Climbing , no ACL

Internet people,

Tore my ACL ( 3rd time) and don't think I want to go through another reconstruction. Obviously I'll consult a doctor but Im curious to what people's experiences are climbing w/o an ACL?

Would really appreciate any anecdotes or advice

-Brian

One of my good friends has been snowboarding without an acl for close to 20 years. One trip we were putting up 5-10k a day in knee to thigh deep steep climbs. Some people don’t need them. 

I had a complete tear of my ACL. The doc suggested try using a brace instead of surgery, always an option. No big deal. I ski with a brace but climbing is NBD. I sometimes even forget which knee it is.

I climb with no ACL. Hasn’t been an issue but it has been a while since my accident (13 years). I only got into climbing a few years ago so I don’t know what it would have been like immediately after the accident.

It is a problem when it comes to certain exercises I do for climbing related strength but I don’t notice it on the wall. 

I’ve had a completely detached ACL since 2006, from a skiing accident. A surgeon I consulted at the time insisted I need reconstruction and that I would be sorry if I didn’t have surgery. I was extremely fit, didn’t want to take the time needed to wait for the operation and rehab, had a friend whose ACL reconstruction went very badly, so I did not have surgery. I also ended up with a bucket tear to my meniscus from the accident and did have part of that removed as I was unable to straighten my knee. I figured there were a lot of NFL players who didn’t bother with ACL construction as it would end their careers and things went well for most of them. I was doing a lot of training and capoeira at the time, so continued working out as hard as I could and stayed in shape. I saw the same surgeon for a follow up examination six months after he removed part of the meniscus and he was astounded I was doing so well.

I’ve never noticed any problems from not having an ACL. I ski resort and backcountry, plus climb without issues. I don’t wear a brace and have no instability.

I completely tore ACL and MCL in 1982 (motocross). Had a surgery they don't do any more (I hope), was in a full cast for 6 weeks, after getting the cast off was pretty messed up obviously and took a long time to overcome the damage from the surgery. The repair never held and I haven't had a ACL for 35 years. I wear a CTI brace to ski cause my quads/vastus medialis are weak. Build them and you won't need a brace. I don't run but never had much problem with climbing but have to be more aware of what I'm doing and how I'm moving so nothing goes awry. Having a bad knee and the compensation I've done to get around it have caused back problems. 

Thanks for the info, hopefully going to be able to join the NBD club in a few months

This is a timely conversation! (A but delayed here on my part.) I fell bouldering and tore my ACL in May as well as sprained my MCL, had a bone bruise, and a couple other things that came up on the MRI. I was supposed to have the reconstruction surgery in June, using my quad tendon. But the Ortho didn’t feel comfortable with it due to complications with an autoimmune disorder I have and knee stiffness at the time. Non surgery PT has been slow going - some setbacks from the autoimmune disorder. I just started some light top roping twice in the last couple weeks. It’s been ok but I definitely still have weakness and instability in my leg. Having relied on crutches and a brace after the injury definitely set me back. I’m following up with the Ortho this week. Will see what he says about surgery or not. I hate the idea of being out of climbing for 6-9 months since it’s already been 3. Glad to hear about some regular climbers going without an ACL, not just pro athletes who have all the time and resources in the world to train and improve. Thanks!

I had four ACL surgeries, all on the same knee, with long periods of not having an ACL, and I can tell that I perform better with an ACL. My doctor was pretty clear that we tend to subliminally baby our injuries/imperfections, making them less noticeable.  

I had about 98.5% of my abilities without the ACL. The 1.5% showed up during heavy torquing (like heel hooks) and from quick pivoting (like trying to do advanced dribbles with a soccer ball to juke somebody). ACLs control the twist of your knees, so not having one will obviously create weakness in that area. Surrounding muscles will supplement help; but it won’t be the same.

I currently have 100% of my knees operating power. I don’t notice a difference in my legs at all. Recovery is hard, and my physical therapist was very clear that most people don’t do it correctly, and that the physical therapy is more important to recovery than the surgery itself

my final surgeon was previously the surgeon for the Baltimore ravens, he was super cool. My first surgeon got caught cheating on his wife, and I think he did shitty surgeries. I could feel that the surgery from the new professional was more solid. Idk.

Tore my ACL (partial thickness, high grade tear ie no more ACL) in January. I’ve had no issues climbing at my previous level after doing initial physio, except at the extreme flexion where some residual swelling prevents full range. 

I agree some people tear them and have no issues. I tore each 1x and they were greatly impactful on my athleticism. I wrestled in college for four years at D1 level. Some people lost them and could wrestle all the same. I never recovered despite best surgeon money could buy and a perfectly optimized postoperative therapy program. In my climbing now, my knees can’t handle knee bars, drop knees, jumping off bouldering walls more than 10 feet.

In short, it seems very variable how people respond. I am glad I repaired mine, but even so life will never be the same for me.

I have no ACL.

My biggest issue is not climbing per se, but rather long descents where I find myself constantly fighting against hyperextending my knee.  

I never climbed at a very high standard, however, so it's possible that if I was a better climber I would notice more of an impediment in my climbing.  

Interesting to read that many of you have stayed relatively active without ACLs. I've had my right ACL redone twice and while it doesn't give me any problems while climbing, trekking poles have become my new best friend for longer approaches. Shortly after my second injury, I tried to get by for a few months without surgery until the entire joint unexpectedly twisted out of place while I was walking on flat ground. Ended up eating the pavement. Even a few years post surgery now, I still stay away from anything involving quick pivoting like basketball/soccer. Y'all built different

Andrew R wrote:

Interesting to read that many of you have stayed relatively active without ACLs. I've had my right ACL redone twice and while it doesn't give me any problems while climbing, trekking poles have become my new best friend for longer approaches. Shortly after my second injury, I tried to get by for a few months without surgery until the entire joint unexpectedly twisted out of place while I was walking on flat ground. Ended up eating the pavement. Even a few years post surgery now, I still stay away from anything involving quick pivoting like basketball/soccer. Y'all built different

I think they just don’t do heavy pivoting. There’s no way a high level athlete can say they perform the same without it. You can be 98% the same, but there’s still a little bit of movement you have to avoid whether you realize it or not. It’s science. Rock climbing doesn’t have too much techniques that torque your knees, so you could likely climb fairly hard without impediment. 

I am confused on this issue myself.  I tore my right ACL 15 years ago.  I had surgery but it tore again a year later.  I eventually got into rock climbing and never had an issue while on the wall.  Then 3 months ago I tore my other ACL.  I have not been able to climb since which is frustrating and confusing considering my other knee did okay without an ACL.  I think time is potentially a big factor - the body just has to learn to work without an ACL for a while.  My surgeon has strongly suggested repair for the recent tear and I am wondering if I need it.  38 years old.

On my left leg I've ruined my ACL, MCL and PCL. Ive had two surgeries over 15 years and didnt get into climbing until after the first one. On my right knee I tore my ACL and had a patella tendon reconstruction. They dont seem to effect my climbing unless Im trying to do a one legged stand from full compression. Hiking down from alpine climbs sucks, that is probably the biggest draw back. Im 42. "You either die a hero, or live long enough to see your self use trekking poles" Graham The Overstoker"          I put up a route to commemorate all the injured knees out there. https://www.mountainproject.com/route/116627945/acl-optional

approx 4.5 months ago I tore both MCL (grade II), and ACL, the manual tests suggested the ACL wasn’t fully torn but an MRI revealed it was atleast grade II, the surgeon was reluctant to give an exact % torn, I had the MRI early on and there was a lot of edema that obscured things

I was weight bearing immediately but had almost zero range of motion, couldn’t go up and down stairs without just trailing the hurt leg behind the good one, my knee throbbed every morning when I woke up and I couldn’t get more than a few degrees bend, bend + twist was particularly brutal, e.g. stepping over the tub to get in the shower was near impossible, but this specific motion could’ve been more due to the MCL 

had I not been weight bearing and had a decent manual test result, I probably would’ve elected surgical reconstruction but I figured I’d go the PT route since you can always tear the replacement ACL and my injury didn’t seem as extreme as friend’s experiences. Very very religious PT and early activity (while avoiding pain) seemed to work very well for me. Big steps down with a heavy pack were painful for the longest time, but just last weekend I handled IC approaches with zero issue. Agreed with Rukas, after knee injury standing up on one knee from fully compressed is challenging both physically and mentally, but it has gotten better with time. I still have some soft tissue shifting during more intense movements and some end range of motion pain (think child’s pose or sitting on heels) but the ROM pain may just be nervous system adaptation at this point 

All that being said, start PT as soon as your doctor says you’re ready, and press them on this, im fortunate to be in a town where the doctors see lots of active folks, I’ve heard from friends elsewhere that a surgeon scheduled them for surgery 6 months out and didn’t even mention the idea of PT (this does seem to be the “American” way ;), I.e. ‘how can the doctor heal me’). Research prehab, there’s lots of discussion around improved outcomes from surgery if you’re rehabbing the knee prior to the surgery, and hey, you might even find you’re doing alright and not need the surgery!

None of this should be treated as actual medical advice.

Bit of a rebirth of this thread so thought I would share my experience as well since I posted:

No ACL so far has OK. After the tear I was able to PT a bunch and get back into climbing and snowboarding at close to my peak in about 6 months with plenty of PT. Cutting never felt great so just really avoided it

Unfortunately there is an exception to this which is I ended up sending it a bit too far off of a jump while snowboarding and tore both meniscuses in my left knee. Unsure if having an ACL would've helped but somewhat suspect it would have. Recovery from that has been long but seem to getting back to a similar fitness spot, just with more of feeling like an old man some days and keeping it a bit lower risk.

I talk a lot with my brother (also 3 ACL tears) about the philosophy of the surgery and we both kind of agree that there's a high chance that knowing what we know now, we would've have never gotten the surgery to being with (or at least done an allograph). The surgery has a lot of side effects, particularly with the hamstring graft. Post hamstring graft I've noticed an acute weakness in certain ranges of motion of the hamstring, despite tons of training. The hamstring is the primary stability provider for the knee , so weakening it by using it as the graft supply site seems extremely counter intuitive. Additionally what was never really mentioned to me is the osteoarthritis that is induced during surgery due to embedding the screws in your bone. Already have grade IV arthritis at the sites of the screws which I'm not psyched about dealing with in 20 ish years.

My general strategy now is to just try and prolong the knee I've got as long as I can making slightly better risk calls with the hopes that medical technology improves by the time it really gives out.