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Author Topic: ACL Avulsion  (Read 3184 times)

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Offline mudruninjury

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ACL Avulsion
« on: January 24, 2011, 02:08:14 AM »
Hi!  On September 25th I injured my knee in a mudrun (4 months ago Tuesday).  I have an ACL avulsion which is stable and has required no surgery.  I still do not have full extension or flexion.  My knee is VERY stiff.  I still limp.  If I walk too much my knee swells.  I am no where near back to normal.  I go to PT 2 days a week.  When I meet with my doc about once a month he wiggles my knee and doesn't have much to offer.  I'm becoming very frustrated with my very very slow recovery!!!!!!  If I just need to be patient...fine.  But, I'm starting to wonder if there is more going on in my knee.  Does anyone have a similar experience or any reccomendations?  Thanks!! 

Offline Audice

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Re: ACL Avulsion
« Reply #1 on: January 24, 2011, 12:01:49 PM »
Hi ~ And welcome to the forum. If indeed your ACL is torn, it's not going to heal & more than likely will continue to tear until you do have a rupture. How was the tear diagnosed - simply my manipulation or by x-ray or MRI? If you've seen no improvement in 4 months it would seem there's something more going on inside your knee & this might be the time to insist on diagnostics that will tell you more specifically what's going on - like an MRI if you haven't had one. Wishing you well...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 mudruninjury

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Re: ACL Avulsion
« Reply #2 on: January 24, 2011, 11:39:31 PM »
Thanks so much for your response.  Mine wasn't a tear...but an avulsion which means it became detached along with a bony fragment of the tibia.  The bony fragment has reattached to the tibia on it's own.  I have had an MRI.  Does anyone else have this experience?  An avulsion vs. a tear that required no surgery.  I did jog for a little bit today...but I have a feeling that my knee is going to be a swollen mess tomorrow.

Offline kscope09

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Re: ACL Avulsion
« Reply #3 on: January 25, 2011, 12:00:53 AM »
Mine is avulsed too.  I injured it in Feb 08, had physios and gps tell me there was nothing wrong and an mri that showed nothing, so I had a scope in August 09.  The surgeon is a specialist on acls and said that I had a small tear but it was really small and the fragment was stuck down the lateral compartment, where it had been causing a lot of catching.  I knew it was catching but the so called proffessionials didn't take it seriously.  The aclw as debribed and the knee was more stable after the surgery than before but once my quads were built up the stability came back.  Pre surgery I ahd no stability issues at all and only a little stiffness.  My knee did swell but only early on and I was still able to do Karate for about 6 months after the injury, before the pain got too bad.

If you want to go back to sports then get your quad strength up and maybe you'll get a couple of years in before you have to quit.  If your not bothered and happy to give them up then just maintain your quads and work on keeping the knee functional for every day laftivities and you might be OK for a few years.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline Audice

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Re: ACL Avulsion
« Reply #4 on: January 25, 2011, 12:34:21 PM »
In my too quick response, I omitted the word "away" as in "torn AWAY." Has the bone fragment reattached correctly?
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 mudruninjury

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Re: ACL Avulsion
« Reply #5 on: January 25, 2011, 05:17:49 PM »
Hi Audice...I'm not sure if it has reattached correctly or not.  I guess most of my problem is that I do not fully understand my injury.  Ugh.  I can live my daily life normally...but I'm 34 years old and limp like an elderly person.  My MRI was done very shortly after the injury...so I'm not sure if that would even indicate whether it has reattached properly.  I have a Doc appt. Feb. 2nd and I'm gonna need a lot of answers. 

Offline Catsmum

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Re: ACL Avulsion
« Reply #6 on: January 26, 2011, 01:53:11 PM »
Hi Mudrun,

It is possible that there is something else going on in your knee. MRI scans are generally accurate but do not always pick up every injury.  4 months seems a long time for your knee to still be so swollen and painful as I would expect that the ACL would have reattached by now.


I had a complete ACL tear (not avulsion)  in May 2010. My MRI showed the tear and some medial meniscal damage. I elected to have reconstructive surgery and partial meniscectomy. It was only during the surgery that it was discovered that I had also damaged the articular cartilage. My understanding is that this type of cartilage injury dies not always show up on a standard MRI scan.


Good luck with your surgeon. Perhaps you could talk with him/her about the possibility of a repeat MRI or arthroscopy.


Offline kscope09

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Re: ACL Avulsion
« Reply #7 on: January 26, 2011, 02:02:53 PM »
my acl damage was so small that it didn't even show up on mri and when I had another mri 15 weeks after the scope, that had nothing to saya bout the acl either, even though it had been debribed.

I don honestly wonder though if acl debribedment actually causing the ligament to be weaker, since the scar tissue attached to it could be helping.
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline mudruninjury

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Re: ACL Avulsion
« Reply #8 on: January 27, 2011, 01:06:14 PM »
Thank you so much everyone for your responses!!!!!  Yesterday I ran 4 miles with my running group (first time running on the road...but have run on treadmill in PT)...

I know it may seem strange that I can run right now considering that I limp when I walk and run...but I think the limp is from not being able to extend my knee.  I had a minor amount of swelling from the run but no pain. 

I have decided that although I'll keep rehabing...I'm going to go on with everything I would normally do even if I can't straighten out my leg. 

Offline kscope09

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Re: ACL Avulsion
« Reply #9 on: January 27, 2011, 01:16:05 PM »
Have you tried heel hangs?

I could still run a bit after my injury too if I was running alte for a bus or train.

it makes sense that you can run because your legs will be mostly bent throughout, butI always think, "walk before youc an run."  It just ameks sense to get the walking sorted out
Feb 08 Inurred right knee
18 months of physio, knee tracking but knee still painful
Aug 09 Scope - Small tear in acl, fragment found in postereo-lateral compartment, suprapatella and lateral plica and small defect in mfc.
May 10 Right knee feeling better but left knee causing trouble as a result o

Offline catsknee

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Re: ACL Avulsion
« Reply #10 on: July 03, 2012, 04:55:00 PM »
Hi Mudruninjury,
I cannot help but to identify myself with what you went through in 2011. Not sure whether you managed to sort out your knee injury and whether extension has returned to normal. I am going through the exact same thing  but it only came to light years after my injury.
I fell off a scooter in feb 2009. I was told I suffered a tibial plateau depressed fracture. I was then kept in a full leg cast for 6 weeks, non-weight bearing. I then had the cast removed and was told to resume activities. I could not extend my leg and trying to do so was extremelly painful. I had months of physio but still the same symptoms were present: swelling, pain and loss of extention (although this did improve eventually though never normal).

I then returned to my GP and eventually had another MRI/Xrays, was told again (same as the time of the injury) that all my ligaments were intact but this time the MRI report concluded that my MRI was 'macerated'. I was then referred to a specialist at Guy's Hospital. During my visit, the specialist doctor concluded that I had condromalacia pattelae and refered me to physio again. I then went through another year of physio.

The symptoms remained the same, a lot of pain, swelling, inability to strainghten leg. I was basically walking with a limp and weight bearing was too much. I did manage to exercise a lot and did commit to the physio but was in constant pain. Some improvement was made but it was clear that things werent going to get any better. I then started developing severe lower back pain and shoulder pain. It was clear (to me, not to doctor or to physiotherapists) that my inability to straighten my leg was not only causing me great knee pain but also started creating problems on other parts of my body. My walk has never bene the same since the injury.

I then decided to consult a private doctor and once again, had MRI and X rays done (this time privatelly) in 2012. It turned out I was misdiagnosed the first time and in fact, I had suffered an ACL avulsion fracture. The fractured piece of bone still attached to the ACL healed prominently. A few days ago I had an arthroscopy. this didnt go so well as the prominent bone healed attached to the ACL and removing it would mean I would lose the ACL so the doctor left it intact. Other work has been done on it and I have felt an improvement  already. It has just been a few days! But I am now waiting to see what impact it will have when trying to straighten the leg once things are back to normal if the 1cm piece of bone is still there.

I am now waiting to see the doctor following the surgery but he mentioned that one option (although not recommended for me) would be to have ACL reconstruction. Neither myself or the doctor are currently looking at this as an option given that my ACL is (relatively) healthy.

During the past three years I have lived through this injury, it has been difficult but at least I think that things have finally moved on. I wonder how things are going for you?

Would be lovely to hear from anyone else who may have had experience with a malunited acl avulsion fracture.

Take care. Thanks for you time.

« Last Edit: July 03, 2012, 05:04:34 PM by catsknee »