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Author Topic: ACL surgery: Long-term side effects  (Read 1825 times)

Offline Don_Atlet

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ACL surgery: Long-term side effects
« on: October 15, 2016, 02:20:45 PM »
Background: Age - mid-twenties, ACL torn (MRI + positive examination by two surgeons), no knee pain, no instability in day-to-day activities, established range of motion and currently strengthening muscles, 5th week after incident, remaining IT band pain

Reaching out to all of those who had a successful ACL reconstruction and ensuing physiotherapy in the past...

...I am pondering whether to have ACL surgery or not, and was curious to hear about your experience in terms of:

- Did the surgery cause any pain in the injured leg that was not there before, i.e. was it a "stability for pain" trade?
- Were you able to fully establish range of motion in your injured knee?
- Did the surgery allay (psychological) concerns around instability in your knee, i.e. do you use your knee now as much as the non-injured knee?

Any personal experience would be much appreciated.

Kind regards from Germany

Offline tinydinosaur

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Re: ACL surgery: Long-term side effects
« Reply #1 on: October 18, 2016, 09:30:53 PM »
Hey there,

I haven't myself had ACL repair (had MPFLr) but thought some general info might be helpful to you since no one else has responded yet.

 Did the surgery cause any pain in the injured leg that was not there before, i.e. was it a "stability for pain" trade?
The surgery itself will cause pain, and it will be painful while it heals, 10% of people (I believe is the statistic) will develop chronic pain or the pain will not resolve over time. And that is just in general, from injury or from surgical pain. There is no reason to expect pain beyond the healing phase and I think they usually estimate 6 months to a year for full recovery from a surgery such as this (full return to sport).

- Were you able to fully establish range of motion in your injured knee?
Barring any surgical complications there is no reason why you wouldn't regain full range of motion. Depending on your surgeon/surgery you might be allowed to fully bear weight and bend your leg as tolerable after surgery. It really depends on the specific surgeon's post-op protocol. (For example I had MPFLr and was non-weight bearing for two weeks but others have posted that they were allowed to weight bear right away, but not bend) I've had several roommates post-op who had ACLs done and they were allowed to weight bear, one couldn't tolerate it because of pain.

The only other complication I can think of is if you have the condition where you produce an excess of scar tissue. Which if your knee scars down, you can get a MUA (manipulation under anesthetic, which I hear is not so fun). When your incisions have healed past the scabby phase it's important to friction them daily to break up the scar tissue there.

- Did the surgery allay (psychological) concerns around instability in your knee, i.e. do you use your knee now as much as the non-injured knee?

If you experience instability because of the ACL tear then yes that should resolve with this surgery, however psychologically if you don't trust your knee or that the ligament has been fully repaired and fully healed then it will not. My MPFLr resolved my constant worry of dislocation (because my kneecap was extremely lax), I however don't fully trust my leg because I am still lacking strength to recover from a fall or if my knee gives way, as it was prone to doing before my many repairs.

With an ACL repair there is always the possibility of re-tearing it, it depends on how active you are, what sports you like to play (is there a lot of wear and tear on the knee) and how well you strengthen all the surrounding muscles supporting the knee pre and post-op. This is why a good physiotherapist/athletic therapist and a good exercise program are important following a major injury or following surgery. I know it's not helpful to say, but psychological concerns really come down to the person.

Some questions you may want to chew over are:

What are the pros and cons of surgery? Does it currently affect your day to day life? Do you want to return to sport and are unable to because of the injury? Would a brace allow you to do so? What are the recommendations of your surgeons? Do they think not having a repair will affect you in the long term, etc.

In the end it comes down to your decision on the pros and cons of surgery and how much your injury is affecting or negatively impacting your life (or if you really passionately want to return to a sport).

Hope this helps some and hope someone who has had ACLr in the past will respond with their thoughts.

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #2 on: October 19, 2016, 08:38:54 PM »
Hello tinydinosaur,

Thank you for taking your time for such an elaborate response. I appreciate this a lot.

My knee does not affect me in my day-to-day life, i.e. there is no pain except for the IT band right in that knee area, and I have the same power in both knees. Instability, at least in my day-to-day life, is not an issue.

However, my surgeons strongly recommended me to have surgery if I wanted to be active in contact sports again (e.g. football). Swimming, cycling, and light running would be fine, too. The one argument I often hear in favour of surgery regardless of my condition is "you are still young" which I intrepret as a proxy for how likely it is that I will want to play football, or any other sport that requires a functioning ACL, in the future.

On the other hand, I think you are right when it comes to the likelihood of tearing an ACL (on either knee) again, that would always be a possibility. Therefore, I would also want to consider any detrimental long-term effects to the affected knee without opting for surgery, even if I avoided contact sports and built up the muscles.

I have read some posts suggesting that a knee with a torn ACL without surgery is more likely to suffer from arthritis, while I have seen posts that suggest that arthritis happened because of surgery. What is right? Is the chance of arthritis not first and foremost dependent on the wear and tear on the knee from the activities that one undertakes?

Maybe other ACL patients, or those who opted against surgery and live with an ACL tear, could share their rationale for deciding for or against surgery.

Offline Hill Girl

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Re: ACL surgery: Long-term side effects
« Reply #3 on: October 19, 2016, 11:06:15 PM »
Hi Don

Don't know if this helps but here's my story. Currently awaiting late-stage ACLR, ten years after original injury. The reason for having surgery now is that I ended up with c75% of my medial meniscus removed earlier this year as a result of which I have been left with a less stable and sore knee. After a year or so of hard rehab following my original injury I had no obvious instability (and never any pain) until the meniscus tore this year in the most benign of situations.

I now understand belatedly there was a high risk of this, especially given my high level of activity in rough terrain since. I am worried about the outlook for it much more now and guess I wish I could turn the clock back - hindsight is a wonderful thing!

I was 38 at the time of the original injury and was initially discouraged from surgery on the basis that I would likely "find myself slowing down" - then achieved great results from hard rehab and when it was next discussed got nervous that I might end up worse off with surgery .... tough call for people who don't have much/obvious instability.

Looking ahead to my surgery I have the same worries as you ... whether I'll end up with more pain, loss of flexbility and I also wonder how well I will be able to trust it after years of what has become presumably sub-conscious adaptation/avoidance of riskier moves. I do wonder sometimes if I am shutting the stable door after the horse has bolted (for those that understand that expression!).

Re arthritis in repaired/non-repaired knees - there is a lot of stuff on the web about how the original mechanism of injury may be the thing that starts the process of arthritic change, especially if you had a traumatic tear with bone bruise etc.  There is also discussion about whether the surgery itself can accelerate this as it's another "trauma" to the knee. But I also understand that a key thing is to try and preserve your mensicus/menisci at all costs as they are there for a reason! Without an ACL it does seem that the risks of the menisci degenerating/tearing and needing surgery increase as time goes by.

The only other thing would be to say that I am not sure how much stability I would be able to maintain into much older age via the non-surgical route. I plan on remaining fit and active but I am not sure I would manage to keep the same muscle tone later in life.

Good luck with your decision!
Mar 2006 ACL rupture skiing.  Bone bruise.  No ACLR - lots of rehab got me back to the hills.

Feb 2016 Medial meniscus bucket handle tear left knee, c75% removed.

ACLR (hamstring autograph) 03/17

Patellofemoral/trochlear wear in the other knee

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #4 on: October 20, 2016, 09:56:32 PM »
Hi Hill Girl,

This is exactly what I was looking for, very helpful. I am sorry to hear that you will have to deal with this after 10 years of what sounds like no issues with your knee. If my knee was instable and sore, I would have probably gone down your route straight away.

The risk of tearing a meniscus is there, but did your accident happen when hiking or cross country running, since you mentioned rough terrain? Is it the non-functioning ACL that definitely led to the meniscus tear, as your knee was stable up until the incident?

Being in my mid-twenties, it is obviously difficult to think what might happen 10 years down the road.  Next week I will try to run again, going into week 7 after my injury. 30 minutes, 50-60% intensity. Let's see how that will feel, especially in terms of stability and pain, I will keep everyone posted!

Fingers crossed for your injury and thank you again, Hill Girl.

Offline Hill Girl

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Re: ACL surgery: Long-term side effects
« Reply #5 on: October 21, 2016, 07:32:29 AM »
Thanks Don_Atlet

Glad it helps but remember that this is just my amateur opinion and personal experience!

My meniscus went when I was out rambling rather than my usual hill running/walking and it just went when I put my foot down from a step - I was even using walking poles!  (My legs weren't as strong at that time as they had been, owing to problems in my other knee - moral of the story, keep those knees strong whatever!).

From what I understand age is a big factor in that the meniscus degenerates over time.  I know people without ACL problems who have torn their meniscus but who haven't been so active, eg I know of someone who did it kneeling to change a DVD).  Chronic ACL deficiency also seems to play its part due to additional stress, as well as the risk of a more traumatic incident from the knee giving way badly.  (I did not appear to have any meniscal damage at the time of my ACL rupture by the way).

After this year's tear I did a lot of reading and recall seeing something like that at 10 years' from rupture 90% of unrepaired knees will have a meniscal tear (some of these might be from the original ACL injury of course).  Not sure if I've remembered that accurately and also not all meniscal tears will be so serious/need surgery. 

My knee was stable up to this year though perhaps not as stable as I thought and I had not done any pivot sports during this time.  Although I did a lot of stuff in the mountains etc I was cautious about things like joining in kids' football games and occasionally was reminded of my weakness when enthusiasm got the better of me!  If I found myself eg on a tennis court I only played carefully so I was avoiding certain activities/knew my limitations but was happy just as long as I could keep going to the mountains!

You are doing well if contemplating running at seven weeks post injury - although I got back to the mountains at three months post ACL tear I wasn't really ready, had minor instability for some time afterwards and full recovery and end of pain took at least a year, with running coming later.  Just make sure both your muscle strength and proprioception is adequate before you start again and build up gently (not sure what sort of running you do/level you are at) - I'm sure you know this :)

PS This thread should really now live in the ACL forum if it can be moved there?
Mar 2006 ACL rupture skiing.  Bone bruise.  No ACLR - lots of rehab got me back to the hills.

Feb 2016 Medial meniscus bucket handle tear left knee, c75% removed.

ACLR (hamstring autograph) 03/17

Patellofemoral/trochlear wear in the other knee

Offline Audice

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Re: ACL surgery: Long-term side effects
« Reply #6 on: October 22, 2016, 12:38:15 PM »
I'll be glad to share my experience with you for whatever it may be worth. I ruptured my ACl & did other damage when I had what us horse people call an "unplanned dismount" from my horse. This all happened 11 years ago when I was 67 years old & my orthopod opined that people my age simply don't have ACLr because apparently us old folk don't move around enough to warrant the surgery. (I hope that attitude has since changed.)

At any rate I created my own form of rehab & was back to riding my horse a month post injury. When I saw the orthopod for a follow up appointment, he deemed my leg muscles strong enough that physical therapy was not needed. His words..."Continue doing whatever it is you're doing." And that was riding my horse.

I did wear a custom brace that first year or a neoprene brace from time to time & before long I was wearing no brace & was fine. I was told I had very little arthritis in my knee even at age 67.

Until I was 75, I not only rode regularly but worked at the farm doing stall cleaning etc. Nothing bothered my knee. Now at age 78 I walk with a cane...not because the knee with no ACL is bothersome but because back issues have made my other leg too painful to walk w/o the support of a cane.

Bottom line...after 11 years with no surgical repair, my right knee continues to do well & at this point actually supports the majority of the body weight I'd ordinarily share with my painful left leg. I'm not at all sorry I never insisted on surgical repair. That being said, if you're going to participate in contact sports or those sports involving lots of quick motion with sudden turns, I'd have to wonder if that unrepaired knee would hold up.

If it's of any comfort, I have a friend who with a ruptured ACL played basketball successfully for several years. To this day that knee remains unrepaired although when he ruptured the ACL in his other knee he did have it reconstructed.

Wishing you well.
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #7 on: October 26, 2016, 07:12:30 PM »
Hello Audice,

Your experience is very helpful indeed. My surgeon told me that the ACL was definitely needed for contact sports...though I will have to weigh up the benefit of playing football against risking the almost full range of motion (137 degrees when bending, basically horizontal when stretching) of my painless knee (it does click from time to time if I fully stretch it). Also, the tendon that would be taken would probably leave the patella or hamstring, depending on where it is taken, weaker than before, or with a little bit of pain even. This is what I need to consider.

Today I ran for the first time since the injury that happended six weeks, about 3.5km in 20 minutes - I must say it did feel different around my injured knee but there was no pain.

Do you know how old your friend was when he first hurt his knee and why he followed through with surgery on the other knee? I mean an important aspect would be the long-term implications for me, even if I quit contact sports.

In any case, thanks a lot for your post, it is much appreciated.

Kind regards


Offline Audice

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Re: ACL surgery: Long-term side effects
« Reply #8 on: October 27, 2016, 12:27:35 PM »
"Do you know how old your friend was when he first hurt his knee and why he followed through with surgery on the other knee? I mean an important aspect would be the long-term implications for me, even if I quit contact sports."

To be honest I don't know what possessed him to leave one knee as is & to reconstruct the other. I'm guessing that it could have been the extent of damages along with the ruptured ACL that had him undergoing surgery. In the years I was friendly with him I never knew him to limp or complain so was surprised when he told me about his knees.

That being said, I would estimate he was in his 30s at the time I met him & he'd already had the second knee repaired. He was a veterinarian by trade so spent a good deal of time on his feet.

Wish I could be more specific but I can't. Wishing you well.
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #9 on: November 15, 2016, 08:11:50 PM »
Quick update (9 weeks post the injury): No pain, no instability, though one surgeon still deems surgical repair necessary, also with regards to longer-term arthritis risk. Will have my knee checked out again this week to see if there is any change. I must admit I underestimated the time it takes for the knee to get back to close to what it was before (if one can say that with a torn ACL), seems like the trauma had indeed a big impact.

Offline minka

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Re: ACL surgery: Long-term side effects
« Reply #10 on: November 19, 2016, 09:15:29 AM »
my freind at age 30 did his acl in playing football
average build bloke they didnt want to do the surgery but he whent private then got it done on nhs
8 WEEKS AND HE WAS RUNNING ON IT AGAIN So dont put it off but it depends how well you cope i suppose.

Offline Niza

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Re: ACL surgery: Long-term side effects
« Reply #11 on: November 20, 2016, 09:46:37 AM »
Hi there,

I had my acl injury a year ago. MRI showed complete rupture of acl but all other structures in my knee perfect with no damage. I was really undecided about whether to get surgery because instability hasn't been any real issue and I don't play contact Sports.  I'm mostly into hiking and some cycling which cause my knee some pain but not too much.

I eventually decided to have the surgery, mostly due to psychological thought that I don't want to have limitations to future activies.

I had the surgery nearly three weeks ago and the surgeon found found there was damage to the meniscus which was repaired with staples/anchors. Clearly the lack of acl significantly contributed to the meniscus tearing within 12 months. Even without hardcore/contact activity.

I hope you find my perspective helpful.

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #12 on: November 23, 2016, 09:08:38 PM »
Much appreciated, Minka and Niza.

Minka: I agree it should depend on how much instability one feels in the knee. I just became curious: When did your friend have surgery (patella or hamstring tendon)? How has he been coping medium-to longer-term, is he still active in sports as much as he used to before the injury? The reason I am asking is that short-term, and with a surgery that went well (as it seems to be in your friend's case), the post-surgery plan is to be bearing weight after 6-8 weeks. Seems like all went fine!

Niza: Very useful, thank you. How did you injure your knee, if I may ask? Did you experience a lot of pain and a was a bone bruise also diagnosed in the MRI? But the meniscal tear was initially not diagnosed via MRI, I presume? I am surprised to hear that there was a meniscal tear with apparently no other trauma/injury event between your initial ACL injury and the moment the surgeon did spot a tear. I was told it would take another major event to cause further damage to other parts of the knee, like ligaments or the menisci. Really valuable insight in terms of the approaches "wait and see" versus opting for surgery. I hope your leg is feeling much better now compared to three weeks ago!

Today I spoke to another orthopaedic at a rehab centre who brought the following paper to my attention: http://bjsm.bmj.com/content/49/10/700.abstract. A study at Lund university that compared and followed up after five years on 120 ACL patients who were treated a) early via ACL reconstruction after 10 weeks or b) first with rehab and then with surgery after up to five years or c) only with rehab. Findings: No change in arthritis between the subgroups (the bad news: irrespective of surgery, the ACL tear makes arthritis more likely, it seems). However, those with a patella tendon graft developed arthritis in the patella area more often.

I will now be starting intensive rehab with 2-hour sessions every weekday, I will keep everyone posted about the progress and events.

Thanks again, Minka and Niza!

Offline BJanson

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Re: ACL surgery: Long-term side effects
« Reply #13 on: December 14, 2016, 09:45:03 PM »
I tore my ACL three years ago.  Returned to soccer/ running in 9 months with no fear of re-injury or concerns about stability.  I have another issue now, but the ACL reconstruction was a success IMO.  If your ACL is torn, you need surgery - there's no rehabbing a torn ACL (even partial tear).  Not if you want to participate in activities that require a stable ACL. 

Are day to day activities all you're interested in?  Then maybe just try the rehab.  Otherwise, get a good surgeon, get a good physical therapist, and do your therapy!! 

- Did the surgery cause any pain in the injured leg that was not there before, i.e. was it a "stability for pain" trade?  No

- Were you able to fully establish range of motion in your injured knee?  Yes

- Did the surgery allay (psychological) concerns around instability in your knee, i.e. do you use your knee now as much as the non-injured knee?  Without the surgery my knee was unstable.  I could walk fine and do day to day things without pain or instability, but running/ soccer was out of the question.  My ACL is rock solid now.  I had no fear of re-injury when I returned to activity.

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #14 on: December 17, 2016, 08:38:46 AM »
Thanks a lot for this, BJanson, that is very useful. I agree that returning to soccer is probably a little bit of a stretch and risky. If I may ask: How many weeks after injuring your knee did you have surgery? If you felt the instability before surgery, you (more or less) fully regained ROM before having surgery?

I am now almost 14 weeks post injury with no surgery so far and have been in intensive rehab for the last two and a half weeks: I exercise 5 times a week, with coordination and hypertrophy exercises mostly, sometimes cardio for the days between workouts. My knee feels very good.

I would say running and even certain jumping exercises seem to work fine for me now. Muscle strength really makes a difference in terms of stability and also well being. Of course, the danger with contact sports like soccer is that, even if (a big if) I could do pivot moves with all the muscles built up, I would run into big trouble if towards the end of a game or whenever I get tired, such a move would leave the knee vulnerable to another incident due to instability. Straight line running on the treadmill does not seem to be an issue, though.

At least that is how my theory goes  :)

Offline BJanson

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Re: ACL surgery: Long-term side effects
« Reply #15 on: December 25, 2016, 12:04:42 AM »
It was 3 months between injury and surgery because it wasn't convenient to have surgery at the time.  Once the swelling went down I had my ROM I suppose.  I don't think I lost much ROM just from the injury and a few days of swelling (knee was drained and I started anti-inflammatory's two days after surgery), but I didn't measure it either.  I did some weight training and stationary bicycling before surgery, but not an organized  protocol. 

Offline Don_Atlet

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Re: ACL surgery: Long-term side effects
« Reply #16 on: December 30, 2016, 04:20:31 PM »
Thanks a lot for coming back on this one, BJanson..

As an update to conclude 2016, now about 4 months post injury: Having exercised for 1.5-2 hours per session every working day for the last 30 days according to a specific plan, I am happy with the progress in terms of strength and coordination. It appears that the muscle tone is stronger now on the injured leg, overcompensating for the dysfunctional ACL. My injured leg is still slightly slower when jumping on one leg and a tad more shaky on the wobbleboard compared to the other side. However, I was able to resolve the issues with the IT band and a few other muscular & tendon issues that caused pain.

Overall, my legs feel great. Standing or walking for a long time does not tire my legs at all. Running is not recommended yet, but I tried it for 30 minutes two weeks ago with no pain whatsoever. Will it be enough to play football again? I do not know and it is probably too early to try. (I am not intending to return to football, anyway.)

Having spoken to a few other patients who had ACL reconstruction, it seems like the conservative treatment (at least here in Germany) is not presented as a viable option by doctors. I am now at the stage where I can say that I do not think about my injured leg most of the time. This was an aspect I was not sure would go away without having surgery.

Thanks for everyone who responded to my posts, I will keep everyone updated in 2017!


Offline jeffmc

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Re: ACL surgery: Long-term side effects
« Reply #17 on: November 09, 2017, 07:52:47 PM »
Thanks a lot for coming back on this one, BJanson..

As an update to conclude 2016, now about 4 months post injury: Having exercised for 1.5-2 hours per session every working day for the last 30 days according to a specific plan, I am happy with the progress in terms of strength and coordination. It appears that the muscle tone is stronger now on the injured leg, overcompensating for the dysfunctional ACL. My injured leg is still slightly slower when jumping on one leg and a tad more shaky on the wobbleboard compared to the other side. However, I was able to resolve the issues with the IT band and a few other muscular & tendon issues that caused pain.

Overall, my legs feel great. Standing or walking for a long time does not tire my legs at all. Running is not recommended yet, but I tried it for 30 minutes two weeks ago with no pain whatsoever. Will it be enough to play football again? I do not know and it is probably too early to try. (I am not intending to return to football, anyway.)

Having spoken to a few other patients who had ACL reconstruction, it seems like the conservative treatment (at least here in Germany) is not presented as a viable option by doctors. I am now at the stage where I can say that I do not think about my injured leg most of the time. This was an aspect I was not sure would go away without having surgery.

Thanks for everyone who responded to my posts, I will keep everyone updated in 2017!

How are you feeling, Don?  I am a fellow coper who tore my ACL/MCL/meniscus 3 years ago. rehabbed for a year and have been playing soccer for the last 2 years. The knee gets sore still after intense exercise and I have issues with a lingering bakers cyst when kneeling but day to day stuff is just fine.

Really worried about developing early arthritis and doing further fast-tracked damage by playing soccer on my acl deficient knee. contemplating surgery next year as I have no plans to stop playing soccer, hence how I came across your story. Cheers.