I recently ruptured my ACL while skiing. I am meeting with a few knee specialists over the coming weeks but was keen to get feedback and experiences from the ‘field’. I am lucky enough that I have no instability and only residual pain 2 weeks post injury.
Reading through recent studies and articles, it seems the debate between surgery vs. no surgery has increased over the last few years with the intention to return to ‘cutting’ sports as one of the key factors in deciding between the two routes. I don’t see myself doing any kind of football, basketball, etc. but I clearly have aspirations to (i) return to FOP triathlon and (ii) have the option to complement tri training with (ultra) trail running, xcountry skiing, etc.
Have any of you been in a similar situation and what did you go for in the end? I should add I am in my early 30s. Clearly not asking for medical advice on ST but asking an orthopedic surgeon whether no surgery is the best path forward feels like asking turkeys to vote for Xmas… Also curious to hear whether it matters which surgery method you go for - if that’s the best way.
Thanks,
BW
ps: I know there are many older posts on the topic but the topic is fast evolving
I tore mine when I was 35, I’m 52 now. Had surgery (allograph) and no regrets. I didn’t go back to much intra-adult cutting sports, but after I became a dad played a ton of soccer, rugby, and football with The Kid. That alone was so much worth any of pain and hassle from the surgery and the rehab. I can’t do as much of it right now b/c of other problems and it’s killing me.
When I had the surgery I was just starting to get into endurance sports. Got back into them once I was healed up, never felt like my knee was limiting my progress.
Anyway, sorry about your injury and best of luck with your recovery, whichever path you choose.
I have a partial acl tear grade 2, with the usual triple crown miniscus and mcl fro ma snowboard tumble.
At that time I had significant instability they said surgery was a maybe, so I did 6 months physio no operation plus a lot of hamstring strength training to address my imbalance hamstring/quads. Lots of biking to really build that acl hamstring backup and watching my knee tracking to eliminate knee valgus movement. Once I did that my knee stability is much better and I wouldn’t do surgery now.
Also the pain in first year is all gone as a lot of fragments in the joint all dissolved. I know many ppl got acl surgery then tore again so it’s highly dependent on surgeon and also recovery protocol
I’ve done both ACL’s(different accidents) and used allograph for both. I’ve never had an issue with running or cycling but I would be skeptical to go play full contact soccer. I don’t doubt the tissue would hold but I would be fearful of it failing and then having to have surgery all over again because I was playing something that didn’t need to be played haha I would rather “stay in my lane†and keep it that way. I should add those injuries occurred back in 2009 and 2011 and I am 31 now.
I’m sorry to hear you tore your ACL. It’s not a lot of fun. I can’t tell you anything regarding current medical views on surgery but I can share my story and hope that it helps. I tore my ACL, lateral and medial meniscus when I was 28 years old in May 2012. I had two surgeries. The first was a semitendinosus hamstring graft for the ACL with meniscus repair. I re-tore my meniscus while rehabbing doing open chain knee extensions as prescribed by my PT at the time and had a second surgery where they again repaired my meniscus and removed some of it that they thought could not be repaired. I later learned that it’s 50/50 amongst doctors if open chain knee extensions should be performed post-op. I did nothing but closed chain stuff after my second surgery. (i.e. foot on the ground such as in a squat)
At the time I had just gotten into triathlon and had a PR of 2:43:57 in an Olympic distance triathlon. It frankly took me a while to get back to the sport. It truly took me about 2 years after the two surgeries to get back to where I could even run a 5k. Frankly my recovery took lot longer than what is typical in part due to the two surgeries. After my second surgery I didn’t have proper PT as I was over my insurance policy’s limit until the start of the new calendar year. I had other things going on in my life too that just made focusing on endurance sports less important between 2014 and 2016.
I started running again in reality in 2017. I started triathlon again in 2018. I still get running injuries from time to time due to a muscle imbalance I have that I can directly connect to my ACL tear. IT Band Syndrome, pulled hamstring, soleus muscle issues, lower back/glute issues. It’s always on the affected side. I certainly have posterior chain weakness on that side and I’ve never been able to fully fix it regardless of how much strength/PT I do. But from a good news standpoint I can assure you that you can get back to FOP. I’m 38 now and was 49th overall/7th age group at Olympic Distance Age Group Nationals last summer. I now have a PR of 2:02:19 which is far faster than pre-injury. All of my running PRs are post ACL including beating my 1 mile time from when I did track. It took me a while but I came back stronger. You can get there a lot quicker than I did if it’s your goal. It certainly wasn’t mine for a while.
When I was 17 (In retrospect) I tore my ACL in a HS wrestling practice. It hurt like a SOB and I had limited function… but like a true, motivated, HS athlete, I kept my mouth shut about the pain and wrestled through the rest of my senior year. Went on to wrestle in college. Went on to play a lot of pickup and club soccer after college. Had a lot of fun and had zero issues.
When I was 25, playing soccer, I did something bad to my knee. MRI showed medial meniscus tear and missing ACL. Subsequent surgery. Surgeon afterwards told me that my ACL had been gone for years (hence me knowing that I tore it at 17). He was old school and didn’t believe that recreational athletes needed an ACL… so I never got it repaired.
I’ve never stopped being active. Lots of running. Lots of tri. Still play soccer. Ski super aggressively every winter.
For me, not having an ACL has never been proven to be an issue. I’m a physician and work with a bunch of orthopedic surgeons. I’ve talked to several of them and they all feel like if it ain’t broke, I shouldn’t fix it.
This is all a long-winded way of letting you know that I am an unrepaired ACL guy who has not regretted not getting the repair. However, I think that I may be an aberration.
I had my ACL replaced with a patellar autograft. My injury was rather substantial and included 2 other ligaments.
That was almost 6 years ago. At that time and I am willing to bet my surgeon would still agree that the surgery should be done in the “acute” phase. You will be weight bearing the next day, most of the rehab will be regaining ROM and rebuilding the muscle damage in the hamstring for the autograph.
My injury was very extensive and had a very different rehab protocol, but I discussed various rehab protocols with my PT a lot, because I was there 3x times a week for months.
If you are fit and can commit to the rehab, I would have it fixed for long term durability. A lot of the no surgery stance comes from the average adult does not have enough VMO strength to survive the rehab. As a pretty high level athlete, I would be surprised if you couldn’t knock it out and return to sport fairly quickly.
Not sure what you mean by “ruptured†but, if the ACL is truly ruptured (complete tear) then you will need surgery. If not fully torn then surgery may not be necessary.
I’m not a doctor and I doubt that you are either but I’m 99.9% sure that your statement isn’t true regarding needing surgery if it’s ruptured and not needing surgery if it’s a partial tear. Plenty of people tear it and do not have surgery. Hines Ward played most of his NFL career without either ACL but he has super human levels of strength that allowed him to compensate. The average Joe and most athletes wouldn’t be able to handle cutting without their ACL.
A partially torn ACL is no different than a fully ruptured ACL with regards to it’s inability to stabilize your knee. Your options for surgery or no surgery are the same regardless. The ACL does not repair itself if it’s only partially torn.
If it’s a grade 3 tear - meaning ruptured - and he wants to participate in sports (ie, triathlons), he will very likely need surgery. If he wants to pursue a dormant lifestyle for the next 50 years, then maybe not.
If it’s not a grade 3, then surgery very well may not be called for.
Without knowing the details, medical advice is a shot in the wind. Frankly, I don’t think it should even be allowed on the main cycling forum. Maybe a sub forum.
For what its worth, I fully tore my ACL while snowboarding almost 20 years ago and never had surgery. It aches sometimes when cold, but I have been a runner and FOP in triathlon for for the last 10 years and have never had any issues. The key is strength. You other muscles learn to compensate to some extent (I believe). Now, I probably cant go play soccer or B-ball in an aggressive manner, but I have no interest.
Also, Im sure the surgery options have changed and there may be a shorter downtime than when I was in this situation.
Thankful for the other helpful answers - not so much for yours. I clearly stated in my initial post that I wasn’t looking for medical advice but comparable experiences.
Worse than asking for medical advice on ST is making statements without any relevant knowledge. Recent studies have shown potential successful routes for non-operative treatment, even in case of patients involved in Level II and Level III sports (ie running and triathlon).
Happy to weigh in with my experience if that helps you. Was in my mid 30’s when I blew my ACL out skiing ~ 10 years ago. Had Allograph surgery and have had zero issues with that knee. Raced 5+ Ironmans, ski very hard annually, plenty of running and tennis and it keeps up great. Like you probably, I keep in very good shape and that matters. I am really glad I did the surgery and used an allograph vs screwing with something in my body that was not broken (lots of opinions here).
I also have a co worker who did the same thing skiing and did not have surgery, so he switched to snow boarding (how dare he, kidding somewhat) and is fine but not a lot of running in his life any more. I am told and yes ask your doc, that running without an ACL just opens up that joint a bit more and will cause more wear/pain over time. Again my data is older now but considering what I know now abut the surgery, taking PT/rehab very seriously and how well I can function now… I would not blink an eye about getting the surgery done and expecting a 97% recovery. That 3-5% is experience chiming in as I age saying do I really need to do a back flip over this lip or should I just stay on the ground?
hi,
I ruptured the ACL in my right knee playing football (soccer) about 25 years ago. my knee kept collapsing in the following months. Then I had keyhole surgery where they repaired the ligament, As part of the physio that followed, cycling was recommended to strengthen the muscles around the knee. I played football for the next 5 years and continued cycling with no knee issues to this day.
Hope yours recovers well.
Pete
Belgian Waffle, first off sorry about your injury. It sucks. I tore mine skiing last season and decided to opt for surgery. Went with quad tendon autograft. It’s really slow going in the beginning, but stick to the pt and you’ll be back at it. Can’t emphasize enough how important it is to rebuild strength in your quad muscles to stabilize the knee. I still have knee pain, hopefully with time it will go away.
Had the procedure in April 21. Was back on the bike trainer in May and running in September. Doing a Full IM this August.
Thankful for the other helpful answers - not so much for yours. I clearly stated in my initial post that I wasn’t looking for medical advice but comparable experiences.
Worse than asking for medical advice on ST is making statements without any relevant knowledge. Recent studies have shown potential successful routes for non-operative treatment, even in case of patients involved in Level II and Level III sports (ie running and triathlon).
Not my area of expertise, but use to associate with people who were. What I remember is an important indicator that surgery was indicated was if a person has episodes of the knee giving away.
Back in PT school we did a literature review on this topic. The takeaway for me was years later the incidence of needing a knee replacement on those that did not repair was overwhelming vs those that had it fixed.
Back in PT school we did a literature review on this topic. The takeaway for me was years later the incidence of needing a knee replacement on those that did not repair was overwhelming vs those that had it fixed.
I blew my ACL and had multiple meniscus tears during a fight 10 years ago. Got an allograft for the ACL and a partial menisectomy. It took me almost 5 years and two more surgeries to get mostly normal. I ended up with arthritis under my knee cap from an unknown reason and still have popping and grinding. My doctor was an expert in the field and actually has a patent on one of the devices used to locate the hole for drilling into the head of the femur. 10 years later and I can finally exercise without swelling. From my experience I learned that there is a medical definition for full range of motion and it doesn’t necessarily match what your healthy leg can do. Compared to my healthy leg I’m 5* short on flexion and 12* short on extension. No amount of stretching has been able to correct that. One upside is that I don’t feel the lactic acid build up in my bad leg nearly as much as my heathy leg, despite putting out more power in that leg on my bike as measured through my Assioma Duos.