58 y.o. needs ACL reconstruction advice

[chumbilly]

Is it just wishful thinking to go without an ACL repair? Anybody out there able to do this? I am a telemarker of 30+ years. I retired 18 months ago at 57 so that I could have 100 ski day seasons and travel the rest of the year to mtn biking destinations. I also climb, sea kayak and hike occasionally. So, I'm active and before tearing my ACL felt and acted like I have for the past 20 years. My orthopedic surgeon and PT both tell me that they know people who are active skiers and mtn bikers who chose not to have ACL reconstruction surgery. If I were younger I would have surgery without any hesitation. At 58 1/2 with (allograft) surgery scheduled for April 8th I'm wondering what life might be like without an ACL. In my current rehab, the knee feels stable and my leg has regained much of it's strength and range of motion. I want to keep skiing powder, scrambling off trail, living life the same as before my accident. My PT says that 5 years out those who have surgery and those who don't perform equally well. I certainly don't want to reinjure or worse by going without surgery. I just don't know which way to go. Thanks for any advice.

[Vitamin I]

I am not a doctor, & your results may vary.

SHORT VERSION:
Tough decision. Do you want 100% performance? Or is 70% good enough? Either way, you can always do a "tape plus brace" solution that will provide stability for some serious and frequent impact---whether short-term or long-term use of tape+brace. You can also have a multi-ski/boot quiver that minimizes risk of re-injury for each snow condition and skiing style (but multi-ski quiver kinda means multi-styles of skiing---which I think makes skiing more fun, but if you're a purist "one style" guy, then multi-style won't fulfill you). Bottom Line: Either get the surgery ASAP, or try 9 months without surgery---but if not satisfied after 9 months, then just get the surgery after 9 months, and DON'T wait longer than 9 months like I did!

Option 1:
If no surgery, then MAYBE you'll never feel stable enough to stop using the brace (no prob, I love my brace), but MAYBE you'll also never feel stable without the tape too (sucks! 100-day ski seasons every year with 100 days of tape will irritate your skin to hell !!!) .

Option 2:
If yes surgery, then you can use this same "tape plus brace" solution until you feel full-strength again, then stop the skin-irritating tape (and maybe also stop the brace), and then you're done!

SUPPLEMENTAL ANSWERS TO YOUR QUESTIONS:
Pro athletes make the NFL Hall of Fame without an ACL (John Elway, Hines Ward, maybe Terrell Davis too?, etc...). So, yes, it can be done. But the bigger the impact you want, the more you should get surgery.

Before surgery, I never ended up feeling stable enough without tape + brace---like on >=30ft ski drops to not-so-soft landings, or landing tame park airs accidentally backseat on a super-stiff tail like Shoots skis (I know, dumb to ride Shoots in the park), or lunging for 50/50 "hospital" balls in soccer or lunging 100% to block shots, or pivoting hard on my bad plant leg while shooting full-strength in soccer, or 80-lb backpack on unstable talus slopes, etc. Plus, weird rare moments really sucked without ACL---sucked to dance, sucked to contort myself to minimize contact while walking thru crowded outdoor concerts, some unpredictably slippery ice really sucked to walk on, parking lot walking with race ski boots in morning made me ski worse for the rest of the day, etc.

I also climb...

During my 5 years without ACL, I refused to hold someone else's life in my hands on any serious climbs, because I KNEW my knee was not 100% reliable, and it would suck for me to live the rest of my life with death on my hands when I KNEW in advance that I was not 100% at rescue. Sometimes you need 100% to save a 220-lb climbing partner.

My orthopedic surgeon and PT both tell me that they know people who are active skiers and mtn bikers who chose not to have ACL reconstruction surgery.

What nation are your docs/PT? I can advise you about biases in USA and Canada, which are very different (well, I know that climate as of 6 years ago).

...surgery scheduled for April 8th

I advise you to keep that date! (but also listen to the opposite viewpoints). Sucks to increase your recovery time by choosing surgery, but in the end, the right "tape & brace" solution enables tons of fun during recovery anyway.

...In my current rehab, the knee feels stable and my leg has regained much of it's strength and range of motion. I want to keep skiing powder, scrambling off trail, living life the same as before my accident. My PT says that 5 years out those who have surgery and those who don't perform equally well. I certainly don't want to reinjure or worse by going without surgery. I just don't know which way to go. Thanks for any advice.

Truthfully, depends on the impact forces you want to handle. But psychologically it's a no brainer...by getting the surgery, it's pretty easy to feel great knowing you are deciding to aim as high as you possibly can by doing what's best for your knee in the long run...and it doesn't matter if you're "old" without a ton of "long-run" left---feels great to aim high.

.

[yeahman]

Vitamin 1, that's a great answer.

OP, I'll share my own limited knowledge and experience. Just turned 50 when I tore my ACL this winter (yep, middle age guy who couldn't let go of my terrain park fetish even though I know better). Like you I ski hard, actually I felt like I still skied like a 25-year-old until this happened. I used to tele but the past few years I switched to alpine (try it, you might like it). I climb peaks, backpack, and elk hunk hard, so lots of off trail, steep side-hilling, heavy loads, and the like. ACL aside, I felt I could continue these activities at a high level for at least ten more years and maybe more.

I really grappled with the idea of surgery because for me natural, non-invasive healing methods have always worked well. I talked to my younger brother (47), who strained his ACL bad two years ago skiing and rehabbed it back, although he said it was a full two years before he really felt stable again. His primary activity is running marathons. It was not a full tear, although he never actually had an MRI. But he definitely felt unstable.

Older brother (56) has hard-skiing friends who have had ACL tears, some had reconstruction and some didn't. He said he thinks they are probably equally satisfied with their decisions. The non-surgery friends always wear a brace (not sure about the tape). My bro is a doctor (he read my MRI) and he said if it were him, he would get the surgery because it is fairly routine these days and he doesn't want to have to worry about it long term. He said for somebody with my lifestyle, I should get it done. He said if it were him he would have it done.

Talked to all my hard-skiing friends. One skied five years without his ACL but eventually, with age, his leg muscles lost some strength and he started to feel unstable, so he had allograft surgery. No problems, glad he did it, still skis hard, no brace. He was a great source of support through the whole process. His wife also had ACL reconstruction after trying to get by without. Her knee buckled on her a few times while hiking, and this caused even more damage to the meniscus etc. So her opinion was definitely do it because if it buckles at the wrong time you risk even more serious injury.

Another friend has one knee with patellar graft and one with allograft. He has pain and some problems with both but he's also carrying around an extra 40 pounds and does not exercise routinely. Plus the doc who did the patellar wasn't good and eventually got shut down. This friend has had multiple knee issues beyond ACL so it's hard to base much on his experience. He still skis and boards hard, although his bell-to-bell days are limited now.

In the end I elected to have the surgery. My surgeon recommended the hamstring graft. He said it has a lower long-term failure rate (6% for hamstring graft vs. 17% for allograft according to him, although I've read other stats elsewhere). He also said that tests have shown that most people's hamstrings regain almost 100% strength over time, and according to him only Olympic sprinters really need 100% hamstring anyway. He said if he tore his ACL tomorrow, hamstring graft is what he would get, so that's what I went with. He is about my age, a couple years younger but active.

I am now seven days out from surgery. First few days sucked but since then progress has been surprising. Five days out I did 30 minutes on the exercise bike and walked a mile in the park. I was smoked afterward but I can already tell it's going to come back and it's not going to be nearly as impossible as I thought when I was a couple days out from surgery (I am very dedicated to the physical therapy, as I'm sure you would be also). One reason I think I'm coming back quickly is because I spent a month doing "prehab" before surgery--once again being very dedicated to it, and also seeing a PT during that time.

One advantage of allograft over hamstring is that allograft uses an actual ligament from a cadaver, so once it's in place recovery can come more quickly than hamstring graft, in which they are essentially taking a tendon and turning it into a ligament. What happens with the hamstring graft is that the tendon (now an ACL) "dies" for a month after surgery, then starts to strengthen and turn itself into a ligament, forms a strong cocoon, etc. Crazy, huh? So for the first month you need to be extra careful with a hamstring graft, but then when the "ligamentizing" starts (or whatever they call it) it gains strength fairly quickly over the next month. The longer time frame for this to happen did not bother me because my skis season was over regardless, and I presently have a desk job. My goal right now is to be hiking (cautiously, with brace and trekking poles) up our local mountain by May 1st (3 miles round trip, 1200 feet elevation gain). I do not know if I'll attain that, but based on how I feel seven days out, I think it's possible. And I think by the time summer rolls around I'll be doing pretty darn good. Again, this is speculation.

Believe me, man, I know what you are going through with this decision. I'm not trying to sway you away from the allograft, I have many friends who got that and have been happy with it, no problems, no pain, skiing hard. I'm just telling you what my surgeon told me regarding long term failure rates. He does all three grafts routinely, works on a lot of college athletes. Patellar he did not recommend due to my age and the arthritis that can come later. He said if I were a 20-something athlete he would do patellar. He said if I really needed to get back to activity (or manual work) faster even at my age then he would probably recommend cadaver. But since that wasn't an issue, he said long term he saw the best results from hamstring. He asked me, do you want to be one of those guys skiing into your mid-seventies? I said hell yes. He said he then recommended hamstring, all things considered.

And needless to say, ask everybody you possibly can who the best surgeon is, and what their long term results have been, before deciding on who does it. You want somebody who does a shit-ton of them, and it helps if they specialize in knees. It's also extremely helpful to ask local physical therapists who they think is best, because they see the aftermath of many ACL reconstructions and they aren't as hesitant to recommend a specific surgeon (some other docs seem to hem and haw about this). And as far as deciding what graft to get, it partly depends on what the surgeon does most of and what he's most comfortable with. Bottom line is there are pros and cons with each graft. It's a personal decision based on many different factors.

Good luck with your decision, and I wish you the best with your recovery no matter what you decide.

[chumbilly]

VitaminI and yeahman, thank you very much! Your advice is an enormous help to me. Thank you for your insights, advice, experience, wisdom and taking the time from your own lives to help a stranger. I see my orthopedic surgeon, Dr. Mike Rossi in Wenatchee, WA again, one week from today. At this point I am pretty sure that I will get the surgery. "Aim high"...saying that reflects my ambition for getting the most out of my active years. I'll adopt it as a positive mantra for erasing doubts and keeping motivation strong. Thanks again.

[Noelle]

I am a 57 year old woman who tore all four knee ligaments 3 yrs ago in my right knee. I have had no surgery other than a clean up meniscus last year. ACL is not attached. MCL has attached to ACL to help stabilize it. I have basic stability in the knee for walking, but used to due high mountain climbs (7 summits). I now have a meniscal cyst on the inside of the knee that flares up every weekend when I do active walking on uneven terrain. It hurts like heck. Ortho says ice and rest. I would like to do some smaller mountains now and am wondering if its worth it to get my ACL repaired. Or? Do I be thankful this is the way it will be from now on and baby it? I want to be active at least trekking at higher altitude into my 70s to stay in shape. Any thoughts are greatly appreciated!

[BFD]

Is the injury preventing you from doing what you really want to be doing? if so get the surgery.

[ticketchecker]

51yo and putting the finishing touches on my fourth ACL repair from May, 2x each knee.

This one I had repaired 20 years ago and it became unstable about three years ago. At that time I started skiing with the brace again, skiing was fine. It was other shit that drove me to another repair. Mountain biking and having to put my foot down when I didn't clean something and it having it go out sucked. Jumping off a surfboard in shallow water sucked. Couldn't run to catch a frisbee but I could ski knee deep pow no problem.

Lots of good advice here already, good luck.

[yeahman]

51yo and putting the finishing touches on my fourth ACL repair from May, 2x each knee.

This one I had repaired 20 years ago and it became unstable about three years ago. At that time I started skiing with the brace again, skiing was fine. It was other shit that drove me to another repair. Mountain biking and having to put my foot down when I didn't clean something and it having it go out sucked. Jumping off a surfboard in shallow water sucked. Couldn't run to catch a frisbee but I could ski knee deep pow no problem.

Lots of good advice here already, good luck.

Curious what type of graft did you choose for these surgeries?

[ticketchecker]

#1 was reattached original acl, bad technique but that was 1983 technology.

#2 patellar graft revision of #1, 1989

#3 patellar graft, 1994

#4 allograft revision of #3 w/stem cell-prp treatment, 2015

Fuck, looks like a shitty resume when I write it out. Maybe I should take up golf