OT: i just tore my ACL, what to do

Submitted by BlueCE on February 16th, 2013 at 3:40 PM
Hey guys, I was skiing today and it looks like I tore my ACL. Doctors said it was my choice Re: surgery. Recommendations? I am 35 and fairly active. Thanks

Comments

HermosaBlue

February 16th, 2013 at 10:28 PM ^

Prof of knee and shoulder surgery at UM Med School did my ACL/LCL reconstruction in 2002. ACL rupture and LCL avulsion fracture while skiing in Utah. Autograft.

Did all my rehab at UM MedSport at Domino's Farms. Also did 10 weeks of pre-op rehab before surgery a few days after graduation.

Rehab sucked, and I was in a lot of pain post-op after all the drilling in my bones. Took 2 years to get all the way back, but I made it back to ski at full speed and play basketball with no noticeable impairment.

Get the surgery. At UM Hospital. And do your rehab.

L'Carpetron Do…

February 17th, 2013 at 11:37 AM ^

I second that.  Do it at the UM hospital.  It's amazing.  I had the same experience you had when I broke my leg.  Surgery at the hospital and rehab through medsport.

When I actually got my ACL I did it at a hospital other than UM and it sucked.  

As someone mentioned earlier, hoops and tennis are probably out of the question.  Anything that requires a lot of hard running, planting, stopping and cutting is going to be tough.  You'll be able to do it, just not the same way you used to.  

Better think about playing first on a sottball team or taking up golf!

MEZman

February 16th, 2013 at 3:57 PM ^

Well my wife is a Psychiatrist and not an Orthopedist but I asked her what you should do.

 

She said "how does it make you feel?" That probably didn't help you much. But that will still be $300.

wigeon

February 16th, 2013 at 6:22 PM ^

then this story is worthwhile.

I'd just stashed a case of Labatt's at Boyne Mtn,  near the warming shed/halfway house at Victor.  To be enjoyed throughout the day, by buddies and me. 

I started skiing away, and a 300 lb hag on skis ran over my tips and I full-yard-saled and in the process wrapped a ski around my skull, snapping it in two.  I had several hundred yards to go, with one ski and a concussion.

I made it to the condo and slept the rest of the day.  

Good times.  

 

Vote_Crisler_1937

February 16th, 2013 at 4:01 PM ^

She is a practicing physician board certified in stroke and blood. Not an ortho but a damn good M educated doctor. She says "get the surgery!" I have rarely seen her so decisive on a med care question. She's srsly you guys.

mooseman

February 16th, 2013 at 4:18 PM ^

You don't need to make any decision quickly. First goal is to get the swelling resolved (time, icing) and get your motion back. In the meantime work to avoid atrophy. Then you need to examine your activity goals. If skiing is something you enjoy, you'll want/need an ACL for that. Low demand, straight line, non-cutting and pivoting or stop/start activities often can be accomplished without an intact ACL.

Ultimately, if you opt for reconstruction, patellar tendon, hamstring, quadraceps autografts or allograft probably doesn't make a big difference. Your surgeon will most likely have a preference. More important is to recognize that your rehab is at least 50% of the equation in terms of a successful reconstruction.

Good luck.

UMICH 15

February 16th, 2013 at 5:05 PM ^

So yes, once the swelling goes down, go for another eval.  More imaging.  Then go to PT before surgery.  Pain shuts muscles down and you want to re-educate them prior to the surgery so it's not so hard to re-educate afterwards.   Which type of surgery is probably up to your physician, I'm a fan of the HS or cadaver, but it's not my knee.  For PT go to Dominos Farms.  They specialize in sports medicine and not all PTs are the same.  Seriously. 

Not everyone needs surgery though.  A lot of PTs don't get ACLs fixed but if you don't rehab will take longer and you will need to do a lot of stability work (for pretty much life) and there is a higher incidence of OA later in life (especially if the stability isn't there).  If you want to be active, get it done.  Regardless, listen to your therapist and finish your program.

And ice is nice too.

Birdman

February 16th, 2013 at 4:22 PM ^

Its simple, if its completely ruptured have the surgery and attack the rehab seriously , dont take it lightly even if you feel like your recovery is going fine. If you can just strengthen the hamstring to tighten the joint do that. If it  completely goes skiing again then have it done. Get the Hamstring graft unless you plan on playing offensive tackle. Oh, and its never the same, no matter what any one tells you. Post surgery is devastating as an athlete mentally, and getting over the hesitation that comes from that can take time to over come. All that being said, I had full reconstruction 6 years ago of the ACL & MCL, and dispite sublte knee pain, I still have a succesful athletic career without a brace.

Baba Booey

February 16th, 2013 at 4:29 PM ^

Tore my ACL when I was 28. I tried to go without the surgery but every time I moved wrong, the knee would swell up for days causing considerable pain.
I decided to have the repair done a year later so I could continue my rec league career but I wish I hadn't. The post surgery pain was nearly unbearable and I was on crutches and off work for eight weeks.

My knee now feels great but I wound up never playing any sports because I was terrified that I would tear it again and I wasn't about to go through that process a second time.

snarling wolverine

February 16th, 2013 at 4:36 PM ^

If you have a complete tear you're going to have to get the surgery.  Otherwise you'll never have a fully functional knee.  The rehab is a real pain and those first few months will suck, but it definitely will pay off down the road.

 

TruBluMich

February 16th, 2013 at 4:40 PM ^

I tore my ACL my Junior year of high school.  The doctor told me the same thing, only diffrence was the rehab time.  I could just let it heal and stay inactive and I wouldnt miss half of my Senior year of wrestling or I could have surgery. If I choose surgery Id be looking at maybe, being ready with a few weeks left of wrestling.  I of course took the quickest route.  Well Im now also in my mid 30's and should have choose the surgery.

Just to add to this, occasionaly my knee still swells up so bad that I cant even walk without being in unbearable pain.  I've been told a few times now that they need to do the surgery, but I keep putting it off, because I don't want to miss race season. I can't play any sport that requires any long periods of rapid change in direction or stopping.

EZ Bud

February 16th, 2013 at 4:43 PM ^

I tore my labrum in my right shoulder in August of 2012. I opted for physical therapy, and the first 3 months were pretty awful. However, I'm now back to playing sports and lifting weights with little to no pain. That being said, I can't imagine going through a similar situation with a knee. I would get the surgery. We're too young to settle for a limited life.

StateStreetBlue

February 16th, 2013 at 4:46 PM ^

Backstory:

I'm 23 and tore my ACL playing soccer.  It was a completely clean tear (kind of unusual) where nothing else was damaged at all (e.g. meniscus, MCL).  Tear was from a noncontact, but instead an unlucky turn of the knee.

Advice:

Get the surgery otherwise your knee will never be the same.  ACL not only helps keep you knee aligned, but also provides cushion on impacts.  Arthritis at an earlier age is very common in people who do not get the surgery.  Also, get the surgery done by a doctor who has specialized in orthopedic surgery and sports medicine.  Many professional sports team doctors also have a practice where they perform surgeries on ordinary guys like you and me (NFL docs are normally at the top of the list).  You want the surgery done by someone who does a lot of them... hence the sports docs.

Patella vs Cadaver: there are benefits to both. Patella is the tried and true gold standard, but obviously is more painful as you are taking your own muscle.  Cadaver takes a bit longer to heal (1-2 months) but also keeps your patella in tact.  More and more pro athletes are going the cadaver route and there is no real evidence to state one is better than the other.

EDIT: As I was able to take an extra month to get back to sports, I chose the Cadaver route. I would do this again if I had the choice.  My surgery was done by doctor of an NFL team and he said that it is almost 50/50 now in the NFL when choosing between patella and Cadaver.

Surgery: Do pre-op physical therapy.  This is where I really skimped and it made it sooo much harder to recover.  A week of muscle atrophy takes about a month to recover.  Muscles right above the kneed and hamstrings are what take the hit.  Trust me, you need to work these out before surgery!

Pain:  Surgery sucks.  No way around it.  You will be basically handicapped entirely for a week (at least in my experience).  You will need someone to help you do ordinary tasks.  It hurts like hell and was the worst thing I've ever had to go through.  But you get through it.

Hope this helps.  Good Luck.

TheTruth41

February 16th, 2013 at 6:22 PM ^

There is real evidence to state one is better than the other.

Go here:

http://www.aaos.org/news/aaosnow/mar12/research5.asp

My backstory:

I'm currently 31.  I tore my left ACL and meniscus (repaired) in 2009 playing basketball and tore my right ACL and meniscus (bucket tear so not repaired, just cleaned up) in 2011 playing kickball (please no comments!).  Both surgeries were done by Dr. Kurt Spindler (Vanderbilt Medical Center), who is one of the very best in the nation.  He's had ACL studies published in the New England Journal of Medicine and is a part of the MOON (Multicenter Orthopaedic Outcomes Network) study (link above) that studues ACL injuries.  There are 3 other medical centers that work together to compile their data: Washington University in St. Louis, Cleveland Clinic and Ohio State University,

The article states just what he explained to me as to what type of procedure I should have.  He asked me if I wanted to stay active and get back to the things I was doing before the injury.  I said yes so given my younger age and desires to stay active he advised to use a part of my patella tendon.  I've had this done with both knees.  The only differences I feel now is due to this type of surgery I have a numb/swelled sensation in my knees when I'm on them.  Not that big of a deal but is a bit annoying but since I'm hardly ever kneeling I don't notice it much.  If I were older and less active I could have done about any type of surgery I wanted due to my chances of reinjuring were much less.  Like the article states, the older and less active you are, surgery type isn't much of a factor but the younger and more active you are you're better off going away from the cadaver.

My friend was going through the same injury in Florida and was going cadaver because of his doctor's advice.  I was a bit confused because my doctor was telling me the exact opposite.  I had this conversation with Dr. Spindler about my friend and I and he cleared things up.  My friend's doctor was telling him what he THOUGHT was best.  My doctor, everyting he advised me to do, was backed up by a study they had done so it wasn't just his opinion supporting his beliefs, he had FACTS.  Dr. Spindler told me the only reason a doctor would tell young, active individual to get the cadaver is so the surgeon can make more money.  The procedure costs are about the same regardless of surgery but the length of surgery varies: surgery takes longer for petella/hamstring because you have to go get the tendon to use vs cadaver surgery in which the cadaver is already sitting there...so over the extent of a day, the surgeon may be able to do one more surgery using all cadavers vs patella/hamstrings and would make more money due to the longer volume of surgeries.

My advice, as well as someone that has done studies on ACL surgeries and chances of retear: get the patella.

Some people are fine without getting the ACL repaired but both instances I never could feel normal.  I couldn't run or do anything active even if it were just in a straight line.  May be because I'm bigger (about 240 lbs) but after surgery I'm back to normal.

Another interesting study Dr. Spindler conducted: knee braces show no signs of prohibiting ACL tears.  Knee braces are designed to keep your knee from buckling out but ACL tears are basically like twisting a towel...which braces don't prohibit this type of motion.  You see offensive linemen wear them since they often get rolled up on which helps but a perfect example of knee braces being useless was RGIII.  The brace only gives you the thought of stability and safety from tearing your ACL.

StateStreetBlue

February 16th, 2013 at 7:07 PM ^

 

I guess that we are just going to have to disagree.  I know that there is literature out there stating that using ones own patella is better.  There is also plenty of literature stating the opposite.  I don’t mean to sound smug, but I was lucky enough to have family connections in the medical world and consulted multiple Professional Team Physicians before my surgery (NFL, MLS…).  I was told pretty universally the same thing each time – using ones own patella used to be hands down what was considered the gold standard.  Then about 15 years ago things started to shift and using Allograft (donated tissue)started to gain momentum.  Fully recovery to 100% form takes a month or two longer, but in the end has almost exactly the same chance re-tearing.

 

Spero Karas was the MD who performed my surgery (http://www.sperokaras.com/).

 

I don’t think that you can go wrong with either one, but if I were an older man (I’m 23) I would definitely want the less invasive surgery and would go for the allograft. 

 

TheTruth41

February 16th, 2013 at 9:26 PM ^

I find it strange that there would be literature stating cadaver would be better for a young active person than taking ones own tendon when there are studies showing that using your own tendon gives you a better chance of not reinjuring again.

The MOON study is a group of research universities so it's not like they have an agenda either way, they just want to know what is the best and must successful procedure (which in their studies has clearly been using ones own tendon).

mooseman

February 16th, 2013 at 9:18 PM ^

Most of the studies noting a difference find age to be the difference in graft success. More evidence is suggesting that under the age of 25-30, autografts (patellar or hamstring) are probably a better choice. At your age of 35, it becomes less clear.

I usually recommend autografts in my younger patients. If I were to tear my ACL at my age of 47 I would have a cadaver graft if I got a reconstruction at all.

TheTruth41

February 16th, 2013 at 9:41 PM ^

Most ACL injuries happen to younger people because they are more active so more data can be compiled for this age group.  The fact that there is so much less data for older people is because they just don't have as many of these types of injuries.

My surgeon (Dr. Spindler) showed me the results of the MOON study and charted age (Y) over % of reinjury (X) and graphed cadaver vs using your own tendon and the two curves had more separation at the younger ages and gradually came together as the ages grew older and older.  I want to say the percentage between the two types of surgeries was 18% difference but not positive for a younger, active person.  Basically no difference in the two for older people.

I wouldn't say a viable reason for doing something is because "that's what they do in the NFL."  I was sold with data, not an opinion.  Someone in the NFL obviously thought a brace would help RGIII and look what happened to him.  If his knee was tweaked to begin with a brace wasn't going to help.  This was how I tore my second ACL.  I turned and heard a pop during a game, walked it off and had another game the next day and wasn't 100% but wanted to play...5 innings in a routine play and my knee gives out completely erasing all doubt as to whether or not I tore anything.