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Chockstone Forum - Accidents & Injuries

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Torn knee anterior cruciate
12:35:58 PM
My daughter and I had been hanging out for months for a trip this weekend to Arapiles, but last night at mixed netball (great fun with work colleagues) I tore my anterior cruciate - or at least that's what the orthopaedic surgeon thinks. I trust his advice as a friend and colleague - and he did fix my ruptured achilles 2 years ago!. Will need several weeks for the pain and swelling to settle. He feels I should think about a knee reconstruction at my leisure as he feels there will be too much knee instability for my lifestyle. Running in a straight line would be OK, but any twisting would be out (will have to give up squash and netball!). I'm 47 and do a fair bit of skiing, bushwalking and some climbing.
Any of you out there manage these activities without an ACL, just with quad strengthening? I'd be interested in some personal experiences.

1:46:39 PM
Personal experience - unless you give up the dynamic activities you will eventually destroy your knee. Sounds like good advice.
Will P
3:33:27 PM
Sorry to hear that, David. I rotated my knee on impact skiing yesterday, and it hurts like hell - am hoping I haven't done the same thing. I'd say go for the surgery. I worked in an ER, then a trauma dept. for years, and if you injure the same knee again without the ACL (which is much more likely), you'll be in all sorts of trouble. Just out of interest, who was the orthopod you saw? Best of luck.
5:17:42 PM
Yeah thanks Will - I feel like I need a bit of sympathy! I'm in Gippsland so I saw Malcolm Thomas - he was pretty honest - said he'd refer me to a knee only specialist if I wanted - but I'm happy with a generalist, and it would be a pain to have to go up to Melbourne.
He was pretty sure of the diagnosis just on the story, and there was major anterior laxity on examination (made me feel quite nauseous when he was showing me). The knee is also very sore the longer the day goes on - the blood in the joint I guess. I think I should be resting it.
From your point of view, any lateral or medial tenderness would make a cartilage or med/lat ligament injury more likely. Malcolm said that if it swells up immediately (blood in the joint) it is probably more likely to be an ACL.

7:59:48 PM
Only a MRI will give a clearer picture of the amount of damage you've done and it isn't until you go under the knife that they really see the true extent of the damage. While it is possible to build up the muscles supporting the knee, it really isn't a good option for those people who are active. Two problems stand out if you decide not to have the op, long term you're more likely to suffer arthritis of the joint, secondly any twisting motion at any stage in the future can cause further pain and inflamation.

While I opted to go under the knife, my time was dependent upon doing a major sailing regatta the week before hand. I worked very hard for 5 months to have the knee stable for the event, but still needed to ice it after most days of competition to keep the inflamation and pain under control.
8:35:30 PM
Thanks for your thoughts Alan and Dougal. I understand about the MRI and inspection at the time of the operation, but the knee has quite scary laxity on examination now, so I think, yes, reconstruction will be needed. Timing also is a problem for me with work commitments and some hiking commitments later this year. Would straight forward walking/hiking be possible in your experience prior to surgery? Or maybe I've got to get my head round not much mobility til I have the surgery.
Will P
9:31:16 PM
From what I've seen, yeah, hiking should be okay. I mean, it's a risk, but a decent brace would help, and hey, if you damage anything else, the surgeon's going in anyway! I've a couple of friends, both physios, who waited over 18 months for their ACL reconstructions, and climbed and hiked a little during that time.

8:09:10 AM
I tore my ACL back in 1980 and endured 7 years of having a very unstable knee that would collapse from under me whenever I put it under strain particularly from twisting it. My knee would fill up with fluid and it would be sore for several days. I eventually broke what as left with it and had a full reconstruction, and this was in the days before arthroscopic surgery.
Twenty years on, I've trekked in the Himalayas for a month, led up to 25 and no further fluid or stability problems. I find running is a problem - knee gets very sore and impact sports are probably not the go - I manage tennis OK.
Basically, I would advise get it done asap before you do any further damage internally. Also - being on crutches for 4 months does wonders for the upper body strength!

10:41:59 AM
Sad story ive heard just too many times as a physio and climber!! I would suggest very strongly that given what you want to do with your knee having a repair woud be a very good idea. In the mean time maintain your fitness suggestions include swimming (dont use flippers!) plus or minus some bike work depending on how your knee copes with it.

Disclaimer: i have not reviewed your knee so take my advice with a pinch if you like just dont sue me!!!
12:53:59 PM
Thanks Bel. I'm seeing a physio Monday to make sure I don't lose too much quad strength. Its amazing how things have changed over the last 20 years. I tore my medial ligament playing footy 25 years ago, had the arthroscopy, then immobilisation in full leg plaster for 6 weeks! Not a physio in sight. Needless to stay took ages to come back from that.
The trouble with bike riding is that a personal experience at a friends terrible death in a bicycle accident, and living in the country with narrow roads and fast cars/trucks means I just can't bring myself to do it. Even though bike riding is the new golf - eh? Basically I'm too scared - too many flashbacks. Perhaps an exercise bike.
Why do you say no flippers? Does it put too much strain through the unstable knee?

1:28:25 PM
Basically your acl is designed to stop your tibia slideing forawrd on your femur. Your leg is already a large lever and kicking dowards agaist the resistance of the water will pit pressure on your knee. Adding flippers will massively add to this pressure. Also flippers = cralf cramps especially if you have a tight calf (very likely!!) ps dont reckon you would cope with breaststroke either!

Surgery in general has come a long way. 15 years ago they didnt even do acl repairs! As for riding on the road fully understand its always scary and having had a few run ins with cars myself im scared of riding on busy roads. An exercise bike also has the added advantage of being adjustable. IE if riding sitting on the seat is too hard you can take the seat away completely and ride sitting behind the bike in a normal chair (hope that made sense!) this will reduce the angle your knee has to bend to make the pedals go round.

3:12:08 PM
Yep. Recon and give up impact sports (includes lots of running) and the knee will be good as and last till you don't kneed it.

9:38:52 PM
Mate, general practicioners generally dont know shit. Go and see a specialist and get a scan. My wife tore a CHUNK of bone from her thigh bone and it floated around in her knee joint for 3 months until she went to a specialist and they decided to operate all the while the local G.P had no Idea what was happening and said an X-RAY was a waste of time
I slightly tore my ACL whilst climbing quite a few years ago and with the help of my phythio/massuese/witch doctor I was doing six day off track bushwalks within 4 weeks, The best way to heal is reduce the swelling drugs, ice, compression, cold ocean wading or sitting, rest, NO ALCOHOL, GOOD FOOD, ditch the takeaway and look at protein supplements as well then when the healing starts get onto the hot/cold packs and get some massage into the muscles again to relax them as one side of your body will overcompensate to protect the damaged side causing its own problems. If you need any specific info eg good massuese etc send us a P.M.
Good Luck

9:53:56 PM
On 30/08/2007 davids wrote:
>Thanks for your thoughts Alan and Dougal. I understand about the MRI and
>inspection at the time of the operation, but the knee has quite scary laxity
>on examination now, so I think, yes, reconstruction will be needed. Timing
>also is a problem for me with work commitments and some hiking commitments
>later this year. Would straight forward walking/hiking be possible in your
>experience prior to surgery? Or maybe I've got to get my head round not
>much mobility til I have the surgery.

I'd really be hesitant in doing a long walk before the operation. Not so much the actual walking, but think about the remoteness of where you'll be walking, what happens if take a small stumble and the whole knee blows up again causing a loss of mobility. IMO you're putting a lot of pressure on the others you're walking with and any people involved in your extraction.
10:47:57 AM
Thanks for all your opinions - I've sought out lots, including from people who have managed without an ACL.
I've decided to have the reconstruction earlier (that is next week), as it means I'll only have one rehab to do, not two. Stuffs up my walking plans, but will be road crew, and will need to find another trip leader. Its taking a group of venturers (older scouts) on the overland track and we've already booked and paid airfares. Oh well, these things are sent to try us.
I'm actually getting around pretty well today using a brace that the physio has lent me.

9:32:49 PM
Don't give up entirely on the walk, but make other back up plans, also don't commit one way or the other. How quick your recovery is will depend on how tight the graft is and how much work you're will to put in. Assuming a December walk, that's three months. In my case I had a very tight graft that slowed up my recovery, but I was back climbing and sailing within 3 months. Some people are back running within 2 weeks, in my case it was about 4-6 weeks.
9:27:47 AM
Hi Alan
yes its two weeks post surgery, and my graft might be a bit tight too as I still don't have full extension. Unfortunately there was a major cartilage tear as well, so maybe that will slow my recovery down. Still plenty of fluid in the joint also. Am trying hard with the physio. Its amazing how stupidly weak your quads become isn't it? I think I'll be doing well to be running at 6 weeks, but maybe I'll turn the corner soon. The surgeon said 12 months for climbing - but I think he's being a tad conservative! From the bush-walking point of view he said earlier than that, and he strongly recommended walking poles for stability.

9:48:05 AM
hey man good to see you went ahead and had the surgery, bugger about the meniscal tear, they tend to go hand in hand. Work hard at that extension the later it gets the harder it gets. Hope your physio is doing lots of nasty hamstring release to help. dont be in a hurry whats a few extra months off climbing if it means it right when your come back.
12:27:33 PM
I've found climbing mostly ok since disclocating my patella. I'm missing cartidge from the back of the patella & had an arthroscopy (spelling?) to get the bits out. this was all 3 years ago.

The approach walk (especially downhill) are harder - climbing tends to be fairly, controlled movement so not too bad. All the little minor twinges/injuries to my knees since have been caused by walking more often than the actual climbing.
5:40:55 PM
The reason he says 12 months is that the graft takes that long to develop full strength.If you rupture your graft it is very difficult to repair.AS long as you are not climbing near your limit and do not fall off there is no reason not to do some climbing between 6 and 12 months.Also be careful heelhooking with the affected leg.Do the physio!Good luck

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