Originally Posted by drschemel
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.