Bad News Today....seeking advice

[JohnnyB]

Back in early December I hyperextended my knee playing soccer. It immediately swelled up. Initial exam by Dr. and Orthopedic led them to believe there was no structural damage. Swelling has continued to erupt regularly. Ortho suspected a torn meniscus and did an MRI. Today, I got the news that I tore the ACL. Now my head is spinning with questions....of course, I will be asking the surgeon these questions and more but am looking for insight from Tex and others that have been here recently....

Could I get the brace and do lots of PT/training to strengthen and stabilize so I barefoot through the summer and get the surgery in fall???
What is the risk of doing this??
If I do it now, I'm not back on the water for at least 6mos......
How long should I plan on being off work?
Patellar graft or cadavar tendon?

BTW I turn 42 in July....

[mwg]

You may want to look at this thread.. there is some pretty good info concerning ACL tears & surgery

http://mastercraft.com/teamtalk/showthread.php?t=51621&highlight=surgery

Good luck

[drschemel]

You will get all sorts of "advice" so take this for what it's worth. The ACL provides knee stability front to back and without it, you knee has a tendancy to "pivot shift" causing a sudden loss of strength and buckling when you walk. In time, this abnormal motion with damage the articular cartilage and you will develop arthritis. In the short term (like over the Summer) you risk tearing one of the meniscal cartilages if you knee gets torqued. A brace with hinged metal side stays will help protect againt this and would probably take you safely through the Summer. If you decide on this course, you will need to be doing quad exercises to avoid loosing leg stength. Some people are able to compensate well enough with strong quads and don't have the surgical repair done. Most people will go ahead with a surgical repair. Your surgeon can best advise you as to what type. Unfortunately, any repair can fail. A tendon repair with either cadaver or autologous tendon graft will most closely restore the natural knee mechanics and may reduce your risk of arthritis down the road. This is usually done in women or men with smaller muscles as it might not be quite as strong and may fail more often. The patellar tendon reposition is thought to be a stronger repair and more often done for people with larger muscles or people that are going to demand a lot from their knees (like skiers, boarders, etc). It does change the knee mechanics slightly and you will be looking at a knee replacement in 20 or 30 years.
Good luck on your rehab. It's a bummer of an injury.

[TayMC197]

Been there, get a good brace and your fine

[_fng_]

You will get all sorts of "advice" so take this for what it's worth.

^^ excellent write up! And the same goes for my post regarding online advice! There has been a lot of research recently looking at those that can function with and without an ACL (copers vs non-copers). Major predictors for being able to return to high level function without requiring ACL reconstruction include: normal range of motion, no or minimal knee swelling (sounds like you're not fitting this category), good quad strength, good static and dynamic balance (proprioception), and no episodes of the knee giving way. These are just guidelines though and a decision should be made after discussing pros/cons with your surgeon. Most people opt for the surgery because return to high level function afterwards is high. Return to high level function postop is variable (Adrian Peterson vs Derrick Rose) and dependent on many factors but research indicates that going into surgery with full ROM, good quad strength, and minimal swelling helps the rehab process. Below is a powerpoint that covers the topic and explains a lot.

Good luck and don't half-a** the rehab!!

http://sportsmed.bartonhealth.org/PDF/Do%20All%20ACL%20Injuries%20Require%20Surgery.pdf

[JohnnyB]

You may want to look at this thread.. there is some pretty good info concerning ACL tears & surgery

http://mastercraft.com/teamtalk/showthread.php?t=51621&highlight=surgery

Good luck

Thanks...did a search on ACL and nothing came up.

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[TxsRiverRat]

Mike ("Tex") made the mistake of trying to come back too early from his ACL and he ended up re-injuring himself and that I believe cost him 2 seasons on the water. Now that he is 'recovered' he skis with a brace all the time.

[bcd]

Is the meniscus torn at all? If not, I would advise against waiting until after season and trying to barefoot with a brace. I'm not a Dr, and I didn't stay in a Holiday Inn, but a torn ACL sucks and is a very painful procedure and recovery, but once you are through with it, it usually doesn't have lingering effects. Torn meniscus constantly gives people trouble. The knee swells up with fluid after activities. The only treatments are draining the fluid, cortizone shots, and scoping the knee to cut off the loose pieces, which then fray more.

If the meniscus is torn, you still risk tearing it more, which could increase your risk to potential problems down the road. I don't know if you have winter sports or not. I snow ski, so when I tore mine in June, I did surgery right away. Waiting for a down season wasn't an option for me. Plan on 6 months after surgery (minimum), depending on which option you go with and how hard you do PT. I had surgery in July and skied the mountains over Christmas break.

I did the patellar tendon. I didn't tear any meniscus, and my knee never bothers me anymore. It does hurt to kneel on hard surfaces, which is a negative to the patellar tendon option. I've never heard of the patellar tendon option causing knee replacements down the road as drschemel says. Drschemel, do have any weblinks to studies done on that?

[onejdgreen]

I've had 2 major reconstructive surgeries on my knee, of course this was 15 years ago. Do the surgery now, IMO. Miss the skiing this summer and do the rehab! The rehab is the most important part. Even if you wait until this fall to do the surgery, there is a chance that you won't be able to ski next summer. Not everyone is Adrian Peterson and can come back 8 months after an ACL surgery to be better than they were before!

[gocougs]

Had both ACL surger done when I was 42 and had the meniscuse on the same knee a year ago. I am always a proponent of surgery instead of dealing with the mental aspect of doing more damage or having it give out any time. I don't have any ill effects now and it is strong. I also had a torn achilles on the same leg about 13 years ago and no effects except scars. All from playing football on the old astro turf through college.

[94PS190]

8 surgeries on my right knee, Choose the options that make the most sence to you, but most importantly, Check out your doctor. Just like everything else, there are good ones and bad ones. I went to a highly recomended practice to later find out my doctor wan not the so highly thought of.

[TxsRiverRat]

Where can he get some deer antler spray?

[JohnnyB]

Where can he get some deer antler spray?

That crossed my mind. Going to go look for sheds tonight.....

Major predictors for being able to return to high level function without requiring ACL reconstruction include:

normal range of motion - RESTRICTION IS I CAN'T RUN
no or minimal knee swelling - MINIMAL TO MODERATE
good quad strength - NOT AN ISSUE
good static and dynamic balance - DOESN'T SEEM TO BE AN ISSUE
no episodes of the knee giving way - NO ISSUE

Very similar to my Dr.'s and my discussion today. _FNG_ are you a PT??

[kodiak]

My wife just had her ACL FCL, PCL and Posterolateral corner replace by this guy.
http://drrobertlaprademd.com/complex...ament-injuries
They suspect the reason her injury was so bad was her ACL, which was done 20 years ago
was weak. She had surgery 5 weeks ago and still can't walk on it.

[tex]

Mike ("Tex") made the mistake of trying to come back too early from his ACL and he ended up re-injuring himself and that I believe cost him 2 seasons on the water. Now that he is 'recovered' he skis with a brace all the time.

I know this guy you call Mike("Tex") and no he didn't try to come back too early. He was skiing with a great ortho's advice on what he could and couldn't do and suffered a freak injury the 2nd time riding a sky ski. They have written this Tex guy up in medical journals to try and figure out why this happened! I bet his insight would be trust your doctor! There has been so much advances in the area of operations. I took double cadaver and double hamstring grafts. An ACL is a day at the lake compared to what it used to be! If you want to have some fun, try an ACL/MCL/PCL! Good luck, listen to the doctors(they have a big head for a reason-Unlike others here), and do your PT! Oh yes....Doctor says wear my DonJoy at everything above a jog so I wear it every time I ski and enjoy the heck out of it and I hate braces!