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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[Canuck Physio]

The ACL should be able to heal naturally with Physio, a conservative treatment and a progressive program would probably do it.

[karen.hankey]

There are people out there in high level sport without an ACL at all. The preference for most people is conservative rehab intially. Surgery is only indicated if conservative rehab fails or there is instability.

Your rehab will entail gaining full movement and get rid of any swelling. Once that is done, you start on strength exercises. I can't be too specific on exercises because it is individual to each person. But a basic programme usually involves, squats (both two-legged and singe-leg), going up and down stairs, jumping and hopping. To enable you to run you must be able to hop without pain. The emphasis for the exercises is to be able to control the knee, so that the muscles take over the job of the ACL.

With regard to a physio I would reccommend someone who has done this sort of rehab before.

Hope that helps a little. Any more questions just ask

[physiobob]

I tend to agree with the above comments. The ACL does NOT provide any direct structural support to the knee joint. What it does is send information about load and angular velocities to the brain so that the brain can then send messages to the muscles to support the knee during activity. A reconstruction tries to create a structural stability to the knee because this feedback is not working anymore without an intact ACL.

So overall a partial, still functioning ACL is a better option than having it removed even if it were replaced with a graft as the graft cannot replace the actual function of the ACL.

[Canuck Physio]

I agree, no surgery if it was me

The ACL (anterior cruciate ligament) is one of two "hidden" knee ligaments that attach the thigh (femur) to the lower leg (tibia) by "crossing" each other at the knee joint, hence the term "cruciates".

As the name suggests, the ACL attaches from anterior surface of the tibia, blends with the anterior horn of the lateral meniscus and travels backwards to attach to the posterior part of the medial surface of the femoral condyle (thigh bone). The PCL (posterior cruciate ligament) crosses the knee joint the opposite way and works with the ACL to hold the knee together when the joint is under load or tension. Injury to the ACL is much more common.

At an American Osteopaedic Sports Medicine Society meeting, Dr Bernard Bach presented an insightful discussion on the indications and contradictions for ACL (anterior cruciate ligament) surgery. He concluded with the old adage emphasized by Dr Jack Hughston years ago, "nothing is so bad that it can't be made worse by surgery". Implying that not all patients with ACL tears require surgery.

The ACL provides 86% of stability in anterior displacement and 30% to any medial displacement. However, rupturing the PCL is worse, as it provides 96% of stability to any posterior movement and 36% to lateral stress. As you have probably found, closed chain movements such as the squat and leg presses are fine. It's not until you attempt to perform some form of dynamic action that involves movement in all three dimensions that you have trouble. This is why many doctors and surgeons adopt a "wait and see" approach on ACLs before recommending surgery. Unless the patient regularly performs dynamic, open chain movements they see no need to operate.

With the correct rehabilitation strategies the hamstring muscles learn peripheral compensation and provide a great deal of anterior shift stability.

Seek out a local physio before you contemplate going under the 'knife'

[mouk786]

I tend to agree with the above comments. The ACL does NOT provide any direct structural support to the knee joint. What it does is send information about load and angular velocities to the brain so that the brain can then send messages to the muscles to support the knee during activity. A reconstruction tries to create a structural stability to the knee because this feedback is not working anymore without an intact ACL.

So overall a partial, still functioning ACL is a better option than having it removed even if it were replaced with a graft as the graft cannot replace the actual function of the ACL.

The partial ACL cannot heal proeprly right? but can it still send signals back?

I have felt a difference and slight instability in my knee (i.e no cofidence to play football/soccer) so that must mean the partial tear is fairly significant - the Dr wouldn;t say how much though.

Any info on arthritis on surgery v no nsurgery scenario? i am thinking long term effects here. should i give up footy?

[physiofixme]

Your success is going to depend on the type of exercises you get given. you need a programme that is going to incorporate leg strength with core strength. Your Quads are probably the focus but you should also be looking at strengthening your butt, hamstrings and core stabilising muscles. Basically this means you need to seek out a good sports physio!! Your rehab programme should also involve some sport specific drills later on before you return to football. Things like running, kicking changing direction etc. This all helps retrain your muscles to send the right signals back to your brain, and to get your muscles co-ordinating properly.

There is some evidence that a damaged ACL can cause extra load to be placed on your cartilage and therefore increase the liklihood of arthritis??? I don't think this is proven however. If your rehab isn't working/helping then you can rethink the surgery option.Do you want to be injury free? Physiofixme

[mouk786]

Hi
Thanks for the reply

The Dr mentioned regaining 'control' of my leg - any info on this? this is probably the major annoyance i have as my leg/knee doesnt seem to go back ot the normal range of motion all the time - i.e when i am walking

I have been recommended to a physio at an NHS hospital - i'll assume theyre pretty good!

[physiobob]

The partial ACL cannot heal properly right? but can it still send signals back?

I have felt a difference and slight instability in my knee (i.e no confidence to play football/soccer) so that must mean the partial tear is fairly significant - the Dr wouldn't say how much though.

Any info on arthritis on surgery v no surgery scenario? i am thinking long term effects here. should i give up footy?

Hard to say what fibers are torn and therefore how much that relates to the signals going to the brain. The feeling of laxity often increases with time but in terms of the early onset of arthritis that is more related to intact menisci (knee cartilages). Surgery is likely to involve trimming or removing some of that which if possible is best avoided as we are making steady progress in the medical fields or tissue replacement, growth, repair etc so the longer the joint surfaces are protected the better.

As for "footy", this is something hard to play without an intact ACL due to the pivoting and side to side movements. If the knee is unstable and you continue to play chances are you will progress to a full tear and the likelihood of injuring the menisci at the same time.

[mouk786]

I suppose the essential questions are can I :

a) go back to a near normal knee without surgery but with physio
b) can i get back to some sort of level of playing football without surgery

The Dr/specialist at the hospital seemed confident and kept say that I don't need surgery to get back to what I want.

[physiobob]

I suppose the essential questions are can I :

a) go back to a near normal knee without surgery but with physio
b) can i get back to some sort of level of playing football without surgery

a) Depends on the extent of the tear and which fibers are damaged
b) This is possible although you will always be at more risk of further injury than prior to the recent tear. Surgery will provide perhaps a reduced risk or reinjury but the functionality and dynamic movement "might" be better without.

As I read in another post somewhere a surgeon wrote "The is no condition so bad that cannot be made worse with surgery". This is something worth thinking about.

[physio.smith]

I hope since you last posted that you are making good progress.

One of the key things is regain the strength at your knee before doing anything too dynamic. You really need 80-90% strength in your injured leg (compared to your non injured) before doing anything too dynamic.

You must ensure however that you have full range of motion at your knee before embarking on too much else. If you are lacking full extension (or hyperextension) compared to the other side you are more likely to cause long term damage and not full trust the joint and will struggle to regain strength. Also if you are lacking full range you may still have swelling, this can take a long time to settle and range may change if you over do the exercises and stir up the joint, so do monitor.

You may find that due to NHS constraints that you are not taken as far as you need to in terms of rehab (not sure if this is true...as not worked in NHS for a long time). They should however ensure that you regain full range of movement and start you on a program, with specific goals and targets to meet. You may need further input as you progress.

Please seek the advice of a physio who has assessed you (as these may not be appropriate for you and technique is important), however below are a few tests that you may find useful to help you monitor your progress....

*Single leg press (1 Rep max) assertain limb symmetry
*Star excursion balance test
*Step down test
*Figure of 8 shuttle runs
*Cross over hop tests
(obviously there are much more basic tests and many more others out there)

The Lower Extremity Functional Scale (Brinkley et al. (1999) Physical Therapy. 79: 371-383) may help you monitor how your knee is feeling.

Good luck.

[glog1066]

I suppose the essential questions are can I :

a) go back to a near normal knee without surgery but with physio
b) can i get back to some sort of level of playing football without surgery

The Dr/specialist at the hospital seemed confident and kept say that I don't need surgery to get back to what I want.

hi there im new to this forum and have viewed your post, i know you had the problem a while ago but im wondering how your knee is, the reason im asking is im goining through exactly what you did i have a partial tear to my right acl and dont know weather to push for surgery or try the physio route, i did this playing football and would love to get back playing again, many thanks russ

[mouk786]

hi there im new to this forum and have viewed your post, i know you had the problem a while ago but im wondering how your knee is, the reason im asking is im goining through exactly what you did i have a partial tear to my right acl and dont know weather to push for surgery or try the physio route, i did this playing football and would love to get back playing again, many thanks russ

Hi

Its been ages since that post

Effectivley I rehabbed hard and got the strengh back up in my knee. I amanged to play 5 a side football for about a year - playing upto 2 games a week sometimes with no problems.

The knee itself wasnt bad, no pain and fairly stable but not as rock solid a joint as my normal knee

unfortunatley after about a year of playing i somehow managed to tear the rest of the ACL whilst twisting.

I have since had the ACL reconstruction and the knee feels more solid, although I managed to tear some cartialge as well which has caused me more problems

so my advise is push for the surgery if you want to play footy again.

[glog1066]

hi thanks for the speedy reply, you sound like youve had a tough time, i think after speaking to a few people including you i think surgery will be the best option for me,if they will do it of course, thanks very much for yiur help, cheers russ

[John Ross]

Let us know how you got on. Any kind of future sporting life (contact or non-contact) suggests you should have surgery...

[Kevoras]

I happen to be in the exact same position now, and stumbling on this post.

I recently on June, had my left knee ACL partially torn, and now doctors are recommending that I do physio, and they seem confident that I can return to my previous level of play. (but again, the doctors doesn't look like athletes.. not sure if they understand the roughness on the pitch.)

I am a near professional level Football player.
and for the last 2 months, I have been doing hardcore physio, trying to regain strength..
so far.. knee doesnt feel solid at all. And no confidence for football has returned yet...

I would really like to know if the original poster can return to football since his ACL reconstruction....
appreciated

[physiobob]

The ACL does NOT provide any direct structural support to the knee joint. What it does is send information about load and angular velocities to the brain so that the brain can then send messages to the muscles to support the knee during activity.

So if the partial tear is enough to reduce those connections to the brain the knee will feel more unstable. If you have done a lot of side to side movement rehab and change or direction etc and this has produced no results in terms of feeling more in control then perhaps you will need a reconstruction in time (mainly as you will probably reinjure and rupture it). It's a hard call - I am in favor of leaving what's still attached, attached as this something to connect to the brain. But then at a high level of sport like football that may not be enough to play at that level with confidence. The original poster was in 2007 so I am not sure if they will respond to this still.

[Kevoras]

thanks for the reply.

yea, pretty disheartening to have the ACL partially torn, and 2 months of rehab is not doing much at all.
Just Tuesday, I did a pivot test to check its stability, and it failed miserably.

I do notice if I concentrate heavily, and if I know what's coming, then I can hold the knee fine.
but otherwise, it just feels kinda weird. (and it crashes once a while... completely knocking off my balance.)

I am worried about further injuries damaging the Meniscus, which as of right now, are still in good shape.

I keep telling myself that rehab can bring it back to strength.
but I guess I have been disappointed with the results so far...

Guess I will try for another month first. and see where that leads.

any other advices, or recommended exercises will be very much appreciated. thanks.

[physiobob]

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.

[Dolores]

Physical therapy has made my injury a lot worse,,,specially pedaling on the stationary bike ...leg raises w/out added pounds are fine but aftr more than 40 reps I start getting a sharp pain in the inside of the knee,,,its been very frustrating,, seems like the more effort I put into working it the worse it gets,,,,everybody tells me not be a baby and to just keep trying because pain is part of the recovery but the pain I get from physical therapy is more like injury pain...now I cant you bear any weight on the injured knee for more than 10 minutes without feeling an uncomfortable stretch in the back muscles...

Been going through this 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 plus my job and my independence... it looks like my back is now compensating for that lack of joint,,,2 orthopedists said theres nothing wrong with it and recommended me to do physical therapy to strengthen the quads buttocks and hamstring muscles but like I sid 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,,,,im gonna see another dr next week hopefully Ill get more info! I know I have to stay positive and try not to overdo it...but this injury sucks...im actually considering a leg amputation but I dont know if Ill actually do it,,,does anybody know how long this type of injuries take to heal?
and is it better to get a knee join replacement or ligament reconstruction?

[mouk786]

Leg amputation is the last resort. Before that is a knee replacement and you are unlikely to get one if you are in your 30s. Its a significant operation.

ACL ligament reconstruction is pretty standard.

You ideally need an MRI scan to see what is happening inside.

My first prot of call woudl be a sports physio - but looks like you areseeing a Dr so maybe they will refer you to a specialist.

I also have problems with my hips compensating for my weak side - all my msucle have tighted on my good side.

If you do not have laxity(looseness) i nthe need then it may be cartilage damage.

Sharp pain is abd and need slooking at.

[Kevoras]

Just an update on my status.

I been through 5 months of Physio, and thought I got a good set of control over my partial torn ACL.
I passed all tests given, and the doctor was confident.

then on my FIRST day of returning to football, 15 mins into a warm up game, a side step totally wrecked my knee.

My ACL is now completely torn, and I am suffering from meniscus injury as well.

So to whoever is out there, with ACL partial torn... Don't listen to the doctors, they DONT understand the physical demand of a game on your knee, and anyone that said they manage to get well with physio therapy probably didn't even have the ACL damaged in the first place. (or rather, very minor injury only.)

Your knee muscles CANNOT respond quick enough to hold the knee together when it is happening very fast, I read about it, and that's why all professionals always get an ACL reconstruction almost immediately. MY ACL partial torn was actually my chance of not getting my meniscus torn... but I thought my knee was strong enough to recover...

If anyone has ACL damage, and your knee feels 'any bit' loose, I will strongly suggest you push for ACL reconstruction from a professional sports injury doctor.

Just sharing.

[Linz_89]

Hi folks,

I injured my knee by falling a fair height, wrenching my knee, leaving me unable to walk without crutches for about a week. When I went to hospital on the day of my injury I was given an x-ray and told that it was just a sprain. Since then, I have fallen twice because my knee has completely collapsed under me, leaving me in great pain and unable to bear weight again for many hours (thankfully, both times friends were there to help me get home).

After some internet research I became fairly sure I had torn my ACL so I booked an appointment with my GP. She told my that there was laxity in my ACL and has referred me to an orthopaedic surgeon. I am now waiting to be contacted and given an appointment with the surgeon.

My knee is very unstable - both times that I have fallen (since the original accident) I was not doing anything even vaguely strenuous. I'm therefore hoping that I won't be fobbed off with physio as I really feel I need the surgery. Even just doing everyday walking I don't feel confident in my knee. I stress out if I have to get on a bus, cross a road, climb stairs, walk on anything that isn't completely flat, basically do anything!.

My main question for those that have been treated by the NHS is what was the timescale of treatment? How long did it take for you to get an appointment with an orthopaedic surgeon after initial referral and how long after that did you receive physio/surgery? I'm really hoping it that it doesn't take too long because I feel the chances of me falling again are high and I know each time I do I'll probably be doing further damage

[Kevoras]

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 folks,

I injured my knee by falling a fair height, wrenching my knee, leaving me unable to walk without crutches for about a week. When I went to hospital on the day of my injury I was given an x-ray and told that it was just a sprain. Since then, I have fallen twice because my knee has completely collapsed under me, leaving me in great pain and unable to bear weight again for many hours (thankfully, both times friends were there to help me get home).

After some internet research I became fairly sure I had torn my ACL so I booked an appointment with my GP. She told my that there was laxity in my ACL and has referred me to an orthopaedic surgeon. I am now waiting to be contacted and given an appointment with the surgeon.

My knee is very unstable - both times that I have fallen (since the original accident) I was not doing anything even vaguely strenuous. I'm therefore hoping that I won't be fobbed off with physio as I really feel I need the surgery. Even just doing everyday walking I don't feel confident in my knee. I stress out if I have to get on a bus, cross a road, climb stairs, walk on anything that isn't completely flat, basically do anything!.

My main question for those that have been treated by the NHS is what was the timescale of treatment? How long did it take for you to get an appointment with an orthopaedic surgeon after initial referral and how long after that did you receive physio/surgery? I'm really hoping it that it doesn't take too long because I feel the chances of me falling again are high and I know each time I do I'll probably be doing further damage