ACL Tear

[Redcell19512]

My girlfriend and I took my two daughters to the beach back in June. It was the first time my youngest ever saw the ocean which was really neat for me to witness. Unfortunatley, life has a sense of humor and an hour into our visit a wave knocked me flat on my face. On my way down I felt a series of pops in my knee. My family doc ordered an MRI which revealed a torn ACL.

I'll be getting a petellar tendon graft. I'm currently waiting for a surgery date but I expect to have it done before the end of August. Right now my boss has me on light duty (I'm redesigning our trucks and jump kits, doing lots of QA, and also yard work lol). The surgeon tells me that most people are able to return to their normal activities in four months with a return to sports in 6 months. When I asked him how long he thought it would be until I could get back to working as a medic he said probably 4 to 6 months if everything goes well and if I stick to the rehab plan.

Has anyone else had this surgery? How long until you were able to get back to working on the street? What difficulties did you encounter?

[Kaisu]

I tore my ACL during a flying side kick at a heavy bag.. went down like a rock! I spent about 3 weeks rehabbing the knee to get range of motion and strenght, then had the patellar autograft. I had a CPM (continuous passive motion) machine for 24 hours following surgery and my first rehab 48 hours after surgery. It took me about 6 months to be fully functional; however, my knee was not 100% until approximately 13 months post surgery. ACL recovery is a marathon, not a sprint.

I found this site to be an invaluable source of encouragement, information and support.

Knee Guru

Good luck!

[Redcell19512]

Thanks for the link.

[Aeromedic]

I've spent a good portion of my career doubling in Sports Med (actually, it was Sports Med that got me into EMS) and ACL can be either a total nightmare or a walk in the park.

Having worked with quite a few ACL tears from Fastball, Football, Skiing and Hockey, the common theme for good recovery is persistent training and rehab along with following the directions of the Doc, Therapist and most importantly, your knee. First and Foremost, listen to the Doc and the Physiotherapist/Athletic Therapist that you are dealing with. If they give you a timeline, stick to it. I have seen many athletes kill careers by pushing too hard, trying to accelerate things and causing irreparable damage in the process. Like CrapMagnet said, it is a marathon and will take time and patience.

Talk to your practitioners about options for braces as well. After injuring an ACL your knee will be more susceptible to re-injury and often a hard brace can take the strain off the ligament and help healing as well as preventing further injury.

The most important thing to remember (and isn't stressed enough imo) is listen to your body. Your knee will hurt, when it hurts it is telling you to take it easy for a while. I know this sounds repetitive, stupid and/or common sense but it works. Too many people go into Physical Therapy thinking that the therapist is all knowing. Even the best don't know when something is getting sore, so tell them. "Hey, it hurts more when I do this" or "Its starting to get really sore now" are phrases that can be the difference between 4 weeks in rehab or a lifetime of pain.

Finally, be aware of your limitations and the movements/stresses that can cause re-injury. By knowing what could put you at risk of re-injury, you can find ways to shift body position while lifting/moving that put less strain on the affected knee. Be careful of your other joints and especially your other knee however. Because you will be putting a lot more strain on the non affected side, it will become sensitive and susceptible to injury as well so be aware of both knees/hips/ankles and rest as needed.

Here's to a speedy recovery.

[FireMedic65]

I tore mine back in high school when I was on the track team. It hurt like a mofo! Recovery was around the same time as your doc is talking about. Although, I must admit I slacked on doing the PT exercises at home. PT was painful and I just didn't want to endure anymore pain at home than I had to. Word of advice... do not do as I did.. do the PT.. and do the exercises. PT sucks, it hurts, but it does help.

Also.. you better heal up in time for Marsh Madness!

[Richard B the EMT]

Torn meniscus, 1997. Laser arthroscopic surgery to correct. 2 separate additional injuries to same knee, Now developing Arthritis in same knee. I can predict bad weather, sometimes up to 72 hours before we see clouds in the sky, due to the discomfort from the lowering atmospheric pressure.

By the way, Red, which beach?

[fire6811]

Been there, Done that. I had to test the sticker on the top step of a ladder that said do not step here, this is not a step.

I had a hamstring graft last November. I would say that my affected leg is at 99% now, my other leg is at about 98%. That is because I think we concentrated too much on the affected leg.

Do as much PT as possible before the surgery. The stronger your leg is before the surgery, the faster the recovery will be after the surgery. I had a month between the injury and the surgery and in that time, I lost 2 cm circumference on my calf and 4cm on my thigh. This was working with my physical therapist 3x week and 2x on my own at home.

I don't know how agressive your Dr and PT is going to be, but I got out of surgery at 8pm and at 9am the next morning, they had me up and walking down the hallway without a brace, cast, crutches, or a walker. I started out with therapy 3x per week and after 2 weeks dropped to 2x / week and exercises at home everyday.

LISTEN TO YOUR PHYSICAL THERAPIST. ASK QUESTIONS, DO NOT ASSUME. I had a substitute PT for a couple of days who had me try a couple of exercises that the Dr and my regular PT did not have scheduled yet (know the difference between closed chain exercises; your foot is always in contact with the flat stable surface i.e. leg press, bike, or squats vs. open chain exercises where your foot is free floating i.e hamstring curls, quad / leg extensions).

The Dr said after the first week, I could do limited duty, My chief told me I was a big boy and could determine what that meant on call response (mainly, minimal staffing for ALS and several new ALS providers needing mentoring meant I needed to do some mentoring in the back of the ambulance).

WIth doing some unauthorized exercises and that night running command on a 3 hour structure fire 10 days out, my knee started swelling and basically took 3 weeks of intense ice therapy and electrical therapy to reduce the swelling and get me back on track. The swelling got so bad, my PT thought I was going to have to have my knee aspirated.

At 4 months out, I was cleared for everything except ladders, wildland fire and heavy carrying as long as I wore my brace. These were the only times I wore my brace after the surgery.

Since 6 months out, I have been on wildland fires in some fairly rugged terrain, participated in high angle rescues, and just about everything else. At 2 months out, there was no problem going up hill all day long. It was about 7 months before it was comfortable going downhill. At 5 months post surgery, I had full range of motion back in my leg (5 degrees extension and 150 degrees flexion). I have several friends who have had surgery who each state that they got back to 0 degrees extension and quit and have regretted it ever since.

The patellar graft is the strongest of the grafts, but the one theme I have heard is there is a fine line between agressive PT getting the knee back in shape and being over agressive and developing patellar tendonitis. I live near Aspen and know about 20 - 30 people who have had one or more of the different surgeries (patellar, hamstring, cadevar). Each have their pluses and minuses.

While doing my therapy, the one thing I noticed on days when I took a Vicodin or Percocet 45 minutes before PT, I could still feel pain and you can tell when you are over doing it, but it was managable and I was able to bear more stretching and bending and was able to progress faster than days when I did not. My PT also said that the clients who worked actively with her and the Dr on pain management typically progressed faster. I threatened to get a sign for over my PT's office that said "Welcome to Erin's House of Pain; Abandon hope all ye who enter". She was a sadist at times.

If I can answer any more questions, please let me know.

[Redcell19512]

Thanks for the replies.

I am extremely worried about the rehab process. I met with a physical therapist a week after the injury and she gave me a series of home exercises to do as well as some things I could do at the gym. She recommended leg presses at the gym....that was a disaster. Pre-injury I would do 3 sets, 15 reps with 240 pounds no problem. The first time I used the machine post injury I put 15 pounds on it and I could feel the bones in my knee shifting and grinding. I wanted to vomit. So I stuck to the leg lifts and resistance band exercises at home. I also got a stationary bike from a co-worker to use at home (I'm gonna be on a tight budget after surgery so the gym membership is probably gonna have to go away). I have no choice but to save my PT benefits till after surgery so I'm not getting any guidance from a physical therapist right now. My insurance will only pay for 20 PT sessions though I'm going to try to trade some of my in patient psych/drug and alcohol treatment benefits for more PT. We'll see how that goes. Oh and my health insurance has a $1000 deductible, followed by another $1500 80/20 split. $35 copay for all PT visits and Orthopod appts. I'm looking at out of pocket expenses here of at least $3500...probably over $4000. I have money set aside in saving that will cover the costs. Of course that money was set aside to help pay for college costs. College is now on hold. I'm not in a happy place mentally over that.

I'm putting in four 12 hour shifts followed by four days off at work, light duty of course. On the four days off I have housework and the kids (I'm the only adult in the house). My youngest lives with her mother an hour away. It's going to be difficult to see her after surgery so I'm spending as much time as I can with her now. Before I know it the entire week has gone by and i've done my exercises ONCE! Seems like when I do try to work on my home PT someone interrupts me or there's something that requires my attention. It doesn't help that I'm incredibly independent. I refuse to allow people to do things for me. So when I'm riding the stationary bike at home and someone walks in the room...I get pissed. Tonight is the perfect example. I was on the bike, my teenager comes into the room and throws a pillow at me to be funny. I was 2 seconds from throwing the stationary bike through the window. I'm on the bike because I'm hurt, I got hurt because I'm weak....that's what goes on in my head. Then I get miserable. It's like that now. I can't imagine what it's going to be like after surgery. I have to get my head in the game...and fast.

I've read about tendonitis and pain when kneeling on the donor site in post op patellar tendon graft surgery. My surgeon doesn't like the hamstring tendons and said the allograft (cadaver donor) would be the worst choice in his opinion. He is actually the third surgeon I saw and was the only one that gave me what i would call a "no BS" assessment of my situation and options. He told me what was going to work and what was not going to work then explained why. So I feel pretty good about the surgery itself. Of course that's only based on my gut feeling.

Richard, it was Rehoboth in Delaware.

[snoopy911]

What part of PA are you in? If you are near me, i can reccomend a few good surgeons.

[Redcell19512]

What part of PA are you in? If you are near me, i can reccomend a few good surgeons.

South Eastern PA. I already have a surgeon. He came highly reccomended. 15 years in practice. Has co-authored several textbooks.