Hi fellow COTHers. I tore my ACL last week and am looking for some information from other riders. MRI says complete tear of ACL at proximal insertion with bone bruising and mild MCL strain. Ortho surgeon said a month of physio before he will do anything. My options then are: no surgery (if everything is healing well), surgery at a later date (ie after indoors) or immediate surgery. He says that you don’t need an ACL to ride a horse which I didn’t know. Having said that, I’m young and ride professionally which means I ride a lot of greenies and youngsters and the reality is I’m going to fall off again. I would love to ride this season and have surgery in the fall but I don’t want to risk further injury. Thoughts? Suggestions? Your stories?
My daughter tore her ACL 4 years ago when she was bucked off and landed on her feet. She tore the ACL off the tibia bone rather than tearing the ACL itself into pieces. I don’t know if the ACL reattached itself at all or if it is still completely not functioning. She hasn’t bothered to get another MRI because the knee has not bothered her, other than a very rare twinge of soreness. She rides daily and works 50-60hrs a week. At the time of the injury, she did not want surgery because of her school schedule. The orthopedist advised her that the bone might reattach if she kept her knee straight, in a velcro knee support, for 6 weeks. She did not bend the knee for 6 weeks.
Be sure you need an ACL. You may find that you don’t need it, although many active people do need it. Look into having ACL surgery done by a scope rather than the traditional procedure with the long incision. Be prepared for a long recovery after the surgery, particularly if you have the long incision. Of the active riders that we know, my daughter is the only one with an ACL injury who did not get it fixed. The people we know waited a couple of years after the injury to get it done because their lives were busy.
I believe it was Joe Montana the quarterback with multiple Superbowl wins that played his entire professional career with a torn ACL.
Where I think you could have problems is not with the riding but more with ground work with young horses. If you need to quickly pivot or move to the side when a young horse it acting up your knee could give out.
I tore my ACL a few years ago. I would have need surgery to at least remove the piece that was hanging down. It was keeping me from bending the knee. I also need my MCL and meniscus cleaned up. Since I was going to be under anesthesia anyway I opted to have the ACL repaired at that time.
Be aware from an insurance perspective you may only have 30 Physical Therapy visits per year- this is a common limit on many policies. I used some PT visits before the surgery and then needed many after the surgery. I ran out and had to pay the last 8 or 10 visits on my own. The PT place did give me the insurance discount. PT 3xs per week adds up quickly.
ACL rehab is not easy. Pick your PT place carefully. IMO they are just as important as what surgeon you pick.
My understanding if you opt to not have the ACL surgery it can create some instability in the joint that won’t bother you on a day to day basis by may lead faster wear on the joint.
As far as I know ACL surgery is always done nowdays with a scope. The long scars that you sometime still see is where they have removed the patella tendon to use to replace the ACL. If you decide to have the ACL reconstructed do your research on what you want to use to replace the ligament. There are pros & cons to the 3 options. Many people cannot kneel if the patella tendon is used. Hamstring is an option or cadaver. Some women don’t have enough hamstring on one side to use so they use some from each side. With both the patellar and hamstrings you are recovering from the ACL reconstruction and the harvesting at the same time.
My doctor used a cadaver tendon for me. I do have a 3 inch scar that is just below my knee. This was the entry point for the really big titanium screw that holds one of the ends of the new ligament. The screw doesn’t fit through a scope.
My surgeon does not do a continuous passive motion device after the surgery. If I ever need ACL reconstruction again I will pick a surgeon that does use a CPM. Friends whose surgeons had them used one seemed to have a better recovery than I did. My surgeon also does not have his patients use a brace beyond the first 6/8 weeks. Many surgeons have you use one for sports for 1 year post surgery.
Good luck with whatever you decide.
Just Jingles for you ~ so sorry this has happened & hope you are feeling better soon.
I used a sports medicine surgeon from Johns Hopkins (Orioles team physician). He had be do 3 months of PT before surgery, 9 months after (3 x a week). My knee was unstable and kept swelling. I worked in a gymnastics center and the soft footing on the gym floor was very difficult to navigate.
I wore the ACL brace for 1 year after. Then as needed for severe physical stress. It’s been 4 1/2 years and my knee is as good as it’s going to get. I do favor it a bit and it aches sometimes, but, other than that, it’s good as new.
I tore my ACL while skiing and also fractured my tibial plateau at the same time. I had mine repaired a month later ( as soon as the swelling went down)and then began PT 48 hours post op.
Personally, I would get it repaired if it was totally transected. All of the ligaments within the knee help to keep it stable. You may feel fine now but the total loss of any one of the ligaments is going to lead to some sort of compensation and arthritis sooner than you would expect without the injury.
Walking in deep footing and sand without an ACL could cause significant instability and further injury.
If you are young (under thirty) I would use your hamstring or a cadaver donor for replacement. I am older and used my Patellar tendon as the donor and I found that harder to recover from than the fracture.
Good luck to you.
Thank you so much for all your replies. My injury is less than two weeks old and I already have quite a bit of ROM back. It does still feel very unstable though. I think surgery will be necessary, now I just have to decide if I should do it now or wait until the fall.
I had my reconstructed back in '92, when they still did the big open cuts.
I injured mine in January and waited until June to have the surgery. I was in HS at the time and I wanted to rehab when I was out of school.
If you delay it, get going on your physical therapy. You’ll recover from surgery much faster if you strenghten the muscles up first. I had one of the fastest recoveries my physical therapist had seen, and I’m sure part of it was due to the work done beforehand.
Mine is a patellar graft, and to be honest the most problems I have are from the graft site. I can’t kneel on hard surfaces due to the missing section of tendon/kneecap/tibia.
I’d look into some of the other graft options just to avoid that, because it makes life such a pain to not be able to kneel. It really put stress on my other knee due to overcompensation, and as a result that one is starting to have issues (I’m only 34).
A co-worker of mine had a hamstring graft and it seemed to work out well.
If you are young and intend an active life then you should get the surgery. While you don’t “need” it to ride, it sure makes life a lot easier. The chance of doing more damage to other knee essentials (meniscus tears, MCL tears, etc.) that can leave you in need of further surgery or knee replacement down the line increase with the lack of stability that a missing ACL can lead to.
I tore mine off the femur 4 years ago, but it was ultimately a partial avulsion and “reattached” to the bone. I was supposed to have a patellar graft following 6 weeks of PT to get as much movement and strength as possible before surgery. Ended up just doing a clean out when surgeon discovered the self-healing during surgery. PT is a real bear, but DO IT.
Good luck.
If you’re unstable, you’re probably looking at surgery. :\
My trainer (MY trainer, as in my gym coach, LOL) tore both of his late last year, but was fully stable. Finally goes and gets an MRI since they’re so sore, torn in both knees. Opts not to have surgery since he’s stable and just sore, does his own PT (he was a PT and amateur powerlifter before he got into professional training)
I’ve had 2 major surgeries on my left knee, and I would say if you can avoid surgery- avoid it and see if nature will put you back together. But if you’re unstable, it’s probably just a ticking timebomb and better to get it repaired. 
Believe me, I sympathize.
Ouch! I snapped my ACL (right leg) about 20 years ago. No surgery. I tried to be very good about my physical therapy, and remember that I had a lot of swelling in that leg for months. My knee would give out every once in awhile, but eventually that stopped as my leg got strong again. Riding didn’t bother my knee but mounting, dismounting and overcoming my fear of hurting myself again were big issues.
I did end up with arthritis in both knees - but have begun taking a couple of supplements that seem to work for me. Might just be ‘in my head’:lol::lol:.
Good luck to you. And your Dr. is correct…you don’t need your ACL to ride. Get your surrounding tendons, etc. strong and you’ll be good to go.
I completely tore mine a couple years ago along with massive bone bruising and small meniscus tear. I hated all the instability so had it repaired as soon as I could which was a long time, a couple months without insurance and then waiting on the surgeon. It was going great until a horse struck me straight on my knee and bent it backwards 10 weeks post-op, it broke a screw and partially ruptured my graft. Had surgery to fix that up and am still very grateful that I went through with surgery.
I had the patellar tendon graft and still can’t kneel on that knee unless on very soft ground, I think I would go with a hamstring graft next time but I hear they are harder to rehab from.
I wore a brace for a year after surgery for working and riding ( I am a trimmer) but could ride from 6 weeks out. I also rode before surgery but limited trotting both before and after for a bit. 12 weeks post-op I went to an endurance ride and did the 12 mile fun ride mostly trotting and did it with the broken screw and partially ruptured graft, the screw didn’t pop out into the joint for another 5 weeks. :lol:
The hinged brace did not interfere with riding.
Ann Szolas
I tore my ACL and MCL six years ago. I had the ACL surgically repaired about six weeks later, as soon as I could. The MCL will repair itself, but not the ACL. I am SO glad that I got it fixed…I have no stability problems at all. And I was old at the time of my surgery, and you have youth in your favor. My original ortho said people my age don’t need an ACL if they make a few “modifications”. My PT told me to get the surgery so I switched orthos and got it done. I have never regretted it. I also didn’t have to wear any brace afterward. Before hand, yes, but not afterward. I was riding lightly about five weeks after my surgery. Not on Dr. orders, obviously, but bareback on Mr. Reliable. They used my hamstrig and if I had to do it again, I would probably opt for the donor graft. But maybe not if I was as young as you are… My advice is to get it done ASAP and get on with your life :).
As a doctor and a rider, who has had my ACL reconstructed last year, I recommend having it repaired if you are young. You will avoid further knee damage and future arthritis if you get it repaired sooner than later. Glad I had mine done but it was not a fun recovery! Was out of the saddle for 3 months.
Thanks again for all your replies. I’m certainly leaning towards surgery sooner rather than later. I would rather take the time to heal now so that I can put this behind me and hopefully not have any other problems with it down the road.
Good luck. You will be happy you made this choice down the road. I know that I am.
if indoors is important to you, then you could wait until after indoors to get your ACL fixed. but i would not ride long term without an ACL. i ruptured mine 8 years ago when i fell off jumping when my horse refused a fence. i had to wait 2 months for the swelling to go down before i was able to get it repaired. but i did it right away rather than wait. the problem is that your knee is not stable now, so if you fall again you can really damage your other ligaments and do great damage to your meniscus. not worth damaging your knee. you can really work at PT and strengthen the muscles around you knee so they take over the work of your ACL. but long term if you are really active i dont think this is a good option. i had a friend who chose this option and she was really physically fit. but eventually her knee gave out more and more and she ended up with surgery after i had long since healed and moved on with my life.
ACL rehab is not that bad. i had the cadaver graft and have only 2 very small incisions on my knee. barely noticeable. the cadaver graft is just fine. your own body grows structure over the graft to make it strong and you have less pain using the cadaver. the rehab is basically getting in good shape. the only thing that hurt was getting heel to butt. i got mine at 8 weeks but i had an aggressive PT.
8 years later my knee never bothered me but now i added to my problems in that i shattered my tibia and fibula in spiral fractures on ice. my knee held up to the twisting motion, my ankle did not! i now have a rod in my leg and this rehab is soooooooooooo much worst than the ACL!
if you want to get some protection riding, i would by the CTI2 knee brace. its was about 1600 when i bought mine. insurance covered most of it. i could ride no problem in the brace and it brought me some confidence that if i fell the brace would help stablilize. i rode in it and showed in it for one year. and it was very comfortable. its the only brace that you would be able to ride in since its soft against your knee. and inner upper calf. the hard shell is on the outside. i still have the brace somewhere but havent seen it in years as my knee healed up really well! i hope my tibia and fibula heal just as nicely!
Thank you for all your responses. I am nearly nine weeks post injury and have nearly full ROM back and minimal swelling. I can fully weight bear and I can walk, I am just slow and careful. Uneven ground is difficult so sometimes I’ll use a cane. I can ride, I just have to get on from the wrong side and use a big mounting block. It’s not too painful when I ride, unless I have one that jumps up big and round. I’m doing lots of PT, strengthening and accupuncture to help control pain. I’m scheduled to have a hamstring graft reconstruction in the fall. If I am having too much trouble getting around, or it becomes increasingly painful, I can opt to have it done sooner. Thanks again for sharing all your stories!
