Riding without an ACL

Colleague road hard without an ACL for 7 years. But football took its toll so he had the opp in the end. Full strength now

Would not the additional wear and tear from walking etc cause issues over time - bear in mind you'll be hike a biking etc, climbing over rocks with the bike, and twisting and turning - the MTB would worry me more.

Currently 27yrs without a ACL in my left knee. In that time I've MTB'd all over UK/Europe, road raced to a high level, walked, windsurfed and done plenty of other things. I keep up the strength in the leg and gave up football/squash/running when I bust my ACL. I try not to do any big step downs/jumps when walking but otherwise I'm fine. No pain. I'd suggest a knee support when you are riding MTB in recovery. Off to ride the Haute Route on Saturday.

First of all, every case is different and it very much depends on the stability of your knee, which will be different from everyone. It can be improved substantially with rehab and muscle development around the knee, but some people will always have an unstable knee without an ACL.

I ruptured my PCL, MCL and 50%+ of my ACL in 2019. Bit of meniscus damage too. I was advised not to have surgery at the time (by different top-class knee specialists) but to monitor progress and potentially consider surgery again a year or so down the line. I was 40 at the time and I'm a full-time snowboard instructor and bike guide.

The injury happened in January and I was able to see out the rest of the winter season without missing any work, but I really wouldn't recommend that. I was really struggling and in a lot of pain at times. Fortunately, I could snowboard a lot better than I could walk. I wore a surgeon-recommended knee brace while on the snowboard. I was able to guide on the bike that summer without any real problems - the knee really felt pretty good on the bike, but still struggling to walk properly. No brace on the bike.

The main issue was getting my leg fully straight. Despite constant physio, it took me 6 months to get full leg extension and therefore stop walking with a pronounced limp. Fortunately, both snowboarding and mountain biking are best if you don't fully extend your leg!

It took a full 2 years for the knee to feel "decent" and 3 for it feel good.

TL:DR - it's doable but it might take a long time for the knee to feel good.

There was an article about a footballer competing at elite level without an ACL a few years back, they took the decision on how long he would be out of play if he had it repaired etc. So it can be done! Football is certainly considerably harder on your ACL (or lack of!) than cycling. As above, they compensated for the lack of ACL by keeping all the muscles around the knee as strong as possible. If you already exercise regularly, especially if you are a gym goer, then this will be a fairly easy task for you

I'm 59, I had ACL reconstruction in November last year, having snapped it a year earlier. Prior to the op I eventually got to a stage where I could ride some MTB again, but it stopped me doing a lot of other things. Running, hillwalking etc. It would even give way on me when I just walking normally some times.

The knee specialist I saw briefly was stressed, in a rush and had no real time to listen to me. He effectively said 'you're too old for surgery, some physio is all we can offer'. I started to put on weight and get quite depressed that the active side of my life appeared to be over.

My NHS physio was excellent. She said 'you do know you're entitled to a second opinion? I can refer you if you like'? I got a referral to an excellent consultant at the RJAH orthopedic hospital in Oswestry. The experience there was night and day different to the general hospital in Shrewsbury I first went to.

He chatted to me for 40 minutes, went over my MRI scans and gave me options. He told me he had done an ACL op recently on a bloke in 70s with great results. He was convinced I would benefit from ACL reconstruction and a concurrent arthroscopy. He considered doing my MCL at the same time as that also appeared damaged.

I had the op. Under the knife he found the MCL was ok, so did my ACL and the arthroscopy. 10 months in I am back to full on MTB - I did heaven of the south a few months ago, full days at BPW etc with no issues. I am back to gentle runs and do weights three times a week - including heavy squats and deadlifts.

My quality of life is massively improved. I did stick rigidly to the pre and post op physio which helped.

Get a second opinion, mention the effects on your mental as well as physical health. Have sharp elbows and don't take no for an answer. The squeaky wheel gets the oil. You're not too old. Good luck!

I went nearly 10 years with no ACL, was ruptured while still growing so surgery wasn't an option, then when it was an option I couldn't be bothered with the hassle of rehab again, having just done rehab to get me fit again without one.

General riding day to day was fine, but I regularly hurt it during crashes, and 3 times ended up in A&E and on crutches as a result. Things were noticeably better when I was fit and on top of regular work on leg strength, when I didn't it was more prone to damage.

Over that time professional opinions varied but generally got the impression that most advice on whether "cycling" was ok assumed a bit of bimbling along a canal path and didn't really take into account the stress and strains of MTB.

In the end I got it fixed, because I couldn't be bothered with any of the above on an ongoing basis. Obviously individual circumstances will vary significantly.

Thanks all, I'll see how it goes. Luckily both the surgeons I've seen have been very good in terms of talking things through, I still have the option of asking for reconstruction in 3 months time after the physio.

Quad and Hamstring strength is key. Cycling was very good for recovery and keeping strong (best thing initially was hydrotherapy).
If I dont do any exercise for a bit I notice that my ACL isn't right and i get the odd wobble. Not stopped me doing anything though.

I’m 59, I had ACL reconstruction in November last year, having snapped it a year earlier. Prior to the op I eventually got to a stage where I could ride some MTB again, but it stopped me doing a lot of other things. Running, hillwalking etc. It would even give way on me when I just walking normally some times.

The knee specialist I saw briefly was stressed, in a rush and had no real time to listen to me. He effectively said ‘you’re too old for surgery, some physio is all we can offer’. I started to put on weight and get quite depressed that the active side of my life appeared to be over.

My NHS physio was excellent. She said ‘you do know you’re entitled to a second opinion? I can refer you if you like’? I got a referral to an excellent consultant at the RJAH orthopedic hospital in Oswestry. The experience there was night and day different to the general hospital in Shrewsbury I first went to.

He chatted to me for 40 minutes, went over my MRI scans and gave me options. He told me he had done an ACL op recently on a bloke in 70s with great results. He was convinced I would benefit from ACL reconstruction and a concurrent arthroscopy. He considered doing my MCL at the same time as that also appeared damaged.

I had the op. Under the knife he found the MCL was ok, so did my ACL and the arthroscopy. 10 months in I am back to full on MTB – I did heaven of the south a few months ago, full days at BPW etc with no issues. I am back to gentle runs and do weights three times a week – including heavy squats and deadlifts.

My quality of life is massively improved. I did stick rigidly to the pre and post op physio which helped.

Get a second opinion, mention the effects on your mental as well as physical health. Have sharp elbows and don’t take no for an answer. The squeaky wheel gets the oil. You’re not too old. Good luck!

This is a great story, thanks for sharing!

Thanks. I've had some other not so positive health issues in the last few years, so this was a real boost. The other thing I'd add is that despite everything you hear, I've used the NHS loads recently (5 ops under general anesthetic last year) and they have been superb.

The missus snapped her ACL and tore her MCL and the end of Feb skiing.  She is super strong and was cycling 100 mile road rides in May.     She had it reconstructed 8th June and had just climbed her first col in the Pyrenees today.   She’s not MTBing or walking in the mountains this holiday as she is only 10 weeks post surgery she’s 51.

She has had it done as she wants to be back skiing next season.    Personally i don’t think the risk is worth the reward so many folk I know seem to get injured in “freak” accidents.

Only got one and it's never really bothered me, was bad after I tore it initially but they tidied it up and now it's all good.

I ruptured my ACL in 2016, although wasn’t fully diagnosed until 2019. Initially I was told it was likely cartilage damage and to just strengthen the muscles round the knee to try to protect it.

I play a lot of sports aside from cycling (tennis and touch rugby being the main ones) and I kept having my knee give way when playing touch. I eventually got a scan, etc and they confirmed the ruptured ACL. I’d managed to keep up all my sports over the 3 years between injury and diagnosis, so the specialist said not to bother with surgery if I was getting on ok. I wear a knee brace now when playing touch (just competed in the European Championships for Scotland M40 team last week in France), but for anything else I just get on with it and have had little to no issues. Have done MTB, long road cycles (Lejog, NC500), trail running, including a few munros, and tennis and have got on ok.

My leg muscles have always been fairly strong as I’ve done a lot of exercise since I was a teenager, so maybe that has helped overall.

I have had setbacks, mainly when taking things a bit too far at touch - currently limping a bit after a knee wobble last week which the knee brace didn’t fully stop. However I played 7 matches before it happened with no issues, and have played and trained for a few major tournaments since 2019 with no issues.

@stevomcd speaks the truth. My right knee has progressed to pretty much his level of ligament damage and finally ACL let go a few days before going out the Alps. He did notice that mine wasn't working properly but I still rode happily with Rab.

Both mine are damaged to the extent that I can't carry a brew without spilling it.

Haven't had them done as I'll be getting new knees sooner rather than later.

Can't say I notice it much whist riding, but football is an avenue of pleasure down which I no longer stroll. 😶

At least it's taught me to carry less stuff on my back whilst out in the hills.

<p style="text-align: left;">In short, you can, yes. I did for 10 years. Then got sick of it and had one of these to minimise recovery time and get back to work.</p>
https://www.mackayclinic.co.uk/internal-brace-in-depth-the-knee/

Walking after two weeks, back at work on my feet after three and mountain biking singlespeed rigid round dunkeld in five months.

Now three years down the line and so glad I had it done. That surgery is very different to traditional.

^^ is that Gordon Mackay ? He did a few knee arthroscopies for me 10 years or so back, at Ross Hall.

He does a lot of footballer injuries, I always chuckled at his RS8 parked outside with the number plate           4 ACL…

It is indeed. He's a nice fella. Pioneered the method and now teaches it to people from all over the world. Rolling out on the NHS as well.

Interesting thread and cheers @blokeuptheroad for your insight. I crashed into a tree last Christmas, landing awkwardly with a loud crack in my left knee and figured I’d damaged my MCL - in the States at the time so self-treated with duck tape and a Walmart knee brace 🙄 On return to the UK a month later my physio diagnosed an ACL tear with a positive anterior drawer test. I was referred for an MRI with a view to repair but the request was refused due to my age 😬 I was given the opportunity for an Ortho referral but as I spend 50% of my time Stateside I figured I’d stick with the physio route.

Fast forward 6-7 months and I’m still riding MTB and BMX with a knee brace and keeping up the strengthening exercises but the intermittent limping is getting me down and I’m starting to notice quads wasting on the injured side. Any exercise advice would be much appreciated - I’m back in the States right now so keeping pretty active with yard maintenance, but have noticed my knee giving way more when I don’t have the brace on (reluctant to use it too much unless I’m riding as I don’t want to become totally reliant on it).

I tore mine 20 yrs ago and had surgery. MRI after median meniscus tear 5 yrs back showed the repair was gone (screws but nothing between them). No problem from cycling but a very long walk/hike can cause pain later or the following day. I tried 5 a side soccer a yr back, despite wearing a brace the pain the next day was awful. So cycling with either flats or spds, no issue. Other exercise causes pain.