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View Full Version : Bad News Today....seeking advice


JohnnyB
02-14-2013, 01:36 PM
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....

:mad::mad::mad:

mwg
02-14-2013, 01:52 PM
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
02-14-2013, 01:54 PM
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
02-14-2013, 02:01 PM
Been there, get a good brace and your fine

_fng_
02-14-2013, 02:28 PM
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
02-14-2013, 02:28 PM
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
02-14-2013, 03:05 PM
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
02-14-2013, 03:36 PM
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
02-14-2013, 03:46 PM
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
02-14-2013, 04:00 PM
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
02-14-2013, 04:14 PM
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
02-14-2013, 04:47 PM
Where can he get some deer antler spray?

JohnnyB
02-14-2013, 05:29 PM
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
02-14-2013, 06:56 PM
My wife just had her ACL FCL, PCL and Posterolateral corner replace by this guy.
http://drrobertlaprademd.com/complex-and-multi-ligament-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
02-14-2013, 08:53 PM
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!

ahhudgins
02-14-2013, 09:24 PM
Iím no doctor, but if itís true that you could be at risk for tearing your meniscus without corrective surgery on the ACL, I would have the surgery and possibly miss a season. I torn my meniscus about 12 years ago and had to have quite a bit of it removed. Since the surgery, I can no longer do any activity that involves impact to the knee. Well I can, but not without several days of pain following the activity. I can ski, barefoot, and wakeboard, but I no longer land in the flats. I can ride a bicycle or use an elliptical but running is not an option. I did a few light squats at the gym last night, stood on concrete for 10 hours today and my knee is killing me. Once cartilage is removed, it doesnít grow back.


Bottom line: Follow the doctor's advice. And good luck.

Big Dogg
02-15-2013, 01:31 AM
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.

Doc, your information here is great. I was wondering your thoughts from the rehabilitation position post surgical, about muscular strengthening for reduced knee valgosity and correct patellar tracking. I have seen research that supports that gluteus medius as an external rotator of the femur (inherently inhibited control because of long duration sitting) can be trained through rehabilitative exercises both functionally and proprioceptively to activate better and control the knee from diving into valgosity. Especially in the functional screens of an overhead squat test or one leg squat test (the assumed position that a skier/barefooter takes as they move across the water) To further that stability, increasing VMO activity to provide better patellar tracking. Other clinical approaches have included manipulation of the femur head/acetabular articulation for improved mobility through the hip capsule and manipulation of the ankle mortise and talus/navicular articulation to improve tibial rotation and foot pronation through the gait cycle. All of this combined to reduce torsional and valgus stresses on the ACL/MCL. While it sounds like this case is most definitely a need for surgical intervention to repair the ligaments, I was interested in your thoughts for rehabilitative procedures to get him back on the water faster, more stable, and of course pain free.

~Inquisitive mind of a (near graduation) Chiropractic student who enjoys working with pre/post surgical rehabilitation and chiropractic management cases.

_fng_
02-15-2013, 08:01 AM
_FNG_ are you a PT??

Yes sir.

drschemel
02-15-2013, 09:19 AM
Sorry BigDogg, it's out of my pay grade! I just diagnose and send to the rehab specialist for the rest. Everything you suggest sounds apropriate. There is a lot of science and physics behind the rehab but in general, anything that strengthens the thigh is going to help. Start light, do a lot of repetitions and increase resistance as the knee responds. I alway have people see a therapist or chiropractic doctor that specializes in sports medicine.

Big Dogg
02-15-2013, 10:11 AM
Sorry BigDogg, it's out of my pay grade! I just diagnose and send to the rehab specialist for the rest. Everything you suggest sounds apropriate. There is a lot of science and physics behind the rehab but in general, anything that strengthens the thigh is going to help. Start light, do a lot of repetitions and increase resistance as the knee responds. I alway have people see a therapist or chiropractic doctor that specializes in sports medicine.

Doc,
I appreciate your honesty as well as your support of the ideals that I proposed. Its great to see a physicians such as yourself providing patients co-management options to optimize health, performance, and return to play.

Thanks,
Aaron

TxsRiverRat
02-15-2013, 10:21 AM
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.

Ahh, I remember the sky ski re-injury - was that at the fly in, or was it that crazy group you ran around with?

They have written this Tex guy up in medical journals to try and figure out why this happened!

Skiing has nothing to do with this! :D

tex
02-15-2013, 08:15 PM
Ahh, I remember the sky ski re-injury - was that at the fly in, or was it that crazy group you ran around with? It was actually with a great group that met here on TT!


Skiing has nothing to do with this! :D

Good point!

JohnnyB
02-17-2013, 11:33 AM
Talked to a good friend who is a PT/AT and got some good info on surgeons, etc.
Thinking of having it done in April after preplanned family spring break vac in MX. Going to get fitted for a don joy brace this week so i can enjoy vac.


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tex
02-17-2013, 12:30 PM
Talked to a good friend who is a PT/AT and got some good info on surgeons, etc.
Thinking of having it done in April after preplanned family spring break vac in MX. Going to get fitted for a don joy brace this week so i can enjoy vac.


Sent from my Motorola RAZR MAXX using Tapatalk 2

I love my DonJoy! Get a good doc, it will make a huge difference!

JohnnyB
02-17-2013, 06:49 PM
In the process of screening doctors right now....

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JohnnyB
04-20-2013, 05:29 PM
Had my acl reconstruct on Thursday. Did the patellar graft. Doing hourly physical therapy exercises and plugged into the ice machine near 24h a day.

Will get some pics when I hit 48 hours snd can shower.


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bcd
04-20-2013, 06:32 PM
Pop an extra hydrocodone before you go to your first PT session.

JohnnyB
04-21-2013, 08:11 AM
pt was 24h post op.....still had nerve blocker in effect so got a demo and list of exercises to do once it was gone. Did them every hour yesterday. Walking "as tolerated" turned into the full distance from BR to Kitchen to couch without issue

Laurel_Lake_Skier
04-21-2013, 09:55 AM
Sounds like things went well and that's good news. With the spring we're having, it doesn't look like there will be any rush to get out on the water this year!

JohnnyB
04-21-2013, 12:44 PM
Bustin it w a goal to get cleared to ski in 6mos or less...

Shower and redressing this am felt great!

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JohnnyB
09-07-2013, 05:02 PM
So after tearing my ACL on Dec 16th of last year and having a patellar autograft on April 18th, and getting my surgeon's OK yesterday, I ran today for the first time since my injury!!!! :banana::banana::banana::firejump::firejump::firej ump::headbang::headbang::friday::cool:

Nothing real fantastic but holy crap am I outta shape.....

All treadmill work.....walked 4min @ 4.5mph, ran 1min at 7.5mph x 4 cycles. I made it through and felt a bit stronger and more confident each running interval.

Home alone as the wife and daughters are shopping so sharing with you guys....just emailed my PT, too.

Sitting with the ice pump running to make sure I don't swell up!!

Doc thinks it is very realistic that I can return to playing soccer for our January season.

Also thinks it is realistic for me to be waterskiing then!!!! Might have to head to FL

thatsmrmastercraft
09-07-2013, 05:07 PM
Great to hear you are moving forward! :toast:

markmcfarland
09-07-2013, 06:02 PM
Hang in there. Rehab rehab rehab. I lost my acl and 75% meniscus in 9-03 6 weeks after getting my new x2 (age 34) doing a back roll. After rehab I was wake boarding the next summer with a brace. No longer use the brace still do back rolls and ski. I know of guys that didn't rehab as hard and nowhere near as good results. Sounds like you were like me. Amazing how much you take things for granted till you can't do them.

markmcfarland
09-07-2013, 06:08 PM
Btw I used a cti2 brace can't remember who made it. It was awesome. Waterproof and everything. It was what the pro boarders were all using at the time. Probably better ones out now. Also my insurance actually covered that brace.

markmcfarland
09-07-2013, 06:10 PM
Hang in there. It will definitely be worth it.

mikeg205
09-07-2013, 06:37 PM
awesome news!!!! way to go!

JohnnyB
09-07-2013, 06:50 PM
Hang in there. Rehab rehab rehab. I lost my acl and 75% meniscus in 9-03 6 weeks after getting my new x2 (age 34) doing a back roll. After rehab I was wake boarding the next summer with a brace. No longer use the brace still do back rolls and ski. I know of guys that didn't rehab as hard and nowhere near as good results. Sounds like you were like me. Amazing how much you take things for granted till you can't do them.

Pushed too hard early on and was getting patellar tendon tendonitis...had to back off and ice for a week and got back at it. Really seemed to turn the corner 2 weeks ago (week 18 and 19) where I was building strength quickly and lots of stability with almost no swelling.

Was wearing a Don Joy brace pre-op and have used it post op when I'm doing physical things I probably shouldn't be doing (putting in the dock, moving boat lift, cutting down trees, etc)

Traxx822
09-08-2013, 10:03 AM
good to hear. Now be careful will yah :D

scott023
09-08-2013, 10:40 AM
Pushed too hard early on and was getting patellar tendon tendonitis...had to back off and ice for a week and got back at it. Really seemed to turn the corner 2 weeks ago (week 18 and 19) where I was building strength quickly and lots of stability with almost no swelling.

Was wearing a Don Joy brace pre-op and have used it post op when I'm doing physical things I probably shouldn't be doing (putting in the dock, moving boat lift, cutting down trees, etc)

That's great news Johnny. Now stay safe

JohnnyB
02-17-2014, 08:39 PM
Just shy of 10 months post op and operated knee is within 95% or better in every physical category....cleared to return to full activity. Back on the water at ice out for sure

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tex
02-17-2014, 08:44 PM
Congrats JB! Keep following the doc's orders!

mikeg205
02-17-2014, 08:47 PM
Just shy of 10 months post op and operated knee is within 95% or better in every physical category....cleared to return to full activity. Back on the water at ice out for sure

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awesome --- yeah!!! - "Hit it!"

scott023
02-17-2014, 09:15 PM
Just shy of 10 months post op and operated knee is within 95% or better in every physical category....cleared to return to full activity. Back on the water at ice out for sure

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That's fantastic news Johnny. Congrats!!!

atihanyi
02-17-2014, 09:51 PM
Congrats . I am 3 months post op on a shoulder reconstruction and hitting the pt hard with a goal of skiing by may . My therapist says I am on track . Good to hear your hard work has paid off

thatsmrmastercraft
02-17-2014, 09:53 PM
Just shy of 10 months post op and operated knee is within 95% or better in every physical category....cleared to return to full activity. Back on the water at ice out for sure

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:woohoo::woohoo::woohoo:

barefoot
02-18-2014, 09:35 AM
Congrats Johnny! I think I've shared that I've had two ACL surgeries on my knee. Once you get through that first year, you'll begin to trust it more and it will become stronger. You will soon be at the point where you forget about it and you'll be back to normal.

TayMC197
02-18-2014, 03:40 PM
I don't think about mine anymore, just stay active and get on the bicycle as soon as you can to work out that scar tissue.

scott023
02-18-2014, 03:45 PM
I don't think about mine anymore, just stay active and get on the bicycle as soon as you can to work out that scar tissue.

This is key. If you let the scar tissue linger, it'll always bug you.

JohnnyB
05-31-2014, 06:57 PM
Finally flooding subsided...had 3 good footin runs yesterday. ...going to try a couple slalom runs early tomorrow morning

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