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Please, anyone in the medical field or who has had an ACL tear, can you give me your thoughts?

BACK STORY:

I tore my left ACL on Nov 19 when I slipped and "fell" (didn't actually land on the floor) on some wet flooring at a Subway restaurant. There was a pop, intense pain, and a complete lack of knee stability. Oddly, I didn't have much swelling at all, and no bruising. The swelling came later.

I went to an urgent care doctor, who suspected some kind of tear and sent me to the ER. At the ER they looked at it a bit, did some x-rays, said they didn't know for sure, and referred me to an orthopedic specialist.

I went to the ortho as soon as he could get me in, and he looked at the xrays, confirmed that there were no breaks or fractures, and had me get an MRI, which I got the day before Thanksgiving, so the results took rather longer than usual. Once they were in, the ortho told me that I had a torn ACL which might require surgery and referred me to an orthopedic surgeon (Eric Heiden, for anyone that remembers the 1980 Winter Olympics in Lake Placid, where he won 5 gold medals in speed-skating). He has a sports injury practice.

Dr. Heiden is terrific, I really like him. I finally got in to see him on Dec 9. He did some examinations and told me that yes, I definitely needed surgery, the ACL was a complete tear with some kind of tearing of the meniscus as well. He prescribed 2 weeks of PT, as he won't operate until you have achieved your maximum range of motion possible.

2 weeks of PT went great, I made terrific progress, so I saw him again on Dec 23 to schedule surgery. Since I had to go on an education tour with the Symphony on a chartered bus for two weeks in mid-January and he will be out of the country the last week of January (now), we couldn't schedule the surgery until Feb 6. Believe me, I have been counting the minutes until I can get this damn thing fixed!

HERE IS THE ISSUE:

I have had quite an increase in swelling, stiffness, and pain in the last few weeks. I am worried. For those in the medical field and/or those who have suffered ACL tears - what's going on? A friend of mine said I've been trying to do too much and not "babying" it enough.

My wife has the same issue. You need to elevate the knee, put a brace on it, and ice the heck out of it. The swelling will go down. You need to have surgery soon.

My dd has torn her ACL 2.5 times and had surgery twice.

My first advice - go with a cadaver replacement instead of the patella tendon. The recovery was soooooo much easier with the cadaver tendon. She first had the patella tendon and it was 2 surgeries in one that she had to recover from.

The PT ahead of time is to strengthen the leg muscles so they don't atrophy too much while you are down - but they don't let ya be down for long before getting right back to the PT after surgery.

As for the swelling now? She had swelling from the moment she tore it until after recovery. I would call the office and ask to talk to the PA. They should be able to answer questions like this. Or the PT could probably answer as well.

Good Luck!

Separate issue here:

The Subway is liable unless you were behaving recklessly. Consult a personal injury attorney. The "slip and fall" should have been documented at the store at the time of the incident.

I don't have any ACL wisdom, my cat tore his but he is, you know, a cat. So no wisdom here!

I ruptured my ACL 6 years ago, with no other tears involved. The swelling was normal for me. See if someone can loan you an icing machine, because you will be using it a lot, after surgery. My doc required one. Perhaps craigslist, or ask your PT if they know of anybody that wants to sell theirs. If you have no one to help you after surgery you will appreciate it. I loved it as it worked better than an ice pack.

Anyway, elevation and ice are your best friends for now.

Rehab is long and hard work. It is not only at the PT's office. I had homework 2-3 times per day. Be prepared and make sure your insurance covers enough PT visits. My PT started hours after I woke up from surgery, and I had to have my leg strapped into a machine that flexed my knee back and forth 24 hours a day for awhile. It amazed me I could sleep through that...sure the narcotics helped!!

I had the patellar tendon reconstruction. Lucky is right..two recoveries at the same time, and in my case my body did not react well and developed scar tissue which hindered extension of my knee...then a second surgery which fixed me up. My advice, ask your surgeon what he recommends and prefers, and why.

Good Luck

[This message edited by Chrysalis123 at 1:53 PM, January 29th (Wednesday)]

Thanks, all of you!

We have a personal injury attorney on this. Thank heavens my W was with me, as she took a pic of the wet place (with the skid-marks my shoe left) and spoke with an employee who exclaimed, "Oh! This is still wet from when I mopped! And I forgot to put the Wet Floor sign out!" Nonetheless, Subway has been completely uncooperative, the PITAs.

My behavior was walking to the mens room after placing my order, so I'm definitely not liable!

My surgeon only does the cadaver method, so I'm good with that.

I've been doing the icing, brace, PT exercises. I did call the surgeon, and his nurse told me that I AM DOING TOO MUCH and not staying off it/elevating it enough. I hate hate hate feeling so restricted in my movement and activities! And yesterday I discovered that I'd put on 10 lbs!

Thank God, surgery is next week! I'm so ready to get this done.

Well the increased weight will definitely increase the swelling. It's more stress on the joint. Sorry. So lots of lean protein and good veggies for now.

Be glad that you have a fantastic surgeon, and that he is up to date on how to fix it.

My Spouse blew out his ACL at 16, and lost his soccer scholarship too. Of course back then MRI's were a rare thing, and it went misdiagnosed through 2 surgeries (arthroscopies). So when he got a good surgeon here, that took care of several of the local sports teams, he took one look at the knee and the description of the original injury and diagnosed it. He fixed it with a Patellar split surgery (this was 1984 mind you) and he recovered quite nicely. He played intramural basketball, soccer, and football in college, and NEVER once twisted it out of place again, which is what tends to happen with the Patellar split surgery. My BIL had the same surgery 5 years later, and is still battling it.

Now my H is 45, so 30 years later, and he has no cartilage left, and needs a total knee replacement. It swells and gets painful when it's cold, but for the most part is tolerable.

The Cadaver surgeries have a high success rate, and by the time you have wear down to the point of needing more surgeries they will have perfected total knees to a simpler surgery even more, and it won't be a big deal.

The main thing preventing my H from doing anything at this point is it's not that horrible as far as the pain goes, and he doesn't want to take the amount of time off work that he will need to for recovery. Plus he will need to do it in the fall winter, due to our Bee business.

Good Luck, and remember PT is your friend, no matter how bad it hurts.

[This message edited by MadnessMuse at 9:38 PM, April 18th (Friday)]

Not to scare you, but ask your PT if you can take pain meds before PT, and at what time (to have maximum effect when they smile so sweetly...and lie.....this won't hurt a bit).

I had the cadaver replacement and I'm a HUGE advocate for it. Less scaring, less invasive, just all around better.

I'm wondering if the two week bus ride contributed to the swelling. Having to sit with your knee bent for long periods of time isn't good for it.

Do your PT and within a year you will be fine.

k9

I am in the orthopedic vendor arena and have been in on many knee reconstructions and have actually had ACL surgery on myself. The different choices in grafts all have advantages and disadvantages. Allografts are less painful, less time under anesthesia but statistically have more chance of failure. Autografts include the Pateller tendon graft which is more painful and can cause later tendinitis in the knee. However, for very active folks and young athletes (this is what the pros have done) they are preferred for their stability and low failure rate.

I personally would choose an autograft such as a hamstring as I think this is somewhat in the middle of the above mentioned. However, this choice should be made with your surgeons advice (surgeons comfort level on the surgical procedure chosen is extremely important...they are not all comfortable on certain procedures) and with you doing the due diligence. Good luck and hang in there...You will be fine

[This message edited by asurvivor at 10:22 AM, January 30th (Thursday)]

I had both my ACL's replaced with cadaver tissue about 10 years ago at Stanford. Both doing fine. I also had meniscus tears that were cleaned up and some arthritis behind my patella. Not trivial surgery with a long PT following.

Swelling, well yeah. You tore the ACL in half, it's gonna be swollen. PT will aggravate things sometimes but you need it prior to (and following) surgery. NICER: NSAIDS Ice Compression Elevation Rest. Are you missing any one of these? If not, fix that! Do ALL.

The best thing you can do is ask a ton of questions of both your PT and Ortho.

In my experience, doing more frequent PT exercises below the threshold set by my PT was helpful to me to speed healing as long as I didn't overdo it when swelling/pain was up. Inactivity was terrible for me. YMMV.

I tore my ACL and meniscus in college, but not complete tear. Rehabbed and am good for the most part. My knee does swell up occasionally, NSAIDs and ice!! Elevate and do some massage to the surrounding tissue to help the fluid move.