ACL tears

[DVM2003]

I’m very bummed. Wednesday night I got on my mare who has a history of being cold backed. I had not had an issue with her acting up during mounting in 2 years. I lunged her (but clearly not long enough). Got on, took two steps away from the mounting block and she started getting humpy backed. So I hopped off. Pushed off a bit to hard and landed on my right leg only tearing my ACL in the process.

When to the orthopedist and he’s 100% sure ACL is torn, but wants an MRI to check meniscus. If meniscus is torn he’ll fix both at the same time right away. If it’s just an ACL he wants to see what 90 days of rehab will do and only will consider surgery if it’s still unstable.

I’m beyond upset. I’m an equine vet and it’s going to make working ridiculously tough. Every time I think of one more thing I won’t be able to do for a while I’m more bummed. Stupid stuff like flexion tests, paring out an abscess, getting out of the way of a naughty horse.

I’m not sure what I’m asking…I guess people’s experience with not doing surgery…how long till it feels a little more stable? How was riding after? What do I do with my TB mare for the next 3-6 months? How do I trust her again? Maybe I’m just looking for sympathy from strangers;)

[stolen_virtue]

I tore my ACL and meniscus July 2, 2014 had surgery July 30. I am beyond bored and pissed. I am looking for someone to part lease my 7 year old OTTB who is going very well now, I had planned to spend the summer riding him. I have 4-6 month of rehab before riding. I am in a large brace that I can only wear yoga pants under, cannot drive so work at the office is tough but I did promise to be in the office all next week to help another project manager.

Not sure what to say, my ACL was a complete tear so no other option beyond surgery. Sorry, one of my vets had the same thing happen and she is two months into her rehab and yes, struggling with handling horses for lamness issues. She is primarily a lamness vet.

[AKB]

My daughter tore her ACL one summer when she was in vet school and was bucked off. Hers was not the usual tear in that the ligament itself was intact but detached with a small piece of bone from the tibia, so it was not functional. Since she was in vet school at Virginia Tech, and they would have made her take a semester or year off if she was on crutches for a few weeks, she opted to not have it surgically repaired. She wore a knee support for 6 weeks, but was riding in a few days and walking well within 2 weeks. Her orthopedist, who had torn his own ACL twice and does competitive bicycle riding despite his torn ACL, advised her that she might do well without surgery. It has been 8 years since her unrepaired ACL injury, and it is rare that she has any knee soreness. She has no problems with instability.

Everyone is different. You may find that in a few weeks, your knee works well.

[Robyn]

I had mine surgically repaired about six weeks after tearing it. Did not have to wear a brace but used crutches for about two weeks. It was my right knee and I was driving in about two to three weeks. PT for about six weeks and was never in such good shape as I was when I finished! No problems since and I’d do it again.

[DVM2003]

Thanks for the replies so far. Today is a much better day. The swelling has gone down tremendously and I’ve started doing some range of motion exercises. On Friday I could hardly bend it 45 degrees now it’s almost normal. Honestly the thing that hurts the most is my calf muscle. When I walk it feels like I have a continuous Charley horse. Not sure if it’s from walking bizarrely or if I strained it when the ACL tore. I’m crossing fingers that MRI shows no meniscal tear and I can go with PT only. It’s not really painful, just oddly unstable feeling.

[stolen_virtue]

My knee before surgery was not stable. I had it wrapped with one of my horse’s flannels in order to keep it more stable. That will be key to whether you can go without surgery. As I said mine was a complete tear, but yours may be OK with PT as long as it is relatively stable. Also, the back of my knee was very painfull which is the location of the ACL, so the calf pain could mean something other than ACL. Good luck, I had no idea an ACL reconstruction would take so long to recover from.

[vali]

The skidiva website has a lot of information on rehabbing from ACL injuries without surgery. See http://www.theskidiva.com/forums/index.php?threads/no-acl-no-surgery-no-problem-my-new-normal-as-a-coper.15049/

I tore the ACL and the LCL (also called FCL), plus meniscus tears, and wasn’t able to get enough functionality with just PT, but mine was an unusual case. I did the surgery and have recovered well, but if it’s just the ACL it’s definitely worth trying to rehab it without surgery.

[AKB]

You probably should get your calf checked to be sure you don’t have a DVT in addition to the knee issues. A d dimer blood test might be a false positive from the bruising from the knee injury. If so, they can do an ultrasound to make sure there are no clots there.

[DVM2003]

Thanks AKB - The doc already put me on aspirin as he was worried about clots since I’m flying next week and I have an unrelated medical issue that makes me more prone. I may give him a call tommorow and just double check he doesn’t want to see me again before I go. The pain is definitely muscular - only hurts when I try to push off with the bad leg. I also finally looked and there is a bruise in the perfect shape of a roller ball spur - I think I somehow nailed my self with my other spur when my knee buckled and I went down:(

[AKB]

It sounds like you have it all under control. When do you get the MRI? I think an MRI can be used to detect clots, if the tech and radiologist set it up that way. I have only seen clots detected by the d dimer followed by the ultrasound, but my area is pediatrics. Kids don’t get clots very often. Teenager on birth control pills with calf pain is my usual scenario. Yours is a little more complex.

You might measure your maximal calf diameter in both legs before you call the orthopedist in the am. If you have swelling in the leg that is “uninjured” he may be more concerned. Of course, it is hard to know if the uninjured leg is swollen since your injured leg may have some calf swelling and not be suitable as a normal comparison.

I’m glad the knee is feeling better. A swollen, painful, knee makes it so hard to get anything done.

[DVM2003]

Thanks AKB

No swelling in either calf. Just a little swelling in knee joint itself. Got my MRI scheduled for next Wednesday. I just want to get it done so I know what I’m going to have to deal with going forward. Luckily I’m in a 5 doctor equine practice and my co workers have been great about picking up the slack for me. I never realized how much of my job requires squatting until I couldn’t do it!!

And I got a potential plan for my mare. A wonderful friend/previous vet assistant of mine has agreed to take her on training board for as long as I need. I let my current barn know today. They were wonderful too. Said as soon as I want to come back they will find me a stall. Glad to gave good folks taking care of my horse. I’d keep her at the current barn, but they don’t have a resident trainer, or really anyone that could commit to keeping her in work 2-3 times a week.

The place she would go us great. Jen has rode her in the past for me, and actually helped me when I bought her. She does a lot of breaking/problem horses and does great desensitizing and groundwork which I think the mare needs.

[DVM2003]

AKB- thanks for your concern about the possibility of a clot. I called the orthopedist when my calf pain was getting worse and he had the same concern as you. Sent me for a Stat vascular ultrasound and thankfully it was normal. He’s not screwing around since I’m going to be traveling so he upped my aspirin to twice a day. I’m really thankful you mentioned it as I wasn’t that concerned until you brought it up. My doc said I was really smart to come in and that the last 5 folks that had complained of calf pain or swelling that he sent for ultrasounds did have clots. Said he’d rather do 10 negative studies than miss 1. Thanks again:)

[AKB]

I’m glad you got the ultrasound and that it was negative. DVT are scary because the signs and symptoms are not very specific.

Years ago, before the d dimer screening, I saw a young adult who had knee pain after moving furniture. He did not have calf pain or swelling. The next day, he dropped dead; probably from a clot. I felt terribly that I had missed it, but there was no reason to think he had a clot. The clot may have come from his non painful leg, as he had an old motorcycle injury that caused some major damage to that leg. He said the motorcycle injury leg was not bothering him at all the day I saw him. I now have great respect for clotting problems.

I’m glad your calf is ok.

[amastrike]

DVM, if I were you, I’d go to a new ortho who won’t make you wait for surgery. I tore mine on 5/20/10 in a riding accident that also broke my other leg. Because of the broken leg, I had to wait a bit for surgery… had it fixed ~7/28/10. I was up and walking, albeit not very well, the next day. Ortho had me wait about 6 weeks to start PT, then I went twice a week for about two months. When I started PT, I couldn’t even come close to straightening the leg. I ended up regaining full ROM and was even able to regain my ability to hyperextend my knee… it wasn’t until I finished PT that the physical therapist told me he’d been concerned that I would never regain full ROM.

You said it doesn’t really hurt, it just feels unstable… trust me, when that instability leads to your knee giving out, it HURTS. Honestly, the hardest part of my rehab was learning to trust my body again. My knee only gave out maybe 3 times before surgery, but it took me a good year to stop being afraid of it giving out.

The surgery is quick, the recovery is easy, and if you’re going to have to do PT anyway, why not just get it fixed and do the postsurgical PT?

[Robyn]

Agreed.
Original ortho said people “my age” could usually get along with modifications and no surgery. The PT who fitted me for my brace (had it before surgery but not after) told me to get another ortho and have the surgery. He said he’d fix me up and get me back to doing what I wanted to do and he did. Hardest part of the whole thing was the pre-surgery what ifs. And that winter when I was walking over uneven hard packed snow/ice daily I realized how debilitating an unstable knee would have been.
Do it. Then move on.

[garland]

I tore my ACL and meniscus in a very similar way last fall. I had the surgery a month after the injury, followed by 4 months of physical therapy. I couldn’t ride for 4-5 months. Luckily, my knee does not hurt at all when I ride, but it still becomes stiff and sore after other activities. I’m glad that I had the surgery, but it has been a very long healing process.

I had my trainer and a friend keep my horse going for me. I also had trust issues with my horse, even though I feel that the accident was more my fault. I’m just more careful now and I try not to ride alone.

[normandy_shores]

I’ve torn both ACLs (complete tears, no joint stability, couldn’t walk on it without the joint collapsing, no meniscus damage). Personally, if you’re active and want everything shipshape, do the surgery. You’re off your feet for a few weeks, and back to walking and slow rehab in a matter of weeks no problem. By 3 months, I was lightly jogging and I was riding and playing goal in ice hockey by 6 months (I was pretty fit, that helped).

It beats doing PT and always having a so-so knee. After having the surgery, your “new” ACL will be stronger than the original.

For work, it would mean a bit of time off and then having a trusted assistant help you for the first while back. Not sure of your work situation, but maybe time to offer some hands on experience for a vet student or new vet? I know my chiropractor, after relocating, started a service where he’d travel to cover other chiros businesses while they took vacation or personal leave or whatever. Maybe something like that to help you out in the short term…

[DVM2003]

UPDATE:

Got my MRI results and I have a torn ACL, small meniscal tear and shockingly a compression fracture of my tibia (which didn’t show up on xrays). Doc doesn’t seem concerned about the fracture - didn’t even mention it - he just gave me a copy of the MRI read out cause he knew I’d be interested/understand it and I saw it there.

He still wants to try PT first as he says that there is a portion of the population that do great without an ACL. Whoever mentioned that Ski-Diva site - THANK YOU! It is great.

He did say that if it was still unstable after the period of PT, that I would want surgery and he would do it/deal with meniscus at that time. He said some people chose to live with some instability and just modify what they do, but because of my job/activity level I wouldn’t be happy with that.

I’ve started PT and am headed out to join the Y. They want me doing formal PT 3x a week and then my own the other 4 days. If nothing else I will be in good shape and get back to working out.

They are also ordering me a custom ACL brace that I can use now and also after surgery if I end up having it. Says I will be much more stable in that.

My leg feels stronger, but it’s still very unstable. He’s happy with my range of motion (now normal) and that I have minimal swelling. I had basically none, but it did get a little pissed off after the first PT session.

Thanks for the support. It’s been tough - talk about emotional swings lately. I go from happy and optimistic to bawling with not much warning:(

[amastrike]

DVM, I still suggest a second opinion. I really don’t understand the point of making you wait when you’re so unstable and unhappy.

[AKB]

I would wait on surgery and see what a few weeks of PT can do. Some people get better fairly quickly after ACL surgery, but it takes many months for others to be functional. You are in a job where it is hard if you are not agile for months after surgery.