ACL Surgery--To do or not to do?

i don't know of any athletes who have continued to compete after tearing an acl, but i do know of a few adults who tore their acl as young adults and never had them fixed. they seem to be fine, but obviously aren't able to compete in any serious manner of sport.

the acl gives the knee stability; if it is torn completely through, the risk is the knee collapsing and causing more severe damage. that said, i don't know what the risk in a sport like xc would be exactly. there isn't any lateral movement--the danger in general for tearing knee ligaments--but one wrong step could mean much more serious damage.

Depends if she is a coper or non-coper (look it up, but basically some people quickly adapt and function normally without the ACL for stability) but in my experience, most high school girls are non-copers and need surgery. Waiting increases the likelihood of damaging the joint due to decreased stability and will encourage bad habits that she's using for compensation.

Thanks for these two responses. I think they'll jump on the "copers" vs "non-copers", but both responses warn about possible ramifications.

do

Hines Ward.

Anyway, nobocy on these boards knows $hit. HAve your daughter see a great orthopaedic surgeon. Ask him or her your question. Then find another great one and ask him or her.

where do you live? If by chance you live in the DC area, Dr Matt Levine was an outstanding track athlete (400m oly trials) and will understand a runners desire to not operate and just run if possible. He is fellowship trained in sports med at Duke and is VERY highly regarded in the area. go see Dr Levine or someone like him.

Unfortuanately we're nowhere near DC, but have a few great knee surgeons because of our proximity to some great ski areas.

- revisions never do as well

- most acl's are done by Dr's who only do 10-20yr and "sports Drs" average about 50-70, go to someone who has been in practice at least 5yrs with a fellowship

-depends what her future athletic plans are...yes you can wait till end of season if no meniscus or cartilage defect and no gross instability meaning it gives out spontaneously and frequently.

-most young people who are athletic should have acl done

-graft choice can be tough... i like achilles allograft even for a young revison

Choice of surgeon matters a ton - don't just go for convenience or a shorter wait time to get back to a high school level sport sooner. If you have access to top knee surgeons that work on high level athletes and specialize in this sort of reconstruction wait to see them. The success or failure of an ACL reconstruction depends a great deal on establishing the proper angle of the tunnel that they run the new ligament through. As a Physiotherapist who routinely rehabilitates ACL reconstructions, I can definitely see a significant difference in the quality of repairs from different surgeons.

Also to echo what an earlier poster said, the lack of an ACL may lead to further injury (meniscus tearing/degeneration) as well as earlier onset of osteoarthritis later in life. Likely if she decides the forego the surgery to remain on the team for the season, her performance will remain poor and she'll end up needing the surgery anyhow. Full rehabilitation is supposed to be 9+ months, so if she wastes time now she'll probably miss next season as well.

medrunner wrote:

- revisions never do as well

- most acl's are done by Dr's who only do 10-20yr and "sports Drs" average about 50-70, go to someone who has been in practice at least 5yrs with a fellowship

-depends what her future athletic plans are...yes you can wait till end of season if no meniscus or cartilage defect and no gross instability meaning it gives out spontaneously and frequently.

-most young people who are athletic should have acl done

-graft choice can be tough... i like achilles allograft even for a young revison

Medrunner: why do you like the achilles allograft? My surgeon is recommending hammy graft but I feel like getting a 2nd opinion. Adrian Peterson opted for patella graft and everyone knows about his great comeback. Thx.

acl tear1 wrote:

Medrunner: why do you like the achilles allograft? My surgeon is recommending hammy graft but I feel like getting a 2nd opinion. Adrian Peterson opted for patella graft and everyone knows about his great comeback. Thx.

The achilles tissue is going be stronger.

The gold standard at this point bone-patellar tendon-bone, however this can lead to increased anterior knee pain. A 4 strand hamstring graft has been shown to get just as effective. Don't get the 2 strand hamstring graft, not quite as stronger.

AD is not a good example; he's a freak, in a good way.

Most of the surgeons with whom I work perform the hamstring graft, with a cadaver graft every now and then.

Any word on the OP and the daughter's teammate?

Well, acl reconstruction failed yesterday. Reason is because my hamstrings had prior injuries (tendinitis, strains). Semitendinosus failed during harvesting and gracilis failed during tension test. Surgeon recommends using cadaver tibialis anterior for the next try. Not sure when. You'd think they would ask for history of prior injuries when considering which body part to use. Meanwhile, I'm losing valuable training time.

You knew you had prior injuries and still thought it was a good idea to harvest your hamstring? Don't blame the surgeon for that.

I wanted patella graft but decided to trust doc. I wouldn't say I'm blaming him...just saying the previous hammy injury question should be asked. I didn't think to mention it since I didn't think it would be an issue. Those injuries happened years ago.

I tore an ACL skiing. I had a diagnostic scope and a little debridement and NO Repair. Recovered almost completely within the first 6 months. Full confidence in lateral stability for tennis, skiing took years.

I tore the other ACL playing racquetball. The knee remained unstable. It would collapse frequently when I would simply pivot in daily life. To prevent early degenerative arthritis and improve life quality I had reconstruction with my own Patellar tendon.

I never fully regained quad strength despite a very motivated and dedicated rehab. I also lost proprioception over my entire knee for years. And I had a post op DVT/PE

Neither knee worries me running even on technical trails.

I ski but avoid difficult terrain particularly if fatiqued. I coast when playing basketball or tennis.

YMMV

Thanks. That gives me hope that 30% could be enough. Sorry your other knee didn't cooperate.

I failed to heed my own advice of avoiding difficult terrain while fatigued while skiing.

3 days ago I tore my ACL. Funny how quickly the mind can process things. I felt it tear and pop. Before I even hit the ground I contemplated: getting off the mountain, getting home, work, surgeon consult, PCP consult, surgery and rehab.

Oh, no! Sorry to hear it. Keep us updated on your progress.

Well, it's been almost 1.5 years since the surgery and I can run. But, my hamstring is very weak. I used to warm up with 14 second 100's and now I can barely run 18's. I'm up to a :75 400 vs. 58 seconds. If I had to do it all over again, I'd pick cadaver.