ACL to repair or not to repair. (knee ligament)

I have had ACL reconstructions performed on both knees. In 2001, I tore my ACL, MCL, and LCL in my right knee. My ligaments were created from my patellar tendon. It took a solid year to really get back to playing basketball and running. I started cycling in late 2004. In the spring of 2005, I tore my ACL in my left knee. I was back on my bike (trainer only due for safety) in less than a month. 2006 was my first real year of cycling and I have absolutely no problems from my left knee. I have no tendonitis or anything. I think spinning on the trainer really aided my quick recovery. My IT-band flares up really bad on my right knee from just walking, but the bike doesn't affect it at all. My only complaint is that I had so much muscle atrophy from both of my surgeries that I am still very weak in my quads. You may have to learn to spin at a higher cadence to get the same power-outputs as you are now.

If you get it fixed, use your patellar tendon. Recovery is usually faster. In addition, strong hamstrings are the key to protecting your ACL. If you have surgery that weakens them, your recovery will be longer and you will be more prone to re-injury.

Lastly, I was told that an ACL repair usually lasts for around 25 years, and that I would eventually need complete knee replacements. I don't know how much that will be a factor for you.

Sorry for being so long. Let us know what you decide to do.

JB

I did my ACL a few years ago and replaced it with my hamstring. Both PT and hamstring have their pros/cons, but if you make the effort to rehab properly then i think either would work out.

I have noticed that i never developed my quad and hamstring back to what they were, but i got slack with my rehab at the end. Even after a few years i can prob start doing some weights etc to bring a complete balance back to the strength of my leg.

Cycling is great for rehab and you'll be on a stationary cycle very soon after your operation. Playing sport where there is lateral movement (basketball, squash etc) will have to wait for about 6 months though.

If you get it done in Aust. I'm sure it will end up being quite a good job. Football (AFL), Rugby and basketballers do so many ACLs that surgery on them has become very mainstream and there are a lot of specialists to choose from.

Michael

I'm wondering if it will be able to handle a full on sprint and not snap or pull out... 9 months after? 6 months after? A year after?....

After 9 months of full rehab it is quite possible to almost be 100%. If you're talking about sprinting on a bike it will probably be sooner. I wouldn't think 6 months is out of the question if you are diligent with your rehab.

It's probably best that you didn't get it done 20 years ago ... techniques have improved a lot since then.

I am 5 weeks post-ACL surgery. What I found was that deciding to get it done is totally an individual decision; my doctor boiled it down to "is your knee stable doing the sports you want to do, or isn't it?" In my case it wasn't stable rock climbing and skiing, and I kept re-injuring it, so the decision wasn't that hard to make.

Surgery is no picnic but isn't as bad I as I thought it might be. I was off crutches in 2 days and hobbling around. I was riding on a stationary bike with no resistance about 10 days after surgery, and after 2 weeks I could start adding resistance. I just started getting onto a real bike now at 5 weeks. Riding a real bike is still a bit dicey; today I tried some real hills and the knee is sore after 5 miles. (My doc has advised against hills for a few weeks but I was being stubborn). Tomorrow I'll go longer and easier.

Both a patellar tendon graft and a hamstring graft can have good long-term outcomes, as can an allograft (from a cadaver). It seems up to the doc which one is preferable in my experience. If you kneel for work or for hobbies then the patellar tendon is likely to be a bad decision. If you are younger then an allograft is a bad decision (according to my doc, those under 25). I went for the hamstring as I like to crawl around in caves so kneeling is necessary, and it was my doctor's first choice as well. My hammy is pretty weak but I have faith that I can get it back mostly.

In any event, be prepared for lots of physical therapy, 2-3 hours a day if you can spare the time. It's not an easy road but I think I made the right decision. I look forward to full recovery in 6-12 months.

Other advice: Get a doctor who specializes in sports medicine. There's a huge difference in what an athelete needs to get out of this operation vs. a couch potato.

Good luck.

they both work fine, but the patellar sometimes takes a little while to recover from the loss of the piece that was cut out of it so kneeling may be discomfort for a while

either way they are supposed to be stronger than original once done properly
make sure it is a doc who has done many and has experience esp with soccer players since they are amongst the most common acl patients

JAPANic said:

I have 2 decisions I need to make.

1) Have my anterior crucial ligament repaired after waiting 20 years to do so.
(It doesn't effect my cycling but every once in a while my knee dislocates and is painful for a few days). I originally ruptured the ligament in a rugby/skiing/drunken time during my early 20s.
I had a minor operation but did not get the ACL repaired back then. (Doctor was an idiot as well).

If I do the operation I'll be out of competitive cycling for abut 9 months and may not be be better after that. The operation may make cycling even harder. More aggravation? Inflamation? Less flexible?

2)
If I do go through with it which would you rather them use?
A bit of hamstring?
A bit of patella tendon?
Both could be aggravated during cycling....

For details on the operation and where I intend to get it done.

Surgery details:

hamstring or patella?

These doctors I believe are the best in the world and I'll travel to Australia to get it done and pay cash for the experience.... :eek:

Do I keep riding now and do this when I'm older or never?
Do I get it done asap and hope for the best?

Anybody else ride with minus an ACL like me?

To be honest, I am the best doctor of all time, so please pardon my not reading all of the posts except the 1st in the thread. I would never recommend surgery to repair connective tissues.

Here is what to do for bad ACL:

1)eat a whole fresh orange(peeling, seeds, etc.)
2)next, apply aloe vera to ANY AND EVERY part of the skin near where you feel any type of pain
3)finally eat a small amount of ground cayenne pepper, approximately 100 grams

Take it easy and you should see gradual, eventual improvement in the ACL region.

Jacob

btw, the single best way to avoid (as in prophylaxis) knee ligament destruction is by hiking.

Jacob

Personally, I would forget the ACL reconstruction at this point - don't need it for cycle activity - and purchase a custom fitted brace for either day to day activities or sports that require it... there are plenty of good orthopods here in Japan that can help you out with a brace and if you have National Health Ins. then that will help a lot....

An ACL recovery can be a tough gig unless you are a "full time" athlete or have access to REALLY good Physio here in Japan... If you are in business or teaching then likely you will not get the time you need to see the kind of active recovery times that are being touted here ( not everybody understands the commitment and work hours it takes to survive here - hence less time for proper recovery ) - a lot also has to do with your language skills if you intend to re-coup in Japan...

Frankly, even for competetive cycle racing you simply don't need the ACL nearly as much as other sports and for some of those sports a knee brace is a good idea even after you recoup... If you are experiencing instability now in simple day to day activities then you should get one regardless so you don't pop that thing out just walking down the stairs ( down is usually the culprit )...

I blew my ACL 17 years while racing off-road MX and never had it fixed because of business responsabilities at the time even though I did have to get a medial miniscotomy ( MMC removal ) - my right leg looks kinda like a > now but I still ski without the ACL by just wearing a light brace...

Just my thoughts but I think that you need to weigh the need vs. the benefits for yourself...

It's a spendy operation too, if you have to pay cash plus go to Aus for it... :eek:

I've survived for 20 years so far, but have not been able to go a year without periods of instability. Sometimes just walking at a funny angle around a desk it would pop out a little bit.

I think the pain is worth the gain. The returned stability will give me more confidence to run a bit more and have less worry about it clicking in and out even when I get out of bed in the morning.

I also don't want to be using a walking stick later in life.

The good thing is my cycling (probably) won't be effected one way or the other except for the recovery period and that's the main thing.

Rehab will be mostly done by myself and that is the biggest challenge. I do work long hours but I can cut back a lot quite easily. Light riding to and from work 25km each way will play a mojor role in recovery after the 6 week post op stage and my good leg can do the hard work if need be till the 'new' knee gets accustomed to itself.

I have a home gym for leg lifts, stationary cycling, will need to find a pool for walking backwards in (that helped a lot 20 years ago after my 1st knee op.).

Going for it....

The extra stability is worth it. I had a right lateral meniscopy done about 4 years ago to deal with knee pain, instability, and a tendency to lock in certain positions as a result of what turned out to be a bucket-handle tear of the meniscus.

At first it was a bit sketchy, as surfing put a lot of torsional load on the knee, but since cycling 4-5 days a week my knees are now much, much stronger. I did have to hasten slowly though early on, occasionally taking days off the bike to let my joints recover (I'm mid-40s).

The bottom line is now I can do things that haven't been possible for years, such as running around the park playing cricket with my 11yo son, and going mountain biking with him around Manly Dam.

Without the op AND the cycling, those things would not have been possible.

So if you have kids and being able to do stuff with them is important to you, the short time off your feet and maybe the bike while you recover is well worth the longer-term gains.

On January 7th I got my knee fixed....finally.

Back in October I badly ruptured my left calf and while at the doc's asked him if he did ACL reconstructions....His eyes lit up and within a week and after questioning his track record I decided he was the man for the job...

I gave myself 2 months before the surgery to build up as much quad muscle as possible....

15 days after surgery now and I'm in a brace...Less than 10 degrees to go before I can fully extend my leg.

See the doc tomorrow as have been back at work a week already...he'll take the stitches out and advise further...
The physio guy can't believe how fast I'm recovering either...

They like to keep you in hospital longer here in Japan, but I went home after a week as I was bored to death and all i was doing was waiting for physio each day....
Only used the crutches because we had some heavy snow and just for extra protection...

Can walk up stairs....

sat on my stationary trainer a few days ago to see how many more degrees I need to go before I can pedal...still a bit too tight on the up pedal....a few more weeks....

glad i got it done so far....

Had the double bundle (two hamstring tendon grafts in two drilled holes).... so glad I waited till they got this perfected...they've been doing this for 8 years in Japan...

2 titanium screws, 2 titanium buttons....all very nice and clean incisions...no bruising...