Over 50...ACL reconstruction or not?

[feggie]

I am a 54 year old woman with a torn ACL and meniscus. I have seen 3 doctors... One said "not if you are over 40..." one said, "I hate to do it in people over 50", and one said..."lets fix it". I am not athletic, and sustained the injury sidestepping and twisting on an airplane, getting into my seat. My knee feels very unstable, and I have pain, especially when getting up from a low seat. I have had no pre surgery PT (none mentioned...) and that worries me. I have had to wait 5 mos. for the surgery, which is scheduled for 11/1/05. I would love to hear from folks who have had the sugery over age 40. My orthopedist says he is using donor ACL tissue, as the recovery is easier in people my age...Thanks for any input...

[christinaz]

I would push for pre surgical PT, especially if your surgery is 5 months away. It is crucial to have good quad strength when going into this surgery for your recovery to go well. It is much easier to keep a good quad than to have to rebuild especially when you will be trying to regain ROM. Also make sure your OS is going to have you in a CPM (continuous passive motion) machine immediately post op with a cryo cuff or ice man unit. You will also need to start a PT regimen immediately and a good post op will have you weight bearing or partial weight bearing immediately. Make sure that after your surgery that you take your pain meds as directed whether you feel the pain or not. It's important to stay on top of the pain rather than let it get out of control before you try to get it down. Ice will be your best friend for a while. So will Ibuprofren, because it will help control the swelling.

I had a patellar tendon autograft ( from my own leg) for my first acl reconstruction and it worked very well. I had a patellar tendon allograft ( from a donor cadaver) for my revision acl reconstruction and the graft itself is strong. Make sure you go over the risks of an allograft before you decide on one. As with any donor material, there is a risk of infection. However, they are cryogenically frozen so the risk is much lower.

If it were me, I would want to have it done. Who likes to live their life in pain? I have had a host of problems from my revision, my mine is an extreme case.

Go to www.aclmd.com and check out the pre and post op protocol on acl recon to familiarize yourself with what to do. I strongly believe in being as informed as possible beforehand.

Good Luck and if you have any questions the closer your surgery comes, feel free to IM me and I'll give you as much info as I can as to what to expect and what to bring to the hospital, etc. Also, there is an acl section on this board where you can find a host of great information and people willing to help. Everyone here is fantastic and is a great support family for you anytime you need us.

Love,

Christina

[Audice]

Hi ~ I'm a 67 yr old female with a ruptured ACl & torn meniscus as well as a few other rt knee problems. I am athletic & ruptured the ligament because I came off my horse & landed wrong. My injury was in April of this year & two ortho surgeons, one a friend, said that reconstruction on people my age simply isn't done as there's no real need. I'm no longer playing any sport where twisting or pivoting is crucial & there are few daily incidences where I might be twisting to accomplish something.

I do have a custom brace that I wear when I'm doing heavy work around the farm or hiking in the wooded hills just so I don't do further damage. But even walking my 3 dogs daily I no longer feel the need for the brace. My knee is strong & I push to remain active.

Once past the initial pain of the injury, I found my knee became increasingly stabile & from thinking that I'd have to spend the rest of my life in pain, I find I can comfortably do anything I want to do. I don't miss the ACl particularly except when I forget I don't have it & try jumping over something. <g> The torn meniscus is more problematic & when that becomes more than I want to handle I'll have surgery.

But the key I believe, to living w/o an ACl or preparing for surgical reconstruction, is to keep the leg muscles just as strong as possible. If you're not doing it thru your daily activities PT might make a difference. As my OS friend said...go to PT just to learn what exercises you need to rebuild or keep those muscles strong that support the knee.

Wishing you well...Ellie

[clesher]

Hello! Sorry to hear about your injury. This is the site to come to for info, though the following is just one experience and my own opinion.
I'm 46 and tore my acl when I was 44. I tried "healing" it on my own (not knowing that I had torn something.) After 6 months, I saw a doctor who sent me on to an OS. He diagnosed the problem (as best as he could without an arthroscopy) and gave me the option of surgery or waiting a year and trying to stabilize my knee through exercise. I was (am) already very disciplined and active, with an established exercise routine, so I wasn't sure what MORE I could do. (Especially because he told me to limit anything that really pounded on my knee to prevent even further damage.) After a year of instability (but little pain), I went back and we decided on surgery. He offered both a hamstring autograft or an allograft. He didn't suggest a patellar autograft for me because of my yoga practice (lots of kneeling).
Anyhow, more than a year after my initial injury, I had a tibialis allograft done. It took about 3 hours in surgery and more in recovery, but I was home that night. For about a week, I felt awkward, but wasn't in pain. I didn't have a brace or an ice machine. In fact, I used no ice at all. (Yes, I know that is unusual. Believe it or not, my OS doesn't recommend it. He says it decreases blood flow. I'm not saying I agree.) I was weight-bearing immediately, because I didn't need any further work done other than the acl replacement. The wrap was removed 2 days later and I was off crutches in a week. I took another 2 weeks off of my teaching job because it was icy wintery weather and I was nervous about getting about and through the aisles at school.
I have not gone to any formal PT, but saw my OS often for the first 3 months. And I continued to do my exercises and activities from the 1st day, though of course they were limited in the first few weeks.
It is now 9 months post operation and I am thrilled I had it done. It is great to be able to pivot and run again. Most of the time, I'm not even aware I had a problem. (That may be a danger in and of itself, because I don't think I'm out of the woods yet.) I have 3 little portal hole scars and a 3 cm. scar below my knee where the OS drilled.
My surgeon was not "the best" as most people here seem to have had, but he does many knee surgeries each year and was recommended. I guess I also did much "wrong" in that I waited a long time between injury and surgery (though I had excellent muscle tone and full ROM back.) I didn't use ice or PT either, as is usually recommended.
I'm not saying my experience was the way to go, but just wanted to share another option with you. Sorry it took so long to tell!
Whatever you decide, good luck! Remember that 54 is the new 34! You still need a functional knee! Carole

[feggie]

Thank you so much for the replies... Maybe most of the pain I am having is from the torn meniscus, but I guess the instability is the lack of the ACL... I am scheduled for the surgery a month from today (11/1), so I am going to exercise my legs as much as possible between now and then, and keep researching on what I should do...I do have a lot of faith in the doc, as knees are all he does. (That is why I have waited 5 mos.for my date, he was so booked up.)Just wish I could sit down with him for a long talk, but you know how much time you get to spend face to face with the doctor... He's in a huge ortho group where every doc does 1 specialty. I am a dental hygienist, up and down all day long, and getting up is the most uncomfortable thing. Thanks again for any insights.
Fran

[harry78]

Feggie, I had an ACLreconstruction recently and was told to minimise the damage being done being without the ACL. I did mainly quadriceps isometrics and hamstring curls to build the leg up. Now after nearly 15 weeks after the op, I am feeling the leg getting stronger and stronger. So the more you do now is worth twice afterwards.

[LP32]

Fran-

If I were you, I'd make sure that you do squats every day for quad development. There is also an exercise where you sit, tighten your leg straight, and lift it up and down slowly. I would get used to that feeling of tightening the quad to straighten the leg, as well as using the quad in that up and down squat motion. After surgery, you'll be amazed how difficult it is to truly straighten the leg with your muscles only. Also, I had some minor knee cap pain due to poor quad strength. It is my understanding that the quads work with the movement of the tendons in the knee. There is extra strain on the knee if the quads are not functioning at full strength and if you get a good idea of what that strength feels like before surgery, I believe you'll have a faster recovery with less pain.

So, my 20 cents is to work those quads at in at the very least, 3 sets of 15, 3 times a day (as long as there is no pain). You will save yourself in rehab in the long run and the knee feels so much better when those muscles are working well. If you can, also get to the gym and try the leg press- on that leg only- increasing weight accordingly, stand on that leg and balance, and in general try to get very comfortable relying on your "bad" leg for strength (not cutting, pivoting, etc). The confidence that you build will help in the long run. Also, keep in mind, you'll do this rehab until the knee feels great and the theory after having surgery is that you can then go back to your activities, without having to continually condition the quads. If you opted out of surgery, you would not have that luxury, since you would not have the ACL ligament and in my opinion, over time, your ligaments would become more brittle, muscles would become weaker as you age, and you could have further knee damage in the long run. To me, not having ACL surgery is a ticket to constant physcial therapy to make up for the loss. This, of course, is based on the current knowledge that I have of ACL reconstruction and does not take into account exceptions to the rule, acts of God, how the knee feels, one's mental attitude, etc. (which also contribute to this ailment).

[feggie]

It has been 7 months since my ACL reconstruction and meniscus repair. I think it was a total success. Considering I am an inactive 54 year old, I am very pleased. I did a month of physical therapy after the surgery. I was in a continuous motion machine from the time I got out of the hospital, for about 10 days. I had the electric ice machine apparatus which I think was what helped me heal so well.
I still have a little stiffness when I go down stairs, and sometimes I feel like my legs no longer "match"...
My doc says this spacial perception...feeling your leg in space...will get better with time, and to wear an elastic bandage, as this helps with the feeling where your leg is...
I had a course of hygan injections in my "good knee"...which used to be my bad knee, before I completely severed my ACL. This has worked great. I don't look forward to having it again, which the literature says needs to be repeated after a year.
Bottom line...regardless of age, fix your ACL if it is gone, as you will continue to damage your other ligaments without an ACL...that is what I hear from Docs and what I havae read.
I am a happy patient.
Good luck to those anticipating this surgery.

[emphatic]

Bottom line...regardless of age, fix your ACL if it is gone, as you will continue to damage your other ligaments without an ACL...that is what I hear from Docs and what I havae read.
I am a happy patient.

Excellent advice!

Congratulations on a wonderful result!

Meg

[jb-knee-geek]

good posts feg, thanks for the followup. I'm in the "over 40" camp and tried conservative treatment with poor results.

Glad to hear your surgery/post-op went well, we have similar injuries, supposed to have an ankle tibialis graft.

My OS doesn't recommend the CPM Or ice machines, says light rehab and ice will be a less costly substitiute.....

[fabienzan]

I am a 54 year old woman with a torn ACL and meniscus. I have seen 3 doctors... One said "not if you are over 40..." one said, "I hate to do it in people over 50", and one said..."lets fix it". I am not athletic, and sustained the injury sidestepping and twisting on an airplane, getting into my seat. My knee feels very unstable, and I have pain, especially when getting up from a low seat. I have had no pre surgery PT (none mentioned...) and that worries me. I have had to wait 5 mos. for the surgery, which is scheduled for 11/1/05. I would love to hear from folks who have had the sugery over age 40. My orthopedist says he is using donor ACL tissue, as the recovery is easier in people my age...Thanks for any input...

I am 43 and I am having the surgery in 4 days. I have ACL and meniscus tear on both meniscus.
Did you get the surgery ? It is a big deal specially because of the rehab and the meniscus tear. I am wondering if you did the surgery and how you are doing now. My understanding is that you will need the meniscus tear to be fixed anyway and If you don't stabilise your knee you are likely to do more damage to your meniscus.

[fabienzan]

Hi ~ I'm a 67 yr old female with a ruptured ACl & torn meniscus as well as a few other rt knee problems. I am athletic & ruptured the ligament because I came off my horse & landed wrong. My injury was in April of this year & two ortho surgeons, one a friend, said that reconstruction on people my age simply isn't done as there's no real need. I'm no longer playing any sport where twisting or pivoting is crucial & there are few daily incidences where I might be twisting to accomplish something.

I do have a custom brace that I wear when I'm doing heavy work around the farm or hiking in the wooded hills just so I don't do further damage. But even walking my 3 dogs daily I no longer feel the need for the brace. My knee is strong & I push to remain active.

Once past the initial pain of the injury, I found my knee became increasingly stabile & from thinking that I'd have to spend the rest of my life in pain, I find I can comfortably do anything I want to do. I don't miss the ACl particularly except when I forget I don't have it & try jumping over something. <g> The torn meniscus is more problematic & when that becomes more than I want to handle I'll have surgery.

But the key I believe, to living w/o an ACl or preparing for surgical reconstruction, is to keep the leg muscles just as strong as possible. If you're not doing it thru your daily activities PT might make a difference. As my OS friend said...go to PT just to learn what exercises you need to rebuild or keep those muscles strong that support the knee.

Wishing you well...Ellie

Hi Ellie,

How have you recover from your surgery for ACL rupture, medial meniscus tear within posterior horn to articular surface. I have the exact same injury. I am worry about the medial meniscus tear as this has longer term consequence with OA and I am interested in your experience.

[fabienzan]

It has been 7 months since my ACL reconstruction and meniscus repair. I think it was a total success. Considering I am an inactive 54 year old, I am very pleased. I did a month of physical therapy after the surgery. I was in a continuous motion machine from the time I got out of the hospital, for about 10 days. I had the electric ice machine apparatus which I think was what helped me heal so well.
I still have a little stiffness when I go down stairs, and sometimes I feel like my legs no longer "match"...
My doc says this spacial perception...feeling your leg in space...will get better with time, and to wear an elastic bandage, as this helps with the feeling where your leg is...
I had a course of hygan injections in my "good knee"...which used to be my bad knee, before I completely severed my ACL. This has worked great. I don't look forward to having it again, which the literature says needs to be repeated after a year.
Bottom line...regardless of age, fix your ACL if it is gone, as you will continue to damage your other ligaments without an ACL...that is what I hear from Docs and what I havae read.
I am a happy patient.
Good luck to those anticipating this surgery.

I am curious to know how you are going now ? DO you have any more meniscus issue or knee pain ?

[fabienzan]

Thank you so much for the replies... Maybe most of the pain I am having is from the torn meniscus, but I guess the instability is the lack of the ACL... I am scheduled for the surgery a month from today (11/1), so I am going to exercise my legs as much as possible between now and then, and keep researching on what I should do...I do have a lot of faith in the doc, as knees are all he does. (That is why I have waited 5 mos.for my date, he was so booked up.)Just wish I could sit down with him for a long talk, but you know how much time you get to spend face to face with the doctor... He's in a huge ortho group where every doc does 1 specialty. I am a dental hygienist, up and down all day long, and getting up is the most uncomfortable thing. Thanks again for any insights.
Fran

Hi Fran,

Eveything that you write here is very similar to myself. I had torn acl and meniscus damage to both lateral and medial about 4 months ago playing basketball. I am going for surgery on 23/09/2014. I am wondering how yours went and how well you recovered from it as you did it about 9 years ago.
Any limitation , signed of OA or other complications would greatly help me. Also how old were you when you had your surgery ? I am 43 and an active man.

[Audice]

fabienzan asked..."How have you recover from your surgery for ACL rupture, medial meniscus tear within posterior horn to articular surface. I have the exact same injury. I am worry about the medial meniscus tear as this has longer term consequence with OA and I am interested in your experience."

fabienzan, I wrote my response back in 2005 just 6 months post injury. I'm now almost 10 years beyond that date & I've still had no repairs. I'm now 76 years old, no longer riding my horse but still working with horses & managing just fine. Only rarely (as in once or twice a year) do I even turn to the brace. It's a matter of keeping going, I think...Ellie