Banner - Hide this banner





Author Topic: Possible ACL and Menisci damage- What now please?  (Read 6446 times)

0 Members and 1 Guest are viewing this topic.

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Possible ACL and Menisci damage- What now please?
« on: September 25, 2011, 04:03:11 PM »
Hi everybody, im a newbie so please be gentle.   ;)

Ok, recently i have been suffering from pain behind my knee (it seemed to follow my calf right up to the 'behind' of my knee) and occasional pain from roughly the same area when i played football, normall when i overstreched to try to get past an opponent. However, i began to notice that i was getting tackled by players that couldn't normally tackle me....which was rather humiliating to be honest. Additionaly i noticed that i wasn't as fast as i was, say, a few months ago. Also, my knee felt very tender either side of my knee when my gf massaged it.

I visited my local Doctor who performed that test where they put their hands behind your knee/calf and kind of pulled the leg forward, played with the sides of my knee and told me he was pretty sure id damaged my ACL and both the medial and lateral Menisci and carefully explained that i should stop playing football immediately, to which i felt like crying as i absolutely love playing football and, being 35, am fully aware that i haven't got too long to play, especially being a striker!

He has referred me to a specialist at my local-ish hospital , who im a litle nervous about seeing again as i was diagnosed with possible damaged menisci and possible ACL damage last year but had to refuse keyhole surgery to my cartilage due to work commitments.

Now, this is the bit where i expect you all to tell me what a fool i am-  I stupidly tried playing for my team two days after the Doctor's appointment, i wore a knee support and even though i apparently played well, the same problems arose for me: I couldn't get past players that i normally would have and i seemed to have hardly any power in my shooting! Basically, i considered myself to be 60% the player i was, even though my knee has never actually 'given way' as im constantly being told is the main symptom of ACL damage?

So, what im asking, is please can someone help me with these questions:
1, Do my symptoms sound as if i do have ACL and menisci damage? (being as i can run full pelt with no problem/pain and can race up the stairs in my house fine)
2, What would happen if i continued to play, ie- is it possible/probable that my knee will suffer serious ACL damage as opposed to the seemingly minor damage/tear that i curently have?
3, Being as my Doctor told me to contact him again if the Hospital haven't contacted me again within a month, would there be any advantage in booking with a private knee expert at the Chester Knee Clinic (Mr Bobic) for an MRI scan to finally determine the actual damage as opposed to waiting for my NHS appointment, which could take a long time, and, i get the impression that i will just have keyhole surgery with no MRI scan? (The reason i assume this is that is what was going to happen last year when i had these same symptoms)


Sorry for the lengthy post everybody!   :-[

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Possible ACL and Menisci damage- What now please?
« Reply #1 on: September 26, 2011, 01:54:32 AM »
Sorry to hear this. It's horrible to feel limited or kept away from the sports you love by injury. :(

I'm not a medical professional (just an interested patient) but based on my experience with my own ACL tear these are my thoughts on your questions.

1) Yes - but it could also be something else. The tests aren't infallible, and while an MRI may confirm things one way or another you may not know for certain until they're inside your knee. The soreness certainly sounds like meniscus damage, and your doc did the appropriate tests for ACL damage and most likely found some laxity in the knee if he suggested that this was one of the possibilities. If your leg muscles are strong (which yours probably are from playing soccer) they will provide a certain amount of support for the knee even if the ACL is fully or partially torn. After I tore my ACL completely I was still able to cycle and run while I waited for surgery, and I never had any instability in the knee.

2) If the doctor is right about your injuries, you're putting yourself at risk of further damage by continuing to play. Once your ACL is fully or partially torn, your knee no longer has the lateral support that an intact ACL provides. If your leg is basically strong this may not cause any issues with day-to-day or even quite strenuous sporting activities, but where it is at risk is when you're performing movements that involve twisting, cutting or pivoting. If you did suffer another injury or awkward fall, the lack of lateral protection means you'd be at a high risk of causing further damage to other structures in the knee: in particular the meniscus (which may already be compromised) and the articular cartilage (which cannot easily be repaired.) Even without injury, the extra wear and tear can lead to a greater risk of long-term problems like arthritis. That said, it's really a personal choice as to whether this is something you want to take a chance on or not. I'm not a great example to use here, as my leg felt so strong that I did continue to ski (although with a number of restrictions) between my ACL tear and surgery. My physiotherapist did insist on putting me into an ACL-specific protective brace, and I'd recommend this if you do choose to continue to play. Ossur and Townsend make really good braces for this purpose.

Something else to keep in mind is that unless your ACL tear is very minor, a tear is a tear - it doesn't really matter if it's full or partial. If it's serious enough for there to be laxity in the knee, the ligament isn't doing its job any more. I partially tore my ACL four years before it finally gave way completely, and actually had a lot more difficulty recovering from the partial tear (probably because I wasn't in very good shape at the time.) The next time that knee was put under any significant strain, the rest of the ACL tore through.

The most important thing you can do is listen to your body. You say that you feel 60% of the player you were; I would say that's a pretty clear sign that something's not right.

3. Again, this is really up to you. I went private for my MRI (I'm in Canada) because of the wait times; I knew that my knee wasn't right and that I would most likely need surgery, and I just wanted to get the show on the road. This did save me from going through investigative surgery - the MRI scan showed the ACL tear very clearly, and I was able to proceed with the reconstruction. MRIs aren't always 100% clear, though, and can be wrong - it's not an absolute guarantee that things will move faster.

Sorry you're facing such tough choices. I'm afraid there are no easy answers - all of these things are personal decisions based on the information you have at hand and the signals your body is sending you. My main piece of advice is to be sure that you're fully aware of the pros and cons of both sides before making your final choices. Best of luck, and let us know how you get on.
« Last Edit: September 26, 2011, 01:57:45 AM by Snowy »
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #2 on: September 27, 2011, 09:50:02 PM »
Hi Snowy,
Thank you for a very informative answer, i really appreciated that and you have helped me understand much more than sifting through many a web page  ;)

You talk sense and i think that is what i needed to read to be honest. I believe that a lot of people who suffer knee damage seem to almost disregard medical advice in the belief that they can somehow 'overcome' it...I think i may have been one of those !

May i ask, what is the recovery time for an operation to repair the menisci, the same question for ACL?

Thank you once again.
- Buel

Ps- After reading your signature i was actually shocked at how much work you've had done. Are you back to 'normal' now? I do hope so!

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Possible ACL and Menisci damage- What now please?
« Reply #3 on: September 28, 2011, 04:29:25 AM »
No problem...really glad that the info was helpful. As I said, just keep in mind that I'm not a medical expert, just someone who went through this particular journey not so long ago.

Again, the individual experience can vary tremendously, but these are some ballparks for you. If the torn piece of the meniscus is simply removed, you'll be mobile right afterwards and probably looking at a few weeks to get back to normal activity. My coworker who had a meniscus trim was riding her bike again after two weeks, and was able to resume full activity at about six weeks out. If the meniscus is repaired (which is better even though it's a longer recovery, as you don't lose a piece of the cushioning cartilage in your knee) you'd most likely spend a bit of time non-weight bearing to protect the repair and be looking at a longer period (3-4 months) before you were back to full activities.

ACL reconstruction rehab also varies quite a bit. Depending on the graft type and the surgeon's protocol, you're generally looking at anywhere from 6-12 months to go back to full activities; 9 months is fairly standard. Most surgeons prefer to use your own tissue where possible. The patellar tendon graft is generally considered to be the strongest and heals in place faster because the fixation is bone-to-bone, but has a higher risk of long-term side effects like pain on kneeling. A hamstring graft takes a bit longer to heal because the tunnels have to fill with new bone, but has few side effects apart from a slight loss of hamstring strength for which most people compensate in time. An allograft (donor ligament) takes longer to regain full strength than using your own tissue, but does have the advantage of not having to heal a donor site as well as the knee. There are also synthetic ligaments available, but be cautious with these - the latest generation are relatively new and as a result there's little data on the long-term patient outcomes.

ACL rehab is very carefully managed, and it's critical to have a good physiotherapist with lots of experience with post-ACLr patients. In the early days you have to be extremely cautious and activities are very restricted to give the graft time to develop a blood supply and regain strength, so you spend a lot of time doing very tedious, repetitive exercises. Over time activities are gradually reintroduced as the graft strengthens, and you'll usually be released to full activity at a point when the graft and fixation are both strong and muscle strength in the operated leg is the same as the good side. It's a slow process, and it's really important to be diligent both about doing the exercises and sticking to the surgeon's timeline for activities. The good news is that as long as you do these things, it's a surgery with a very good success rate.

As for me, I'm pleased to report that in spite of the litany of abuse my knee has suffered over the years, I'm in great shape at the moment. I'm skiing again, climbing mountains, and competing in bike marathons - in short, everything I did before the injury and surgery. I was released to full activity at 8 months post surgery, but if I'm being honest it was a full year before my knee really felt normal again. For me, having the surgery was definitely the right choice; I'm pretty active and more than anything, I didn't want to be restricted when I skied. If you're interested, there's a horribly detailed thread down in the >300 post-op diaries where I documented my surgery and recovery.

Best of luck deciding what to do next...I'll keep my fingers crossed that whatever surgery you require isn't too serious, and you can avoid the ACLr if possible. This board is a great source of advice and experience (it kept me sane after my injury, and again after surgery) so do post more questions if you have them. :)
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #4 on: October 05, 2011, 08:24:07 AM »
Hi again all (and Snowy).
Just a few (more)questions id like to ask if i may?

Firstly, i have yet to see the specialist so will try and hurry them along later today but in the meantime i've noticed a constant swelling behind my knee which i can feel when my leg is extended. Please can i ask is this a symptom of ACL damage?

Secondly, im interested to find out the minimum time that someone who has had an ACL operation could return to basic light duties at work? For example, i am a Welder so i could get away with simply standing for 8 hours a day while somebody brings the work to me.....i was thinking four weeks?

Thank you in advance and a special thank you to Snowy for the great answers!






Offline Kaputt_Knee

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 24562
  • Liked: 75
  • [Ed: Sue sadly passed away in 2016]
Re: Possible ACL and Menisci damage- What now please?
« Reply #5 on: October 05, 2011, 09:50:56 AM »
Quote
Firstly, i have yet to see the specialist so will try and hurry them along later today but in the meantime i've noticed a constant swelling behind my knee which i can feel when my leg is extended. Please can i ask is this a symptom of ACL damage?

Secondly, im interested to find out the minimum time that someone who has had an ACL operation could return to basic light duties at work? For example, i am a Welder so i could get away with simply standing for 8 hours a day while somebody brings the work to me.....i was thinking four weeks?

Answer to the first question is that it could be: but it could also be a result of meniscus damage &/or a cyst (sometimes called Baker's Cyst). Just keep icing and hope that it disappears after the operation.

As for the minimum time out - so much depends on how your surgeon works. If you have a meniscus repair for example you could be non-weight bearing for a while. You really can only decide with your surgeon AFTER the operation.

A rule of thumb is if you are sitting most of the day, i.e. a desk jockey like myself, then you can return after 4 weeks if your journey is not too bad and you can make arrangements to ice and elevate while in work. For a more physical job where you are on your feet all day, it is better to make sure all the post-op swelling is gone and that you have full extension and can stand on both legs equally. When I was a PE teacher my surgeon would not let me back to work in less than 12 weeks, even though I was only instructing, not taking part. Standing around all day while your leg is still swollen is not good for the rehab, you'll find you will stiffen up and it really does slow down your progress by going back too soon.

Good luck with the operation though.

Sue
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #6 on: October 05, 2011, 03:08:20 PM »
Thank you for that, i appreciate it.

So am i right in thinking that the recovery from a Menicus operation is longer than from an ACL operation?

Offline Kaputt_Knee

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 24562
  • Liked: 75
  • [Ed: Sue sadly passed away in 2016]
Re: Possible ACL and Menisci damage- What now please?
« Reply #7 on: October 05, 2011, 06:38:04 PM »
No you have a false understanding there. Even a a repair should be more or less healed by 8 weeks, although physio will need to continue until you have full movement, etc. An ACL reconstruction is at it's most vulnerable between approximately week 6 and week 12. This is when the graft is dying back and the revascularising of the new tissue is taking place.

In terms of a return to sport, you could be looking at anything from 6 months to a year, depending on you (how you heal and rehab), what kind of graft you receive, and what other work is done.

After my last meniscus trim (2004)  I was back skiing in 3 weeks and instructing at 6 weeks. After my revision in 2008 where I had a new ACL and LCL grafted in as well as some other work, I was back skiing at 6 months, but wearing a functional brace.

Remember the stories you read here are most often the exceptions; people come here when things go wrong. Some people (like Snowy for example) have few if any problems and never feel the need to come to a site like
this.


Sue  :)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #8 on: October 23, 2011, 03:43:44 PM »
Hi everybody,
Just a little update:
I have an appointment with a Wolfgang Wagner who is the locum knee surgeon  http://www.rjah.nhs.uk/getattachment/About-Us/News/Staff-Newsletters/September-2011---Communicate-Staff-Newsletter/Communicate_September_2011---2.pdf.aspx    at my local hospital in late November and, according to his secretary, he will be able to operate in mid-December.

That is excellent news, however, i plan to fly to America  in late March so please could someone tell me is this going to be a problem? Will i struggle to walkl just 14 weeks after the operation?

Thank you in advance.

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Possible ACL and Menisci damage- What now please?
« Reply #9 on: October 23, 2011, 04:12:31 PM »
By fourteen weeks you should, as long as all goes well, be pretty mobile. You'll be past the super-cautious early stage of healing, and in fact won't be too far off the point where a lot of rehab protocols introduce a running program (mine started at 16 weeks). You shouldn't be having any difficulty getting around and dealing with day-to-day activity by that point. In fact probably the worst part will be having to stay still for so long during the flight - make sure you get up and stretch and do gentle knee exercises regularly to keep it from stiffening up. But as long as everything goes well after the op, you should be fine to make the trip.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #10 on: October 23, 2011, 04:41:04 PM »
Thank you Snowy! Appreciate it!!

If i may ask two more questions-
Being as i neither experienced the intense pain when i hurt my knee or a 'popping' noise, is there still a possibility that i may not need to have an operation? The only 'test' that i failed was the laxity test where the doctor sits on the foot and pulls the shin bone towards him?

If/when i do have the operation, please may i ask will i be able to get about afterwards(3 or so days after), as in with crutches, or will i have to stay in the hospital for a week or so?

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Possible ACL and Menisci damage- What now please?
« Reply #11 on: October 23, 2011, 10:19:36 PM »
Unfortunately there's no way to know the answer to the first question until you're under the knife. If the manual test showed laxity in your knee then the chances are high that the ACL is gone, but there's no way to know 100% for certain until the surgeon is inside your knee. Even MRIs can be wrong - there's one user here who had both her original ACL injury and a subsequent graft failure missed by the MRI. On the plus side, I know of two people whose docs told them their ACL was gone and it turned out to be intact. My experience was much the same as yours; no intense pain (I was able to ski out the run) and no popping, but my ACL was completely gone.

Here in Canada, ACL reconstruction/meniscus repair is normally done as a day surgery. I went under the knife about 8am, woke up from the anaesthetic at about 10am, and was on my way home by 2pm. Almost all the ACL/meniscus ops I've about here have been day surgeries. Every now and again someone stays in overnight (this seems to be more common in Europe) but I can't imagine they'd keep you in longer unless there were complications. I was in a lot of pain when I first got home (word from the wise: stay on top of your pain meds, 'cause if the pain gets ahead of you you'll be in for a rough few hours until you get it back under control) but things were better the next day, and after that it was a slow, steady improvement - I was mostly off the crutches by day four. Even if you're stuck on crutches for longer because of a meniscus repair or a different protocol, you'll be given some gentle physio exercises to work on when you first get home to keep the joint mobile.

Did the doc tell you what kind of graft he prefers to use? This is good info to have in advance, as your rehab protocol will vary a bit depending on the graft used. I'd start checking out physiotherapists, too - a good physio is absolutely essential to a successful recovery from ACL reconstruction.

Good luck!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #12 on: October 24, 2011, 08:43:59 PM »
Thanks Snowy (again),
That is very useful information to have, i am very lucky to have such good advice!!
The Doc didn't tell me what kind of graft he prefers/uses, by this do you mean either using the patient's own hamstring or patella tendon? Am i right in thinking that a graft from a corpse (shudder) is highly unlikely?

Ps- thanks for the advice regarding the physion- i'll get on it!!

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Possible ACL and Menisci damage- What now please?
« Reply #13 on: October 29, 2011, 07:39:22 PM »
Most surgeons use either the hamstring or patella tendon autograft, but other possibilities include the quad tendon, allografts (donor tissue), or even synthetic grafts (though there's little data on long-term outcomes for these). There are pros and cons to all of them, and the choice of graft will have some implications (not huge ones) for your rehab protocol and length of time until release to full activity. Most surgeons have a strong preference for one type of graft, so I'd give your OS's office a call and ask them about this. It's definitely something I would want to know in advance.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline buel

  • MINIgeek (20-50 posts)
  • **
  • Posts: 29
  • Liked: 0
Re: Possible ACL and Menisci damage- What now please?
« Reply #14 on: October 31, 2011, 09:37:27 AM »

Thank you again Snowy. I will contact the OS and ask. Im sorry for these many questions but i do find it all very interesting.
Please may i ask how long you were in plaster for after the operation, as a guideline for what to expect. And how long after could you walk/clomb the stairs ok?
Thank you in advance!