Home Forums Chat Forum Grade 3 ACL tear: what are my options?

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  • Grade 3 ACL tear: what are my options?
  • spicer
    Free Member

    Last week I went skiing for the first (and probably last!) time.

    It seems that I’ve got a complete/grade 3 tear of my ACL after a crash (on the last day of course). I saw an orthopaedic knee injury specialist today who showed me some movements definitely not normal for a knee and shin (and drained a lot of fluid out of it), with an MRI tomorrow to confirm.

    I gather some people proceed without surgery even with a grade 3? I just thought I’d see if anyone can share their experiences of the same injury, and thoughts on surgery vs not.

    An initial chat with the consultant suggested that without surgery I would struggle with the injury in the long run, particularly for the things I like doing (dh, steep trail running and big days out hiking/backpacking). I’ve heard a few stories of people who develop early arthritis post surgery, as well as those who have had no issues even without surgery. I’m 31 for context.

    Cheers!

    anorak
    Full Member

    ACL full tear – what’s the prognosis

    This may give some useful info. Good luck with the rehab whichever path you choose!

    2POC
    Full Member

    Did the same when I was 30. Had surgery then 9 months of proper rehab. I’m now 46 and knee is fine. I continue to Ski, MTB, CrossFit, football, run, hike. I’m sure others have horror stories but for me it’s been all good.

    dlabz
    Full Member

    I ruptured my ACL early in 2016 and didn’t actually know as physios suggested it was cartilage damage. After my knee recovering I’d go back to sport and I’d end up with it “collapsing” when side-stepping or putting a sideways load through it. When it was recovering I’d wear a knee brace and then stop wearing it when it was “better”.

    Eventually I got a bit fed up of the issues and went to see a specialist who got a MRI done and confirmed the ACL was ruptured. This was in 2019. She said as I’d managed to continue doing all the sports I like to do (more on that in a minute) I could elect not to have surgery and then if I found it causing issues further down the line I could then do so.

    I’ve been able to keep going with all my normal sports. I’ve never had any issues mountain biking, cycling, or running, and I’ve done some trail running/Munros with no problems. I play tennis and that’s been ok. The only sport I’ve had issues with is touch rugby, as there’s a lot more lateral movement. When I play that I wear a knee brace. I’ve played in the last few European Championships and have the World Cup coming up this year, and although it is just age grade level as opposed to the open teams, I’ve got on fine.

    I also went skiing this year for a week with no issues. I wore the knee brace for that as a precautionary measure but never felt there being any issues.

    I have a friend who ruptured their one years ago and, at the time, was playing for the Scottish women’s rugby Union side. They recommended not to get surgery and she went through a strengthening regime of all the muscles, etc round the knee and went back to playing international rugby.

    And maybe better to rupture your ACL on the last day of your trip rather than the first!

    1
    sprootlet
    Free Member

    Everyone is different is the honest answer. Some people will have significant stability problems and others (once recovered fro the initial injury) seem to manage perfectly well.

    There is not a right or wrong answer, early onset of arthritis can happen regardless of surgery. It seems more dependent if there was an associated meniscal injury.

    A good knee ACL knee brace can be a game changer (that allowed me to play tennis, without it I couldn’t hit a backhand).

    Personally, I would try rehab fist and see if that was sufficient to allow me to do all my activities, if it didn’t then I’d consider the surgical route. Rehab will not be wasted as it will put you in a better position if you do require surgery.

    The rehab post op is 6 months long (for return to everything) and absolutely essential. If you cannot commit to this then do not have the surgery, you will not have a good outcome.

    spicer
    Free Member

    Thanks folks.


    @dlabz
    was yours a complete (grade 3) or partial?

    Good note on the physio, I can feel my muscles working hard to keep it stable as it is, so I’m thankful for having strong legs anyway. I’ll discuss this option with the consultant when I see them next.

    joefm
    Free Member

    Get on with physio as early as possible.  even pre surgery If you can move it. Hydrotherapy was really good.

    dlabz
    Full Member

    @spicer it was a complete rupture. I did it playing touch rugby, and it hurt a bit when I did it, but didn’t get much swelling around the knee and so the physios assumed cartilage damage. When I eventually got it scanned the specialist confirmed I didn’t have an ACL in that knee.

    lamp
    Free Member

    I’ve followed (not in the literal sense!) this girl for a while, she’s recovering from a damaged ACL. She talks through her recovery and physio. She’s also a skier so you should have something in common! :D

    https://www.youtube.com/@DelilahCupp

    1
    dafoj
    Free Member

    I tore mine playing rugby about 20 years ago. Keyhole surgery to tidy it up and did a load of physio to get back, you’re basically looking to build leg strength so the muscles do the work of the ACL. Was all fine until a drunken fall and instability in the joint and surgeon suggested an ACL replacement, which involves grafting some hamstring. Lots more physio for recovery, which was painful and hard, you need to work at it to get the range of motion back. Now 15 years later I don’t notice it at all, done marathons, fell running loads of riding and don’t notice any difference to my good knee. Amazing what they can do.

    mildred
    Full Member

    Just as an update to the other thread on this topic, my son’s is a complete tear plus fairly catastrophic meniscus damage,

    In the words of the consultant “This is as serious as it gets without needing a new knee”.

    The MRI didn’t show the full extent of the damage, which was a root tear; it was explained to me as follows: imagine the roots of a tree – this is how your meniscus is attached to the bone. Your son’s meniscus & all its roots have been ripped out of the bone, so it was just floating around inside. It was also torn almost in half & folded back on itself.

    In the first operation the meniscus has been sewed onto the bone & he’s now 3 months into his rehabilitation. The strengthening & stability exercise regime he’s been given is brutal, & he struggles with it, but the results are slowly coming.

    That said, & this is where it relates to  you @spicer he can now perform most movements  including basic ball skill, lunges, squats & any “closed chain” exercises without any great issues.

    Had he been just a snowboarder or cyclist they would leave it at that & forgo the ACL repair/replacement; the fore-aft movement is now minimal as his muscles are literally taking up the slack, so it’s perfectly possible to have an active life without an ACL.

    spicer
    Free Member

    Thanks everyone, it’s really interesting to read these replies and the other thread.

    I’ve got a surprising amount of strength and stability back over the last few days after making an effort to keep it moving and keep the muscles working, but range of motion is very limited (I’m not sure what exactly is causing that) and I don’t need the MRI results to know there is some damage to the Lateral ligament too.

    However, this small progress and some of the comments here are giving me some reassurance that I’ll get back to normal, whether it’s surgery or not. Let’s see what the scan says on Tuesday!

    sprootlet
    Free Member

    @Spicer

    I managed fine with a knee brace for tennis for >5 years before I went for the reconstruction. I played squash, ran, HIIT and skied with no problems at all (and didn’t need the brace).

    Unfortunately my knee was unstable walking and after it gave way 5 times in less than 1 mile I bit the surgery bullet. Surgeon couldn’t believe I had no problems with squash and skiing yet couldn’t walk to town without giving way but everyone is different.

    mamadirt
    Free Member

    Tore mine with an unplanned dismount almost a year and a half ago. Unfortunately due to my age they wouldn’t even consider an MRI to check the extent of the damage let alone a repair 😔 (diagnosed with anterior drawer test).

    I was 3 months off the bike and with physio regained a good range of movement by around the 6 month mark – probably a little longer before I could kneel properly. Walking reasonably normally now although some days I limp like the OAP I am 😂 and my knee does occasionally give way. I wear a hinged brace for biking (mainly BMX trails) and my strength doesn’t seem to be affected but anything involving twisting movements is definitely a no no.

    Good luck with the recovery and yes, definitely go for the repair 👍

    1
    spicer
    Free Member

    Thanks folks. I just thought I would give a little update: surgery is booked in for mid-may, which gives me time for ‘pre-hab’ to get movement back and for the swelling/fluid build up to go.

    It’ll be a fairly standard hamstring graft surgery, with support from a synthetic brace.

    I’m surprised how much better movement has got in the last week- it’s come along a long way!

    I may have just spent a fortune on LEGO for the recovery period! :D

    mamadirt
    Free Member

    Good to hear. Good luck with the recovery – keep us updated 👍

    1
    spicer
    Free Member

    I thought I’ll update this every now and then incase anyone else goes through this and wants to know what to expect :)

    Surgery was 1 week ago today. They used a hamstring graft and ultratape internal brace to support it. 3x keyhole holes and 1x 8cm cut under my knee, stapled together.

    Pain: Regular painkillers are required! I’m just taking paracetamol and ibuprofen though, which is working well. They gave me Codeine and Oramorph, but I haven’t felt the need to take them, so they’ll go in the first aid kit once I’m back on the bike ;)

    What you probably won’t realise before is how many different bits of your leg will hurt. Your quads will have a hole drilled through them to reach the bone. Your hamstring and calf will be very sore from the hamstring tendon graft. The knee is obviously going to hurt. But the worst of the pain is from cutting/drilling through muscle.

    Mobility: extension is pretty good, which is the most important thing. I can’t bend it much, but not fussed about that at the moment as that won’t come back until the swelling has gone down anyway. Don’t expect loads of mobility after 1 week. It’s just starting to improve a little, but it’ll take time.

    By day 3 I’d basically decided I didn’t need crutches anymore, after getting over the mental barrier of realising you can load bear through that leg still. I carried the crutches about with me for a few more days, but didn’t really use them. Don’t expect to be walking far though- 400m round the block is enough for me 1 week in.

    All in all, not as bad as I was expecting if I’m honest, but a long way to go.

    1
    susepic
    Full Member

    Hi Spicer, good luck with the rehab. As a fellow hamstring graft recipient, take it easy for a little while and don’t push it too soon.

    They probably told you about timescales for the graft, but it takes a while to settle down as the body incorporates it into the knee, and my guidance was that at 8-12 weeks it would be at it’s weakest while that process stabilised.

    Good news is that once it’s settled down you should be back to full fitness within a year or so.

    2
    spicer
    Free Member

    Another monthly update for anyone else who goes through an ACL reconstruction. I’m about 2 months post-op

    In a nutshell- weeks 5-8 were a huge improvement over the first month. Consider your first month recovery from surgery, and month 2 as a proper start to getting some strength and mobility back.

    • I’ve got full extension back if I rest my ankle on something and let my knee sag. I can’t fully extend under muscle control yet, but it’s not far off. Basically, it’s improving by this point and nearly there, so much less to worry about.

    • So I’m walking pretty much normally, but not quite due to the lack of full extension and limiting it to about 5,000 steps a day (swells up a bit if I try and do more than that on consecutive days)

    • First 4 weeks were rubbish, from week 5-6 it really started to pick up and get some strength back. I’m now in the gym starting to do 5 mins on a spin bike with moderate load at a time, and other basic gym stuff (20k leg extensions etc).

    • Lots of physio which is actually quite fun- lunges, various squats etc. It’s great to feel progress.

    • the hamstring feels like the weakest part of the recovery- just feels ‘wrong’ to push it too hard but this is less important than the quads so progress is fine in reality- but it’s feeling like it can take moderate exercise now (e.g. bridges on an exercise ball)

    Feeling much more positive and feeling confident that I’m going to come back to the bike stronger and fitter than I was before the accident

    datsunman
    Full Member

    I’m about to make the surgery or not decision myself – full rupture a few weeks ago. Already into the prehab exercises and coming on well.

    Trying to decide whether to go for the Internal Brace or not bother with surgery at all. It’s not particularly unstable even with my quad not firing particularly well yet, and my main worry is going through a ‘normal’ graft procedure and then rupturing it again after nine months of hard work!

    susepic
    Full Member

    Datsun, why would you rupture again after 9 months? Unless you were overdoing the rehab, or doing too much too soon?

    susepic
    Full Member

    Spicer, good to hear your rehab is going well. Keep it up :)

    datsunman
    Full Member

    @susepic oh I probably wouldn’t, just being pessimistic. :D

    datsunman
    Full Member

    And @spicer, good to hear your recovery is going well. I’ve decided to book mine in asap.

    spicer
    Free Member

    @datsunman obviously it’s early days for me, but the recovery is not as miserable as reading other experiences on the internet led me to believe! 2 months in and I’m basically walking about as normal (ok, no hiking or uneven surfaces), but I’ve had to ditch biking and running for the gym instead (it’s actually kind of nice to have a break after 15+ years riding!). My point is, don’t the recovery put you off deciding to get surgery.

    I can’t compare a non-surgical outcome to a surgical one, but I’ve got biking friends who never had their fixed and have been fine for years (but wear a brace for big hikes). From what I’ve been told not having surgery can lead to a higher change of arthritis later in life and more damage from small injuries you might not even notice- stuff having an ACL/fix in plate is likely to have prevented.

    I do feel confident hitting the prehab hard has made a big difference, so keep at it. I haven’t lost all that much muscle mass tbh, but it was very weak for the first few weeks- that would have been a real struggle if I had chicken legs to start with!

    Good luck with the surgery!

    tonyg2003
    Full Member

    Great to see your updates Spicer. I had a complete tear of my ACL 30yrs ago and my son did his 3 yrs ago, both playing footie.

    My lad, who is very good footballer, had a patella tendon repair and did huge amounts of physio. It took him ~18months to get back to full competitive fitness. He has no issues now.

    Mine back 30yrs ago, was a very invasive surgery option with lots of long term issues (“you will need a knee replacement in 20-25yrs). I gave up all the less knee friendly sports, squash, running, footie and concentrated on cycling. I’ve raced at a high level and I’m still biking (Alps in 3 weeks) and I have the same knee. I get the odd niggle and I’m careful about some movements.

    Hopefully it all continues to get well for you! Try to avoid the worst sports for your knee.

    datsunman
    Full Member

    Thanks @spicer – appointment on Tuesday to book in the op, lesser of two evils as I like to run offroad and climb too, so worth it long term I think.

    Keep us updated, good to hear you’re recovering well. I’ll add to the thread in a few weeks with any luck!

    1
    downhiller
    Full Member

    Following with interest @spicer.  Tedious story time:

    19 days ago I tore mine as well.  At my first fracture clinic appointment (day 3) the anterior drawer test confirmed that.  4 days later I had an MRI (on the NHS! 4 days!!).  At my second fracture clinic (day 10) the report hadn’t come in yet, but my orthopod went and spoke to the radiologist and his verbal report said full ACL tear, MCL sprain and no meniscus damage.

    His suggestion was that with no meniscus damage, and not playing football/rugby etc, I should manage the injury conservatively without surgery.  Wear a knee brace for 12 weeks to aid the MCL healing, and do plenty of range of motion physio, and he’d see me again in 3 months.  He also advised that I could weight bear with immediate effect, which after 9 days on crutches was a delight.

    However.  I was sceptical about the non-surgery route.  I felt he didn’t really understand what “downhill mountain biking” meant.  Both in how important it is to me, and how demanding it can be on our knees.

    I emailed his secretary to get a copy of the MRI report once it had been written up, and – lo and behold! – it DOES now say I have a meniscal tear.  I’m undecided if this is bad (will onset early arthiritis) news, or good (pro-surgery) news.  Time will tell.

    So… I nagged at her and have another appointment to see him on Monday (day 24).  I’m curious if his opinion will now be that I need surgery because of the meniscus tear.  I think (as much as it’ll suck for 6 months) I WANT surgery.  But I’m happy to listen to his opinion.  And then maybe seek a second one… :facepalm:

    I’ll certainly be showing him some clips on YouTube.  I’ve no doubt that being ACL-less is fine when ON the bike, riding without error.  And I’m also sure that an unlucky or particularly bad crash will have bad knee outcomes whether I have a reconstruction or not.

    But… what I REALLY want to get clarity on from him is… the outcome with or without surgery for all of those SMALL moments.  A dab here, a tumble there.  Hell, just trying to do a track walk on a tricky section!

    These are the things I worry about, going forwards.  Not riding.  Riding is the easy bit, knee-wise.

    datsunman
    Full Member

    @downhiller – you’re almost identical to me, albeit I don’t have the meniscus damage, ‘just’ a fractured tibial plateau… I was offered both surgical and non-surgical options, also with a ‘either will work’ approach.

    I also am not bothered by the riding bit, it’s awkward ground, running off road, climbing too. Those are the bits that I was bothered about. My main driver for the repair was that if I did the same again without the repair, the damage would likely be catastrophic, so that’s why I chose the reconstruction option.

    downhiller
    Full Member

    @datsunman – oddly my x-ray appeared to show a fractured tibial plateau, but it’s not mentioned at all in the MRI report.  Something else I should ask about, just for my own understanding!

    “if I did the same again without the repair, the damage would likely be catastrophic, so that’s why I chose the reconstruction option.”

    When I posited this issue to him he said something along the lines of “my reconstruction wouldn’t survive a serious crash anyway”, which I totally get.  It’s the minor things I want it to survive, that’s what I need to stress when I see him on Monday.

    I hope you get a timely surgery date – you on the NHS or private?

    datsunman
    Full Member

    Sounds like a very similar conversation – I figured that the reconstruction would give me the extra support for the minor things. I also agreed that it won’t stop the same happening again, but if it did then the reconstruction would take some of the load and leave the remaining ligaments etc less likely to fail too.

    Pencilled in for 6th August, privately. So another three-four weeks of prehab (done ten days so far) then hopefully fixed.

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