<p>That is, someone neither under 20 nor an athlete with a career to preserve. </p>
<pre><code>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.
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<p>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.</p>
<pre><code>Anyone been there, done that? Any advice?
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<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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. </p>
<p>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.</p>
<p>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.</p>
<p>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. </p>
<p>She was told that she can no longer do forward flips… but I saw her doing backward flips on a concrete floor just fine…</p>
<p>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.</p>
<p>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.</p>
<pre><code>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.
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<p>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. </p>
<p>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.)</p>
<p>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.</p>
<p>I think having the surgery, although he put it off a long time, was a good idea.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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.</p>
<p>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!)</p>
<pre><code>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…”)
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<p>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? </p>
<p>mowc: Was you son’s ACL replacement a donor ligament?</p>
<p>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.</p>
<p>Interesting point, thanks. I think the recuperation takes longer when using your own ligament because the body has to heal from that assault as well. And I think the incision is a bigger one (which also has to heal) in that case, than the smaller incision used to install the donor ligament. </p>
<p>I’m thinking that in addition to doing a lot of research, I should get a second doctor’s opinion.</p>
<p>I tore my ACL totally. I am not athletic. I tore mine eight years ago (I was not quite 50 but was almost there.) I asked the orthopedist what would he have done if it were him. He said that since I was not going to be playing football, and neither was he, and given our ages his decision would have to be to skip surgery and follow the therapy route. That is exactly what I did. The recovery between surgery and no surgery was estimated to be about the same. </p>
<p>My knee is fine. I have arthritis in other parts of my body but the knee has not bothered me. It felt a little shaky as it was healing, but once healed I did not notice any difference from before. As I was healing I learned from a number of people that they too had chosen to forego the surgery and were doing great.</p>
<p>My father was a doctor and was always weary of anesthesia. So any time that I can avoid going under, I avoid it. Good luck and do get a second professional opinion.</p>
<p>Jazzymom, I believe there are 3 types of ACL replacements that can be done.
Patellar Tendon
Hamstring tendon (I think)
Cadavar</p>
<p>I have been told that the Cadavar is more likely to re-rupture.</p>
<p>Rehab will likely include lots of hamstring and quadriceps strengthening. There really isn’t anything that can be done for the ligaments… But building those hamstrings and quadriceps muscle groups will go a long way in protecting that knee.</p>
<p>My son tore his ACL about 10 months ago. Had the cadaver replacement surgery right away (15 days after the injury), rehabed for 6 months and is now 100%. </p>
<p>We considered the other two major options:</p>
<p>1) Patella tendon harvesting (Jerry Rice did this one). The issue with this one is the second injury with the harvesting and the potential of weakening the kneecap.</p>
<p>2) Hamstring (which is what Tiger Woods did) - Issue here is again the second injury and in this case, the hamstring never regains full strength. If you want to play golf, it doesn’t matter - but running sports will be somewhat limited.</p>
<p>My son ran 2 miles, on the beach, in just under 14 minutes the other day. He will be playing college sports this spring without any restrictions. His was a simple ACL tear - no other damage to the knee. What his doctor told him was that not having the surgery would most likely result in meniscus damage - which ultimately leads to major arthritis in the knees.</p>
<p>One of the guys who works for me had his ACL done 10 years ago- Patella transplant. He had waited several years and in the mean time had done significant damage to his meniscus. He is scheduled for full knee replacement later this spring as the arthritis is now too painful to live with.</p>