Partial ACL Tear....

[MrDJB]

Hi all, am new around here, but it looks a useful place to come for some advice so here goes. It's quite a long story, but i'll keep is as brief as possible.

Back in April 2007, i turned sharply whilst playing football (Soccer) and damaged my right knee. Eventually, i paid for an MRI scan to save about 3 months of waiting time and this showed that i had torn the bucket something or other meniscus and that there was possibly a tear in the ACL but they were not to sure.

At the time i didn't have a huge range of motion in my knee and i could neither straighten or bend my leg fully. Although movement did come back, i was added to the operation waiting list to have the arthroscopy to sort out the cartlidge.

In October last year i had the removal and was told after by the surgeon that there was some damage to my ACl - a partial tear. A month after the operation i went back to see the surgeon to speak about where i went next. I was told that the tear was only partial and that there was a chance that i could do a rehabilitation program at the physio for a number of weeks and then after that I may be able to return to sports.

I went and did 8 weeks of rehabilitation at the physio. At no point throughout those 8 weeks did i feel like i had a particularly weak knee. It's fairly stable (i'd say around 95%) and its relaltivly painless. Throughout the weeks i built up on excercises which included heel raises, squats, single leg squats, jogging, cycling and eventually hopping and figure 8 runs.

After the physio sessions were complete i paid a final visit to my surgeon who had a look around my knee and moved about a bit. He told me that the only way to find out whether my knee would be strong enough to play soccer again would be to build up the muscles and then go out and try it. The worst that could happen would be that it may give way and i'd end up on my face - but at least i'd know that i needed a full reconstruction. He also told me that the tear had reattatched to itself but that didn't make much sense to me. He also said that i wouldn't really need any form of knee brace.

So, i started jogging on the streets - about 1mile to 2 miles per day and everything is fairly comfortable. Last week i decided to start turning and twisting a bit more and kicking a football - so i bought a hinged brace. Although it may not do a great deal as people tell me they've never been proven to work - mentally i feel more confident with the brace on when turning. Occasionally i get a small pain if i stretch too far without the brace but it's not a massive pain.

Having kicked a football for an hour - apart from the odd twinge if i mistimed the kick, my knee fdelt pretty strong. A little sore around the outside at the lower part of the knee the day after - but my left leg was a bit sore too, so i'm guessing that could be down to just lack of excercise.

So here is where i am now - I feel confident in my knee, it feels strong and i feel pretty fit - but actually diving back into football where there turns will be more spontanius and forcefull, along with tackling is nerve wracking for me. All i can hear in my head is that i have a tear and i shouldnt go and play as i will make it worse, but i miss playing.

is going out there and playing really wise - or is a reconstruction more recommended? Does anybody understand the ligament "reattatching" term which my surgeon used?

[MrDJB]

any replies!?! please!

What injuries am a likely to sustain if i go out and play football and the knee buckles? Will i be again in a position where i can't work for a few weeks or will i just have a less stable knee?

[sixphysio]

ok - your meniscus tear has been sorted surgically and won't grow back. the difference between that and your acl is vascularity. if you tear your acl and a is still attached to b by a few threads then it should regrow because of the vascularity (blood vessels). BUT it may not have the same strenght or lenght, potentially making your knee unstable. not necessarily in straight line stuff, but in rotational activities.

this is the dilemma of braces. they'll give you false support by making the muscles around the knee more active, but as a ridgid structure can't protect the rotatory componant (unless they drill into your bone!)

perhaps reattaching is the wrong word, unless the tear is at the bone/tendon junction of the acl then it probably won't, but with the right rehab protocol to improve rotatory control, hammys and gluts then you may not require to rest and depend on the tensegrity of your cruiciate.

don't get it reconstructed unless it's knackered (gives way, blows up type thing). but do get going on rotatory control, plyometrics not just booting a ball around.

cheers

sixphysio

[MrDJB]

Thanks for the reply

How do you recommend i best go about improving the rotational control? Are there specific excerices or am i just best to concentrate on the muscle groups i've been told to.

Even if i improve the rotary control, is the brace a bad idea to use? I mean, is using it as a "mental" aid going to affect the workings or is the brace fine as long as i improve the rotational control?

[sixphysio]

tricky to explain with panache!

rotatory control is about planting your foot on the ground and then controlling the amount of rotating (rolling in or out) your thigh does above it - hence the bit why braces can't fully control this bit.

your cruciate is under greatest strain when your foot is pointing to 2 o'clock and your knee is pointing to 10 o'clock. it's a normal function and usually your cruciate passively controls the extreme's of rotation in your knee. yours being a bit dodgy won't be as efficient so you need your muscles to control this.

you need to practice with your foot static and then get more dynamic with planting your foot. it's all about control - not just doing it. it also gets you to concentrate on not only brute strength around the knee but control around the hip.

as for braces - if you think you need one then your probably not ready to do stuff on it yet! there is no harm in having one, mentally you'll feel tougher but don't rely on it!

cheers

sixphysio

[MrDJB]

thanks for the reply again...

During the rehabilition at the physio, i didn't wear any form of brace. I ran, hopped, jumped and turned without it. I decided to wear it during the kickabout more as a mental booster. I think what i plan to do is as you say - build up the rotary control, and muscles without the brace. Whilst kicking a ball about, i think i'll stick with it for now and gradually do more and more without it as my knee feels stronger and i feel more confident.

A friend of mine has spoken to me about plyometric excericises although he's not a qualified physio (yet!). He beleives jumping up stairs and jumping over and back over an object sideways are good excercises. Is he correct?

Thanks again for the help

[sixphysio]

that's not a bad place to start with the plyometrics. it's controlled, explosive, functional, multidircetional stuff.

keep cracking on. control is key!

cheers

sixphysio

[MrDJB]

So i've been jogging and trying to do some plyometric excercises (ie jumping up stairs and hopping over objects) without the knee brace. I gradually took that off throughout the last few weeks.

All in all, my knee feels pretty much as stable as it ever has. I get the occasional twinge which is nothing more than i get in my left knee which has never been injured, but i only notice it because of the injury. If i had the same twinge in the left knee, i carry on regardless.

What i'd like to know is, what sort of timescale are we looking at from starting to work on hamstrings and everything else etc to actually going out for some casual laid back 5-a-side footy? Is the test, just to go out and play and see how it goes - because, although i feel stable, that scares the crap out of me! lol

Another thing is, when i do go out and start doing some twisting and turning, whats likley to happen in the worst case scenario, ie, i suffer another partial tear, or tear it where it is weak? I can't afford to take time off of work like i did last time because i was unable to drive therefore unable to work.

Was my problem with not being able to stand due to the ligament tear or the cartlidge tear? I've never been too sure. I've heard of people who tear their ligament and can still walk although they lose alot of balance and stability. If i tear my ligament again, am i likely to able to walk, drive?

[MrDJB]

Hi All,

Thanks for all the help so far...thought i'd update my story.

Last friday, i took the bull by the horns and decided to try football. i've spent a lot of time running, and trying to build up my leg muscles. I have to say i haven't really had chance to try the plyometrics which were recommended on a regular basis. I had been doing figure 8 runs at a fairly quick pace - hence the reason i thought i would give football a go.

Anyway, football was fine, apart from one twist where i felt a short sharp pain in the knee and went to the ground, partially precausional and partially because it hurt! Within 5-10 seconds, pain was gone and i was able to continue playing. Now i did take it fairly easy in comparison to how i used to play, but all in all i found twisting and turning to be ok....but it was never really sharp.

For the last couple of days, i've had a niggley pain in the knee. nothing really sore, but it hurts a bit if i stretch my leg fully.....a little bit like it did a week or so after i had my cartlidge done. I'm not sure now whether playing was the right thing to do!!

Am i likely to be making a partially torn ACL worse every time i feel the pain? Or is it normal for something thats not been really tested for consiberale length of time to hurt the first few times its used?

I've got an appointment in a month or so as the physio/surgeon told me to let them know how i've got on at football....but am unsure as to whether to try again now!

[Canuck Physio]

I would consider taking it easy and just allowing yourself to be reconditioned in a controlled rehabilitation environment.
It was good of you to take the fall and not allow your knee to take the full force of the twist.
For longevity's sake it is best to heed caution to the wind.

Regards

[MrDJB]

New update!

Since the football, i've experianced pain more often than i did before. I still have full range of motion in the knee but there is a slight pain at both extremes (Ie Pulling knee towards myself and pushing knee down towards floor if sat down).

I can still jog and hop fine and i can also still do the one legged squats, but there must be some reason the pain is still there. Originally i thought it was because i hadnt played football for 12 months but now i'm wondering if i've made it worse.

Is it time to admit defeat and go and see about a full reconstruction?