Advice Required

[Nokneeleft]

Hi

Find myself in a bit of a quandry at the moment.  Have completely ruptured right ACL (been gone about 2 years) and have requested a reconstructon (currently waiting for date from NHS).  In the interim, have restarted playing touch rugby and have done for the past 3 weeks. Additionally, have done lots of work on hammies and quads and dropped some weight.  I am not suffering from any instability, pain or swelling following the activity (which, as you can imagine, is full of pivot activity), nor does it seem to impede in any way playing the games (currently playing twice a week for about 2 hours a time).  I don't have any instability during normal activity either.

Those who have had their ACL reconstructed, would you have gone for it given the above and what you know about the rehab and associated pain from the surgery?

Thanks in advance.

Andy.

[Kai]

I had an aclr almost a year ago because my knee was extremely unstable... it wobbled when I walked, never mind trying to do any physcial activities.  I had a very good result, returning to all my activities in a short period of time.  Many on this board have not.

There are many different factors to consider when deciding whether to operate or not.  Someone here will be able to give you studies and discussions about it. (just not me..  Im not that good at the search  )

In my personal opinion, if the knee is stable and works, than do NOT operate.  If it is not stable or becomes wobbly, then get the reconstruction.  Good luck.

[Kaputt_Knee]

Hi Andy

from what you say about your activity levels and lack of problems I cannot understand why you have asked for an ACL reconstruction. If you are not having any problems then you are lucky enough to be able to continue for the time being without an ACL. By having good Quad and Hamstring condition you compensate for the loss of the ligament. An ACLr will never be as good as the original that Mother Nature gave you.

I would cancel the reconstruction appointment until you really have problems if I were you! It would be useful to have the knee monitored though as maltracking of the knee cap can slowly but surely lead to osteoarthritis and associated problems. Stay as far away from the knife for as long as you can!

Sue

(3 x ACLr on right knee, 1x ACLr on left knee - second being threatened)

[sazzle1]

Hi Noneeleft!  I agree with Kai. About 4 years ago I fell over in a rather ungracefull manner and was in a lot of pain. This went on for a few months until eventually after repeated visits to Dr/PT ect an MRI was ordered where they confirmed Bucket handle meniscus tear, (no mention of ACL at this time) which was subsequently  removed.(40%) It was during this operation when they 'discovered' that I had also complete rupture of ACL. I had been complaining of instability for a long time, in fact 4 years. It was because of this instability (giving way & falling over) that the OS said i had to have it reconstructed. They said that the frequent damage i was doing to the joint was a significant enough issue to get it done, rather than a TKR when i get to my 50's!!!!! In all it took 4 years to make the decision and one that i reluctantly had to agree with.
However if you are not having instability problems perhaps you could look into it a bit further if possible. Surgery is the very last option really and is well worth avoiding if you can live with out your ACL ok. But as you are on the list for the operation your OS must have concluded that the ACLR is the best thing for you.
It is a big commitment, having ACLR as the whole thing from begining to end is a lengthy game. Also, a consideration is your job. Depending on what you do.....
can you take the rellevant time off. (eg a friend of mine at PT is a cleaner and was advised 6 mths off)  
In my case, the operation/rehab/pain, will be well worth it as i couldn't function with out my ACL properly and in the process damaging my knee's future.
Well done you for your recent rugby, weight loss and muscle build up, these things will help you in your pre op. The fitter you go in, the better your recovery, if you have this done. Good luck hope this helps a bit!! sazzle1

[lurchyboy]

This is a really similar situation to my knee. I had no ACL, it had fused slightly to my PCL, but was essentially gone totally. I was capable of doing all sport, I played high level lacrosse and was absolutely fine. Like you I was perfectly happy to leave my knee like that until it 'went' sometime in the future (If you look back at my past posts I wrote about my knee and how I wanted to follow a conservative route - this one is particularly relevant I think http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=32597.msg241091#msg241091).
The reason I decided to have the ACL repaired was because I want to join the military and I knew my knee was slightly loose when I did long runs with weighted backpacks. So basically, career wise, I needed it fixed.
But, if you have definitely decided against a future in the military or don't even get looseness when running with weights (or, like normal people, have no desire to run with weighted backpacks!) and have no problems with instability, then do go down the conservative route. Just bear in mind that you don't have and ACL and one day it's entirely possible you will develop instability.
One important thing I was told when planning on avoiding the op was rehab as if you had had the reconstruction. That way your legs stay strong and if you ever need the operation you're ready.
Anyway, good luck with whatever you decide!
Dave

[jathib]

Given how long it takes to get surgery in the UK I'd probably make the appointment. Maybe just keep moving it out if it gets too close. I know from experience that the next time you injure the knee it's going to hurt a lot more than it did the first time. Being in the US I'd probably wait and see because you can generally get into surgery within a month after an injury.

[Nokneeleft]

Thanks for all advice thus far folks!  I'm leaning towards not getting it done, however, at last consultation following exploratory, the OS did say that there is a "hole" developing in one of the leg bones due to cartiledge having been taken out previously and that he would fix by drilling into the bone during the ACLr op.  Tempted therefore to get that issue fixed and see how I get on with the ACL over time.

I guess my big issue is that it is not restricting me in any way at all currently, but what damage am I letting myself into for the future - and no one can answer that with complete certainty!!!

Dave - think we "spoke" before, had a place in the marines but couldn't take the weight of the packs on the marches due to partial ACL tear and didn't really want to get the reconstruction at that point as was about 15 years ago - so bailed out.

Thanks again.

Andy.

[jb-knee-geek]

Those who have had their ACL reconstructed, would you have gone for it given the above and what you know about the rehab and associated pain from the surgery?

I waited until my knee was unstable. The issue is how much damage is done while you're running around with a slight wobble, you have some cartiledge damage and prior meniscus surgery(?), this is not to be take lightly over time.

My original OS put it this way, "you can see me now, or see me later - your choice". Your knee is not getting better with a torn ACL.

For me, the worry was worse than the surgery. I'm enjoying the fitness aspect of the rehab, I'm at near 100% at 9 months post-op. Though I've decided not to return to pivot sports at this point.

check these:

http://orthoassociates.com/ACL_Indications.htm

http://orthoinfo.aaos.org/indepth/thr_report.cfm?Thread_ID=14&topcategory=Knee#surg

good luck

[Kai]

For me, the rehab and associated pain was less than feared.... the length of time (one year and counting) was more...   given that I had the injury, and that my knee was so unstable, I would do the surgery again.  I think if I had to do over, I would try PT for 4-6 months..   although my result was good, I have learned from many people's experiences that it could have been bad.... surgery opens you up for so many potential complications.  In a way, Im glad I didnt know then what I know now - then the decision was easy - FIX IT !!...  now I know that these decisions are never that simple...

[kazer111]

I was almost like you I was playing sports without an acl for almost 3 years. I was playing football, soccer, tennis, basketball all the time. However every once in a while when I would land from a high jump playing basketball it would give way a little bit so I decided to have the surgery.

[jathib]

Those who have had their ACL reconstructed, would you have gone for it given the above and what you know about the rehab and associated pain from the surgery?

I absolutely would have had the surgery. Especially if I was playing sports. You never know when your knee is going to crash and burn. And when it does, it's likely going to damage something else. For me, the meniscus tear that resulted from instability was the most devastating injury. The ACL was rebuilt, but once you lose a meniscus a knee replacement is inevitable if you live long enough.

[Annika]

Tough choice,

I had my ACLr within 5 weeks of injury - at that point I had full extension and flexion, both legs same size and well fit. The most obvious difference was when standing on one leg on a trampoline and tossing and receiving balls. That showed up the instability quite clearly. My Physio thought it was funny because he said I was better on the bad leg then lot of people are on the good leg but once he saw my balance on the good leg it was clearly superior to the bad. Ultimately because of my quick recovery I could have tried the conservative route and right now post 4 1/2 weeks I wonder if I shouldn't have? However at the time I made my decision I was surrounded by skiers, who like me work in the skiing industry, and those who had had the op was unanimous in their conviction that the op would be the best solution, those who had not had the op were all operating (scuse the pun) on a 70% use of their previous level. I guess what I am saying - no one but you and your OS can tell who this is affecting you. For sure the rehab is no fun but then levelling out at 70 % of previous activity level as seemed to be the average of no-ops was simply not going to work for me. No-op means you could be totally fine but in a bad instance you could get more damage - on the other hand you could get that anyway - the way you got damaged in the first place.

Wouldn't it be great if there was just one answer? 

[Nola]

... the OS did say that there is a "hole" developing in one of the leg bones due to cartiledge having been taken out previously and that he would fix by drilling into the bone during the ACLr op.  Tempted therefore to get that issue fixed and see how I get on with the ACL over time...

Andy, did he explain the "hole" or mention avascular necrosis?  That would indeed be my warning sign to get something done.  If he is saying it is due to something (cartilage) being removed from before, that could have interrupted the natural blood supply and effectively cause a "hole".  I would probe much deeper into what he means by a hole!

[knee-will-be-great]

I would get the ACL done.  If you do not have an ACL, your knee will jiggle around and you will end up with more osteoarthritis and therefore pain and injury to the joint that way.  As far as the "hole", it sounds like (in my humble opinion) that it could be a bare spot on your joint where the cartilage has worn out.  If it is isolated (the hole, that is), then the surgeon is giving your very good service if he/she is going to repair the "hole".  Find out what the surgeon intends to do with the "hole"  Will it be mosaicplasty or a whole host of other carticlage treatments?  Find out if you do not know and then research it.

As for walking the walk re: ACL reparis, I am going in for my 3rd one.  The first was ripped by a swipe to the side of my knee by a large dog; the second as a result of a pivot tear - but the second one was not positioned properly when it was put in - so it was susceptable to stretching and tearing which it eventually did do.  So here I am for number 3; and quite frankly, I can't wait.  I have injured my other knee by falling when my ACL-deificient knee gave way ... which sooner or later it will do with increasing regualrity (in my humble opinion).  So to be balanced and stable, one should really get the ACL done.

You can't have proper, balanced ambulation without an ACL in one leg.  In terms of the rehab, it really is not that bad; at least you will get it over with.  As for me, been there done that, made the t-shirt, saved a few t-ahirts for selling to others.... so they can say "been there, done that, bought the t-shirt".

Then when I get the right knee all healed up, I will have to have some floating cartilage removed from the good left knee.

Cheers from Knee-will-be-great!