ACL Tear - advice on surgery?

rooftop59 · September 2018

So I blew out my knee at noon basketball on Monday. Luckily it was a clean break of the ACL, sprained the outside ligaments but they will heal on their on, and menisci and cartilage are both find. Docs say knee looks really good overall considering. I turned 40 in April, I’ve been playing in the noon game 2-3 a week for 11 years or so, and last year reduced b ball to twice a week and added f-45 (a lot like CrossFit) twice a week. I’m basically in the best overall shape since my first kid was born almost 11 years ago.

Now my general doc (who is in his 30s) and my ortho (in his 50s I would guess) are pushing hard towards surgery. They kept referring to me as young and fit and mean and lean (hahaha I have never been called that before - more like a skinny white nerd 😂) and said we need to get you back to normal so you can do all the things you are used to doing (including chasing around and wrestling with 4 young kids).

So I have two questions: first, if I do the surgery the ortho recommended the hamstring graft over the other options. What do y’all think about this option? Any experience with it or the others?

Second, one of my best friends blew out one knee in college and the other about 8 years ago. He got surgery on the first but not in the second (which was very similar injury to mine) and he thinks that I should NOT get surgery, just live without an ACL. He says the repaired knee bothers him more than the other kine. He can’t play b ball anymore, but he is a very active mountain biker and does f-45 more than I do. So, would anyone recommend against getting surgery?

Thanks in advance!

jeremymarcinko · September 2018

Listen to the doc.

rooftop59 · September 2018

That’s my inclination Jeremy, but he is a surgeon that admittedly likes to cut. We are in similar places in life, would you get it?

Viking64 · September 2018

My ex-wife used to be an avid runner. She had knee surgery and she can no longer run.

She didn't have knee replacement. I think she had her menisci (I like that word!) removed. I would think that these types of treatments have a large YMMV factor involved based on genetics and other variables such as age, weight, health, etc.

rooftop59 · September 2018

Wow yea the menisci is the thin cartilage in the knee between the upper and lower leg. Having that removed would suck! This is very different...

pitdogg2 · September 2018

rooftop59 wrote: »

Wow yea the menisci is the thin cartilage in the knee between the upper and lower leg. Having that removed would suck! This is very different...

How could you remove it? It would then be bone on bone no?
I've had tears in both knees meniscus and surgery to fix both no problems.
The ACL is very important, I'd be inclined to get a second opinion and go from there. Doing nothing would not be in the cards if it were me. You have a long way to go in life for constant knee problems.

I've BMX'd since i was 13 both dirt racing and tore up the skateparks getting off the wrong side of the bike many times. Trained in Shotokan for 30 yrs. Both are very hard on joints I'm glad i followed the doctors orders. It's kept my going strong.
I'm 53 and still riding parks once in a while and training in Shotokan 3-4 times a week.

Listen to doctors and make informed decisions.

jeremymarcinko · September 2018

So after re reading I am confused. If the ACL is torn it will not heal on its own, right? You knee will be unstable if it’s not repaired, so I would have the repair.

If it will heal on it’s own, sprained, then no brace it and be careful.

I have a slight tear in my right ACL, (ATV hill climb gone wrong) and it’s not as stable as it could/should be. Happened about 16 years ago and I have lived with it. I have sprained it a few time since; being it’s been easier to do. It doesn’t really limit me much though. Just have to watch it. Still lift and play ball I do know that it will likely need replacing one day if I live long enough. All of the extra movement is causing wear and arthritis I’m told.

So yeah if it’s bad get it fixed. If you think it might be alright try some PT first, you can always have it repaired down the road.

rooftop59 · September 2018

I had to look up Shotokan lol...

The same ortho told my friend not get surgery, and he is still very active...

rooftop59 · September 2018

Yes Jeremy the ACL is dust as the doc said, complete clean break. You can live without it. Lots of football players in the 70s did. My buddy does and he mountain bikes and does f-45 all the time. So you can live without it. But things like football, basketball, and skiing are basically out fo the question if it’s not repaired.

I am definitely leaning towards just getting the surgery. Just looking for other opinions...

decal · September 2018

Laymen opinions on surgery are like opinions on audio, different strokes for different folks. You might come out like the 10 million dollar man or you might be a cripple. Get a second, third or even a fourth opinion from an ortho doc. Just my 2cents worth of opinion !!!

Mikey081057 · September 2018

I chose to live without an ACL that I injured in 1975... I played hockey with a brace until my 40's and still today can do all low impact stuff (Biking,swimming, walking. drinking). I really didn't have the option of modern surgery back then and will be getting a total replacement at some point. If I had the chance to when I injured it I would have.... rehab for both is a mother but when you are younger it is easier. Find the best ortho you can find!!!

Go for it.

Viking64 · September 2018

pitdogg2 wrote: »

How could you remove it? It would then be bone on bone no?
I've had tears in both knees meniscus and surgery to fix both no problems.

Judging from this video, meniscus surgery is pretty common. 700,000 surgeries annually. 4% of those are repairs and 96% are removals.

You are right about the bone-on-bone aspect, Ivan. Apparently the surgery can be more painful than leaving it alone in many cases.

https://www.youtube.com/watch?v=B99ebcTbRKc

pitdogg2 · September 2018

Wow never knew.

rooftop59 · September 2018

decal wrote: »

Laymen opinions on surgery are like opinions on audio, different strokes for different folks. You might come out like the 10 million dollar man or you might be a cripple. Get a second, third or even a fourth opinion from an ortho doc. Just my 2cents worth of opinion !!!

I agree, but I am mainly interested in people’s experience. So Jeremy and Ivan and mike that is helpful thanks.

[Deleted User] · September 2018

I would get the surgery. I had a torn meniscus and went under the knife and don't regret it at all. Plus you get to take a little nap during the day.

Having a torn ligament is a bigger deal in my opinion. I would compare it to driving with bad shocks on your car but you never get to trade in the car and those shocks can only get worse.

Modern surgery methods are so minimally invasive that it takes days rather than months to recover. Having said that, they could make a mistake and accidentally remove your manhood. When i had my surgery I tricked the surgeon by making mine really, really small. Everything is still intact as far as I can tell.

shawn474 · September 2018

I have been practicing sports medicine for 25 years; PM me. Happy to give advice. Short answer is to get the acl repaired (many different types of grafts) and repair the meniscus if possible.

Mikey081057 · September 2018

Recovery and rehab for ACL graft surgery is MUCH LONGER.

https://www.emoryhealthcare.org/centers-programs/acl-program/recovery/rehab-timeline.html

You are in for about a year of recovery/rehab.

rooftop59 · September 2018

shawn474 wrote: »

I have been practicing sports medicine for 25 years; PM me. Happy to give advice. Short answer is to get the acl repaired (many different types of grafts) and repair the meniscus if possible.

Hey Shawn I will shoot you a pm, but the meniscus and all cartilage are fine. Only permanent damage is a snapped ACL. Otherwise knee looks good all things considered! Already walking gingerly on it...

rooftop59 · September 2018

Mikey081057 wrote: »

Recovery and rehab for ACL graft surgery is MUCH LONGER.

https://www.emoryhealthcare.org/centers-programs/acl-program/recovery/rehab-timeline.html

You are in for about a year of recovery/rehab.

Yea the year of rehab does not sound fun, but I got young kids and a lot of life left and my motto is short term pain long term gain...

Are saying you think that is a better option than the graft surgery???

Mikey081057 · September 2018

At your age the graft... I would do it now if I was younger....

verb · September 2018

I would get some more opinions. FWIW. Good luck sir!

shawn474 · September 2018

It’s a no brainer to fix the acl. No need for a ton of consultation or visits. Too many cooks spoil the meal. It’s a very common surgery these days. You basically have 3 choices of grafts:
1. Cadaver
2. Patellar tendon
3. Hamstring
All have pros and cons. Patellar tendon is considered gold standard but rehab is a bit more intensive. They often won’t know for sure of any damage to meniscus until they scope it. The surgeon will likely have this conversation with you prior to surgery or before they perform the procedure.

If there IS a meniscus tear, repair it all costs if possible. If there is not a tear, that’s best case scenario.

The rehab is ESSENTIAL and often where the surgeries fail. Doing too much too soon is obviously not good. But not doing enough, or having someone who doesn’t perform therapy often on active patients, can be just as detrimental. Get the recovery protocol from your surgeon in advance. Make sure you have full strength and range of motion BEFORE having the acl reconstruction. Having a stiff, weak and swollen knee prior to surgery is a recipe for disaster and a sure fire way to have a failed outcome.

A LOT of people have great intentions on advice and it’s never bad to take everything into account. Not getting the surgery provides opportunity for an unstable knee to give way and could lead to other problems (meniscus tears, chondral defects, etc - Which all can lead to increased incidence of arthritis and possibility for need for future procedures). An isolated acl reconstruction is a common procedure and gives best results for a positive outcome with an educated and informed patient.

rooftop59 · September 2018

Thanks Shawn thats awesome! My ortho is against the first. And doesn’t like the patellar tendon as much because he says you might develop pain and irritation in the front of the knee when getting down on one knee for instance. So he he is pushing for hamstring graft.

It’s a sports medicine clinic. They have already given lots PT advice, I think they will do good on that front...

shawn474 · September 2018

FWIW, I agree with your surgeon......

Just do me a favor and do not go into the procedure until you have full strength and range of motion. If you do that, after the first week, it will be a breeze.

Clipdat · September 2018

My wife is a former certified athletic trainer who used to work with an orthopedic surgeon, here are her recommendations:

"Get it fixed, but wait at least 6 weeks to allow for joint swelling to subside and full range of motion to return.

Use patellar tendon instead of hamstring. Hamstring is painful to harvest and recovery is long. Patellar tendon provides a stronger graft and a better surgical outcome overall. Playing basketball again is definitely doable after surgery and rehab. If you choose not to have it fixed, the activities that you have previously been doing will be much more difficult or impossible."

nooshinjohn · September 2018

Adrian Peterson, Dalvin Cook, and a couple other Vikings I can’t think of at the moment, used cadaver grafts. Seems to be the choice of professional athletes....

Sorry to hear about your difficulties. I can offer no real advice, but will keep you in my prayers for a speedy and complete recovery.

Dabutcher · September 2018

I had ACL tear 35 years ago. Dr. said to just live with it. So I did. I did not play any sports after that . Only walking and bicycle riding. Had about seven clean up surgeries in the last ten years and just now had knee replacement in December. No regrets. But you should get yours repaired. Good luck. D

rooftop59 · September 2018

Thanks all yes my worry with NOT repairing is that it increases the chances of arthritis and cartilage damage and thus the need for a full replacement. I think repairing now will be better long term...

cfrizz · September 2018

It's never a good idea to wait until something HAS to be done. Repair it now while you are still young, the recovery will be quicker, with fewer problems later on down the line when you are older and will take longer to recover.

Best of luck.

rooftop59 · April 2019

Well 5 months after surgery I was just released from pt. Advised to wait for full sports for a couple more months. Doc told me I was a “stud” and that I should train some of his high school athletes 😂. I said doc you got to buy me dinner first jeez...at 41 that’s a great way to butter up your patient...

Tony M · April 2019

At 41 and a Doc says that to you...you're definitely showing your ability to overcome and surpass normal expectations of recovery.

I'm always impressed with NFL athletes who have had knee injuries, go through those intense workouts to get their knees strong again. I see them on TV doing things for rehab that I couldn't do with 2 good knees at any point in my life.

NFL players are super-humans in my eyes!

I haven't had a knee injury but I would think knees are NOT an easy joint to make strong again without suffering.

Every step, twist, squats and other bodily moves seems to involve the knees.

You must have stamina and determination that's higher than most people and the Doc has acknowledged that to you by saying you would make a great teacher for sports injury recovery therapy.

Keep it up!

Keep making that knee better and stronger than it was, if that's possible.

ACL Tear - advice on surgery?

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