Torn ACL - to repair or not?

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2/5/2018 9:38 AM

Well, tore my ACL, MCL & Meniscus. From the research I've been doing, there are a ton of trade off's from one graft choice to another. Thought I'd ask some of other mx'ers that have torn an ACL of their experience. Doesn't sound like a fun surgery by any means!

I'm 40 and active, not so much for pivoting sports but like to ride MTB and dirt bikes but not really racing but still get after it.

My main questions are:
-Have any of you had a torn ACL and not have it repaired? Any problems with stability?
-If repaired, which graft did you opt for and how was the recovery?
-Curious about the anesthesia, were you put under general anesthesia or did they do a spinal similar to an epidermal?

Thanks for any input!

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2/5/2018 9:55 AM

Surgery and recover is anywhere in the 8 - 14 month range, depending on your ability to make rehab, the program you get into, and whether or not anything else needs to be fixed (microfractures, other ligament damage, etc.).

In your case, I think it'd be silly not to get everything fixed. Do you want 8-14 months of hard work and discomfort, or a potential 10+ year case of a floppy knee, worrying about the slightest twist that could cause issues again? Most doctors will recommend allograft (IE cadaver) at your age.

Most research suggests even at higher ages, most surgeries are pretty successful with most returning to their previous activity level. Again, a lot of that will depend on your ability to recover and your insurance ability to allow for therapy.

I know people who ride with no ACL and/or other damaged ligaments. They can still ride fast, but I think several would tell you they are starting to suffer a bit with arthritis and significant issues in recovery after riding. And, for them, all it takes it one wrong bump and their day is done (yes, I know, any knee injury can occur with just a wrong twist or placing it wrong).

Like anything else, ask probing high level questions with your doc, do your research, and consider your options.

Some light reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225626/

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2/5/2018 10:02 AM

Tore my Acl in a turn bout two years ago. Let it heal naturally and started riding prolly a month or two after the incident. Then i overjumped a jump to flat and completely anihlated what was left of it. Best advice, do the surgery. I got the patella tendon graft and was back riding lightly 4 months after surgery. Of course youth and aggressive rehab helped, but my knee feels just as good as ever. Still a little weak as far as post workouts, but thats just my inability to do strength training on it. (Busy college kid)

Get it done.
Regular anesthesia and surgery only took about an hour and a half.

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2/5/2018 10:03 AM

If you don't have the surgeries you may pay the price later on in life,
I tore one in 1990 and the other side in 2000 ish,

I was able to do most sports that didn't involve quick direction changes, I even ran a half marathon,
At times when i was fully relaxed ( drunk ) i would buckle over but quickly get up.

Now days i can't even jog and i am in constant pain. may knees have different wear patterns that now means i can not get ACL repairs done, and now i suffer from daily pain and waiting for Knee replacements in the far future.

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2/5/2018 10:06 AM
Edited Date/Time: 2/5/2018 10:07 AM

Tore my left completely in two, in 93, had it repaired. Does a lot of clunking, when I stand up, and straighten it out. Tore my right, in a brace, in 03. Never had it repaired, and other than some discomfort in the first couple of months afterward, it’s never bothered me. Don’t regret not having it repaired at all. I also don’t regret having my left repaired, NOW, but holy fuckin HELL, did it hurt right after surgery. Patella graft, not sure if that’s still common. Dr Amendola, from U of Iowa did mine, best in the biz, at the time. Still in Canada, in 93. 55 now, and my left is the worse of the two.

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2/5/2018 10:32 AM

I suggest getting it done because a torn ACL will cause some instability in the knee which will accelerate wear in your knee- Leading to a knee replacement sooner than later.

I went a year with a torn ACL, until it got stuck somewhere inside my knee and locked it up. Needed surgery the next day.

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2/5/2018 10:44 AM
Edited Date/Time: 2/5/2018 10:46 AM

While I believe you should get it repaired, I tore mine completely 9 years ago and did not have it fixed. I am 95% today. If you train like an athlete, you can probably get away without doing it, as long as all other ligaments are okay,(which it sounds like your MCL isn't) I spent years training 5x week afterwards though... My hamstring makes up for the lack of that ACL quite a bit.

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2/5/2018 10:48 AM

Follow doctor's recomendations

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2/5/2018 10:52 AM

Great feedback guys! I figured I needed to get it done but was really hoping not just due to not wanting to have surgery.

Thanks for the help.

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2/5/2018 12:16 PM

Pretty sure the type of graft determines recovery. Patella being the longest, then hamstring, and cadaver being the shortest.

I have a patella tendon on the right and no ACL on the left with zero issues. Strong hamstring makes up for having no ACL. Will get it done later in life if it starts bothering me or knee replacement comes first.

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2/5/2018 12:22 PM

Would you tie your bike down with one tie down? Didn’t think so, get it fixed, train the house down and you will end up being stronger. I had patellar graft acl surgery. You will no longer refer to them as knees, but the good one and the bad one lol

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2/5/2018 12:24 PM

Tore both ACLs both times tried to ride the problem is planting your foot caused the knee to pop out creating intense pain and swelling and limping for a few days this happened twice with the first acl then I got the surgery ( patellar tendon) and once with the second acl and then I got the surgery ( used a new technique with the quad tendon). I would recommend the patellar tendon.

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2/5/2018 12:34 PM

I tore my ACL about 10 years ago. Had a gust of wind take the bike out from under me going over a jump. I just lived with it for 4-5 years. For the most part I got along fine. Like an earlier poster said even ran a half marathon on it. It would occasionally pop out though. Usually from a hard landing or pounding through the woops. Not great places to have a knee suddenly go out. This was even while wearing a pretty sturdy knee brace. I got it fixed 4-5 years ago using the patella graft. My recovery was about 6 months before being pretty much back to 100%. But I'm married to a PT so I had lots of therapy that I didn't have to pay for. Well I guess I paid for it but not in cash haha. One thing I noticed after the surgery was some bad habits I had developed in order to compensate for the bad knee. I had started using my left leg almost exclusively to go from seated to standing position. This caused me to put almost all my weight on the left peg every time I stood up. Every time I had to stand I would veer left a little. Not cool when you're entering the woops or a rock garden.

My advice is to have it fixed. You wouldn't keep riding your bike if the rear wheel bearings went out would you?

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2/5/2018 12:34 PM

Advice I received by the assistant surgeon was that even when people think their knee is stable without having an ACL repair there is still minor movements/slippage in the knee. This movement might not be noticeable to you straight away but over time it wears away at your meniscus.

I had the hamstring graft. Seems this is more popular in Aus but in America looks like patella is used more often.

General anethisia

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2/5/2018 12:37 PM

Did mine 13 years ago, had it fixed. All my research and professional advice I received at the time suggested that you can get by without repair, but you will almost certainly face a knee replacement later in life.

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2/5/2018 12:37 PM

miketherider wrote:

Surgery and recover is anywhere in the 8 - 14 month range, depending on your ability to make rehab, the program you get into, and whether or not anything else needs to be fixed (microfractures, other ligament damage, etc.).

In your case, I think it'd be silly not to get everything fixed. Do you want 8-14 months of hard work and discomfort, or a potential 10+ year case of a floppy knee, worrying about the slightest twist that could cause issues again? Most doctors will recommend allograft (IE cadaver) at your age.

Most research suggests even at higher ages, most surgeries are pretty successful with most returning to their previous activity level. Again, a lot of that will depend on your ability to recover and your insurance ability to allow for therapy.

I know people who ride with no ACL and/or other damaged ligaments. They can still ride fast, but I think several would tell you they are starting to suffer a bit with arthritis and significant issues in recovery after riding. And, for them, all it takes it one wrong bump and their day is done (yes, I know, any knee injury can occur with just a wrong twist or placing it wrong).

Like anything else, ask probing high level questions with your doc, do your research, and consider your options.

Some light reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225626/

Solid advice, thanks!

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2/5/2018 12:56 PM

Torn ACL. Cadaver replacement. 4 months and I was back on the bike. I never fully trust it though....this is a mental thing that you will have to get over. I have to do extra exercises that I normally wouldn't do to keep the knee area strong. 9 months to feel comfortable running though....

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2/5/2018 12:59 PM

miketherider wrote:

Surgery and recover is anywhere in the 8 - 14 month range, depending on your ability to make rehab, the program you get into, and whether or not anything else needs to be fixed (microfractures, other ligament damage, etc.).

In your case, I think it'd be silly not to get everything fixed. Do you want 8-14 months of hard work and discomfort, or a potential 10+ year case of a floppy knee, worrying about the slightest twist that could cause issues again? Most doctors will recommend allograft (IE cadaver) at your age.

Most research suggests even at higher ages, most surgeries are pretty successful with most returning to their previous activity level. Again, a lot of that will depend on your ability to recover and your insurance ability to allow for therapy.

I know people who ride with no ACL and/or other damaged ligaments. They can still ride fast, but I think several would tell you they are starting to suffer a bit with arthritis and significant issues in recovery after riding. And, for them, all it takes it one wrong bump and their day is done (yes, I know, any knee injury can occur with just a wrong twist or placing it wrong).

Like anything else, ask probing high level questions with your doc, do your research, and consider your options.

Some light reading:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225626/

DirtBikeKid46 wrote:

Solid advice, thanks!

spot on advice from Mike. Additionally, your recovery starts now. You should be icing and elevating your leg as much as possible. Get the swelling down, and range of motion back before surgery. Find the best orthopedic surgeon and physical therapist in your area and follow their instructions.

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2/5/2018 1:10 PM

Regular tear on my left one regular good night anesthesia. Already had a rod in the leg so they couldn't use the patella tendon, had to use a cadaver tendon. Was on a machine moving the knee the next morning and gawd damn that felt awesome!!!
Was at therapy two times a week 2 weeks out and was walking without crutches at about 6 weeks. I was back at my desk job after the 3rd week.
Back riding mx with a knee brace about 3 months later, sore as F knee but smiling... no I wasn't haulin ass but I was riding.

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2/5/2018 1:18 PM

cjmx wrote:

spot on advice from Mike. Additionally, your recovery starts now. You should be icing and elevating your leg as much as possible. Get the swelling down, and range of motion back before surgery. Find the best orthopedic surgeon and physical therapist in your area and follow their instructions.

^^^THIS. You need to get your range of motion back now. Like asap. I spent hours in the pool the first two weeks after the injury pushing through the pain trying to get my ROM back.

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2/5/2018 1:29 PM

Repair. I have torn ACL in both knees for 18 years and my left knee dislocates on sudden side movements. I can run, etc but sports that require side movements is out of question.

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2/5/2018 2:18 PM

I'm a doc:

1. Get it done. You have the unhappy triad. You'll end up with a knee replacement in the next few years if you don't get it done

2. Best graft is the patella tendon graft. # 2 is hamstring. # 3 is cadaver. This is in regards to failure rates and what gets you closest to your native graft.

3. I wouldn't do an epidural for knee surgery. If you do it at the right place you'll get sciatic + femoral nerve blocks for pain help in the first 48-72 hours.

Good luck.

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2/5/2018 2:31 PM

Get it fixed. Opposite knee patella tendon as the graft. Yeah, you have to re-hab both knees that way, but you don't need to wait for the graft to heal before starting the ACL rehab. Talk to Doc Sanders in Houston. 3 months back on the bike if you follow his protocol.

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2/5/2018 2:42 PM

Right one gone, was 26 in the navy they would not fix, tore left one at 45 still in the navy, got fixed with a hamstring graft, feels strong but def less rom. Right one will get messed up if I case or overjump, I'm now 54 still ride a bit, mtb more, I would get it fixed if I had a do over.

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2/5/2018 3:20 PM

57 yoa, rides mx tracks every weekend, tore alc, mcl and meniscus last June. Did PT but constant discomfort and swelling I was ready to get surgery. Then doc said those symptoms were not because of acl, maybe from Meniscus or arthritis and gave me a cortisone shot. Wow what a difference. While it felt good I joined a gym and do workouts three times a week always working on knee / leg strength. I’d say it’s about 85% and getting better, I’m leaning towards no surgery. I bought Mobuis braces. It has affected my riding aggression a little, but not much. If I ride a bunch or jab my foot hard it may get a little sore.

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2/5/2018 5:01 PM
Edited Date/Time: 2/5/2018 5:20 PM

Get it fixed. The longer you wait the worse if there’s swelling. That can lead to arthritis and obv more injuries.
If your Dr. is recommending a Patella graft he hasn’t progressed. That’s 90’s Tech. Hamstring autograft, OOOR....I have heard technologies have progressed with how a cadaver ligament is “cleaned”. Methods when I had my knee done (2010) to strip the bio footprint caused them to be weak.
The hamstring will grow back eventually, Patella will NEVER grow back. My knee with hamstring autograft is considerably more tight and stable than my stock knee...I did have a weaker hamstring that was noticeable with the tension of knee brace straps when putting foot back and forth from brake to peg. I was riding at the 4 month point BTW. I didn’t do anything special to strengthen hammy and it was a few years before it became a non-issue.
P.S. This might be the worst place to ask for advice next to ThumperTalk. pinch

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2/5/2018 5:24 PM

No ACL in my right knee, no issues at all. Honestly it is better than my left knee.

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2/5/2018 5:50 PM

DirtBikeKid46 wrote:

Well, tore my ACL, MCL & Meniscus. From the research I've been doing, there are a ton of trade off's from one graft choice to another. Thought I'd ask some of other mx'ers that have torn an ACL of their experience. Doesn't sound like a fun surgery by any means!

I'm 40 and active, not so much for pivoting sports but like to ride MTB and dirt bikes but not really racing but still get after it.

My main questions are:
-Have any of you had a torn ACL and not have it repaired? Any problems with stability?
-If repaired, which graft did you opt for and how was the recovery?
-Curious about the anesthesia, were you put under general anesthesia or did they do a spinal similar to an epidermal?

Thanks for any input!

In the last 13 years I've had it pretty rough, and feel for anyone whos had knee problems

- Left ACL torn + tibial plateau fracture and meniscus partial tear. repaired the ACL (hamstring graft). Healing process was rough, had to have an extra operation to clear out the scar tissue locking mobility in the joint. Took about 10 months total before I could get back on the bike ( injury happened with knee pads, no braces)

-3 years later, left torn again - opted for the synthetic graft to try something different. took about 6 months total before light riding. (Injury happened with asterisk cell braces - broke braces in half)

-3 years later tore the right ACL (used patellar tendon) , stretched LCL, stretched MCL torn meniscus and broken femur. This actually took the least amount of recovery - about 5 months of constant physical therapy & training.
(Injury happened in POD K700 braces - still great braces and would reccommend - no brace would've helped the way I hit)

All surgeries were gen. anesthesia

Now 3 years after my last surgery - I am living with 2 torn ACL's yet again at 27 years old - after having issues with both knees within the last year on and off the bike. I am opting on not repairing them which may not be the smartest option long term, but I've given up the idea that my knees are ever going to be 100%. So for now I'll be waiting for some bionic legs to be coming available while I stay as active as I can. I still ride once a week, definitely not at the level I once did, and am still fighting other issues with cysts rooting from my meniscus, along with the normal clicking and popping which is growing to cause more constant pain in my day to day.

For first timer's, I'd recommend at least trying to repair. Which I've seen the best results with the patella tendon.

PSA: PROTECT YOUR KNEES

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2/5/2018 5:54 PM

Just had my right knee done before christmas. It was done with a cadaver, and doc fixed the meniscus while he was in there since the inner part of it was torn.

Never really had much pain after surgery, more discomfort then anything. Did the knee machine and ice right out of surgery for 3 weeks and started PT after that at home just doing simple work outs getting the strength back in my leg. I was putting pressure on it in a brace a few days after surgery to get to the bathroom and what not. Doc then cleared me to walk with the brace at all times, one week after surgery.

At home, I am not using the brace as I try to stay still and not do too much. But if I am out and about running to stores or whatever I will wear it just to be save. Supposed to get my functional brace within a week or so and that I will have to wear for a few months basically at all times Doc said.

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2/5/2018 5:54 PM

Man you guys are awesome, great to hear your stories and the way you got it repaired. Hey, the way I look at it is I research the hell out of aftermarket parts for my bike...damn right I'll do it for my body!

Had my first day of physical therapy tonight, cute girl stretched me all out. My insurance for PT blows and costs $80 a session so can't imagine I'll be going too much and need to work my ass off at home.

I'm restricted to a certain mile radius with my insurance so I need to stay with a doc around the Philadelphia area.

Hardest decision at this point is which graft to get. Are any of you Patella guys experiencing any pain on your knees when kneeling down?

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