Surprised by ACL Tear

[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.