Author Topic: Torn MCL/ACL  (Read 343 times)

Offline randoma

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Torn MCL/ACL
« on: September 22, 2017, 07:03:28 AM »
Hopefully this is an appropriate forum for this..

I had a mishap with my knee at a Brazilian Jiu Jitsu competition last weekend. Basically, I was thrown and my lower leg stayed vertical while the rest of me went sideways...  (The bend was outwards, not inwards). There was a very distinct popping sound, but my leg almost immediately straightened out. It was, by far, the most painful injury I've ever experienced...

I iced the knee immediately and went to the ER. The ER gave me a knee immobilizer and crutches.

I saw an Orthopedic Dr the following day. She said I have a Grade 2 or 3 MCL tear as well as possible damage to ACL and Meniscus. She told me to continue wearing the immobilizer whenever I was moving around, but that I should talk it off when I'm sitting..etc.

I have an MRI scheduled for Saturday, and hopefully will hear back from that sometime next week..

Currently I can not fully straighten my leg, and I can bend it only about 80 degrees. There is still significant swelling. I've been avoiding NSAID's but have been icing it a few times a day.

Anyway, my question is - can I walk, or stand (with weight on both legs) without crutches if I use the knee immobilizer? I haven't tried putting my full weight on it, but with the knee immobilizer it will definitely support some weight. Assuming I can bear weight on it with the knee immobilizer, and assuming it isn't painful, will walking that way (or even standing that way) cause any additional damage? I seem to be limited to standing on one leg for about 10 minutes and there are many things I can do while using crutches to support myself, so at a minimum, I'd like to be able to stand with my leg in the immobilizer.....


Offline Navtinho

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 1
Re: Torn MCL/ACL
« Reply #1 on: September 22, 2017, 02:50:57 PM »
Hi really sorry to hear about your injury.
Its still early days after your injury and you still have considerable swelling, so your injury is still in the acute phase. If I were in your situation I wouldnt want put any unnecesary stress on the joint until the swelling goes down. Also from my experience some mobility will be restored once the swelling subsides so dont stress too much about Range of Motion right now. I would suggest that you continue with RICE and give the knee the time it needs. If you've done your ACL and MCL together you are going to have a really unstable knee for the first few weeks at least.

Unfortunately from what you describe and from my own experience, it does sound like you could have some ACL damage as well....
Having said that it could just be a partial tear, considering your BJJ activity you would probably still need surgery and there are some new techniques out there which aim to augment and preserve the existing ligament as much as possible. So dont risk losing this option.

Anyway my point is although the risk may be low, dont push yourself and take a chance, at least until you know the full extent of the damage and the swelling subsides.

Good luck with the MRI ! Keep us posted.

Offline randoma

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Torn MCL/ACL
« Reply #2 on: September 25, 2017, 10:53:42 PM »
Thanks for the input, Navtinho!

I got the results from the MRI........

Full tear of my ACL. Full tear of my MCL. Partial tear in both meniscus... I guess I should be happy I didn't fracture anything as well! :o

So, I'm very active for my age (46), I do combat sports and powerlifting. Anyone have any advice on what I should ask the surgeon? Any techniques I should look into?

Thanks for any help!

Oh.. I also had Patellofemoral syndrome which was quite bad a few years ago (I spent a year doing physical therapy/rehab, and still do some bandwork multiple times a week). As a result I have some osteoarthritis in both knees.
« Last Edit: September 25, 2017, 10:56:41 PM by randoma, Reason: Added Patellofemoral syndrome »

Offline Navtinho

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 1
Re: Torn MCL/ACL
« Reply #3 on: September 27, 2017, 08:43:56 PM »
Hi, Damn, complete ACL and MCL tear ! That is a serious injury.

The first bit of advice I would give you would be to accept that it will be a fair amount of time before you can return to your activities. I've learned that knee injuries are a diferente beast and they need to be given the time and attention (rehab) they require.

Regarding the graft choices/techniques, If you had a partial tear, there are some expensive but minimallly invasive methods that I have heard about (PRP therapy) that could help, but you have a complete tear, I am not a doctor but  from my experience and reading this is what I know ..

There are 2 types of grafts ie. autografts (use your own body tissue) and allografts (which use synthetic material or donor tissue)
Regarding the allografts, synthetic material sucks, so that leaves you with the donor tissue option. Although a donor tissue allograft has a risk of rejection  and/or infection, the advantage is that you dont have to weaken another part of your leg in order to harvest a new ligament. Given your history of OA and patellofemoral syndrome I would think that this would be a good option for you to consider, so I would advise you to question your surgeon about this option. if he agrees that you could follow this route, then the next step would be to question what donor material would be used to create the new graft, I would suggest the donor patellar tendon (reasons below) or the donor ACL itself (im not sure if they do this normally but I read that Michael Owen the footballer went with this route).

If we look at the common autograft options we have the patellar tendon autograft and the hamstring autograft.
The patellar tendon autograft uses the middle portion of your patelar tendon (in the front of your knee|) with two bits of bone on either end (bone plugs) which help to form a more natural bond between the new ligament and your femur and tibia. From my knowledge, people who want to return to high level/high impact activity usually go with this option eg. Conor McGregor (UFC). However the recovery is usually longer and there is a significant risk of chronic pain in the front of the knee when you kneel. Considering your history of OA and patellofemoral syndrome, I don't think that the patellar tendon autograft (although I think that the donor graft is a good idea) would be a good option for you, but please chat to your surgeon about it.
That leaves us with the hamstring autograft (which I had myself), basically they use the tendon of the semitendinosus muscle of your hamstrings, ie the inner hamstring muscle. The tendon can be detached completely and inserted into the tibia and femur or it can be detached at one end only, leaving the end of the tendon that is already attached to the tibia in place, pulling it through and attaching it to the femur. Some surgeons say that the second methods has better outcomes. Recovery is generally faster for both hamstring graft methods, however you have to accept that you could have long term hamstring strength deficits (20 - 30 %) in that leg (although it depends on the person and their rehab). This graft could would probably be the option that your surgeon suggests
Usually surgeons specialise in either the patellar tendon autograft or the hamstring autograft and they would make their suggestion based on your situation and their expertise. From my experience, most surgeons nowadays go with the hamstring autograft.
Regarding the meniscus, I would suggest that you ask your surgeon whether he could do a meniscal repair rather than just shaving off the torn bits (which they usually do), considering that you have OA you will need to preserve as much of your meniscos as possible.

I am 33 years Old and I had my hamstring autograft (graft detached at both ends and inserted) 7-8 years ago. The graft is still intact although no matter how much I train, I still have a strength deficit in my hamstring (but as I said that depends on the individual). I am also a martial artist, but I have only recently returned to training. I have also accepted that I will not be able to compete at the same level or be the same athlete that I used to be.
I would suggest that you have the surgery, rehab religously and give yourself the time your require. Afterwards you should really reasses whether you would want to continue your activities at the same level.

Hope this helps.....Keep posting !

Offline swimmermex

  • MICROgeek (<20 posts)
  • *
  • Posts: 7
  • Liked: 1
Re: Torn MCL/ACL
« Reply #4 on: September 30, 2017, 03:11:52 PM »
I feel you!!! I had 2nd degree MCL tear and full ACL tear. It will take time. I am on my 7month and I am starting to regain strength. My Dr told me I will be ok by the 6months, I guess he was wrong. These things take 1 full year. The first 3 months post op are really important and when you hit the 6month it is when you really start to feel better and begin to trust your leg again. I hope you the best!

Offline randoma

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Torn MCL/ACL
« Reply #5 on: September 30, 2017, 06:22:37 PM »
Thanks for the responses! The surgeon I met with recommended an achilles tendon allograft. Due to my age and the type of sports I do (Brazilian Jiu Jitu, Taekwando, Powerlifting) he did not recommend an autograft. For the autografts he ruled out a BPB graft because of BJJ and Hamstring because of the powerlifting. He said he would prefer an allograft over a quad autograft due to recovery time.

I asked about an ACL allograft - he said that it is nearly impossible to get a length match - the donor tissue would have to be the exact length as yours. Probably possible if you have large sums of money (pro football player), but not possible for a regular person.

I read a couple of studies that seemed to say that the age of the donor tissue has an effect on the quality/strength of the repair. He said that A) they can't specify the age of the donor tissue and B) that it doesn't make a significant difference. Does anyone know if this is, in fact, true?

Right now I'm on 5 weeks of pre-hab - he wants me to have full range of motion before the surgery. He says that it is much harder to regain range of motion afterwards if you don't do the pre-hab. He claims recovery time after surgery will be 6 months, but I'm expecting 6-12, possibly more before I can get back to full contact sports.

During the pre-hab I'm wearing a Donjon Playmaker II brace. They told me that it is okay to wear it all the time while I'm awake, but I'm concerned about blood flow restrictions - does anyone know anything about long term brace usage?


Offline Navtinho

  • MICROgeek (<20 posts)
  • *
  • Posts: 18
  • Liked: 1
Re: Torn MCL/ACL
« Reply #6 on: October 02, 2017, 03:34:44 PM »
Hey,
Cool, its good that your surgeon made the call to go with the allograft. I've read that the achilles tendon can provide a really strong graft, so all the best with that !

Regarding the age of the donor and its impact on the strength of the graft, I honestly havent done any reading on that because I had an autograft. But I wouldnt worry because I understand that the achilles tendon is quite long and thick with quite a high tensile strength (naturally higher than the native acl), therefore it will have to be cut to suitable dimensions, so because of its naturally higher tensile strength, I dont think than donor age would play such a big impact, also once its grafted to your body, it goes through a ligamentization process via which it undergoes some changes and is vascularised by you own blood supply, so dont stress.

Regarding your brace usage, I waited a year before my surgery and I regularly used a brace throughout this period. Basically you just have to ensure that its tight enough to secure your knee but not to the point where it cuts of your blood supply. Just pay attention to the áreas around the quad and the calf. Considering that you will probably only wear it for a month or two, I wouldnt be that worried.

By the way, I was actually thinking of getting a Donjoy Playmaker myself. It seems to be the best value brace from DonJoy. You probably wont be able to tell me much about the functionality right now, but hows the comfort and quality of the brace ? Whats your take ?

Offline randoma

  • MICROgeek (<20 posts)
  • *
  • Posts: 4
  • Liked: 0
Re: Torn MCL/ACL
« Reply #7 on: October 03, 2017, 08:42:29 PM »
Regarding the Donjoy Playmaker II... As braces go it isn't bad. However, I find that the further restricts my range of motion and tends to cut into the back of my calf (right behind my knee). I find that I take it off as much as possible. On the other hand, there have been many times where I've been very glad I was wearing it because it definitely helps with twisting and sideways forces.

It was extremely itchy for the first couple days but that seems to have subsided.

Also, even though it appears to be fitted correctly - if anything it is on the tight side - it tends to fall down on my leg to where it is about 1-2" lower than it should be.

I'm told that I will have a different brace post-surgery.

Offline candie kissiz

  • MICROgeek (<20 posts)
  • *
  • Posts: 1
  • Liked: 0
Re: Torn MCL/ACL
« Reply #8 on: October 09, 2017, 06:48:42 PM »
I HAD ACL AND MENISCUS REPAIR DONE SEPT. 6, 2017 AND I STILL HAVE NUMBNESS IN MY LEG!
IM WALKING ALOT BETTER, BUT I STILL HAVE A LITTLE SWELLING AND I CAN STILL FEEL SOME SORT OF SHARP PAIN WHERE MY MENICUS WAS REPAIRED.
IM HAVING SURGERY ON MY OTHER KNEE IN ANOTHER MONTH I HOPE IT GETS BETTER BEFORE THEN!

 

Advertisement














support