Left Knee ACL tear and medial and lateral retinaculum tear

[Dyvyne]

Hey guys,

I was playing a game on Sunday morning, and I tripped and fell hard on my left knee. It ended up swelling a lot with a lot of pain involved. I'm not able to weight bear.

The doctor said it looks like either a meniscal or ACL tear so he referred me for an MRI. The report says that I have a Grade I ACL tear and I have tears on both my medial and lateral retinaculum with patellar subluxation and joint effusion.

I know for Grade I ACL tears, the treatment is usually physio. But since I have to the other two tears, I'm not sure what will be required.

Will it be to do physiotherapy or will I have to go for surgery?

Thank you! =).

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[physiobob]

Ouch, sounds painful. FYI here's the grades and what they correspond to. It may be that you suffered a small dislocation and resultant subluxation during the incident.

• Grade 1 tear: a small number of fibres are torn resulting in some pain but allowing full function
• Grade 2 tear: a significant number of fibres are torn with moderate loss of function.
• Grade 3 tear: all fibres are ruptured resulting in knee instability and major loss of function. Often other structures are also injured such as the menisci or collateral ligaments. Surgery is often required.

In my opinion it is to early to tell if surgery is required but for now mine would be a conservative approach i.e. non-surgical. I would say you need acute treatment for 3-4 weeks to see how it settles down. If it is only a grade 1 tear then the rest will heal over 4-6 weeks to a state where you can begin to test things functionally. Might want to brace it for now to give the retinacular tissue some support while its healing.

[Dyvyne]

Hi, thank you for your quick reply and your advice. The surgeon I met with said that I wil have to wear a knee brace for a period of 21 days and no weight bearing activities on the leg, so I have crutches as well. I'm on different medications and have been icing it regularly.

He said that after the 3 week period, I can begin to slowly start walking and do some physiotherapy. But he mentioned that I won't be able to run, dance or play sports at all. All of which I was doing prior to this. He said that if I ever wanted to run again, I have to get an ACL reconstruction surgery, otherwise no running for life.

Do you think it's possible to go to the gym and run on the treadmill without the surgery? The surgeon advised me that could lead to further tearing of the ACL.

It's quite upsetting that I can't run or dance. I had signed up for a half marathon in September, so obviously upset I'll have to give that a miss.

Any advice would be helpful! Thank you!

[physiobob]

That advice contradicts the diagnosis of a Grade 1 ACL tear. i.e. one that does not require surgery. If you have has a full (Grade 3) rupture and want to play sport then a reconstruction would be my suggestion. It is early days and to be honest if it is a grade 1 then you can't tell how that has affected the feedback/feed-forward mechanisms that the ACL provides to the brain during movement. Only then will you know how stable the knee is and what can be combated with conservative management. In either respect any conservative rehab you do would be the same you'd need to do post surgery so all time spent doing it would benefit a later surgical intervention.

[Dyvyne]

Hmm, so I guess I'll have to see what kind of activities I will be able to do once I get better. Thank you!

I was training for a run in September and trying to lose some weight as well as I'm getting married this year. Not sure how that's going to go! Haha.

Thanks for your help. =).