ACL and Meniscus repair without surgery

FailBetter

Semi-Pro
A week ago, I played on hardcourts for the first time and immediately injured my right knee.
I tore my MCL, ACL, and Meniscus. The MCL should heal on its own.
Has anyone here managed to recover from an ACL and Meniscus injury using only physical therapy, without undergoing surgery?

I think if it were only the ACL, I might try recovering without surgery. But I'm not sure about this combined injury. Can the Meniscus heal if the ACL is also compromised?
 

FailBetter

Semi-Pro
thx man! he recommends surgery but thats also his job. was just wondering if somebody came back without surgery.
I know that its possible for MCL and ACL to heal and/or stabilize the knee to play tennis again.
 

andfor

Legend
thx man! he recommends surgery but thats also his job. was just wondering if somebody came back without surgery.
I know that its possible for MCL and ACL to heal and/or stabilize the knee to play tennis again.
Hope you get a response. I haven't experienced that specific injury myself.

You've probably already considered it, but a 2nd opinion WILL be in your best interest. If you have X-Rays and MRI's and I'm guessing you do, that would make the 2nd opinion procedure go faster, at least it did for me. FYI, my second opinion was done virtually, covered by my insurance, etc.

Searching the internet (I know medical professionals cringe), it seems MCL/ACL non-surgical options are less clear. At a glance it seems the grade of the tears guide the physicians decision to operate or suggest rehab. The following two articles may help.



Good luck.
 
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WYK

Hall of Fame
Get another opinion. Not because I disagree, but it will help you. It is the only body you have, spend the time and money on it.
I tore my MCl very badly once. I didn't play tennis for over a year. And it took two years before the muscles started to act and look normal.
And this with me being able to 'walk' off the court when it happened.
 
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Jst21121

Rookie
A week ago, I played on hardcourts for the first time and immediately injured my right knee.
I tore my MCL, ACL, and Meniscus. The MCL should heal on its own.
Has anyone here managed to recover from an ACL and Meniscus injury using only physical therapy, without undergoing surgery?

I think if it were only the ACL, I might try recovering without surgery. But I'm not sure about this combined injury. Can the Meniscus heal if the ACL is also compromised?

Wow... talk to your doc about that. My hitting partner tore his ACL and had to have surgery. 1 year off the courts minimum and he doesn't even know when he can go 100%...it might be 2-3 years. ACL tears are basically known as career ending injuries for professional athletes. If a professional athlete cannot go back to normal with the best surgeons around- then your chances aren't exactly the best.

This is serious injury. Tennis isn't worth gimping your life over.
 

ollinger

G.O.A.T.
Waiting to see if things heal on their own has at least two major disadvantages:
1) they frequently don't.
2)) the instability in the knee while you wait causes trauma within the knee joint that can cause arthritis, which studies have shown makes attempts to repair a meniscus later on largely pointless and ineffective.

You should get at least two good orthopedist opinions.
 

socallefty

G.O.A.T.
I’ve seen a lot of knee injuries from playing multiple sports. I’ve never seen anyone even try to recover from two torn knee ligaments without surgery. If you get a second opinion, surgery will likely be recommended by that doctor also.
 

mikeler

Moderator
I apparently tore my ACL in college. Never got it checked out back then (stupid I know). It took a year to play sports again and I did so without problems until around age 45.

That's when I had a very bad bucket handle meniscus tear in the same knee and an MCL sprain. I couldn't straighten my leg and found out I was "missing" my ACL after getting an MRI. It was completely gone, no sign of it. I got the ACL replaced and the meniscus trimmed off since I still hopefully have a few more decades of tennis left to play.

I took physical therapy afterward seriously. It took a long time for the swelling to go down in my knee. I could straight line run on a treadmill at 3 months post surgery, hit tennis balls (no cutting) at 4 months, doubles at 5 months and singles at 6 months. Good luck and like others said it doesn't hurt to get a 2nd or 3rd opinion.
 

Bxb

Rookie
A week ago, I played on hardcourts for the first time and immediately injured my right knee.
I tore my MCL, ACL, and Meniscus. The MCL should heal on its own.
Has anyone here managed to recover from an ACL and Meniscus injury using only physical therapy, without undergoing surgery?

I think if it were only the ACL, I might try recovering without surgery. But I'm not sure about this combined injury. Can the Meniscus heal if the ACL is also compromised?

I tore my medial meniscus (a bucket handle tear), and one thing I learned after reading a ton about meniscus injuries is that apparently they have a higher chance of healing if repaired with concomitant ACL reconstruction. As opposed to fixing an isolated meniscus injury. I've understood it has to do with the body diffusing nutrients from the ACL repair site also to the adjacent meniscus which has rather poor blood supply on its own. A big portion of a meniscus is avascular. A potential silver lining in your case OP, if it comes down to a surgery.

Depending on the type and location of the meniscus tear, they may also heal on their own. The smaller the tear, the closer to the outer rim (so called red red zone), and the younger the person, the better the chance of the tear healing on its own. But to my understanding it's still a slower process. For the time being one needs to avoid twisting and bending the knees too much. The tear should be allowed to remain stable for it to be able to heal, and a deeper kneebend especially puts a good bit of pressure on the meniscus. The tear I had typically requires an operation. I was unable to fully extend my knee due to sth (likely part of the meniscus) physically preventing the action. I had mine operated roughly a year ago, but it may have failed to heal despite my full dedication to the rehab. Going to have another MRI in a few days and will find out soon. No knowledge on whether ACL injuries can heal on their own. From what I've read the consensus seems to be no, but apparently there are also some differing POVs.
 
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nyta2

Legend
A week ago, I played on hardcourts for the first time and immediately injured my right knee.
I tore my MCL, ACL, and Meniscus. The MCL should heal on its own.
Has anyone here managed to recover from an ACL and Meniscus injury using only physical therapy, without undergoing surgery?

I think if it were only the ACL, I might try recovering without surgery. But I'm not sure about this combined injury. Can the Meniscus heal if the ACL is also compromised?
i got my ACL replaced decades ago... but from what i remember when doing research back then:

the severity of a tear matters...
if it's full tear (grade3?), to replace it is the only option.
if it's just a tiny tear (grade1?), can heal on it's own
but it's the grey area (grade2) in between that makes the decision for surgery harder... ie is it closer to 3, or to 1? grade2 could take longer to heal (ie. if it's "hanging on by thread") than a complete replacement.
but to know for sure, how much it's torn, also requires surgery, minor, but still surgery :(

i also recall you can survive perfectly fine without an ACL, even play sports, etc... (pre-ACL-replacement-surgery I did a full 100d season of snowboarding - looking back it was dumb)... BUT (per my doc) if you again find yourself in the same type of compromising position that tore your ACL in the first place (especially the twisting variety), you will likely also tear all the other supporting knee ligaments {MCL, LCL, PCL}... i always thought of the ACL as a "circuit breaker" in this mental model.
 

FailBetter

Semi-Pro
Thx for all the helpful messages.
Will see my doctor again on monday.
ATM I think I will go for the surgery.

Just because of what ive read and my current situation,
being in my early 30s ACL fully torn, meniscus partial torn and I want to go back to sports/tennis in a condition as good as possible.
 

artdeco

Semi-Pro
How did you manage to tear both MCL ACL and meniscus?
That kind of injury is normally seen in skiers or soccer/american football tackles where massive forces are applied to the knee in the wrong direction.
 

yossarian

Professional
My personal bias would be to attempt to rehab conservatively and determine if I’m a coper or non coper. Some people can get strong enough to the point where they don’t have any functional instability

That said, most docs are going to recommend surgery for a complex multi ligament injury especially if you are younger with aspirations of returning to higher impact sport/activity
 

FailBetter

Semi-Pro
How did you manage to tear both MCL ACL and meniscus?
That kind of injury is normally seen in skiers or soccer/american football tackles where massive forces are applied to the knee in the wrong direction.
first time played on that kind of hardcourt and landed with a somewhat straight leg and the court just stopped abruptly what i wasnt used to I think.
a little bit far away, but I have it on tape.
For everyone dont do this on hardcourts:
 

Jst21121

Rookie
first time played on that kind of hardcourt and landed with a somewhat straight leg and the court just stopped abruptly what i wasnt used to I think.
a little bit far away, but I have it on tape.
For everyone dont do this on hardcourts:


Jeez crazy how fast life can change. For a pro this a career ending injury… for a rec player this is a 1-2 year break from tennis with possible residual injury where you can’t run or jump or play tennis like you used to.

What’s scary is that it looks so normal- you running for a backhand. Nothing crazy at all. Not a hard ball to return, not a wierd angle, not a crazy jump.

Getting old sucks :(
 

Jst21121

Rookie
yes things can change very fast!


absolutely had a foot injury (minor), hip injury (from skiing, with surgery in 2022), and now knee. everything after I turned 30.
before I never had any injury or other issues with my body

36 here and I think 35 was my turning point…
 

FailBetter

Semi-Pro
Which injuries did you guys experience?
At the same time, I see 60+ players here moving quite well and fast around the court.

I also wonder if my injury would have occurred had I stuck to the courts I'm familiar with.
 

Fintft

G.O.A.T.
Minor meniscus problems alone, might cure on their own(popping back in) or with the help of Glucosamine(in 2 weeks for me). For a major one and thorn ligaments, I had surgery (after 6 months wait) in high school.
 

Shroud

Talk Tennis Guru
My meniscus healed on its own six years later I could tear it again. It has healed again. The doc said if it healed he had done his job, and if it didn't then we would do surgery and he would do his job.
No clue on acl.
 

Injured Again

Hall of Fame
Which injuries did you guys experience?
At the same time, I see 60+ players here moving quite well and fast around the court.

I also wonder if my injury would have occurred had I stuck to the courts I'm familiar with.

Best of luck if you have the surgery. I was just talking to a guy today who is in his 60's and had an ACL repair not long ago. He's still as fast around the court as most guys in their 40's.

Being 62, I learned tennis in the days when it wasn't a thing to slide on a hard court. I see juniors and younger adults doing that all the time and it just amazes me that you can play on a court for the first time and manage to slide not knowing how grippy the surface is.
 

nyta2

Legend
straight leg
another thing i learned from my acl injury: you can actually play tennis with no acl (mine was torn and i actually did play after swelling subsided).. as long as you keep your knees bent (same with snowboarding, was able to finish the season with no acl)...
but stay in a "knee-bent-athletic-position" all the time takes alot of energy & conditioning
which is when i adopted the mantra of "you need to get in shape to play tennis, not play tennis to get in shape..."
 

yourtennisfit

Professional
So if you really have ACL, MCL and meniskus torn - get the surgery!
In most cases the surgeon will find additional damage within the knee (capsula etc) which can result in scar tissue and further problems

You don't just want to get back to the court asap, but also live healthy and have a good knee in the long-run, right?
And this surgery, if done well, can help with all of this :)

I know the outlook of surgery isn't always super great and especially a 3 hour knee surgery will frighten people.
But for me, I tore 4 ligaments in my foot once and healed it without surgery - lots of therapy etc
After 2 years, my foot out of nowhere would start swelling and the scar tissue got trapped in the ankle apparently, so I had to get it fixed nevertheless
 

FailBetter

Semi-Pro
A little update:
I had surgery at the beginning of february (4.5 months ago). They flushed out a lot of fluid because my knee was still swollen during the surgery. Replaced my ACL and fixed the meniscus. MCL healed itself. Doing a lot of PT, stretching etc since day 1 (after surgery). I am already back on court hitting some easy balls since maybe 3 Months after surgery. Almost no pain anymore. The knee/leg is still not very strong and not 100% flexible atm, but I'm working on it. For going back to competion I think it will take 9-12 months. I am not planing to play any matches this year.
 

mikeler

Moderator
A little update:
I had surgery at the beginning of february (4.5 months ago). They flushed out a lot of fluid because my knee was still swollen during the surgery. Replaced my ACL and fixed the meniscus. MCL healed itself. Doing a lot of PT, stretching etc since day 1 (after surgery). I am already back on court hitting some easy balls since maybe 3 Months after surgery. Almost no pain anymore. The knee/leg is still not very strong and not 100% flexible atm, but I'm working on it. For going back to competion I think it will take 9-12 months. I am not planing to play any matches this year.

Since I had my ACL and meniscus trimmed (plus the MCL healing itself), my timeline was month 3 I would run on a treadmill only, no cutting. Month 4 I started hitting again with little running. Month 5 I graduated to doubles and Month 6, I finally started playing singles again on a limited basis. Somewhere between 9 months and a year, I was back playing singles several times per week.
 

FailBetter

Semi-Pro
Since I had my ACL and meniscus trimmed (plus the MCL healing itself), my timeline was month 3 I would run on a treadmill only, no cutting. Month 4 I started hitting again with little running. Month 5 I graduated to doubles and Month 6, I finally started playing singles again on a limited basis. Somewhere between 9 months and a year, I was back playing singles several times per week.
Sounds like a quick recovery. My doctor said it takes about 12 months for the ACL to fully heal in the bone. Did you play with a knee brace? How old were you at the time of the inury?
 

mikeler

Moderator
Sounds like a quick recovery. My doctor said it takes about 12 months for the ACL to fully heal in the bone. Did you play with a knee brace? How old were you at the time of the inury?

I think my doc said about the same thing for full strength. He said I could hit balls at 3 months but I wasn't mentally ready for it, so I waited an extra month. His big thing was to get the quads and hamstrings strong which I did. Did you get a cadaver ACL?

I didn't play with a brace but a knee sleeve for a long time. My injury/surgery were just before and after my 45th birthday.
 

FailBetter

Semi-Pro
No, they used a hamstring graft for my ACL reconstruction. Did you receive a cadaver ACL? Yes, I lost a lot of muscle mass, especially in my quads and hamstrings. It also seems to not be coming back quickly despite doing my exercises regularly.
 

nyta2

Legend
landed with a somewhat straight leg...
I also wonder if my injury would have occurred had I stuck to the courts I'm familiar with.
main issue is not landing with a sufficient bend (eg. let muscles absorb impact)... typically would happen to me when: (a) i'm running on the full stretch - eg. dropshot (b) need to stop abruptly (eg. gonna touch the net) (c) am too tired (mentally and/or physically) to maintain good form (knees bent!)

arguably if you're used to playing on something more slippery where you might slide (eg. clay), it might have saved you
No, they used a hamstring graft for my ACL reconstruction. Did you receive a cadaver ACL? Yes, I lost a lot of muscle mass, especially in my quads and hamstrings. It also seems to not be coming back quickly despite doing my exercises regularly.
interesting... did you have an option for an allograf? now you have to recovery from both the knee surgery AND the hamstring surgery... which from my recollection is a longer recovery (including geting muscle mass/strength back to where it was)... i had an allograf...

my decision model:

* allograf
PRO: faster recovery (only knee surgery)
CON: chance of rejection of ligament from cadaver (requiring doing it again)

* hamstring graft
PRO: no chance of rejection
CON: must heal in 2 places
<side note: i also always presumed it would weaken my hamstring liga/tend, but doc mentioned in usually is never an issue>
 

mikeler

Moderator
main issue is not landing with a sufficient bend (eg. let muscles absorb impact)... typically would happen to me when: (a) i'm running on the full stretch - eg. dropshot (b) need to stop abruptly (eg. gonna touch the net) (c) am too tired (mentally and/or physically) to maintain good form (knees bent!)

arguably if you're used to playing on something more slippery where you might slide (eg. clay), it might have saved you

interesting... did you have an option for an allograf? now you have to recovery from both the knee surgery AND the hamstring surgery... which from my recollection is a longer recovery (including geting muscle mass/strength back to where it was)... i had an allograf...

my decision model:

* allograf
PRO: faster recovery (only knee surgery)
CON: chance of rejection of ligament from cadaver (requiring doing it again)

* hamstring graft
PRO: no chance of rejection
CON: must heal in 2 places
<side note: i also always presumed it would weaken my hamstring liga/tend, but doc mentioned in usually is never an issue>

I also did the allograft due to the shorter recovery time. My doc recommended it but said he can do it either way. Some of my 40 and over teammates said the USTA might disqualify me for having a body part less than 40 years old after the surgery. ;)
 
I also did the allograft due to the shorter recovery time. My doc recommended it but said he can do it either way. Some of my 40 and over teammates said the USTA might disqualify me for having a body part less than 40 years old after the surgery. ;)
USTA also says people can't have dampeners above the bottom most cross string in their racquets, and foot faults are not not allowed and players should self regulate their own feet positions on serves...

I think you'll be just fine under these USTA "suggestions".
 

mmk

Hall of Fame
I also did the allograft due to the shorter recovery time. My doc recommended it but said he can do it either way. Some of my 40 and over teammates said the USTA might disqualify me for having a body part less than 40 years old after the surgery. ;)
I just tell people that if I kick them it isn't my fault, the allograft must have been from some evil guy who likes to kick people.
 
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