ACL Tear, reluctance to operate

Hi All

I tore my ACL playing football on the 1st feb this year.

I was mis-diagnosed initially, by both doctors and physios with injuries such an impact injury, a cartilage injury, torn hamstring all given as possible causes of the pain i was experiencing.

It took 4 months for me to get an MRI scan, which concluded (After 2 months of waiting for the results) that i had torn my ACL.

I was referred for an appointment with a specialist - saw him today (8 months to the day after my injury)

I was hoping to get referred for surgery, however i was told i needed to go on a course of physio specific to ACL injuries, to strengthen the muscles around the knee, to a.) be in a better position to recover from a potential operation, and b.) to see if i even need the op as it may stabilise the knee to the point that i may not require surgery.

Now im very confused/dissatisfied with what I’ve been told.

Is this standard practice having to do this physio as i thought building up the muscles is OK, and you can live without an ACL, but not if you wish to participate in physical sport ?(I am, sorry was :(, playing football at semi-professional level prior to the injury).

I understand building up the muscle helps recovery post op etc etc, but I have been hitting the gym numerous in times a week since my injury keeping my legs strong which questions if id even need the physio, and not only that, but the way the specialist was going on, he said the ACL reconstruction would be in the worst case scenario and that hopefully I wouldn’t need it. He claimed plenty of athletes do without an ACL.

Very confused – any advice?

hi mate,
there was a big article published in KNEE journal this year showing the risks of not having your acl repaired. im sorry i dont have a link! previous thinking was that you could rehab the muscle strength and get similar outcomes as the repair. this has been shown not to be true and without a repair the long term effects are not nice: massively increased risk of meniscal damage (cartilage), long term instability and increased risk of osteoarthritis.
id push for the repair mate and in the meantime keep it nice and strong as it will improve post surgery recovery!

oh and yes atheletes have gone the rehab route before with minimal success! roy keane a big example, tried to strengthen but knee failed again and ended up in surgery! you can get away without a repair if u are going to give up all pivoting sport! doesnt sound like you!

One of the big questions to ask when deciding about repair vs non-repair is what you are intending on doing with regard to sport/activity. If your aim is to be able to return to football then you may wish to look seriously at the surgical option. My reason for saying this is that football is a high risk sport considering the amount of pivoting etc involved. Playing a high risk sport on an unstable knee increases the risk of re-injury.

Doing strengthening now in preparation for surgery is vital. It is in effect "prehabilitation" or in other words, the first stage in your rehab.....it just starts before you have the surgery. The stronger your knee is going in to the surgery, the better your recovery will be. Your strengthening does need to be specific however to give you the best chance! A physio should be able to point you in the right direction regarding the exercises you should (and equally importatntly shouldn't) be doing!

MAN!!!............PERSONALLY SPEAKING all the athletes afraid of the surgery.......reason they have to be in bed for atleast 2 to 3 months and everything gone......

i have adviced one cricketer for surgery why .....coz if i won't hen he definl ended up with OA.......or repetiive unstability may make his young to not able to stand properly

conservaive treatment do help but not for everyone..............and not for every grade of tear.........

I had my ACL operated on April last year after tearing it 8 moths before playing netball. It took me almost 6 months to recover the injury, strengthening the surrounding muscles. At that time I decided not to return to netball but focus on my running.

I didn't have to have surgery but if I wanted to play sports which involved changing direction, twisting and turning then having surgery would be benefical, as a PE teacher I choose to have surgery.

It really wasn't that painful, the physio was hard but nothing worse than when recovering from the initial injury. My knee is now more secure and feels much better when playing sports. I do still get some pain and swelling but nowhere near as bad as before surgery.

I would say go for it.

Hi,
I found this forum after searching on whether I can play netball without a cruciate ligament and am extremely frustrated and confused with my position.
I tore my ACL in September 2009 playing netball and after scans, waiting times etc went in for my ACL reconstruction operation in January 2010. When I came round I was told that the surgeon had removed the ACL but felt that my leg was strong enough to suffice without the reconstruction. I said at the time that I had been told by my physio beforehand that I could not return to netball without the reconstruction and was worried that they hadn't done it and was told that the surgeon knew your aim to return to sport and thinks that the knee will become strong enough.
After a pretty crappy rehab program with the NHS I am still no nearer to returning to training let alone competition. Once I had reached the stage where I could walk and go about my daily life ok the assistance seemed to go away! Added to the fact that there were 3 physios all telling me different things, one saying to strengthen my quads, one saying to strengthen my hamstrings and the other stood with letters from both saying she was confused!!!
I am back to outdoor running and slowly trying to build my fitness back up but I cannot see how I can get back to competition with no cruciate ligament at all!

Any thoughts??

Hi mufc68
I know exactly how you feel as I too tore my ACL playing netball. I was offered no help my the NHS after the initial injury and after sitting around for 4 weeks doing nothing I found a physio myself.

Its both the quads AND hamstrings that stabilise the knee, so it was wise to strengthen both. However, I ran and played some sports before my operation and turning/changing direction was difficult and painful without an acl and my knee occassionaly felt like it was going to give way. I choose not to return to netball for other reasons but knew that if I did want to play sports where it involved me changing direction I needed a new acl.

My advice would be that if you want to return to netball get a new acl. Insisting I got one and even though it cost me money, getting a private physio who was a lower limbs specialist and who was also a sports physiotherapist rather than a general nhs physio made a world of difference.

I hope I was of some help and let me know how you get on.

Hi All,
I totally agree with the above post suggesting surgery,especially if you are planning to continue your sorts career involving pivoting and twisting movements.
Relating to rehab part,there is a misconception regarding strengthening muscles.Some give emphasis on quadriceps.But biomechanically more role in knee stabilization and assisting work to ACL comes from Hamstring muscles and the recent research works also supports its importance in knee rehab after ACL surgery.
In later weight bearing phase,more emphasis is given to close kinetic exercises.here both quadriceps and hamstrings are contracting together to support the knee .tibial anterior translation and stress on the ACL graft is minimal during close kinematic partial squatting exercises.

Advantages of using Double-Bundle over Single-Bundle ACL Reconstruction Surgery

There is a significant amount of scientific evidence supporting double bundle surgery:

The ACL is composed of two functional bundles, the anteromedial (AM) bundle and the posterolateral (PL) bundle, not just one.

Between 10% and 30% of patients complain of pain and residual instability following Single-Bundle ACL reconstruction.

Arthritis has been observed on x-rays in up to 90% of patients at long-term follow-up after Single-Bundle ACL reconstruction.

Single-Bundle ACL reconstruction does not adequately restore normal knee stability, particularly tibial rotation

Anatomic Double-Bundle reconstruction better restores knee stability compared to Single-Bundle reconstruction.
For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876

Quote:

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Originally Posted by Colbury

Hi All

I tore my ACL playing football on the 1st feb this year.

I was mis-diagnosed initially, by both doctors and physios with injuries such an impact injury, a cartilage injury, torn hamstring all given as possible causes of the pain i was experiencing.

It took 4 months for me to get an MRI scan, which concluded (After 2 months of waiting for the results) that i had torn my ACL.

I was referred for an appointment with a specialist - saw him today (8 months to the day after my injury)

I was hoping to get referred for surgery, however i was told i needed to go on a course of physio specific to ACL injuries, to strengthen the muscles around the knee, to a.) be in a better position to recover from a potential operation, and b.) to see if i even need the op as it may stabilise the knee to the point that i may not require surgery.

Now im very confused/dissatisfied with what I’ve been told.

Is this standard practice having to do this physio as i thought building up the muscles is OK, and you can live without an ACL, but not if you wish to participate in physical sport ?(I am, sorry was :(, playing football at semi-professional level prior to the injury).

I understand building up the muscle helps recovery post op etc etc, but I have been hitting the gym numerous in times a week since my injury keeping my legs strong which questions if id even need the physio, and not only that, but the way the specialist was going on, he said the ACL reconstruction would be in the worst case scenario and that hopefully I wouldn’t need it. He claimed plenty of athletes do without an ACL.

Very confused – any advice?

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I'm only glad I didn't tear my ACL in the UK! This is a sorry tale.
<a title="ACL Surgery" href="http://www.aclrecoverysecrets.com/acl-surgery/">ACL Surgery</a> requires a much more serious, rigorous approach than seems to be the case in the UK.

I cant ear any weight on the injured knee for more than 10 minutes without feeling an uncomfortable stretch in the back muscles just wondering if this because my back is compensating for the lack of support from the knee joint....I ve been going through this disabling condition 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 feels very unstable kinda mushy and it looks like my back is now compensating,,,2 orthopedists said theres nothing wrong with my knee 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,,,,im gonna see one next week hopefully Ill be able to get another mri to figure out whats wrong...I just stay positive trying not to overdo it and being patient...but the reality is that this injury sucks...does anyone know how long it takes to heal if it can actually heal on its own...or would it be better to get a knee joint replacement ,ligament reconstruction or an above the knee amputation? i know how drastic all these alternatives sound but Im just so confused....could it be just a very slow healer?