ACL INJURY FAQ Here are some of the most frequently asked questions that I hear.How can I tell if I have a torn ACL? Sometimes it's tough to tell. Even for the doctors. When you tear your ACL it feels a lot "looser" than your good knee. It almost feels like it could pop out of place at any minute. The stability just isn't there. When some people tear their ACL, they hear a "pop" when it happens. It's usually pretty loud and noticeable. This is what happened to me. Although, at the time I had no idea what that "pop" sound meant. If you have a torn ACL it also usually swells up immediately... the pain isn't always severe, but swelling is a tell-tale sign. Your knee will also go out of place pretty easily. Do I really need surgery? There several things that will affect this answer. Do you plan on playing sports or are you happy giving them up and doing things less stressful on the knees? If you can give up the sports that are rough on the knees, you might get by without surgery. Does your knee "go out" a lot? If it does and you have little control over it, surgery would probably be your best bet. If you would like to try rehabbing your knee and wearing a brace to see if that works, go ahead. Just keep in mind that every time your knee goes out of place, there is more damage being done. That is the route I took and I'm a little bit sorry about it. I ended up doing a lot of damage that I could have avoided. Should I get an allograft or autograft? This is something you need to discuss with your doctor. As a rule of thumb, most doctors will tell you to go with autograft. An autograft means the tissue being used for your new ACL will come from your own body. Most often this is either the patellar tendon (the tendon that attaches your kneecap to your tibia) or the hamstring. An allograft means the tissue for your new ACL will come from someone else. Cadavers are used for this. Don't let that scare you off though, this method is safe and works well. The tissue taken from the cadaver isn't "living" tissue, so there is almost NO chance of contracting any sort of disease or virus. It's NOT the same thing as having a organ transplant. You won't have to take any drugs that suppress your immune system like you would for a organ transplant. And since it isn't "living" tissue, there isn't a problem with your body "rejecting" the new ACL. There is generally less pain involved when having an allograft. Since you won't be harvesting tissue from your own patellar tendon or hamstring, the pain will be minimal. That is one of the major advantages of an allograft. An allograft isn't considered to be quite as strong as an autograft, but close. Recovery time is also a little bit quicker. Allografts are also used most of the time if you have had a previous ACL reconstruction. Autografts are used in the majority of first time ACL reconstructions. They tend to be strong, but also result in a little more pain than the allograft. However, the pain isn't overwhelming by any means, so this fact alone shouldn't be a major deciding factor. Talk to your doctor. Should I use patellar tendon or hamstring graft? This is another thing that you should discuss with your doctor. There are a lot of different opinions and reasons for one over the other. First off, you should probably go with the method your surgeon is good at. Surgeons will perform more of one type than the other and will soon get better with one method. Now, don't get me wrong, the surgeon can and will do both types of surgery, they involve a lot of the same principles, but one will be his "favorite" method and as a result, the surgeon will be more comfortable with it. BOTH methods work. The Patellar tendon graft is considered to be a little stronger, but that can be debated. Most professional athletes go with the Patellar Tendon, the slightly stronger graft may be of use to them, but hamstring grafts will work just fine for most everyone. If you are fairly short and have short hamstrings, the surgeon may not give you a choice. Discuss this stuff with your doctor. Should I use general anesthesia or regional? Either way will work. There are people on both sides of the fence that will tell you one is better than the other. Don't always listen, it's a very personal choice. With general anesthesia, you will be unconscious and have no recollection of the surgery. It will feel like you have simply blinked and the surgery will be over. General anesthesia has a bad effect on some people though. It could make you sick to your stomach for a few days. Doctors don't know exactly why or how general anesthesia does what it does, so there is always a slight risk. Some people are afraid they won't wake up. But the risk is very, VERY small. Regional anesthesia can be given to you a couple different ways. It will either be an epidural or a spinal. They are very similar. Both are injected into your back. As a result, the pain signals from your knee never reach the brain. They are blocked by the regional anesthesia. This will allow you to be "awake" for the surgery. Now I say "awake" because you can choose your level of awareness. You can choose to have a regional anesthetic and still not be aware or remember a single thing from your surgery. This is done by giving you a sedative. The anesthesiologist will probably ask you what level you want. 1.) Awake, Aware, but unconcerned. 2.) Awake, Somewhat aware, not concerned. 3.) Awake, and not aware. Or 4.) Hammered. (They will give you enough of the sedative to make you sleep, but if you were to wake up during the surgery, you wouldn't care and probably wouldn't remember waking up anyway.) What type of graft and anesthesia did you use? I had the Patellar Tendon graft and used general anesthesia. I didn't want to be awake or aware of anything in the operating room. I didn't have much of a problem with general anesthesia, but the morphine injection immediately made me puke. The same with the codeine pain pills they sent home with me. Make sure you take those pills with food, or you will more than likely not be able to keep them down. Even food doesn't help some people. How long will it take to return to sports? Everyone recovers at a different rate. The most standard answer that you will hear from the doctor is six months. It's possible to return sooner than six months, but the risks for re-injury are higher. It takes about 12-18 months for your new ACL to be in peak condition. At six months, it is about 80-85%, this is considered to be strong enough to return to sports. Usually wearing a brace of some sort, but not always. My doctor doesn't believe in any kind of bracing after recovery. How hard is physical therapy and does it hurt? Physical Therapy isn't all that bad. Some things are easy and some are hard. One thing that is a little painful are the extension and flexion exercises. And after a while, those don't really hurt that much either. I've heard horror stories from people who say that PT (Physical Therapy) was the worst and they cried every time they had to do it, but that wasn't my experience at all. The exercises get tougher as you go, but it's a good feeling to be doing some work. Should I use a brace for sports afterwards? Your doctor will have a say in this. Some doctors believe in bracing, some don't. Mine, fortunately, doesn't believe in using braces for sports after 12-18 months. That was good news to me, I personally don't like braces. They serve a useful purpose in recovery and for a partial ACL tear, but in my opinion, if you are going to have ACL surgery to fix your knee, a brace isn't necessary. I used a brace for 5 years after I tore my ACL and before I had the ACL surgery. In that time, I continued to have problems with my knee "going out" on me at least twice/year. Even with the brace on. Since the surgery, I haven't worn a brace for any sport and I haven't had a problem. I have to admit, I was real nervous at first since I had previously worn a brace all the time, but now it's been a while and most of the fear has gone away. If I use a brace, should I buy a custom brace or over-the-counter brace? A custom brace is always the better bet. It can be fitted to you specifically. No "over-the-counter" brace will ever be as effective. With that said, I believe that braces in general are ineffective for sports. In certain situations (like football) braces can serve a useful purpose. They do protect the knee from direct contact. But any other sport, they don't do much for. Most of the time it's the twisting action that tears your ACL and no brace will prevent that. When can I take a bath/shower? It seems silly, but you will have to get your doctor's permission to take your first shower. Baths will be allowed later than showers. You will be given permission to shower usually somewhere around 5-10 days. The doc wants to make sure the wound is healed enough so the risk of infection is minimal. He will also tell you to wrap your knee in a plastic bag, or something similar and tape the top and bottom so it is watertight. You need to keep the water out so there is no chance of infection. After a couple weeks, he will give you the ok to go ahead and take a "real" shower or bath. HOW will I be able to take a shower? Very carfully! The easiest way for me to take a shower was to actually put a lawn chair in the shower and do it that way. Then I could sit on the chair and keep my leg up. It worked pretty well. Why does my knee have a burning sensation? Most of the time the burning sensation is cause by the drilling of your bones. When the surgeon performs ACL reconstruction, he drills a hole through your tibia and femur bones. That results in the "burning" sensation. Ice should help control this, but it will last for a while. The drilling will also cause bruising in your leg. Is bruising like this normal? It looks bad. The bruising is normal and will vary from person to person. My bruising looked absolutely terrible. At one point, it was funny, when I would go in and do physical therapy, there were a few days when they would close the curtain around me so other patients in the PT room couldn't see me. The PT assistant just smiled and said they didn't want to scare away any of the other patients. Most of the severe bruising was looking better after a couple weeks. How much should I ice my knee? As much as you want. For me, the more I iced, the better it felt. So I iced a lot. It helps a great deal with the swelling and with the pain. I had to stop taking the pain medications the 2nd day post-op because they made me sick to my stomach. Ice was a very good pain reliever. When can I get off these crutches? The doc will usually give you permission around the two week mark. Unless you had meniscus repair. If you had the repair and not the removal, you will be on crutches significantly longer. This will allow the meniscus to heal. I had meniscus removal and honestly, I was off crutches in less than a week. Everyone is different. Do I have to take all this medication? Unfortunately, you do. If the medication doesn't make you sick to your stomach, it does help a great deal. The ibuprofen also helps with the swelling in your knee. Just be aware that a side effect of the pain medications (codeine, vicodin, morphine, etc.)... is that it will make you constipated. How long will it take after surgery to have a bowel movement? I didn't realize that I would be constipated from the surgery and pain meds until it actually happened. No one warned me. I don't remember exactly how many days it was, but it was somewhere around 5-8 days. When will I get full ROM (Range of Motion) back? It depends on how hard you work at it. For me, extension came back way before flexion did. Extension took less than a week to return. And flexion, well that's a different story. I got most of it back within a month, but I really don't think it's all the way back. I can get it to flex the same as the good knee, but it takes a while. I can't just squat and do it. I have to "warm it up" first. I feel weird pains in my knee, is this normal? Yes. You have to remember that no matter how good doctors get at ACL surgery, it is still a major procedure that will effect you for a long time. At about 16 months post-op and I still got unexplained pains. They never lasted long, but the were always popping up in different spots and varying degrees. I just took it as a reminder to take it easy once in a while. I'm still VERY happy that I had my ACL surgery. Do I really have to do all these exercises? YES, YES, YES. You have to follow your doctor's protocol. It's there for a reason. The stronger you can get your leg, the better off you will be. You will also have to work hard to regain the flexion and extension in your knee. I know it's painful at times, but it is all for the best. You don't want to only be able to bend your knee half-way for the rest of your life do you? When can I kneel again? If you have the Patellar tendon method, this will take a lot longer than the hamstring method. If you go with hamstring, you will be able to kneel pretty quick. I had the patellar method and it took a few months to be able to kneel. I can kneel now, but it still feels different than the other knee. It also depends on the floor surface. I could kneel on carpet and outside on the ground WAY before I could kneel on hardwood floors. Will glucosamine help me? It might. There are no studies that say it helps. But there are also no studies that say it doesn't. Glucosamine isn't all that expensive, so I would say go out and get a bottle, take some and find out. Make sure it is quality glucosamine though, don't just go out and buy the cheapest stuff possible. My knee pops a lot, is something wrong? Probably not. My knee pops all the time. I must admit it is a little annoying, but it's never caused a problem. I asked my OS about it and he said it was probably scar tissue. I'm not sure what to think about that explanation, but like I said, it's never given me a real problem. How long until I can drive? If you have ACL surgery on your left knee, you could be driving within a week or two. Just make sure you aren't on any medication that will impair your driving. If you have surgery on your right knee, it will be a little longer. As soon as you can bend your knee and press down on the brake with some force, you will be ok. It took me about 3 weeks because my doctor wouldn't let me get rid of the big brace until then. I fell, is my knee ok? It's probably ok. Did you twist it or did your knee "buckle"? If not, it's probaby ok, but if you are worried about it, then by all means, call the doctor. You aren't going to do much damage to it simply by falling on it. Still, be careful because there's no doubt about it, if you fall on it, it hurts. It hurts a great deal. But your graft will more than likely be ok Why do I feel depressed? Sooner or later, this feeling happens to everyone. It is more severe in some people than it is in others. For example, me and my friend both underwent ACL surgery. Neither one of us had a problem with depression, but there were a couple days during the recovery where we were depressed. It helps to keep busy. I started learning to build websites and that passed a lot of the time. Before I knew it, my knee was better and I could do stuff again. If you have a lot of setbacks, depression is normal, just make sure you realize it when you are starting to feel depressed and do things that you like to do. Don't let your depression get too far. Would you like to add a question to the ACL FAQ? If so, email the question to me and if I hear the same question a bunch of times, I'll add it. |
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