ACL Surgery "Not Needed" ?

[kneeknic]

I'm confused... Partially tore ACL twelve years ago. Had intense therapy and wore CTi2 brace when active. Knee gave out last June, and completely tore ACL along with medial meniscus damage, nondisplaced tibial plateau fractures and osteochondral fracture, grade II-III chondromalacia. Was expecting to have reconstruction, but only had scope to shave cartilage in July. Intense physical therapy since to strengthen quads and hams. I'm 35, don't play sports actively, but still consider myself young and physically active. OS says I don't need ACL surgery, even with all my concerns (still plan to have kids, etc.)... I do have trouble going down stairs - extremely wobbly and painful under kneecap, and experience some type of cracking/shifting sensation when walking straight at normal pace or occasionally going down stairs - it's like I have to wait for the leg to go back into place (but doesn't fully feel like it gives out like it did last June - to cause me to fall. I also have small constant pain on lateral side just below knee, and pain extending down that radiates through ankle on lateral side. Any thoughts? I'm ready and willing to have recon and even let my surgeon know this, but still says I don't need it. Worried about quality of daily activities/future damage.

[crumpet]

Hey there..kneeknic:

Ya know...I'm not sure if I'm the right person to be answering here but, FWIW...I'd say you are an excellent candidate for ACLr!

As you rightly pointed out..there is a LOT of world out there besides sport...and at 35 you are still WAY young.

I'm wondering why your doc has the hesitation? Maybe he's got some other issues going on, and he's afraid of doing the work?

I'd be hitting up some other consultative appointments to get a fresh eye on the matter.

Good luck...


~Crumpet

[Kaputt_Knee]

Get thee to another surgeon and a knee specialist at that!

That pain on the lateral side could indicate further complications and you need an expert to look at it. Definitely ask around and actively seek out someone who is acknowledge as a patello-femoral expert who does dozens of recons a year.

What you are describing will impact on the quality of your life initially and permanently in the form of osteo-arthritis if you carry on with it how it is.

Sue

[feeny]

*looks up above* What Sue said!

In my case, if I was not going to return to soccer, I would likely not have had ACLr - the information I was given at the time I was making a decision was:

- I could still go jogging / cycling / swimming / most inline activities
- I could build the knee and train it to avoid hurting itself whilst doing regular day to day activities
- I could not return to pivoting sports.

The advantages of this approach would have been:
- no surgery needed
- possibly better quality knee later in life (due to not having surgery and associated osteoarthritis that will come from it)

The disadvantages would have been:
- no pivot / soccer / sports I love
- possibly worse quality knee due to not having the surgery...

Trouble with this forum is its full of kneegeeks who have mostly had ACLr - I know many OSs try to convince patients to take a conservative route and not have surgery done - and Im sure that path is perfect for some ! Unfortunately its a bit like buying insurance - you dont really know if its worth anything And even once you get it done, you still have no idea if you would have been better off not getting it done - as I recall reading someplace that as many as 1/3 acl deficient people will do just fine without ...!
We really dont know and there arent too many studies done on those that dont have ACLr...

[vts69]

Hi KK,

I was in a similar position, injured at 34, at 35 told 'too old', can live a fulfilling life without pivotting sports etc...

3 yrs later I've had the op:

- pain when twisting in seat in cinema, on bus etc letting people through. It's minor but I am reminded I know it's 'bad'
- a pretty girl asked me to dance, I did till I fell in agony 2 mins later. Embarrassing, very painful and means settling for 'dancing like your Dad'
- Knowledge that some of these minor mishaps can have really bad outcomes of damaging other parts = living in fear
- saying 'No'. No I won't go on the dodgems 'cos it hurts my knee. No I won't dance, I could hurt myself. No to moving to catch a frisbee. No to activity holidays. In your case, No to a lot of stairs?
- I also feel young, but started behaving old - talking in the past tense 'I used to XYZ'
- I've already had an arthroscopy so already have the risk of arthritis.
- Now lost contact with soccer friends but really miss social/fitness activities - I go to the gym a lot but really hate it. No badminton, squash, surfing, skiing - none of which I do regularly but they're the variety that makes life fun.

It's a trade-off. Do you want an easier life now and possibly a less painful old age but with the fear of a serious mishap? Or go through a lot of trauma now which will mean after a tough year you can do anything you want that anyone else can do, have fun but possibly have a more painful old age.

[Audice]

KK ~ I agree with the others who say, "Find another OS." I'm living w/o an ACL but I'm 70 years old & can still do whatever I want to do. So I can't squat any longer but that doesn't affect my lifestyle. I do have a horse & work with horses & big dogs daily. I can pretty much do whatever I want w/o worrying that my knee will give out. It's been a couple of years since I've felt the need to wear a brace but if this knee were altering my life I'd sure be looking elsewhere for help. Wishing you well...Ellie

[kneeknic]

Thank you so much for all your replies. Knee just gave out today at work going down stairs, but luckily caught myself in time before falling. I have a followup appt. Monday, so if that doesn't do it then I'll definitely get a second opinion. I'm confident in my current OS (he's the OS to major league sports team in my area, came highly recommended, and is a specialist in ACL recon), but if he's still being too conservative with me (maybe due to age or not being on an actual sports team even though I'm active) off I go for another opinion. Thanks again for your responses. They're greatly appreciated!!!

[dancer49]

KneeKnic,

Everyone's posts here are dead on!
Your OS is right that you can live the rest of your life without reconstruction.
My husband tore his at age 20 and has lived 30 years with out an ACL.
However, constant bracing, exercise, giving out and falling are a way of life for him.
He had to stop running as well.

I injured myself at age 49, and even the surgeon who is going to do the operating on me discouraged
me from having ACLr "at your age..."- however, living like my husband and the uncertainty and instability is not what I call quality of life. I'd have to give up jazz and tap dancing- which has been part of my life and even my identity. I'm choosing surgery, the tough year to have a greater quality of life, period.

My doc suggested that I try living 6 months without the surgery and then decide. But I have already given up a year of dance (season is from Sept-June) and if I don't have the surgery now, I'll lose another year if I wait the 6 months. The ACLr isn't an 'urgent' surgery for most. See how you get by without it for a while and then decide. It really depends on you, your lifestyle and what you are willing to handle.

Also- going to another doc gives you perspective. My first doc was fine, but found that the second doc made more sense on some issues, and now with pre-hab, I feel stronger going into surgery. Also- first doc said my surgery would be almost 2 hours, while second doc said only 1 hour 15 minutes. That's a 45 min difference under anasthesia! So even if you like your first doc, like I did, a second one might be even better-

Good luck!

[loz8]

Dont want to get shouted at here, but I think your OS is correct and if I was in your positon I think id probably not have the recon even tho ive had a very succesful one myself. Firstly he will be considering one of the key surgical decisions for this op 'patient selection'. As you say you arent actively playing sports you could potentially do without the operation. I was given a similar choice but it was you can do without having ACLR but you will have to give up playing football, so it was a no brainer and I had it done.

I had previously had a partial tear and taken a non operative approach which worked for a long while whilst i was playing competitive sport.

At 35 and not playing sports I can see exactly why you wouldnt have the operation. Rehab is a 'sport' in its own right and requires a goal. If your goal is just to have a stable knee for normal life whilst not playing sport I think you could potentially achieve this with rehab and strengthening alone. Personally if its purely a lifestyle choice recon could prove alot harder than you think.

Obviously I take on board the others views about future problems but my view is similar to that of your OS.

good luck with it

L

[dancer49]

loz8,

I think you give very good advice here!
It really is up to the individual and their lifestyle isn't it?

My doc says that without surgery, the 'success rate' is like a bell curve.
Some will have very poor results no matter what PT they do, and it will always give out and be unstable, and then there are others who will do just fine, most as if they never had an injury.

For me, at age 49, I figure I have about 10 years of dancing left, and I've already lost this year. So I didn't want to wait 2-3 years to see how MY bell curve would go...I wanted to be able to turn, twist, leap and land on my leg a year after my initial injury.

Surgery should never be taken lightly-

[loz8]

As I said, yours is a lifestyle choice - you want to dance for 10 more years then those moves need an ACL as you rightly say. Kneeknic is not in that position. OS's probably look at patient selection....
1) are you a professional/elite sportsperson
2) are you an amateur where sport is a key part of your life
3) no sport but having a 100% knee is important to your work
4) no sport but having a 100% knee is important to your home life
There are probably more groups to add but I would imagine no 4 means conservative approach for ACLR.
L

[dancer49]

Agreed.
Also, I keep reading that people who don't have the reconstruction might
be facing arthritis in the knee at an earlier age.
And if someone is on the lower end of the bell curve, they might re-injure themselves when
their knee gives out or locks into place, making their knee sitch worse.

Your list is on the mark though!

[feeny]

Those of us that DO have ACLr will DEFINITELY be facing osteoarthritis at later stages. No question about it.

Those that don't may not .. they also may...

[kneeknic]

There are excellent points to both sides of the issue, and I appreciate all the posts. I can understand the conservative approach seeing that I don't play sports professionally or actively. I'd probably opt for just living with a torn ACL too, if I didn't consider myself active in normal, everyday life. My biggest problem is that I'm concerned about the cracking/shifting sensation I have several times during the day when walking around at work or at home. Sometimes it feels like just a normal cracking, as if you were cracking your knuckles. More often than not though, it's as if there's something shifting or moving on the inside of the knee/lower leg and I have to wait for it to feel as if it moves or goes back into place. It doesn't feel like a total giving out of the knee, but almost as if it it's a partial giving out if that makes any sense. I just don't want to damage it any further, seeing I had the nondisplaced tibial and osteochondral fractures (no mention of those by my surgeon to date either). I'm also tired of not being able to bound up and down the stairs like I used to, and I really do think my quads and hams are back up to par. Either way, I have a followup appointment with my surgeon on Monday. I'll bring up my concerns again and let him know that I'm all for the surgery if it'd help. If he still says no, then I think I will seek a second opinion just for peace of mind. I sure would like to be able to run and jump and turn and even just walk at a good clip to stay healthy and not worry about it - and if that means recon, then why not? Thanks again for all your posts - they are greatly appreciated!!

[galeforce]

Hello, what a weird thread? I cannot see why someone in their late 30's who does not actively participate in sport should NOT have the personal option to have their ACL reconstructed.

I am 38 and not an active sports person - haven't been for 20 years. I lived for 6 months without my ACL and it was a nightmare - couldn't drive, manage my family and didn't have support on how to manage to strengthen the other muscles to cope. It had nothing to do with my lifestyle, it had everything to do with the quality of my life, becoming whole and feeling like a normal human being again.

6 weeks post op, whether I am justified in having the op or not by anyone's standards... I love my new knee, I have a long way to go to get it back to normal and I have a lot of work to do on it, but I can feel the difference every day - I am glad that I had the option. I believe that everybody should have the right to have their ACL surgically fixed and that silly social prejudices are unnecessary.

kneeknic stand your ground and get what you need to make yourself better!!!

xxxxx Natalie