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ACL surgery -- the pros and cons for someone like me

jazzymomjazzymom Registered User Posts: 3,676 Senior Member
edited December 2010 in Parent Cafe
That is, someone neither under 20 nor an athlete with a career to preserve.

So a couple weeks ago, I took a bad spill at Mammoth and managed to tear three of the ligaments in my right knee. The ACL is a complete tear. The other two are partial tears. The meniscus is okay. I'm starting physical therapy to see how much knee stability I can regain, but I also wonder if the best fix is to have surgery as soon as possible.

I'm hearing conflicting advice about the pros and cons of surgery --- repairing the ACL with a graft --- and the nonsurgical approach, which seems to be to use therapy and exercise to strengthen the muscles and ligaments to provide support to the knee that, without surgery, will no longer have a functioning ACL.

Anyone been there, done that? Any advice?
Post edited by jazzymom on

Replies to: ACL surgery -- the pros and cons for someone like me

  • somemomsomemom Registered User Posts: 10,519 Senior Member
    I tore my ACL- not completely, but painfully, doing gymnastics in my mid 30s (hmmm, what was I thinking???!!! but I did get back all my high school tricks!); they gave me the same options, surgery or not and I chose not, due to money primarily.

    I cannot downhill ski, but i can cross country ski. Soccer was not a good plan, though volleyball was fine as long as I wore a knee brace for protection.

    Other than not being able to do the above items, it was no big deal. I did not want to pay $20k or more and had a lousy insurance situation.
  • kdmomkdmom Registered User Posts: 362 Member
    My son was under 20 and an athlete when he tore his ACL. He had repair surgery, did physical therapy for 10 months, and then tried to resume his sport.

    The knee never felt good. After a month he went for another MRI and discovered that the repair ligament had also torn. He didn't want to go through surgery and recovery again, so he decided to live with it.

    He can't play serious sports any more, but he can go running and play various pick-up games as long as he wears a heavy-duty knee brace.
  • nngmmnngmm Registered User Posts: 5,708 Senior Member
    A co-worker of mine was a gymnast in HS and college, and tore ACLs in both of her knees. She did not have surgery, and I am not sure how much PT she had.

    She was told that she can no longer do forward flips... but I saw her doing backward flips on a concrete floor just fine...
  • BromfieldBromfield Registered User Posts: 1,936 Senior Member
    My stepdaughter tore her ACL while skiing about 5 years ago. She decided to try the physical therapy route. While her knee felt better, she still can't ski or engage in some of the physical activities that she did before. She's fine with that. On the other hand, her spouse would never deal well with not being able to downhill ski. He can't believe that she didn't have the surgery. I guess the decision is a personal one--are you content with the limitations that might result from not doing the surgery.
  • jazzymomjazzymom Registered User Posts: 3,676 Senior Member
    The replies have touched on my two main concerns: a. that surgery has the risks associated with anesthesia and possible infection and then what if it doesn't work.... and b. that the nonsurgical course will mean limits for the rest of my life.

    I don't play tennis, or run marathons, or hike mountains (don't even ballroom dance), but I do like downhill skiing, walking miles with the dogs and going on long bike rides with H. I want to be able to walk the long distances, and up hills and stairs, that you tend to do when you travel. I didn't realize how fond I was of both knees until I messed one of them up.

    Well, I have three or four weeks to do more research. The doc said they won't do surgery until I regain more flexibility in the knee through physical therapy anyway.

    Any more anecdotes?
  • cnp55cnp55 Registered User Posts: 3,710 Senior Member
    My H "wrecked his knee" several times playing lacrosse in the 70s/early 80s. He never had surgery, just did some PTY and exercises and kept on playing. In 1985, we'd been in our new house maybe 3 weeks and I came home to find him on crutches in the foyer of our high-ranch (i.e. the basement.... everything was on the upper floor!). He'd injured himself stepping wrong on a job site. THIS time it was a workman's comp injury, he had the surgery, the pt, and an offer of 6 weeks off. (He took two days, including the day of the surgery.)

    Fast forward 23 years. He has been relatively sound and stable all this time. If he overworks the knee it swells and gets sore. He generally wears a brace, sometimes just a wrap, if he is going to stress the knee playing lacrosse or skiing. He is not supposed to jog/run anymore -- he's really pounded the knee too much.

    I think having the surgery, although he put it off a long time, was a good idea.
  • MomofWildChildMomofWildChild Registered User Posts: 21,879 Senior Member
    I know quite a bit about this since my athlete-son tore his ACL in 7th grade back when they did not do the repair on a young person who had open growth plates. He ran successfully for many years, but could not play "cutting" sports such as lacrosse or soccer. However, when he intensified his training in preparation for college, his knee was not OK. It manifested in IT Band problems. Long story, but after one non-ACL surgery, we got to an incredible surgeon here in TN and he said if you DON'T do the ACL surgery, later in life you have much more risk of serious arthritis. Son had his ACL surgery in May 2007. He needed a follow-up surgery for something unrelated, and still isn't able to train the way he used to, but his ACL surgery was very successful. The recovery was pretty easy, too.
  • busyparentbusyparent Registered User Posts: 714 Member
    Spouse had the acl repaired 18 years ago and found the PT afterwards very painful. He elected to have the repair done with a piece of his own patellar tendon. About 8 years ago he fell again and ruptured the patellar tendon in the same leg and underwent surgery to repair it. This had to be done as his knee cap was half way up his thigh. He walks with a limp and his shoes on the leg have a funny wear pattern.

    He says he would do it again.
  • soozievtsoozievt Registered User, ! Posts: 31,317 Senior Member
    Jazzymom, I can relate. About ten years ago, I completely tore my ACL in a ski accident too (and injured other ligaments). I went through PT but did not replace my ACL as I was told I didn't really need it unless a serious athlete. I was 41 at the time, if I recall. I am not athletic anyway. Not having an ACL has not affected me in any noticable way. I could ski if I want.
  • hops_scouthops_scout Registered User Posts: 3,903 Senior Member
    Jazzymom, if you're not going to be cutting and things like that, then you don't really need an ACL. Physical therapy can help you strengthen the structures around the knee so much so that it will actually help to take the place of the ligament.

    I worked with our DI-AA football team this year where we had one player who wore a brace because he had a torn ACL and another who I'm pretty sure played without one. These guys WERE cutting, etc and were fine.
  • MomofWildChildMomofWildChild Registered User Posts: 21,879 Senior Member
    The issue is later in life there is a lot more chance of arthritis if you don't do the repair
  • somemomsomemom Registered User Posts: 10,519 Senior Member
    OP- long dog walks, going up stairs, bike rides, those are all straight motion and should be fine, as they said above it is cutting-soccer, downhill skiing etc.

    I tore mine part way and I tried soccer, scrimmaging with middle schoolers and there was no way, I made one mild cut and I was down & out. In the early years I also noticed impact- like jumping down from a boulder on a hike etc. could be painful, not always, but could be. A am still careful about jumping and landing, other than that I do not think about it and have no pain ( no arthritis yet!)
  • jazzymomjazzymom Registered User Posts: 3,676 Senior Member
    Thanks for all the replies.

    MOWC: Yes, the arthritis concern is one I saw mentioned during a google search. It concerns me and adds to the "pro" column of having the surgery done. (Of course, the info came from the website of the college of orthopedic surgeons so I don't know if there's a tiny bit of spin going on there.)

    Regarding the argument that you can strengthen the surrounding structures through PT and live without the ACL --- I do have a friend who has done just that. She has one surgically reconstructed knee and one knee with a blown ACL, but didn't do the surgery on that one. She still skies, but with a brace.

    My question, though, is that her ACL complete tear was not accompanied in that knee by tears in the other ligaments, as is the case with my knee. I really wonder if the partially torn ligaments can really heal or rehabilitate enough to compensate for the loss of the ACL.

    I know there must be research being done on this question, but I'll wager most of it is done on young folks and athletes.

    Has anyone heard whether there's a difference in recuperation between using your own ligament for the surgery and using a donated (or "cadaver") ligament? I've heard the healing is longer and more painful using your own ligament. (Oh boy, is this one of those "questions you wish you didn't have to ask....")
  • jazzymomjazzymom Registered User Posts: 3,676 Senior Member
    soozie: How bad were the tears to the other ligaments? Did the rehab with PT take a long time? Does your affected knee ever feel like it could give out on you? Do you feel the need to use a brace ever?

    mowc: Was you son's ACL replacement a donor ligament?
  • great lakes momgreat lakes mom Registered User Posts: 2,746 Senior Member
    When my son had ACL surgery, he was given the option of cadaver rather than his own ligament. He was going on exchange a few months post op, and wanted to be really ready to hike and so on in Ecuador. Cadaver sounded like a good idea, until I talked with a friend who had previously worked as an otho PA. He said at that time, there had been some infection risks with cadaver ligaments. Small chance, but why risk it? He felt strongly that best care was not using the cadaver donation. So we went with his recommendation, and despite a far longer immobilizer time than anticipated due to meniscus repairs, he was fine on that exchange. His knee has been fine in the years since, though sometimes needs a little extra stretching. He's playing basketball, etc, with no problem.
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