Partial ACL tear - no surgery

[mouk786]

Hi

I posted on this forum before - thanks for all the help.


My situation is this

I am 23 years old, male and fairly fit.

I got my MRI results today and have a partial ACL tear (not sure to what extent).

I definitley want to get back to having a strong knee/leg and am willing to work like a btich to get there.

I also wanna get back to being able to run properly and play soccer. Not to a high level but to a fairly decent standard maybe once a week.

Now reading (hundreds) of pages online about ACL tears and surgery I geared myself up for some news on surgery today as I expected a full ACL tear.

The Dr says that he recommends I take physio instead as if I do it well enough I can go back to near enough where I was pre-injury and that surgery was a last resort and he doesn't recommend it.

There MAY be pressure on him to prevent people going for surgery as its on the NHS (in the UK) and so it costs them a lot of money - but I do udnerstand his reasoning - though he was pushing hard for physio rather than surgery.

I spsoe worst case is I do physio for 3 months and if its still not OK I can have surgery.

I spose I am looking for re-assurance. Can I really get back really good just with physio therapy? I dunno how much is left of my ACL though.

Also the physio he was talking about seems to be about strength,control and all sorts -which sounds good as it may help me A LOT more than I originally expected.

Has anyone recovered prerly from a aprtial ACL tear like this?

Also, when I originally saw my physio (not on the NHS) he suggested that continuing without a proepr ACL may lead to artiritis. However the guy today said that now I have the knee injury I have a higher risk of arthiritis anyway - who is correct? Do i leave myself open to a much higher chance of arthritis if I have no surgery or is it possible to recover enough to be on roughly the same level (i.e surgery and physio and no surgery and physio).

Also can any physios who actually do the treatment give me a rough idea of what to expect? What kind of treatments do you do that i wouldnt think of myself (i.e squats/ankle weight exercises etc)


Any suggestions?

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[Dolores]

Thanks a lot for the advise!
I stopped seeing the Physical Therapist because her approach seemed a bit too aggressive for me considering the extent of my injury and because my insurance stopped covering the sessions. I can't explain how much I've been struggling with this injury, it has affected all aspects of my life. I had to stop my career, lost my job, got evicted and haven't been able to get another job because I can barely walk with a cane, and the truth is that nobody wants to hire a crippled person. I'm actually in the process of filing a Disability claim because I'm afraid this is going to be permanent and I'm kinda worried about my future.

Luckily my one and only friend offered me shelter and has been helping me tremendously. I feel very fortunate in that regard but the situation is still frustrating because I used to be a self sufficient independent person and now I can't even handle my own grocery bags. However, I've been trying to remain positive just pushing trough the pain and doing mainly the leg raises that the PT showed me to strengthen the muscles but without overdoing it and I feel more comfortable going at my own pace. Unfortunately I can only do so much physical therapy because too many repetitions start producing an excruciating sharp pain directly on the ACL area, sometimes in the front of the patella tendon as well, so I have to stop myself and its been hard to work the quad muscles.
It's also very difficult to bear total weight on the knee, it just feels mushy and "very unstable" like its going to give out anytime. I can't even walk without a cane or a crutch, can't go up and/or down the stairs without holding on to the rail and the cane, I can't jump nor run....I have seen 3 orthopedist surgeons so far and have gotten an MRI which surprisingly showed all ligaments and cartilage to be "intact" but I still was diagnosed with a "Knee Joint Derangement" and "Patellofemoral syndrome" and was simply advised to continue with physical therapy.
I am very confused and beginning to question the accuracy of MRIs. Perhaps they are not good at detecting partial ruptures, so I am wondering if there are other ways of determining what exactly is wrong with my knee joint, and if its going to need to be repaired in order to be fully functional again. It's been 11 months since the accident and I don't see much progress,,could it be a slow healer or something more serious that is going to require surgery? From what I've read about ligaments, they don't heal on their own, so I don't know but there is definitely something wrong with my mine...I'm probably just going to get another MRI, it's been 3 months since the last one...any suggestions will be greatly appreciated....Good Luck to all of you and Dont give up.
This support systems are definitely what keep the faith alive!

[Dolores]

GLad to hear your knee feels better after the ligament reconstruction! I can imagine all you had to go through to get to that point...But hard work pays off and now you are on your way to recovery, just take your time and take it easy you might want to wait until the joint feels more stable before going back to the field or just cut down on the sports,,,I know its hard but focus on healing your knee so it can get strong...I've considering a ligament reconstruction too because the PT hasn't been very effective for me,,,I can't hardly work out the muscles on the injured leg because the ligaments are not a 100% there,,
I have a feeling its a partial ACL & Patella tendon rupture with a quad muscle overstretch,,,I was just running fast
(well more like hovering...)
What a retard...I really wish I could go back in time and just Walked,,,but it is what it is and the damage is done,,,ugh
Well i wanted to ask you what type of graft did you use for the reconstruction and if you don't mind describing the experience a bit more..
Can you bear weight on the repaired knee without feeling pain at all, is it stable?

Thanks and I wish you a lot of success on your rehabilitation! Be patient and just take it one step at a time.

[Dolores]

Yep, basically consider a lot more agility training and plyometric type work. You'll need a trainer or PT to work out a plan for you locally. If the brain is not sure about things it simple won't give more power to the muscles so you are weak through inhibition and that's something that strength training can only assist a little with. It is 'neural connection strength' you need. Best of luck in the coming month and let us know how you get on.

Thanks Physiobob!

I truly appreciate your suggestions but I'm not sure if inhibition is what's causing my painful knee joint derangement symptoms although I really hope that's the case because it means that there's a chance I won't be needing an ACL reconstruction...and that it's simply up to me to regain full functionality of the joint.
However, I was looking at some lower body Plyometric exercises and the ones I saw require "Jumping" (even w/Low Intensity) which is one of the activities I have not been able to do since the day I injured the knee joint from running (11 months ago, almost a year) I just started to bear some weight in the knee about 3 months ago but I have to use a cane to walk because the knee still feels very unstable and it really hurts, in other words I cant stand on the injured leg for more than 20 seconds without some sort of support,,,otherwise I start getting a sharp shooting pain...
I'm also wearing a hinged knee brace for extra support because the joint feels kinda loose inside,,,,
so I don't think the jumping exercises are going to work for me because even if I try, I'm afraid that whatever is left of the ACL and patella tendon,
will fully rupture when I land....but I could be wrong,,,
I guess there's only one way to find out but it sounds way too risky....
Do you think its because I have some significant missing fibers in the acl and patella tendon and that's why my brain is getting mixed signals... hence the sensation of pain? I just don't understand why the pain? Is it a good sign or a bad sign?
that's what I'm not sure about,,,
does it mean that it's healing or that it's getting worse?
I guess that what I'm trying to understand is if the pain is part of the recovery process or if the reason for the pain is because am I injuring the ligaments even more by forcing myself to walk and work out. I know its a lot of questions ,,,its just so confusing.....any feedback would be highly appreciated!

Best regards,
Dolores

[Dolores]

Yep, basically consider a lot more agility training and plyometric type work. You'll need a trainer or PT to work out a plan for you locally. If the brain is not sure about things it simple won't give more power to the muscles so you are weak through inhibition and that's something that strength training can only assist a little with. It is 'neural connection strength' you need. Best of luck in the coming month and let us know how you get on.

The more I think about the partial ACL tear the more I realize that I'm wasting my life away by waiting for it to heal,,,
Surgeons will not try to repair it if its not fully torn they only suggest "Physical Therapy" which is totally useless because it's like a dead end road,,,
Perhaps the only alternative for this cases is to tear it completely in order to get it fixed,,,
what is the use of having a piece of useless tissue constantly sending pain signals to the brain? If I could at least walk on it, it would make sense but if it's making it impossible to move on and it's going to break eventually then why even hold on to it?
I know how radical this sounds but if that is the only way to get it reconstructed then it does make sense,,otherwise its just going to continue being a HUGE bump on the road...I can't even get a job and since the ligament is not fully torn it's not really considered a "disability" as disabling as it really is,,,
This is not about pain,,,its more about a tiny rupture that has ruptured my life completely,,,its starting to look like I'm just going to end up homeless living in the streets and unable to walk,,,

[syamir]

Hi guys,

i'm 22 and a very active sportsmen.. i play rugby (club level), football/futsal (college level) and tennis/badminton (occasional)..

He asked me to do some self physio such as cycling and swimming for rehabilitation. a need for immediate surgery was not neccesary in late nov 2011 i partially torn my ACL at rugby training while i was side stepping.. went to see the specialist & got myself an MRI scan.. the doctor confirmed that it was a partially torn ACL..

an immediate surgery isnt necessary.. since i'm still doing my internship, the specialist gave me time to regain strength and rehab my knee before the next check-up.. if there is still signs of instability, a full reconstruction may be required.. after 2 months of occasional swimming, cycling & weights training, i do have full motion of my knee but it still hurts at times..

My questions are:
1) can anyone define "instability"?
2) is there much benefit of "arthroscopy"? *arthroscopy: trimming out the torn portion
3) after rehab, the chances of turning a partial tear into a full tear is there. does strapping tape help in anyway during sports?
4) after a complete reconstruction, does the possibility of the same injury increase, maintain the same or decrease? Is the new ACL stronger, the same or weaker than the original ACL?
5) trough the thread, there are contradictions between PTs and patients.. PT says use what u hv left (use it until fully torn with possibility of MCL injuries as well), patient says straight reconsruction.. can anyone verify who to follow?

hope someone can help out.. really want to get back on to the field.. a young man that really wants to get back on his feet..

[Dolores]

First of all you are very young so that's a good thing!
If you allow it to heal and stop doing the activities that are making your knee pain worst then it might get better,,,but if the MRI has confirmed that there is a partial tear then it's time to make adjustments in your life by modifying your level of activity,,,Many people who continue their active life styles after partially tearing their ACL, end up breaking it completely,,,,
I would recommend that you take it easy with the physical therapy,,,I know its hard but just try not to overdo it and listen to the signs that your knee is sending, if its painful just give it a rest, ice it, wait until the pain is gone before doing more training and wait until the ligament feels stronger before doing the cycling movement and especially the weight training...avoid painkillers as they trick the mind by masking the sensation of pain and puts your ACL at more risk for further injury,,,BE VERY CAREFUL
I've been dealing with a similar injury for 11 months and was able to start walking with a cane just 3 months ago,,,It took me so long because I wore a brace that immobilized the entire leg for 5 months,,I probably over did it so my quads and calves muscles on that leg shrunk drastically making it a lot harder to stand on it but I had to brace it because at the time of the injury my ligament was so sore I couldn't even bend the knee,,and
i kept on making it worse by forcing myself to walk when it wasn't ready,,it's definitely been a slow recovery but I've had to deal with other issues too,,,
what I've learned is that the less stressed out you get, the faster it will heal,,,but the healing process does takes a long time,,, my ligament still hurts a lot at times and feels unstable unlike my other knee which feels solid and strong,,
At this point I'm trying to avoid the reconstructive surgery to see if it can heal on its own mainly because I don't trust "Doctors",,don't have insurance, a place to live nor anyone who can take care of me if I get a surgery,,,that's something you must keep in mind, a lot of assistance and proper accommodations will be required after surgery,,,but if you fully trust your surgeon, have a comfortable place to stay plus someone who can help you during your recovery then consider yourself blessed!
Just follow up with your orthopedist surgeon,,,and take it easy,,,eat very healthy,,,fruits, vegetables, legumes, drink lots of water,,,try quinoa, it aids in the repair of tissues...Do stretching exercises like soft yoga but take it slowly,,,breath deeply,,,Google the knee pain guru,,it's got a lot of useful and conscientious information about knee injuries and how to deal with the pain,,,it's the anti-surgery approach,,,
I don't know man but I think that the proper treatment for this injuries is complete rest,,,unless the tear is so bad that the tibia is completely dis attached from the femur,,,there's a couple of videos on you tube that show an ACL tear and it looks terribly painful! Check them out when you get a chance,,,
just avoid forcing yourself to walk if the knee is not responding well because you can actually cause more damage, delay the healing process and/or injure your good knee...so try to stay off of it as much as you can,,,and by that I mean get a wheel chair while its healing and keep strengthening the quads and calves without putting too much pressure on the injured ligament...play it by ear,,,listen to your body
In my opinion, instability of the knee is the symptom of an injured ligament, tendon or cartilage in the joint. It's caused by the inability to properly bear weight on the knee making it hard and almost impossible stand up for more than 10 seconds because of the lack of support in that mid joint. So instability is basically whenever a cane, a walker, a crutch, walking stick, or anything that can aid in regaining some sort of balance in order to keep the upper body perpendicular to the ground is needed.
Arthroscopy may sometimes be necessary,,I'm not sure how effective it is,,,Ive heard in some cases it can be helpful but I've also read/heard that it can increase the risk for future arthritis...just keep doing more research and talk to people who have had the procedure done...As far as the ligament reconstruction is concerned,,,same thing, Ive heard positive things about it like people being able to walk, go back to their active lifestyles and even play sports again! but just like with any other surgeries there's always a risk for complications. I've heard/read negative things like the reconstructive tissue getting infected, breaking again or not being flexible or strong enough, or irreparable damage on the site used for the graft ,,so I guess it depends on many factors...it's a tricky one that's why you must be very selective with the surgeon you choose ...Good Luck to you!

[Dolores]

Are you able to walk at all? When are you planning on getting the ACL reconstruction surgery? What type of graft are you planning on using?

[Dolores]

Has anyone had an arthrogram with contrast done to diagnose their torn acl or knee joint problem? The reason why I'm curious to know is because my orthopedist surgeon is sending me to get one done but I've read that the the Gadolinium (fluid dye) that is injected on the joint can cause infection and other adverse reactions such as tissue degeneration when combined with the radiation,,,,so,,,Im kinda skeptical about the whole procedure,,,and quite confused,,,I've already had 3 x-rays and 1 MRI done on the knee so I don't know if it can get worse from more radiation....

[syamir]

Are you able to walk at all? When are you planning on getting the ACL reconstruction surgery? What type of graft are you planning on using?

I can walk 3 days after I torn my acl.. the problem is not walking but getting back to competitive sports as I am a sportmen.. my target isnt just to be able to move but run, side-step, tackle & hope as soon as possible..

it should be done by march and i'm using the hamstring as recovers faster.

[Dolores]

I can walk 3 days after I torn my acl.. the problem is not walking but getting back to competitive sports as I am a sportmen.. my target isnt just to be able to move but run, side-step, tackle & hope as soon as possible..

it should be done by march and i'm using the hamstring as recovers faster.

I wish you the best on your recovery and future plans! Take it easy though, try not to overdo it until your knee is fully healed. I totally understand your need to get the surgery,,trust me, I've been struggling a lot for the past 11 months with this disabling injury waiting to see if it's ever going to heal at all and I still can't walk without a cane,,,can't stand nor bear weight for more than 2 minutes on the injured leg because the knee joint just gives out and then my back starts hurting from overcompensating, and to make things even worse now I sprained my ankle for putting all the weight on it,,,so I can't stand on the foot with confidence anymore and im afraid my hip joint is also suffering the consequences of that torn acl or knee joint derangement because it also feels funny,,,

Whoever wrote in this forum that the acl is not a supporting structure might just want to re evaluate that because if it wasnt a supporting/stabilizing structure in the knee joint, then the ankle, the hip and the back would not be overcompensating for that lack of SUPPORT.
The fact is that once any ligament of the knee joint is damaged in some way, it off sets the balance of body and starts a domino effect of injuries that simply leads to more problems and a disjointed way of life, I know this because it's exactly what I've been having to go through,,,and its a very complicated situation because I can't even get a job with this injury,,,I'm totally broke and actually making arrangements to go to a woman's shelter until my disability claim comes through, well that's if it gets approved,,so getting that sucker repaired it's definitely the way to go especially for a young competitive athlete. Keep us updated on your recovery,,,I'm interested in learning more about your surgery, maybe I'll go get one too! Take care

[Dolores]

Has anyone heard anything about the arthrogram/mri contrast agents “gadolinium”?
The reason why Im asking is because the ortho sent me to get one so he can figure out what is wrong inside the knee joint, but I still havent had the guts to schedule the appointment.

After reading about the adverse side effects and countless law suits against it, I just got very skeptical about the procedure. I'm just wondering how safe it really is? The last thing I need is to have more damage done to whatever is still semi holding my knee joint together,,but I may be wrong and perhaps that silver based agent is not that harmful,,but I'm still VERY confused....

[anka_nikoleta]

Hey Bud.

I am no doctor.
but I recently had my surgery. so I feel I can say something..

immediately after my surgery, my knee already feels better, albeit, right now I can really straight it all the way.. but that's expected, need to do physio for that.
the time you need to book the surgery is NOT very long at all, maybe 2 weeks in advance will do, for me, it was really more about the demand of the hospital's operation theatre more than anything.

you however, must expect a lengthy rehab afterwards though.
as all doctors are telling me now, the rehab, is more important than the surgery afterwards.

GOOD LUCK.

Hi Guys,

Just a quick questions for the patients that have been managed with conservative treatment or for the physios here which have had patients referred from Consultants: what kind of braces were you given initially ( if advised on any). Did you have a brace with an extension lock ( limited into straightening your knee) or just a hinged one, or none at all?

Thank you in advance for your answers.

[samhughes1398]

Have you tried a stem cell treatment? I am a personal trainer and I had a terrible pain in my knee. I kept waking up with pain after an injury; just going to do my shopping was painful. I had to have a knee replacement surgery recently with Dr. Zanasi, I was really happy with the treatment. The recovery was really fast and now I can do my normal activities, as there’s no downtime with this kind of treatment. I highly recommend him, this is his website Home – Dr Zanasi Stem Cells
Best wishes
Sam

[archenstone]

I had a martial arts injury in 2012 that left my knee freely rotating. The hospital said nothing was broke and gave me a used pair of crutches, said don't wrap it and go see an ortho [Indiana, USA if your curious] At the time I was in a bad living situation and could not go to a doctor. I had to wrap it, keep it straight and non load bearing as much as possible while taking care of 3 kids. After I could set weight on it again I did my own therapy...gentle stretches and practicing weight load, slowly easing it back to normal weight distribution....but its still not perfect. For one the leg feels shorter and the knee doesn't straighten entirely..it gets close.. and even now if have moderate to heavy strain the knee which gives inward a little. About a year ago I could finally feel confidant in walking a flight of stairs with out fear of the knee buckling as for many years it would buckle under stress like...walking down the road, getting in and out of the car, up or down stairs or playing dance dance revolution. Weight gain from various activities hasn't helped either in all honestly...

But as of about October on last year I am finally able to roundhouse, front kick and side kick lightly which I couldn't before. Very slow recovery if you do it by yourself and kills your chance at doing sports activities. Definitely see a doctor and if your not sure then get other opinions.