ACL and LCL Ruptures

[SCHMUCKO]

Im in Australia, if that helps

[physio.smith]

If they wont fix it at this stage then your only option may be to stick with the physio. My experience of multiple ligament ruptures is that it does not matter how strong you get all the stabilising and mobilising muscles the joint is still unstable when activity levels are increased.

Generally when I have had trouble not being able to access surgery for this type of injury we have just worked hard on reducing swelling, regaining full movement, stabilising as much as we can...working glut, trans abdominals etc as well as major knee muscles. Often functionally a brace is required to prevent collapsing of the joint and further injury.

Using functional markers / outcome measures with your physio will give you a good idea of where you are at now...repeat these maybe monthly and thus when you see the surgeon again you can show them what progress you have (or have not) made. This will give them an idea of how motivated you are, what problems you are still having etc...and thus how much you would benefit from surgery.

Good luck

[SCHMUCKO]

I've started at the gym and it amazes me how much worse my injured knee is compared to the good one, as i didnt think it would be as bad as it is. I dont really trust my knee, even just walking. My physio has said my strength is pretty good at the moment, but hopefully the gym will improve it more. The annoying thing is though, the stronger it gets, the more I seem to notice the instability. How common is conservative management for this type of injury, for active and young people? The original specialist has kind of fobbed me off it seems, havent had any followups with him since, the upcoming appointment is for a 2nd opinion with another surgeon he referred me too, but he basically implied I'll get nowhere. He was quite arrogant, i was under the impression im very low priority on his patient list.

Thanks for the advice

[physio.smith]

I deal mainly with fit young men and they routinely don't get surgery straight away for various reasons. I do not necessarily agree that they should have to wait or that they always need to wait but that is down to surgeons and bigger powers that be!

Often swelling or reduced range at the joint will mean that surgery may need to wait. It may be that the first surgeon you saw was not confident that he could help you, as you may have hoped.

I have treated many ACL repairs and a few ACL / MCL repairs (with or without meniscus repairs), of the ACL most do pretty well and some get back to very high levels of activity...a few don't do as well, for various reasons. ACL with MCL is more complicated, obviously the more unstable your knee is the more complicated the surgery is.

Personally if it was my knee I would probably opt for surgery as if the knee feels unstable with day to day activity then you are increasing the general wear and tear at the joint.

You are right to seek a second opinion, it will do no harm, as I said before let them know what you have been doing. Be careful at the gym, as certain exercises can cause a shearing effect at the joint...ie. knee extension (open chain), which will make it feel more unstable.

When you go for the second opinion be mindful that the 2nd surgeon may be friends with the first! That is not to say that they wont help you...just that they are unlikely to appreciate negative comments about a collegue.

Good luck, don't give up, keep seeing that physio and watch out for joint movt. (shearing / sliding) when you are exercising.