Knee Injury - ACL surgery?

[Sticky19619]

HI.
I had a knee injury August 2006 playing soccer.  An MRI scan showed a slight disruption to the ACL.  I received physio for this and then attended a consultant who had a 2 minute look and said I needed ACL reconstruction surgery!!  I have had no bother at all in the past 12 months and will not be returning to competitive sport as I broke my ankle at work Aug 07 (Enough is enough).  Would the ACL surgery still be required..??? I am not keen on surgery after my ankle injury.

Thanks

[JainMD]

Hi,
I can understand the fear regarding surgery that you have after you have had surgery of ankle in past.
This suggests that you had bad experience from your last surgery.
What did the doctor say regarding the status of your Anterior Cruciate Ligament? Has it healed or is it still the same? When you started with your physiotherapy, did you consult an orthopaedician before that?
The ACL is critical for knee function in athletes who require knee stability in activities such as running, cutting, jumping, and kicking.
The ACL originates on the posteromedial aspect of the lateral femoral condyle and inserts anterior to and between the intercondylar eminences of the tibia.
The ACL is composed of 2 bundles, an anteromedial bundle and a posterolateral bundle.
What did the orthopaedician say which one is affected?
What kind of imaging study is being done? MRI is the imaging modality of choice for evaluating the ACL and associated bony contusions and ligamentous or meniscal injuries.
Treatment options in the skeletally mature patient include nonoperative interventions and intra-articular ligamentous reconstruction.
Intra-articular ACL reconstruction currently is favored for: Those with active lifestyles but acute ACL deficiency and those with chronic ACL deficiencies that result in functional instability that endangers the menisci.
Keep me informed if you have any queries.
Bye.

[CassCore]

Hello,

I am an Athletic Training student in my junior year and I have done a lot of work with ACL's. We had three tears this semester alone that required surgery on our athletes that I worked with! Anyway, the ACL will not heal itself, unlike the MCL. It is located within the capsule of the knee and has a poor vascular supply. This is why ACL's are so commonly reconstructed. Have you been to an orthopedic surgeon or a sports med MD? These people could look and see how significant the damage is to your ACL.

Now if the MD reccomends surgery and you want to be active at all in life, play with your kids and grandkids or play pick up games of whatever sport, I would higly suggest the surgery. You can chose between an autograft and allograft. Both are done arthroscopically.

An allograft means you take tissue from a cadaver- you can chose a patellar tendon, hamstring, or Achillie's tendon- surgeons preferences differ. The autograft means the sugeon takes tisse either from your patellar tendon, called a bone-patellar-bone which is the standard, or most common surgical intervention and once healed is no more likely to tear than your original ligament, or from your gracillis and semitendinosis muscles- part of your hamstring. The hamstring autograft has a quicker healing period, but is more likely to tear again in competitive sport situations; however, since you are no longer participating in competitive sport, this may be a good option for you as many people have success with it. The bone-patellar-bone takes around 4-9 months to heal completely to where we would send athletes back to play. Most people fall closer to the 4-6 month range. With the hamstring 3-4 months is the recovery time for athletes.

If you choose no surgery which can be done, you will need to make sure you are keeping good strength in your quads and hamstrings. You may look into getting a custom knee brace for when you might choose to engage in physical activity. However, those can cost around $1500, insurance may help. With this route you are more likely to end up with arthritis of the knee joint and articular cartilage damage.

Good luck with everything and I hope this helped.

Cassandra