ACL tear - without surgery

S

sachin_patel

New User
Hi Guys,

Sorry for long description. Here goes my story.

I had a knee injury about 3 months ago. I went to doctor and he said my ligament feels loose so lets do MRI. MRI Results showed partial tear in knee but he said It looks like you have complete tear. (Because you have bone bruises and usually that happens with complete tear). I haven't torn my meniscus.

I went to another doctor for second opinion. He also said you have complete tear looking at MRI.

All this time my knee doesn't feel unstable. So far it gave way only once on the day I was injured.

The first doctor prescribed Physical Therapy as I was skeptical about operation.

After a month i had followup appointment yesterday and he said, my knee feels pretty stable to him. no need for surgery.. call us back if you have instability.. continue exercise and use a brace.


I am now worried if this is bad decision for long term... has anyone done something like this?

Thanks in advance.
 
Look out for when you are not ready/musculature not activated; stepping off a curb; going down steps cold; a bad spot.

All depends on your athletic life/goals. If you don't fix and knee becomes unstable at wrong spot and you tear your meniscus...

Then there's not much you'll be able to do (technically).
 
ACL surgery is an ELECTIVE surgery.

There's no way to know if by not getting the surgery, that down the road you'll develop arthritis because your knee has been traumatized which has possibly planted the seed of OA. Plus because a main stabilizer of the knee is gone, your body will have to compensate with other parts to order to maintain the stability of the knee, which may add to compression forces which could possibly contribute to the development of OA.

But that's not to say that by getting the ACL reconstructed that down the road you WON'T get any OA, again your knee has been traumatized, now twice - once for the initial injury and another for the surgery. Again, that in of itself may have planted the seed for OA.

Don't give into the fear of other people telling you oh you might hurt something by stepping off the curb or stairs bc you don't have an ACL....like you can't do with a knee that has an ACL?

You're not feeling any instability with your knee at this moment which is good. Bc if you were, then the surgery wouldn't even be questioned.

The question you have to ask yourself is can I tolerate being out a good 6 months minimum from all sports activities because that's the time frame for the rehab. 6 months MINIMUM. And that's just the time frame. I'm not going to get into how much work it is in this post.
 
See if you can throw a football.

I tore my ACL (and partial tear of LCL) playing basketball. After a couple of days I went to the doctor. He did all the standard manipulations to see if the ACL was loose, and it did not appear to be (this was before MRI's were common, and my legs were exceptionally strong back then). I skied and played tennis on it just fine, though it felt a little strange. However, one day I threw a football to my son. I fell over. I tried again. I fell over again. Something about planting the front leg and then twisting over it when throwing a football just could not be done with the torn ACL.
 
RogueFLIP said:
ACL surgery is an ELECTIVE surgery.

There's no way to know if by not getting the surgery, that down the road you'll develop arthritis because your knee has been traumatized which has possibly planted the seed of OA. Plus because a main stabilizer of the knee is gone, your body will have to compensate with other parts to order to maintain the stability of the knee, which may add to compression forces which could possibly contribute to the development of OA.

But that's not to say that by getting the ACL reconstructed that down the road you WON'T get any OA, again your knee has been traumatized, now twice - once for the initial injury and another for the surgery. Again, that in of itself may have planted the seed for OA.

Don't give into the fear of other people telling you oh you might hurt something by stepping off the curb or stairs bc you don't have an ACL....like you can't do with a knee that has an ACL?

You're not feeling any instability with your knee at this moment which is good. Bc if you were, then the surgery wouldn't even be questioned.

The question you have to ask yourself is can I tolerate being out a good 6 months minimum from all sports activities because that's the time frame for the rehab. 6 months MINIMUM. And that's just the time frame. I'm not going to get into how much work it is in this post.
Click to expand...


yeah.. i don't mind being out for 6 months.. i don't like it but i have to do it for my knee..
 
waves2ya said:
Look out for when you are not ready/musculature not activated; stepping off a curb; going down steps cold; a bad spot.

All depends on your athletic life/goals. If you don't fix and knee becomes unstable at wrong spot and you tear your meniscus...

Then there's not much you'll be able to do (technically).
Click to expand...

That is also something I am afraid of.. I know I won't be careful all the time..
 
NLBwell said:
See if you can throw a football.

I tore my ACL (and partial tear of LCL) playing basketball. After a couple of days I went to the doctor. He did all the standard manipulations to see if the ACL was loose, and it did not appear to be (this was before MRI's were common, and my legs were exceptionally strong back then). I skied and played tennis on it just fine, though it felt a little strange. However, one day I threw a football to my son. I fell over. I tried again. I fell over again. Something about planting the front leg and then twisting over it when throwing a football just could not be done with the torn ACL.
Click to expand...

You mean throw a football with hand or kick it with the good leg?
 
Throwing the football. The front leg plants into the ground and the body rotates over it as you throw. I could toss a baseball around without a problem.
 
I'm a 40yo female and tore my ACL in April playing tennis. I also had a tibia contusion form the force of the rupture and a minor lateral meniscus tear.

Did you see an orthopedist or a GP? My MRI was read by three different radiologists, and only one recognized that my ACL was torn (complete). My GP claimed my ACL seemed fine after his exam, but an orthopedist was able to notice the tear on his exam.

I just had the reconstructive surgery two weeks ago. I decided to do it because I want to continue to play tennis, which because of the movements specific to the sport really shouldn't be played without an ACL.

I was pretty worried about the surgery, but I am glad I did it, happily reporting that I have been walking, almost normally, for several days now. I am really amazed at how quickly I am recovering from this procedure.
 
I tore my ACL at 21 in my first rugby game my sr year.
It took about 6 months and 5ish doctors to diagnose it. Which means I lived without an ACL for quite some time. I went skiing/snowboarding and tried other sports, but never felt right, which is why I went back to the doc.
I had the surgery, and can't imagine life without having done it.
12yrs later, my "repaired" leg is just as strong as my other leg, and I never think about my knee when doing anything. I have never been limited doing anything because of the knee, this includes tennis, bball, rugby, skiing, soccer, you name it.
I would say if you have any issues at all with the knee to go for surgery. It has advanced so much that it really isn't even a big deal anymore, and 6 months rehab is nothing, if you don't have to think about it going forward.
 
RiceWithThat said:
I'm a 40yo female and tore my ACL in April playing tennis. I also had a tibia contusion form the force of the rupture and a minor lateral meniscus tear.

Did you see an orthopedist or a GP? My MRI was read by three different radiologists, and only one recognized that my ACL was torn (complete). My GP claimed my ACL seemed fine after his exam, but an orthopedist was able to notice the tear on his exam.

I just had the reconstructive surgery two weeks ago. I decided to do it because I want to continue to play tennis, which because of the movements specific to the sport really shouldn't be played without an ACL.

I was pretty worried about the surgery, but I am glad I did it, happily reporting that I have been walking, almost normally, for several days now. I am really amazed at how quickly I am recovering from this procedure.
Click to expand...
thanks for encouraging words.. which acl graft did you use?
 
Sumo said:
I tore my ACL at 21 in my first rugby game my sr year.
It took about 6 months and 5ish doctors to diagnose it. Which means I lived without an ACL for quite some time. I went skiing/snowboarding and tried other sports, but never felt right, which is why I went back to the doc.
I had the surgery, and can't imagine life without having done it.
12yrs later, my "repaired" leg is just as strong as my other leg, and I never think about my knee when doing anything. I have never been limited doing anything because of the knee, this includes tennis, bball, rugby, skiing, soccer, you name it.
I would say if you have any issues at all with the knee to go for surgery. It has advanced so much that it really isn't even a big deal anymore, and 6 months rehab is nothing, if you don't have to think about it going forward.
Click to expand...
Thanks, I am planning to go to another doctor in couple of days.

Which acl graft did you use? both the doctors i visited suggested if i have to go for surgery, cadaver graft works for me..
 
What is the best way to prevent ACL tear ?? is there a good stretching excercises ? or that kind of thing doesn't help at all in preventing this injury.

This question is for people never had ACL tear and also for those who had it and have recovered.
 
RiceWithThat said:
I'm a 40yo female and tore my ACL in April playing tennis. I also had a tibia contusion form the force of the rupture and a minor lateral meniscus tear.

Did you see an orthopedist or a GP? My MRI was read by three different radiologists, and only one recognized that my ACL was torn (complete). My GP claimed my ACL seemed fine after his exam, but an orthopedist was able to notice the tear on his exam.
Click to expand...

I'm not surprised with the confusion. I don't know too many GP's who are familiar with most of the "special tests" that orthopedist's do. Well, familiar, maybe, but experienced, maybe not so much.

But even ortho's can be wrong. Just don't tell them that. :)
Ortho referred me a young kid with a "knee strain". Parent said ortho cleared knee, everything was intact. Ortho contradicted what was on MRI report of ACL tear. Now, I'm not a radiologist, just a lowly physical therapist, I'm not great at reading films, but even I could see the gap where the ACL was missing. And my exam also confirmed the tear. But the ortho was having none of it. "I've been doing this for 30 years, 1000s of patients, surgeries, yadda, yadda....the kid doesn't have a tear".

Always get a 2nd or 3rd opinion if something doesn't feel right.

RiceWithThat said:
I just had the reconstructive surgery two weeks ago. I decided to do it because I want to continue to play tennis, which because of the movements specific to the sport really shouldn't be played without an ACL.

I was pretty worried about the surgery, but I am glad I did it, happily reporting that I have been walking, almost normally, for several days now. I am really amazed at how quickly I am recovering from this procedure.
Click to expand...

Getting back to normal activities of daily living shouldn't take that long. Regaining the strength and proprioception awareness of a sport, THAT'S where the time comes into play.

Hope you found a good physical therapist, don't rush the rehab, and I hope you have a speedy recovery. Good luck.
 
RiceWithThat said:
I just had the reconstructive surgery two weeks ago. I decided to do it because I want to continue to play tennis, which because of the movements specific to the sport really shouldn't be played without an ACL.
Click to expand...

Again, it's an ELECTIVE surgery. I know pleny of people and patients who compete in sports activities without an ACL.

Personal note: uncle (professor at NorthWestern University - so he's an intelligent guy who did his research) with complete tear of ACL....runs, does Brazillian Jiu-Jijitsu.....no problems.

Another physical therapist friend of mine, complete tear of ACL.....owns his own business, so isn't able to take the time off...but that was only part of the reason to forgo the surgery....lots of rehab, but again, runs, other athletic endeavors, going for 2nd degree black belt in karate....no problems....

It's possible to survive without one. And yes playing tennis too.

But if you feel like you want to get it done for peace of mind, by all means, get the surgery.

I'm just trying to paint the picture that you can function very well without one.
 
Nostradamus said:
What is the best way to prevent ACL tear ?? is there a good stretching excercises ? or that kind of thing doesn't help at all in preventing this injury.

This question is for people never had ACL tear and also for those who had it and have recovered.
Click to expand...

There isn't a specific exercise/stretch/program designed to prevent ACL tears.

You'd be surprised what a generalized strength and conditioning/flexibility program can do to prevent injuries and aid in recovery times for small nagging things.

But in the end, if it's your time, it's your time. :oops:
 
Patel - I should have added I'm a '92 ACL (patella graft) recovery story; some my walk is in this forum...

Also - there are now numerous protocols for ACL 'prehabilitation', many focusing on female athletes. Mike Boyle, Grey Cook - a lot of single leg work and lateral motion drills...

Folks know a lot about the injury now; deceleration key...

Charlie may weigh in.
 
RogueFLIP said:
Again, it's an ELECTIVE surgery. I know pleny of people and patients who compete in sports activities without an ACL.

Personal note: uncle (professor at NorthWestern University - so he's an intelligent guy who did his research) with complete tear of ACL....runs, does Brazillian Jiu-Jijitsu.....no problems.

Another physical therapist friend of mine, complete tear of ACL.....owns his own business, so isn't able to take the time off...but that was only part of the reason to forgo the surgery....lots of rehab, but again, runs, other athletic endeavors, going for 2nd degree black belt in karate....no problems....

It's possible to survive without one. And yes playing tennis too.

But if you feel like you want to get it done for peace of mind, by all means, get the surgery.

I'm just trying to paint the picture that you can function very well without one.
Click to expand...
This is definitely true, but depends on how your knee is built. I personally couldn't have done much had I not had the surgery. I had it collapse multiple times just walking around.
sachin_patel said:
Thanks, I am planning to go to another doctor in couple of days.

Which acl graft did you use? both the doctors i visited suggested if i have to go for surgery, cadaver graft works for me..
Click to expand...
I went patella, but mostly because that was what my surgeon did. My surgery was also in 2001, and orthopedics have advanced a lot since then, so it's very possible it would be done differently if I had it today.
RogueFLIP said:
There isn't a specific exercise/stretch/program designed to prevent ACL tears.

You'd be surprised what a generalized strength and conditioning/flexibility program can do to prevent injuries and aid in recovery times for small nagging things.

But in the end, if it's your time, it's your time. :oops:
Click to expand...
I'm convinced mine happened because I was out of shape. Vowed afterwards to never let that be the reason for something like that again.
 
Sumo said:
This is definitely true, but depends on how your knee is built. I personally couldn't have done much had I not had the surgery. I had it collapse multiple times just walking around.


I went patella, but mostly because that was what my surgeon did. My surgery was also in 2001, and orthopedics have advanced a lot since then, so it's very possible it would be done differently if I had it today.
Click to expand...

Most reconstructions today are done allograft (cadavar patella graft) vs autograft (your own patella tendon). Of course some doctors will give you a choice, some doctors prefer one way versus another. In the end, I don't see too much difference in total recovery time for either way in the clinic.

Sumo said:
I'm convinced mine happened because I was out of shape. Vowed afterwards to never let that be the reason for something like that again.
Click to expand...

While I'm sure being out of condition was a factor in your injury, just because you're in some kind of shape cannot guarantee you won't injury yourself (ACL or other injury).
 
Hines Ward, the former NFL Pittsburgh Steeler wide receiver and Georgia standout, did not have an ACL due to a bicycle accident as a kid. It was only found out when the NFL teams did a per-draft physical after college. I'm told if you have amazing hamstring strength it isn't necessary; most people don't.
 
interestingly i read below.. not sure how many believes this..

i already have surgery scheduled in two weeks and my knee feels normal right about now.. not sure what to do..
 
A cousin of mine tore his ACL playing basketball and had several doctors look at him. Like stated before surgery is elective. One doctor asked him...How much do you want to go back to playing right away? Went through the risks and what can happen with surgery.

That doctor informed him, that it is always best to avoid surgery whenever possible. He then went on to physical therapy and went 9mos without doing physical activity involving his knee. He eventually was able to walk then swim for some exercise. Year and a half later he was back to playing without the need of a brace and said his knee feels just fine but its the psychological aspect of "will it pop again?" that he had to get over.

Another friend tore his playing basketball during a playoff game. IT was grusome. He elected for surgery and was shooting around in 6mos and back to full form with knee brace in a year.
 
Well, that's an interesting article.

OP, the question I ask to alleviate your confusion is:

What does your intuition tell you to do?
 
Yesterday I felt absolutely find and I was thinking to myself. am I doing right by going for the surgery? In the evening when walking in walmart I walked with relexed attitude(not being careful) and I felt that something is missing in my right knee. I right away felt comfortable that I am doing right thing by going for surgery. May be muscles are helping me cope up but they won't be ready all the time..
 
sachin_patel said:
Hi Guys,

Sorry for long description. Here goes my story.

I had a knee injury about 3 months ago. I went to doctor and he said my ligament feels loose so lets do MRI. MRI Results showed partial tear in knee but he said It looks like you have complete tear. (Because you have bone bruises and usually that happens with complete tear). I haven't torn my meniscus.

I went to another doctor for second opinion. He also said you have complete tear looking at MRI.

All this time my knee doesn't feel unstable. So far it gave way only once on the day I was injured.

The first doctor prescribed Physical Therapy as I was skeptical about operation.

After a month i had followup appointment yesterday and he said, my knee feels pretty stable to him. no need for surgery.. call us back if you have instability.. continue exercise and use a brace.


I am now worried if this is bad decision for long term... has anyone done something like this?

Thanks in advance.
Click to expand...

Just get it done.
 
RiceWithThat said:
I'm a 40yo female and tore my ACL in April playing tennis. I also had a tibia contusion form the force of the rupture and a minor lateral meniscus tear.

Did you see an orthopedist or a GP? My MRI was read by three different radiologists, and only one recognized that my ACL was torn (complete). My GP claimed my ACL seemed fine after his exam, but an orthopedist was able to notice the tear on his exam.

I just had the reconstructive surgery two weeks ago. I decided to do it because I want to continue to play tennis, which because of the movements specific to the sport really shouldn't be played without an ACL.

I was pretty worried about the surgery, but I am glad I did it, happily reporting that I have been walking, almost normally, for several days now. I am really amazed at how quickly I am recovering from this procedure.
Click to expand...

I had a very similar experience when I was 40, which was a few years ago. IMO, the surgery is necessary to avoid ongoing instability and to decrease the chance of arthritis developing prematurely, if at all. The rehab will take about nine months, if you go about it diligently and properly. In the 15 years since I had the surgery I've continued to play tennis, as well as soccer, mt biking, running, etc, all completely normally.
 
sachin_patel said:
I mean "I felt absolutely fine"*
Click to expand...

The day AFTER I had the MRI, I ran 5 miles before my appointment with the radiologist. He asked me how a felt, and I told him that I'd just run so there could not possibly be anything wrong with my knee. He told me that the ACL was completely torn along with other damage. The point is this: you can continue to do many activities with a torn ACL but your knee is still damaged and you don't know when it will fail.

As a previous poster has written: Just get the surgery done.
 
sachin_patel said:
what is the level of pain after surgery? I read a lot of threads where people complain about unbearable pain..
Click to expand...

When I immediately awoke from surgery, the pain was severe. My moaning and writhing prompted the nurse to administer a pain med into my IV. So, severe pain lasted for me about 1 minute! From then, I took regular doses of hydrocodone for the next few days, and pain was mostly absent. After that, I took the pain med mostly at night. At the end of the week I no longer needed it at all.

I purchased a DonJoy cold water therapy machine, which I wore (at a safe temperature) almost continuously for the first few days. That helped a lot with pain. I used it for about three weeks. I highly recommend using a cold water therapy device.
 
sovertennis said:
I had a very similar experience when I was 40, which was a few years ago. IMO, the surgery is necessary to avoid ongoing instability and to decrease the chance of arthritis developing prematurely, if at all. The rehab will take about nine months, if you go about it diligently and properly. In the 15 years since I had the surgery I've continued to play tennis, as well as soccer, mt biking, running, etc, all completely normally.
Click to expand...

Thanks for the encouraging tale of recovery! I am glad your reconstruction was a complete success. So far, I am doing really well. I achieved full extension at 2 weeks and almost full flexion at 6 weeks out. I am working hard at rehab and following the rules, despite how good my knee is feeling--no tennis until late spring 2014. Sigh. But, I will be better than I was before...bigger, stronger, faster...
 
sachin_patel said:
what is the level of pain after surgery? I read a lot of threads where people complain about unbearable pain..
Click to expand...

IIRC, most of my knee pain was due to the inflammation.

The most pain also I had was when I was in that damn CPM (Continuous Passive Motion) machine. Usually the goal is to gain 10 degrees a day. Here's a tip: don't set it for 10 degrees off the bat! Few hours in the morning on 5 degrees, then when your knee is comfortable, a few hours in the afternoon another 5 degrees. You'll thank me later.

Oh, yes, any kind of ice wrap (I used a Cryo Cuff) will certainly help reduce inflammation and increase ROM.
 
RogueFLIP said:
The most pain also I had was when I was in that damn CPM (Continuous Passive Motion) machine. Usually the goal is to gain 10 degrees a day. Here's a tip: don't set it for 10 degrees off the bat! Few hours in the morning on 5 degrees, then when your knee is comfortable, a few hours in the afternoon another 5 degrees. .
Click to expand...

It is interesting how everyone can have varying experiences! For me, the CPM device actually brought pain relief. I used it over 12 hours each day for the first 4 days. Whenever the pain kicked in, I got in the CPM machine and had significant pain relief. I even slept in it each night initially.

I started at 35 degrees and went up by 5 degrees every day. In a little over a week I was to 90 degree flexion and stopped using the CPM device.
 
RiceWithThat said:
It is interesting how everyone can have varying experiences! For me, the CPM device actually brought pain relief. I used it over 12 hours each day for the first 4 days. Whenever the pain kicked in, I got in the CPM machine and had significant pain relief. I even slept in it each night initially.

I started at 35 degrees and went up by 5 degrees every day. In a little over a week I was to 90 degree flexion and stopped using the CPM device.
Click to expand...

You should have tried 10 degrees at a time and seen what that felt like. :(

When I did 5 degrees for half the day and another 5 for the other half, it was good.


So speaking of different experiences, I had my surgery on Monday, by Thursday I was off crutches and by that Friday I had full ROM. I attribute this by:

1. CPM machine
2. Cyro cuff
3. Multiple daily massages to flush the knee
4. Neuro-stim unit set for muscle pumping

Now I wasn't walking pretty by any stretch of the imagination, but I was pretty much pain free by the end of the week. Unstable, yes, but pain free. IIRC I didn't take any pain meds past the first week.
 
I got my surgery done on Friday and started using CPM machine..
I will start a thread to post my experience and progress..

I have pretty good ROM .. Day one.. not the night of surgery I had 60% of Rom and today i have 70% of ROM.. it doesn't feel tight to me at all.. i feel i can easily go to 80%.. but I am not doing it for precautionary reason...
 
RiceWithThat said:
Thanks for the encouraging tale of recovery! I am glad your reconstruction was a complete success. So far, I am doing really well. I achieved full extension at 2 weeks and almost full flexion at 6 weeks out. I am working hard at rehab and following the rules, despite how good my knee is feeling--no tennis until late spring 2014. Sigh. But, I will be better than I was before...bigger, stronger, faster...
Click to expand...

Glad you rehab is going well. As I recall, the most helpful piece of equipment during my rehab was a jump rope. I did all sorts of exercises (both legs, one leg, alternating legs, etc) and could measure the progress in my repaired knee very clearly. Give it a try.
 
RiceWithThat said:
Thanks for the encouraging tale of recovery! I am glad your reconstruction was a complete success. So far, I am doing really well. I achieved full extension at 2 weeks and almost full flexion at 6 weeks out. I am working hard at rehab and following the rules, despite how good my knee is feeling--no tennis until late spring 2014. Sigh. But, I will be better than I was before...bigger, stronger, faster...
Click to expand...

What Graft did you use?
 
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