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Author Topic: Acl partial tear with mcl tear, surgery or not?  (Read 1937 times)

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Offline Darren102

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Acl partial tear with mcl tear, surgery or not?
« on: January 18, 2013, 07:44:00 AM »
Hi everyone,

recently I got into a ski accident which left my mcl torn and acl partially torn.

As far the acl tear goes its probably less than 50%.

I am a very active competitve floorballer and it requires me to play without worrying about my knee's ability to pivot.

I also do not plan on giving sports up and it would make me really sad as I am only 19.

Right now I am not experiencing any form of side to side buckling during any motion or walking nor any sort of pain due to the acl, mostly due to the mcl.
However, the knee tends to feel weak and collapses backwards when i bend it, into hyperextention.
The doctors say this may be due to the muscle atrophy in the area, which was significant.

Is it possible for the partial tear to tighten up and become close to normal again?
I am going for physiotherapy now and they seem to be teaching me exercises to use different muscles to offload the weight on my knees. But I don't want to have to be so concerned about my knee whenever im playing my game , I don't want to have to hold back so much.


I have not tried to really stress the acl by doing vigourous pivoting motions (nor should I because its a bad idea , the injury being only 3 weeks ago) but I need to know if it will hold up in time. Or is it just a semi-torn rubberband waiting to be torn?

Does the acl have any propensity to heal from minor tears?
And if I don't do the surgery and just do rehab like the doctor recommended, can I go back to playing competitive sports like before in the long run?
What should I do? |

Thanks :)

Offline AllyBally

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Re: Acl partial tear with mcl tear, surgery or not?
« Reply #1 on: January 18, 2013, 09:00:24 PM »
Hi Darren,
I really think that you should speak to a very good orthopedics surgeon who you trust and who deals with sporty people and ask him directly what he thinks will be best in the long run for you. A lot of people still play sports without problems with torn acls but this possibility doesn't only depend on how much muscle you put on but also from your physique. Long-limbed types with lax ligaments are more likely to have problems with partial tears. Bear in mind that you could in the long run cause problems to your cartilage if your acl is lax.

From my experience- yes it is possible to continue doing sports with a partial tear but I had the impression that during the years small traumas, sprains were gnawing away at the tear. I had  a partial tear of my left acl in Jan 2009 and was out of sports  for that winter ( skiing and ski-touring ) and did not go back to aikido ( lots of  pivoting ) until September after working hard to build up muscle. My OS told me that if my knee was stable it was ok to leave for the time being. It held and wasn't unstable at any point for 2 years. I basically had 3 good years with the skiing and aikido even if I did notice that last year something wasn't right as my knee was feeling less stable ( specifically pivoting at aikido felt wrong)  than before despite doing proprioceptive exercises and having plenty of muscle. I suspect that at this point my acl tear had deteriorated. My acl probably tore completely in august hill-walking after placing my foot badly. No major swelling, no pop, no pain and walked normally afterwards.
Jan 2008- Right acl repair using controlateral hamstring. Cartlilage with microfracture.
Jan 2009 - Left acl partial tear.
29 th Nov. 2012- Left acl repair using controlateral hamstring. Meniscectomy of left posterior horn.

Offline Darren102

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Re: Acl partial tear with mcl tear, surgery or not?
« Reply #2 on: January 18, 2013, 09:22:19 PM »
Hmmm that sounds unsettling..

My ortho just says its a wait and see scenario, so I'm not exactly sure what I'm going to do, the problem is that theres so much uncertainty .
I myself am a tae kwon do black belt and it would suck if i couldn't practice it anymore due to not being able to pivot , or having to baby my knee while doing so.
Your story of a partially torn acl completely tearing in time is one that is dreadful. It is really like a ticking timebomb.
However, I also hear that some people return to competitive sports (football , rugby) with the partial tear.

I am under good medical coverage at the moment so I can afford to go for the surgery. However, by the time I waited to see how it would do in a year, I would no longer be covered. And will have to foot the exorbitant cost of the acl surgery.

Hence I am really unsure of what to do and need further input.

How much was your ligement torn by in %? And did you feel any initial instability?


Offline AllyBally

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Re: Acl partial tear with mcl tear, surgery or not?
« Reply #3 on: January 18, 2013, 09:46:09 PM »
Darren, don't worry too much as I am also long-limbed and have lax ligaments, I normally hyperextend  my legs  :D
I have no idea how much my tear was in %. Do know that it was deflected on the MRI scan and there was some laxity compared to the other knee. The knee however was stable even after the trauma, I didn't feel any of the instability that I had with my other acl tear where my knee would give way in the shower and felt it was going all over the place. The hyperextension post trauma wasn't more noticeable than the other leg. If there had been any sign of instability I wouldn't have thought twice about it I would have gone for surgery.
Returning to aikido I did not have any problems at all apart from last year where my knee didn't give way but just  didn't feel right and I had more "difficulty" pivoting on the one side.
As I am in Europe I did not have the problem of insurance and timing with that but bear in mind that I did have a  trauma ( be it a small one)  to tear it completely.
In waiting to see how it goes you will know soon enough when you start some sports specific/ agility exercises if your knee is stable or not.
Jan 2008- Right acl repair using controlateral hamstring. Cartlilage with microfracture.
Jan 2009 - Left acl partial tear.
29 th Nov. 2012- Left acl repair using controlateral hamstring. Meniscectomy of left posterior horn.

Offline Darren102

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Re: Acl partial tear with mcl tear, surgery or not?
« Reply #4 on: January 19, 2013, 05:40:37 PM »
I haven't felt any sort of instability and if you didn't tell me it was torn I wouldn't know.

Today I tried doing some pivoting, and it was scary (as I was not sure if it would hurt the ligament more)
But the knee didn't collapse or anything.

But then I became really paranoid, so I need to ask this, if I try to pivot now , mild pivoting, such as walking and changing direction quickly, will it hurt the recovery process?  Because I still can't believe I am doomed to a life of no sports and the doctor says it's a matter of testing the knee.
I kinda am worried that with each pivot I do the ligament tears abit more, is this true?

Help me out here :(

Offline Snowy

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Re: Acl partial tear with mcl tear, surgery or not?
« Reply #5 on: January 20, 2013, 02:27:37 AM »
Hey Darren,

I think the most important thing to understand is that every situation is unique, and that the only way to tell if your knee is sufficiently stable to continue participating in sports is to put it through a thorough rehab program (a physiotherapist can guide you through this) to recover from the injury and strengthen the muscles around the knee, and then see how it holds up. If you experience any buckling or instability following the rehab program, that's the red flag that what's left of your ACL isn't providing the support that the knee needs and that it's time to consider surgery.

I'm afraid that the ACL has no ability to heal itself once torn. There's a surgical procedure called healing response that can be performed on a partial tear that may help, but this can only be carried out under very specific circumstances. However, the tear itself isn't necessarily the end of the world. People with ACL tears - even complete ruptures - fall into one of three categories: able to continue with all sports without instability following rehab (copers); able to live without an ACL but unable to continue participating in sporting activities that place lateral stress on the knee (adapters); and unable to carry out day-to-day activities without buckling and instability (non-copers). The difficulty is that the only way to know which category you fall into is to go through a rehab program and see how your knee manages. There's no quick answer. However, the more of the ligament you have left the better your chances of being a coper.

My own story is very similar to AllyBally's. I suffered a partial tear while kickboxing, and mostly due to very vague medical advice and a lack of knowledge didn't even consider surgery. Once I'd built my strength back up I was able to continue participating in all of my sports, including fairly high level skiing, with a knee brace for support. I didn't scale back my level of activity at all. The knee held up to it; however, it never felt quite right after the injury. It wasn't at all unstable, but it just didn't feel quite as strong and capable as the other leg.

In terms of whether the activities you're trying now will cause more damage, I would strongly advise seeing a physiotherapist and having them give you some guidance on when your knee is ready to try particular activities. It doesn't sound as though you're doing anything unreasonable, but your knee has been through a trauma and it's important to give it a chance to settle and heal before putting strenuous demands on it.

Four years after the partial tear, I took a very innocuous fall on a ski jump and tore through what was left of the ligament. This time I had excellent medical advice and again made a very good recovery, returning to cycling after ten days and skiing after six weeks. All the signs were that I was going to be a coper, but I opted for surgery because I felt that it wasn't worth the risk of going back to demanding sport with a compromised knee. Surgery and rehab were not easy, but for me it's definitely been the right decision in the long term.

As I said, though, this is my own situation and not necessarily the way things will work out for you. A partially torn ACL will never be as strong as one that's fully intact, but if your rehab goes well then you might well find that it holds up well without the need for surgery. Best of luck - I hope things go well for you.
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