ACL tear: surgery or no surgery?
Hi all
Got a knee sprain in dec 2011 (90kg guy fell on my knee while MMA training), sprain was diagnosed as a minor by ER (no broken bones and i could walk on the knee...ER doc said no need to do an MRI...)
Since the accident, my knee would "pop" on occasion when i would play soccer or go surf , with a minor pain for 2 days, but nothing serious...i would not give it much thoughts as i could run, ride and swim close to my best level (preaccident) with 0 pain in the knee...
Last week however, i twisted my knee yet again but this time was serious as the internal meniscus "popped out" and was pinched between the bones so i couldn't straighten my leg let alone walk on it...a chiro friend of mine worked his magic and popped the meniscus back in (99% of the pain subsided immidiatly) but can feel some discomfort when walking or lifting my twins
MRI shows an old ACL tear and internal meniscus tear... 2 surgeons checked my MRI...1 said i should get that ACL repaired (he is a back specialist)...the other (who is a "knee specialist") said that based on the "MRI only" he was about to tell me to get that ACL fixed but after a 30' talk with me, he's not so sure, as i did 2 full IM and 4 halfIM with the "unstable knee" with no pain or discomfort in the knee. The knee would only be a problem with sports that or not "inline" (soccer, surf, breaststroke swimming, etc..)
the "knee surgeon" says i'm in the 5% sport junky who tolerates an ACL tear very well and should probably try and go on like this as long as i stick to "inline" sport (althought the unstable knee would "grind" at the meniscus and cartilage more quickly)
He says he can repair the ACL and get my knee strengh back to 100% but says at 39YO, he can't garantee i can be back to the same level of running performance...He said if i was 29, that would be a different story...
so i'm kind of lost, should i get that surgery and crawl my way back to fitness with no garantee or should i just get some weeks of runjail and go on with an unstable knee?
I know a lot of u guys had acl surgery (or similar) so i'm hungry for your feedback
surgery pros and cons:
Pros:
get a "stable" knee, allowing me to play soccer and go surf with my kids (major pro for me)
slowing the "grinding" of the meniscus and cartilage, delaying the knee arthritis
getting a lot of time off the Knee that might allow the meniscus to heal
cons:
no garantee i can get back to a decent running level
doc says 1 year OFF serious training (running intervals) (although Kori is showing us that's not the case)
spending time in hospital, not being able to help with the kids
any thoughts, advices are welcome...
thank u all
Comments
If it were me, I would avoid surgery for as long as possible, AS LONG as I could maintain the activities that I enjoyed. As far as not getting back to a decent running level... I have a little different opinion than your doc. I know that no two surgeries are the same and no two people heal up the same, but I know the mentality of most of the people on this forum and the hard work they are willing to put in. With ACL surgery, the surgery is a piece of cake, the rehab is hell. If you treat rehab like training for an IM, I believe you'll be fine. I've set a PR in every distance from the mile to the marathon within the last two years of my life. I have things that are holding me back, but it not my knees.
I wish you the best with your decision.
Good luck!
1. All of the long term followup studies show that folks who have an ACL tear develop arthritis of the knee significantly earlier than they otherwise would.
2. The purpose of the ACL is to prevent the bones of the knee from moving in an abnormal fashion (the "grinding" that you mention) and if the ACL is not intact, you may continue to function in certain activities by strengthening the muscles around the knee but that does not restore normal anatomic function.
3. If you have a meniscal tear that is unstable and has locked your knee, it is likely that it will recur and/or worsen over time if not addressed. If you are going to have surgery for the meniscus, it would seem reasonable to do the ACL reconstruction at the same time. The meniscal tear is likely from the fact that the knee is moving abnormally and will most probably worsen if untreated.
4. ACL reconstruction is typically an outpatient procedure so there is really no associated overnight hospital stay.
5. The bit about guaranteeing that you will get back to your full run potential is a problematic statement. There is never any guarantee on stuff like that and anyone that suggests that there is is misleading you. He also cannot guarantee that you won't spend months in run jail and then have the problem recur and need surgery anyway.
So, If it was your car and the motor was making this funny clanking noise in the motor that comes and goes, would you drive it until it breaks so you can't drive it at all (and possibly do worse damage) or do you get the problem addressed and potentially prevent further damage. That is pretty much the philisophical question that you have to ask.
If it was a potential crack on your carbon bike frame, would you look at it and say "looks ok to me, I will ride it and see what happens" or would you get it fixed?
In a couch potato, no discussion, leave it. In a 21 year old athlete, no discussion, fix it. I would suggest that you have more in common with the athlete and since the off season is coming up, If it was me (and I'm 50) I would have it fixed.
Nobody ever wants surgery and the timing is never convenient but many folks don't understand that the potential problems from not fixing things can be much worse in the long run.
Hope that helps,
Good Luck,
Ralph