ACL Recovery without surgery? - Page 2

Hi All,

I am 22 years old.I did tore my ACL just about a month back. I met with an accident while riding on the bike. Initial findings on a MRI scan were:

1. ACL tear.
2. Partial tear of MCL.

I was kept on a knee immobilizer for about 3 weeks after the injury. Initially after the injury i had 2 incidents of my knee giving away in 5 days while climbing the stairs.  After 3 weeks I had an appointment with my OS again and he confirmed that MCL had healed. I also  had a discussion with my OS regarding the ACL reconstruction surgery, he is of the opinion that if i could manage fine without the ACL, he would not prefer an ACL reconstruction surgery on me.The only puzzeling thought in my mind is that if i do not undergo an ACL reconstruction are there any chances of me damaging my other parts of the knee (osteoartheitis, cartilage, meniscus injuries etc). The OS is also of the opinion that a surgery will not solely ensure that the damage to the other parts of the knee, just that it may stabilize my leg. The dilemma is to undergo a surgery or not provided my knee remains stable. 

Can anyone help me out if an ACL reconstruction surgery can protect me from the possible long term injuries to my knee?    

Regards,
Vishwa

I think that most of us would be guessing about long term effects, but I'll tell you what I've heard/think.

I decided to have surgery with an OS who performs a "double bundle" graft- essentially two intertwined grafts which is more similar to your original ACL than the traditional single graft.  One of the possible benefits that my OS and PT mentioned is the possibility of a reduced risk of osteoarthritis in the knee which is found in a higher % people with ACL repairs than the general public.  Not sure where they get these stats from and if there are any stats comparing long term effects of those without an ACL vs those with a traditional repair. 

Assuming osteoarthritis is caused by excessive movement (laxity/instability) in the knee, logic tells me that a standard ACL repair is better than no repair, but that the double bundle repair may be better than the single.  

I am a just over a year post-op and my knee feels stable without pain and close to, but not yet 100% "normal"  You can read postings from others who have done well without an ACL so the choice is not obvious IF YOUR KNEE FEELS STABLE, but given your age, would go for surgery if it does not feel stable.

Good luck with whatever decision you make.

Hello all.  I am new to the forum and have enjoyed reading and learning from everyone's experiences. 

I am struggling with my decision on whether or not to move forward with surgery.  I tore my ACL and medial meniscus (most likely) 8 years ago.  At the time, it went undiagnosed (I had bad insurance and my doctors told me to just RICE and I'd be fine).  I have had 4 sprains on the same knee since then- all landing from a jump while playing basketball. A recent MRI revealed I have a chronically torn ACL, torn medial meniscus, and grade II sprain of the MCL. 

My knee is stable (probably due to 8 years of my other ligaments and muscles compensating for the lack of ACL stability). My Orthopedic Surgeon, PT, and Orthotist are all very surprised at the muscle mass I have on my quadriceps as well as the balance/control/stability I exhibit given what my MRI shows.  Although the leg is strong, I have gone through 3 weeks of PT anyways to be safe.  I've been fitted with a CTi2 Brace and given a confident okay to go on my ski trip to Bridger/Big Sky next week as long as I stay away from Moguls and Jumps of any sort (it will be 6 weeks post my recent sprain). 

The knee is strong/stable.  I have no experiences of instability aside from the poor landings from jumps.  I have no problems leaving out the most high risk activities and pivoting sports from my life (basketball, football, etc.), but skiing is not something I want to give up.  

I have seen that most advisors that are pro-surgery lean that way because of the risk of re-injury that would likely tear the meniscus leading to OA down the road.  I feel like the prognosis of OA is inevitable due to the damage that has already been done, so why go under the knife to repair the ACL if my knee is overall stable on that front anyways?  Does anyone have any insight/advice on ACL surgery given that my meniscus is already torn?  Are there other factors I am overlooking? 

Side note- the tear on my meniscus is in the white zone, so surgery will likely be a menisectomy and not a repair.  I would see the point to get the ACL reconstructed if I am going to have surgery for the meniscus anyways, but there is no locking or intereference with my activities of daily living, so surgery for the meniscus is not a complete necessity either. 

Also, does anyone have any advice as to whether or not my binding settings should be dialed down for an earlier release for my upcoming trip? I'm 5'5", 150lbs, intermediate skier, 24.5 Boot size, current DIN at a 6.5.



Thanks!

my MRI read the same as HOKOYO. Ugly with total tear. The bone bruise and little menicus tear I think provided most of the pain and swelling. Now two month out, I am trying the ARPWAVE machine - check it out. It is certainy interesting. I am commited to trying this with out surgery. I went to a couple of the best clinics in the west and if they sell ACL reconstructions they tell me I have to have one. I do ski 100 days per year, am 47, and want to continue. I have had no instances of instability, and the MCL feels the worst when I have limped around on my skis a little bit. Pilates/gyro gets right at the strngthening stuff and I figure I have until July to see if this will work!

Alright, everyone on here under 30 with a tear should seriously consider sugery, the acl doesnt get enough bloodflow to heal itself and can lead to damaged menisci and severe arthritis which will definantly hinder your skiing. I tore my acl two years ago in high school football. Did pt for a month and the surgeon did a hamstring graft. The knee is extremely stable and ive had no problem skiing bumps and jumps all year. I can run on it pivot on it and do whatever sport i feel like without a problem, if your young you dont want to be limited in the sports you can play.

I appreciate the dilemma. I tore my ACL completely during a bad landing at Whistler eight weeks ago, but I have to admit that I have never seriously considered the possibility of not getting surgery. Both my PT (who I'd been working with on some existing knee issues) and the sports medicine doctor I saw were adamant that for me to return to the type and level of activity I enjoyed before, and to avoid the risk of further long-term damage to the knee, surgery is a must.

That said, I've been extremely lucky in that my recovery from the injury has been unusually fast. I was in good condition when it happened and had been skiing loads, so my quads were in good shape. I spent a week on crutches, was back on my road bike after three weeks, completed a 100k road race after four weeks, and am now back on snow with a brace for support at my PT's recommendation. I skied all day at Whistler yesterday and the knee felt rock solid.

It's tempting to think that this rapid recovery and return to activity eliminate the need for surgery, but I know that for me that's not the case. The knee feels very stable, but tests show it to be lax and my PT has been very upfront about the risk this puts me at if I carry on walking around without an ACL in the long term. Given my overall condition and the effort I've put into getting my quad strength back (two hours of PT a day, at least 6 days a week) he's happy for me to ski with the brace, but he did recommend that I stick to groomers and avoid jumps and bumps. For now I'm just happy to be back on snow, but that's not the way I want to ski for the rest of my life.

That said, every knee is different and some people get by fine without an ACL - I think the term doctors use is "copers." The fact that my knee is still lax in spite of my quad strength indicates that I'm not a coper, so I'm comfortable with the decision to go for a reconstruction just as soon as I can get through the wait list. ;)

I tore my ACL a few days ago skiing . I was pretty upset as I moved out west after kids left to college so I could learn to ski better and enjoy the great outdoors. After walking around pretty well on a brace and having no swelling or pain in my knee, the Dr. agreed I could definitely try PT for 90 days and see how it goes. These postings were very helpful and make me realize I am not crazy for delaying or trying to avoid surgery. Thank you all for the positive, yet realistic feedback.  I start physical therapy next week, Anything I should definitely avoid assuming I am wearing a brace during the day?

not a doctor and not even remotely giving advice.  I have learned a lot in 3 weeks! 

 

1- acl tear or detachment or whatever: its the level of instability in the joint that matters to a high degree.  Strength is good but seems to be meaningless if you are unstable.

 

2- timing- not important but you do want the leg as strong as possible before surgery. Just remember that you will be in recovery and rehab for about 4 plus months.

 

3- age-  30?  WTF? I would be more concerned with activity level.  if you are active in skiing running mtn biking and any other sport involving "cutting movements' like soccer, lacrosse, hockey basketball, you are at risk. Here's a scenario, you are coming down a no-fall or a "oh shit this will hurt if I fall line" do you want the knee to decide to fail here?

 

4- increased potential for more damage- yep. statistically, if your active ..  couch potatoes, not so much

 

5- ACL damage is usually accompanied by other injury to the bone, meniscus, other major ligaments. So be careful not to push it too soon. Some are very lucky and just tear/detach the ACL and can go at it faster. I was on bike within week but cannot do any weight bearing excercises due to bruised bones. So be careful!  Don't F-up the leg even more.

 

6- grafts- hamstring or patellar seem to be most preferred with the nod to Hamstring overall,  Cadaver, not so much anymore.  - if anyone has better imperical data, please post.

 

7- lots of people live without ACL's.....  so ignore everything above...  Listen to your doctor..... 

 

 

 

 

Finndog:  Thanks for the advice. I am 43, moderately active and willing to tone it down further if I can avoid surgery. Let's see how this goes.

best of luck to you!  Tone down sounds boring though?

http://www.arthritis.org/oa-acl-tear.php seems to show a good prognosis for this approach (when combined with PT), but I sympathize with FinnDog

 

JUST to be clear here, listen to your doctor!  
 

 

Hi.  This is my first post.  I saw this thread and made an account just to ask a question on here.

 

I am an occasional skiier.  I only ski a few times every winter.  6 days ago, I was stupid and decided to ski on an off course trail with some friends.  My ski got caught in a deep patch of snow and I fell and twisted my left knee. I could feel a sharp pop in my knee when I fell.  I had no idea how bad it was.  I was able to get up after a minute of laying there in pain and made it out of the trees and down the rest of the mountain on a moderate level on course slope.  When I got to the bottom, I took a rest in the lodge.  I was able to walk but since I was wearing ski boots it was hard to try walking normally.  After a rest, I decided to go back on the slopes because I wasn't sure how bad it was.  I only stuck to the easiest begginer slope because I didnt want to test my luck.  I couldnt actually put my ski back on because when I put hard preassure down on my left foot, the pain in my knee was too great.  My friend helped push the boot into the ski.  I was able to ski a few more hours with no major issues on the easy slope.  After skiing I called it a day and went to a hot spring.  Then, I stayed the night in a lodge with people and got drunk.  I iced the knee with some snow.  It was really swollen up later in the evening and I had to limp. 

 

I was too busy to go see a doctor until 3 days after the injury.  I got an MRI and Xray done.  Doctor said its an ACL rupture.  Currently I am on a knee brace.  He took some blood from my knee and said it was bleeding which is why its swollen.  I have been able to walk around on my own with little to no pain if I dont bend my knee the wrong way but I limp.  I cant bend my knee much and cant make it completely straight.  Doctor says I might need surgery.  He says if I don't do surgery it will only heal 50-80% and if I do it will probably heal fully. 

 

Operation is expensive and I can't afford to take the time off to get it right now.  Since I am not very active as far as sports and hardly ever ski, do you think I could expect to get by without the surgery from your experiences? 

 

Also, I read that drinking alcohol for the first few days after an injury likes this thins the blood and causes more swelling (so what I did was stupid but I didnt know any better and it helped with pain), but one week after the injury, would drinking alcohol have any really negative effects on my knee?

 

Thank you for any advice you can give.

 

BTW I am a 29 year old male.

Dude, where do you live?  Why did the dr take fluid out of your knee? Is this an ortho or a regular family doctor?  I think you need to see an orthopedic  dr.  Some of your info does not sound right.  

I have read those studies.  The knee is less stable and there is more movement without an ACL which contributes to OA.  Avoid that.  My wife had a grade 2 ACL tear 17 years ago and only had arthroscopic repair and cleanup.  Due to her age reconstruction was not considered.  She got a custom brace and went through extensive PT and contined on her own even until today.  With the brace she was able to ski and hike OK but now has some OA problems in the knee.  Age is not your friend and injuries accelerate problems. 

 

If I were a young guy again with injuries I would seek the best conservative advice and also modify my skiing until the knee was stable.  Bumps...I would say sayonora to them and readjust how and where I skied.  There is life after bumps.  All of us will eventually give them up at some point.  Better to enjoy some type of skiing than not ski at all.  Just my opinion.

 

Bill

I am from America but I live in Japan right now.  I think he just took the blood from my knee to test if it was bleeding internally.  I went to the largest hospital in the area (a pretty small city) and that is the doctor they told me to see.  I don't know the extent of his qualifications specifically. 

 

Does it sound like he knows what he is talking about?  Do you guys think I could get away with not getting the operation if I don't really do sports much for a while? 

 

Also, is it safe to me to be drinking alcohol one week after the injury?

Hi everyone,

 

First - thank you, the info on here is really helpful! ...So an MRI says I tore my right ACL completely the day after Thanksgiving (Heavenly, Tahoe). I'm ok if I don't ski again (this was my first trip!), but I hike and do yoga and contemporary dance. Does anyone know much about these kind of activities without an ACL?

 

I'm still working on regaining my flexibility, a bit worried that I won't be able to get it back. My PT said to not even try to sit "Indian style" with my legs crossed as it puts too much strain on the knee. I can't imagine doing yoga and dance without this basic flexibility/position...

 

Also, though my knee is generally stable (lachman test fine, no buckling), I find myself limping and in pain just with normal amounts of walking by the end of the day. Shed any light? Could it be from the bone bruises? - even now 2.5 months after? And, er, does the stiffness in the morning ever go away?

 

 

 

 

 

Have you seen an Orthopedic Surgeon yet?  If not, find a good one.  There may be other issues besides the ACL.  I had a bone bruise and depending on severity, they can take several months to heal.  You should discuss your options with an OS based on your activities.  I assume the dancing you are doing requires lots of twist and turns.  Based on this the OS will give you the best direction for the activities you want to do.  You can live without an ACL but you may not be able to do the things you used to do without reconstruction.  FWIW I am back to skiing on a fully torn ACL in my right knee from Dec. 10, 2011 ski fall using a functional brace.  I am doing this based on my meeting with my OS.

sounds familiar.....  :)  you need to find a good ortho and have a long chat.  since you are active and engage in activities that will push the knee why not get it recon'd? Its a solid 4 months either way (surgery or non) .......  BTW- bruised bones suck. I am at 2 months and my tib still can be very painful at times.

Thanks for the replies. I've had two appointments with an OS - no long chats though! He's like in and out in five and the treatment is do PT and "wait and see." He thinks my knee may be otherwise strong enough to do without surgery. My last visit was a month ago when I was just starting to walk more than a few blocks at a time. My next visit is not until April - trying not to go out of my head in the meantime. I would prefer to have the brace he ordered for me (which is weeks late in arriving) but from threads sounds like braces are half-psychological anyway. So I guess I'll try some careful yoga and dance and "see" what happens.

 

In terms of pain after a long day of normal mobility, can I blame my weak quad which is still a couple inches down in size? Good to know that it could also be from the bone bruises which I'd forgotten about. I guess I'm generally trying to figure out what the "new normal" might be without surgery.

 

 

typically, as long as your insurance covers it, you get a custom CTI or donjoy made and should have in a few days. If the dr;s not giving you enough face-time, get a new doctor.  

Hi all.

 

seeing as i am currnetly off games and on rest following my knee giving way i thought'd i'd share my experience of the last 18 months - of particular interest to younger active people who have sustained ACL injuries.  I am female, 28 and a ski instructor in Europe and am almost at the end of the British qualification.  I am a pretty active person esp with sports that involve going up and down things - climbing, MTB and road biking, skiing and touring and have always been reasonably fit.

 

I originally injured my L knee whilst GS (giant slalom) training in France - a complete ACL rupture and strain of MCL.  The french Dr also diagnosed a meniscal tear but the UK Dr didn't with both looking at the same MRI.  The MRI was done a week after the injury and so there was still a reasonable amount of swelling.  I am from the UK and so returned there to see a specialist who i saw 1 month to the day after the injury.  By this time I had given up on the full leg brace the french had given me and was walking almost without a limp as long as I went slowly.  I had started rehab exercises and using a balance board etc from a physio and the knee felt stable.

 

The Dr was pleased with all the stability tests and the strength I had gained over the month and we agreed that I would try a conservative approach for 2 months of intensive physio etc.  I spent 2 months back in the ski resort in France where I spend the winters going to physio and started classic x country skiing which done gently on the flat to start with was brilliant.

 

Three months on I was feeling strong, not 100%, but my knee definately didn't feel unstable at all and I wasn't getting any swelling anymore.  I started climbing and bought a mountain bike to start riding around on as I was about to kill myself listening to French music TV in the gym!

 

The summer and autumn were spent riding a bike as much as poss (100 - 200 miles a week) and up biggish hills in the Alps, doing weights and core exercises to be ready for the winter.  Come November (11 months on) I was the fittest I had been in a long time and desperate to get skiing again which I did with no problems.  I skiied for 2 1/2  months with a brace which included a month of GS race training, bumps, off piste, touring and teaching with no pain or swelling, and my legs felt great! They were so strong from all the rehab they didn't get tired that much and the L knee felt better than the R.  And then in a split second whilst on a L legged turn to the R in a GS course it all came crashing down.  One second I was turning and the next I was sliding headfirst down the snow into a snowdrift at the side as my knee had given way.    I was only able to rest it for a day as had a ski exam to do so I carried on skiing and ate alot of ibufrofen and after about a week felt ok again. 

Only a week later it gave way again this time standing on my skis on a flat bit of snow having my photo taken with the group I was teaching.  busiest week of the season and so was unable to rest it and had to carry on skiing.   Felt ok again after about a week and then a few days later it gave way again getting into the lift queue and someone skiing into the side of me.  So I am now on day 4 of rest and it has made an emormous difference to the knee swelling has pretty much gone and movement is almost back to normal and ready to ski gently to the end of the season as I have a living to earn.  I am now researching and planning to have it operated on as soon as I can after the winter.  

I think what I was lacking was any real rest and recovery which over a few months took its toll and the muscles had just had enough.  Interestingly every Dr I have spoken to here in France and Switzerland have said if you are young and active you should definately have surgery.

 

So there we go every knee is different and even the same ones become different.  if you do go down the no surgery route it is definately do-able, but you need to factor in rest and recovery and really look after it.  unfortunately in the ski teaching industry it isn't always possible!  Good luck to everyone on here!

Just curious, were you wearing a brace at the time of the fall on the GS course?

yes a donjoy fourcepoint with armour I think its called.  I think it probably helped protect the other ligaments from twisting but doesn't stop the tibia moving forwards.

 Had my last appointment with the OS and PT last week.  PT had me doing sprints and cuts without brace to see how stable the knee really is.  The only issue I had was right to left side steps due to the L2 LCL strain.  He mentioned that should continue to heal and should be pain free in the next 3 to 4 months.  My OS is a skier and one of the top surgeons in the area.  We left on the directions that if I begin to have stability issues, we would re-convene and discuss surgery but otherwise to continue to use the brace on high demand activities and continue with exercises to further improve knee stability.  They did say some people are good copmensators for missing ACLs and they don't know why.

 

This past Saturday was the last ski day here in southern Wisconsin.  It was 83° and I skied in shorts and tee shirt (thank goodness for fluro wax).  Overall I only missed 3 to 4 weeks of the season with this injury so I feel very fortunate.  Time will tell on surgery but for now, I will stay the course and make sure I keep stability there.  I will also be making up for missing my trip out west by taking two next year (SLC and Whitefish).  Good luck to everyone on here.  This post has been a great resource for me and I will continue to watch and participate in the discussions.

 

I also forgot to mention, they put me in a Bledsoe Z-12D brace.  This is the Z-12 with the dynamic portion to better protect from anterior drawer of the tibia.  They had this feature on one of their longer braces that will not work with ski boots.  The Z-12 is shorter and works well with ski boots.  If you are looking into one, have your orthotist contact them as mine didn't know about them at first.  I happened to meet the sales rep and discuss options and he put me on to it.  It works much better than the standard Z-12.

Interesting about the device name and Whitefish.  The Bledsoes are here.  My daughter has skied with Drew and his kid.
 

 

There are such a wide range of situations that only you can make your own decision, with the advice of your trusted physician!

 

I had a complete ACL rupture but with NO other damage, and I immediately had moderate instability. After some PT my knee seemed perfectly fine and stable walking around. I had been skiing around 60 days per year and wanted to continue doing so in future years while minimizing my risk of further damage and arthritis down the road. I ended up having a traditional allograft using a piece of achilles tendon from a cadaever, by a highly exerienced/reknown surgeon, as soon as the surgery could be scheduled on his busy calendar. The surgery was done leap day 2008, so just over 4 years ago, and yesterday was my 231st day skiing on the graft over the past 4 ski seasons.

 

The whole cost of surgery, PT, etc., was around $20K and my insurance paid all but $2K since that was my out-of-pocket maximum.

Hokoyo

Im just wondering how the knee is now four years later. I really did a number on mine month and a half ago. My knee is functional but looks kinda distorted. I wonder if it will ever look normal again. Does Yours look normal again  after all this time? I have a clicking sound in mt knee when I move my ankle without any weight on it. 

Wow, very helpful discussion. Tore my ACL and partial MCL tear on March 14, skiing like i did when I was a kid, except i am 46 and more sedentary than before. Just started PT last week. Very eager or rapid improvement. Therapist said 10 minutes on a bike, but I can do 30. Exercises are 2 to 3 times a day, but are very basic. Leg still aches a lot. Just not feeling a direction yet.

How are you now?