acl rupture

[winger]

hi i was wondering if theres any one with any advice for me,
I am a 19year old,im very active, play most sports, mainly now rugby. Whilst playing with rugby I attempted to sidestep herd a notorious 'pop' sound, my knee swelled up and i could fully flew/extend the knee for a few weeks, but being as determined as I am went back to playing but suffered repeated incidence of my knee giving way and constant pain even on just walking, i stopped all running as of may however i was still experiencing pain. after seeing the appropriate consultants and having an MRI it was confirmed that i had torn my acl and the consultant has put me on the surgery waiting list and recommended physio. Now i have been doing excercises the physio recommended and have noted the muscles around the knee joint have got stronger but my knee is quite unstable and walking is still painful. As my last season with the club is about to start im as determined than ever to just 'run through the pain', i just cant tell when my knee will give way, like there are no signs like increased pain.sometimes fore it did go a whole game without giving way. would it be very unwise to start the season and just see how it goes?im carrying on my physio excercises everyday. and i do want surgery eventually but even though i doubt i would get a date before christmas it would be right in the middle of my season and probably rule the rest of the season, including the biggest match of the year out.as ive heard it takes p to 5 months to recover. i am a talented winger and the only one the team has so i feel ike i atleast want to try and run through it. having the surgery post season would allow the whole summer to recover. please does anyone have any advice?
thanks in advanced.

[msk101]

Hi Winger,
If you do a little more research into ACL reconstruction you'll be able to make a more informed decision about whether you continue conservatively or with surgery. Reconstruction is generally recommended for younger active people, but older people tend not to have the surgery.
Reconstruction surgery would usually recommend no impact exercises until about 6 months post-op although some surgeons' protocols start about 4months. You shouldn't really be starting to play rugby again until 9-12 months after your surgery depending on your recovery and rehab, when your knee is very strong and the new ACL ligament has healed into place and strengthened (there is a period of time when the ACL is newly implanted that it's strong but your muscles are weak, then as your muscles get stronger the ligament actually needs to degrade and rebuild in it's "new home" - this is the point when most people who re-rupture the ligament do it because their muscles feel good but the integrity of the ligament is at it's poorest - this is about 3-4 months post op). then after about 6 months you can start gentle light jogging and straight line work. about 9 months is starting to do sport specific drills and higher level stuff before return to sport. Average person will take 12 months to maximum strength and recovery, elite athlete, about 7 -9 months depending on how long between injury and surgery, type of graft, pre-op strength, and type of sport etc.
If you choose to NOT have the surgery you do run the risk of further joint damage because your knee doesn't have the usual ligamentous supports without an ACL and there will be much more unusual movement at the joint. Plus you're not going to be as stable with quick maneouvres and turning. Your physio should be able to explain this more. Your current exercises need to be strengthening your quads, hamstrings, glut (medius especially) and working on your balance.

At the age of 19, I'd probably recommend take the season off, do the surgery and the rehab really properly, and then get back to rugby in a year - by no means should your playing career be over just yet but be patient if you want your knee in top shape for the long haul. I can't stress enough that it's so important to see your physio for a proper assessment and advice.. if you don't trust your physio at the moment, find one you do trust!!!

[winger]

hi,

thankyou for your reply and advice it has been very useful. I doubt that i will get a date for surgery that is before christmas, due to long waiting lists etc. if prior to that my knee does feel strong and i go back to training would i be doing alot of damage if my knees were to give way again?ive seen there are good taping techniques and braces available. im not sure weather my tear is a full rupture or a partial tear. would there be any sports that i could participate in relatively with less chance of doing alot more damage?ive been cycling to keep the cardio as well as working on the main muscles around the knee. so physically i feel pretty fit but just dont trust the knee not to give way at crucial momments.however my basic speed is enough to get me through a game without sidestepping which i have been notoriously known for before.

thanku for your help, i really appreciate it.

[msk101]

Because it's uncommon to just rupture an ACL without damaging some cartilage or other ligaments at the knee, if your knee buckles when you're running at high speed you do risk damaging further other ligaments and the cartilage (menisci) of the knee. Your physio will be able to assess your knee and give a fairly good estimate on whether you have any ACL left or not, and whether there's much damage to other structures, particularly the MCL and the medial menisicus. also the MRI report should detail partial or complete rupture, and other damage.
Other sports you can do to minimise further damage are cycling, elliptical trainer, swimming (but no breast-stroke and no flippers on), you might be good to do some straight line jogging but hard to say without seeing you and assessing knee, and you can do all your upper body work as per usual. you can also use a rowing machine but making sure you do NOT lock your knees out at the end or fully compress them in the crunch position. if you're keen on group classes at the gym then try for a spin/RPM class. your physio should also have you on a program of specific hamstring and quads strength and balance exercises which you can get to a very high level and are hard work!
ACL rehab is long and boring but rewarding in the long run.

[physiofixme]

I think the advice you have been given so far by msk101 is excellent.

If I was to put my 2 cents worth in I'd say cross train from now until the surgery and don't play. You really need to preserve your cartilage and other structures of your knee. If you run too much on an unstable knee you can do further damage which will mean more problems long term.

Keep up your fitness and strength with gym work and cycling.