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ACL Injury (Human): Update 5/6/19 - had the surgery

Riders with Health Issues
#1

Looking for advice or experience with ACL injuries and how it affects you long term…

I got injured 1/19/19 at an ice hockey game. Heard the knee “pop” as someone fell on me and forced my knee to bend to the left, then, felt like my leg would slip out from under me any time I tried to bear weight. I played a few shifts but couldn’t push off, and had to sit out the rest of the game because my knee just wouldn’t support me. Went to orthopedist, they said my knee felt stable on palpitation but that it could be because I am so active/muscled over that area. Eventually had a CT Scan/IR (can’t do MRI because of a metal plate in my head). Had to wait a few weeks for consultation and diagnostics.

Lots of re-checkups, referrals to different orthopedists and $$ later, orthopedist gives me a nebulous answer: “may be partial or complete ACL tear, can’t tell which, check back in 3 weeks after PT, see where you are and if you want to pursue surgery. If you do surgery, it’s 9 months before you can ride or play hockey again. If you don’t do surgery it might heal on its own, or it might not, we don’t know.”

At the moment it’s fine to walk around in (.5/10 pain). If I articulate the knee fully (riding, chores for example), the pain rises right back to how it was the day it happens. After my previous check-up (before I pushed for a CT scan) they told me to “resume normal activity” (hockey 3-4x week, riding…) and… lol… I can’t do “normal” activities that require some degree of knee weight bearing or flexion. Doctor gave me PT exercises and some of them I really can’t do. I am not a wimp about pain and this knee has me wincing like a baby. It has now been a month and a half since the date of injury and I am still not riding, or playing hockey, because I don’t feel it is even at 50% much less 100%.

Is it worth it to commit to the surgery, even if you don’t have a definitive diagnosis? I’d be out for nine months according to orthopedist. I play hockey 3-4x a week… I ride every day… I’d be missing a full season of showing (ugh, another one, too - I missed last season as well :no: ), and obviously wouldn’t be able to play hockey either… But at the same time I am worried if I don’t get it surgically repaired that it might cause secondary injuries down the road, or that it might not heal at all and I might waste more time.

That being said, the knee is still bothering me and I am not sure if that is normal. So, I almost feel like I should push for the surgery.

I am just really not sure what to do. Any advice or insight in, would be appreciated.

#2

They do not always operate on an ACL. Side note: Really weird as my cousins husband tore his ACL playing hockey a few days ago and they are in CT. Not sure where the game was. If I knew he didn’t ride I would think it was him posting.

Anyway. I think PT is pretty worthless. Give me the exercises and leave me alone. If I were you, I would get a second opinion, make them see if it’s a full or partial tear and see the pros and cons of surgery.

The BoT knee brace is amazing. I had knee surgery and it really helps, even with residual pain that I sometimes get.

ETA: Any orthopedist worth their salt can tell what’s going on.

#3

I blew out ACL is on my right knee about 35 years ago. I also experienced many "giveaway " moments in my knee as you have described. It is one of the diagnostic elements for failed ACL’s. I was on crutches for at least six months.
I opted not to have surgery at the time, and it did take about a year for my knee to get somewhat normal. I think I started riding at about 2 1/2 months, however I was primarily on my very quiet horse at the time. He would let me use him as a crutch, and shimmy up to the side of the arena for me to mount, since I couldn’t get my leg over him from a mounting block. It took both hands to lift the leg over the saddle…Longer stirrups were sort of OK… shorter/jumping length stirrups were absolutely out of the question.
After a few years I could walk on uneven ground for a while, go on flat hikes, and do some gentle bike rides. NO walking down even a gentle slope. No jumping at all. The knee would blow up and need to be iced of I pissed it off.

eventually, it adapted, my muscles around the knee got stronger (especially after I ditched the brace, which made the muscles atrophy). I re-injured it during Tango, and another six months of limping ensued.

the last surgeon I saw declined to operate: he asked a lot of questions, made me walk on my knees and squat like a duck to walk. Neither of things would have been possible within two or three years of the original injury. I am now quite functional, and I don’t do things that bother it like loooong hilly hikes, skiing or skating (falling on it would not be good). he said I should wait until I needed a full knee replacement. He also pointed out that coming off a horse in a way that would injure the bum knee would also injure a “fixed” bum knee. And then it would be a second surgery, which is not good.

So, that’s my experience with having zero ACL on my right knee. Possibly I’d there was the type of less invasive surgery that we have now, I would have done it at the time of the original injury.
Get to the best sports. dr in your area. I went to the one who worked on the city’s pro basketball team, and he’s the one who declined to do the surgery.

#4

Thank you. I have the BOT brace, but don’t use it currently because they gave me an ACL brace to use… but I was using it before they gave me the brace and it did definitely help.

Orthopedists are blaming the reason for a nebulous answer is on the fact I can’t do an MRI - words were “we prefer MRIs for this because CT is not a reliable diagnostic tool, so we can’t give you an exact diagnosis.”

Thanks for your reply. Best wishes to your cousin’s husband, and jingling for a speedy recovery.

Thank you for your reply, and you gave me some things to think about that had not occurred to me. Are you finding secondary injuries down the road? The things you mention avoiding doing are things I do regularly (hikes, skating, etc…)…

I can definitely say without a doubt if I dismounted off of my horse as I normally do I think it would wreck me. A few weeks ago I had to help move the roundbale and lightly jumped down from the truck and I had to sit down because the pain was so astronomical.

#5

Not being able to do an MRI is hard. That is what they did for me. My knee was visibly trashed so the MRI happened before any surgery. I am not trying to pry in your personal business but is there anyway around the no MRI?

Would an ultrasound show the damage?

#6

Unfortunately not at the moment. I have a cochlear implant. It is an older model, so until I get a new magnet + processor (which would be its own surgery) installed, I have to work with what I have :lol:

Of course, I was told I could still have the MRI if I removed the magnet… lol… (for those that do not know, the magnet is internal - so you would have to have surgery to have the magnet removed, and then surgery put back in after it has all healed - and in the mean time, you cannot hear…)

I am not sure why an ultrasound is not used for this kind of diagnostic? I was surprised they went straight to CT, but I am not a medical professional.

#7

I developed a dismount that invoved wrapping my arms around the horse’s neck, sliding off and ending up under the neck facing the horse. My horse was 16.2 and four years old at the time…he figured it all out, and I could gently put the good foot down first. Then he’d let me use him as a crutch to get to the real crutches.

secondary issues involved needing a chiropractor to keep up with low back pain and left shoulder issue from compensatory holding.

it really is excruciating, and it took mine a very long time to settle down. Wrapping it helped a ton.

#8

Would your vet be willing and able to do it? I’m not above doing that and have done it before.

#9

First, I’m sorry. This sucks. I tore the ACL and MCL 4 years ago when the ladder to the hayloft slipped and sent me to the barn floor in a hurry.

It did not present normally - usually your knee blows up because tearing the ACL usually also tears a blood vessel and mind did not. So I had a very normal looking knee. It just wouldn’t hold me up unless I carefully weighted the side of my leg.

It didn’t really hurt - unless I was throwing it out. But again - not much swelling.

There is a funky push-pull manipulation they can do that if your ACL is there, won’t move. If your ACL is gone/torn, your lower leg will move weirdly indpendently. Don’t watch if you’re squeamish.

So - your pain is not at all like mine- doc said if the ligament is severed, there’s no pain. You may also have meniscus damage - that can hurt a lot.

It was the MRI that showed the tears.

I had the surgery at the beginning of April - they used my hamstring. I was sitting on a horse (sitting, on the lawn) in July. I was riding a little in August but it made it sore. I ran a mile in October. I don’t play hockey but you’d be better by hockey season next winter. .

Big test? I put my Dehners on (no zippers) the following spring. Torque/twisting is really really sketchy for a long time. Things like jumping out of the truck bed I was really cautious about. I didn’t trust it, and I REALLY didn’t want to re-injure it.

PT after surgery is 1000% necessary.

1 Like
#10

No long term experience/prognosis here, but in the same boat. In the middle of February, I was riding my horse in a hackamore & the chin strap broke. He spooked and bolted off, so I decided to bail off the side and landed on my right leg, twisting/popping it in the knee and ankle. I knew immediately something was very wrong.

Took a week to get appointment & MRI, and then it took another 5 days to get the results. The doctor informed me over the phone that I had a bone bruise, MCL & ACL injury. I finally got myself an appointment at a good orthopedic clinic and my doctor there did not even give me an option to not do surgery.

I think the recommendation to do surgery was based on my activity level and the severity of my injury. I’m hoping this wasn’t a mistake! I was told that my ACL has no chance of healing on its own and was in essence “dead” hanging out in my knee just causing more issues. I still was convinced when they went in to do surgery that they were going to find something else, just didn’t feel like my diagnosis was very 100% either!

I did 10 days of PT & then had the surgery (Patellar Tendon graft) 3 days ago. Before my surgery, the pain was pretty bad and I never could walk normally or even feel comfortable doing things like changing horse blankets due to my leg instability.

I’m a pretty tough person, but the pain has been horrible after surgery. The worst pain I’ve ever had in my life. I’ve also broken a collar bone, wrist, been kicked in the face, etc. so it’s not like horse injuries are new to me. Walking from one end of the house to the other has been a major accomplishment.

I am already able to do leg lifts and make my leg completely straight (could not do that before surgery), but cannot bend my knee more than 40 deg or so. I am worried that I’m not doing enough & I know getting motion/flexibility back is super important.

My doctor did inform me that if I rehab this knee properly it will be stronger than my other knee. My physical therapist says I can walk around and do light riding in 3-4 months and should be back out competing in 6 months.

#11

If you are only a week out of surgery,not being able to bend the knee much is normal - it’s pretty swollen in there!! I think when they graft from your own body the upside is no rejection, and your tissues are likely to be strong. But the downside is that they moved them from their original home to your knee so it will be painful - my hamstring was SO painful for several days. If you watch an ACL surgery on youtube it’s pretty physical (don’t do this before surgery!!) so it’s normal to hurt a LOT right afterwards. They cut you up and put you back together! You’ve got screws in your bones too.

#12

In June, my 59 yo boyfriend slid off my horse, bareback at a walk, and full tear of ACL, partial tear of MCL and Menicus. Our barn has a former football player who advised against surgery – he said there are several players who still play football and opted no surgery because sometimes the surgery is too tight or too loose and the knee never feels right. Doc said that unless he did a lot of twisting/turning he didn’t necessarily need surgery, and delaying surgery would not cause further issues, so we opted to delay. PT was critical for him, as they got him balancing and moving the knee right away – things he would have been afraid to do on his own.

He loves motorcycles and does a 120 roundtrip daily commute. At first he worse a brace, as he wouldn’t be able to hold the bike up if it tipped, but he no longer does. Only occasionally does he notice it doesn’t feel quite right, usually after some heavy lifting or household maintenance activity, but those events are fewer and far between and recovery is usually 24 hours.

However, he never felt the pain you are feeling, nor is he playing hockey. He hikes, dog walks, rides motorcycle and leads a pretty normal life without issue.

#13

Here is my 2 cents based on my experiences. Tore my ACL on the right knee 9 years ago when I was thrown off my horse. I also had bad bone bruising, swelling and the lovely instability. After diagnosis, doctor said do PT to strengthen then call when I felt ready if and when for the surgery. He said some people, depending on activity level, can get along fine without surgery (though it can’t “heal” by itself- PT strengthens hamstring and quads, which help compensate for loss of ACL.) I got to where it felt pretty good, but moving laterally I could feel it give sometimes. So, 6 months after injury, I had the surgery, did PT and was riding I think 5 months later. A few years later, I had was standing in the bed of my truck tying down hay and lost my balance. Snap went the other ACL. MRI was inconclusive as far as whether it was partial or full tear, but I did PT and it felt better than ever. 2 years later, I apparently completed the tear- same pop, instability, pain, frustration! Did PT and Dr. said again, if I decided I could live with it, fine, but I could opt to fix it. I didn’t want to be out of commission again so I decided I’d live with it. Then last summer I sprained it doing something very minor and had another incident a couple months ago. I just can’t count on it and it really limits what I can do. So, April 5th I’m having it fixed. Not looking forward to it but looking forward to it being stable. If you’re having that much pain, you may have something additional going on, like torn meniscus. That push/pull thing Hilary mentioned is pretty indicative of a tear, and is a bit gross to see if you’re squeamish.

#14

I tore my ACL and meniscus. I had no pain but did not have full extension on the knee. The lose piece of ligament had flipped through the hinge and was blocking me from extending the knee.
I had a cadaver graft. I was riding within 4 months.

My trainer has had 2 ACL tears. The first one she had hamstring. The 2nd one cadaver. Because hers was a second she had to wait 6 months to ride. She has a brace to use. She mentioned the surgery with the cadaver ligament was much easier recovery and the use of the continuous passive motion machine helped a huge amount.

Once I was done my 3 months of PT my surgeon did not believe in knee braces so never had one.

From the research I have done some people do not need an ACL and other people do need one for the stability. I am pretty sure I have retorn or mostly retorn mine. I am fine. Trainer when she re-tore hers it would give out on her.

The NFL QB Dan Marino played most of his football career with a torn ACL.

I pay medical claims for a living and have done so for 30 years. In my experience it is rare to tear an ACL and not tear something else in the knee also- meniscus is the most common and MCL 2nd most common thing to tear as part of the injury.

#15

Thanks for the feedback… and the positivity. I could use some.

Still not sure what this injury is. I’m frustrated, because my orthopedist says “may/may not need surgery”, and also still has no idea what the injury is. It’s really frustrating.

I was told that the manipulation test was not very conclusive, because apparently while there was laxity in my injured knee, it was also there in my uninjured one.

Yesterday I tripped and went to recover as I would normally. Doing so made inside the knee very painful I’d say a 5/10. Small stuff like that is aggravating my knee, which tells me I really am far away from being able to ride or play hockey if I can’t even do simple things. I definitely still cannot completely bend the knee, cross-legged is out of the question, as is squatting. Both cause a lot of pain.

I am now exactly 2 months from the day of injury and it is still bothering me in day-to-day things. So I am thinking I will go for surgery. I have my check-up tomorrow with orthopedist and will report back.

Good luck in your upcoming appointments, @stressgirl37

#16

I tore my ACL in 2014 in a riding accident. It was 80% torn which was seen in the MRI. I will tell you from first hand experience that it will not take you 9 months to get back in the saddle. I had my surgery mid-July and was riding by Thanksgiving. My doctor said that because the knee is against the saddle it is supported. Ease back into your riding and things will be fine.

I highly encourage you to get a second opinion. If you are having that much slippage you may increase your chances of arthritis later in life. If you do get surgery there are multiple options for grafts. If you intend on playing hockey still go with the patella graft. It is stronger than your original ACL. You may end up with patella pain, which I have, but its nothing a little CBD oil and motrin can’t handle.

I also broke my leg when I tore my ACL and it set me back when it came time to do PT since I had muscle attrophy by the time I went to surgery. Do not forgo your PT after surgery!! You NEED to do it. Find a PT that will push you and will get you the range of motion. It will hurt. But it is worth it. I have full range and every time the PT bent my knee and I thought I was going to die I just sent my mind into the show ring, my happy place. LOL

Happy to share more about my experience with you.

#17

Thank you. I may reach out soon. I had an appointment yesterday, and my orthopedist thinks I should go the surgery route and is concerned we are dealing with something more severe than the films indicate. I scheduled my appointment for surgery, April 8th.

ACL reconstruction questions
#18

Just bumping this up. I had surgery 4/8! I did indeed have a full ACL rupture, as surgeon suspected going in. I did not get a cadaver, but did get a hamstring graft.

I’m not able to go to PT until I can drive myself again (2 more weeks). Does anyone have any stretches I should be doing in the interim? I am still feeling like my leg can’t flex all the way (maybe like half way) is that normal?

I have a checkup on the 8th, will be asking my doctor this too, but figured I’d pick the mind of the collective as well.

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#19

I was wondering if you had gone ahead with it. I remember asking my surgeon about PT thinking I needed to START RIGHT IN - he gave his best effort telling me to be patient…

There are all kinds of post-surgery protocols that were not mine - I was non weight bearing for two weeks. My goal was bending it to a 90 degree angle- so if I sat in a hard chair with my foot on the floor, could it bend to 90 degrees, and then could I slide my foot forward 2". I think I started PT 3-4 weeks after surgery. Maybe a little longer? I had a very small range of motion because of the swelling, so yes, totally normal that you can’t fully bend or straighten. Straightening for me came long before full bending. That was months. Your hamstring will be really really weak too, so you will also do things like standing on the good leg and lifting your foot (Don’t do it until they tell you to!) to regain that.

You can go down a youtube tunnel of people marching around their apartments after driving themselves home from the surgery. I have no idea what program they were on. It sure was not me. :slight_smile:

My PT involved gradually becoming weight bearing correctly as well as range of motion. No cheating by twisting or leaning. Bending it more, using a press to regain the quad strength - if your quad muscle went entirely AWOL that is normal. Just waking it up it took a couple of weeks.

My therapist would do massage work on the joint to reduce the swelling which helped a lot. I had some weird torque of my tib/fib, and of my hip, which probably happened when I took the fall - I was unable to do one of her exercises and she had to fix that.

The list of exercises required a spreadsheet- this one 3x a day 10 reps, this one once a day 20 reps, etc. I usually had 4-5 different ones at a a time.

At one point the surgeon reminded me that tissues can only heal so fast. " you are in the 99%th percentile for recovery speed". He indicated the professional athletes who appear to be good to go in 6 months are not doing it without “help”.
Also- don’t make PT appointments on Mondays - she always knew I’d overdone it on weekends when I had a Monday appointment. I got a lot of lectures about patience but I did do all the exercises.

Good luck!

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#20

Welcome to the club! I had mine on 4/5 (other knee on '09). I started PT after 2 weeks, but did have a few light exercises to start post surgery when I felt up to it. Goal for 2 weeks post surgery according to doctor was 90 degree bend. I was at 80 percent but am now at about 100. Need to get to 120. It’s important you follow guidelines. There are certain movements you absolutely should not do at first. I had my brace locked straight for 2 weeks. After that, I still have to wear it at all times, except sleeping, for 4 more weeks. Your PT goals will be strengthening quads, hamstrings, hip-flexors and getting that bend. It all takes time. I had hoped to do some hiking this summer but PT says too soon. Good luck!

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