2nd ACL rupture - what to do?!

A snowHead

Thanks in advance for advice.

I ruptured my acl in 2018. Had an allograft replacement (due to my own severe hypermobility) in May 2019. I was very conscientious with rehab, got strength back and all felt fine. Skiing winter 2018/2019 was fine though I wore a bespoke brace for extra security.

In Feb 2020 I skied again went over an invisible ledge and on landing fulling compressed both my knees and fell. But no twisting as far as I noticed. I actually carried on skiing the rest of that day and the next. Knee was sore and a bit swollen but not noticeably unstable (which had been VERY obvious the first time).

When I returned to the UK both physio and consultant tested the knee manually and said they thought the ACL was intact but I had an MRI that revealed apparently a full ACL rupture.

This was just as lockdown kicked in and I was told nothing would be done because of Covid so there was no need to make any decisions in the short term.

I did some rehab and strengthening exercises and have been conscientious about fairly full on PT 3-4 times a week all year. Plus lots of dog walking.

I can jump, jog, lunge jump, star jump, do burpees, dance (badly!) all without problem. I can fully extend and fully bend the knee to exactly the same degree as the other. Did Alpine hiking for a month over the summer, several hours a day again no problem. I have no pain or swelling only occasional slight "catching" when I am standing with the leg fully extended and my weight on that side.

I am 50 years old and a passionate and experienced skier - that and hiking are my priorities.

So I'm now wondering whether I should look at redoing the ACL to avoid problems in the future. Or just be satisfied I am pretty much symptom free for now. I'd hate to be in pain in 5 years time, unable to ski and be told it's too late, I should have fixed it sooner. But equally it's very hard to be motivated to go through ACL surgery again (and the rehab!) when I am functioning apparently fine...

Any thoughts, experiences or advice would be gratefully received!

A snowHead

@Kits23, when I was in rehab following on from my ACL Op I decided on keyhole on my other knee as there were some issues with that too.

The surgeon at the time did a video commentary of the operation and fast forward to 5:10 to hear what he found!

http://youtube.com/v/Km3iF8wOCQk

So in the past something had happened to the ACL in that knee and it never really affected me (I do seem to recall a knee issue five years prior) but nowhere near as bad as my other knee, so just goes to show.

That was back in 2012 and I saw the same consultant last year as I'd done something to the knee and I'd had an MRI three months after when I did it (compression falling into a deep snow hole in Japan) and I asked him about the ACL and he said it was no longer such an issue, so you do hear that they can reattach etc and you do hear of people who have been told they've done their ACL but they can carry after some time off games.

So sounds like hopefully you're like that ?

Well, the person's real but it's just a made up name, see?

I am in a similar position. I’ve had a few previous knee ops with one of them being an ACL reconstruction in 2010. In September 2019 I tore the other ACL but couldn’t have the surgery as I work as a ski instructor and couldn’t afford to miss the season. I got my other knee scanned at the same time as I wanted to see how it was after all the previous surgery and it turned out I’d torn the graft in that knee at some point also! I made it through the season and wouldn’t have know there was a problem with either by the end. Covid had just kicked off so couldn’t have them operated on again last summer so I have just finished another winter coaching skiing and racing motocross without any problems. I spoke to the surgeon last week who reckons there is no need to repair either if functioning fine. I’m 33 and he didn’t seem concerned that by not getting them done I would have future issues as long as activity is pain free etc

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@Kits23, my experience is not directly comparable, but may be useful.

I twatted my ACL and MCL 20ish years ago, and it was misdiagnosed (twice) as just an MCL injury. After 4 months it still didn't feel right, and I saw a sports specialist physio who diagnosed the ACL primarily via a machine to measure eccentric and concentric strength of the leg muscles (the injured leg was at ~50% of the other). I was then given a 4 to 6 week weights program before a second visit. At the start of the second session, it was clear that, from the case notes, he was expecting to recommend surgery, but after retesting the strength I was up to ~90% strength, and he changed his recommendation to not go for surgery. At that time there was a general opinion that surgical intervention was most effective soon after the injury, and this was 5+ months after the injury. I don't know if this has changed since then

I then skied for ~3 years with a titanium brace, then worked myself off it, and have essentially been fine for the last 20 years, skiing typically 3 to 5 weeks a year. Outside of winter my main sport is cycling, which is good for many aspects of fitness, but not that skiing-specific, and especially not eccentric strength. I spend 4 to 6 weeks pre-season training specifically for skiing - primarily plyometric exercises and leg blasters. The worst damage I've done to my knee is dancing whilst drunk, and it only had significant impact on the first 5 days of my honeymoon

Anyway, snowHeads is much more fun if you do.

@Weathercam, That video is amazing! Thanks for sharing.

Very reassuring to hear these stories. Not sure whether I should get the knee rechecked to make sure the catching sensation doesn't mean something should be looked at but good to hear it's possible to carry on like this.

I do wonder what old age will look like if I am unable to work out and retain muscle strength to the same degree. As a woman too I wonder if that might affect muscle deterioration as I age.

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@jjc, That's great that you've been able to carry on working and all seems fine. Seems very hopeful

Then you can post your own questions or snow reports...

@Weathercam, That video is amazing! Thanks for sharing.

Very reassuring to hear these stories. Not sure whether I should get the knee rechecked to make sure the catching sensation doesn't mean something should be looked at but good to hear it's possible to carry on like this.

I do wonder what old age will look like if I am unable to work out and retain muscle strength to the same degree. As a woman too I wonder if that might affect muscle deterioration as I age.

After all it is free

@Jonathan Bell, Many thanks for responding. I think I will go back to my surgeon for a follow up.

Help!!

2nd ACL rupture - what to do?!

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