the Corporate Challenge in Boston yesterday which is 3.5 miles with no knee pain at all.

It really depends on your existing leg strength, pre and post rehab and exercises, and how bad you want to get back on the slopes.
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