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Author Topic: ACL/Tibial Plateau at 53  (Read 2066 times)

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Offline a2n

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ACL/Tibial Plateau at 53
« on: August 07, 2005, 01:47:10 PM »
Hi, What a great site!
Here's my situation, and I would welcome any advise, as this is all new to me....
First of all, I am a 53 year old active woman, probably the oldest one posting here. ?
On July 11th I was descending a ladder and missed the last 2 steps.   I came down really hard and twisted on my left leg as I landed, causing a crunching sound I will never forget, and of course the pain.  Wow.  I passed out several times and my husband called the ambulance.
At the ER, xrays showed 2 non-displaced fractures/tibial plateau, and suspected acl damage.  No cast, but no weight bearing on the leg.  Referred to family doctor, then to a very good O.P. in our area.   After CT scan, and MRI, it was determined that the ACL is gone.  Also damage to cartilage. 
OP said the bone must heal first, so I am to continue non weight bearing until 23rd of Aug. then more x rays to see if I can try walking.
I am doing many reps of leg lifts in the meantime, and using my crutches.  Life has really slowed down.  I would normally be bike riding, gardening, antique hunting, doing chores around our 2 acre home.   I have had to make some emotional adjustments, and fight off some crying spells.   I have a very supportive husband, and friends who have been lifesavers through this so far.
Since I am a high school teacher, I have the luxury of a few more weeks off, then plan to go back to get the schoolyear started, and take a month off (or whatever it takes) to have the acl reconstruction and begin the rehab, then return to work.    My OP uses hamstring graft I believe.  We haven't actually discussed the surgery much, because he is primarily concerned about the fracture healing first.   I intend to have the surgery though, as I do not want to be dealing with a 'trick knee' or do more damage.   I want to remain active, although I'm not into contact sports of any kind.   
The various postings and diaries here have been so helpful, and I will continue to check in.
I have anxiety about the surgery, and the pain/recovery period.   Morphine makes me barf, and I'm worried about being nauseated through the pain-reliever phase.    I have never had a serious injury before, so don't really have a frame of reference here.   
Still, I am pretty healthy and willing to do the work to recover.
If any of you have any advise for me, it would surely be welcomed.
Thanks,  Ann
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline Nettan

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Re: ACL/Tibial Plateau at 53
« Reply #1 on: August 07, 2005, 04:02:49 PM »
Hey Ann !!

I want to welcome here !! Sorry about your accident. This with pain after surgery there are a lot of options which are better then morphine. Morphine is often only used after surgery and not as a med you take at home. But if you feel sick of it there are lots of other meds and treatments to get pain under control. You can have a block f.i.
So talk with the surgeon and ask lots of questions. When you come up with things you need answers on write them down and bring it with you at next appointment. You are not the eldest here, definately not.
I'm sure you will be back doing all things you like sooner of further, you just need to be patient. I know it's not easy, but when time goes you will get better and better.
You can read more about ACL and surgery if you scroll down on this site.
Wish you the best. Please keep us updated. Feel free ask and I will try answer the best I can.

Hugs Nettan  8)
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline raquetball1

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Re: ACL/Tibial Plateau at 53
« Reply #2 on: August 07, 2005, 05:35:27 PM »
Welcome a2n,

I believe a poster named audice might write and let you know she's in her sixties, although her OS won't repair her acl because of her age.  If you scroll down to Cruciate Ligament board, you'll find there are a few of us in our fifties who have had the reconstruction done, so you're not alone.  What to expect from surgery is no different than for the younger folk posting on the board.  The only real difference for us "oldsters" is watching the younger ones getting to move on in rehab more quickly than we do.  Every time I'd look at another acl recon patient in rehab doing something I wasn't doing I'd ask the PT assistant why I wasn't doing that yet and every time the response was the same:  "You're about thirty years older than most of the others in here.  You'll get there.  You just have to be more patient." 

Post surgery I was on low doses of Percoset, as needed for pain, for only about five days. I usually don't tolerate any narcotics very well, but had no problem with Percoset.   I then switched to 600mg Ibuprofen tabs figuring the anti-inflammatory effect would be useful. 

So as not to make to long a post here, below is another post with the abstract and source citation from a study on acl recon in over age fifty patients.  Best of luck to you a2n.
« Last Edit: August 07, 2005, 05:42:10 PM by raquetball1 »
autopatellar acl recon Nov. 2004 at age 51

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Offline raquetball1

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Re: ACL/Tibial Plateau at 53
« Reply #3 on: August 07, 2005, 05:40:16 PM »
Author(s): Blyth, Mark J G; Gosal, Harminder S; Peake, Wendy M;
  Bartlett, R John
Title: Anterior cruciate ligament reconstruction in patients over the
  age of 50 years: 2- to 8-year follow-up.
Source: Knee Surgery, Sports Traumatology, Arthroscopy : Official
  Journal of the ESSKA. vol. 11, no. 4 (2003 Jul): 204-11.
Abstract: We present medium-term results in 30 prospectively followed
  patients aged over 50 years at the time of ACL reconstruction (31
  procedures); mean follow-up time was 46 months (range 24-95). Mean
  Lysholm score improved significantly from 63 pre-operatively to 93 at
  final review Cincinnati score from 49 to 89. In IKDC score 25 knees
  (81%) were considered normal or nearly normal and 6 abnormal; there
  were no severely abnormal results. Mean Tegner activity scores
  improved from pre-operatively from 3.7 to 5.2 at review. Mean
  side-to-side difference measured by the KT-1000 at maximal manual
  pressure was 2.7 mm; two knees had. a measured difference greater
  than 5 mm. The mean torque ratio for isokinetic flexion strength was
  102% and for extension strength 94%. Poor results as determined by
  the three scoring systems were associated mainly with advanced
  articular degenerative changes (Outerbridge grade 3 or 4) seen at the
  time of reconstruction. Despite this all patients reported
  improvement in stability and overall function of the knee.
  Degenerative change itself was associated with increased time to
  surgery from injury. This study demonstrates that the ACL can be
  reliably reconstructed in patients over the age of 50 years with good
  symptomatic relief, restoration of function and return to sporting
  activity.


Citation is from the Medline database.
autopatellar acl recon Nov. 2004 at age 51

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Offline Audice

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Re: ACL/Tibial Plateau at 53
« Reply #4 on: August 07, 2005, 08:38:40 PM »
Hi Ann ~ I think, as Racquetball suggested, I claim the dubious distintion of knee geeks senior citizen (& a retired teacher). I'm 67 & w/o an ACL(destroyed along with lots of other knee parts in April) & I have to say the missing part is the least of the problems. There's not an awful lot I do that requires the cruciate & so long as I keep my leg muscles as strong as possible, there's less chance of knee instability resulting in arthritic changes.

I'm active, too, & continue to walk the dogs & ride my horse on a regular basis but am finding the torn menisci are more problematic than the non-existent ACL. Those can & probably will have to be scoped at some point but like Racquetball I find Advil liquid gels do the most to relieve the pains.

Advil & ice is nice - is fast becoming my mantra!

This is a great site & you'll find nothing but support from everyone here & I suspect you'll feel better about everything once you can become mobile again...Ellie
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 a2n

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Re: ACL/Tibial Plateau at 53
« Reply #5 on: August 07, 2005, 11:42:38 PM »
Thanks to all who have taken the time to respond.    I appreciate this support system so much !
It's good to talk to others who understand this experience.
The study on acl replacements after 50 was inspiring, as were all the kind words.
As I prepare to begin weight-bearing on my leg again in 2 weeks, I am a bit parinoid about the knee 'going out'. 
Is this a painful thing, or just a sudden weakness ?   I have no idea what to expect.  I am going to be SO careful.   I am hoping that my op will let me have the repair surgery asap.
I have been taking Motrin for this initial healing of fractures phase, and that helps a lot.    I have good range of motion, but
I have a lot of soreness on the outside of my knee too, like maybe another side ligament is involved in the injury, but the op said nothing about that. 
Audice, are you planning to have the reconstruction done at some point in the future ?  It sounds like you are an active person too.  I like your mantra! 
Best wishes to ALL of you, and I will keep reading and posting.
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline Audice

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Re: ACL/Tibial Plateau at 53
« Reply #6 on: August 08, 2005, 10:53:52 AM »
Hi Ann ~ Two OSs claim no ACL reconstruction has ever been done on a person my age so the answer is, "No. there'll be no reconstruction." I have a custom brace which I use when I just don't want to be too careful about where I'm placing my foot. So for the most part I avoid the buckling knee.

When it does give, I can feel what I equate as a grinding of bone on bone as the tibia slips sideways. There's instant pain, then it's gone. I just fear the ultimate damage from the slipping motion so am careful to wear the brace whenever I think I'll need it - as when I'm walking 3 dogs at a time or longeing my horse. My concentration, then, is elsewhere. The farther I get from the original injury the more stabile my knee seems to be. It's those menisci that are giving me grief...Ellie   
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 a2n

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Re: ACL/Tibial Plateau at 53
« Reply #7 on: August 08, 2005, 11:53:55 AM »
Audice, it sounds like you are managing the situation well, and I thank you for the information about what the knee feels like when it gives.
Hope you continue to do well with the custom knee brace.  Stay active and strong.    Ann
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline raquetball1

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Re: ACL/Tibial Plateau at 53
« Reply #8 on: August 08, 2005, 05:49:23 PM »
a2n,

Regarding soreness on outside of your knee.  Much of the general soreness (not talking the pain of knee giving out) one feels in the knee from a ligament injury is from the fluid that accumulates from the injury.  The fluid tends to migrate around the knee capsule thus the pain can crop up anywhere from a torn acl.  In my nonrepaired knee (torn acl and lcl) on any given day the pain can be right on the kneecap, medial, lateral etc.  I too hope you can move on to your surgery quickly after your fracture is healed. 

Hello Audice. :)   and Best of luck to both you and a2n. 
autopatellar acl recon Nov. 2004 at age 51

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Offline feggie

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Re: ACL/Tibial Plateau at 53
« Reply #9 on: October 02, 2005, 02:24:43 AM »
My OS said that when he was living in Colorado, he did ACL reconstruction in people 80 years old,who demanded a strong knee for their skiiing!! He has no qualms about fixing up an inactive 54 year old, who would like to have a knee that is stable.
complete acl tear w/ meniscus damage 4/05; acl allograft recon. w/ meniscus repair 11/1/05

Offline Audice

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Re: ACL/Tibial Plateau at 53
« Reply #10 on: October 02, 2005, 11:35:05 AM »
My OS said that when he was living in Colorado, he did ACL reconstruction in people 80 years old,who demanded a strong knee for their skiiing!! He has no qualms about fixing up an inactive 54 year old, who would like to have a knee that is stable.

Wow, feggie...when I asked about reconstruction, my OS said I'd be the first person my age in history who had ACL reconstruction. I wonder what my Top Doc OS would say if I pushed for reconstruction.

Bottom line is that I honestly don't feel the need for the ACL. Since the original post on this topic in August, my knee is so much more stabile that I'm no longer even thinking reconstruction. I honestly don't need the ACL.

I wear the brace less & less & as I've said before it's not the missing ACL that gives me grief, it's the meniscus/menisci...Ellie
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 a2n

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Re: ACL/Tibial Plateau at 53
« Reply #11 on: October 02, 2005, 01:36:51 PM »
Hi everyone
I had my acl reconstruction Sept. 12 and everything is going very well.   I posted my experience in the Post-Op Diary section on this message board, and will continue to update there.
It has been slow going for the last few weeks post op, but I am happy to be on the other side of surgery and every day is a little better than the last.   I am still on crutches, and wear the brace at all times for now, but this is just a precautionary measure as I heal.   My OP is taking a conservative approach to my rehab.  Maybe because of my age, or maybe because lf the allograft, which can take a little longer to reach it's potential. In any event, the allograft was much less invasive, and is one less place to heal. OP highly recommended that choice for me.   I see a PT 3 times a week, and am gradually rebuilding the strength in that leg.  I feel very optomistic about the whole proceedure.   I will continue to post my progress in the Post OP Diary section for those of you who are interested.
When I initially asked my OP if my age was a consideration, he answered, 'not at all'.  My insrance has also paid up beautifully.
The only down side to this so far, is that it IS a slow recovery, and you must do the PT, but none of it has been too difficult at this point.   The 'teacher' part of me understands patience.
Check out my diary if you want,
Best wishes to you, the help I have gotten here has been GREAT!
Ann
age 53
fall from ladder on July 11, 2005
2 fractures tibial plateau, non-displaced
damaged meniscus
torn acl
acl reconstruction surgery /allograft Sep. 12, 2005

Offline feggie

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Re: ACL/Tibial Plateau at 53
« Reply #12 on: October 02, 2005, 06:12:02 PM »
I am scheduled for ACL reconstruction and cleaning up my damaged meniscus on Nov. 1.  I live in Florida, and my doc acts like my age is no big deal...maybe in different localities they approach this differently!
My knee feels unstable, I can't kneel, but that could be from the meniscus.  One of the OS I saw, said a reason to do it, is to keep from falling and breaking a hip as you get older.  I am 54 by the way.
The horror stories I read about recovery are making me question what I should do!!
Good luck, glad you are doing better.
Feggie
complete acl tear w/ meniscus damage 4/05; acl allograft recon. w/ meniscus repair 11/1/05

Offline raquetball1

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Re: ACL/Tibial Plateau at 53
« Reply #13 on: October 02, 2005, 11:43:04 PM »
Yo Feggie,

If you are speaking about the horror stories you've read on this forum, please remember except for just general advice on exercise or experience, many posters post because their surgery didn't go well and they are seeking help and advice and information.  Probably many who have had successful recons, no particularly bad side effects/complications, quit posting once they get some moral support early in the surgery decision process and/or post-op process.  Search through many of the posts here or in Cruciate Ligaments forum and you will find a goodly number of people posting their "success" stories.  I'm almost eleven months post autopatellar recon, have been back on the racquetball court since month six and have kicked up my movement on the court almost to where it was pre-injury (of course, some things I used to do like dive for balls on the court will no longer be a part of my game) and my knee feels better while playing than any other time during a given day.  I'm not going to say the knee never hurts off the court.  It still does at times, but it's no big deal pain and I still fully expect the pain to totally disappear eventually.  I'm thinking that perhaps being an "older" recon patient just makes the healing process slower.  My other knee has been acl deficient for over ten years and the pain in that knee from not having it reconstructed is chronic and ain't going to get any better, just worse. (I wear a functional brace on that leg while playing rball.)  So, please consider the predominantly successful outcomes before questioning whether you should have the surgery.  Best of luck to you....and WAY TO GO a2n!!!  Great attitude. 
autopatellar acl recon Nov. 2004 at age 51

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Offline ski bum

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Re: ACL/Tibial Plateau at 53
« Reply #14 on: October 02, 2005, 11:55:14 PM »
All,

I too am in my 50's (55 next month) and am doing fine now.  A friend who is 53 had her ACL repaired in June--and is back to life as it was before the tear--after two months of PT (she is a half-marathoner plus spinner).  A cousin who is in her late 50's had a tibia plateau fraction this past ski season--but is planning to return to skiing this season.

If you are active and willing--no reason why age should matter.

Andy
12/23/04:  complete ACL tear, partial LCL, tibia bruise
1/19/05:  allograph ACL
7/8/05:  AIR-scar tissue & ACL graft girth reduction
8/4/05 nearly full ROM-released to ski
8/11/06: AIR-scar tissue, grade 3 cartilage potholes on femur
10/13/10:  Mfx, L knee to fix 3cm pothole