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

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.

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.

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.

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

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.

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.

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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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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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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How are you feeling post op? I have my surgery next week (full ACL rupture, leaning towards the hamstring graft) and I’m a bit apprehensive about it.

You need to do the surgery… but don’t be apprehensive. The surgery was the easiest surgery I’ve ever had. Was in and out in a breeze, I don’t recall the ride home, and they gave me some pretty heavy hitting painkillers. It was a fun and adventurous day :lol:

Be prepared for it to feel worse before it gets better. The first few days were fine, the rest of the week was not… but now it is in the past. :yes: The week after the surgery was trying. The hamstring area hurt more than the knee. Stock up on comfort foods, cook ahead. Buy cleaning wipes because you will not be able to shower. I’m independent by nature, and had a very hard time being indisposed. I pretty much slept the first week, binged some shows I’ve been meaning to watch…

Make sure you stay ahead of your pain. I don’t like the feeling I get from painkillers, and did not take them as often as I should have: BIG MISTAKE! It made me miserable and if I had just sucked it up and taken the prescribed dose I would have been fine… I also found that for my particular prescription, it was useless if taken at half-dose and/or without the prescribed tylenol on top of it. Don’t forget to take the aspirin daily, and also, stock up on stool relaxers depending on your medication.

I am now a month from post op, and it does not hurt at all to walk around on :yes: It still hurts to bend, but that, I am told, is normal. And… it is nothing like it was pre-surgery, where it would kill if I stepped on it funny.

P.S, Thank you for chiming in Hilary, I was hoping you’d come back with some encouraging words – and thanks also, to stressgirl37… sorry hiking is not in the cards for you this year :no:

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I didn’t tear my ACL, but ripped it off where it attaches to the tibia.
original injury was a year ago March, my horse bolted while lunging and I was pulled forward hyperextending my right knee. I had no pain until I tried to take a step and the knee buckled.
Went to ER had a x-ray, and er doc said nothing broken and sent me home with a giant leg wrap and crutches and was told to come back in a week.
After a week I still couldn’t bear weight, and almost no range of motion. was sent to Ortho and put on the wait list for MRI. Sent back home in another giant wrap and half cast.
Finally 6weeks after injury I saw a surgeon, who said tibial emmesis fracture and minor tear to ACL and MCL. Two weeks later I had surgery to reattach the ACL.
After surgery I was in a full leg wrap with casting for a few weeks, no weight bearing. Then in full leg brace at full extension for another few weeks. I did months of physio, they let you ‘graduate’ when you can reach 110 degrees of flexion.
I started riding again about 8 weeks after surgery, I couldn’t get my for in the stirrup so I rode without them for about two months.
I am now a year out from surgery and I still can’t fully extend the knee, after stretching I can get to 5 degrees, pre injury I could hyperextend -5 degrees, and I can flex to 120 but it’s painful.
The knee is really stiff all the time and I have a fair amount of pain, but I can ride and walk my dog so it’s just kind of become my new normal

My trainer had her ACL repaired the first time with her hamstring. She re-tore it again 15 years later. She had cadaver the second time. She said the recovery with the cadavar was much easier. Only one spot to heal. She also had a continuous passive motion machine the second time but not the first. She thinks that made a big difference.

I had cadaver. Talking to other people that have had patellar or hamstring the initial rehab and pain levels are better with cadaver.

Rehab is not fun. I agree that you need to take the meds and stay ahead of the pain. If you are in pain it will make your PT and rehab exercise worse. You will need less of a dose to stay comfortable rather than waiting to take it when it hurts.

For narcotics I find I need to take with a milk product to keep from getting nauseous. Pudding, protein shake, ice cream, cottage cheese works best. I only needed a few bites. Do NOT take on an empty stomach.

Take something like Senakote to offset the effects of the narcotics

Thanks for the info! According to my surgeon (and the research I’ve done) the revision rates are unacceptable for younger people who want to return to sports with the cadaver graft, so while not having to deal with a secondary injury site would be nice (the robbing Peter to pay Paul dilemma) it seems that the cadaver graft isn’t a good option for me.

As a gym rat, I’m not afraid of the PT, I’m just afraid of the mental side of it.

Just want it over with! One week…

@weixiao I had to play with the pain meds because the full dose made me sick and hallucinate. I ended up taking 1/2 dose of the narcotic plus tylenol for about 10 days, plus Naproxen 2x/day to help with inflammation. My doctor did a nerve block and when that wore off in 2 days, ouch! After the big bandage came off after 3 days, I could do a sit down shower. Painful but doable. I had a cadaver graft on both of my repairs. I’m 6 weeks out and just got freed of my brace, still doing PT, on track with progress but it is a long process to be fully healed. No riding for me for several more months. Good luck!

@weixiao Big jingles for a smooth surgery today. Check in when you are feeling well and good :slight_smile: let me know if I can order you Doordash or Ubereats this week if you are hungry!! I know I lived off of it when I was still on “stall rest” :winkgrin:

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Yes, hope your surgery goes well!

My funny story about the hamstring graft. Post op they kept asking me how far it was to the toilet from my bed. We had a funny set up in the house where the downstairs half bath had a bed in it. So I’m like 6 feet? It’s a small room.

What they failed to mention was that while most of my leg was blocked, the back of my thigh was not. And that is where they took the hamstring graft. I hadn’t taken any pain meds because the block was in effect.

First time I had to pee I carefully made my way the whole 6 feet over to the toilet and sat. Only to experience the excruciating pain of weight on the unblocked hamstring graft area! Pretty sure I levitated right back up. Lots of bad words ensued and I’m like OF ALL THE THINGS you might have mentioned this to me!!

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Thanks guys! I really appreciate it! Had the first surgery of the day and got home a couple of hours ago. Feeling pretty good so far! They loaded me up with anti-nausea medication so no trouble with that, thankfully. Ended up going with a quad graft which is cool! Nerve block didn’t seem to take that well and is already wearing off a lot, but so far really no pain at all, just a bit of soreness in the back of my knee and under the knee cap. I know there is more to come but nice to start around 0! No pain at all at the graft site and already have a lot of extension (hard to tell if I’m at full extension with all the bandages but it is definitely at least close). Fingers crossed the ride doesn’t get too rough from here!

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Good update! Keep us in the know :yes: hope today you are doing well!!

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Thank you! Still really can’t complain! Ended up going out for a burger last night with my sister. Had a couple of hours that made me sweat this afternoon when the last of the block wore off with some rebound pain, but it’s settled down again. Been doing my PT/ice/elevation diligently and managed to shower with the help of some garbage bags/cling wrap/waterproof tape so feeling pretty good! Still only just shy of the 36 hour mark so I’m guessing that it could still get worse over the next couple of days before it gets better but hopefully not too much?

I’m dying to see what it looks like under the gauze and wrap, but have to be patient and wait for my appointment on Tuesday. I should have thought of that extra day before I booked to have surgery before a holiday weekend!

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