Injured knee…

[robbo90]

Hey all, well from the start I’ve had a bucket handle tear on my left knee removed 2 weeks ago. I’m now seeing my physio with exercises to get the range of motion back till I can get back in and have my ACL repaired, as its 90% gone- as my surgeon told me. As its on a knee that had an ACL recontruction before( 7 yrs ago) and I had a patella graft done then, what are my best options from any experiance you’ve had with this situation.
My surgeon has said he’s keen to try and take a patella graft from my right knee, which is apparently a new thing thats been trialled/used to good effect in Aussie. I’m a little worried with my right knee being used when I could possibly have a hamstring graft from my already injured left leg.
Also, what are your experiences concerning longevity after 2 reconstructions with ACL’s and knee’s??? I’m lucky i’ve a full off season to have this done( though my team’s now in play offs for promotion right now- bugger!!) and then get it properly repaired/strengthened to hopefully continue my playing/coaching for a couple more years at least. Cheers for any help, Robbo90…

[fergus]

I’d be inclined to see if there is a reason for re-occurrence first, albeit 7 years ago. I suspect hamstring strength (or absence of) may be a contributing factor which would influence the graft for me.
The dilemma about where to take the graft from is interesting and some will tell you different things, but in most cases the patella tendon is used.
You may benefit from, in an ironic way, having the graft from the opposite knee.
The other question is age and length of playing career – and finally if you can play without an ACL.
It is possible and depends on how long you want to play on for.

[onspeed]

hey mate

I tend to agree with Ferg on this one – I have seen 12 grafts over last 2 years using opposing (healthy) leg tissue – the majority successful to some extent

you indicate you had a previous graft at time of ACL reconstruction 7 years ago – how well did that hold up? what were the underlying reasons for reoccurence – obvioulsy traumatic injury may have been the trigger but were there weaknesses to start with

Two full ACL recons starts to be a big load on one knee mate and to be honest you are on a track to oestoarthritis in that joint.

I am sorry to say the best advice I can give you is to think long and hard about your playing future – your age and the level at whch you are playing

If your passion continues to drive you then as Ferg suggests it is important to understand outside of surgery what you can do for the mechanics of knee joint stability and equally allow enough time to full rehab and fully strengthen this leg – most people rush it …. connective tissue can require a minimum of 6 months retraining to reach a good strength / support level

Good luck mate – wish you the best

[diehards]

The research shows there is no difference in graft location as to the outcome of reconstructions. The major difference is quality of surgeons!!! The most important factor is actually the placement of the graft inside the knee. One thing to look at is the issue of the quality of your collagen – if you are hyoermobile generally, might even pay to use allograft. All things to ask your surgeon.

The other point is that on the 2nd reco it is a 12 month rehab period – which should be the case with all reco’s anyway but that is another issue.

Even after 1 reco the rate of OA is increased, which is increased after 2. I have seen plenty of people come back after 2 recos, but 1 more on the same knee and it is career over!!!!

[fergus]

I agree (to a certain extent) on the surgeon comment – but I personally think the rehab is a huge area of weakness in ACL rehab…. or maybe I should be more positive … an area of huge potential!
😉

[diehards]

I agree – Suki Hobson from the QAS is doing some good stuff in this area

The thing with the rehab from ACL is if you dont have a good graft to start with, it doesnt really matter how good the rehab is, you all always up against it, and as a physio I have seen some shockers!!!

[robbo90]

Cheers for the replies guys, I’d have thought the original graft was pretty good as the surgeon was pretty well known I think in rugby circles.

I could say possibly, due to time of season and my focus being on conditioning, my leg strength wasn’t where it should’ve been, at the start of the season, and that could’ve attributed to this. As I made a tackle (I know a first-five tackling in Ireland’s rare- shock horror)and drove into your man, all his weight and mine went through my left knee and it sort’ve locked back into place possibly hyper-extension I don’t know the full wording on it.

I’ve been asked if I could try the long rehab without the recon, and have read it can be done- though I think its tempting fate, it’s been done by a few. Have you any succes that way from your experiences, and if so what area’s would I really need to focus on there.

I’m 31 and am a player/coach here in Ireland. I see myself with a couple more competitive years ahead before hanging the boots up and returning home( I’m a Kiwi probably return to Aussie) to coach. Of course this ACL injury will have a huge bearing on this last paragraph, but any help would be appreciated- as were the previous posts. Cheers Robbo90.

[fergus]

If you have …
1. A very good rehab program and very good rehab support
2. A very good mindset and attitude
… you can return to competitive team sports with out ACL surgery.

(Personally, that would be my preference)

[diehards]

Playing without ACL has been done but very rarely.
The problem is you will probably increase the rate of OA development in your knee due to increased rotary instability.

My thoughts are generally if you want to live your life in straight lines, dont get it reco’d, you want to play again – get the op and dont skip corners with your rehab

[fergus]

🙂

Oh … I see the potential for a long debate on this one! Lol!

[diehards]

This is one subject where there has been plenty of debate and with the new LARS procedure that is out there.

Unfortunately, like a lot of topics the more we know, the more there is to debate!!!

[fergus]

True, my thoughts essentially are that every opportunity should be made to rehabilitate an injury without recourse to surgery first, which is viewed as the quick fix in some cases.

[lloydy]

Don’t want to hijack thread but thought I would post here as it’s relevant. I’m awaiting surgeon for ACL reconstruction which has a slight tear and cartilage trim, it’s about 6 weeks away. I’m trying to strengthened lower body to hopefully give me a head start to rehabilitation. I was wondering if by squating I could possibly do more harm than good? Is there any exercises I should be focusing on to aid recovery.

Thanks for any help.

[ashley]

@lloydy 1624 wrote:

Don’t want to hijack thread but thought I would post here as it’s relevant. I’m awaiting surgeon for ACL reconstruction which has a slight tear and cartilage trim, it’s about 6 weeks away. I’m trying to strengthened lower body to hopefully give me a head start to rehabilitation. I was wondering if by squating I could possibly do more harm than good? Is there any exercises I should be focusing on to aid recovery.

Thanks for any help.

If you can access any bars such as a safety squat bar or a cambered bar
you can squat without any stress on your shoulders, other wise a belt
squat would be best to take all the stress off of your shoulder area and
allow you to stimulate hips and legs, cheers,ash

[robbo90]

Well its been a while between posts, still waiting for my next surgery however, I’m almost at the stage where I’m thinking of abondoning the surgery and spending the next 6 months fully strengthening my left knee and surrounding muscles.

My surgeon here in Ireland seems to be having trouble with the equipment used on my last ACL recon and this is slowing proceedings down. I’m able now to squat- nothing too heavy yet though, and my conditioning has improved in the last 3 weeks from cycling and straight line running and DB circuit work-carefully. How would you guys target strengthening an ACL, thats not fully gone but fairly close, as in exercises and intensity.

I’m still hoping to play footy from Dec onwards and because of this my physio is leaning towards getting the surgery done for life after rugby and another couple of years playing.

Cheers for your thoughts and views fella’s…

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