Torn ACL Advice

Torn ACL Advice Please

I recently tore my ACL, and I am trying to decide what kind of treatment to pursue. The main options are surgery, or rehab without surgery. I was wondering if you know of skiers who are able to continue skiing at a relatively high level without an ACL? (I usually do about 3 ski marathons per year both classic and skate). If I can avoid surgery and continue skiing that would be ideal!

I had a complete tear of my ACL from downhill skiing which I did have repaired for 8 years. During all that time I skate skiied and did inline speedskate racing extensively including many ultramarathon events. The movement of inline skating and skate and classic skiing does not require the support of the ACL and can be performed at a high competitive level. That said, many other sport and everyday activities do and if you are physically active you will have minor injuries from rotation and torque events and will have to be conscious of limitations for the rest of your life irrespective of the level of strengthening you do for the supporting muscles. Also, for all those eight years my damaged knee was always slightly swollen and somewhat inflexibile. I was able to greatly mitigate the swelling and inflexibility with a regular program of yoga including postures directed specifically at the knees. The desire to do sports requiring rotation and also a bad injury from lifting a heavy suitcase and twisting led to a decision to have the ACL repaired (age approximately 45, used cadaver tissue) and my only regret was that I waited 8 years to do it. My repaired knee is now stronger than my good knee, I have no limitations in sport or any other activity, flexibility is 98% of the good knee, and my skiing and inline skating improved considerably which I attribute mainly to the benefit of being able to “go for it” without the mental reservation that came from performing with a torn ACL.I am happy to answer any further questions.

I think I can offer some reasonably germane information concerning the relationship between ACL tears and cross country racing at a fairly high level. I tore my right ACL in 1959, skiing alpine with the old traps and thongs. There was no decent repair in those days and I was still young enough and dumb enough to believe I was immortal and continued to do things, like playing intramural football, that damaged the articular cartilage in that knee until it started “going out”. I had gotten back into cross country racing at that point and the knee certainly did cause me problems. In 1992 I had the ACL reconstructed. which stabilized the knee, although the cartilage damage was still there. In 1998 I tore my left ACL, trying a fancy way of throwing a heavy canoe onto my shoulders. This time I went the the orthopedist immediately and it was decided to leave well enough along. The knee hadn’t loosened significantly and I keep the muscles around the knee as strong as I can. I don’t play football any more, nor do I do things that put a rotational strain on the knee (tennis, basketball, etc). So far the knee hasn’t given me any trouble, skiing or elsewhere. Since about 1990 I was competing in 3 or 4 marathons a year and I started competing in the Masters Nations and Masters World Cup in about 1995, working my way up to several national championships and a silver medal at the Worlds in 2008. This just to indicate that I have been racing seriously, although that’s coming to an end, in part due to wear and tear and in part to a nasty case of Lyme disease that I contracted 2 years ago. You’re better off with a torn ACL than with Lyme! So, I’d say that, if you haven’t stretched ligaments and if you are willing to forego behaviors that might lead to more damage, you can continue to race without getting the ACL repaired. However, if you’re “young” and want to do some of those “bad” things, I would suggest getting the ACL repaired. It may be a pain, but I think it’s worth the pain (literally).Good luck

My daughter tore her ACL playing AAU basketball in the 8th grade a week before the state track and field championships. She was a strong track and field athlete, ranked first in the state in four events at the high school level in the small schools division. ACL surgery appeared to be the only option for her to continue competing at a high level. Surgery was in July, rehab took six months, following by a lot of cycling to strengthen the quads, and she competed in track and field the following spring in just the field events (setting three school records). She was running strong again by the following spring. It took two years for her to fully recover and in her Junior year she won the state 1600 meter championship and led her team to gold medals in the 4 X 400 and 4 X 800 relay races. I doubt that she could have achieved these results without the surgery. She is also a strong x-c skier. I know of other athletes that have had ACL surgery and were able to compete again after just six months. Good luck with whatever decision you make!

In 2000, at the relatively “young” age of 61, I tore my ACL while skiing. I was a serious long-time nordic skier, but had never done any racing. In May of that year I opted for ACL reconstruction surgery, using my own patella tendon transplant, and have never regretted the surgery. After extensive PT, I skied following season, tentatively at first, and then got serious about training that Fall and challenged myself with a marathon. In 2002 I completed my first marathon and have averaged one each season since then. The PT is tough, but worth it. You have the advantage of going into the surgery in great physical shape and with good training discipline. Before surgery, I could always sense a little instability and movement in that knee. Since the ACL is a primary stabilizer in your knee, not having one can lead to premature cartilage damage and arthritis, especially at your activity level.

I’ve had both my ACL’s repaired at different times. First one 26 years ago with so so results (repair technique still in its infancy) The other knee 8 years ago with excellent results. I’m also a family practice physician and have seen my share of torn ACL’s. Assuming you 1. Are less than 65, 2. always had reasonably low bodyfat/decent conditioning 3. have no other additional knee structures involved in that knee 4. get a good surgeon (important) and rehab person, (and follow their advice) then I think you’re better off to have it repaired!

I’m not a high level skier, but for what its worth, I’m a wave 2 birkie skier and had my ACL fixed in 2002. I only skate due to a foot injury from my soccer days. I had an allograft procedure (using tendon or ligament from a donor) rather than my own, done laproscpically. Rehab for me was quick and fast, I started skiing the following year and have had no issues. And the bonus for that procedure is you can say you’re a dead man walking. This is mostly speculation, but having an intact ACL might help save other ligaments in a bad fall or crash, or someone else being out of control coming into you. I recently tore my meniscus, cartilage in your knee. I was lucky enough to not need surgery and recover on my own. But, we had a friend who tore their ACL. She had surgery in January. It was hard for her, but she iced regularly, got physical therapy, biked a lot, and followed the doctors orders. Now by May she is up to running and getting much better. So, realistically (I’m not an expert by any means) from what I’ve observed you’ll probably be better off with surgery and physical therapy if you want a quick recovery.
Best of Luck,

Regarding your question about Anterior Cruciate Ligament (ACL) reconstruction: The ACL is an ligament on the inside of your knee and is one of the four big ligaments in your knee. The ligament attaches from your femur to your tibia. It’s primary role is to keep your tibia from moving forward (anterior translation). This is most important with activities where there is a lot of jumping and quick stops. Typically the standard of care in the US of A has been to get reconstruction done in athletic people. A recent article from Sweden published in the New England Journal of Medicine, however, didn’t find a difference in outcomes between young athletes who had immediate reconstruction vs those who delayed surgery and only had surgery if they had instability in the knee (about 1/3 of the people who delayed surgery ended up needing surgery). There’s obviously been a lot of discussion and issues with the article but it is thought provoking. There are a few other factors to also consider when deciding on surgery versus no surgery. Gender may play a role (women may need surgery more than men). Also, if there is any other damage to other ligaments or to the mensicus in the knee, surgery may help protect the knee to further damage down the line. Finally, they type of sports people play has a role. Someone playing sports with lots of sudden starts/stops or lots of stress on the knee (basketball, racquetball, football, volleyball, downhill skiing) would likely notice ACL instability more often and may get more benefit from surgery. If an athlete only does sports like swimming or cycling, with relatively less stress on the ACL, there may be less of a need for surgery. Anecdotally, I’ve been running/xc skiing/cycling without an ACL for almost 20 years now. When I tore my, my surgeon basically didn’t give me a choice and told me I should rehab it and see how I do without surgery. Knock on wood, I’ve been doing fine. My wife tore her ACL, had it fixed, and is also doing really well. Good luck with your decision!

I can provide a single case report on this issue. I am 59 and tore my ACL at the Noquemonon Marathon at around the 8 km point. Since there was no assistance available I kept skiing and actually finished the race. It seemed pretty stable skiing classic up the hills, but the downhills were interesting to say the least. I saw a sports med Orthopod who said I may do ok without surgery, and that it was a personal decision. There was a moderate MCL tear, but no cartilage damage. I finished the Birkie four weeks later, and had no major problems. Managed a second wave classic time in spite of being mostly off skis for February and marginal wax. I am back biking at a reasonable level simply wearing a neoprene sleeve brace. Rollerskiing will be a better test of long term stability, and I am cleared to run.So I think it can be done, but it is an individual decision. I was told that surgery can be done at any time, so giving it a chance to rehab is a very reasonable option.

I partially tore my ACL training for the 2010 Birkie. I was able to complete the 2010 race without too much difficultly, although my time was not great due to lack of training. I completely tore my ACL two weeks after the Birkie and underwent ACL replacement surgery on May 11, 2010. The doctor recommended using a portion of my hamstring and I went with that as the replacement ligament. I also had a torn meniscus, which slowed my recovery, but after 6 months of therapy I was ready to go for the 2011 ski season. I wore a brace, but had no trouble at any point this year as a classic skier. I posted some of my best times this year, which was likely due to the core training I did in physical therapy. I would recommend using a hamstring as a replacement ligament. I did run into another skier while training this year who elected not to have surgery. She wore a brace and reported no problems skiing with her torn ACL.

Hello- I had a full tear of my ACL about 9 years ago at age 45. I opted for surgery. With very intense re-hab, I skied the Birkie the following year. I am a wave 1 Birkie skier. The risk of not getting it fixed is the slow and or twisting falls that sometimes occur on both Nordic and Alpine skis. This assumes that you have not been able to properly build up all of the stabilizing muscles around it. Additionally, my Dr. was concerned about continued wear and tear on the cartilage in the knee, which could result later in a knee replacement.

The person did not specify whether their ACL was torn completely or partially. Based on the comment “skiing at a relatively high level without an ACL”, I assume it means their ACL was completely torn.
I completely tore my ACL while downhill skiing about 3 years ago. I also do some recreational X-C skiing and ski in a 20km race each year. I can’t imagine being able to ski without an ACL. As far as I know, without an ACL your activity is basically limited to walking and very light-duty activity. Any type of activity that requires a twisting / turning or cutting motion of the knee requires an ACL otherwise you will have no stability and risk damaging the other ligaments that hold the knee together (PCL, MCL, LCL). I would imagine that without an ACL, it would not be possible to skate-ski or handle a twisty downhill run. In my case, I had ACL surgery in late February (so I missed a big chunk of ski season that year), but by June I was able to hike in the mountains of Alaska, and by the next ski season I was back at 100% capacity. Due to my age at the time of surgery (42), my doctor recommended a cadaver ACL replacement (as opposed to an autograft where they take out a portion of your patellar tendon). The main benefit of the cadaver graft is that the cross-section of tissue is larger, therefore resulting in a stronger repair over time. My doctor told me that my “new” ACL is stronger than my original one. So I would definitely recommend the surgery. The short-term “downtime” and subsequent rehab period
Hi SkiPost – Classical skiing should be OK without ACL reconstruction, but I’ve seen patients who have pain with skating (especially if there was a meniscus tear at same time as ACL rupture). Otherwise there’s little harm in delaying the surgery and trying it for a season, but would definitely recommend skiing in an ACL brace, and doing an physical therapy program for knee stability (on a regular basis). The bigger factor is OTHER sporting activities. If you do anything else that involved cutting/pivoting/jumping/etc you should have the reconstruction. Anytime the knee gives out (subluxes) there is additional damage to the cartilage and more risk of arthritis. Under age 30, I definitely recommend the surgery (regardless of activities). Good luck!

I tore my ACL in 2002 at the age of 44. I decided to go without surgery and see how the knee would handle it. So far, so good. I ski about 500-700 miles a year and cycle about 4,000-5,000 miles a year in hilly SW Wisconsin. My belief is that cycling has helped strengthen and stabilize the knee. I only ski classic, no skating. And I’ve never had a pivot shift or other problem with my knee while skiing. I wear a simple neoprene wrap when I ski, more to remind me not to be too reckless than to actually prevent further injury. I’ve skied the Birkie every year since the initial injury and have moved up from wave 7 to wave 2 during that time. So in my experience it is possible to ski at a reasonably high level without an ACL. As long as your toes are pointed forward, you can ski, bike, run, etc. Side to side movements can cause problems. No basketball, volleyball, etc. Skate skiing could be a problem, but since I don’t do it, I’ll let others speak to their experience with that technique. Good luck.

I have torn both of my ACLs. I tore the first one 11 years ago and the second one 9 years ago – both times while tele skiing. I was teaching X-C skiing and doing a fair amount of long distance skate and classic skiing (i.e. >= 1200 k/yr) plus some marathon racing (not high level though) at the time. My knees were very unstable immediately after injury and remained so until having surgery approximately 6 weeks post injury…. Hence I was very glad to have ACL repair. Honestly I am not sure how well I would have done with physical therapy alone, but my impression at the time was that in order to ski ‘safely’ I would always need to ski with a brace if I chose not to have the surgery. I had the middle-third patelar tendon graft – type ACL repairs done by an orthopaedic surgeon who specializes in ACL reconstruction in Bozeman, MT. Recovery from surgery can be difficulty, particularly for someone used to going hard and long all of the time. After my first surgery I was able to work essentially full time on rehab (PT plus lots of gym time) so the recovery went rather quickly (I THINK I remember doing track workouts ~ 6 weeks post surgery). I think that recover time depends largely on age, time invested in the gym, how well the surgery works, and of course luck. Being a decade older now, I’m sure it would suck even worse than it did then.

My advice would be to consult a really good physical therapist AND an orthopaedic surgeon with LOTS of ACL experience with athletes before deciding whether to have surgery. I know a few people who have skied (downhill or tele) for decades with no ACL, but noone who has done serious XC racing with a torn ACL.My advice in a nutshell given limited info on your age/other lifestyle details. If you are 12 years old and have not finished growing-don’t do it as the ACL graft fixation may interfere with your growth plates at the tibial bone and you run the risk of asymmetrical leg length development. If you are 22 and may still be shooting for the college scholarship to complete a graduate degree, don’t do it yet but keep training very ski specific and discontinue bounding and plyometrics during your dryland phase. If you are a strong skier who enjoys participating in marathons and the overall fitness culture that nordic skiing can provide recreational enthusiasts, and plan on enjoying your level of fitness for many years to come, here is my advice. First, understanding that the ACL limits excessive anterior and rotatory movements at the knee joint (femur on tibia), an ACL deficient knee is more prone to cartilage surface wear, and in a few years you may be writing weanswer@skipost for advice on a total knee replacement. That being said, from muscle testing and biofeedback testing that I’ve conducted on various athletes, nordic skiers tend to have good hamstring strength which does help provide more stability in the ACL deficient knee. I work in an very active and healthy community, and while some practitioners (both surgeons and sports medicine crowd) don’t agree that ACL repair is necessary beyond 60, I wholeheartedly tend to differ. My clientele are both nordic and alpine enthusiasts with backcountry skiing thrown in, and it is my general philosophy that we want to play hard through the decades and not be sidelined by a painful joint. But really, this is very individual depending on your range of exercise and athletic activities, whether a meniscal lesion is involved, and numerous other factors. Do your homework. Get several opinions from specialists…not just surgeons, but perhaps some experienced trainers and physical therapists who are quite familiar with nordic skiing. Find the right fit for you. If you do chose to have your ACL repaired, listen and understand the vulnerability of the graft during the healing phase. We tend to feel stronger at certain points than the graft can tolerate, and nothing is worse than going back for a surgical revision in mid summer when you could be 12 weeks into rehab and seeing that next season need not be a wash. And DO NOT stop physical therapy too early. That is by far the most common mistake people make (“But hey..don’t I have better healing capabilities because of my healthy lifestyle? Surely this timeline doesn’t apply to me!”…..). Wanna bet?

My experience is 4 surgeries a long time ago. I have been 25 years, some of them as a decent athlete, with a marginal right knee (I have competed in alpine and nordic events as well as bike racing, and just recently some running). I have a fragment of an ACL left…my knee is stable (that is, it wont pivot-shift) but is still susceptible to swelling and being a general pain in my athletic butt. If the ACL is completely torn he should definitely fix it through surgery. Though some athletes apparently get by without one, the knee will never be truly stable and no matter how strong he is he will be susceptible to further injury (of the minisci which you REALLY REALLY don’t want) through stupid things like stepping off a curb in the dark. If the ACL is only partially torn then it is your call. If it was me and could go back in time I’d start with the best possible knee (surgery 5) and the commitment to longer time off and longer rehab and have essentially no liabilities moving forward. Good luck and ski fast.
I tore my ACL in March. I was told I might be able to ski without the surgery, but we wouldn’t know for sure until next ski season. I decided I wanted to have the surgery now in stead of during ski season. I had my surgery April 11, and I am almost 100% back to normal doing whatever I want. However, the doctor said I would not be able to ski for 7 months. That doesn’t really answer your question, but should give you some idea of recovery for ACL. I am extremely pleased with my surgery and am happy I did it. I have a friend who tore his ACL years ago, he never had surgery and he skis, but he doesn’t ski competitively. You can wait as long as you want to have the surgery. An ACL isn’t necessary for anything except cutting sports. My doctor told me I could go either way. He wasn’t sure. You can always rehab it and if you aren’t happy with it next season, have the surgery then. It really is all about timing.
Being a former racer and veteran of this dilemma, no ACL for 6 years, I can tell you that it is better to get it fixed now than to end up with a worn out knee, (worn out articular cartiledge, no meniscus, significant laxity, and lifestyle limiting instabilty) as I have experienced. I stay in good shape, am very fit and my knee is stable when the muscles are dynamically set, and very unstable when it is passive or relaxed. When you limit the fore/aft motion of the tibia with an intact ACL, you limit the damage to the cartiledge surfaces. I’d advise that you get it repaired!!! The procedure is minimal these days, arthroscopic and recovery is shorter than ever. Your knees have to last a lifetime, think about that now!
If you don’t get it fixed, the fore/aft movement of the tibia will result in other problems, as stated above. I have now had 10 surgeries (necessary to keep me active) and am facing replacement as the bone surfaces as well as the meniscus has been compromised and worn out by this laxity (no ACL). Even 2 microfracture procedures and great joint support supplementation has not stopped the degradation of the joint. I think the 6-8 months recovery and therapy is well worth the effort to have a good, solid, knee without risking further instability and more extensive joint damage in the future.

Those with an ACL deficient knee are divided into 3 categories in the rehab literature: Copers, Non-Copers and an in-between group. Copers are able to train and perform at or near pre-injury levels without episodes of instability or putting the knee at risk of further insult. This group does not require surgery. Non-Copers can not perform routine activities or moderate activity without episodes of instability “giving way”. They are at risk of further knee injury. These folks most often require surgery or have dramatic functional decline. The In-between group can go either way and can often rehab (3-6 months) there way back to performance (become a Coper) or reach a point where higher level activity causes instability to occur. They can choose to modify there activity to fit this level and avoid surgery, or decide that a higher level of performance is desired and will require surgery. Take Home Message: Allow the acute phase to pass (1-2 weeks), obtain full Range of Motion, and progressively increase activity. Consult a rehab specialist to create a plan. Base decisions on your performance and risk factors not your diagnosis.

Joe Dengler PT, OCS. Tahoe Center for Health and Sports Performance

Without an ACL any side to side thrusting with one’s legs is going to be a problem. At 58, I tore my ACL this winter (OK it was Alpine skiing & moguls) which ended my skiing season. I was still able to bicycle, swim, and classic…but Alpine, soccer, and karate were all out. (I tried skate, but my knee “went out” each time my form was not perfect.) I did three months of balance and strength training for quads and hamstrings. I could balance on a yoga disk while juggling and one-foot leg press 250lbs, but could not hop on a trampoline (a reasonable test of stability) on the ACL-less leg. Finally, I was told that I could try to wear a brace while I skied or played soccer (karate would definitely be out.) I am now 3 weeks into my post-ACL reconstruction PT. If I take real good care of my rehab, I may be able to return to skiing by January.

I tore the ACL in my left knee in January 2010 while downhill skiing. I finished with some easy skiing that day and two days later did some light x-c skiing. I had had a MRI of that knee the previous July so the comparison MRI in January showed a complete tear. The advice from the surgeon was that until I experienced instability or lack of support in the knee to do whatever I wanted. Surgery was still an option once I would experience any problems. I have x-c skied marathons and shorter races for the past two winters, and have downhilled skied this past winter with no pain, limitations and/or instability. I am 63 and because of a bad back have given up running which might have been hard on the knee. I do core work and leg/knee exercises but not to any extreme. I do alot of summer x-c roller skiing, pole hiking and biking but to no ill effect. In orthopedic follow ups the surgeon has been surprised but pleased that the knee has worked so well. I am still of the mind of doing whatever I want and if the knee fails then I will consider surgery.
I damaged my right knee on a ladder nearly forty years ago. By the second surgery all the cartilage was gone and the ACL was too. Leg extensions, and lots of miles on a bike, keep me skiing and hiking till I finally had a knee replacement two years ago. If I was in his position I would not go digging around in there till it has to be done, unrelenting rehab, keeping the quadricep strong will stabilize the knee, I was a wave three skier at the birkie so………This is just a personnel observation, it worked for me
To repair or not repair an ACL is a personal decision but I am living proof that you can ski at a high level without an ACL.

I am 58 and have been an avid skier since childhood. I have also had knee problems all my life. I had medial menisectomies in both knees by the time I was 30. I had what was described as a “left knee strain and possible ACL tear” in the mid-80’s. It was not surgically repaired but I rehabbed hard over a summer and it was fine.
I ruptured my right knee patellar tendon and ACL in 1991 at age 39. The patellar tendon was repaired but I was left without an ACL. I worked hard at rehab and was back to Nordic skiing, wearing first an Omni TS7 knee brace and later a Don Joy Custom knee brace, 50+ days a season by 1993. I kept working on getting stronger and by the mid-90’s in addition to track skiing I was backcountry skiing and doing an occasional telemark skiing day on the lifts. I averaged 70 ski days a season in the late 90’s through the 2007-2008 season, always wearing a brace on my ACL deficient right knee.

By the end of the ’07-‘08 season I was having more frequent pain in my right knee and needing more recovery time. That summer it got much worse so I had a total right knee replacement October 2008. When you have a total knee replacement you give up your ACL- it has to be removed to accommodate the prosthesis. By January 2009 I was skiing both skate and classic on easy terrain with no problems and no brace. The doctor said if I worked at staying strong and avoided high impact activities I didn’t need a brace. Running, jumping and high impact cardio work are out; bicycling, canoeing, inline skating/roller skiing, low impact aerobics and hiking are in.

My new right knee worked great by the following season- my skate and classic skiing was as good as ever and my knee was pain free- no brace and no ACL. So much so that the limiting factor became my other knee- the knee that had a medial menisectomy in 1972 and a”strain and possible ACL tear” in 1986. This season I tried to do some backcountry skiing in early season but the pain in my “original equipment” left knee was too much, even wearing a Don Joy Defender brace. Skate and classic skiing were still OK but I was limited to about 2 days a week. I did the 2011 Boulder Mountain Tour (14th time in 15 years, I missed 2009 when my new right knee was only 13 weeks post op) but my left knee was so sore and swollen after the race that I had a total left knee replacement in March 2011. The surgeon told me that while installing my new left knee he observed that the ACL was totally gone and had probably been gone for years. Maybe since 1986. I am looking forward to pain and brace free Nordic skiing this coming season and have every reason to believe I will be back to fairly serious backcountry telemark skiing by late season. No ACL’s needed. It’s hard to say if I would have needed knee replacements if today’s ACL replacement technology was available in 1986 and 1991. What I can say is that my wife has had 3 ACL reconstructions in the last 10 years. Her first is still OK but her second failed after 4 years.
I was hit by a car while rollerskiing in Oct 2008. The car hit right at my left knee and shattered my tibia just below the knee. We don’t even know the extent of the internal knee damage b/c the fractures took precedence at the time and I have been functioning well. It is an unstable knee for sure and I can’t imagine the ACl isn’t at least partially torn. However, with strength and endurance exercises I manage very well. 16 months after the accident I had my best ever (and 10th) Birkie. Mind you I’m not fast but the injury didn’t seem to hold me back. Unless your doctor feels that without surgery your knee will deteriorate more quickly, you may want to see how the rehab and training goes.This does not take into consideration your race potential. I’m not sure if an unstable knee will allow peak race performance. it seems to be fine for a middle of the packer.

Last season, I learned that I tore my R ACL likely about 24-25 years ago (in my late 30’s) when I consider timing of past injuries and current MRI image of the knee for what turned out to be a mildly torn MCL. The MRI showed an old complete separation of the ACL. When I initially injured it back in the 1980’s, I was told it was a MCL sprain and given some strengthening exercises. I continued skiing on track and backcountry and have done fairly well though the intensity of my training and skiing varies from year to year. I also continue to Alpine and Telemark ski. In really good years, I’ve done two-three 20-39 km races a year though I’m not a really fast skier. It sounds like you do more than that. Also, I tend to stride more than I skate. With good muscle strength supporting it, I haven’t had much trouble with it. So you know, I’m a woman in my early 60’s. Good Luck,

I am a 50 year old female. I tore my ACL at age 26 and continued to do all my normal activities until it became unstable 6 years later. ( I was also waiting for the surgical procedure to advance technically.) I had it repaired and continue to race 3 marathons a year without problems and no brace. In fact, the repaired knee is tighter than the other one. I worked with a good PT person strengthening the surrounding muscles before and after my surgery. Rehab is the real key as well as an experienced surgeon who has done a lot of ACL repairs. Ask many questions and make sure you feel comfortable! I would follow the advise of your orthopedic team making sure they are aware of your fitness goals. You may want to consider a second opinion with another orthopedic surgeon. The danger of waiting is you could do more damage and have bigger problems to repair down the road if your knee is unstable without a brace. The reality is ACL repair is an easy surgery to rehab from when you are in as good a shape as it sounds like you are. I’m sure things have advanced since I had my surgery 20 years ago. Good luck!

I tore my ACL playing baseball at 15, back when doctors still thought that part was vestigial (like our tail bone). Hence, I received the wrong treatment (a cast). I didn’t find this out until 33 years later, when upon having arthroscopy I discovered it was fully ruptured. Since the ACL supports the cartilege, that also went a few months later and had to be repaired, which effectively started the demise of my school basketball career. By the time of the arthroscopy, the knee was bone on bone, which would have made an ACL repair ineffective. Over the years before then (and since), I’d get chronic swelling when restarting activity and then really pushing it, such as longer or harder runs, playing basketball and much later, cross-country skiing. One other thing that developed over those decades was that my leg apparently compensated for the lack of knee support by bending in above the knee and and out below. That meant functionally one hip was lower than the other by a considerable amount, perhaps one centimeter or more, and I couldn’t quite fully extend the knee. As you might imagine, with the foot not under the knee/upper leg most of the time and the knee unable to extend on one side, getting a full push, especially in ski skating, has been impossible (chronic swelling hasn’t helped either). The difference in pelvic height has also seemingly made it impossible to swing one leg properly when striding (vs. carrying it forward), since I’m in effect skiing uphill and downhill during each cycle. Serious swelling and “locking” knee – the bone on bone effect – have made downhill and telemark skiing painful, if not impossible, after about 15-30 minutes. At 64, I’ve been able to make it so far without a knee replacement, I can see that’s coming. The writer didn’t give any details, but my suggestion is to think long term. If the doctor thinks recovery will heal it, then try that and be patient and follow appropriate rehab. Otherwise, I wouldn’t hesitate to get an ACL replacement. Just do the rehab diligently and be patient with the healing and restrengthening process: we can often use an injured/repaired part vigorously long before its strength has fully returned.

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2 Responses to Torn ACL Advice

  1. sue glynn says:

    Hi Well I am the Mom of a competitive skier. She had her ACL replaced. Although the surgery went OK, she developed a surgical infection and for 3 years she was out of competitive skiing. We turned to Caring Medical for Prolotherapy. Check out their website. Dr Hauser is a great alternative to surgery. Wish we would have met him before surgery. Good Luck with your decision.

  2. Max Walker says:

    I tore my right ACL, medial collateral ligament, and medial meniscus 46 years ago, at age 22. With vigorous therapy I was able to continue most sports for 14 years until the meniscus locked and had to be removed ( now I would strongly recommend a partial meniscectomy or repair). The knee has since been quite stable. Then 20 years ago I tore my left ACL and medial collateral windsurfing. Physical therapy has been moderately successful, but the knee is not quite as stable as the other. I participate in several xc ski races every year, ski classic and skating 4 to 5 times a week in the winter, bike 5-6 days a week in the summer, and hike in the mountains regularly without problems from those activities. So no ACL repair has worked for me. I have been told that there is accelerated degeneration of the knee post ACL repair overall, so I would think that rehab and physical therapy would be a good choice for perhaps most of us unless we have definite instability from the sports we enjoy.

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