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  1. #1
    Join Date
    Oct. 22, 2006
    Posts
    256

    Default ACL reconstruction.....yes or no?

    I severed my left ACL about 3 wks ago.
    Hurt horribly at first but the pain stopped pretty quick. Iced and elevated until I could see an Ortho 2 days post injury. MRI showed that I had totally severed it. Knee doesn't give out anymore and doesn't hurt, just feels weak and strange.
    I start PT tomorrow and have surgery for reconstruction scheduled for the first week in May but will cancel that if I find the PT has helped and it doesn't cause me any problems between now and then. Per the Ortho MD, he said that many people live their lives without their ACL. Anyone here opt to not fix theirs and has it caused any problems? Anyone get it fixed and wish they had left it alone? I am 51 and do not ride competivley, just for fun, have no real plans to get back into showing in hunter land again but do have a nice ammie horse so I really should....any thoughts on if I should fix it or live with it? Thanks!



  2. #2
    Join Date
    Nov. 1, 1999
    Location
    Shangri-LA
    Posts
    1,776

    Default

    I've had ACL replacement done on both knees, blew both out at different times many years apart. It's a pita. With the last one, the orthopedic surgeon said that many do in fact leave them as is and do just fine. I think its pretty much up to you. If your knee is stable and you keep yourself in shape it might not be an issue. That said, the first knee I had the ACL replaced using part of the tendon from the knee cap, it was a 4+ hour surgery, 3 days in the hospital and a 6+ month recovery (9 months total time) it was painful and physical therapy brutal and I have a 6 inch scar down the front of my knee. The second knee I opted for a donor graft, day surgery, home by late afternoon. Minimal pain, physical therapy wasn't nearly as bad and recovery time was about 2-3 months total, hardly used crutches or a brace. If you do opt for surgery go the donor graft, you'll be back on your feet and riding etc much quicker and far less if any pain. Add, the first surgery was in my 40's the second knee I was in my 50s.



  3. #3
    Join Date
    Nov. 1, 2001
    Posts
    9,344

    Default

    I totally snapped my ACL at 48 and tried to go without surgery doing PT for about a year. Got the same story from my Ortho DR. In that time, I re-injured my knee and did more damage (meniscus, MCL which was not surgically repaired). I shouldn't have wasted the time. I don't think they realize what riders actually do. I had the cadaver graft. The PT post surgery (6 months worth) was different than what I did for the initial injury.

    I am much better off now, 6 years post surgery.
    See those flying monkeys? They work for me.



  4. #4
    Join Date
    Oct. 12, 2001
    Location
    Center of the Universe
    Posts
    6,926

    Default

    looks like most people have slightly better outcomes by skipping the surgery- a lower incidence of arthritis.



    Knee Surg Sports Traumatol Arthrosc. 2008 May;16(5):442-8. doi: 10.1007/s00167-008-0498-x.

    Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment.

    Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS.


    Source

    Department of Traumatology and Orthopaedic Surgery, Campus Innenstadt, Ludwig-Maximilians University Munich, Munich, Germany. info@markus-kessler.de


    Abstract


    ACL-reconstruction aims to restore joint stability and prevent osteoarthritis; however, malfunction and osteoarthritis are often the sequelae. Our study asks whether ACL-reconstruction or conservative treatment lead to better long-term results. In this retrospective cohort study, 136 patients with isolated ACL-rupture who had been treated by bone-ligament-bone transplant or conservatively were identified. Twenty-seven of these were excluded because of a revision operation in the 11.1 years follow-up period, leaving 109 patients (60 reconstructions and 49 conservatively treated) for evaluation based on clinical, radiological and internationally accepted knee-scores (Tegner, IKDC, Kellgren and Lawrence). An individual cohort study is classified as EBM level 2b according to the Oxford Centre of EBM. We observed significantly better knee-stability (P = 0.008) but more osteoarthritis (Grade II or higher) after ACL-reconstruction (42% vs. 25%). Physical activity levels were similar in both groups during the follow-up period (P = 0.16). Eleven years after ACL-rupture the physical activity levels are similar for both groups. After ACL-reconstruction, stability is higher as is osteoarthritis, whereby the result is not necessarily perceived as better subjectively. Specifically, this retrospective study yielded a 24% incidence of oseoarthrits 11 years after conservative management of ACL-rupture in patients not needing secondary surgery. The risk of secondary meniscal tears is reduced after ACL reconstruction, which reduces the negative effects of OA after surgery. The ultimate objective would be to achieve a good subjective outcome by conservative treatment followed by a rehabilitation program designed to keep secondary meniscus tears at a low level.


    PMID: 18292988 [PubMed - indexed for MEDLINE]



  5. #5
    Join Date
    Sep. 7, 2006
    Location
    WNY
    Posts
    5,643

    Default

    YES. I never even considered not having the surgery. How people manage without an ACL is a mystery to me. My knee was horribly unstable. Get a good ortho and get it fixed.

    (FWIW, mine was a hamstring graft.)
    Against My Better Judgement: A blog about my new FLF OTTB
    Do not buy a Volkswagen. I did and I regret it.
    VW sucks.



  6. #6
    Join Date
    Jan. 9, 2006
    Location
    Maryland
    Posts
    375

    Default YES!

    I tore mine 13 years ago and had it reconstructed using the central third of my patellar (sp?) tendon. At the time I was an active runner, having just completed a marathon, and I wanted to remain active. The original ortho gave me the same speech about fixing/not fixing, but his case load was mostly from a retirement home.

    I quickly found a sports ortho who scheduled me for surgery asap.

    My advice: have surgery and be aggressive with pt. Very aggressive!
    Alison Howard
    Homestead Farms, Maryland www.freshorganicvegetables.com



  7. #7
    Join Date
    Jun. 16, 2009
    Posts
    552

    Default

    ABSOLUTELY GET IT DONE. Had mine done this past summer. I am now back to 100%. I found there was too much instability without it. Absolutely do it.



  8. #8
    Join Date
    Aug. 14, 2000
    Location
    Clarksdale, MS--the golden buckle on the cotton belt
    Posts
    18,691

    Default

    GET IT DONE. Without an ACL, one is always at risk for knee collapse; twisting motions bring it on. If all you do is go forward in a straight line, you don't need an ACL, but if you want to do a sport that involves planting and twisting (like tennis) you are SOL. Mine was so unstable that just slipping in mud would send me crashing--but I had a bucket handle tear of the meniscus. If you get the surgery, you won't risk THAT.

    I had a cadaver.

    I ruptured the other ACL last summer and haven't had surgery, but the meniscus wasn't involved. If it were, I'd be on the table ASAP. At my age and type of activity, I don't need an ACL; but if the meniscus ever tears, and the doctors will do the surgery, I'll have it done.
    "I'm a lumberjack, and I'm okay."
    Thread killer Extraordinaire



  9. #9
    Join Date
    Apr. 9, 2012
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    NYC=center of the universe
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    1,946

    Default

    Worth it!!!

    So many folks who don't get it done have meniscus and other knee injuries later because of a less stable knee.

    I knew I wanted mine fixed. I didn't want to ride through a spook or other quick maneuver and have my knee give out. I just felt it would be safer to get it fixed.

    I had a donor graft to reduce down time.

    Do look for a good PT. I think my PT was very rough and caused a lot of scar tissue to build up. PT does hurt as they stretch the tendon to create the range of motion.
    Born under a rock and owned by beasts!



  10. #10
    Join Date
    Oct. 22, 2006
    Posts
    256

    Default

    I lean towards getting it fixed and then talk myself out of it all in a few minutes time! It is a scary thought to have surgery. I will have PT for the first time tomorrow and maybe that will make me go one way or another....
    Ugh it just sucks. Worst part is how I did it. I decided I was going to get on while bringing in Mr big boy 17 hh from the pasture. Climbed up on the 4 board fence and as I was swinging my right leg over, with my left foot planted on the 3rd board, my knee went snap and down I went. Didn't even get my leg over him. Just a freakish stupid thing. Not to mention I was getting on by climbing a fence, no helmet, halter and lead rope. To ride into the barn....all wrong on so many levels! Yes I am now paying the stupid tax! He was so sweet about it as I fell into his neck grabbing to keep from falling on my face and saying horrible 4 letter words on the way down, he just stood there and looked down at me on the ground in front of him...." Mom, whatcha doin?" look on his face. Yes it was a stupid, unexciting way to blow my ACL out. Doc said it was a first for him that he has seen that happen just trying to get on a horse....only me! Thanks for everyone's input!



  11. #11
    Join Date
    Sep. 7, 2009
    Location
    Lexington, KY
    Posts
    18,016

    Default

    I had mine fixed because my knee was so unstable. Find the best sports medicine ortho you can and make sure you turn PT after surgery into your religion.
    "We can judge the heart of a man by his treatment of animals." ~Immanuel Kant



  12. #12
    Join Date
    Nov. 12, 2011
    Posts
    1,096

    Default

    My mother tore her ACL and opted to have part of her hamstring (I think) made into a new one. It has never been the same. I always hear that the cadaver option is much better.

    Quote Originally Posted by js View Post
    I've had ACL replacement done on both knees, blew both out at different times many years apart. It's a pita. With the last one, the orthopedic surgeon said that many do in fact leave them as is and do just fine. I think its pretty much up to you. If your knee is stable and you keep yourself in shape it might not be an issue. That said, the first knee I had the ACL replaced using part of the tendon from the knee cap, it was a 4+ hour surgery, 3 days in the hospital and a 6+ month recovery (9 months total time) it was painful and physical therapy brutal and I have a 6 inch scar down the front of my knee. The second knee I opted for a donor graft, day surgery, home by late afternoon. Minimal pain, physical therapy wasn't nearly as bad and recovery time was about 2-3 months total, hardly used crutches or a brace. If you do opt for surgery go the donor graft, you'll be back on your feet and riding etc much quicker and far less if any pain. Add, the first surgery was in my 40's the second knee I was in my 50s.
    "A horse gallops with his lungs, perseveres with his heart, and wins with his character." - Tesio



  13. #13
    Join Date
    Nov. 12, 2011
    Posts
    1,096

    Default

    My mother tore her ACL and opted to have part of her hamstring (I think) made into a new one. It has never been the same. I always hear that the cadaver option is much better.

    Quote Originally Posted by js View Post
    I've had ACL replacement done on both knees, blew both out at different times many years apart. It's a pita. With the last one, the orthopedic surgeon said that many do in fact leave them as is and do just fine. I think its pretty much up to you. If your knee is stable and you keep yourself in shape it might not be an issue. That said, the first knee I had the ACL replaced using part of the tendon from the knee cap, it was a 4+ hour surgery, 3 days in the hospital and a 6+ month recovery (9 months total time) it was painful and physical therapy brutal and I have a 6 inch scar down the front of my knee. The second knee I opted for a donor graft, day surgery, home by late afternoon. Minimal pain, physical therapy wasn't nearly as bad and recovery time was about 2-3 months total, hardly used crutches or a brace. If you do opt for surgery go the donor graft, you'll be back on your feet and riding etc much quicker and far less if any pain. Add, the first surgery was in my 40's the second knee I was in my 50s.
    "A horse gallops with his lungs, perseveres with his heart, and wins with his character." - Tesio



  14. #14
    Join Date
    Nov. 18, 2010
    Location
    california
    Posts
    4,249

    Default

    I opted not to have it replaced. I do just fine I also ski (downhill) and I just don't have 9 months to not ride. I lost mine in the 80's and I bet the surgery is much better now.



  15. #15
    Join Date
    Apr. 9, 2012
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    NYC=center of the universe
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    If it's any consolation, I did mine trying to mount inappropriately, as well! Yes, it sucks!! Stable mounting blocks for both of us from now on!
    Born under a rock and owned by beasts!



  16. #16
    Join Date
    Mar. 29, 2007
    Posts
    311

    Default

    I tore mine when I was about 25. Lived without it for years and years, had it fixed about five years ago at the ripe old age of 47. The surgery itself wasn't really all that bad nor was the PT, what hurt like crazy is where they took my hamstring to make a new ligament. YIKES! I also will tell you I am now facing a TKR because by not fixing it, it has caused severe arthritis and while my ACL is very strong, my knee is trashed. I vote for you to get it fixed!!



  17. #17
    Join Date
    Mar. 30, 2013
    Location
    Florida
    Posts
    84

    Default

    MY dad tore both of his playing basketball at two different times, once before I existed and once when I was very young (he had wooden crutches!). I don't know a whole lot about his experience, but since then he's been an active triathlete (did an full ironman once), marathon runner and still plays basketball with my brother, for a short time he did a city/club baseball/softball thing when I was younger.

    He got off with twin scars on both his knees, and that was before cosmetic surgery, but stable knees and hasn't had a problem with them at all. I vote for the surgery, you don't want to lose out on anything by making an injury worse.
    Of the heart-aching, hard-working, hope-having, horse-loving and horse-less variety. We are a sad species indeed.



  18. #18
    Join Date
    Mar. 4, 2013
    Location
    Neither Here nor There
    Posts
    33

    Default

    Get it done! Probably one of the wisest medical decisions of my life. I had a donor graft, which from what I hear is definitely the way to go.

    I had a pretty freaking "active" lifestyle before my injury, and I firmly believe the only reason I am still able to enjoy said lifestyle is because of my brilliant surgeon and team of PTs. That being said I was also quite young and my cousin has gotten her PhD in physical therapy three weeks prior and knew a lot of people and called in a few favors Talk to people and don't go with the first doctor you meet- each injury is unique and you need a doctor appropriate for you.

    I've definitely had more than one sports medecine professional tell me there's no way I'd be doing what I'm doing now w.out my surgery- still going strong, jumping 4', completed my RAD Advanced 2 exams, and definitely couldn't do things on the pole like the bird, bridges, cocoon, etc.

    Good luck with your recovery either direction you go!
    "Sit back and prepare to be pissed off!"

    Eventer, Ballerina, Dancer, Model, and Waitress Extraordinaire (cos a girls gotta eat!).



  19. #19
    Join Date
    Nov. 13, 2006
    Posts
    1,360

    Default

    I am 3 months post ACL reconstruction and I would do it all over again. I was wavering on what to do and then I slipped on the ice when I was doing errands and my knee gave out. It hurt like heck. It was a good 30 min before I could function mentally or physically again. I kept thinking of all kinds of scenarios where being out of commission unexpectedly for 30 min would have been devastating.

    I had the hamstring graft. At 19 days post op I was managing both farms 21 horses and my 3yo daughter by myself. It sucked but I survived.



  20. #20
    Join Date
    Mar. 25, 2010
    Posts
    1,166

    Default

    Well I tore mine just about the same exact way, trying to get on bareback from the arena fence, body went one way, knee went the other. I did also have meniscus damage. Primary care doc said nothing wrong with me, 4 years later and another meniscus tear later, I told him send me to orthopod!!! Ortho said lets try cleaning up the meniscii and see how you are, sometimes that stabilizes the knee sufficiently, if not we can go back in and do acl, but the recovery/ pt is a bear. Did the meniscus repairs, and after 6 months my knee was much moroe stable. Its not perfect, but I can ride and be pretty normal, so glad I didn't do the acl.



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