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  1. #1
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    Brief Medical History Overview

    Age: 23, Male, Presenting Problem Since: 3 years, Symptom Behaviour: remaining constant, Symptoms Worse (24hr Behaviour): morning, Investigations: X-Ray, MRI, No Diabetes, No history of High Blood Pressure, No Medications, No Osteoporosis, No Hx of Cancer, No Unexplained Weight Loss, No Bowel/Bladder issues

    ACL tear Surgery or not?

    Physical Agents In Rehabilitation
    I'm just wondering if anyone can help me make my mind up so here goes,

    I was 19 (3 years ago)and I was playing soccer jumped for the ball , when landed my knee buckled and i was in extreme pain. So i went to the hospital and they done an x-ray couldn't find any problems so sent me away saying it was just a sprain, So about 2 weeks later I still couldn't put much pressure on my knee and ended up being booked in for a Knee Arthroscopy. After I had that I was told that my cartilage had a small tear and they trimmed it down and cleaned up inside and I should be fine within 2 weeks.... The pain continued so I was sent to physio for 2 months where it was to painful to do any exercises so then I was sent for an MRI scan. Anyway it turns out to be a partial ACL tear and now I have been put on the waiting list for reconstructive knee surgery ( with the NHS ) in the UK could take months to hear anything.


    BUT..

    I've recently moved to work Denmark and to make my time here permanent I will need to register to live in this country therefor possibly sacrificing my operation at home.
    After I went for physio and I found it to hard to complete so I have kind of given up trying some exercise to build my quads to support my knee, but in recent weeks when I start to force some pressure on my knee I don't get the pain I used to have so im in 2 minds about the operation and I really want to start training my knee and trying to work my way into light running just to see how things go.

    Also my knee makes loud clicking noises if for example I relax for 30 mins in a sitting position and then quickly stand up there's a loud crack coming from my knee and it causes pain for a few seconds then just disappears, And if I place the palm of my hand over my knee cap and bend and straighten my knee I can feel what I can only describe as a crunching feeling

    So I really need some advice ,
    Is this beyond the help of a physio because its been so long and would my best option be to take the operation or do I just hope for the best and not take the operation and work hard to build up the muscles again?

    Any advice would be greatly appreciated .

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  2. #2
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    Re: ACL tear Surgery or not?

    I am not the most expert physio here, but I would say you don't need a surgical operation for that, usually surgical operation are just for complete rupture or very unstable ACL.
    Did you knee swell a lot and in a matter of few minutes/hour at the momemnt of the injury you had? Do you feel now that your knee is unstable and literally gives the way (almost you fall on the floor) Does it lock at all?

    Sounds very strange that they didn't have a look to your ACL during the arthroscopy, if there was something wrong with it they would have mentioned it.

    Don't worry too much about the clicking and noisy sound coming from the knee, almost certainly are not due to ACL problem.

    All the best

    Emanuele


  3. #3
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    Re: ACL tear Surgery or not?

    can you bear any weight on the injured knee for more than 10 minutes without feeling an uncomfortable stretch in the back muscles? just wondering because thats what I ve been going through for the past 10 months,,,I was running and somehow ended up with a very strange left knee injury. I never fell so I must have just stepped wrong or hyperflexed the ligaments,,,its been hell though I lost complete support on that joint and it looks like my back is now compensating,,,2 orthopedists said theres nothing wrong with it and recommended me to do physical therapy to strengthen the quads buttocks and hamstring muscles but it has not been very effective for me on the contrary it just makes the interior of the knee hurt a lot more i might have injured the pcl or acl,,,its quite disabling and I would suggest for you to get an mri and see a specialist,,,im gonna see one next week hopefully Ill get more info! just stay positive try not to overdo it and be patient...trust me I know how much this injury sucks...



  4. #4
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    Re: ACL tear Surgery or not?

    Hi there,
    I'm sorry it took them so long to figure out that it was an ACL tear.
    Denmark have as good, possibly better healthcare system than the UK, so make deciding on the surgery or not your issue rather than worrying about where to do it.
    You say:
    "After I went for physio and I found it to hard to complete so I have kind of given up trying some exercise to build my quads to support my knee"
    Did you mention that your were struggling with your exercises to your physio? Did you make attempts to get your pain under control with anti-inflammatories and pain relief via your doctor?
    Did you actually follow an ACL rehab program after you found out or just have one physio session?




  5. #5
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    Re: ACL tear Surgery or not?

    Aircast Airselect Short Boot
    I know several consultants who would agree that "prehabilitation" is just as important as rehabilitation. Your reluctance to attempt any exercises now doesn't bode well for if you do have the op as you need seriously high levels of motivation and commitment to progress with ACL rehab! Yes, pain needs to be controlled through analgesia but exercise can be graduated and slowly progressed, tailored to suit your level. Seeing a physiotherapist to get a professional re-assessment is required, I think. They can advise you on how to best strengthen your knee without stirring your symptoms up majorly, although I would add that initially, the exercises are bound to cause some discomfort/pain due to weakening of muscles, decreased balance etc. Knees crunch and creak a lot without major problems so I would not be too concerned about this, although sometimes difficult to ignore.

    I was referred a patient several months ago who had been misdiagnosed 3 years ago and due to his age (80) was obviously too high a risk for surgical repair. He had a very lax ACL which I suspect was near enough a complete tear due to the laxity. It was giving way on a daily basis and made it difficult for him to walk around on the flat or down slopes. After starting him on a rehab programme and working on hamstring strength, quads and balance exercises (tailoring it specifically to what he needed), he was almost asymptomatic and found he could manage much better than previously. Obviously, this is different from your case but the point I am trying to make is that you'll never really know what your prognosis will be if you haven't given rehab a good go. Usually, conservative management is the first port of call unless otherwise indicated (i.e. high functioning athlete or severe loss of function/disability following injury). I would see a physiotherapist for their assessment and go from their advice, it probably won't do you any good "guessing" what exercises to do even on the advice of qualified professionals here, nothing can substitute a face-to-face objective assessment.

    Hope this helps.



 
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