ACL Repair
Need some advice and we have a wicked amount of knowledge in the group, so looking for input.
Background:
I was hit by a car on June 6 and launched into the air, smacking into a metal gate and landing stomach-down on a concrete block. Up until that day, I had been having an awesome training build, heading into the World Long Course Champs in Sweden and then IMWisco. MRI confirms that my ACL in my right knee was RE-torn. Yep, I had surgery on this knee 15 years ago. It's been crazy strong since with NO issues. The tear this time was "clean" meaning it was done on impact and "sheared" with no weight bearing. Hence, no additional cartilage or meniscus damage and minimal swelling. To be honest, the pain/swelling/bruising in both my quads from the impact is more of a limiter to training than anything, but I'm working through that with PT and ice.
Plan Moving Forward:
I thought I would be in awful shape after that, but about 4 days later I swam and went for a long-ish walk. 5 days later I swam 2700m. 6 days later I rode indoors for 2 hours and swam 1500m. 7 days later I ran 7 miles with walking breaks to "check in" with my legs. Things still ache, and I'm covered in road rash, but I'm getting there.
My Ortho is one of the best in the country (thank heavens) and we are planning to fix my knee as soon as the skin heals enough to allow him to do surgery. Allograft is the plan (instead of using my hamstring - not a big fan of that). And he is doing something with the Anterior Lateral Ligament too which is the latest strategy with highly active people undergoing repair to add additional robustness to the knee. It doesn't add any MORE recovery time to what he's already doing. Since I have to wait about 2-3 weeks from today, I'm planning to still go to Sweden and swim (4k) and ride (~80miles) and there's a small part of my brain that wants to attempt to run/walk the 18 miles (if I'm gonna be there anyway...). New bike should be done and in my hands by tomorrow afternoon.
Open Questions:
-There's a small part of my brain that thinks I should wait until after IM Wisconsin to get the ACL fixed. I can clearly get back to training rather quickly here and still have enough time to build fitness again. BUT my reservations are mainly this: when I tore my ACL the first time, I waited a year to get it fixed and in that year, I must've "popped my knee out" dozens of times. BAD. Every time you do that, you add damage to an already fragile joint. I have three small kids. I'm super active. I chase them around. Do I roll the dice and see if I can "make it" until September without hurting it more? Will it even be worth it considering I won't be THAT competitive in Wisco? If I delay surgery until early October, we're talking about a return to training early 2016. Which doesn't set me up great for 2016. If I do it early July, by mid-October I'm getting back into the swing of things and getting my fitness back.
-Any other thoughts on this? My mind is reeling between insurance companies, ambulance-chasers calling me 5x/day, doc appts, PT appts, trying to get back to work, etc. I kinda need a mental vaca but know I gotta keep my wits about me.
Thanks for the support, team.
Comments
That being said, either way, I'm sure you will come back STRONGER than ever. Most important thing either way will be to listen to your body and do what the PT and MD say!
This is why not getting it fixed seems like a bad idea. I don't know what the studies were based on, but I'm curious to see how active the people who didn't get it fixed truly were. Sure, you can live a fairly normal life, but with my level of activity, having three very small kids to chase around, and not wanting to do any MORE damage to that joint by popping it in and out all the time....living the rest of my life with no ACL doesn't seem like an option.
I realize non-surgical may seem less severe, but I've already had surgery on that knee, so that ship has kinda already sailed....
Hi Kori - You picked that surgeon for a reason. Have you discussed now versus waiting and your goals (kids + tri) with him?
No idea if you would do something similar, but I realized afterwards that I started debating the surgery timing in my case when I didn't like the surgeon's timing recommendation because it interfered with life/tri plans, not because I disagreed about his surgical recommendation or had any reason to doubt his timing recommendation.
I'm not worried about the timing as in whether it's this month or next month or the month after that. I'm more concerned about whether to do it at all.
I am leaning (probably like 70/30) in favor of doing it, since I don't feel like rolling the dice on my knee popping out.
The doc know the extent of the injury better than any of us, including you. But, having watched some of your posts since you've returned to action, I want to offer my 2cents worth.
Personally, I'm very conservative. I don't like to take ibuprofen unless it's unbearable. Stuff like that. And, I work in the OR. People who work in healthcare are usually on either end of the intervention spectrum. I tend to be on the conservative, less is more side.
I wouldn't get it fixed. But, I stay active and athletic despite my resemblance to that old hound along the rural highway roads that keeps getting hit by cars, takes time to heal, learns to compensate with a limp or something, and still continues to chase the cars.
It may come down to what you expect of yourself and your racing performances down the road.
[Edit: as I reread your posts, it's pretty clear that you think you should get this done. The comments regarding chasing kids and knees popping are legitimate concerns. Therefore, it's a gut feeling to you. I know people that didn't get it fixed and were still very competitive masters athletes and I know people that did get the ACL fixed and struggled after. No way to tell you which way to go. Just opinions. God gave us gut feelings for a reason
]
My 2 cents and PT brain would say some people can manage without surgery however seeing you have a history of previous collapse and choosing a sport where quad fatigue is expected I would think you be at a substantially higher risk for more buckling and collapse,and as you've already stated increased damage. Obviously you won't know until it happens however with the fatigue factor of tri's I would be impressed with your quads ability to dynamically control that knee in a race that long.
-dan
My experience sounds different than yours, as I never had that popping out. I may have thought differently if that had been the case, but wanted to give you an example of someone living ACL-free. Lol.
Good luck whatever you do!