Are there any ACL Copers out here?

losergood2011

I'd love to hear what PT has been successful and what motions to avoid. Doing OK right now and think I will give not having surgery a go. Can still climb ladders, walk on slopes, ride my horses but there is some shiftiness and knee pain. No deep lunges per the PT mini sq2uats and lunges. Thinking of doing TRX again for the support.

GiddyupTim

Hi loser:
There are people who can chose not to have surgery and who will never have a problem. (That is, a giving way episode.) I know that medical researchers have noted these people and have attempted to answer what it is that is different about those people. I am pretty sure they have identified a few things. You should look this up because probably there are exercises you can do.
I do not remember -- so I hesitate to writing this -- but I believe they identified the quadriceps as critical. The people who can do fine without an ACL are people with strong quadriceps. Maybe you could, or should, be doing quadriceps exercises?

canadjineh

Yep, tufel is correct... Talk to a sport med doc in conjunction with your PT so that you get the correct balance of muscle training in your quads. They are called quads for a reason so make sure you are balancing all four in your work and not overworking one while letting another lag behind. I found that using a little biofeedback sensor set on my knees helped me retrain my exercise in PT, since while I was teaching fitness, I got a little lazy about concentrating on my own balanced muscle work. It's always better to avoid surgery if possible... anytime there's cut & stitch involved (lol) it lessens the integrity of the tissues. (Straight out of my orthopaedic surgeon's mouth)

losergood2011

Thanks to both of you! I see the ortho again for reeval this Monday. Currently have been doing PT twice a week and at home daily - hamstrings, calf, glutes mostly and there is a big difference. Everyone is amazed how well I am doing 90 days post dislocation and tears. 10K plus steps a day, riding (even posted a bit sunday) etc. Guess I am on the right track! Now to drop some more weight :-)

Sam_I_Am77

canadjineh wrote: »

Yep, tufel is correct... Talk to a sport med doc in conjunction with your PT so that you get the correct balance of muscle training in your quads. They are called quads for a reason so make sure you are balancing all four in your work and not overworking one while letting another lag behind. I found that using a little biofeedback sensor set on my knees helped me retrain my exercise in PT, since while I was teaching fitness, I got a little lazy about concentrating on my own balanced muscle work. It's always better to avoid surgery if possible... anytime there's cut & stitch involved (lol) it lessens the integrity of the tissues. (Straight out of my orthopaedic surgeon's mouth)

Did your PT determine that you had a quadriceps deficiency that led to your tear? There are a few ways that one can tear an ACL but a quadriceps deficiency is usually more rare.

losergood2011

Me - no I fell forward down a slope to right my foot went left dislocated knee - popped ACL tore medial and meniscus - she said it was just the torque on my joint as my muscles tried to hold everything where is should be. Guess I have very good muscles.
- that is one of the reasons the ortho said I may not need surgery. At 3 months I am walking without brace etc. Guess that is unusual

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losergood2011

I guess I am not a coper after all - :-( Yesterday with my hinged brace on my knew blew out getting out of the trailer - OMG it hurts!! That is it - I can't deal with that and I have a high pain tolerance (according to doc and PT) :-( so surgery it is. I will blog about it once I get the energy to do it.

sofaking6

Well let me say this - I snapped mine about 10 years after it first tore. The thing I really regret was being out of shape at the time I had surgery. I snapped it on the ski slopes and had to get back to the city and then wait a week for my procedure, and I didn't put that foot down the whole time. It took almost a week to re-engage my quadriceps after that and it really sucked. So if you have strong muscles you're already ahead of the game (even though you're going for surgery). Just do whatever exercises you can leading up to surgery to minimize the time that you're not using that big muscle.

Good luck with yours!!! Get the patellar repair, too.

SonyaCele

i lived with mine completely broken for a year and a half, and decided i couldnt deal with it. the unstability prevented me from doing anything besides walking in a straight line on level surfaces. There are different levels of ACL tears. mine was completely torn. sometimes they are only partial, and maybe you can strengthen your muscles to compensate. I could not. I'm very strong with massive quads and it didnt help at all. It took me about a year to rebuild the muscle i lost from atrophy from the original injury . I just had my ACL replaced in november, its an 8-12 month rehab. I went into it with huge quads, and came out with a spaghetti leg that will take me a year to rebuild back to size. I believe it was worth it, at 5 months post surgery, im' happy with the results, i still have many more months of rehab. I opted for a donor tendon because i didn't' want to lose any of my hamstring or patellar tendon. The donor tendon takes longer to heal.

losergood2011

Thanks both of you! I have been building my hamstrings and the ortho is surprised and pleased with my muscles (that surprised me!!). I have just started propriation(?) exercised - drills crabwalk, grapevine, balance on one foot. sigh. so super bummed. I was wondering about the donor graft vs hamstring. pretty sure I don't want pattelar graft due to yoga and having to kneel to work. I appreciate the realistic rehab timeline SonyaCele. I tend to be optimistic so I want to set my goal very realistically!

GiddyupTim

I just saw this. You will probably not be a candidate for either a patellar graft or a hamstring graft. With us "older" folks, they usually give you a cadaver graft. We don't heal as well as kids. Taking an autograft needs more incisions and creates more damage that doesn't really heal as well for us.
Cadaver is not a problem. Supposedly, a cadaver graft gets a bit weaker than the autografts at some point during the healing, as what they put in gets weaker and your own tissue has not yet grown in and replaced it. I think that 'point' is about six months to one year. But people don't really reinjure a repaired knee. That is, people don't reinjure a repaired knee any more often than they injure their good knee, meaning that loss of strength really isn't that important. It doesn't leave your repaired knee more fragile.
Eventually, your own stem cells migrate into the graft and, over time, replace it with your own, living tissue. That is the thinking, anyways...

girlchemist1

I had my reconstruction in September. I had a lot of difficulty getting the flexion ( bending) back. But like the others said, quads, quads, quads! Even if you can't do alot, do whatever the PT says, and do it more than they say. Keep up with the PT and you will be happier after surgery. BTW, the pain sucks. It was three weeks of nonstop pain, not to scare you, but I can do almost everything I used to now. Working on getting my distance back on the running now. Good luck on your journey here!

sst036

I have hyper mobility problems, so I've blown both of my ACLs and then re tore my hamstring graft. I have decided against another surgery (they can't repair the left because of the surgery I had to correct/fail to correct the patella alignment and stop the subluxation so I'm destined for bilateral knee replacements) so have really focused on my quads but what really helped was balance exercises. As soon as you have flexion and extension back, start standing on one leg - heel to toe, raising your good leg back, single leg squats, balance board. It's made all the difference to me. I run, bike, row, swim, all with minor problems that are easily overcome. Squats with weights are the only thing that I'm taking super slow.

Just don't cross your legs if you're prone to dislocations or you might get stuck!

losergood2011

LOL sst036 that's great advice - and the balance exercises were fantastic until my knee subluxed on me getting out of a trailer (kind of like walking off a curb) so surgery it is. pretty swollen and angry right now so see the surgeon next Thursday to schedule. Sigh. BUT last night was able to do some yoga, leg raises and resume balance exercises. gotta keep moving along to keep the quads, hams, and calfs strong. Think I will start ablog this weekend. Might help me stay motivated.

shifterbrainz

My son did about 3 months of strengthening prior to left knee ACL replacement surgery. Surgeon said the stronger you are before surgery, the easier and more effective therapy will be after. The first thing the PT did was make sure spine, hips, knees, ankles were all in alignment. Everything had shifted to compensate for the knee pain while walking. His hips had shifted enough that his right foot was 2" lower than his left. Once aligned and all muscles were firing properly, he worked like a dog before surgery. ACL replacement was Dec 27 and he was pitching effectively by the end of March, with doctor's blessings. 10+ years since and he's been able to do anything and everything he has wanted to with no restrictions or limitations.

Getting to that point was an exasperating ordeal. All told, he had 3 knee surgeries in a 6 month period. First surgery was in June to "repair" a torn meniscus. After 2 months, knee felt worse than before surgery. Doc said the only thing left to do was " try a brace". What??? I never got a good feeling about this doc and looking back, I can see why. Trust your instincts!!!

Went to another doc to see if there really was nothing more that could be done. She looked at all the records and decided she needed to go in to see what was causing the pain because clearly, something was wrong. She was shocked at how bad the knee looked. The meniscus "repair" was ragged and there was all kinds of "stuff" floating around. She cleaned up what she could since she was already in there but was very concerned about how "amateurish" the meniscus repair appeared. She decided to refer us to another doc when she saw what looked like a torn ACL. Nothing had ever been mentioned about a torn ACL before that.

The 3rd doc confirmed a torn ACL and wanted to do surgery right away. Considering the fiasco this was turning in to, a friend recommended a 2nd opinion before proceeding with yet another (3rd now) surgery. That 4th doc confirmed the torn ACL and recommended ACL replacement. So, 4 docs and 6 months after the original injury, he had the 3rd surgery. In a short period of time, my son felt a real difference in how much more stable and pain free his knee felt.

On a side note, an interesting thing the 4th doc said was repeat ACL failures are almost always failures at the attachment. Either the attachment to the bone fails or the attachment holds and a small chunk of bone pulls off. Rarely does the actual tendon used as the replacement ligament snap.

SonyaCele

regarding the donor tendon, i did have the option of a hamstring tendon at my "older" age of 48. I decided against the hamstring because i power lift. He said the donor tendon does take longer to secure and is prone to stretching, but if you rehab correctly, it lowers that risk. I was on crutches 8 weeks instead of the normal 4 weeks. Zero weight for 8 weeks, and then he adds a few more months of slow rehab with a donor tendon. Follow your PT orders exactly, no more no less. Do exactly what your DR and PT say to do. The biggest reason these repairs don't work is people rush the rehab. At about 6 weeks you feel great like you can do everything, but inside its still healing for many more months. And yeah for 3 weeks i was constant pain, Its a long slow process, have patience. And remember athletes that have gone through an injury and rehab generally come out stronger mentally and physically. its worth the time and effort.

sofaking6

Re @shifterbrainz' story: Yes there will be a lot of pain for a couple of days. After that though, it should start to subside pretty rapidly. I was in a ton of pain after my surgery, doctor and PT both just told me to toughen up. So I did and limped around for two years until the unsettled screw finally worked its way completely out of the bone, taking plenty of bone chunks with it.

GROSS DETAILS

They couldn't sew up the hole after de-screwing me because of all the bone slivers still in there. Twice a day I had to pour a bottle of hydrogen peroxide into the big hole in my knee and then watch all the little bone pieces bubble out.

So the moral is, if you feel like something's wrong, don't let them shine you on about it.

losergood2011

Thanks everyone! Shifterbrainz I appreciate the message! I am scheduled for surgery May 19 with a college surgeon who does hundreds a year. I am confident and optimistic. He recommends a cadaver due to age (52) And says he is optimistic as I am committed. Again thanks so much! I tried to blog but is did not upload. I will try again later!

losergood2011

I WILL do well! I WILL make it through :-) thanks so much for the info!