Experience From - Scott Rafferty , Shelli Johnson, John Vonhof , Chuck Zeugner , Rick Rochelle , Shelli Johnson#2 , Mark Wood , Bob , George Beinhorn , Andy MacGinnitie ,
A week and a half ago, I fell off a fence and twisted my knee. The initial prognosis was pretty rosy, and the doctor told me that surgical arthroscopy was nothing to worry about and had a 2-3 week recovery He has now seen the MRI report (but not the film) and has told me over the telephone that I can either run with a brace or face an arthroscopic reconstruction with 9 months without running. This involves a transplant of ligament. He says this will not be a complete recovery. I take him the films tomorrow.
I have had ACL reconstructive surgery in both of my knees. Both were blunt injuries that occurred while playing basketball for the University of Montana. One knee was in 1986, the other in 1991.
I have nothing but good news to report. Both of my injuries were serious, and I run, hike, snowboard, rock climb, mountain bike, play racquet ball, and more - all without a brace, and all WITH NO PAIN OR DIFFICULTY WHATSOEVER. I am very athletic and competitive in all that I do.
With that said, knee surgery is amazing. (By the way, I've tried skiing with a brace and playing basketball with a brace during the first year following surgery. That, in my opinion is a real pain. I did it for psychological reasons in the beginning, but do not wear a brace on either knee now, and in fact, my operated-on knees are probably better than "the originals."
What I would recommend, though, is going to a doctor that has experience doing ACL surgeries on very active people like yourself. Ask him about success stories and even for some names and numbers of people he operated on with similar situations. Also, go to an orthopod that has aggressive/progressive rehab protocols. The sooner the doc has you doing stuff, the better off you'll be. And stay strict to the rehab guidelines.Like I said, I have no problems and no limitations whatsoever and I give credit to the rehab I did and to the doctor that performed the surgeries.
Also, for your information, they did a patellar strip for my 1991 (my most recent) ACL reconstructive surgery and there's only a small incision and again, the knee recovered 100%.
Bottom line is I wish you the best of luck. I don't know that any of this will be of help to you, or if we're even talking the same injuries or procedures, but I do want to emphasize that ACL surgeries have been great for me.
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This is not the end of the world, I know a person who began running and completed two marathons after an ACL tear (surgery). I also know a person who continued bicycle racing after an ACL tear (with a brace). I think he even did a 300K ride once, which is starting to become a bike ultra.
You'll have to "consider the source" for the following. I'm not medically trained. I'm just curious and nosy, and I ask a lot of questions whenever I find myself in the ortho's office or in PT. I'm posting this to the whole list so if it's wrong someone will undoubtedly speak up. :)
Your Doc should tell you that there are several sources for the "new" ACL. One source is a cadaver. Another source is a strip of the patellar tendon. I think I remember reading an article about artificial sources. There may be others, but my ignorance is showing itself. Whatever, the source, I'd be sure to ask about the consequences of each technique. For example using a slice of the patellar tendon may cause additional problems for you.
I too have a completely torn ACL. Keep in mind my medical training is limited to being an EMT and an avid learner. I tore my medial meniscus in 1983 (traumatic wrestling injury at age 19) and had arthroscopic knee surgery to remove 1/3 of it and clean up the rough edges. This was very successful. At that time the orthopedic MD said the ACL was partially torn. I've always kept my legs strong (weight-lifting for many years; now backpacking, running, and telemarking). In 1990, I finished tearing the ACL walking down the street. It was painful for a week or two but I didn't want to take a year off for recovery. In '96 I ran my first 50 and 100-milers.
Last year I saw an experienced (Team USA wrestling physician) orthopedic doctor about mild pain I was having from overtraining. (I teach mountaineering for a living and go into the mountains for 5 weeks at a time. After 5 weeks in Alaska with 0 mpw, I jumped to 60 mpw upon my return, and ran VT100 in July -- soreness -- big surprise, eh?) Anyway, this doctor said that 30% of people without an ACL function just fine. He concluded that with my activities, that I am in that functional fraction. My point is, why not wait and see how it recovers for a few weeks or months before committing to the reconstruction. I'd also ask the doctor if he could go in, clean up any "simple" meniscus-type problems and leave the ACL issue for later. Ask him about the supplements glucosamine and chondroitin if the meniscus is involved (or read about them in The Arthritis Cure). Also ask about the down-side of waiting. Are there chronic wear and tear issues? Noakes (Lore of Running) reports that increased mileage does not correlate with arthritis down the trail. But this is only true for previously uninjured knees. I agree strongly with previous posts about looking for an experienced physician. Put at least as much effort into it as buying a vehicle (or home?)!
I do know a couple of very active people who've had reconstruction and are happy with it, but I just wanted you to know that there are at least a few of us out there who were told to wear a brace (lasted a month or so), then decided to forego it, and now function fine without one. Feel free to ask me for more details and good luck with your decision. Also be aware that temporary depression often affects injured athletes deprived of their daily dose of sanity...this too shall pass.
1983 medial meniscus tear, partial ACL tear, arthroscopy but no reconstruction
1990 complete ACL tear...no surgery
1996 Superior Trail 100...no brace
1997 Leadville 100
1998 Vermont 100
1999 hmmm...Mile-high 24-hour or Kettle Moraine 100
I certainly agree with all Rick Rochelle's post says. And yet waiting and/or holding off on surgery or some other type of action would obviously depend on the extent of your injury. For example, after my first acl blowout in 1986 (which, according to my orthopod, may have resulted from torn meniscus that went never repaired), I waited a good week or week and a half before even going to an orthopod. There's no way it would have recovered well enough to not do at least something about it. My knee was so swollen and tight that I could hardly bend my leg at the knee, despite elevating my leg for long periods of time and frequent icing.
In other words, if your knee is not this bad, perhaps waiting a little and being more conservative is the right answer; if it's swollen and painful and unchanging in more than a week, then definitely weigh all of your options and maybe even get 2-3 opinions if the recommendation(s) seem too liberal or harsh.
Again, I do agree with the conservative, avoid-surgery-if-possible thinking; I had a badly sprained ankle one year. If I had done what my orthopod at that time recommended, I would have had surgery the day following the injury. In fact, I did nothing, except tape and elevate and ice the ankle for a good 3 weeks and today, it's as if NOTHING ever happened to my ankle in the first place. It is not weaker than my other ankle and there is no evidence that I even seriously injured it back then.
Scott, Sorry to hear about your injury, I know that you have been one of the more active ultra runners on this list. I had ACL surgery done in 1991. I would recommend it, as opposed to going through life with a potentially cranky knee. I have had no problems with my knee since the surgery. For me it was 9 months and wearing a brace for the next year when doing athletics. No brace since then. I would echo that you need to follow the doctor's orders during rehab and use weights, just like someone who didn't go through the surgery should, to keep the muscles around your knees strong. My orthopedic surgeon is an avid skier and went through the same surgery. I would bet that with your athletic background you would tend to come back sooner than most. I've run Western States,Leadville,the Boston Marathon and numerous other ultras since. I've also heard that there are now numerous variations to this surgery now. I had a ligament transplant, but have heard of a gortex material being used also.
On may 10th I was running down a very steep trail here in Tucson. I tripped with my right foot and immediately slammed my left foot down to try and catch my balance. I ended up hyperextending my left knee and completely tore my left ACL. I could not walk. I had to be helicoptered out because of the steep and remote location. As far as my running was concerned I new and felt I was in deep do do. I had the same thoughts and questions that you are having now.
To make a long story short I opted to have surgery though there wasn't much of a question in my mind that it was the choice to make. Due to HMO problems and trouble finding a surgeon that would perform the operation. I did not have surgery until Oct. 2nd. I had replacement surgery using a portion of my patella tendon as my new ligament. One month after surgery I was cycling 26 miles on roads. And I'm not a bike nut. In seven weeks I was able to do 3 mile runs on flat level surfaces. 8 weeks out I entered and finished a half marathon in 2:18. Please don't think I'm bragging. I'm just letting you know that your injury is by no means the end of your running. You just have to stack some odds in your favor.
This is for the lister who recently posted about an ACL injury I browsed the http://www.bewell.com site and saw an article on ACL. Here's the URL:
Bonnie Prudden is a long-time health activist who specialized in injury recovery. Her method, simplified, involves active recovery and expert massage. I've used both aspects with great success when recovering from knee injuries, ankle sprains (severe), back strains, etc.
The idea is that you NEVER push to the point of real pain, but that an injury will recovery far more quickly if you keep the injured part moving, or "move it" with careful massage (again, only to the point of generous tolerance).
It works. Oh, and another thought, about icing. Be careful! An iced area feels stronger than it is, even though it's still extremely vulnerable. I reinjured a knee after bodysurfing in cold ocean water. I felt invulnerable, but wasn't.
I had ACL reconstruction using part of the patellar tendon in late 1991. I also had most of the medial part of my meniscus (the cartiledge "padding" at the end of the bone) removed because it was torn.
I have been able to run pretty well since, so don't despair. I have modified my running so that I don't run two days in a row. bit I've finished several ultra and even a 100 on my knee without much incident. I've come to believe that this was a wise move for me anyway as I get older.
First, I think needing a brace to run if you don't have the surgery is overkill. As someone else mentioned, many people with torn ACLs function quite well without it. In fact, the orthopedic surgeon who did the operation told me there are players in the NBA with torn ACLs. Some peoples knees are just stable enough to not need the ACL. You very well might need a brace for activities with a lot of cutting and pivoting like basketball or tennis but I don't think even trail running puts enough stress on the knee to need a brace.
If you have torn the meniscus as well, I would recommend getting that fixed by arthroscopy soon. Loose cartiledge floating around inside your knee joint will just make things worse.
I would not rush into reconstruction however. I think that if you are willing to forego playing other sports seriously (those that require lots of cutting) I suspect you can do all the running you want without problems. I would at least give a try to rehabilitating the knee without surgery and see how that works. You can always get surgery later, but once you go under the knife, that is it. Studies show that people who've had knee surgery are prone to arthritis in the knee. It is not clear if this is a result of the surgery or the knee injury, however.
As they say, surgeons always want to operate, so I'd try to talk your options over with a physician with expertise in sports medicine who is not an orthopedic surgeon (both family medicine and physiatry rehab offer certification in sports medicne).
If you do have surgery, make sure to get a good, experienced surgeon. All the studies show that doing a lot of surgeries leads to better outcomes. Don't be afraid to ask how many of the surgeries the surgeon has done and to seek a second opinion.