ACL full tear – what’s the prognosis

My 15 year old lad is a footballer & during a pre-season friendly he suffered a knee injury. That was 6 weeks ago.

We’ve just had his post MRI scan appointment to be told it’s a full tear of the ACL & a couple of tears to his meniscus.

Naturally he’s gutted; it’s early days yet & we haven’t seen a physio or know what the next steps will be. The Dr was talking about a “normal life” without an ACL but not sport. Sport is his life – particularly football & snowboarding.

How do I get his chin up? What do I say to a lad who’s whole life, including his choice of GCSEs & potential A levels has been towards a life in sport?

Also, does anyone know of how likely he is to get reconstructive surgery? The Dr said that “might” be an option, but seemed to gloss over it quite quickly.

Lastly, has anyone got some good news stories, anecdotes etc? We could do with a bit of a silver lining to this cloud.

Don’t know how positive this is but Brendan Fairclough talks about his ACL injury here: https://www.youtube.com/watch?v=09nhy208g-Y and he’s still riding pretty well.

Sounds a lot like my ACL rupture. Left acl rupture, tear in the miniscal cartilage and sprain/strain to all the other soft tissue in the knee.
Initial injury in March 2022 & reconstruction in February this year. I’m just back to martial arts now having been back on bike 5 months post surgery. All feels nearly normal and should get better as I ramp up the exercise.
I’m 50 and according to the consultant physio I saw at the first knee clinic, at the upper end of the age range for reconstruction. Orthopaedic consultant was fine to do the reconstruction once I explained I wanted to get back to martial arts.

After the initial injury it took 6 months or so to settle down enough to start prehab at the gym & I think it was 3 months or so and I was back doing gentle cycling (don’t mention riding the Macavalance with a heavily strapped knee 2 weeks after the injury).
Anything that involved twisting was out though.

If sport is his life I’d push for ACL reconstruction, especially if its football and snowboarding as you need a stable knee for that.
A word of warning, the first 6 weeks post surgery are hell. I seriously wondered why the **** I’d done it given the step back it felt like but 38 weeks down the line I’m glad I had the reconstruction.

For a non sporty person the knee will heal well enough for daily activities.  Stabilise it with exercises and so on

For a sporty person?  the reconstruction is needed to continue being sporty.  However as above rehab is difficult post reconstruction and at 15 he is still growing – I have no idea how that affects reconstruction.

A classic NHS issue.  Being well and fit enough for your daily activities is enough.  You will probably have to push hard to get a reconstruction would be my guess.  You could emphasise the mental health aspect which might help

I had my ACL reconstructed at 40. Drs said I was about on the limit for surgery age wise. Your kid should certainly get it done he has a whole life ahead of him. Don’t accept no as an answer. My physio said I should get it done… so I did.

I’m 59, I’m coming up to a year post ACL reconstruction. I had to get a second opinion to get the op (encouraged by my physio), but the surgeon who did it said he’d routinely done it on active people up to 70 with good results. Rehab has been hard but my knee now feels almost as good as pre injury, and crucially much more stable. It used to give way on me quite often before.

Your son shouldn’t have to have the door shut on his sporting ambitions at that age. You are entitled to a second opinion.

AFAIK it’s normally a surgical repair unless the risks outweigh the benefits.
ACL repairs are long rehabs unfortunately, about a year. Not sure at which point he’d be returning to sport, but I’d imagine it would be before the year is up. Apologies to be so vague, it’s a little outside my area

My daughter’s now 15. 18 months ago she blew her ACL playing rugby (and then playing on, and then going swim training). She had some months of physio to get her muscles back into shape then she had her ACL reconstructed. She’s back playing sport and swimming competitive all strokes including breast stroke which puts most strain on the knee.

As she was under 16 she needed a paediatric knee surgeon so had to go to Oxford but other than that, no problems. She’d already stopped growing, girls tend to stop earlier than boys so that may be a factor. Don’t accept “normal life without sport”.

I was feeling left out so blew my ACL this summer falling off my MTB. I’ve been given the “normal life without sport” lecture but I’m going back in November to get booked in for reconstruction. The way I look at it is that without an ACL I’ll always have a weakness in that knee and I’m young enough still at 59 to stand the operation. I really, really don’t want to have to give up riding my MTB and just stick to road…

I wish your son good luck, if he wants to talk to my daughter about what the reconstruction was like I’m sure she’d be happy to do so.

If I was in your shoes I would find a well respected local sportsfysio and get an appointment asap. They can get his rehab started and advise and support you in your NHS journey. 

Returning to football is trickier than snowboarding, from my limited experience on a board your knees are pretty stable, skating the board in and around lifts will take a bit of care but all doable. 

I’m pretty sure a fair few professional footballers have had this injury without it being career ending! 

Good luck!

Lots of ways to properly fix an ACL these days – I had some of this action to help hold my ankle together

Knee injuries

Not sure if it’s on the site but there’s a very interesting study about him putting a pro snowboarders ACL back together and the guy doing an ultra marathon within 6 months (maybe less)

Thanks all, that’s all very reassuring 👍🏻.

I would find a well respected local sportsfysio and get an appointment asap. They can get his rehab started and advise and support you in your NHS journey.

Already booked 👍🏻

it’s just a real shame it’s his GCSE year; he’s already been visiting colleges with a view to A level PE, and he’s just been signed for a decent football club. One of his problems will now be evidencing his performance towards his GCSE; without that he can’t get the grades to go on to A level. We’ll hopefully get a meeting with his teacher this week. We’re happy we can evidence years of football for his team sport (trophy’s, medals, photos etc. plus he played for the school team), and we’ve got quite a lot of snowboarding footage for his solo sport, but we’ve got nothing for his 3rd sport. Ah well, mustn’t get ahead of ourselves. Again, thanks for all 👍🏻

I have an internal brace from the Mackay clinic and can very much recommend it. After living without an ACL for 10 years following an NHS miss-diagnosis and then essentially needing to be on my feet for work, the traditional surgery has too long a rehab. Had it fixed end of 2019 (just in time eh!) Surgery end of November, walking in two weeks, longer walks of 5k mixed terrain by Xmas day, on the bike by lockdown, decent length 70k+ MTB rides including singlespeed through that summer. Sitting here three years later and it hasn’t felt better since 24 when I did it. Running off road, loads of MTB, snowboarding etc all spot on.

Their speciality with the surgery is essentially ‘you do sport and want to pretend this never happened, and quickly’

It cost about the same as a posh bike, or a mid range ebike, and I would spend it again.

If travelling to Glasgow is too far, he was training other people in 2019 so should be available other places now, and there were early trials to offer it on the NHS, so worth looking into it.

I had this 2 years ago, my faith in the capacity of the NHS has been dented over the years so I’ve paid more than once to see a private consultant, discussed the options and asked to be put on their NHS  list (having checked in advance that they work in both public and private sectors) . This worked for an arthroscopy 10 years ago and more recent ACL rupture. It took 6 months for the latest op to come through.

The caveat on the recent one was that it had to be done in the private hospital so the NHS would have a recharge for the operation, consultant and anaesthetist etc. Had to make it clear that I was desperate to get back to sport and it helped that he did running and mtb so understood.  To be fair to my NHS doctor she was happy to refer me to the same bloke through NHS but it was clear I would be waiting a lot longer.  Consultation cost about £250, small price for health.  Got to commit fully to the physio afterwards, took 5 months before I was back on a bike, 10 months for running, a year to be riding without fear of buggering it all up again. Good luck with getting  him back to full health.  

i had a acl reconstruction in 1992 after getting cannonballed in a rugby tackle.

it was about 9 months before i was ok to play again.  strict physio worked for me, as with all my surgeries.

i was 26 when i did my knee, and played my last proper game aged 40.  knee aches like heck as i have bad arthritis, but has never stopped me doing anything.

tell your lad he will be able to play footy again, once the knee is fixed.

👍🏻👍🏻

What level does your son play football to ? ie is there any club support to go privately?

Its very difficult for anyone on here to give a prognosis without being a knee surgeon or knowing the full extent of the injury

As has been said above the NHS is there to get you back to ‘normal’ life. If you want above and beyond that you have to pay for it.

There are knee specialist in the NHS who work with sports professionals. What part of the country are you in?

As has been said above the NHS is there to get you back to ‘normal’ life. If you want above and beyond that you have to pay for it.

Not necessarily will you have to go private but you will have to make a case for reconstruction rather than conservative treatment

TJ yep agree but unfortunately with back logs as they are it’s unlikely that optimal treatment is going to be offered. By that I mean surgery and rehab

Op does have the option to go to nhs trust of choice for treatment unfortunately with that the knee surgeons with sport’s interest will have long waiting lists.

Op may be in a centre with a good knee surgeon and will get optimal treatment. If I were op I’d be researching their knee surgeons history

As said above, I had an ACL reconstruction just under a year ago at 58. This was on the NHS. I did have to push for it. The first consultant I saw told me I was too old. My NHS physio encouraged me to get a second opinion – she actually organised it for me.

The second consultant was night and day different and actually took the time to listen to me. I explained that I had been very fit and active before  the injury and it was really affecting my fitness, mental health and quality of life. I was clear that I wanted to return to riding mtb, running, weights and hill bashing. All of this was true.

I have learned that you sometimes need sharp elbows when dealing with the NHS. The squeaky wheel gets the oil.

My experience of a full tear was that it would definitely not support normal life, my knee would ocassionally feel like it didn’t line up properly and I’d end up on the floor in pain and it would take a couple of days to be able to walk comfortably again. I tried to live with it for a year, as the doctor in the A&E told me it was just soft tissue damage and I’d be fine. It wasn’t fine. Got a reconstruction, 9-12 months of physio, good as new.

Back in 2004 when I was 26, I snapped my right knee acl, damaged meniscus and partially tore the medial ligament.

The doctor advised that I changed my lifestyle and didn’t have surgery.  I asked to have surgery against his advice. In the meantime, I was put onto a course of ‘circuit training for knees’ at the hospital.  This went on for two years before I had the surgery.  During this time, my knee got stronger but would still occasionally buckle.

I had the surgery in 2006 (hamstring for the new ligament) and post operation, you have to be very careful.   6 months of very gentle exercise and about a year before I’d say it was fully healed.

Things to note, although my knee is fine for walking, running, biking etc, I have never played contact sports again and have never skiied or been Snowboarding since.  I don’t fully trust it and don’t want to go through it again. Also, the two years waiting for surgery meant I was overcompensating for the injury and this damaged the meniscus in my left knee.  A meniscus clean up on the other knee followed.

I my experience, surgery works, but an injury like this, going forward, will affect him.  It’s never back to 100% and will always mentally be there.

My son had the same injury aged 16 playing football. The NHS waiting list were going to prioritise him as he played gaelic football and soccer at representative level – so that was only an 18 month waiting list. If it had happened playing gaelic they would have covered the private bill but as it was soccer training with his local club we had to cover the £7k bill for surgery! Going private meant a wait of only 3 weeks post diagnosis. He had a hamstring graft from the same leg and it probably caused him more issues getting back to fitness post surgery. His physio was very experienced with this type of injury and while an adult could be back playing anywhere from 6 to 9 months for someone under 18 a year was the recommendation. My son was great with his rehab despite a few hamstring pulls but we found that when he was ready to play that his peers had moved on rapidly in their development and it also took him a few months before he trusted the knee (I’m not sure he’s still 100% there, trust wise 2 years later). He’s not playing at the level he was before, his education comes before his sport now – his choice, but I’d be fairly sure it stopped him getting to where he would have been without the injury. I’d recommend surgery but be aware that it’s a long road back again esp at his age. Good luck with it – also donor (cadaver) ligaments are an option

East Midlands & unfortunately no support from his club at his age group, though there may be an insurance scheme that may help with rehab down the line.

As an aside to the physical injury, my biggest fear is his mental health. He’s had a few set backs over the years and has a genetic condition, which affect his growth & immune system, & moods if he doesn’t take his medication properly.

As a result of this condition he’s already stopped growing. Trying to look on the bright side, this may encourage his Dr to put him up for reconstructive surgery. That is, he’s not going to complicate matters with a growth spurt.

Just as a counter point to some of the above. I had mine done at 18 with a graft from the patella and I snowboarded/ski’d/mountain biked/got pissed and never had an issue post rehab. It does take quite a while to really feel confident in it again but you do get back to it. I’ve never heard of someone getting back to normal sporting activity without the op.

That is properly bad luck, but he should be able to make a full return to sport following a reconstruction. Younger folks seem to make a speedy recovery. My lad’s mate did similar playing rugby, back in under a year.

Surprised you’re being told that he can manage without ACLR, but that seems to be a stock response, and you need to lobby to get the op. Depending on his mobility he may have to do some prehab prior to the op, or if mobility limited by the meniscal tear, you might want to push for the op sooner to reduce muscle decline and then go for the rehab.

I’d navigate your local facilities and work out how to proceed. I’d be tempted to go straight to a good knee doc in preferenec to a sports physio, but you might get a good recommendation for a surgeon to approach.
You might find that the NHS has some dedicated orthopaedic treatment facilities where they are just managing hips, knees etc. If you can find a knee surgeon who works privately and within such an NHS facility, you should contact them to discuss (even if you do this privately) whether they would support an ACLR for a young athlete. WHen you find someone saying yes, you might then find that they can make sure you get the referral into the NHS facility and it happens relatively quickly.

(this system worked for me, told within the NHS that I was too old (familiar story to others on the thread), but was recommended a knee doc who worked across the private sector and NHS orthopaedic facility, and he was happy to operate, saw him for a private consult about my MRI, and he was able to get me into the NHS facility as otherwise they would have had unused theatre time. I had to have a discussion with the local muskuloskeletal referral team and they were easily persuaded to agree to that course of action)

Good luck, I hope he gets the op and is back on the field soonest.

“Normal life without ACL/sport” is nonsense (especially as an immediate outcome). Anyone who expects you to just settle for that is letting you down.
Obviously you should be polite and constructive as you push/lobby for better.  But for the avoidance of doubt, keep in mind that you are in the right here:  that’s not a reasonable default outcome for a sporty 15 year old, you are absolutely right to push for more.  Don’t let anyone make you feel otherwise, and if anyone does, find a way to talk to someone else.
I’m parent to a sporty teen, it means so much to them.  I’d be absolutely gutted if I was expected to swallow that…but I’m also conscious that (deliberately or not) some of the people you deal with in these situations can make it feel like you are being demanding or awkward, which makes life harder and makes it more work to get what you want.  Don’t let them.

Colleague did one recently (~2 months ago). Fairly handy sprinter in his youth, always remained sporty, etc.
NHS were a bit useless, apparently it was all “some physio and you’ll be fine to walk up and down the high street.”
Went private, because company insurance policy covered it – got a scan immediately, and surgery scheduled in very very quickly after.
Reconstructive surgery is in around a months time, so 3 month timeline for him.
He’s being advised it will never be quite 100% but will be very close.

Obviously I can provide only third hand experience here, and he’s not yet done with it.

I can only suggest to push the mental health and sport aspects as hard as possible. As someone said, the squeaky wheel gets the oil…

Had a bit of good news; took a call yesterday for a hospital appointment tonight. A further examination & instantly booked in for his meniscus repairing in next few weeks, with a follow up some weeks later for the ACL op’.

We’re all much more positive now. Only issue so far is his quads have switched off so requires a fair bit of physio “prehab” to get those firing again. Been told 6-9 months after a successful hop test before any competitive sport. So with some hard work he’ll see the start of next season.

Good news (comparatively)

Does he play at academy level, if so are they keeping him on contract?

No he doesn’t play for an academy, though they do play against academies in their league. He’s a little too private to openly discuss his dreams but I’m fairly certain that he was hoping to be spotted this year.

On a plus note he’s shown an interest mountain biking with me, which would be brilliant, but also because it’s one of the things he’ll be able to do sooner than later. Plus it’d be good to see him ride again – his first sport was BMX; he did a season at our local club and never finished below 3rd. However, it was his nerves & that knowledge that it was “all down to him” come the final, that made his head fall off and cause us to find him a team sport. So to see him ride just for pleasure may pull him back towards biking.

good news that,  he will be ok. strict physio, and strict parenting, not letting him play too soon.

easy to get talked round by team mates.

also,once op has been done and physio is in place, swimming and aqua aerobics is ace for knees.

My son did his playing football when he was 18. He had a patella repair (supposedly less likely to relapse that a hamstring tear) and took about 14-15months of very intensive physio to get back to playing at his previous level