I am posting for my brother, who really wants to get into runnning and triathlons. Poor guy keeps getting injured! His first time around really was an overuse injury - went out too much too soon and wrecked his knee. After surgery and almost 2 years of PT and recovery, he started training for NYC marathon this year, got a month out and partially tore his ACL (playing soccer) on the same knee.
He is at the point w/ his doctor now where he needs to decide whether or not to have surgery. He has been back in PT for a few months and he says the knee feels good. But, the ACL is partially torn and will never be “right” without surgery.
Can he continue his running and triathlon pursuits with a partially torn ACL and if so for how long? Indefinitely ? Will continuing to train hard running and biking create further problems? his doctor believes the surgery is “optional”, I am just wondering how you think this will relate to long-term running, swimming, and biking goals.
Tough call, probably even for the doctor. I tried to continue living without an ACL for about a month when I tore mine and that didnt work out so well. My knee started popping out all the time and finally it popped out so bad I damaged my LCL, MCL, and tore a bunch of meniscus. I ended up getting an Allograft of an achielles tendon from a donor and my knee has never been better. It’s actually alot more stable than my other knee. Rehab took about 5 months total but I was cycling in 5 days and running slow and easy on a treadmill in 2 months. Also being that I got a donor graft, I have no pain from any harvesting on my own body to replace the ligament.
Yeah, it is a tough decision - probably also depends on how much stability he has in his knee, knowing that he’s going to have to work to make sure that the muscles around the knee stay strong if he dosen’t get it reconstructed . I competed for 20 years after completely tearing my ACL - ran about 20 marathons, did 2 IMs - but it finally caught up with me and I ended up having it reconstructed to stabilize my knee to try and stop the resulting degeneration. At that point, though, there was too much damage to the articular cartilage and the meniscus and I have been told not to run any more. So, even if his knee feels better now, he really needs to consider how this decision will impact him long term.
Like the poster above I completely tore my ACL in 1997. I had the knee scoped to remove some damaged tissue that was catching on something and it has been great ever since as long as I run in a straight line and use good running shoes. This meens no soccer, football, baskettball or anything that involves fast movements side to side.
I experienced both approaches of 1) limiting activity with my ACL; and, 2) having it replaced. Tore it in 1998 and the doc said I could “manage” it by giving up any type of sports that involved sideways movement (racquet sports, softball, basketball, soccer). I was racing mtb at the time so it was no problem. After three years of managing it, I started to yearn for other sports and wanted to play soccer with my son, so I looked back into ACL surgery. I had also started putting my knee out regularly (every day or so) when stepping off curbs and walking down stairs. The factors that sealed a 2001 ACL replacement for me were:
I can go back to playing sports
A major displacement in a weakened knee can take out the MCL, too
My assigned doc had an excellent reputation for rebuilding athletes’ ACLs
Healing and recovery from an ACL is faster when you are younger (I was 36)
I had a quad tendon ACL replacement (I would go with a cadaver tendon now if I had the same choice) with some removal of damaged meniscus. Recovery was longish back to full function (8 months) but I was back teaching spinning within 30 days. In terms of running and sports now, I have never been faster than now. My only discomfort comes when I don’t run for several days.
Bottom line: If you like your doc, get it done. You aren’t getting younger and ACL replacement is pretty technologically advanced these days.
The ACL provides great stability to the knee; without a fully functioning ACL, yes you can run in straight lines on perfectly flat surfaces, and cycle as much as you want; but the joint will be more prone to osteoarthritis than a joint that has an ACL.
Consider the swim to bike transition, running on beaches, grassy fields, tree roots, paths through the woods…that’s the setup for twisting the knee; and that’s the situation where an ACL will keep the knee stable.
I’ve already had ACL reconstruction twice. If I tore an ACL again, I’d have the reconstruction again. IMO, allograft is the way to go. If you take a part of your own body from someplace else, I think you compromise that other body part.
Wow, thanks for all the great advice, I’m happy to hear so many success stories.
This is good to know, I think his doc is thinking along the “straight line activities” theory, he did say that as long as my bro’s athletic interests wouldn’t be involving soccer, football, etc., then he shoudl be able to perform. But, a lot of good points about stability, etc. Though I have probably trained and raced on a lot of stuff I shouldn’t have, I know it wouldn’t be a good feeling for me to train really knowing something was already damaged, AND fixable.
The good news is that he is continuing PT, so at least that’s some consolation for strengthening the surrouding muscles, and he is way better than me at knowing when his body is reaching/has reached it’s limits and laying off appropriately I think though that the timing of this, coming right off surgery and finally recovery on the same knee, the prosepct of having to do it all again could be really discouraging.
I am not a physcian but I have had an ACL reconstruction and several other knee surgeries.
My ACL was initially injured in a ski accident, then re-injured along with my back in another accident.
I had a surgical procedure done to repair my fully torn ACL and lateral collateral ligament. The procedure for the ACL was called “Middle Third” where they remove the middle 1/3rd of my patellar tendon and use it to manufacture a new ACL, then bolt that into place. I told them I was an endurance athlete and I was active military at the time of the accident so they made the repair very tight.
Since that (and about six other) surgeries I have done nearly 100 triathlons including 5 Ironmans with a PR of 10:46 and an Olympic distance PR of 2:02:00. I’ve also done the Discovery Channel Eco Challenge, Raid Gauloises, Marathon des Sables (152 mile running race in the Sahara), Desert Cup (102 mile runing race in Jordan along Iraqi/Jordanian border) and climbed the highest mountains on three continents. I just finished shovelling a shitload of snow too.
The ACL repair is totally solid. I’ve had absolutely zero problems with it.
The key, in my un-learned opinion, is to be certain to impress upon your health care team that you are ***not ***a recreational athlete: That you are a serious endurance athlete. Medical care being what it is in the U.S. (or at least, medical insurance…) they are looking to do the minimum to get you on your feet. That may not be enough to get you back *racing. *
Best of luck with your injury. Never let anyone tell you (or more correctly, your friend) that you can’t come back. I think I am on my third life now. If I always listened to what doctors told me I would have quit years ago.
I think though that the timing of this, coming right off surgery and finally recovery on the same knee, the prosepct of having to do it all again could be really discouraging.