Bad News Today....seeking advice

[JohnnyB]

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....

[mwg]

You may want to look at this thread.. there is some pretty good info concerning ACL tears & surgery

http://mastercraft.com/teamtalk/show...hlight=surgery

Good luck

[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.

[_fng_]

Originally Posted by drschemel

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/PD...%20Surgery.pdf

[Big Dogg]

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.

[drschemel]

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]

Originally Posted by drschemel

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

[TayMC197]

Been there, get a good brace and your fine

[JohnnyB]

Originally Posted by mwg

You may want to look at this thread.. there is some pretty good info concerning ACL tears & surgery

http://mastercraft.com/teamtalk/show...hlight=surgery

Good luck

Thanks...did a search on ACL and nothing came up.

Sent from my Motorola RAZR MAXX using Tapatalk 2

[TxsRiverRat]

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.