Anyone aware of any evidence-based research or meta-studies between those who've had their ACLs rebuilt and those who have not?
The way our family schedule's shaping up, I have a "window of opportunity" to rebuild my left knee this summer. If it goes well then maybe I'd do the right knee a couple years later. No hurry.
But I don't feel the anticipation of taking in a high-mileage car for body & fender work-- it's more like the resignation of turning myself in to the authorities to confront the inevitable. Or for you submariners, it feels like the workup for an inspection.
I tore both my ACLs seven years ago but didn't figure it out until two years ago when I sprained my left knee yet again. That also tore cartilage which keeps me from fully straightening the joint, but it's not noticeable in my stance or gait. The good news is that I've stopped stretch-stressing my joints and I've tremendously strengthened the remaining ligaments & muscles. I've returned to taekwondo with much better technique, control, & balance. Custom-fit orthopedic braces keep me stable during sparring and heavy lifting (yardwork, weight training). Bicycling and elliptical machines are OK now. Even without braces I have full squatting mobility with no swelling, but I'm still working on single-leg squats and other exotic quad [-]tortures[/-] exercises. Lunges, long walks, and an infrequent two-mile run are fine.
I can cope with the status quo as long as it doesn't get worse. I'm nearly pain-free (ibuprofen) but if I curl up in a chair then I stiffen up as if a metal sleeve was clamped around the joint. When I go down tall/uneven steps, my left knee bends to a point where it just stops supporting my weight, "gives out", and drops me down on my right foot. I stay safe but I struggle for control and I still can't tell if it's weakness or a lack of mechanical leverage. Same thing with hopping on my left foot (skipping rope on mats)-- it's much weaker than my right and it's taken a long time to develop the musculature to overcome the lack of ligament. These little [-]whining[/-] issues make me wonder if delaying surgery might cause irreversible damage. Of course the surgery might cause even more irreversible damage.
A couple orthopedic surgeons and a couple more sports physicians have recommended ACL reconstruction. The theory is that without an ACL my knees will lose stability, leading to bone-on-bone osteoarthritis and total knee replacement. But unlike most injured athletes, I have months to prepare for the surgery and the physical therapy. Today my knees are much stronger than when I tore the ACLs.
I'm waffling. Can things get worse? Evidence-based medicine doesn't seem to show whether ACL reconstruction delays osteoarthritis. There's not much evidence for lifestyle/exercise preventing it, either, but that's a lot less trauma than arthroscopic surgery. OTOH I've only heard from one person who has elected to forego the surgery, but they seem to be built to run dozens of miles a week. I don't have enough cartilage for that lifestyle. I haven't talked to any patient who felt that the surgery went especially well, and several have said they wish they'd skipped it.
Surrounded by doctors & surgeons who tend to see solutions in terms of surgery, it's hard to feel as if there's a choice. But Dr. Jolie Bookspan has a different perspective. Her blog has started a three-part article on ACL surgery: What Works Better Than Knee Surgery? (Warning-- includes a gross photo of an old-school post-op knee incision. Put down your beverage and swallow that mouthful before clicking the link.) She feels that surgery is just asking for more trouble.
I've learned that allograft tendons are probably better than cadaver ligaments. I've learned that pre-surgery physical conditioning is key, as is minimizing post-op swelling and starting physical therapy. I've learned all sorts of details about side effects and recovery. What I haven't learned is whether any of it is necessary in the first place.
Let me know if you've seen any compelling evidence to motivate me for elective surgery...
The way our family schedule's shaping up, I have a "window of opportunity" to rebuild my left knee this summer. If it goes well then maybe I'd do the right knee a couple years later. No hurry.
But I don't feel the anticipation of taking in a high-mileage car for body & fender work-- it's more like the resignation of turning myself in to the authorities to confront the inevitable. Or for you submariners, it feels like the workup for an inspection.
I tore both my ACLs seven years ago but didn't figure it out until two years ago when I sprained my left knee yet again. That also tore cartilage which keeps me from fully straightening the joint, but it's not noticeable in my stance or gait. The good news is that I've stopped stretch-stressing my joints and I've tremendously strengthened the remaining ligaments & muscles. I've returned to taekwondo with much better technique, control, & balance. Custom-fit orthopedic braces keep me stable during sparring and heavy lifting (yardwork, weight training). Bicycling and elliptical machines are OK now. Even without braces I have full squatting mobility with no swelling, but I'm still working on single-leg squats and other exotic quad [-]tortures[/-] exercises. Lunges, long walks, and an infrequent two-mile run are fine.
I can cope with the status quo as long as it doesn't get worse. I'm nearly pain-free (ibuprofen) but if I curl up in a chair then I stiffen up as if a metal sleeve was clamped around the joint. When I go down tall/uneven steps, my left knee bends to a point where it just stops supporting my weight, "gives out", and drops me down on my right foot. I stay safe but I struggle for control and I still can't tell if it's weakness or a lack of mechanical leverage. Same thing with hopping on my left foot (skipping rope on mats)-- it's much weaker than my right and it's taken a long time to develop the musculature to overcome the lack of ligament. These little [-]whining[/-] issues make me wonder if delaying surgery might cause irreversible damage. Of course the surgery might cause even more irreversible damage.
A couple orthopedic surgeons and a couple more sports physicians have recommended ACL reconstruction. The theory is that without an ACL my knees will lose stability, leading to bone-on-bone osteoarthritis and total knee replacement. But unlike most injured athletes, I have months to prepare for the surgery and the physical therapy. Today my knees are much stronger than when I tore the ACLs.
I'm waffling. Can things get worse? Evidence-based medicine doesn't seem to show whether ACL reconstruction delays osteoarthritis. There's not much evidence for lifestyle/exercise preventing it, either, but that's a lot less trauma than arthroscopic surgery. OTOH I've only heard from one person who has elected to forego the surgery, but they seem to be built to run dozens of miles a week. I don't have enough cartilage for that lifestyle. I haven't talked to any patient who felt that the surgery went especially well, and several have said they wish they'd skipped it.
Surrounded by doctors & surgeons who tend to see solutions in terms of surgery, it's hard to feel as if there's a choice. But Dr. Jolie Bookspan has a different perspective. Her blog has started a three-part article on ACL surgery: What Works Better Than Knee Surgery? (Warning-- includes a gross photo of an old-school post-op knee incision. Put down your beverage and swallow that mouthful before clicking the link.) She feels that surgery is just asking for more trouble.
I've learned that allograft tendons are probably better than cadaver ligaments. I've learned that pre-surgery physical conditioning is key, as is minimizing post-op swelling and starting physical therapy. I've learned all sorts of details about side effects and recovery. What I haven't learned is whether any of it is necessary in the first place.
Let me know if you've seen any compelling evidence to motivate me for elective surgery...
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