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No ACL and doing fine?

 Poster: A snowHead
Poster: A snowHead
OK, so there are lots of discussion threads on ACL construction and rehab but I find myself at a crossroad, a life skiing with an ACL or no ACL? I know it all depends on what you want to do in life, active or quiet but.....

My profile
Aged 62 and skied for over 40 years, currently a leader for ski club of Great Britain
Very fit and active, never a dull moment
In Jan 18 had a accident, cat 3 rupture of MCL and ACL
Wore a leg brace for 6 weeks and currently been getting around without one
Now Week 8, after a great deal of stiffness I can straighten my leg as normal and about 6” from fully bending
I have been working with a physio since week 1
Not felt any instability albeit I can tell my injured knee it is different from my good one
Now swimming, cycling and in gym most days doing weights to get my leg back in order
I am seeing a well recommended consultant who initially said he would carry out a full reconstruction at about 9 weeks, however this has been put back to 14 weeks since he wants to see me built up more muscle mass

At my last consultation at 6 weeks he said I could possibly manage without surgery and wear a brace for skiing. I somehow suspect at my next consultation he is going to play a straight bat to me with both options on the table.

Initially I was desperate for surgery and could not see a future but now there is a seed of doubt. I have been privileged to attend talks by Jonathan Bell re knee surgery and I would have seen him first but being a northern lad made the travel to Wimbledon seem daunting. Is there anybody out there who has been here before and managed without an ACL? I would love to hear from you.


Last edited by Poster: A snowHead on Sat 3-03-18 23:19; edited 3 times in total
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@ttrucwy, friend of mine persevered for a number of years without and ACL both skiing and playing hockey. He ended up doing a lot more damage to his meniscus as a result of trying to carry on with just a brace and ended up having the surgery. He advised me when I did mine to definitely get the surgery (I was also a hockey player... only subsequently damaging my reconstruction has forced me to give that up but thankfully not give up skiing). My knee felt unstable even while walking and from what I have read a persons stability without an ACL varies from person to person.

Best of luck which ever course you pursue.
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I am a little younger than you, female, doubtless nowhere near as fit nor as good a skier ( though was planning to work on it). I lost both ACLs completely and badly tore both MCLs end of last March. I had both a physio and consultant who wanted to take the conservative ( no surgery) route from the off, based on the laxity & feel of my knees and my reported stability.
I struggled with regaining full flexibility ( took 6+ months) and had a lot of stiffness and pain ( still do on occasions, especially after hard exercise) and my knees feel nowhere near what they were - but I am back on skis and board now, and have been coping with mountain, fell and rough ground walking since summer. Still a lot of strengthening to do ( and to be fair I have done nowhere near as much as I should because of health and personal circumstances, and what I have done is just home-based or out on the hills; don't cycle, swim, run or gym), and a fair bit of lost stamina and now some definite irritations and pains and occasional swellings: but physio advice is just to carry on. It's getting stronger every time I ski. I can manage a couple of days, maybe more, of rough UK skiing; haven't gone abroad or done fast groomers yet, but lots of crud, bumps and short turns. Pull lifts are the most annoying things for me.
Not using braces beyond simple neoprene wraps: my consultant was very against them, my physios had no interest in them and just said "get strong".
I was prepared for but didn't want surgery ( for many reasons); then reasoned that if I had to rehab to get strong again then I would have to do that anyway, surgery or not. If it all went, or goes, wrong then that's when I let the butchers in: but it was bad and restrictive enough getting back to anywhere near normal last year, and I really don't want to go through that again if I can avoid it, and with no guarantees that it'll be any better with surgery (consultant said it won't). So the general consensus is that I have to accept that I now have traumatised and sensitive knees and look after them as best I can, possibly with an increased OA and meniscal/cartilage damage risk: but who knows what would have happened anyway? I am not yet back to 'normal' and don't know if I ever will; but I can't say that 2 sets of surgeries and lengthy recoveries would help me any further either, nor remove the damage of future OA risk nor the other pains and annoyances associated with now my prematurely- creaky knees.
At the end of the day this is a very personal, and a very hard decision. Most people will advise the surgery route; I was not convinced that it was for me if I could avoid it. So far, I hope that it was the right decision. ( I will of course stress here that I have 2 knees out, which might change things in various ways.)
I did a lot of reading and research on surgery vs not, "copers" vs non-copers, got chatting online to a few people who have managed long-term without surgery or ACLs.
Good luck whichever route you take.
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@ttrucwy,

It is very clear some people can manage with and ACL injury and have no treatment whatso ever.
It is , however, not a simple debate/ discussion.
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@Grizzler, hello. I feel humbled in comparison to your injuries. However, your story gives me faith that there is another way. Many thanks
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@NickyJ, Hello. I know how tough hockey is, my son played for Wakefield. I used to come away from matches thinking helmets and face masks should be mandatory, at times it was carnage but I have the greatest respect for the players. Thanks for your comments, it’s always good to share ones stories.
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@ttrucwy, I don’t like generalising from my experience since each individual is different but here goes.

1982 bad motorcycle accident - wrecked LH ACL. Very badly torn but not fully detached.
1988 did it again - but skiing.

From then on - very unstable knee. All sorts of problems of pain, repeated dislocations, inflammation.
Cycled, and cycled, and cycled. Built up the muscles a great deal.
Continued sports climbing, mountaineering, skiing and mountain biking.
Kept on dislocating and swelling.

By 2008 I had become concerned, since a full dislocation, or other such, climbing at altitude would endanger others, not just me.

So I went to George Bailey (Sir) at Stanmore. One of the best in the business and my friends’ uncle. He took plain plate X rays and did a ligament check. He stood looking intently at the X ray for maybe 5 mins in silence, while I wondered what on earth he was doing. Then he said ‘ I will use you with all my students - severe damage in your twenties, no surgery, muscles built up nicely through intense exercise; increasing stability will come with more muscle tone; keep on stressing your knee with every sport that you do..very interesting case which justifies conservative treatement....’. Which was EXCELLENT NEWS. But not the end of the story.

When skiing it was still troublesome, including massive swelling after off piste. Likewise a friend of mine with an ACL but without cartilage. In 2016 I had intensive coaching to help me really drive my skies at all times. Swelling has reduced by around 75%, muscle tone greatly improved. I therefore bought the same coaching for my friend (bought from Swiss Mountain Sports). It had the same hugely positive effect. He can now ski all day, where before it was a maximum of 2-3 hours.

With an injury you can ski defensively, which gets you in the back seat, which stresses your knee terribly. The proper coaching gets rid of this probelm.

Now, none of this may apply to you, but it is a story of over 30 years experience of having almost no ACL in my LH knee, and now I enjoy skiing, cycling and climbing to the full.....
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valais2 wrote:
In 2016 I had intensive coaching to help me really drive my skies at all times. Swelling has reduced by around 75%, muscle tone greatly improved. I therefore bought the same coaching for my friend (bought from Swiss Mountain Sports). It had the same hugely positive effect. He can now ski all day, where before it was a maximum of 2-3 hours. .


Great story! I see so many people skiing off piste, massively in the rear seat and shudder to think of the pressure they are putting on their knees.......
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@valais2, That's encouraging news Smile Though I'm a bit worried that with all those activities you were told that you still needed more muscle tone...
What did the "carry on stressing the knee" advice mean? (Stressing sounds bad and painful to me.)
And care to share any tips from your coaching? (There isn't a hopeful smiley...)
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After a few painful tweaks I finally ruptured my ACL in January 2016. I was 60 at the time. The surgeon wasn't too helpful in terms of definitive advice. He was a skier, so understood the issues, and seemed to suggest that I should leave it. It is unstable in some instances - for example I couldn't possibly kick a ball with that leg, and being my left leg I can no longer swing a golf club, or jump and land on it, but I cycle a lot and that is no problem (apart from a bit of pain occasionally from worn cartilage). I invested in a CTi brace, probably a placebo. I didn't ski much at all last year, the excuse being that the conditions weren't great, but this year I have skied a total of 23 days, albeit perhaps 3 hours per day and on piste and mainly blues with a few reds if piste conditions are OK. I ski defensively, being very afraid of falling, but I have been quite encouraged and have had no swelling or other issues. I also use a mojo, which takes some of the pressure off the knee, and that probably helps my worn knees rather than the absence of an ACL.
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@Grizzler, ...I think I understood his message to be quite simple: he emphasised that I was really doing the right things and should carry on doing things which place usual stress on the body, thus building muscle...ie pushing on not easing up...climbing, cycling (in particular)...

..and the coaching is all described in this article/blog on In The Snow, written by....er.....me....

https://www.inthesnow.com/i-dont-need-skiing-lessons/
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@valais2, Thanks. Glad to hear that advice; pretty much what various physics (oops, physios) have told me too - and so far, though sometimes painful afterwards, the muscle/strength is returning. Nice blog article.


Last edited by And love to help out and answer questions and of course, read each other's snow reports. on Sat 10-03-18 19:42; edited 1 time in total
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@Grizzler, ....thanks....aim to please....
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I'm very curious to follow this thread.

So, here is my recent story. 46 years old. I ruptured my right ACL while skiing in Saint Nicolas de Veroce. Long story short but I ruptured my ACL, sprained my MCL (third degree, I think... will have to double-check)and a bit more of this and that. It was a grab bag of injuries. This happened on March 16th... 20 days ago. Doctor in France confirmed I had probably blown my ACL. Doctor back home said the same and the MRI confirmed it.

OK, so here is where it gets confusing for me.

20 days.

Swelling is mostly down although some of the swelling and inflammation make my calf and hamstring feel tight at times. I have most of my range of motion back on my injured knee - almost equal with the other one. I can walk without a noticeable limp. I've been through a physical therapy evaluation (yesterday) and my injured leg is "good" while clearly my other one is better. By good I mean I can squat down comfortable (not going too far for obvious reasons), I have good flexibility, my quad retains good strength, I don't have instability and I can balance on my injured leg for 30+ seconds.

So far, I'll be doing PT once a week with a therapist and taking care of the rest on my own... one leg bridges, side planks with hip extensions, goblet squats, one leg RDL and the like. My workouts feel pretty good. Not like before but fine and not necessarily painful.

Yes, I have stiffness when I sit for a long time and have to get back up but, for the most part, I can walk and stand for long periods of time and I'm not wearing a brace.

Yeah, so, I am equally confused and hopeful. My goal is to get back to skiing again. I sprained my MCL two years ago (other knee) and worked hard to get back on the slopes. This past trip, up until the injury, was amazing. Off piste on the Grand Montets, time spent in Courmayeur... it was amazing until the end.

So, I already told my doctor and PT that for the time being, I want to wait before thinking of surgery. I know the possible issues but want to see how the conservative approach plays out and if I can, as some say, cope.
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@ttrucwy, a friend of about your age ruptured a cruciate ligament while skiing about 15 years ago. Not repaired. He still skis every year, using an elasticated brace for additional support. He runs (off road / cross country) about three times a week, circuit training once a week, etc so has well developed leg muscles - which is probably what lets him get away without the repair.
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 Poster: A snowHead
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I have skied for the last 3 years with no ACL in my left leg. I was offered reconstruction and an arthoscopy to remove the 'gunk' but have taken a raincheck on both. It was very much a personal choice and supported by the surgeon Yes, I have had to adapt certain things: I'm fine walking day to day, but go up and down stairs differently; cannot run( or dance Laughing ) and take great care when walking on uneven ground eg fells. I now exercise via a cross trainer, bike and rower instead. I do get some pain behind the knee (from the gunk) but rest sorts this out. No pain when skiing but I know about it when I come home. I do have a custom fit brace from ossur which is akin to a caliper and I personally wouldn't ski without it. If there comes a stage when I feel that I cannot cope with the amount of instability then I will reconsider surgery, but my view was that provided I could ski, I may as well try life ACL free. So far, so good. Good luck with whatever you decide. I am 48.
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"Good luck with whatever you decide."

Thank you! That's the tough part... its a very personal decision since our knees and bodies and muscles are different. Some people look at me like I'm insane when I tell them I'm not planning on getting surgery but then they see me walking around without a limp.

There's no doubt my knee feels different... the injury is too fresh, so to speak, but the level of activity I can already manage without pain makes me very hopeful. Likewise everything that happened during the physical therapy evaluation gave me a great deal of comfort. Time will tell but, yes, like you my decision has focused on skiing despite living in a location that does not allow me to ski as often as I'd like. Perhaps my perspective would be different if I skied 30-60 days a year. That's not going to be the case for me.
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@ItaloSkier, At 20 days post injury you sound like you're doing magnificently! You also sound like you do a lot of leg strength exercises and can already do them with your injured leg. If you carry on the way that you are then you sound like a good "coper" candidate. I hope that it works out for you.
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Grizzler - certainly feels like a hopeful situation. We'll see what happens when we work on agility and something to truly test the ACL.
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Just "popped" in to look at this thread after taking a look at the shambles of the other thread where a Ortho Consulatant has been hounded out of town, as a dear friend (second one in two weeks) was blood wagon-ed off the hill yesterday, and it all points to a ruptured ACL (French doctor gave him 45min examination and concurred as much with the usual painful tests).

However we've been busy this morning with him going back to the same Dr and getting a referral letter for an MRI then going down to Radiologie in Briancon and getting a MRI for 23rd April in Gap, so a result!

He's 61 and French Dr said that they do not operate on people over 60, I've not heard this before, and hopefully that's now not the case in the UK on the NHS?

Hopefully it's down to how fit and active you are etc

I opted for the operation back in 2011 and I'll link to my blog again (have not for a while) as people who have just done their ACL often respond back saying how helpful it is/was as I concentrate both of pre-op and post-op

Link here

What is quite stunning was that whilst in rehab I decided on having some keyhole on the other knee and the consultant videoed the op along with commentary and at 05:10 into it there's a major bombshell, and just maybe if I knew before would I have had the ACL reconstruction, in hindsight seven years later probably yes.


http://youtube.com/v/Km3iF8wOCQk
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Look forward to reading your blog.

I'm still leaning (no pun intended) towards a non-surgical path. PT went well yesterday - the therapist had me go through more challenging exercises like this one
http://youtube.com/v/P0WxR8xW5RY but with the round/blue side down so less stable. Felt good. More time spent doing suitcase squats, lunges onto the Bosu ball, more band work, etc. Most of the pain from yesterday's PT was from the heavy amount of work on my hips and glutes and the roller he used on the side of my knee.

There are times that if I don't think about my knee, I forget its injured. That has its pros/cons since its easy to want to do something "normal" that is not wise right now.
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@ItaloSkier, brushing your teeth on one leg with your eyes closed is almost a good as a bosu ball Smile
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...and certainly less expensive!
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@Weathercam, You forgot to add in the hamstring forward bends/deadlifts and one-legged squats at the same time Very Happy
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@ttrucwy, Hi,
I had a fairly big trauma on my left knee back in mid 90s , 95% tear of acl and completely tore the Mcl of the inside of my knee. (think this is correct)
The mcl tore away with a chunk of bone and so was able to be reattached and allowed to fuse as bone .
I was extremely peed off that they didn't repair my acl during surgery (same era as Paul Gasgoine having a similar opp iirc) but the consultant was of the opinion that as I has shortish thick well muscled legs all would be ok.
After the opp and 6/7 weeks in plaster I found it difficult to carry out physio due to knee pain and difficulty walking esp carrying the then young kids around etc,
Some time later and still struggling we were on holiday and I fell coming out of a swimming pool. I felt a severe stabbing pain in my knee and feared I had done some serious damage. However I stood up alright and everything seemed ok, infact really good !
Knee has been great ever since, the stab of pain was that last bit of acl parting .
It was a 18months before I skied but have skied every year since, ramping up to 2/3 trips a year off piste, ski touring , and this year Japan . Played squash until a few years ago (i'm 57 now) when it was my right knee that started to give problems ! I do struggle when swimming, esp breast stroke as it dislocates occasionally , clicks straight back in but is painful.
ACL ?? who needs it Laughing
I have just buggered things up again tho' having had a crash on my mtb and fractured my left hip. A new one was installed within 24hrs (NHS are amazing) but I think the surgeon has been a bit rough with my knee during the opp . 4 weeks in now and knee is improving , i'm just keeping my fingers crossed it gets back to its ab'normal. Hoping to get back on my bike this weekend and start the muscle building process.
Hope all goes well for you, obviously you are working hard at making it improve and getting back to full use. Maybe see you on a ski club trip ?
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Love reading these "who needs an ACL?" Very inspiring. Stubbornness plus hope make for a great combination.
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I skied and boarded without an ACL for years. Only snag was knee would blow up every day and moving around particularly after an apres drive became a real battle. Eventually had it reconned and wish I hadn't been so stubborn for so long.
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ItaloSkier wrote:
Stubbornness plus hope make for a great combination.

I love that Very Happy Very true - if you're lucky enough to be able to adopt the attitude.
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When the doctor in Argentiere asked me what I wanted to eventually be able to do, the answer was easy... ski. That is the goal. If I can get to that, honestly, all other activities work. I'm not playing anything like recreational basketball. Other than kicking the ball around with my son, there aren't other activities that matter as much. If skiing is possible, so is gardening, hiking, biking, running... in fact, gardening and hiking are mostly possible now. The goal is snow - plain and simple.

After what we went to in our home town with massive flooding and devastation for over 100,000 houses, the knee seems like a small obstacle to overcome.
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@Dave of the Marmottes, I do hear of quite a few people who eventually have an ACL reconstruction after many years of coping without, and like you they often say they wish they'd had it done before. Why is that? What difference does it make that far on in time? Is it purely down to having back the ACL's stabilising effect (and perhaps reduced muscle effort or reduced ongoing friction or irritation somewhere within the knee as a direct effect of being ACL-less), or is it that during the ACL recon surgery there is other repair and improvement work done? Or should they have been in the group who really needed surgery from the start (e.g. instability or continuing pain or high risk, high level activities) but chose not to or were otherwise denied it?
I find this a very hard part of the surgery or no surgery decision. If there is an ACL-deficient knee but good strength, stability and few to no (or only occasional) other symptoms, what is the risk/reward of surgery? Amongst many other pros and cons, some arguments run that surgery can in itself cause more irritation and inflammation and thus predispose to OA and other damage in due course. But others, such as yourself, seem to regret pushing on: so will I also regret not having it done before my years advance too far? Or do I push on and see how well I can use those years enjoying them, and only think on surgery if there is sufficient pain and nuisance from the knees after each hard use?
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@valais2, With your instability and repeated dislocations, is there not more chance of further soft tissue damage and early arthritis ?
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Knee specialist just confirmed that my left ACL is ruptured after twisting it skiing 3 weeks ago. As per @ItaloSkier, the swelling has gone down and it’s not really stopping me doing anything but doesn’t feel stable with lateral pressure. Did the right 3 years ago, got it reconstructed and it feels bulletproof now. So going for reconstruction on the left knee on May 1st. Fingers crossed it recovers well (disciplined rehab key) and ready to go for 2018/2019 season🤞
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@BobinCH, good luck Very Happy
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@KenX, thanks. If anything I came back stronger last time from all the squats and plyometrics and was able to get back on the bike after about 6 weeks so hopefully won’t interfere with Summer activities too much. Have my eye on La Grave for a last weekend hurrah if the heat doesn’t do too much damage! Assume it got another plastering this week?
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@BobinCH, confused, you ruptured your ACL three weeks ago and yet you're still skiing ????
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@BobinCH, my wife ruptured hers playing tennis a few years ago. Had the reconstruction done and is now as good as new. The key being to follow the exercise/physio scheme to the letter and not go out disco dancing after four months! If it were me I would do the same thing.
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Weathercam wrote:
@BobinCH, confused, you ruptured your ACL three weeks ago and yet you're still skiing ????


RICE for a week after, brace for skiing and being very careful with technique (avoid backseat and any twisting). Can’t miss April 😉
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@BobinCH, chapeau - when I did mine no way could I ski / run or do anything for a good three or so weeks - and when it felt not too bad all I did was cycle, and back then I was an avid windsurfer living on the beach and I did not go near my gear until I had the op.

A friend who was in Japan with us twisted her knee on the second to last day and made quite a big thing of it (as you do) then when we were walking in the airport I commented that she was not even limping - week later she let us know the MRI results and she's done hers ??!!

I wonder if there are different grades of rupture / tear etc in much the same way as I must have done something in the past to my other knee (the one that I was surprised to find out I did not really have much of an ACL) and I can't really recall injuring that knee severely ??

Maybe it's something for consideration when thinking about an OP if the MRI shows it's a small tear and some of the ligament is still attached if that's at all possible ????
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Dooooohhhh the answer to the above was in the feckin feature my OH did with a knee consultant rolling eyes


Can you live and continue to ski with a torn ACL or do you have to have surgery?

Initially the knee is painful and unstable (wobbly). Walking to the bar for a drink is challenge enough. There are different grades of ACL injury depending on how much of the secondary stabilisers are compromised. The ACL is termed a primary stabiliser (against rotation), however, there are secondary stabilisers. It is often the degree of these injuries that dictates whether or not someone will 'cope' with a ruptured ACL. With an isolated ACL rupture some people's knees will respond to time and rehab and function reasonably well except for sports with a rotational element. Some people will ski post ACL rupture in a brace. Most ,however, opt to have the ligament reconstructed. The operation is so much more refined than even only three years ago.
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Weathercam wrote:
Maybe it's something for consideration when thinking about an OP if the MRI shows it's a small tear and some of the ligament is still attached if that's at all possible ????

It is possible. I was told that my right ACL was "very loose" when I started having problems with that knee. MRI showed that it was half detached at the front on the tibia and had interstitial tearing of the ligament. It was a term I hadn't come across before but was explained as the equivalent of a fraying rope. Effectively, it was stretched.

I had an arthroscopy to clean out the scar tissue and PRP injections and now, a few years later, it's relatively normal. The last MRI that I had didn't list the half detached bit at the front which may be down to the quality of the interpretation or maybe it has reattached. I hope so.
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