ACL: To Repair or Not to Repair?
HI Steph,
I’ve read your posts on your ACL injury, surgery and recovery.I tore my ACL and I am about to start physio. Although it’s a complete rupture the physio says that it is possible to recover without surgery, though not for some sports which place a lot of stress on the knees, such as contact sports.
My physio is a sports injury specialist, though he isn’t very familiar with rock climbing. It’s not that I straight up disagree with his prognosis, but I want to make sure that my physio is basing the treatment plan on the proper information.
Do you have any advice for how I could explain/ show my physio what climbing involves where your knees are concerned? (I am predominantly a boulderer, but also a sport climber.)
Any help would be much appreciated.
Thanks,
Irene
Hi Irene,
When I first went to my surgeon, he also commented that I could consider not having the repair as one viable option, which I found very strange. With my ACL gone, I couldn’t walk casually on uneven terrain (across steep slopes, over talus and scree) without my knee buckling–this meant not wanting to go into the mountains because I knew I could get into trouble too easily. I also couldn’t pull in with my leg on steep climbs which ruled out a lot of sport routes–at least if I didn’t want them to be automatically a letter grade harder at least. I stopped bouldering because I didn’t want to fall and twist that knee–most climbers I know with torn ACLs have actually done it in a bouldering fall. I was able to skate ski with a brace, but the downhills were pretty stressful and hurt my leg from torquing it in a guarded way, which made me nervous. Landing parachutes was scary, and I would slide in or take all the impact on my other leg. Trail running was fine without the ACL, but that was the only activity I do that was fine without it. If I didn’t climb, jump or go into the mountains, then I could see maybe not getting it repaired, but given my habits, it was really cramping my style.
It boggles my mind to know that many skiers do not get ACLs repaired, because there were so many things I couldn’t do with that leg before I got mine repaired, and I especially couldn’t imagine doing serious downhill skiing and/or crashing on it. Maybe some people have much stronger muscles around the joint than I do? It’s the only explanation I can come up with. I was extremely compromised without mine, but I know that there are people who do a lot without an ACL, though I have no idea how.
So personally, I think not getting repaired would have been a terrible idea for me: my leg didn’t work well at all when the ACL was missing, and now it’s great. I was also getting a lot of imbalance from favoring that leg–my bone density was actually higher on the uninjured side from two years of taking all impact on the good side. You know from my posts that it takes a while to recover, and it took me a full year after my knee was repaired to really trust it and feel at full confidence with it. Now, 4 years later, I barely even remember I had it done, and I’m so glad I did.
Good luck! Steph
there are lots of great comments and suggestions on the facebook link to this post: https://www.facebook.com/stephdavisclimb
Irene, I feel for you, having just had to face the same decision. Something to consider is that non-surgical “recovery” from a torn ACL does not mean that your ACL will repair itself. This is physically impossible because of the way the joint is structured. You can make your other muscles stronger to compensate, but you will always have this weakness in your knee if you do not have it surgically reconstructed. I wrote more about the biology here, if you’re interested: http://kneedtoknow.wordpress.com/2013/09/18/to-cut-or-not-to-cut-that-is-the-question/
thanks Carry, i think you are right–just get it fixed 🙂
My doctor pushed me into having the surgery when I was 15 to replace my ACL, MCL, and meniscus. 6 months later I tore my other ACL and MCL and 6 months after that I re-tore the repaired knee. I spent months on crutches and thousands on a surgery and physical therapy that didn’t work. With the first surgery my doctor promised 80% functional recovery. When he recommended the next two he said I would be lucky to get 50%.
I wouldn’t recommend this surgery to anyone. It was incredibly painful and has caused arthritis in the knee I had surgery on. I was in constant pain for almost 6 years. After working to significantly improve the muscles surrounding the joint I experience little pain and almost no physical limitations.
I was only 15 when I underwent the surgery and I was supposed to have the best chance of a full recovery because I was so young. After tearing both ACLs again I did more research into the procedure to see how common it is for people to re-injure their ACL. I realized that re-injury was so common in young people (mainly women) that I never should have had the surgery in the first place.
You will never regain full function in the knee whether or not you have surgery. But be careful weighing the pros and cons of surgery, especially the time it takes to REALLY recover. And, as with any surgical site where they remove bone, arthritis is a VERY real con.
I run, climb, ski, and hike without ACLs, MCLs, or a meniscus in either knee. Looking back, I never would’ve had the surgery that weakened my body so much that I tore my other knee. And I wouldn’t recommend it to anyone else.
My sister tore her ACL probably 10 years ago and opted to have it repaired. I know the surgery and physical therapy were painful for her, but she has had no problems since and is glad it was done. I know there are different ways to repair it via surgery (different types of grafts), though I don’t know specifics about the different types. I think Steph has mentioned some of these in previous blogs. If you have surgery, make sure you get a graft that will last!
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Steph and all… have you seen this? 97% of humans have an ALL too… previously undiscovered, see this Time Mag story! Could totally revolutionize how they treat ACL issues….. http://newsfeed.time.com/2013/11/06/your-knee-bones-connected-to-your-what-scientists-discover-new-body-part/#ixzz2juitaYQE
Croation Alpine ski racer Ivica Kostelic is still skiing on the World Cup at a winning level after ten knee surgeries! http://www.reuters.com/article/2012/02/12/alpine-skiing-men-kostelic-idUSFYO26166820120212
I tore my ACL 4 years ago in a ski crash and had it reconstructed. I was unable to even do a slow jog, my knee was so unstable. I had it reconstructed and I was very happy with the results, I would say I was back to 85% in that knee. Then last year I re-tore the same ACL (skiing again!) but did not experience the same instability as the first time. I do not plan to have surgery and I’ve gotten back to all of my activities. Even though my MRI results the second time said ‘complete ACL tear’ my surgeon said I likely still had some strands of ACL intact based on my current level of function. So… I would base your decision on your level of function… if it’s limiting your activities the surgery can be very successful!
What makes all the difference in any surgery, is the right surgeon. Surgery may be a skill that most anyone can learn, but it’s also an art, and some people have a natural Ability, And others don’t. This is a delicate surgery, so before you let somebody undertake it or any other surgery on your body, find out who they are, and what Their surgical record is. And this is no easy task, Since bad surgeons don’t get exposed Until they’ve horribly butchered a dozen or more people In most instances and even then they can go on practicing. So do whatever you have to do To find the right surgeon.
I highly recommend Dr. Steven Aoki at the Univeristy of Utah Orthopedic Center in Salt Lake: he is an incredible surgeon
help
has anyone here had a 4th needing a 5th ACL on the same knee within 12 yrs? im only 29
I fully ruptured my ACL in a climbing accident over 3 years ago. I opted out from a reconstruction but my knee was never the same. I experienced something similar to what Steph wrote about. My knee always felt a bit unstable and there were certain climbing moves that all of sudden became very tricky – high knee rock overs, certain aggressive dropped knees etc. I built muscles around the knee and could even kick box again but I never trusted it fully.
Had a bad bouldering landing a few months ago which hurt my menisci. I had to have a surgery to fix my menisci so decided to fix my acl as well – that was 12 weeks ago and the knee is already so much more stable. It’s scary facing an operation and a long rehab but with a good surgeon, good training plan and a positive outlook, it is definitely doable.
Good luck with your healing Irene and thanks Steph for sharing your ACL story!
20 days back, I ruptured my ACL (Third Grade Tear). Today, I performed some basic ACL tests like Lachman and Drawer tests with the help of a friend and the knee seems stable (I think). I also tried to walk on an inclined plane and every thing seems ok. However, I cannot run like the way I used to run and I still have some pain on the back side of my knee. Should I go for MRI for the confirmation. I cannot understand because I read online that once ruptured the ACL cannot reconstruct without surgery. Then why my knee is still stable?