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There was another thing.

I tore my anterior cruciate off this year. I have recovered (if not quite fully), but am considering an operation to repair the damage. However, the doctors I have seen recommend different approaches. One says don't operate, the other says do.

What's the balance of medical opinion?



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    How long ago did you tear it?

    The problem with the ACL is that it heals slowly due to poor blood supply, mechanical shearing forces and the synovial fluid inhibiting proper repair processes. While resting the joint is imperative at first, prolonged immobilization will result in a poorer outcome. But it sounds like you're past that stage. As a result of the factors already mentioned, neither direct nor nonoperative repair will conclude with regaining the full strength of the ACL. The function you get out of it will depend on the initial damage done, and the rehabilitation program you follow (controlled motion and exercises).

    If you go for the option of no direct intervention, I would recommend fairly regular visits to a physio to keep it in check with exercises and such. If you opt for the surgery, be sure you need it. You'll probably hear plenty of stories where people go for surgery and regret it for one reason or another, but don't forget that most operations will be very successful. Different surgeons and doctors will occasionally arrive at different conclusions as to the appropriate course of action so try to get a few opinions. Explain your concerns, perhaps you could try physio for a while and if it doesn't work out, or if you injure that joint again, then you may have to go for surgery.

    From my own perspective, I recently dislocated my shoulder and I was hoping that I would not need surgery on it! I would always prefer minimal intervention but if you need it, you need it.

    One final piece of advice, (and this goes for what you're reading now!) be cautious of medical advice you get online- I'm not saying it's wrong necessarily but it's often equivocal, be cautious of it!

    Hope this is of some use to you, best of luck!

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    Many thanks for the advice.

    I had an MRI when it happened and apart from the ACL being completely torn off, they said that there was no damage to the menisces (is that the plural?). I waited a little bit too long for physio, perhaps, but have been seeing someone for a while and been given excercises to do. Nevertheless, it is now 4-1/2 months since it happened and I still can't bend my leg all the way back and have some pain, especially when I twist the knee joint.

    I cycle OK and swim, but haven't started running yet, on the advice of the physio. If this is the best it is going to get -- which I have been told -- then I am pretty disappointed and would risk surgery for the chance to be able to run again.

    Anyway. Many thanks again
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    physio's perspective (actually run an ACL deficient group so vaguely know what I'm talking about.....!)

    it's unfortunate you've waited so long for physio. but no point crying over spilt milk. I work closely with a number of knee specialists who do the reconstructions and their current thinking is give it three months of physio with loads of proprioceptive training then re-assess. provided improvements continue then carry on with the non-surgical approach. If improvements stop or there is significant instability (ie knee gives way) then surgery is probably the way forward. But give it at least 3 months of solid physio training before making any decisions.

    I don't want to tread on my colleagues toes here, but you must make sure that you are doing loads of balance work, lots of eccentric (muscle getting longer as it contracts eg. step down off steps very slowly) quads, hamstring, calf exercises. progress to more dynamic exs, eg lunging, hopping, jumping, plyometric exercises, running with twisting and turning (once safe to do so). I do a lot with gym/swiss/physio balls to achieve this.

    All the while you MUST have propper alignment of you lower limb with the correct muscle patterning. Your physio should advise you on this to make sure you have the propper technique.

    Do ensure your feet have been looked at to check you do not overpronate (a common risk factor), and check your hip stability- again your physio will advise you on this.

    as for your trust in the surgeon, make sure you go with the one who REGULARLY does reconstruction surgery, has special interest in knees, or is ACL specialist. There is a register of medics listing their specialities and special interests, ? on the BMA website (perhaps "the doc" can clarify that one) I've come across too many gung ho orthopaedic surgeons (nice blokes but will have a go at anything, even if they're maybe not up to the job).

    hope that helps.

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    Hi, I have had my ACL reconstructed along with tears to the meniscus repaired. I had the option of not having it done but the instability in the joint would have remained so I decided to have the operation plus my competitive sport at the time was swimming breastroke- I had four op's in total. I had mine done at Gobowen near Oswestry which is a specialised sports injury hospital with an excellent reputation for knee surgery. I got referred there after my local hospital did more harm than good. I was in a brace for over 6 months so muscle wastage was a big problem before i got a referral.

    Whatever you decide, good luck. As far as I am concerned having the knee repaired was the best thing I could have done. You are lucky in that you haven't torn your meniscus. Three of my op's were to repair tears. By the way, I have since completed the 'Longest day' ironman and the knee was fine - the rest of me wasn't! The rehab is grim and a long grind with plenty of dark moments along the way and you can write 9 months off but for me it was worth it.

    Hope this helps.

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    jon_gjon_g Posts: 318

    I tore my ACL about 6 years ago. My doctor didnt even know what i'd done so told me to stop exercise for a month and see if it still hurt. About 3 months after that i was playing football and my knee collapsed and i was in agony. My doctor finally sent me to a knee specialist and i had it surgically repaired. I'm so glad i did. I could've done triathlons without having surgery,but it's the other sports i do (football, squash) that made me decide to go under the knife. I spent 6 months out of action, but now it's perfect. Better than my right knee which aches sometimes!
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    Endorphine junkie, as a physio, whats your view on all these high tech shoes for correcting pronation? Is it a money spinning excercise or worthy of the cost? Apologies for digressing slightly.
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