ACL tear - please tell me about your recovery

[TerrorAustralis]

I tore my ACL two months ago. It’s a complete tear so no chance of it healing on its own. I saw a surgeon who is anti-surgery and have been doing rehab under the guidance of a physiotherapist. I recently saw the surgeon for a follow up and he said I’m improving well and continued to advise against surgery, but he’ll do it if I really want it.

I don’t know what the best thing to do is. My recovery feels so slow and I’m still in a lot of pain and discomfort. I can’t walk far or fast at all. My sleep is disturbed every night because of this. But it seems like surgery will set me back and will make my recovery even longer. I’m just at a loss of what to do.

If you have suffered an ACL tear, can you share your experiences? Did you have surgery or just physio rehab? How long did it take until you saw significant improvement? Is there anything that really helped?

**Note, I’m not in the UK so NHS protocols or waiting times don’t apply. I’ve got easy access to both the physio and surgeon and wouldn’t have to wait long for surgery. I could also get a second opinion if necessary.

TerrorAustralia, just wondered how you are getting on now? I have torn my ACL completely plus a meniscus tear a couple of months ago. As I am not an athlete, the surgeon is sitting on the fence about surgery. I am having physio, but it like you, it's a slow journey. Finding it difficult to walk any distance or stand on leg for long, now a few months down the line. How have you progressed? Did you have surgery or manage with physio?

@Misgivingmum sorry to hear about your injury. It’s completely shit, so you have my commiserations. I wrote my post two months in (I had my accident on New Year’s Day this year) so it was very early days. I can give you my experience nearly 11 months in.

I didn’t have surgery and at this stage I don’t think I will. It’s definitely my choice (not in the UK, so not reliant on the NHS) but I think the conservative approach has been the right one for me.

I have been reasonably disciplined with physio and doing my rehab exercises, going to the gym at least three times a week (most weeks) and adding in different exercises as I go along. I also need to listen to my body. For example, a few months ago the physio got me doing a lot of hopping and jumping and it made my knee really flare up and swell, so I cut back on that and the physio adjusted my program. I have kept doing hopping and jumping onto soft surfaces like a Bosu ball and a soft gym box.

I have been doing a lot of leg strength work (90 degree leg press, calf raise, leg curl etc.) using the machines at the gym. Plus small dumbbell and kettle bell weights (squats, lunges etc.). I haven’t yet been given the all clear to use free barbells for deadlifts and heavy squats yet, but I feel like I’m just about ready for that.

Lots of plyometric exercises and balance as well, and that is really important in the early days, where you are now. My balance is probably better than is was pre-accident. One thing I didn’t know before is that the ACL plays an important role in proprioception (knowing where your body is in space). Back in the early days I would frequently get a weird sensation of falling towards my injured side, even when I was upright and stable – this often happened on the stationary bike or walking up stairs, which was quite unnerving! This apparently related to the whole proprioception thing.

I’ve done a lot of time on the stationary bike and have added in the rowing machine recently. It’s only recently that I have stared like I can walk longer distances without a problem, so I’m trying to get my daily step count back up. For reference, last year I did a 35km walk for charity, so I didn’t have a problem walking or hiking for hours. Last week for the first time I went on the treadmill at the gym and added in some 60-second bursts of running (11–12km/hr) and was pleasantly surprised to find it felt OK and I didn’t suffer afterwards.

I am not doing it so much anymore, but earlier on I would always elevate and ice my knee after the gym. Plus elastic compression bandages are helpful. It was swollen for a really, REALLY long time, which I hadn’t expected. It’s probably still a bit swollen now, or at least after exercise.

This has been really long, but I hope it’s helpful for you. It does get better if you stick with the exercise. And be kind to yourself. I was really depressed by it (honestly the injury was the shit icing on top of a shit couple of years cake). So some days I struggled to make myself do anything. But mostly I have stuck with the programme and I have dragged myself to the gym even when I would rather have eaten broken glass. It’s felt like an age, but I do feel like I can see the light at the end of the tunnel.

Not sure if this will help @TerrorAustralis and @Misgivingmum I tore my ACL some years ago, also in Australia. I had mine reconstructed with an artificial (LARS) graft. It was very painful surgery and a long recovery involving a lot of physio. Honestly, it's never been the same since. It was a skiing accident, I can ski on it now, I was back to skiing 6 months after the initial injury, but not at the same level.

My ex DH also tore his skiing, and after advice from specialist sports physicians (not ortho surgeons who will always advise reconstruction) opted not to have his repaired. He's a keen cyclist and very fit so has compensated for the tear by having very strong muscles.

You have to work out what's best for you given your individual circumstances, but the idea that you HAVE to have it reconstructed is quite out dated.

Let me know if there's anything else I can help with.

I saw an ortho surgeon who advised against surgery (but said he would do it if I really wanted it). 20 years ago in Australia I think most/all orthos would advise you to have surgery. Today it’s the opposite and the research supports a more conservative approach.

On the other hand, in Austria (where I had my accident) they wanted to operate immediately! The surgeon’s advice was surgery within 72 hours, or to wait 6 weeks. My travel insurance wouldn’t pay so it wasn’t an option anyway.

Thanks @TerrorAustralis and @Lostsadandconfused for your replies. Both the physio and surgeon are taking the let's wait and see approach, advising physio and then after time, seeing if I can get back to normal, which I am OK with. However the surgeon advised it is my meniscus that is more likely to benefit from surgery, which is better done sooner than later, the physio is more wait and see about the meniscus. I just want the best option for my long term knee health and to be able to be as active as I can.
Glad you are making progress @TerrorAustralis. It is such a long journey with so much conflicting advice out there

@Misgivingmum I can't advise on the meniscus. I "only" tore my ACL and everything else was intact. But my advice would be to do the physio prehab programme. Keep at it even when you really don't want to. But if there are some days where it's all too much, be kind to yourself. As long as you're doing it most days then you'll be OK.

One other thing is to notice how you are holding yourself unconsciously. I noticed I was frequently standing on one leg (the uninjured one), or had all my weight on one leg. Particularly when doing something else (e.g. cooking or washing dishes). When you notice, try to correct yourself. Weirdly, I've recently noticed myself sometimes standing on my uninjured leg instead. It's as if all the exercises focusing on that leg have trained my brain to favour it.

Hope this link helps https://amp.abc.net.au/article/103773576
sent to me by my son who is physio in Nz when his sister ruptured her ACL. Suggests that needs structured rehab for 12 weeks prior to decision to operate and finding that many can fully recover without surgery. My daughter did have surgery and has returned to rugby but had to be hugely disciplined in following physio programme. I also had to rehab a knee after surgery for a fractured patella and it took a good year or more to get back to running. It is agonising if you are active to be injured but be patient follow the physio to the letter and it will come good .