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JohnnyB 02-14-2013 02:36 PM

Bad News Today....seeking advice
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 02-14-2013 02:52 PM

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

Good luck

drschemel 02-14-2013 02:54 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 03:01 PM

Been there, get a good brace and your fine

_fng_ 02-14-2013 03:28 PM


Originally Posted by drschemel (Post 909107)
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!!

JohnnyB 02-14-2013 03:28 PM


Originally Posted by mwg (Post 909106)
You may want to look at this thread.. there is some pretty good info concerning ACL tears & surgery

Good luck

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

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TxsRiverRat 02-14-2013 04:05 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 04:36 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 04:46 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 05:00 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.

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