Gefuckered ACL

[Stones of granite]

My son has just suffered a complete ACL separation, verified by MRI. He did it playing Rugby, which he plays at a fairly social level, but it is (as it was mine) a big part of his life, and he will wish to continue playing after rehab.
So, the big question- reconstruction surgery or physiotherapy only? He is fortunate in having private medical cover, but there are pros and cons each way.
What is the collective RR wisdom/experience on this?

[Which Tyler]

Complete rupture of ACL? for someone who wants to play sport again after rehab? there's no question that reconstruction is a better option IMO.

[Stones of granite]

Complete rupture of ACL? for someone who wants to play sport again after rehab? there's no question that reconstruction is a better option IMO.

Cheers

[BBD]

My daughter ruptured her ACL doing gymnastics, but didn't realise it, she went to the doctor when it interfered with her dancing hoping to get some physio
To speed up that process he sent her for a scan where the rupture was discovered. She had reconstructive surgery and was back at dancing 6 months later but easing into it gently.

[Which Tyler]

Post-surgery: 6 months is about right for gentle return; 18-24 months for complete recovery.
Rehab only: 4 months is about right for gentle return; never for complete recovery.

Don't try playing rugby with a ruptured ACL though that's just silly.

[SerjeantWildgoose]

I was hit by a car and ruptured the ACLs in my right knee back in 1984. 8 weeks after the injury and having put myself through a pretty rigid regime to strengthen my quads I began the Commissioning Course at Sandhurst. Getting through it was far from easy as the knee was prone to collapsing and each additional jar did damage to the cartilage. I had several arthoscopic operations to shave off tears to the meniscus. Since I now have no meniscus in my right knee there is no point in going for the reconstructive surgery that is available now, but was not available in the mid-80s. I do have the first blooming of chronic arthritis as a direct consequence of the injury, with worse to look forward to.

My point is that while physio can help (And one of my physios in the early years had served as a locum with the All Blacks), it is not the way to go if surgery is available, particularly if the intent is to lead any sort of active lifestyle. It is possible to build up the surrounding musculature to such a degree that it keeps the knee stable and does the job of the ACLs. However, the long term effects of going down this route almost inevitably lead to early onset of chronic arthritis and this alone should tip the balance absolutely over towards reconstructive surgery.

[Stones of granite]

I was hit by a car and ruptured the ACLs in my right knee back in 1984. 8 weeks after the injury and having put myself through a pretty rigid regime to strengthen my quads I began the Commissioning Course at Sandhurst. Getting through it was far from easy as the knee was prone to collapsing and each additional jar did damage to the cartilage. I had several arthoscopic operations to shave off tears to the meniscus. Since I now have no meniscus in my right knee there is no point in going for the reconstructive surgery that is available now, but was not available in the mid-80s. I do have the first blooming of chronic arthritis as a direct consequence of the injury, with worse to look forward to.

My point is that while physio can help (And one of my physios in the early years had served as a locum with the All Blacks), it is not the way to go if surgery is available, particularly if the intent is to lead any sort of active lifestyle. It is possible to build up the surrounding musculature to such a degree that it keeps the knee stable and does the job of the ACLs. However, the long term effects of going down this route almost inevitably lead to early onset of chronic arthritis and this alone should tip the balance absolutely over towards reconstructive surgery.

Bloody hell! That's it settled then. I'll talk to him over the weekend.

[Which Tyler]

Serj's story is fairly close to worst-case scenario TBH.
Physio and rehab can usually get you(r boy) good enough for every-day life, and he'll be able to jog, swim, go to the gym etc. But we're still talking rehab for life; and always having it in the back of his mind.
It most likely won't be enough for anything that actively challenges a knee - rugby, squash, tennis etc.

ACL reconstruction really isn't that scary these days, and whilst it'll take time, the recovery should reach 100% and never have to worry about the knee again (or possibly getting arthritis a little earlier or a little more severe than the other knee).

[Stones of granite]

Serj's story is fairly close to worst-case scenario TBH.
Physio and rehab can usually get you(r boy) good enough for every-day life, and he'll be able to jog, swim, go to the gym etc. But we're still talking rehab for life; and always having it in the back of his mind.
It most likely won't be enough for anything that actively challenges a knee - rugby, squash, tennis etc.

ACL reconstruction really isn't that scary these days, and whilst it'll take time, the recovery should reach 100% and never have to worry about the knee again (or possibly getting arthritis a little earlier or a little more severe than the other knee).

Thanks for info mate. All good stuff to know.

[SerjeantWildgoose]

Serj's story is fairly close to worst-case scenario TBH.
Physio and rehab can usually get you(r boy) good enough for every-day life, and he'll be able to jog, swim, go to the gym etc. But we're still talking rehab for life; and always having it in the back of his mind.
It most likely won't be enough for anything that actively challenges a knee - rugby, squash, tennis etc.

ACL reconstruction really isn't that scary these days, and whilst it'll take time, the recovery should reach 100% and never have to worry about the knee again (or possibly getting arthritis a little earlier or a little more severe than the other knee).

In my line of work my paltry injury is far from worst case scenario WT. I worked hard at the physio over a long career as an Infantry officer. This in itself is enough to put significant stresses on all of the joints and of course if one is weak you tend to favour it - and that just shifts the problems elsewhere.

I hate to pull you up on a point, but jogging? Forget it. You can just about get away with trundling on a treadmill, but as soon as you start to run on the streets you are putting a massive and sustained shock on your knees. If they're not 100% this will have a toll. I had to do it and am paying the price. Hill walking becomes a nightmare; going up is grand but coming down (Inevitably with legs that are completely shagged out from the climb) feels like the knee is going to burst with every step.

No ifs and buts. If you are intending to live a sedentary lifestyle and can't find the money for the surgery then physio is a workable fall-back. But if any form of active lifestyle is planned and you can afford to get the job done get under the knife.

[Donny osmond]

Its all been pretty much said, but as someone with galloping arthritis in one knee and blossoming arthritis is hip and foot of the same leg, DO ANYTHING HUMANLY POSSIBLE TO AVOID THIS HAPPENING TO YOU OR YOUR LOVED ONES.

Thats all.

Sent from my HUAWEI VNS-L31 using Tapatalk

[Which Tyler]

I never claimed that a dodgy knee is the worst thing that can happen to someone in the forces. I said that your story is about worst-case scenario (in the context of ACL rupture).
For one thing yours wasn't just an ACL rupture (TBH I would suspect that if you did ACL and meniscus, then there a good chance you did your MCL as well)
The physio world knows more than it did 30+ years ago, and we're better at rehab. A ruptured ACL is a ruptured ACL, a knackered meniscus (in your case) is an addition to a ruptured ACL.
Yes, someone with a ruptured ACl treated with physio should be able to return to jogging - which is not to say that someone with a ruptured ACL AND a knackered meniscus can return to full-on military training without any issues.
A knackered meniscus will absolutely hate going downhill, down stairs, and really won't be found of running, jumping, or anything else that sends impact through the the knee. A ruptured ACL (comparatively speaking) won't care too much about that stuff; but will care much more about changes of direction, deceleration lunges, or application of external force (eg a tackle)

[SerjeantWildgoose]

I never claimed that a dodgy knee is the worst thing that can happen to someone in the forces. I said that your story is about worst-case scenario (in the context of ACL rupture).
For one thing yours wasn't just an ACL rupture (TBH I would suspect that if you did ACL and meniscus, then there a good chance you did your MCL as well)
The physio world knows more than it did 30+ years ago, and we're better at rehab. A ruptured ACL is a ruptured ACL, a knackered meniscus (in your case) is an addition to a ruptured ACL.
Yes, someone with a ruptured ACl treated with physio should be able to return to jogging - which is not to say that someone with a ruptured ACL AND a knackered meniscus can return to full-on military training without any issues.
A knackered meniscus will absolutely hate going downhill, down stairs, and really won't be found of running, jumping, or anything else that sends impact through the the knee. A ruptured ACL (comparatively speaking) won't care too much about that stuff; but will care much more about changes of direction, deceleration lunges, or application of external force (eg a tackle)

I wasn't meaning to have a pop WT and the worst case scenario thing was merely a fairly pathetic attempt to play-down my own injury in relation to some I know.

The medials in both knees were 'stretched' along with the ACL in my left but only the ACL in my right knee was severed (I saw the car coming and managed to take half a step back. The car hit my left leg, which was off the ground and in the process of flinging me over the bonnet and into his windscreen, twisted the load-bearing right knee). I would say, in bowing to your professional expertise, that the erosion of my meniscus was the consequence of continuing to place stresses on a knee that wasn't held together properly by the ACL. I accept that my injury may have tended towards the worst case, but immediately following the injury my cartilage was still there and I still had some flabby bit of knicker elastic acting as an MCL. I also admit that my work required that I place some considerable demands on the injured knee, but I would not consider much of what I have done to be extraordinary for anyone leading an active lifestyle. It is this that has resulted in the loss of the meniscus and the resulting arthritis, not the original injury.

I've had to battle through all of those things you say in your last paragraph. Truly fecking miserable at times; I wouldn't have minded if God had made me hard as nails, but I'm a complete puff.

[kk67]

That's shit, Stones. Hope he heals well.

Serj,....you should have joined Michael Palin's regiment.

[Which Tyler]

I saw the, and I thought of you
https://www.physiospot.com/research/inf ... struction/

Basically, get the surgery done, then make sure he goes through the physio properly and seriously. Youth and fewer physio visits are both directly correlated to increased risk of repeated surgery. Dont stint the physio, and don't skimp the homework!

[Stones of granite]

I saw the, and I thought of you
https://www.physiospot.com/research/inf ... struction/

Basically, get the surgery done, then make sure he goes through the physio properly and seriously. Youth and fewer physio visits are both directly correlated to increased risk of repeated surgery. Dont stint the physio, and don't skimp the homework!

Thanks for that, I'll forward to the bairn.

[Stones of granite]

As I type, the boy is under the knife, well, arthroscope. Expecting him to be released to his mother’s tender care late this afternoon, then she’ll bring him home for a couple of weeks pampering tomorrow, if he’s ready to travel.

[Which Tyler]

That's a couple of weeks to lecture and may, and make sure he doesn't skimp on his rehab.
At his age, and f he's wanting to play rugby, he will want more than the NHS can offer him.
Get him a dozen sessions of physio for Christmas

[SerjeantWildgoose]

You're such a drama queen, WT. Get him a foot and a half of tubigrip and 16 tins of White Lightning and he'll be fit for anything.

[Stones of granite]

That's a couple of weeks to lecture and may, and make sure he doesn't skimp on his rehab.
At his age, and f he's wanting to play rugby, he will want more than the NHS can offer him.
Get him a dozen sessions of physio for Christmas

He has full private cover through work, and has been pretty good at doing his physio in the run up to the op. The Doc wanted to see a certain range of motion before he would operate, and the boy wanted it done before Christmas so he had some incentive.

[Stones of granite]

You're such a drama queen, WT. Get him a foot and a half of tubigrip and 16 tins of White Lightning and he'll be fit for anything.

I’ve been stockpiling the 3l bottles of White Ace before the minimum price per unit thing kicks in. Might even let him have some.