"Don't rush into a knee operation."

[Andrew Br]

Just back from seeing the surgeon at Manchester Royal about my snapped ACL.
I seems that there is no other damage eg to cartilage.
Given that I've had no knee instability and I can walk and cycle OK, he's advised me not to have an operation.
This is despite it hurting when I run or try to kneel down (which makes it a sod to get things right from the back of my lower kitchen cupboards).
He's advised me to continue with the conditioning excercises and, as I understood it, try jogging then running and, maybe, even football again.
I'm to make another appointment to see him again in 3 months time.

I'm feeling a bit pissed off with this development since I was expecting "something to be done".

Any suggestions/advice ?

[hatler]

When you see him in three months tell him that it has sub-luxed a couple of times and that your job requires that you have a completely stable knee.

That's what I told my consultant (all true) and I was listed as a priority for an ACL rebuild.

[mrcharly-YHT]

I think he's being cautious. My understanding is that once you go down the surgery path, there isn't any way back. If the surgery doesn't work out, you are stuffed.

OTOH, if you give it a chance without surgery and things don't work out, then there is the surgical option.

[Kim]

Any suggestions/advice ?

Learn to kneel on the other knee?

(Seriously - I appreciate this is surprisingly non-trivial, and on a level with learning to mount a bike from the other side.  I'm so strongly left-kneed that you can tell just by looking at my trousers.)

[Andrew Br]

Interesting comments there, thanks.

I can understand the reason to wait and see how the knee gets on and, as you say mrcharly, surgery is pretty much a one-way route.
I need to get my head to accept the 3 month wait and I also need to try to think positively about running and then graduating to football again.
I walked around a bit yesterday (only about 4 miles but some of it was in a hurry) and my knee ached.
I can kneel on the other knee, it's the getting up without using my arms that can't do. I can't put enough force through the dodgy knee to stand up again.
I knew that I should have hobbled into the surgery rather than strolling in with my bike gear on  

What I'm really struggling with is the thought of it giving when I'm running. I'm imagining that the pain will be quite something and I'm also wary of the potential for further damage if it happens.

Can anyone reassure me ?  

[hatler]

A sub-lux is indeed stomach churning. Best to avoid.

[Andrew Br]

A sub-lux is indeed stomach churning. Best to avoid.

That's what worries me.
Based on what the surgeon said, I should try to start playing football again.
My expectations/fears about turning my knee put me off.

Running again hurts atm. We jogged for the bus last night and I had to stop because of the pain.

[Andrew Br]

Well, 3 months have passed and I'm off to see the surgeon again tomorrow.

Since the last appointment, my knee has settled down and I can jog on it (or run across the road) although I haven't done anything much distance wise. I haven't summoned up the courage to try football.
I can cycle well enough and the football "gap" has partially been filled with more bike rides; I've done considerably more miles this year than at the same time last year.

I'm now in a dilemma about whether I would want an operation if it were offered.
On the plus side I might feel totally confident in my knee again so football and skiing could be entertained.
The downsides are the risk of it going wrong, it going OK but not being any better and the months of pain and rehab not to mention relative inactivity and time off the bike.

Pictures after the "incident" in this thread:- Buggritt. Done my knee in. Now with pictures.

[hellymedic]

If foopball and skiing are important to you, consider an op.
If you have a decent life without these, don't.

I can't judge how much you yearn for the piste and the field.

Indolent of Edgware.

[Regulator]

A sub-lux is indeed stomach churning. Best to avoid.

I had a friend of mine as a kid who suffered from recurrent subluxation and had done from birth.  We got quite skilled at popping it back.

[Andrew Br]

I had the appointment today.
I arrived about 30 minutes early because I overestimated the time to get there and park the bike. I'd just sat down in the waiting area when the surgeon called me through  .
After I'd apologised to him for my grumpy response to his "Wait" advice last time (he hadn't remembered that I'd been like that) he pushed and prodded the knee again and then we had a chat.
Basically I'm in the same place except that the knee pain has gone (as he'd forecast), the range of movement has increased slightly and there hasn't been any instability.
I was complemented on the definition and apparent strength of my quads and hamstrings. Which was nice. He said that, for now, he still wouldn't recommend surgery.
Instead, I should do some running and try football again to see what happens. If the muscles that control the knee are strong enough then I might be OK. If not then I have to decide whether to give up football (I'll have to at some stage anyway  ) or go for an op.

Surprisingly, he said that skiing shouldn't be an issue.
What does the learned panel think ?

I'd imagined that having a long plank lever on my foot could, potentially, put some real force through the joint. I understand that the cruciates control fore and aft movement of the joint and that a good skier (at best I'm near the top end of the "intermediate plateau") would minimise those forces through the knee by unweighting, but I'm still worried about the times that an edge catches and only balance and leg strength keeps you upright.

The appointment was over before I was due to be examined. I'm quietly impressed by that.

[Feline]

The movements that put your cruciate under the most forces are twisting or when the foot comes to an abrupt stop but the femur keeps pushing forward. Of course, when you kick a football that is exactly what happens hence it being a 'footballers knee injury'. I'm not a skier, but I imagine that when you are smoothly gliding along the ACL isn't under too much tension, but if you were to suddenly hit something with a ski it could be bad. The twisting that could occur if you lost control could also be bad.

If your ACL can't hold up to the kind of activity you want to do, maybe it's better to put it to the test and find out about this now, because if that's the case surgery is needed?

I should warn you that my knowledge of ACL problems is based on treating patients with more than 2 legs, although they still have only 2 knees and the surgery we perform on them is pretty much the same (our orthopods learn from human orthopods). I have operated on cruciate ligaments myself  

Good luck!

[andrewc]

A former ju-jitsu training partner had a completely snapped cruciate. On hearing what the operation involved he refused to have it, instead he just built his leg muscles up.  He was always very protective of the leg, but in 8 years of almost daily training with him I can't recall it causing him serious problems.

[Andrew Br]

The movements that put your cruciate under the most forces are twisting or when the foot comes to an abrupt stop but the femur keeps pushing forward. Of course, when you kick a football that is exactly what happens hence it being a 'footballers knee injury'.
Luckily, I'm very right footed (and I've done my left knee) but I plant my left leg to kick. The surgeon said that this wasn't necessarily an issue since I was "bracing" before planting. He said that squash would be a good sport to continue with (or start). My main football worry is dropping my right shoulder and then going left (a la Bobby Charlton) and the lower part of my leg not following the rest of me 

I'm not a skier, but I imagine that when you are smoothly gliding along the ACL isn't under too much tension, but if you were to suddenly hit something with a ski it could be bad. The twisting that could occur if you lost control could also be bad. Yes, those are my worries. I'm wondering about a knee brace

If your ACL can't hold up to the kind of activity you want to do, maybe it's better to put it to the test and find out about this now, because if that's the case surgery is needed? Yes, gritted teeth and see what happnes. Ultimately, I don't think that it will end well

I should warn you that my knowledge of ACL problems is based on treating patients with more than 2 legs, although they still have only 2 knees and the surgery we perform on them is pretty much the same (our orthopods learn from human orthopods). I have operated on cruciate ligaments myself  
My Westie did his when he was chasing a squirrel. He made a full recovery but I still squirm when I think about the vet taking the dressing off. Imagine the hairiest legs imagineable with superglued bandages from foot to thigh. Actually, you probably don't need to imagine 

Good luck!

^ Thanks 

[Andrew Br]

A former ju-jitsu training partner had a completely snapped cruciate. On hearing what the operation involved he refused to have it, instead he just built his leg muscles up.  He was always very protective of the leg, but in 8 years of almost daily training with him I can't recall it causing him serious problems.

That's great to know as well Andrew, thanks  . I'm going to try to find a (non-gym) weights based exercise regime to further strengthen my "knee" muscles. Obviously I'll do as much cycling as possible.

I'm open to suggestions  

[hatler]

Classic ski ACL snap is falling backwards and the toe binding not releasing the upward force from the front of the boot. This results in the top of the lower leg being pulled forward wrt to the femur. (That's how I did mine anyway.)

My surgeon (top knee bod at Addenbrookes) had a theory that the ligaments act as a feedback mechanism for the muscles, ie, if tension comes on the ligament a message goes to the muscles to tighten up.

As I said in the other thread on this one, a mate of mine successfully skied on telemarks for a number of years without an ACL, but he had very strong legs.

My surgeon's advice after I had had mine fixed was not to wear a brace skiing, because the best thing to keep the knee safe is to have strong muscles, and wearing a brace will not help you build muscle strength.

The op is (was) painful, and I have skied fairly aggressively ever since (16 years), so it looks like it's worked for me, but in all that time I don't once recall doing anything to my knee that tweaked it in the manner that would have stressed the ACL. Maybe it's all in my mind ?

My advice ?   Work on the muscles and give skiing and footy a go, but at the first hint of sub-lux, I'd be knocking on your doctor's door again.

One final bit of advice. Only get the op done by someone who does this op day in and day out.

[Andrew Br]

Good stuff there hatler, thanks