[Duma]

Anyone had similar and have experience of returning to climbing? The gf has just been told 9months to a year and is pretty upset...

[Ru]

Alex Puccio climbed 8B about 3-4 months after MCL/ACL reconstruction. Not sure that's to be recommended though.

[reeve]

Hi Duma,

Gutting for your girlfriend... we can sympathise in our household as my girlfriend did a very similar injury 16 months ago. Marie fully ruptured her ACL, MCL, and PCL (not trying to get into a game of knee ligament one-upmanship, obvs!) Presumably your GF's ACL and MCL must be fully ruptured to be requiring surgery? If it's only partially ruptured then it's a much better picture than what I have painted below, but from what you've said it sounds like fully ruptured. Obviously for Marie having the extra ligament ruptured might make it a bit different but I'll share what we've learnt in the hope that it's of some use.

I think basically it's a fucking bad injury, but one that you can recover from well, although perhaps not perfectly.

So timewise, Marie injured her knee in May 2018, and had surgery February 2019 (apparently the outcomes are better if you either have surgery immediately or with a very long wait, I'm not sure why). Currently she can second HVS, which is a fair few grades below where she would like to be climbing but she is still getting stronger in her legs month by month (if not week by week). Currently I'd say there are two things holding her back from climbing harder. Firstly, both legs are weaker than previously (obviously the injured / healing one has atrophied a lot, the muscles are visibly markedly smaller, but also the un-injured one had some hamstring taken from it to replace the ACL). Secondly, the ligament replacements take 12-18 months to fully embed into the bone, so until this time there will continue to be lateral instability in her knee, which limits the kind of moves she can do. I expect that both of these factors will keep improving in the coming year or so.

Over the past 16 months Marie has done a lot of rehab at the gym. This has served her really well, and so I think she is ahead of where most people would be (but about where her [fantastic, NHS] physio expects climbers to be).
It's really shitty, but if Marie's injury is anything to go by then I think your girlfriend is going to have to face not climbing very much over the next year.

Marie doesn't post on here but she just said "I can feel her pain!" and says she's happy to chat with your girlfriend for any advice / personal experience / moral support. PM me or find me on FB if she'd like to take her up on the offer, or of course post here with any other questions.

[Duma]

Hi Reeve, thanks for the reply, and commiserations to Marie!

Injury was 5 weeks ago (motorbikes are dangerous, who knew?) and initial diagnoses was just tear to mcl, no surgery, 8 weeks recovery.
 However got MRI back today and although no rupture, the consultant described the the mcl as like a cheesestraw, and the acl as very stretched and spongy. He is operating to repair rather than reconstruct the mcl, but expects to have to reconstruct the acl in a similar way to the way you described your gfs operation.

How long was it before Marie was walking etc normally?

[mde]

For my wife: unhappy triad (ACL & MCL torn, severe meniscus damage) end of March.
Surgery with ACL & meniscus reconstruction 6 weeks later (mid May), then 6 weeks on crutches.
Back at climbing for the first time 8 weeks after surgery with rapidly increasing results.

Now, it's 18 weeks past surgery. She can still only toprope (will remain so for a few more months), but as long as it's feet-low faceclimbing, she's +/- back at her previous level. But she's worked very hard on her recovery and she's a sport physiotherapist, so pretty well knows what to do and what not, plus she's obtaining feedback from peers that work a loth on knee injuries, et cetera.

[reeve]

Hi Reeve, thanks for the reply, and commiserations to Marie!

Injury was 5 weeks ago (motorbikes are dangerous, who knew?) and initial diagnoses was just tear to mcl, no surgery, 8 weeks recovery.
 However got MRI back today and although no rupture, the consultant described the the mcl as like a cheesestraw, and the acl as very stretched and spongy. He is operating to repair rather than reconstruct the mcl, but expects to have to reconstruct the acl in a similar way to the way you described your gfs operation.

How long was it before Marie was walking etc normally?

No wonder it's upsetting for your girlfriend - 8 weeks recovery sounds fairly okay to cope with but the news of the surgery must have been hard to swallow.
I'd have to check with Marie to get it exactly right, but from memory: Immediately post-surgery Marie was in quite some pain and on crutches for maybe 2 months, then she went back to work another 2 months after that (4 months after surgery in total). She works in an SEN primary school though so not exactly sedentary. She has found walking on concrete much easier than rough ground because the ligaments are there to keep the knee stable, so uneven terrain is still pretty slow going (although recently she has been walking up to high crags in the Lakes).

Has the surgeon spoken about how long to wait until surgery? Marie was told that the longer the wait (with lots of preemptive physio) the better the outcome, although perhaps that's because of a slightly different constellation of ligaments being injured. Another guy who goes to the same NHS physio session had the same injury as Marie but had the surgery done immediately after - his knee is still very stiff and has a much lower range of motion available. This sounds like a different experience than mde describes about their wife, so maybe it depends on the exact injury.

[sheavi]

On the ACL issue only - recent good quality studies indicate that a wait and see approach to surgery with early rehab has good results vs early surgery.

Here is an earlier study that has been backed up with more recent studies.

https://drive.google.com/file/d/0B3prGoH5dQmLNHlDODVCVXYxTUU/view

https://blogs.bmj.com/bjsm/2017/09/20/time-stop-wasting-time-money-debating-graft-types-surgical-approaches-acl-injuries-secret-probably-lies-optimising-rehabilitation/

It's a case by case basis really but personally I'd opt for rehab first with the option of surgery later if this can be agreed with your consultant.

[sheavi]

More here - https://journals.sagepub.com/doi/pdf/10.1177/2325967117S00126.

My opinion (I'm a physio), is get a second opinion re: surgery.  Mounting evidence suggests rehab first with option of surgery later.

[Potash]

On the ACL issue only - recent good quality studies indicate that a wait and see approach to surgery with early rehab has good results vs early surgery.

Here is an earlier study that has been backed up with more recent studies.

https://drive.google.com/file/d/0B3prGoH5dQmLNHlDODVCVXYxTUU/view

https://blogs.bmj.com/bjsm/2017/09/20/time-stop-wasting-time-money-debating-graft-types-surgical-approaches-acl-injuries-secret-probably-lies-optimising-rehabilitation/

It's a case by case basis really but personally I'd opt for rehab first with the option of surgery later if this can be agreed with your consultant.

Anecdote only and a data point of one.

I tore my ACL and went for the non-surgical rehab route. I got my knee really strong, lots of running, big trips to the mountains, walked across half of Greenland and was climbing and bouldering well.

There was however always a slight weakness and about once every 18 months i'd randomly collapse in pain. It turns out that after eight years of this I totally screwed my knee and ended up tearing my ACL, meniscal disks and chipping a big osteochondral defect. This was far far harder to fix thn a ACL repair would have been. It also would not have been possible on the NHS,

As such I'd advise taking the just rehab approach with caution! Might have a higher probability of good outcomes with the remote possibility of far worse outcomes.

[sheavi]

With respect personal anecdotes should be be viewed and interpreted with caution. 

Anyway if your knee kept on giving way post rehab that should have indicated surgery, sooner rather than a lot later.

[Potash]

With respect personal anecdotes should be be viewed and interpreted with caution. 

Anyway if your knee kept on giving way post rehab that should have indicated surgery, sooner rather than a lot later.

Kept giving way is a relative thing.

Persuading the NHS to take it seriously when you present saying you collapse every 18 months is a hard thing to do!

[sheavi]

Yes I understand about the NHS issue and sympathise.  I've had surgery to both knee - meniscectomy - but luckily had a good surgeon that I initially paid privately for an opinion. He gave me the option of wait and see which I did. However two years down the line surgery was needed (locking and giving way).  Studies show long term outcomes for ACL repairs (15 years post) have no difference between surgery vs non-surgery unless there is instability noted. Giving way with pain is instability and more than likely requires surgery to prevent OA. 

My point is that good quality studies, with close monitoring, show better outcomes for non-surgery that early surgery.  Just something to bear in mind because orthopaedic surgeons historically, I'm generalising, perform surgery without a good evidence base to justify their decisions. It seems to be mostly placebo.

[Dexter]

My GF had her ACL surgery 2 years ago almost to the day. Pretty much started weighting it (with crutches) straight out the surgery on the doctors orders. Also told no climbing for 9 months but started climbing after about 4 weeks. The main barrier to overcome was the weakness in the leg (hamstring tendon was used). I think doctors say no climbing without knowing how controlled an experienced climber can be with weighting a recovering limb as compared to a novice. It is not pretty much as strong as the other leg but some mental reservation is still there.

[Potash]

Anecdote only and a data point of one.

I agree that looking at good quality surveys is very important. I was cautioning against taking the non-surgery approach and then putting up with minor instability.

The placebo surgery evidence is really interesting! My friend who is a doctor does gently mock me for having had a placebo knee bone graft. He says he would have pointlessly chopped me open and sewed me up for much less money.

[sheavi]

Yep placebo surgery seems just as good as actual surgery in the review below.

https://www.painscience.com/biblio/four-orthopedic-surgeries-no-better-than-placebo.html

Rotator cuff repairs are the same - most tear again within a few months of surgery anyway.  There's a whole host of orthopaedic surgeries where the outcomes are often no better or worse vs non-operative management.  Just a word of caution to those considering surgery as first choice based on doctors authority and educated guesses. 

[Duma]

Many thanks all for the input, much appreciated and really useful thread.

[duncan]

Commiserations!  Bloody motorbikes...

(apparently the outcomes are better if you either have surgery immediately or with a very long wait, I'm not sure why).

Perhaps the muscles are in better shape? Immediately after the injury they have not yet atrophied; after a long wait they have had a chance to somewhat strengthen again.

It's a tough decision but if it were my knee, unless I was an elite sportsperson with a very limited career span, I think I'd wait and see. I'd work hard at maintaining quads. strength and possibly consult a different surgeon. Given how extensive the injury is there is a fair chance that, nine months down the line, she might still decide to have surgery which could be frustrating but I don't see any (long-term) downsides of waiting and there are potentially some significant benefits.  [/physio.]

Another n=1: my brother-in-law (simple ACL rupture) opted for the non-surgical approach 20 years ago. His knee is still stable for scrambling, hillwalking and running. He's happy with his choice. 

[kelvin]

And another n=1 - ACL tear after bouldering fall about two years ago. No option for surgery as I've had three ops on that knee and knee replacement is the next step, which I'm trying to avoid as long as possible.
Lots of quad work etc and since then I've climbed a new grade, multipitch climbs in the Alps and felt okay with regards to the ACL.
Currently recovering from tweaking ACL again after a fall on a crack climb and my foot caught in the crack. It's slower this time but I have no other option than to do some rehab. I wandered up Ordinary Route on Idwal Slabs the weekend before last which pushed it to it's current limit and I expect it'll be a couple of months before it's good enough for most things.

[Mushin]

The reason to wait with surgery is (to my knowledge) that you have time to train your muscles beforehand, as you loose a lot through atrophy afterwards.

Let me lay another option on the table for you. Instead of a full reconstruction (taking a tendon to replace your ACL) in certain cases it is possible to sow the ACL back together. This makes for a less invasive procedure, and recovery is much quicker, as the tendon does not have to transform into a new ligament over the course of 9-12 months, during much of which it is very weak and you have to be careful not to re-rupture it. This type of procedure is only advisable for proximal tears however.
Google  ACL repair, dr DiFelice, Dr. Sonnery-cottet

I underwent this procedure in March this year and have been climbing full force for the last few months or so. Startet toproping after 2 months. Knee is still a bit sore and stiff after long days, but all in all pretty good.

Wether or not your knee will be stable without surgery depends on the individual and the loads on the knee. I dont think it is possible to give a general guideline. For me, as a skier (high loads), it was not willing to take the risk of not having surgery, only to find out next season that the knee was not stable enough without an ACL. Also the risk of damaging the miniscus is higher without an ACL. But I know of people who function well without one. None of them ski (hard) though.

That all info I can give. Good luck!
Oh yeah, get a hangboard. It kept me sane through the first months.

[petejh]

Can I ask how many of the people with serious knee injuries either posting or mentioned in this thread, are either vegan or vegetarian? I'm just curious, nothing more.

[Fultonius]

PCL/LCL/PFL triple replacement for me Pete, meat eater at the time, now mainly don't eat meat.





Bit unfair as it was a car crash that caused it....

[red_rhodesha]

Hi all

Thought i’d post an update

Firstly, thank you to everyone for your responses - it was really useful to read all the studies, and a special thanks to Reeve/Marie - that has really helped to manage my own expectations, and is comforting to hear other people’s experiences.

The op went ahead last week - the rupture of the mcl required repair before the ligament shrank too much (think Cheestrings) and they performed a reconstruction of the ACL (hamstring graft) at the same time.  Instant gratification monkey also agreed this was the right choice, being an expert in such matters.  I wrestle with him every day but we have certainly had words after this latest escapade.

Due to it being a multi-ligament injury, i’m currently touch-weight bearing only for 6 weeks plus basic rehab (heel prop, assisted heel slides, quadriceps setting) after which I should be able to commence standard ACL rehabilitation.

I’ve been told no climbing before 9 months and better to wait 12 - the risk of re-injury reduces significantly in this period and I have read a number of studies since which seems to support this.

As a boulderer these timings work quite well, and will give me a month or so next year to prepare before the call of the grit rings out across the land.  You’ll find me on low level traverses I suspect, having lost my brave.

We shall see but I am in no rush to repeat this experience!!

Thanks again all x