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pico23
May 30, 2006, 3:38 PM
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tore my ACL in march. partial tear (40%). my doc a fairly well known and experienced surgeon (team doc and co-doc for a college and pro team) recommended doing nothing from a surgical standpoint. brace and keep doing what i've been doing to rehab. physically i am 110-125% at pre injury strenght in both legs.
problem is this weekend i realized the limitations of a "partial tear" which i'm coming to find out is the same as partially pregnant.
anyway, on a light backpacking trip i simply took a mis-step, that is i came up a little short on an upsloping rock which cause my knee to hyperextend due to the ACL insufficiency, and i felt the knee buckle (no i wasn't wearing my ACL brace because the place that fitted me felt I might not pay for it, a whole $230, so they didn't order it).
regardless of the lack of ACL brace, it is apparent I will never get any stronger than I am now. Beyond that I've read considerable medical studies that show (and this would appear obvious) that putting off inevitable surgery will only result in meniscal tearing and early arthritis.
I don't want to jump to conclusions but considering i escaped meniscus damage in the initial injury, I think I might have damaged it this weekend which sucks but was a wakeup call.
so i'm electing to have a ACL reconstruction but i want to know from people who have done this w/ or w/o sucessful outcome. And if you elected to have allograft or autograft.
Also, those who only had partial tears I'd like to know how things have worked out.
And finally, how long was your therapy, could you do most of it yourself after the initial phase, how long did it take you to get back to your basic activities of daily living, and how long to get back to the crag or on the trail.
I've read a lot of stuff but I'd like to hear first hand accounts/recovery times from people involved in similar activities
Thanks.
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skeletos
May 30, 2006, 4:53 PM
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I had blown my acl and torn my mcl in Dec of 04. I needed to let my mcl heal and get full range of motion and some strength back in my leg before acl surgery. So by Feb 4th 05 I was able to have the surgery. I chose to replace it with my patelar tendon because of some research I had done. It sounded that it was a stronger tendon. My doc (Dr. Hugh West of TOSH in Salt Lake) said that it really didn't matter to him which I used. I guess different doc's feel differently about this. Anyway, they were telling me that my recovery would be 4-6 months. I am pretty active and was willing to do whatever it took, so I figured it would be 4 months. I went to PT and I did whatever they told me I could do and got full range of motion back quicker than most. It seemed like it was taking forever to get my strength back, so I tried to push it a little harder with a bridge program(which is supposed to focus in on getting you back doing a specific sport a bit quicker) and started to develop tendinitis. So, I started slowing things down a bit. Then I entered this pool therapy program. This was a little less stress on my knee and really helped me out a lot. By the end of June I got the go ahead to do whatever I wanted. They said my acl was bomber. So I started doing some top-roping and a bit of light wake boarding. By about the end of July I was feeling real good about doing most things. This ski season, I would have to say I took it pretty easy. In the beginning my knee was hurting quite a bit, but by mid season, after all of those little muscles in my knee had built up, I was good to go. There is still some pain here and there, but I'm definitely glad I had the surgery. My advice to you is do a lot of research on who you are getting to do your surgery and also find a real good PT team. I was lucky that I live in a place where excellent knee surgeons and a dime a dozen. One more thing is that I know about a month after i had my surgery a bunch of doc's from here went to some doc in the Midwest who was doing acl surgeries that had only an 11 week recovery time. He had done hundreds of them with good results. I haven't looked into it, but I
think these docs out here are now doing it his way. Something to look into anyway. Hope this helped. Good luck.
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faeiry
May 30, 2006, 5:27 PM
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I have had two allografts (patella and back) on the same knee (scars are the new tattoos).
1. Realize that each human's joints are very unique...so RESEARCH what kind of normal motion you have and make sure the doc understands what the hell you are talking about and works with graph from there.
(I regret having surgery, waste of time and money. My joints are too open and I am now a case study at UCSF on the type of patient that should not have reconstruct! I climb/cycle/swim/hike/skateboard/surf/dance ACL-less now with no pain, no issues, see #2)
2. What kind of yoga are you practicing??? There is really no point in talking about joints if you do not have an athletic practice established...of course in combo with stellar cardio and weights. (If you need to establish a practice, dive into your mindbody, and then check into Ashtanga, if you do not leave the studio dripping and exhausted something is wrong.)
Cheers!
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trenchdigger
May 30, 2006, 6:04 PM
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Do you know where the tear is? If the tear is at the femur, there is another option worth considering. It's called the a Healing-Response surgery. It involves an arthroscopic surgery in which bleeding is stimulated in the femur where the ligament is to attach in order to generate a healing process which will latch the bone back onto the torn ACL.
1.5 years ago, I went into surgery expecting to have a patellar tendon graft reconstruction done. When my doc looked around inside, he found that the ACL was still partially hanging on and that the tear was at the femur, so he decided to try the Healing-Response procedure as we had discussed as a possibility before going into surgery.
The post-op treatment is very different than a reconstruction. The procedure requires that your leg be locked straight in a brace for 6 weeks post-op to give the ligament the opportunity to latch onto the bone. During that period, only minor flexibility building exercises are to be done.
4 months post-op, I was back to around 90% stregth, but still used a brace for support. 6 months post-op, I was back to normal and felt as good as ever.
If the conditions are right for this procedure, it seems that it can be very successful. Of course if it does not work, there is always the option to go back in for a reconstruction surgery.
Here's a couple of links for more info.
http://www.aaos.org/...2004/poster/p343.htm
http://www.steadman-hawkins.com/athleteUpdate.cfm
http://www.orthopedictechreview.com/...es/mayjun02/pg34.htm
I don't know how common this procedure is. The orthopedic surgeon I used in San Diego conveyed that this is a newer procedure that is much less common than the standard reconstructive repair. Read up, print out a few pages, and ask your doc about it.
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pico23
May 30, 2006, 6:04 PM
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In reply to: I had blown my acl and torn my mcl in Dec of 04. I needed to let my mcl heal and get full range of motion and some strength back in my leg before acl surgery. So by Feb 4th 05 I was able to have the surgery. I chose to replace it with my patelar tendon because of some research I had done. It sounded that it was a stronger tendon. My doc (Dr. Hugh West of TOSH in Salt Lake) said that it really didn't matter to him which I used. I guess different doc's feel differently about this. Anyway, they were telling me that my recovery would be 4-6 months. I am pretty active and was willing to do whatever it took, so I figured it would be 4 months. I went to PT and I did whatever they told me I could do and got full range of motion back quicker than most. It seemed like it was taking forever to get my strength back, so I tried to push it a little harder with a bridge program(which is supposed to focus in on getting you back doing a specific sport a bit quicker) and started to develop tendinitis. So, I started slowing things down a bit. Then I entered this pool therapy program. This was a little less stress on my knee and really helped me out a lot. By the end of June I got the go ahead to do whatever I wanted. They said my acl was bomber. So I started doing some top-roping and a bit of light wake boarding. By about the end of July I was feeling real good about doing most things. This ski season, I would have to say I took it pretty easy. In the beginning my knee was hurting quite a bit, but by mid season, after all of those little muscles in my knee had built up, I was good to go. There is still some pain here and there, but I'm definitely glad I had the surgery. My advice to you is do a lot of research on who you are getting to do your surgery and also find a real good PT team. I was lucky that I live in a place where excellent knee surgeons and a dime a dozen. One more thing is that I know about a month after i had my surgery a bunch of doc's from here went to some doc in the Midwest who was doing acl surgeries that had only an 11 week recovery time. He had done hundreds of them with good results. I haven't looked into it, but I think these docs out here are now doing it his way. Something to look into anyway. Hope this helped. Good luck.
I actually got some great info from a site out in SLC. Luckily I wouldn't have to go that far. Vermont happens to be one of the pioneering areas in knee reconstruction. i'm not really convinced I need to go to VT though, these days techniques travel pretty quickly and Burlington is just a stones throw away.
it seems the allo vs. autograft is about 50/50. each group says they made the right choice (or wrong choice of it went bad). so it's a tough call. i'm kinda leaning towards allograft though. can you link me to the research you found on the patellar tendon autograft? I go in for consult Thursday so I'd like to be prepared to discuss all my options.
i'm hoping to get one more long hike in and then have surgery by the middle of june.
also, one other thing. what type of brace did you use post surgery? How long did you wear it? and for what activities? such as did you just wear it for sports or all the time and for how long in both areas.
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tharlow
May 30, 2006, 6:07 PM
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While studying for my Physical Therapy degree, I did a review on the research regarding operative vs non-operative treatment for ACL tears. The studies I reviewed indicated that for sedentary individuals, most could achieve satisfactory outcomes without surgery. But for athletes or active individuals, the non-surgical outcomes were poor. I had one knee reconstructed 16 years ago, and it has performed extremely well, I could not be happier. The surgical and rehab options are much more advanced now than they were when I had it done. Mine was a patellar tendon graft. Since then I ski, climb, run, hike, bike etc with minimal difficulties.
Keep in mind, I do not know your history, I am not an MD, and it would be really irresponsible for me to give you medical advise or encourage you to choose one option or the other. Only thought that I would give you my experience in the hope that it helps you in your decision. Good Luck.
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taterlandclimber
May 30, 2006, 6:55 PM
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Ten years ago I had a partial tear of my left ACL from soccer. I tried to go the no surgery route, but I tore it completely on my first game back. In hindsight, the first doctor I visited wasn't experienced enough in this area but I was a kid and went where my folks told me to go.
After the complete tear I had surgery in Feb. They used my hamstring tendon. I was jogging in 3-4 months and started soccer again in August. I am very happy that I had it done. I would only get a small dull pain if I sat in a cramped space where I couldn't move my knee (car roadtrips, movies). I have since torn the meniscus in that knee skiing, but it was my own fault.
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iamthewallress
May 30, 2006, 8:04 PM
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Registered: Jan 2, 2003
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I had a cadaver graft.
Rehab was hard, and you may need to work at it forever to keep your leg equally strong.
I was TRing on tight TRs as soon as I could (against Dr. orders), and leading when I was sure I wouldn't fall at 4 months. But it took a year to "get through the day without thinking about it" (although sometimes I still did) and about 2 years to get full flexibity and strength back. I haven't had any real problems of late. It's been about 4 years since I had my accident/replacement.
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spunkyredraider
May 31, 2006, 12:21 AM
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Registered: Mar 17, 2006
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I will actually be going in on June 8th to have my ACL reconstructed. I tore the whole thing and they suggested I reconstruct with two of my hamstrings from the same leg. I was told because I dance that if I do the patella surgery with my own or a cadaver I would have pain under the knee cap. I tore it over two months ago and I was being careful and was still able to climb. I would suggest weighing all of your options because I was told I won't be climbing or dancing till December, but the doctor has never done surgery on a climber.
If you have any questions about the surgery you can ask me after the 8th when the drugs wear off.
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spunkyredraider
May 31, 2006, 12:24 AM
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edit: Double posts sorry
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skeletos
May 31, 2006, 2:04 AM
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My doctor was actually against me wearing a brace after surgery. The only time I ever used one was early on in my PT when I was riding a bike. So, to this day I don't wear a brace. I do some pretty serious snowboarding in the winter and never had any issues. Although a lot of people will spend big bucks for some nice braces and just wear them during very physical activities.
As far as links to the pt vs. hamstring, I think I just did a bunch of googling and came across some links.
I'm not a doctor, but in my opinion I would not deal with the healing-response thing because of the chance of it not working and because I think for the average person, it would be a longer recovery. Any time that you have to stabilize your leg for that long of a period, you will have to work it back that much harder. The day after my surgery I was in a machine that passively moved my leg from straight to bent. I was on that thing for about 20 hours a day for 7 days. I was so out of it on Perkocets that it did not bother me. It helped a lot with getting the range of motion back which is a real bitch if you are stabilized for 6 weeks. I know because I was in that situation before also. Also, I would not deal with a cadaver part because who knows if your body will accept or reject it.
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pico23
May 31, 2006, 2:23 AM
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In reply to: Do you know where the tear is? If the tear is at the femur, there is another option worth considering. It's called the a Healing-Response surgery. It involves an arthroscopic surgery in which bleeding is stimulated in the femur where the ligament is to attach in order to generate a healing process which will latch the bone back onto the torn ACL. 1.5 years ago, I went into surgery expecting to have a patellar tendon graft reconstruction done. When my doc looked around inside, he found that the ACL was still partially hanging on and that the tear was at the femur, so he decided to try the Healing-Response procedure as we had discussed as a possibility before going into surgery. The post-op treatment is very different than a reconstruction. The procedure requires that your leg be locked straight in a brace for 6 weeks post-op to give the ligament the opportunity to latch onto the bone. During that period, only minor flexibility building exercises are to be done. 4 months post-op, I was back to around 90% stregth, but still used a brace for support. 6 months post-op, I was back to normal and felt as good as ever. If the conditions are right for this procedure, it seems that it can be very successful. Of course if it does not work, there is always the option to go back in for a reconstruction surgery. Here's a couple of links for more info. http://www.aaos.org/...2004/poster/p343.htm http://www.steadman-hawkins.com/athleteUpdate.cfm http://www.orthopedictechreview.com/...es/mayjun02/pg34.htm I don't know how common this procedure is. The orthopedic surgeon I used in San Diego conveyed that this is a newer procedure that is much less common than the standard reconstructive repair. Read up, print out a few pages, and ask your doc about it.
Thanks for the info on this procedure. I don't know where the tear was. I didn't look at or request the MRI report to this point. My doc actually called me the day after MRI with the results so never had a chance/reason to get the report.
the healing response definitely is another option but i don't see a huge benefit. Actually it seems almost old school in that you are immobilized for weeks. so you expose yourself to muscle atrophy and joint degeneration. assuming all the prior joint research is accurate. most studies stress the importance of early movement both post injury and post op.
Thanks to everyone so far for the advice and recov times. It seems like 4-6 months for full recovery regardless of method. At least I have some questions to ask and some things to consider now.
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cosmiccragsman
May 31, 2006, 4:27 AM
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I tore my acl and pcl completely off, and partially tore my medial collateral, and meniscus back in 1987. The Doc used part of my ilitibial band and gortex to fix me up. I started physical therapy 8 hrs. after surgery. I am unable to climb as hard as I used to, bit I can still climb in the mid 5.10 range. I am unable to really run anymore and I have to wear a brace when I climb. I still have fun though.
http://www.rockclimbing.com/...p.cgi?Detailed=67947
Cosmiccragsman
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pico23
Jun 2, 2006, 2:26 AM
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So long story short my doc pretty much only cared about the MRI #'s which are bordeline. even though he conceeded that he's seen people with 100% tears that he couldn't create instability on exam he wouldn't even consider operating. this was again despite me explaining that I do have instability in the real world and thats what i'm most concerned about. i also explained the fact that i had increased pain since last weekend.
he also denied that i was at an increased risk for chondral and meniscus damage with an ACL insuffiency in the short term but didn't deny that long term i might need surgery anyway.
so i was confused as to why we couldn't do it now rather then wait for things to get worse. suffice to say i am done.
so i'm headed to the Hospital for Special Surgery in Manhattan for a second oppinion. Its the # 2 joint hospital in the US so I'm hoping for a better explanation of my long and short term outcomes. And be given the option to have it definitively repaired sooner then later.
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cosmiccragsman
Jun 2, 2006, 2:47 AM
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Good luck Pico. I hope everything turns out well for you. :)
If there is instability, and your second opinion Doctor does not want to do surgery, ask your Doctor about getting a C.T.I. brace made by
Innovation Sports, in Southern California.
My knee has been unstable since my injury in "87", and without the
brace, chances are, I would have blown it out again, while climbing,
or other sporting activities, I pursue.
Cosmiccragsman :)
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stanfield
Jun 4, 2006, 10:07 PM
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I tore my a.c.l. back in 1984....I had about 40% removed as this was before the high tech repairs done now..I had started climbing about 5 years ago (I am 46)...I use a brace I bought on line that was about $60.00 non allergic with a couple straps and bars, as this cheaper model was recommended by the brace store...nothing fancy.
I have done many climbs, I can follow 5.8 - 5.9 some ice climbing and backpacking with this and have never had any problems using this style brace.
I had re-injured it several times over the years, once running down steps, another time on a motorcycle and mountain biking one time (forgot the brace that ride).
As I can do anything I wish and it does not bother me and the brace is no big deal I am not planning any repairs, unless something bad happens...al
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kmsmoguls
Jun 5, 2006, 12:22 AM
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I am a PT and I work in an outpatient clinic around Boston. Rehab time depends. I had one patient who hardly need any PT but on average it is about 2-3 months of PT and running ~ 4-5 months after surgery. That is the general rehab protocol for most of the MD I work with.
I am not sure if I would recommend surgery if it is a 40% tear. When did you tear it? Could your knee have hyperextended even if you didn't have a tear?
If you do have surgery I would go with a cadaver graft. The next choice would be a hamstring graft. I would not recommend a patella tendon graft because it can adversely effect the patellofemoral joint. However, I would go with whatever the MD is more comfortable performing. You just have to trust him/her.
Good luck with surgery and your rehab.
Erik
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pico23
Jun 5, 2006, 1:48 AM
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In reply to: I am a PT and I work in an outpatient clinic around Boston. Rehab time depends. I had one patient who hardly need any PT but on average it is about 2-3 months of PT and running ~ 4-5 months after surgery. That is the general rehab protocol for most of the MD I work with. I am not sure if I would recommend surgery if it is a 40% tear. When did you tear it? Could your knee have hyperextended even if you didn't have a tear? If you do have surgery I would go with a cadaver graft. The next choice would be a hamstring graft. I would not recommend a patella tendon graft because it can adversely effect the patellofemoral joint. However, I would go with whatever the MD is more comfortable performing. You just have to trust him/her. Good luck with surgery and your rehab. Erik
Thanks for the advice. I was content to not have it surgically repaired initially but the data says it or the surrounding articular cartiledge will need repair at some point.
I never hyper extended my knee before, nor felt pain in either joint doing anything. WHere it happened was a very slight upslope followed by are downward angled rock. Not rough terrain at all. once it did that the whole rest of the weekend it was "giving out". It's been fine since I got home and throughout this week but I hadn't done anything since getting home but walk because of the pain (minor but not normal) for the following few days.
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spunkyredraider
Jun 10, 2006, 12:41 AM
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I just had my ACL reconstructed (June 8) and it hurts alot. They did my own patella because of my age and activity level. They said your body can reject the cadaver patella. They had originally decided to do a hamstring graft, but when they saw the x-rays they said I was the perfect candidate for the patella graft because mine is short and my bones are close together. They did find that my bones were soft so it was good I had this surgery because now I can prevent future bone loss.
The surgery is pain-full and I didn't do well with the anesthetic. I was in the hospital for almost 12 hours because I couldn't keep anything down. I will start physical therapy on Monday and they have me doing exercises already. I think the most painful part was them removing the drain.
Hope all goes well for you.
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gomz
Jun 10, 2006, 2:02 AM
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pico,
Sorry to hear about your knee. I tore my acl and mcl almost a year ago (june 24). I had a great surgeon who was very encouraging and has performed many acl recons. (mostly due to skiing accidents here in Mammoth) I elected to use a patella graft for reasons stated above (age, physical condition) Make sure you obtain full flexibility before having surgery it will speed up your recovery time immensely. Stick to your PT schedule for a full year, at least, and become best friends with your bike (I have riden nearly every day since 2 days after my surgery at least 20 mins usually 2-3 hours on days off) Everyone is different but I was able to start TRing again 6 weeks after surgery and did a three day red rocks trips climbing 20 pitches over 3 days four months out. Was in the valley two weeks ago and tested my knee on a couple of grade 5's done in push style and 1 El Cap route (was so happy to be able to hang with my 22 year old partner) I would say I am at about 90% and will reach 100 by winter. Feel free to email me if you want o know more about my rehab schedule. It's also super important to stay positive and to realize some days are going to be better than others.
Good Luck,
Steve
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