Torn ACL (suspected)

[55]

Hi,

I was diagnosed as having sprained my MCL at the start of September last year, I rested it for 2/3 weeks and then attempted to play football on it with a brace on the 25th September, didn't last long before I felt the knee 'give'. I presumed that I had just aggravated the sprain so stuck to the original advice and rested it etc. I regained ROM and got back to squatting in the gym, however it hasn't ever felt 100% right and I sometimes get discomfort (its not pain as such, just a weird feeling) so I went to see my doctor who referred me to Orthopedics. I was there today and the Dr said from his diagnosis and my description that he would bet money on me having a torn ACL. (Getting an MRI in the next couple weeks to confirm)

I thought of some questions I should have asked before I left but forgot so what i'm wondering is this,

1)He says he thinks it is torn right now, is it likely that it has been torn since september? It seems strange to me that it hasn't healed in that time (Or will it not heal on its own?)

2)From my situation (20 yrs old, highly active etc) it seems like surgery is recommended. If it has been torn for this length of time can I leave it longer without any side effects or causing long lasting damage? I have only recently had time off work due to a broken finger and also have some competitions coming up that I would like to compete in so its not a good time to have to get surgery.

[Snowy]

Sorry to hear about your injury. The ACL has no blood supply, so it can't heal on its own - once it's torn, it's gone.

To answer your second question, it really depends. The ACL provides lateral support for the knee, so without one the risk is that under lateral pressure the shinbone will move too far in relation to the thighbone. This puts other structures in your knee at risk of damage, especially the meniscus. Living without an ACL also leaves you at risk of osteoarthritis in the long term.

Having said that, roughly a third of people are able to cope without an ACL without any major physical restrictions. (A third are able to live without it but have to give up most sports, and a third have a knee so unstable that even everyday activities cause instability and buckling. If you're going to try and live without the ACL for a while, the most important thing is that you start seeing a physiotherapist and start a muscle strengthening program. This will provide extra support and stability for the knee. However, you should also talk to your Ortho about whether it's advisable to continue playing football without an ACL. Football involves cutting, pivoting and contact, and is one of the highest risk sports for the ACL - it generally wouldn't be considered a good idea to go on playing without an ACL unless your leg is exceptionally stable.

Having said this, of course every case is different and you should do some research into the risks of ACL deficiency before making up your mind. Do talk to your surgeon, too; having tested your leg he will be able to tell you how much laxity there is in the joint. Unfortunately from your description (the knee never feeling quite right after the injury, and the regular discomfort you're experiencing) it doesn't sound as though your knee is 100% stable, which means that you do need to be careful and check with your doctor about the activities you should be doing. Pain is a sign that the knee isn't happy, so it's best to pay attention to it.

Good luck! I hope that the MRI shows something else is up rather than the ACL - it's definitely a tough injury to deal with, and it's hard making the decisions around surgery when you have an active lifestyle.