Current Info on ACL tear...

I know this topic has been spoken about in the past. Last in 2009 as I can tell. Wanted to check to see if anyone had anything current regarding any new procedures and/or techniques? Has anyone had a recent tear within the last year or so? How was your Experience/recovery? Did they use a cadaver piece for the repair? My Doctor says at my age (43) that's what they do. I have a follow up with him so I can ask more questions as I want to know if that's best for a highly active person regardless of age. Sadly, I'm no stranger to surgery so I know what to expect.

Thanks!

I tore may acl, mcl, and meniscus last march. Had meniscus surgery right away, and my acl repaired last June With a cadaver. I saw a top sports surgeon in Philadelphia. I agonized over what type of graft, finally going with cadaver bc I already had patellar tendonitis. He thought it would have been a much rougher recovery going that route. Was top roping 12 weeks after surgery (very controlled and with brace). Was climbing multi pitch trad in 6 months.

Started light running around 5 months bc I still had pain.

My advice for what it's worth... Go to the best surgeon who understand climbing.
Rehab like crazy. Lots of biking!
Let me know if I can answer anymore questions. Good luck

I tore an ACL and lateral meniscus too jumping off a boulder problem at age 68 and had them repaired/dissected soon after. I was in excellent shape for my age. Cadaver tendon naturally, because of reduced recovery issues. The cadaver tendon is not as strong but should be good enough unless you want to continue your career as a professional point guard.

Something to note: the cadaver tendon actually gets weaker before it gets stronger and you should be careful rehabbing for the first several months---it is really important not to overdo it. (I don't remember how many months but you'll easily find the info on the internet.)

I was back leading mid-fifth class routes in about seven months. However, the full recovery (which in my case would be the ability to do some trail running) took 2 1/2 years (but remember how old I am---now 71). I think the pain I had that put off running for so long was from the meniscus dissection, not the ACL replacement. (I only had some pain while running, not otherwise.) I now do my trail running with poles and won't be giving those up as long as I can continue the activity. I'm careful running downhill (lots of little steps) and going around sharp turns. My running is slow, but that's as much a feature of age as anything associated with the surgery. In fact, I seek out routes that will oblige me to go slow, which means with as little level running as possible.

Thanks for the input. Much appreciated.

Brad and Rgold did you have any issues with the cadaver? Infection, rejection or otherwise? Hoping it doesn't take 2 years to get back to running trails.

Brad did you have any issues waiting that long to get the ACL done? I have a business trip coming up in early September and was contemplating waiting till after that. I have been doing some rehab exercises already to keep the quads strong.

Rgold good to know about the tendon as I have a habit of doing too much too soon. It's hard for me to sit still.

I had mine done in late 2006 after a climbing related tear.

My surgeon, one of the best in the country at HSS, told me he'd do it however I wanted. BTB (patellar), cadaver, hamstring (he did not advise this, but would have done it had I insisted). His preference, and what seemed to be gold standard was the BTB.

Recovery is a bit longer, you don't always get 100% of the feeling back in the front of the knee cap (this is superficial, not structural in any way).

Anyway, I debated for a while. Faster recovery or better outcome. I opted for the outcome. And quite frankly I was having the chief of surgery at the #1 ortho hospital in the country advise BTB, i'd have to have had a God complex to go a different route.

I should note, they tell you 6-12 months, but if you plan to really work the knee in the mountains or other sports, plan on 12-18 months. By 19 months, the knee was 110% and by 24mos on, I honestly had no idea which was which. I still often look at the knee or have people say, it's your left knee, I can see the scar.

One other thing, the outcome long term is different with a ACL tear alone and a ACL + meniscus. If like me your just tore the ACL (actually tore the MCL as well, but that was fully healed in a few weeks) you should recover fully. With the meniscus it's much more a crapshoot how long you are trouble free.

Good luck.

Rehab is a large part of the outcome. You will need to work to get good results. Don't expect to just play video games and wait 6 months for recovery.

My info isn't current as I tore my left ACL in 2005, but for what it is worth:

My doctor said Patella was the "gold standard" but he recommended hamstring as it had gained in popularity and you don't have to deal with the patella being cut. You lose about 10% of your hamstring strength (so if you are an NFL cornerback skip the hamstring). Recovery is supposedly easier. Both sound like decent options. I went with the Patella graft.

He didn't recommend cadaver, except for advanced age and non-atheltic types.

If you are pretty athletic maybe the cadaver isn't for you. 43 isn't that old. Maybe some people have had good experiences with them though.

The patella is actually stronger than the original ACL. For the most part my knee is 95-100% of the old knee. i don't think about it at all anymore except after a long hike I feel it stiffen up and I still have issues with kneeling directly on my left knee on a hard surface. though it isn't like I'm installing floor tile all day long so I don't notice it that much. I don't think I worked hard enough on desensitizing the knee during recovery.

after about 6 months you can jog/run again. then one year feels pretty normal. but like Serpico I would say 12-24 months before you stop thinking about it and feel really confident again. depending on how you recover. first 1-3 weeks suck.

Thanks for the input all! Great resource here.

• ** Have an update. Turns out the MRI didn't show an ACL tear. Doc was stumped because all his manual tests showed it was. I do have some other issues that will require surgery. I somehow managed to chip something off of the patella and it is now floating in the knee area as well as some other things that need fixing such as the meniscus. Doc thinks 4 months instead of 6. I am crossing my fingers for the 4 and that I'll be back on the trail, and be able to get some ice in.

Any of you guys notice weakness (a sensation like your knee will give out) when going down steps that goes away when warmed up? I'm three years out from my replacement and can hike like a beast, run, boulder hop, heel hook and do pretty much everything but first steps of the day going down stairs feels terribly unsettling.

I haven't noticed this Josh. But there are, I believe, some nerves in the ACL structure that contribute, if I understood what I read a few years back on the internet, to the propreoceptive process. My recollection is that balance training was said to be an important part of rehab in order to develop compensatory pathways, because these nerves are destroyed by the operation and either do not regenerate or regenerate very slowly. If there is any accuracy at all to these memories, then it seems possible that you could have some related issues. Thank god it all goes away after you're warmed up.

Josh,

I have that feeling occasionally. It doesn't seem I do anything specific to make it happen and it happens less and less over time. Mostly on stairs, but sometimes just walking. Now it might be only every few months. Sort of a mini buckling that doesn't hurt, but sure feels unsettling. It has never been anything other than "hmmm that was odd" though.

Maybe try one of those half sphere balance things you see in PT offices. Sort of like safe slack lining. I would imagine slack lining would help also. I'm too afraid that a sudden dismount would lead to another injury so in general I avoid the slack line.

Patella tracking disorder is a problem whose symptoms sometimes include buckling of the leg, see for example webmd.com/hw-popup/patellar… . It seems possible that something like this could in some cases be a byproduct of the surgery or the recovery from it. Treatment usually consists of exercises and stretches.

I am currently 5 days out of ACL and meniscus reconstruction. At 28 and athletic the Dr. recommended hamstring saying that B2B could leave me with chronic knee pain...
Anyways I just started PT a few days ago so I definitely have a long way to go. Because of the work on my meniscus I have to keep my leg straight in the brace while walking for 6 weeks. How far out did you guys feel comfortable walking without crutches? I am still weary about putting weight on it even in the brace.

I recall at first there wasn't a need to weight the leg that much, but keep it moving as much as possible. Obviously weight bearing is important at some point...I'm not sure if it is the first thing to work on. Range of movement seems to be priority one. Though really your PT and doctor should be advising you.

Yes range of motion first. The PT's were especially interested in making sure the leg would completely straighten, but I also worked hard on getting it to bend fully. Straightening was easy, but it took many months to get reasonable bending and 2 1/2 years later I can't sit on the heel of the repaired leg, so I think that's probably going to be a permanent range restriction.

You had meniscus repair, which requires a long period with no bending. I had a partial meniscus dissection and after a day or two never locked my brace. Of course repairing the meniscus is preferable, especially if you are young, because eventually you'll get arthritis without your meniscus. In my case, by the time the arthritis sets in seriously, I'll be dead or incompetent and so not much of an issue for me.

I don't remember crutch time well but I think I stopped using them after three or four weeks. The brace stayed on for longer.

I also got fitted for a prescription custom athletic brace when I was better, but it really didn't work for me. It seems as if it was designed for use in circumstances in which you wouldn't be wearing it for much more than an hour. In order for it to function properly, it had to be strapped relatively tightly above and below the knee, and the below-knee strap in particular eventually restricted circulation to my calf muscle and made it painful enough for me to have to remove the brace if I was hiking for several hours or more. In any case, the main point of the brace seemed to be to protect the knee from lateral blows and that's a relatively minor issue for me.

"H" wrote:I know this topic has been spoken about in the past. Last in 2009 as I can tell. Wanted to check to see if anyone had anything current regarding any new procedures and/or techniques? Has anyone had a recent tear within the last year or so? How was your Experience/recovery? Did they use a cadaver piece for the repair? My Doctor says at my age (43) that's what they do. I have a follow up with him so I can ask more questions as I want to know if that's best for a highly active person regardless of age. Sadly, I'm no stranger to surgery so I know what to expect. Thanks!

I blew mine out in 2003 paintballing when I was 34 years old. I had a cadaver donor graft for my reconstruction. I wasn't climbing back then, more into road bike racing and hiking. It took six months before I was released to full activity. Umm, I remember setting a goal of saying I would walk into the doctors office 1 week post op to get my staples out. I did managed thatusing a cane. I was told not to put any weight on it for three days, I think, then to use crutches for a few more days.

I did take physical therapy very seriously, which was only 4 weeks, going twice a week. All of their exercises I did at home and at the gym which got me though it quickly. I also heeded the advice of the physical therapist and doctor about returning to full activity. I never used a brace.

You need to be careful about pivoting on it and let that graft heal. I had a friend who had his ACL done, and he return to climbing 3 months post op and screwed up his knee, the graft didn't heal right, tracking issues, etc. He pretty much lives in a brace now. Is that from climbing too soon because "the doctors and physical therapist don't know s**t" or not, who knows. I just choose to error on the side of caution, take an extra month off rather than having an extra surgery or risking more complications.

My graft was anchored by placing a titanium bolt in my femur, and drilling a full tunnel in my tibia where they threaded the graft though and stapled it it in front. I guess this was a very short lived practice back then... The staples in the tibia bother me at times and the surrounding tissue swells up. Putting an ice pack on it takes it away and it never bothers me I went to a doctor about getting them removed and he wouldn't do it, because he removed a few in the past and the graft loosened up.

Now the knee is doing great. I do get a little pain and swelling in it when I go running over 5 miles. An ice pack solves this problem after the run and at night when I am going to bed. When backpacking down into the Grand Canyon, I have to put neoprene type brace on it for the downhill part. Hiking out and shorter downhills it's fine. Just 7 - 9 miles of constant downhill pounding is a little much.

John...

Josh Janes wrote:Any of you guys notice weakness (a sensation like your knee will give out) when going down steps that goes away when warmed up? I'm three years out from my replacement and can hike like a beast, run, boulder hop, heel hook and do pretty much everything but first steps of the day going down stairs feels terribly unsettling.

Josh I've had that prior to my current injury. I had my meniscus repaired back in 98, plus a second surgery 6 months later on the same knee 6 months later. I was in my late 20's. Now I have to warm up like an old engine then I'm fine. 43 today, my wife says I act like I'm 16, and my joints feel like their in their 60's sometimes. Although I must say I eliminated certain foods and it seems to have had an impact on inflamation.

daniel arthur wrote:I am currently 5 days out of ACL and meniscus reconstruction. At 28 and athletic the Dr. recommended hamstring saying that B2B could leave me with chronic knee pain... Anyways I just started PT a few days ago so I definitely have a long way to go. Because of the work on my meniscus I have to keep my leg straight in the brace while walking for 6 weeks. How far out did you guys feel comfortable walking without crutches? I am still weary about putting weight on it even in the brace.

Daniel. I had my meniscus repaired in 98. I think I was about your age. It sucked. Back then I had to keep my leg immobilized for 3 months. It slowed me down of course, but I tried way too much way to soon and was back in for a second knee surgery 6 months later. I was driving myself to work (I was fresh out the the Marine Corps and back to lifeguarding at the beach) with the immobilizer. I just did emt stuff in the shack. You'll get comfortable again. I tore my achilles 3 years ago and after 8 months and getting cleared to trail run and climb again, I was really nervous, but once I realized it wasn't going to rupture again I was good. All in good time.

H

I think a few extra weeks or months of cautious rehab and progressive stress on the area are usually ideal. Most competitive people want to prove everyone wrong and be back faster than anyone in history. I always say when people think I'm conservative in my rehab time frame (all successful rehabs), 5 years from now 2 months won't matter, if I fully recover. If I fuck it up, it's probably going to cost me another year or so, maybe longer if I cause new injuries. Wearing a brace for life, or having a surgical revision because you couldn't wait an extra month seems like a bad decision.

I am jealous of the 4 week rehabs. I was rehabbing for 4 months. 3x a week to start, tapering down to weekly and finally bi-weekly.

rgold wrote: Of course repairing the meniscus is preferable, especially if you are young, because eventually you'll get arthritis without your meniscus. In my case, by the time the arthritis sets in seriously, I'll be dead or incompetent and so not much of an issue for me... I also got fitted for a prescription custom athletic brace when I was better, but it really didn't work for me.

It is not always necessary to replace a torn ACL. If one is actively engaged in a cutting sport, e.g., basketball, soccer, then one needs an intact ACL. For most other activities including climbing, it's a matter of how inconvenienced one is by the absence of a functioning ACL. Rushing into surgery is often not warranted. Better to take some time and then make a decision.

I've tried specially fitted athletic braces for the knee. They didn't make anything better so I soon stopped using them.

It's difficult to predict if arthritis will just be an annoyance or disabling. My L knee, lacks a medial meniscus (excised 1973 prior to arthroscopy), an ACL and the weight bearing surface of the medial femoral condyle was chipped in a bouldering accident. For a long time the knee was unstable but as it became arthritic it stabilized as cartilage roughened, and I no longer have giving away incidents. On x-rays the knee looks terrible, but I can walk on it and climb with no noticeable problems. I very seldom take an analgesic. High repetition, medium-weight squats seem to keep the knee going OK. And RG, I'm a lot older than you--84--so that by the time the arthritis sets in, it's quite possible you'll neither be dead nor incompetent.

rob.calm

H - what foods did you eliminate? my friend went gluten and sugar free and supposedly it cured his elbow tendinitis. gluten free would be very difficult for me.

my doc used bio absorbable screws, I suppose they are gone now.

Paul Hunnicutt wrote:H - what foods did you eliminate? my friend went gluten and sugar free and supposedly it cured his elbow tendinitis. gluten free would be very difficult for me. my doc used bio absorbable screws, I suppose they are gone now.

I did eliminate gluten and that was hard for me as I love good bread. I'm not as hardcore as I probably should be, but I do notice when I reintroduce something with gluten back into my diet. I try to get my carbs from veggies and fruits- mostly berries but a lot of veggies. In about a month my joints stopped hurting and didn't feel like I had something sitting in my stomach all day. There are some good gluten free, high abv beers out there but that is my weakness. I love a good beer from time to time! Oh I lost weight as well and don't have stomach bloat.

I rarely if ever use gluten free noodles etc. I slice zuchhini really thin and use that as a pseudo noodle.