Surprised by ACL Tear

[aclsurprise82]

Two and half years ago I landed awkwardly while challenging a ball in a pick-up volleyball game.  The pain was intense, but after an hour I could walk pretty well and the next day I was just stiff.  Since then I have had four or five incidents where my knee has given out while changing direction while playing baseball, misjudging a step and dancing.  Eventually I went to my primary care doctor (I hadn't had one for awhile) and had him check it out.  He didn't see anything wrong after manipulating my leg.  He did refer me to an orthopedist.  One year after that (2.5 years total) I finally saw one.  After getting an x-ray, which I assume showed nothing, and then having him manipulate my leg he was pretty certain that I tore my ACL and started talking about how I needed surgery to fix it.  I am getting an MRI next week, but I am wondering if there is much chance that my ACL is for example not completely torn or are diagnoses made manually usually pretty accurate?  Any thoughts? Does the MRI ever give surprisingly good news?

I am going on the assumption that it is fully torn in the meantime, but it would be great if I could have some hope I won't need surgery.  I am really shocked by all this.  I thought ACL tears would be a lot worse and come with long-lasting pain.  It is also hard to decide to get surgery when I generally feel just fine right now.  It is especially hard when there is no consensus on the right approach.  I have two young kids and a two story house.  It seems like recovery is going to be tough given the circumstances. 

To the extent it helps, I am a 30 year old male who likes to be active but doesn't do a lot of sports.  I also live in the US. 

[Audice]

Hi & welcome to the forum. Since you feel you're doing well enough w/o having surgery, should an MRI reveal a partially or completely torn ACL there's no reason you HAVE to go for reconstruction. It's elective on your part.

The pain comes at the time of the injury but at least for me the only time there's pain from the missing ACL is when I twist & the knee moves out of alignment. That's rare. You may well be able to function just fine as you are. It'll be interesting to see what the MRI reveals so please do let us know.

If, unlike me, there's no other damage to the knee, so long as you keep your leg muscles strong enough to hold the knee in place you should be able to do OK. Wishing you well...Ellie

[aclsurprise82]

Thanks, Audice.  The MRI confirmed a full ACL tear with a small tear to the meniscus.  Surgeon says its up to me but suggests patella allograft considering my age (early 30s) and activity level (not a regular athlete). 

Leaning towards doing the surgery and doing the allograft, but I have to admit that it is a scary proposition considering the fact that I do not have knee pain now.  I have gone under once before for surgery, and the idea of doing it again scares the crap out of me. 

I also wonder if I should do it now considering I have two kids 2 years or younger.  I have my wife to help me, but that seems a lot for her to handle even if she has some help. 

[Audice]

Take it from one who's had no surgery....no pain now doesn't equate with no pain later. If you don't work at keeping the muscles that support your knee strong, that little mensical tear will become increasingly larger with resulting increased pain. My feelings 7 years beyond the accident that caused the damage to my knee is that life revolves around my knee. Should I do this? Should I not attempt it? Always a question before I do something that could cause more problems.

Granted I wasn't offered surgery except for the torn menisci because of my "advanced" age at the time of the accident (my horse zigged & I didn't). I was 67 at the tiime. But I was back riding a month after the injury & remain active.

Yes, there are aches & pains of an interesting variety but life can go on w/o ACLr. It's really your call on this one. I can guarantee you that your knee will not get better with time but does have the potential for getting worse unless you commit to keeping it strong...Ellie

[aclsurprise82]

It is just hard to decide to go under the knife when my life is fine now.  I would be volunteering to have to go through so much pain and take risks in order to get marginal improvement from where I am now.  I understand the logic of surgery, but months of rehab?  People are happy about being able to walk without a limp and going up stairs in the diaries.  Many of them seem to need to have surgery again in a year or two.  It is odd to do that when I have no big problems now.  I can even run just fine.  It is just occasional knee instability that I can count on one hand since the injury. 

[Kaputt_Knee]

Two things to comment on:

1. Do not judge all ACL reconstructions by what you read here. Most people have the reconstruction, do the rehab and get back to their sports without needing to come to a site like this. I know dozens (because I teach skiing) who have done this without any problems. The operation is performed many times per day around the world and there are relatively few people who have things go wrong. By coming here and learning from the excellent information contained in the Information Hub you will at least be able to make an informed decision.

2. You are already aware of the knee and you have had occasional episodes of instability. Believe me, by the time those episodes become regular enough to make you think again, you will have done a lot of other damage in the joint that may make your expectations of a straightforward recovery less likely. Not least of which is the onset of arthritis which is pretty well irreversible. If we did not need the cruciate ligaments to stabilise the knee joint, they would have been evolved out by now. That is what has happened to the appendix remember! 

If you are fit, have good condition and no other problems, why not go ahead and get it done while the expectations of having a successful reconstruction are excellent? I was back skiing 5.5 months after my last reconstruction which was a revision plus a lot of other work as well).

I was not fit going into that revision as I had been messed around by the bureaucracy of Worker's Comp/Industrial Injuries Board here in Germany. I lost nearly 3 years of work because an incompetent surgeon (but approved by the Injuries Board) butchered my knee, then the system operated 3 more times (other surgeons) trying to cover up and make good his damage. Even though I was in pretty poor shape going into the revision I was still back on my feet and working again within 6 months. I used the knowledge I had gained from here to seek out the best surgeon in my region to carry out my revision. Someone like yourself who has the chance to learn about the operation and select the best specialist available and is going into the operation in a very good condition will walk it!

[aclsurprise82]

Thanks, Kaputt.  I guess what I cannot figure out is how bad the recovery will be.    I can deal with a lot of pain and some initial issues, but the months of being limited in daily activities scares me.  With two kids and a job (desk job) with long hours, it is tough to add this to mix. 

[mollyc]

The nature of your recovery depends upon the rehab protocol your doctor prescribes. Good to check this out in advance. Typically, you'll be really, really off your feet and need a lot of help for the first couple days. If you have a rehab protocol that allows you to be weight bearing right off the bat, you'll be somewhat mobile after the first couple days, so won't need as much help with basic life necessities. (If you are non weight bearing and on crutches...something that's possible given that you have meniscus issues as well...then you'll need help a bit longer as it takes a while to figure out how to navigate the world on crutches.) Many people are back to work at desk jobs within a week or two. Whether you can drive or not depends upon what leg it is. I snapped my ACL on my right leg, so it was 6 weeks until I was driving again after surgery. I have heard of other folks driving much, much sooner when it's their left leg.

BUT, you'll need to be doing regular rehab for months. Initially, you're working on extension and flexion and rebuilding muscle strength. However, it takes a long time for the new graft to heal, especially allografts. You need to keep working on building strength, while taking care to protect the new graft for at least six months. If you're super busy, this is something to consider as you really, really need to keep that piece up to ensure success of the procedure. All this is to say that while the initial discomfort and disability tends to be short lived (relatively speaking), you need to build in time for PT and rehab for a good six months at least.

Good luck to you! Molly

[aclsurprise82]

Thanks, Molly!  That is very helpful.  How much time do I usually need to devote to PT for the first 6 months?  It is my left knee, thankfully.  Are minor tears to the meniscus usually addressed during an ACL reconstruction?  I am sure my surgeon mentioned this on the phone, but I was kind of having a hard time paying attention while I was absorbing the news. 

[mollyc]

I don't know that much about meniscus damage, as I didn't suffer it. But, I've noticed that folks on the board who have had ACLr and meniscus repair in the same surgery tend to be non-weight bearing on crutches for 4-6 weeks. This is apparently necessary for the meniscus repair to heal properly. Hopefully someone with more experience with meniscus tear + ACLr can weigh in on this.

The amount of time devoted to PT will vary a lot over time. Initially, you can't do much. I had a series of small exercises that took at 15 minutes, but I did it about 4x a day. As you heal and increase what you do, the amount of time for PT increases as well. I went a little nuts (to be honest) and was doing 1.5 - 2 hours a day, but I know of many, many other people who don't go quite as nuts as I did. Many people take these rehab classes that meet for an hour or so 2-3x a week. The bottom line, though, is you'll get out what you put into it.

You are younger than me, so you'll probably heal faster than I did. (I was 41 when I had my injury and surgery.) The fitter you are going in, the better you'll recover as well. So, putting some time prior to surgery (should you decide to go forward with it) will help shorten your recovery as well.

[Snowy]

I went a little nuts (to be honest) and was doing 1.5 - 2 hours a day

Apparently I'm a lot nuts. From about ten days after surgery to when I went back to work at 8 weeks out, I was doing about 4 hours a day - an hour of hydrotherapy, an hour on the stationary bike, and a whole bunch of repetitive closed-chain exercises that I repeated three times a day. Once I went back to work I scaled it back to an hour on the bike and an hour in the gym each day. It's true that you get out of it what you put in and I regained strength really fast, but I had a lot of trouble with swelling and flex and my PT did caution that that was a result of the amount I was doing. I think there's probably a happier medium than that for most people, but for me the focus on rehab exercises and gaining strength was an important part of staying sane. Your PT and/or surgeon will tell you exactly how much they think you should be doing, but I'm guessing 1-2 hours a day would be a reasonable compromise between doing enough to keep things moving forward, and not doing enough. My PT's advice was that a little and often is better than doing more with longer gaps in between - so a few exercises repeated several times a day would be better than an hour long class 2-3 times a week.

One thing I would say is that after I got through the initial recovery period (for me this was about three weeks, but I think typically it's a bit longer) my daily life didn't feel compromised. I couldn't do the sports that I wanted, but I was able to go to the grocery store, carry bags, walk around the neighbourhood, sit at my computer, clean most of the house, feed the cats, and so on. The months of restrictions really are about sporting activity and specific lateral movements, not day-to-day activity. I did have to be careful going down stairs and I couldn't kneel down to do things for a long time, but I would just allow a bit of extra time for stairs and sit down on the floor rather than kneeling. I also had a left ACLr, and was driving again a week out of surgery - as soon as I'd stopped taking the heavy duty painkillers.

I would also like to second Kaputt_knee's comment about most of the stories here being of unlucky complications rather than normal recoveries. I had my ACL reconstruction in July 2010, had a very straightforward recovery, and was back to gentle skiing in February 2011. By summer 2011 I was hiking up mountains and riding bike marathons, and this winter I was able to go back to skiing with no restrictions and without a brace. I had no instability at all following my ACL rupture, but chose to have the surgery because I wanted to be able to go back to high level skiing and I also knew that even though my knee felt okay, over time the lack of lateral support would lead to degenerative wear and tear that would be much less easily fixable than a torn ligament. That doesn't mean reconstruction is the right choice for everyone, but for me the eight months of rehab were a worthwhile price to pay to know that my knee would be strong and stable enough to support my participation in all the activities that I love. It's also worth keeping in mind that there's work involved in keeping your muscles strong enough to support an ACL-deficient knee, so even if your knee is relatively stable without surgery it's likely that you'll have to give it more time and attention than you did before the injury.

Best of luck making your choice. It's not an easy one - surgery and recovery are both daunting prospects, even when all goes well.

[kneetruth]

I will add this.
Everyones advice here is subjective to their experience...or relayed experience of others. Ive had ACL reconstruction and meniscal repair. 3 years later my knee is still screwed. Yes, i can get about and do things day to day. Can i ski? No. Can i run...yes, but the next day my knee is knackered.

Lets all be honest and clea here. You have screwed your knee. No amount of surgery is going to give you back a perfect knee like you had before. If you have some suregery it MIGHT make it better. But i wont make it lik eit was before. Weigh up what you want versus the risk. The outcome if you have surgery is as follows...if your lucky youll regain a decent knee to do some sports. But you wont EVER have the dependable knee you had before.
Anyone who wants to challenge this opinion get back to me with proof of a 100% recovery.

[Snowy]

Yes, the advice that's being provided here is subjective and based on the individual experience of the posters. However, so is your response.

The surgical success rate for ACL reconstruction is generally reported to be between 85% and 90%. You can check PubMed for a wide variety of different reports on this; there are also a number of web sources such as this interview: http://www.hss.edu/conditions_knee-arthroscopy-acl-meniscal-other-problems.asp. This statistic was, for me at least, an important consideration when I chose to have surgery.

The outcome if you have surgery is as follows...if your lucky youll regain a decent knee to do some sports. But you wont EVER have the dependable knee you had before.

Based on my experience (I will let other posters speak for themselves), I have to disagree with this statement. My reconstructed knee is completely dependable. I can do everything that I did before surgery with confidence, and in fact have upped the ante on some sports that are not known for being knee friendly (for example, this season I started backcountry skiing which is a lot less predictable and more demanding than skiing in-bounds in a resort.) Does my knee feel the same as before? Not exactly. Does it feel weaker, less reliable, less capable? Not at all. Does this mean another poster will have the same outcome I did? No. Does it mean that ACLr is the right choice for the OP of this thread? Not necessarily - that's a personal decision which only they can make once they've had time to research the facts and weigh up the pros and cons of their own situation.

What it does mean is that it's perfectly possible to have an ACL reconstruction, work very hard and diligently at recovery, and have a good outcome that makes the surgery seem worthwhile. That was my experience and it's just as valid as your experience, which was unfortunately a poor outcome and compromised knee. I'm really sorry this happened to you and I can completely sympathize with your frustration that you didn't have a better result, but to claim that it will be the same for everyone is simply not true.

[Kaputt_Knee]

What a totally negative and subjective post Kneetruth. For a first post, you have missed the mark in terms of giving support, but certainly made an impression as a "look at me my knee is a disaster" moaner.

I'm sorry you have had a bad outcome, but if your post is indicative of your attitude, then to be honest I'm not surprised the result was not to your satisfaction.

I echo 100% what Snowy says. It is up to you as the injured person to work at overcoming your problem with the help of the surgeon and the physios working with you on your rehab. Yes, surgeons can make mistakes, it happened to me with both knees. If you are unhappy with your results then like me, you fight for answers as to why things are not right. You do not just accept them no matter what the situation is.

I think there are many hundreds of professional sportsman and women who can easily disprove your arguments and many thousands of happy amateurs as well.

[aclsurprise82]

Thank you everyone for your responses.  I am now leaning towards doing surgery and doing a hamstring graft instead of an allograft because (i) I don't think that I can get over the ickiness and fear associated with where the allograft is coming and (ii) I want to have a high percentage fix and not have to go through this all again.  What stops me from being 100% on this choice is the concern about messing up my hamstring and the more difficult recovery.  I still have not closed the door to an allograft and will discuss the issue further with my OS.  I definitely do not want to sign up for a high chance of knee pain with the patella graft when I have no pain now. 

My biggest concern now is timing.  Probably the earliest I can do this is late August, but with some commitments coming up with work, I would probably really want/need to come back to my demanding (as far as time is concerned) desk job by mid-September.  I am therefore looking at most three weeks off of work before going pretty much full-throtle at work.  That seems perhaps too optimistic. 

My next realistic option is to wait until spring.  I figure that I do not want to be on crutches/rehabbing in winter with the ice and snow I get where I live.  The disadvantage to that is that the surgery will probably cost more because of where my deductible will be at next year and I will probably will be obsessing about the surgery for much longer.  I also could do further damage to my miniscus conceivably.  The advantage would be that I think I would have more time to rehab without pressures from work and I could spend the intervening time strengthening my legs and losing a few extra pounds.

Any thoughts on the better approach? 

[PiotrS]

With regards to timing, I had similar thoughts last year at least regarding weather conditions, as ice and snow are also a problem where I live. In the end I had surgery in late September, and luckily it was a pretty mild winter, although by three months out, I think I could have handled wintery conditions.

Two things to bear in mind is that you want to have enough time to get your muscles in the best possible shape to speed up recovery and also learn how to do the exercises pre-op, and secondly is that you don't want to be going through early recovery when it is hot outside, as your swollen knee probably won't appreciate it!

But the last issue is a minor one, I think the main thing is to give yourself time to prepare before hand and also make a window of time after surgery to be able to really give rehab your full energy. I was back at work after 4 weeks, although to be honest I was working from home half time (from the sofa) one week post surgery with little trouble.

 

[Snowy]

Your OS will be able to guide you on the best graft choice, but I've personally been happy with the hamstring graft. It's true that the graft site is really sore early in recovery, and it does take some work to regain hamstring strength, but in the long-term it hasn't caused me any problems. My hamstring is slightly more prone to strains on that side if I exercise without warming up properly, but that's just a good reminder to do my stretches.

If you're committed to having the surgery, I'd probably go ahead and get it over with sooner rather than later. You mentioned that you had some instability in the knee, and the more buckling incidents you have the greater the risk of doing additional damage to the joint. Summer vs. winter is tricky - I had my surgery in July and sweated through a major heatwave during early recovery, but it was definitely easier than dealing with ice and snow would have been. Then again, if you had the surgery in August you should be back on your feet and pretty stable before winter sets in.

Good luck! I hope the conversation with your surgeon goes well.

[aclsurprise82]

Thanks again for the responses.  I'm waiting to see my OS again.  I have a couple of further questions.

Is it worthwhile to get a second opinion or with the Lachmann's and the MRI is it pretty definitive?

How did you deal with the obsession and regret?  I cannot help running through my mind again and again the injury (and perhaps the secondary injuries) when they happened.  I cannot help thinking about how I could have avoided all of this.  I also cannot help runing thorugh the pros and cons in my head about graft choice, surgeon, timing, etc.  It is starting to take a big toll on the rest of my life, which again sometimes seems wrong because the injury is hardly limiting me right now. 

[Snowy]

Unfortunately there's no such thing as 100% certainty when it comes to an ACL tear; there have been cases here where tears haven't shown up on the MRI but have been discovered once the surgeon went into the knee, and a couple of more unusual cases where the ACL showed as ruptured on the MRI but turned out to be intact. The MRI, Lachman's and classic symptoms of ligament instability are pretty definitive, and getting a second opinion won't hurt if you feel it would reassure you, but you're not going to have absolute certainty until the OS takes a look in your knee.

As for regret, that's a tough one. At the time of my injury, once it had been confirmed as a full ACL tear, I spent a week or two beating myself up pretty hard before reaching a point where I was able to write "There’s no point wasting time or energy wishing this hadn’t happened; it has, and now the only thing to do is get on with it." From then on, I tried really hard to channel all the frustration into prehab - getting my knee as strong as possible before the surgery - and eventually, rehab. I still had bad days, but I set myself some solid short- and long-term goals and tried to keep those in mind when I was struggling. I did find that accepting the reality was easier after I talked to my OS, found out details like the graft type, and signed the papers for the surgery; having that clarity definitely helped me accept that it was all real and there was no going back.

It's hard to make the "what-ifs" go away, but ultimately the road has already forked and there's no way to go back and undo what's done; the best thing you can do is focus on the journey ahead.   

[Lizn8r]

In response to Kneetruth's post in this thread: I haven't posted (or really even checked in) on Kneegeeks in a really long time, but I'm glad I did today.  My ACLr and meniscus repair was years ago now and I can tell you that my knee ... and therefore my life ... is much better than it was before I had the surgery.  I'm completely back to doing things that I couldn't do in the years before my surgery. As a matter of fact, I don't even think about my knee when I strap on my skis, hit the raquetball court, or buckle on my rollerblades, and my knee gives me no trouble before, during or after any activity whatsoever.  I consider myself as close to one hundred percent recovered as a 50 year old woman can get!  

aclsurprise82, in my opinion its almost always advisable to seek a second opinion for any medical diagnosis.  In fact, my OS requested that I go see a second and third OS before I committed to surgery with him. Seeing those 2 other doctors put my mind at ease that having the surgery was the right way to go, and it also provided me with alternative graft choices because my primary OS preferred allografts.

As far as the obsession and regret, there is something about knee injuries that are directly linked somehow to the emotional centers in the brain.  Ha ha, I now that statement is not true, but it sure as heck seems that way at times.  Before I knew what was wrong with my knee, I obsessed about it all the time ... "can I do this activity or will my knee let me down" ... "how in the world did this get to be such a problem?"  Then, as you are going through now, I obsessed about making the right choices in surgeon, graft, and recovery.  I lived for websites such as this  one where I could pore over all the information and estimate how my recovery would go based on inputs from other sufferers.  And then during my recovery, I obsessed about every new little pain, bump or bruise that showed up as I worked my knee back to health. Again, I found myself immersed in these forums trying to find out if anyone had the same symptoms as I had at that point in their rehab. I can remember after one particularly rough rehab session, I lay on the couch bawling my eyes out deep in the throes of the world's biggest pity party for myself.  "this is too much!  Why oh why did I make this decision to do this?" My partner thought I had completely gone off the deep end! Needless to say, something happened: I eventually snapped out of it and continued on to recovery without any serious complications.  Chances are you will too

The only 100% true statement that Kneetruth made in his post was that everyone's advice (including mine) is subjective. No two knee injuries, surgeries, rehabs or recoveries are exactly alike, and the road to full recovery really lies with your commitment to that recovery. Sure, things can happen ... this forum is testament to that ... but odds are in your favor that everything will go well.  And sooner or later you may get to that point where I am; never doubting the strength or stability of your once-injured knee!

Snowy's got some good advice in her post ... channel all your 'regret' into pre-hab conditioning. You cant undo the past, but you can enable your future!

[aclsurprise82]

So I found out that the meniscus may or may not need to be repaired.  The tear appears small, but maybe a little on the surface.  The OS says it may be fine to leave as is, he may need to repair it or he may not be able to repair and may need to excise a portion of it. He will probe at it to see.  How much do they usually take off?  Is the decision making on this pretty straightforward for an OS?  Should I try to restrain him?

[aclsurprise82]

Update:

I went ahead with a second opinion.  The second doctor ran a battery of tests (more so than the first doctor), but he had no doubt about the original diagnosis.  Part of me thought that maybe I wasted his and my time, but on the other hand I think maybe this will help me move on.  I think I know now that I need to have this surgery done.  The second opinion doc certainly laid out the idea of trying to cope with it (more so than the second doc), but after having knee pain and swelling last night when I came down on my leg hard while getting out of the car awkwardly, I think I cannot let this linger too much long.

A large part of me wants just to get this over with.  I might have a window at the end of this month to do this, but my wife is very against that.  We have two young children who are 3 months and 2 years old and she does not think she can take care of a recooperating husband at the same time as she is taking care of the other kids without my help.  Relatives are less available this year, but will be more available next year.  We also have a wedding in which she is in the party that we have to travel to with the kids in early October.  That trip will be six hours both ways not including stops.  Finally, we will be low-staffed at work starting in September due to a maternity leave, so I will be having a difficult time keeping my head above water anyway.  It is pretty certain that I can commit to rehab better if I wait until next year to do the surgery. 

Waiting until probably March next year (want to avoid the winter where I am as much as possible) makes me sad in many ways.  I want to put this in my rear view mirror and move on with my life.  I am also worried about doing more damage to my knee after last night even though I have not had my knee give out since dancing in January. 

People have been so helpful on this board for which I am forever grateful.  I guess I am looking for a little bit more advice here.

(1) Am I making a mistake by waiting given my situation?

(2) For those who did wait awhile to do the surgery, any advice on how not to let your knee consume your life? 

My wife had a long talk with me last night about how my knee is affecting me too much right now and how it is hard to enjoy things together.  This whole ordeal has caused my opinion of myself to take a big hit.  I thought I was pretty resilient up until now and was a rock that my family could depend upon.  I know in the scheme of things, people are dealing with far worse things than this, so I am realizing that I am overreacting I think.  I have to find a way to deal with this better. 

In any event, thanks again for everyone’s advice.  When this surgery finally happens, I hope I can provide a helpful post-op diary for those who come after me. 

[Snowy]

The single most important thing you can do when it comes to ACL surgery is to commit yourself 100% to following the rehab process to the letter. It is quite time-consuming, especially early on, so if waiting until next year means that you will have more time to devote to the rehab process then waiting isn't a mistake. You will also need your wife's support, especially in the immediate aftermath of surgery, so it's important to make a decision that works for you both. I know waiting isn't ideal because you will have to live with an ACL deficient knee that has shown signs of instability until then, but there are things you can do to mitigate the risks of further damage during this time. I would recommend getting an ACL-specific brace for sports and dancing (I had an Ossur Paradigm, which was excellent - lightweight, comfortable and strong; I've also heard good things about Townsend braces) and get a good physiotherapist to give you a "prehab" exercise program to get your knee as strong as possible. Not only will building muscle around the joint give it more support, it will give you an advantage going into surgery and rehab.

Now you've made the decision to wait, try to focus your energy on that prehab exercise program rather than second-guessing your choice or worrying about possible negative consequences. The waiting period is your chance to get your leg in the best possible shape before surgery: try to view it in that light rather than fretting about the possibility of damage that may not occur. Set aside a time each day to do your exercises, even if it's only 30 minutes. Psychologically this gives you something positive to do for the knee each day, and as your leg strengthens the measurable results of moving heavier weights and feeling exercise get easier will give you a boost. Even the smallest improvement means you're better prepared for the surgery and rehab to come. Try to make that exercise time the time when you focus on your knee, and not let it dominate your thoughts outside of that. If you catch yourself worrying, you could even make yourself do a quick set of dips or other exercises that you can do on the spot - channel the concern into a positive action.

I think it's also important to remember that your reaction is completely normal. You've suffered an injury that has changed your life. Of course there are much worse injuries that can happen, but that doesn't diminish the significance of what you're going through. (After I tore my ACL, I remember describing myself as a knee injury with a shell of person around it.) The good news is that it's an injury that can be addressed with surgery and that the surgery has an excellent success rate; and there's lots you can do between now and then to give yourself the best possible chance of a good recovery.

[bansidhe]

Hi,

  I am also preparing mentally for ACLr surgery.  After reading your post I am kind of surprised by your wife's response to this.
You see, I am a single mom with two dogs.  Fortunately, I have people to take my dogs for a few weeks until I can walk them myself.
But I will essentiailly be on my own.  Truth is, I seriously, do not think I will need that much attention.  True I will need some help, if I need to go to the doctor I'll need someone to drive. 

So, I think that perhaps your wife is worrying a bit too much about that.  Heck for the most part the first few days you'll be on the couch..
Personally, I plan to have a cooler beside me for ice and perhaps some snacks.. I'll have my crutches, some books, my iPhone, a laptop..
all within arms reach.  I'll be sure to have something to give myself a quick 'cat-bath' until I am confident enough to shower. It won't be ideal but heck tearing my ACL sure isn't ideal either.  That's is my plan anyway.  My plan is to require minimal assistance from anyone.

Since it's just me the weekend before, I'll be making extra meals that my son can eat.  I'll have all the laundry done, my house all tidied up..  things like that.  All to create and easier, less stressful environment for recovery.

Do you have a plan?

I can completely understand wanting to move on.  I surely do.  Truth is there is no PERFECT time for ACLr.  The recovery is just too long for that. Let's say you wait until March.  Who's to say that something won't come up to make it difficult to find the time to devote to recovery?  Or worse yet, let's say in that time your knee goes out and your slight meniscal tear becomes worse?  That's the real drawback here.  The longer you wait the more likely you'll do further damage. 

As Snowy said, if you are going to wait get a brace.  I am wearing a brace all the time now until surgery just so I don't do any additional damage.  And do prefab.. that is work on strengthening your legs.  Your VMO, calves, hamstring, adductors, abductors.. pretty much everything.  WOrk on balance too.  Oh and your core.  These things keep you "together" and help keep your knee stable.

Good Luck!

[aclsurprise82]

Bansidhe, I think your statement of the risks are valid.  I cannot put this off forever and there is never going to be a perfect time to do this.  That being said, all I hear is how important rehab is to success.  Working 12-13 hr+ days upon my return from a quick time off from work due to us being short staffed if I do it this month (assuming I can even do so at this point) is going to make it very hard for make this to work.

My instability episodes have actually became less frequent since this happened.  Part of it is because I have been more careful and part of it is because I have become more fit over the past couple of years.  I am 30 lbs lighter than when this started and my muscles in my leg and elsewhere are stronger.  I had a bit of a scare last week that may have aggravated things without an instability episode, but I cannot turn back the clock on that.  My wife and I have talked further, however, and we will push this forward if it seems like I have any further issues.  We are also more likely to just get this done in the winter instead of waiting until March. 

[Rothera]

It's really not as bad as you're making out. These days recovery from ACLr is quick and easy. Minimal surgery techniques (check out if you're having all inside). Your job is to stick to rehab but my own experience has been fine...in both knees! As for your wife....she's lucky to have someone who is so concerned. I recovered well enough from my surgery on my own while my husband was in Afghanistan....with two children! I was driving 1 week pst op and back at work after 2.
Only you can decide what to do but you're also in charge of your rehab destiny. All in the mind!

[aclsurprise82]

I think I have now decided on my surgery type (hamstring) and my surgeon.  The problem I have now is that I am worried that my situation has become worse in the interim. 

As I mentioned, I got out of my car a little awkwardly/hard almost two weeks ago.  Since then I have felt soreness, tightness and heat in the front and medial side of my knee.  Sometimes just weird tingly feelings and numbness.  It is a minor annoyance, but I must say that it makes it harder to focus on things other than my knee.  It seems to be gradually getting better, but I wonder whether it is just a little disturbance, just an aggravation of the meniscal tear or the meniscal tear is getting worse and worse. 

I am not asking anyone to give me a diagnosis, but if you ran into this before, it would be helpful to know.  I am trying to move up the surgery, but it is probably still a couple of months away at the earliest. 

[Kaputt_Knee]

Since then I have felt soreness, tightness and heat in the front and medial side of my knee.  Sometimes just weird tingly feelings and numbness.  It is a minor annoyance, but I must say that it makes it harder to focus on things other than my knee.  It seems to be gradually getting better, but I wonder whether it is just a little disturbance, just an aggravation of the meniscal tear or the meniscal tear is getting worse and worse. 

That is what I meant about being aware of your knee now! 

You will experience minor irritations and you will get into the habit of doing day to day things that avoid these as much as possible but you cannot eliminate them completely. Use the time you have before your surgery to get into the best shape you can by cycling walking and swimming. People who go into the surgery in good shape have really good outcomes as a rule.

When you have these little incidents, there is not much you can do apart from RICE. Try not to favour the good leg too much either, just be careful with the bad one. Limping badly to protect the bad knee will cause you to have an imbalance in your whole core and could lead to back and hip pain as well.

TBH, I really do think you are over-analysing everything now. Just get on with your life and getting as fit as possible before surgery. You've made all your decisions, the die is almost set, so go with the flow!


 

[aclsurprise82]

Change in plans.  I am doing the surgery in October. 

Hamstring graft remains the choice (four strand).  I am told by the surgeon that he favors a titantium cortical button on the femur and the new "GraftBolt" for the tibia fixation.  If he is not happy with the tension during surgery he may add some additional fixation on the tibia.  If anyone has any thoughts about this method please let me know.