I have a client that tore her ACL falling off a chair, apparently a complete tear (that’s all info I know). She and her doc decided to take the non-surgical route. Anyone had any experience with this? How long until she can expect (ballpark) to be back to normal activity, maybe even running?
Running again? Whoa
I tore mine in 2005. No way i would have risked much running on it without the stability of the ligament. I had not heard of a non-surgical if you wanted to still be active.
The pain that injury caused scared the shit out of me to pretty much not play soccer again.
Surgical route had me back doing my first Tri i recall about 6-8 months later.
I’m not a Dr. but I’ve had a couple of ACL repairs so I have some experience. She can get back to activity once the swelling goes down and she has her range of motion - usually in the 4-6 weeks time range. I rode bike with a torn ACL without any issues in the time between the tear and surgery. I could not run as I lost all stability in the joint and risked further meniscal damage. She needs to be really careful not to do other damage if the joint.
I’m hoping to chat with her a little later in the weekend when her emotions have calmed down. She definitely wants to be active and has aspirations towards a full marathon. My guess is that the are willing to see how the injury progresses without surgery and leave the surgical route until later. I might keep the 6-8 month surgery recovery thing in mind to use later.
There are a handful of professional athletes and countless more athletes who are ACL deficient. Sufficient muscular strength and proper firing patterns of the quad muscles is the goal in non-surgical rehabs. It will be important for the swelling to go down b/c the slightest bit of fluid will shut down the muscles very quickly (VMO first) and dampen the firing patterns. So while it is important to get rid of the swelling, it is not a green light to get back to activity immediately. Shes going to have to get some serious quad work and neuromuscular re-training in before she can start testing her dynamic abilities. Once the strength and proprioception comes, then its on to endurance.
Its not impossible, and its not unheard of. So with a real solid rehab plan and dedication theres no reason she can’t get back to activity. And anyone, medical professional or not, who makes a blanket definitive statement than she will never be able to, is wrong. Is it appropriate for her? Who knows, theres a lot of other variables that go along with making the surgical vs conservative choice. Other sequelae or complicating injuries, mindset, confidence, baseline strength, strength balance etc. Confidence is a HUGE factor. I find that with many of my own patients confidence is a big risk factor for re-injury in surgical or non-surgical ACLs. If they are not confident then they will not perform the “normal” mechanics and are increasing risk of re-injury.
Any excuse to brag, but hopefully my experience gives your client some hope. I apparently tore mine sometime in the distant past, probably when I was playing contact sports in college. I had to have a knee surgery for a problem related to my patella in 2009. MRI showed the missing ACL and the ortho took pictures during the procedure showing my ACL was gone and had retreated to the attachment points. I don’t know exactly when I did it but would guess 1987. Knee pain has been a periodic limiter to my athletic performance but I probably managed several hundred road races, bike races and triathlons, including 12 IMs, several KQ’s, a couple Konas, 2nd amateur at Silverman and many miles of training with great friends. As I’ve gotten old and slow it is becoming a problem, it will feel like the knee is buckling on downhills, but I can still get out there and enjoy the day. I’m also 6’6’ and between 210 and 225 depending on fitness. Maybe I’m a freak but I bet not. If she gets after it she’ll eventually be running as well as she ever did if not better. There are all sorts of people enjoying this lifestyle with medical charts that say they shouldn’t be. Good luck to her.
Complete ACL tear my first full contact wrestling practice my senior year of high school (didn’t know it at the time) and was back wrestling within a week. Wrestled all the way through to the state finals that year.
Went on to wrestle in college. Played a lot of IM and pick up soccer. Eight years after my original injury I tore my medial meniscus on the same knee playing soccer. Like the guy above, my original ACL tear was diagnosed many years later by MRI and surgery.
Still haven’t had it repaired, 25 years after the original injury and 17 years after diagnosis. I’m pretty active. It does not limit me in any way.
Did a complete tear of mine skiing (very classical injury). A lot pain at the time of injury and of course very unstable. Had to take the tobaggon down :(.
Decided early on that I wanted surgery but went through the build up process. A lot of physio and gym time to build it up. Although I had a brace, I ended up seldom wearing it and was able to cycle at the time. I wasn’t running so that wasn’t an issue. Then at a resort hotel I was getting out of the Jacuzzi and the floor was wet, my bad leg started to slid and without the ACL mtpy knee gave out, again, excruciating pain! And, a list of words that I don’t generally utter around my wife. If I hadn’t been convinced before, that did it.
So, under the knife, the the usual physio and building up the repaired joint. That knee is now “different” (but, I had a slight teat in other ACL many, many years ago). So, the left knee is “tight” while the tight one is a bit loose. But neither gives out!
After the repair, I went back to skiing, first with the brace and then without. I’ve felt that knee just before a binding release and it is stong enough to handle that just fine. Even so, on the last set of skis, I got a “knee” binding which releases laterally as well as in the traditional areas and I’ve had it release a few times.
Oh, and don’t know how much a difference it does or doesn’t make but I was 60 when I tore it. No regrets getting the surgery done.
I am in the same boat as your client. Tore my ACL just over 3 weeks ago skiing. Consulted with a PT and ortho and plan to go the non-surgical route as no meniscus damage. At the very least no surgery until after this triathlon season (Olympic age-group nats,World age-group and IM Chat). Have been doing strength and proceptive exercises from PT. Progression was week one only swimming with a pull buoy (had a big swim week). 2nd week was short easy bike on trainer and eliptical and continued swimming. 3rd week 1 hour bike with some tempo efforts, swimming mostly without buoy, elliptical and 1-2 mile easy jogs. Icing was key to get swelling down and having my VMO and top of the calf tell me when to stop.