ACL reconstruction questions

Early March I injured my knee and 2 1/2 months later an MRI showed a near complete tear of the ACL, meniscus tear, bone bruising and some other stuff. Between March and June, I ended up with some sort of tweaking of the original injury every 3 weeks without fail, that would set me back a few days or so. In June I had another twisting injury and before I could recover from that I sustained a 2nd meniscus tear. Unfortunately, I’m able to do much less now than just a few months ago. In May, was walking 3-4 miles 4x a week without difficulty; now a mile results in several painful days. Yes, I have pain with every step, not severe but bothersome. My knee does feel unstable if I have to catch weight on my toe or move laterally. I do have a physical job that requires lifting, dragging, kneeling, carrying, climbing, a ton of walking over uneven terrain, etc

The questions … have any of you had ACL reconstruction? Why did you decide to go ahead? Are you glad that you did? What are your long lasting effects?

It has a really rough rehab and from what I’ve read/heard, success depends on how well that rehab is done. I expect insurance will cut me off after 2-3 months of PT. How do you keep motivated after this and know what to do?

A small study last year found that quad muscle contraction was altered after surgery and that the quad acted as if it had aged by 10 years. Do you find that to be true?

I just watched a female, pro-soccer player’s update 3 1/2 years after her surgery … she still has pain, periods of instability, decreased range of motion, and a noticeable difference in quad size and strength. This is incredibly discouraging because I don’t see the point of the pain, joint trauma, and devastatingly long rehab of ACL reconstruction to end up with the same problems. And, oh yeah, failure rates for allograft reconstruction are 20-25% or one out of every 4 or 5!

I really don’t know how to handle this so am trying to find out all I can. Super uneasy about surgery due to near term and long term implications. But can’t see going on as is.

There are a couple of ACL threads on here you should check out. I tore my right ACL and MCL falling out of the the hayloft and had the ACL replaced with a hamstring graft. While I was sitting on a very calm horse after 3 months, and riding for real at 4 1/2 I think it was 6 months before I ran a mile.

My quad was completely useless right after surgery - that was freaky!! But it came back to normal. I think the hardest part for me was about 2 months out it’s pretty fragile and even though you feel better you need to pay attention to the PT .

I was doing normal stuff in 6-8 months but it really did take a full year before I stopped worrying about it and really feeling normal again.

Where did you see the 20-25% failure for an allograft? Is it failure due to patient non-compliance? If you go out and think you’re fine at 2 -4 months, yes you will be back at square one.

It’s been 7 years and I never think about it.

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Do the surgery.

My understanding of these injuries is they do not heal well – if at all – without surgical intervention.

Also, girl, slow down!! 3-4 miles while you have a soft tissue injury?? Even one mile is too much!

I have a thread about my ACL here, and it has some other posters chiming in.

It has been a few years but if memory serves, I tore it in Jan. I was playing hockey and someone fell on me. Because it was a men’s league, I stupidly kept playing on it versus letting them think a woman couldn’t take a hit. I didn’t have any driving power behind and I remember driving home I realized I was really screwed: I had a stickshift car and couldn’t use my leg for the gas. I figured maybe I tweaked something, so I gave myself time off from hockey and riding. Four months later it was still hurting too much to even consider physical activity. It did not improve with conservative measures whatsoever. It still hurt just as much the day I went in for surgery which was sometime in April IIRC. In my case, the rads were inconclusive so it was more of a “we’ll see what we get when we cut her open” stitch – once I was under, they realized there was significant MCL involvement too. I had a full ACL rupture with nearly total MCL tear.

I was back on a horse within a few months. I was back to playing hockey that November – well ahead of the conservative “9 month minimum” my orthopedic surgeon preferred. He was not happy, but he was married to a horsewoman and he said we are all the same! Type A and don’t listen to anybody, especially men. :laughing:

I had the hamstring graft since we could not get cadaver. It hurt, and layup was not pretty. I was amazed how my knee instantly was pain free after surgery - it was my hamstring that hurt like a %#^#! There was a period of time where I was worried I’d never be athletic again. But now I don’t even think about it.

It is imperative you go to PT and to be diligent about practicing them at home. I could only afford 2 PT sessions at the time, so they sent me home with multiple packets of “do this on week 2, week 3, etc”. I also had time off from work and it was no issue fitting in the exercises. I would do a few of them every time I went to the bathroom, and then the whole course of them before bed. Once you get into a routine it becomes mindless. I had a lot of atrophy on my right side (ACL/MCL side) initially while I was laying up - I lost almost all of the muscle in my calf and quads. It’s been 3 years and I’m evenly muscled now BUT my hamstring is still rather weak. I only notice it if I try to hold my leg up for 20s at a time.

I have never been better at hockey than this year. I’m faster than I was pre-surgery. I don’t notice any sort of atrophy or one-sidedness while I am skating. It doesn’t hurt at all and I don’t even think about it while doing physical work.

When I am riding, I do notice that there have been some posture changes down my leg. I don’t notice any quad strength reduction, but I do notice that my outside leg is not as strong as it used to be if I’m riding a very slothful horse. Other than that it is no issue; I event, hunter pace, and hunt and I never think of my leg.

The only time I really think about it, ironically, is when I am at my desk at work. If I’m sitting too long, the outside of my knee close to where the graft was will ache - but the second I start moving it is fine.

I didn’t hear anything about failure rates being that high when I went in. I stressed with my orthopedic surgeon about how physical my life is: horses, barn chores, hockey, hiking… I’m never sitting still. He thought the hamstring would be best.

It was the easiest surgery of my life. I went in, went under, woke up 2 hours later, went home a few hours after. I’ve had quite a few surgeries in my life and this one was definitely the least stressful or complicated. It was amazing how fast they worked.

Good luck OP, and I hope you get the surgery. I could not imagine not getting it with how physically busy my life is.

Thanks for the personal insights! I’m especially thrilled to read that you returned to hockey. I’ve actually been thinking of pulling out my Rollerblade for conditioning. I’d love to be on ice but it’s been several decades.

I e-mailed some questions/concerns to the surgeon and have been summoned to return to his office this week. I had been feeling halfway decent but was loading bales into the truck, barely stepped into a hole, and there went the twisting. Sigh. I’m so solid and then I’m not. I just can’t control it when I hit that weak spot.

When Beowulf said “girl, slow down” - this!!! Clearly your leg is not stable, and will not be if you keep doing sh*t like slinging haybales and stepping in holes and twisting. I know you say you ‘can’t’ stop but think of it this way - In the grand scheme of your life don’t you have 6 months to make it better for the next 60 years?

I do know 2 people who did not have the repair. They both are pretty active but both have also had subsequent knee issues 10-15 years down the line.

Treat yourself like you would treat your horse.

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I haven’t read other’s responses, but here is my story.

I tore my ACL in 2010 landing wrong after getting bucked off. After doing a lot of research, I chose to use the graft where they take it from your own knee, the patellar tendon. If I had to do it again, I would choose the cadaver graft instead, downtime is a lot less.

I did some PT before the surgery, as they told me the stronger I was going into surgery, the better my recovery would be. This was all stuff I could have done myself, it was really about building up all the supporting leg muscles. I just don’t know that I would have been diligent about doing it myself. I was told that I would recover as fast as I wanted to. The more work I put into it, the faster I would regain full strength and mobility. I was all hyped before surgery, thinking YEAH!! I’M GONNA NAIL THIS!!! Well, after surgery, I had a different mindset, thinking “it hurts” LOL. One of the things I had going for me, is that I am already very flexible, so gaining full range of motion came very quickly. I was diligent about doing my range of motion exercises at home, but the strength was a lot harder. Post surgery, I had an Iceman, and I would HIGHLY recommend getting one, spend the $, buy one used off craigslist if your insurance doesn’t cover it. Its a machine that you fill with ice and water, and it pumps the ice water through the wrap on your knee. I lived in that thing, it helped immensely with both pain and swelling. It was probably a good year before I felt like I had my strength back, but I had a mental block for years, I could not jump. To this day, I still can’t jump (like jump rope, not jumping horses) but I suspect it is lack of any cushioning left in my knees now.

I get uncomfortable kneeling, but that has to do more with choosing the patellar tendon graft, I can feel where it was removed from. In later years, a different doctor reviewing an MRI made a comment about how he closes up the graft site instead of leaving it open the way my doc did, I am not sure what that meant, but it may have to do with my discomfort in kneeling.

I did read a medical article once upon a time that looked at athletes that both did and did not do PT post surgery, that said without physical therapy, the average person regains the same strength something like 18 months post surgery as someone did with PT. It wasn’t specifically regarding knees/ ACL, just orthopedic surgery in general.

Some people can function just fine without their ACL. In fact, my surgeon didn’t have ACL in either knee. I didn;t feel stable enough without it.

Thanks for sharing your experience.

My surgeon also referred to a friend of his that played college soccer without an ACL. I do wonder if men, as compared to women, are more likely to be able to function ACL-deficient due to muscle patterns. I was hoping I’d be an exception as well but, unfortunately, everything I do is outside and phsycial! I go for a 2nd opinion on Wednesday. If he also suggests surgery to return to function then I’ll schedule for October. It’s just going to be really, really painful. And I hear you on the mental block. I already have that and sometimes struggle to distinguish whether I can’t do or am anticipating pain and so don’t do. Not fun.

I’ll look into the Game Ready and see if I can track one down. To purchase is $4-5K.

Game Ready shows up on craigslist, eBay or FB marketplace with some frequency, barely used, at prices much better than new. I picked one for $1700. But your surgeon should also be able to hook you up with a rental for a few hundred bucks, which is definitely the way to go for a single procedure. The small non compressive machines just don’t compare at all, Game Ready is definitely the way to go.

I had a pretty simple knee scope about nine months ago and I was honestly just floored at how challenging the recovery was. We expected a quick meniscectomy, but found instead a (much bigger than expected) tear in the vascular part of the meniscus, so it was repaired.

I was about 14 weeks out from an absolutely massive hip surgery (my pelvis was actually broken in several places to reorient and screwed back together) and I swear the knee was worse. I was absolutely not mentally prepared for it. I was still pretty sore six months out, all considered normal healing. Got some Regenexx PRP in there and that’s helped a lot, although deep flexion is still not happening, and at this point, I’m not sure I’ll ever get that back.

I would definitely recommend using the absolute BEST surgeon you can find for this. It’s super reasonable to ask where he trained, who he fellowed with for the procedure he’s proposing, how many he does a year, and how he tracks his results. Look up what he’s published on pubmed. Ask if you can talk to a few patients with similar pathology. If you’re anywhere near a major referral center, or are willing to travel, go there. Don’t use your community or regional medicine guys for this.

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