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Partial ACL tear surgery or not? (Read 666 times)

Dexter

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Partial ACL tear surgery or not?
May 16, 2017, 02:39:41 pm
So my girlfriend has partially torn her ACL having dislocated her knee and currently has some instability issues associated with it. Having done a fair bit of reading there seems to be two options each with a similar degree of associated risk.
1) Replace the ACL via surgery. Risks are possible failure (15-20%), ~9 months rehab and usual associated surgery risk but with the possibility of a return to full capacity
2) Do plenty of physio and strengthen supporting muscles etc. Risks are further tears, meniscus damage and ACL deficiency

Does anyone from ukb have much experience with this? Any thoughts or advice? She is also a climber and does a mix of ropes and bouldering so ideally the endpoint would be able to have mostly full use without risk of further instability.

Thanks in advance

Potash

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#1 Re: Partial ACL tear surgery or not?
May 16, 2017, 09:26:29 pm
I have a personal anecdote regarding a partial tear of the ACL and going down option 2.

I injured my knee in 2007 and think that in retrospect I caused some form of ACL tear. I never got it checked out but applied ice and elevation and rest for a few weeks and it sort of got better.

I strengthened my knee to the point that there was no ongoing instability 99.9999% of the time. However approximately once every year and a half I would weight my knee in just the wrong way and collapse in pain. When I approached my GP regarding this they carried out various knee stability tests and could see nothing wrong and certainly could not replicate the failure mechanism.

I carried on with my basically good knee with a few seasons in Patagonia, lots of bouldering and a walk across Greenland.

In 2015 I jumped off a bouldering wall from approximately three feet high and collapsed in pain. I initially assumed it was my once yearly tweak and thought the pain would pass. It did not and I was unable to weight my knee at all. One MRI scan later revealed that I had a no ACL, I had multiple tears to the meniscal disks and had serious bone cartilage damage. This was a real problem as whilst the options for ACL repair and meniscal disk repair and good and available on the NHS the options to deal this the osteochondral defect (bone cartilage fuck up) were more limited.

My surgeon proposed microfracture surgery which is provided by the NHS and I possibly feel this may not have been the most appropriate option but rather the only option available on the NHS. This did not work. Fortuitously my wife got a job in the US so I have been a health tourist and have had all sorts of bone transplants provided by our insurance that you would struggle to get on the NHS. These have worked and I am on the mend.

In summary, I feel you are understating the risks of option 2. There is currently a treatable issue. If you put it off it could progress to an untreatable issue.




tomtom

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#2 Re: Partial ACL tear surgery or not?
May 16, 2017, 10:13:42 pm
A colleague got his daughters ACL fixed by 'dr Knee' in the US - the guy all the footballers go to... mri was done in U.K. Then she went to states for a consultation and the op the next day.... all been fine since... I can find out more if you like but it's $$$

SA Chris

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#3 Re: Partial ACL tear surgery or not?
May 17, 2017, 10:38:47 am
If you read skiing forums / FB pages etc there seems to be a 50/50 split between leaving it and getting it fixed. Both generally seem to have positive outcomes.

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#4 Re: Partial ACL tear surgery or not?
May 17, 2017, 11:47:24 am


Mine's currently MCL but I've done the ACL before and just used one of these (it's hinged) for anything strenuous and leave it off when just bimbling.
I don't usually stop training, though I've taken a week off the load bearing running because I did a 20k after the tear and could hardly stand for two days after (didn't feel it much during the run, just woke up next day with a basketball under the skin where my knee should have been..).
I just gradually wean myself off the support as the pain fades. Dead lifts are no problem, I've reduced my squat weight for the duration though.


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Dexter

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#5 Re: Partial ACL tear surgery or not?
May 18, 2017, 11:16:39 am
Thanks for all the information everyone. Outcomes seem pretty positive both ways so I'll pass on the information and see what she decides

andyh

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#6 Re: Partial ACL tear surgery or not?
May 18, 2017, 01:04:23 pm
My wife tore her ACL over Xmas.

She doesn't really climb but does ski.

She was dead set on an operation until her consultant said that he himself tore his ACL and never had the op, just wears a knee brace for skiing. He said it's her choice, and even though he loves doing operations, he'd suggest seeing how it goes with physio as there's no urgency to have the op right now.

4 months down the line she's getting a lot stronger and has the occasional wobble, but it's largely positive.