UKC

Hi all (don't know whether its the correct forum, but there isnt one for injuries!),

I've just found out that I have ruined my ACL, just how ruined it is remains to be seen, but enough to require an operation. I've seen a guy called Professor Gordon Mackay in Glasgow who has told me that I may be a candidate for a procedure that he has pioneered called an internal brace http://www.mackayclinic.co.uk. In stead of the traditional method of taking a tendon of your hamstring and grafting it into your knee, this method uses a small bungee cord as a kind of splint for the ACL so that its can repair itself and grow around the splint. However as I dont have health insurance I would need to fork out the money myself.

The benefits as far as I can make out are a reduced recovery time and potentially less risk of complications. Im guessing as its a fairly new procedure there doesn't appear to be much evidence focusing on the long term benefits or disadvantages of it. It does say that it 'may' help to prevent osteoarthritis compared to the traditional graft operation. There is little evidence regarding whether or not in the long term those who have had it done have a higher chance of re doing their ACL and needing the traditional graft operation anyway.

So im wondering if anyone has any experience of this internal brace procedure and if so how did it go? Wondering what the general experience of ACL reconstruction is? Have you returned to climbing? How long did it take? Any body been one of the unlucky ones who it hasnt worked for? I'm 25 and have a whole lifetime of climbing to do, so getting it sorted is rather important!!

Cheers in advance,
Dan

In reply to dan-8990:

I've had my ACL repaired twice...
First time hamstring, second (and currently recovering) quad-patella graft.

First time I was climbing again within 2 months and progressed almost back to before if not getting better. It took probably 2 years to return to peak performance. However, it randomly just failed walking along a path 4 years after the surgery.

Second time is taking much longer but I fully expect to climb as hard if not harder. I've had other tendon grafts to help stabilise the knee joint which is why it's taking longer. I started climbing again 4 months after surgery and improving. Almost at 6 months when I might be able to start running (slowly to start). I think I'll be back to normal in another 18months.

I have a friend who had a carbon fibre graft which acts as a bridge to help regrowth and he has had no problems for decades.

For me surgery means climbing at a level I'm happy with. No surgery would mean a very different life... possibly with no climbing.

In reply to dan-8990:

Gordon Mackay gets really good results from what I have heard. Did you see him privately or on NHS? Might be worth exploring him repairing your knee on the NHS?

I know quite a few people who have had traditional ACL repairs and climb just as good as they did before, all be it not absolutely top level!

The best things I could recommend if you are not sure is speak to physio that has seen people after the new repair and speak to another surgeon. Jon Dearing works in Ayr and at Carrick Glen and does a lot of sports injuries.

In reply to dan-8990:

Personally I would find a good physio and go through an aggressive prehab programme. If I doesn't work( as long as you've stuck to the programme)then you've lost nothing and will be in good shape for the op.
There's plenty of athletes including rugby players who are ACL deficient.
It is said of orthopods that the man with the hammer always wants to knock in a nail. Working with them myself, it is true of a lot.

In reply to dan-8990:

If you can't get this special op done, get an NHS referral to Colin Walker, he does NHS work and is one of the top knee surgeons in Scotland. http://www.gsss.co.uk/knee/mr-colin-walker/

I had my PCL, LCL and PFL replaced with some of my hamstring and a "donor" Achilles by him. Since then I've improved my climbing, skiing and snowboarding, and even got into some fell running! . A good operation is important, but the key is doing the physio. It took me 9 months of solid effort to get back into climbing. I never think about my knee now. The only slight limitation is flexion - I cannot sit on my heels (aka child pose in yoga). This affects, at a guess, less than 5%, no, probably less than 2% of climbing moves.

As Dave says - "prehab" is really worth it for ACL - the stronger you are before, the less you have to regain after.

In reply to dan-8990:

I played a very good standard of Rugby without a ACL. I finished playing because of the after game/training pain. After being persuaded to have the ACL repaired (By the rugby club who paid for my op) I never played Rugby again.

If you can manage, my advice would be to not have it repaired. Elastoplast is your friend.........

In reply to dan-8990:
I don't have a working ACL in my right knee after it was damaged over 30 yrs ago. Never stopped me hill walking, skiing, climbing, scrambling, biking, running or anything else over the years (not that I do all that now for other reasons). I have had though to keep the strength in the supporting muscles over the years, and be a bit careful if the muscles get very tired (to avoid hyper extension), but that's all and most of the time I've completely forgotten about it.

As Dave the Rave said find a good Physio and undertake strengthening excercises. It could possibly be an alternative to surgery depending on what you mean by ruined. Maybe like me you will not need any operation at all. BTW re-training and strengthening of all the muscles to fully support the knee will take time though and is not a quick fix.

In reply to dan-8990:

I'm seeing Prof Mackay a week tomorrow and all going well with the consultation I'm booked to have my ACL internal brace operation with Prof Mackay 2 days later. What was a 2 week trip up to Glencoe for some climbing has turned out to be 2 weeks recovery post operation!

I ruptured my left ACL in Feb 16 and initially went for the physio route as there was no way I wanted that 6-12 months until I could get back to the things I enjoy. I worked hard and got my legs really strong, did lots on proprioception and lost some weight. I had reasonable results, didn't dream of doing any cutting/pivoting activities, and managed fine on the bike, ok running in the hills and some climbing.

However, for me it just wasn't working out...I was really conscious of the knee when out on the hill, it has given way a couple of times and occasionally I'd get some soreness after longer (10k plus) runs, particularly those with steeper descents. I'm always worried it might give way at a time I really wouldn't want it too...confidence blown!

I'm 35 and ultimately the decision to go down the surgical route was based around restoring my confidence in the knee, avoiding porential further damamge due to instability, my ability to fully commit to doing the things I enjoy in the hills and maybe, just maybe, having a bit of a kick around with my little boy when he gets a bit older.

As for internal brace, I've probably read the things you have, don't know anyone who's had it done (yet).

Happy to let you know how my experience of the recovery goes...

In reply to dan-8990:
Cheers for all the replies! i think it will come down to the money. I had thought about physio, but have seen 3 physios in the last few days each one recommending that I get an op. The amount of times I've put off buying private health insurance and then this happens. sods law!

In reply to dan-8990:

Hello ACL club

I've no experience of Prof Mackay's internal brace but have read up on it in the past. I don't know if it applies to long-standing injuries with a total rupture - I assume if you leave it too long there's no way the frayed and retracted ends can bridge that gap? (But I'd be interested to know the answer). I don't think you can be referred on the NHS to a surgeon of your choice in Scotland? At least not in my NHS area.

Here's my story for what it's worth. It is possible to live very well with no ACL - I did for 10 years, climbing, hill running, mountain marathons, orienteering etc. It took a good year of hard rehab to recover (lots of strengthening of surrounding muscles, balance work etc). Confidence takes time to fully come back too but I got there then never really thought about it other than "wow, I'm doing this without an ACL" sometimes when running down hills. It stayed entirely stable all that time (though looking back I could have run better down hills with an ACL and I didn't do any pivot sports seriously or regularly).

I'm about to have ACL repair though, following a big meniscus tear which locked my knee and needed cutting out last year. It didn't take much to do this either - just a slight/careful jump down a step in a path, no bad landing, no fall. The loss of the meniscus left my knee not stable enough to do the above (the meniscus plays a role in stability/congruity of bones as well as shock-absorbing). As meniscus does deteriorate with age and I'm nearly 50 I can't say the tear was all to do with the lack of ACL but I did put my knee through a lot considering its vulnerability and imagine it did suffer more than for someone with an ACL, even if I wasn't aware of any instability. (I think research does show a high percentage of meniscal tears as time elapses in unrepaired ACL knees). I have also got some painful wear in my right knee and maybe this has been caused by it taking more than its fair share of the load so that's also worth considering if you do a lot of hill stuff, carrying etc.

Every case is different and the decision to repair or not is not always easy to make. If ball sports had been important to me I am sure I would have had the ACL repair at the time. Now it boils down to what someone said to me more recently "is it stopping you doing what you want to do?" and, having gone through diligent rehab after last year's incident, I have still got regular instability and I can't safely do the stuff I want to do so that's why I'm belatedly having the op.

The key thing is patience (easier said than done) - rehab and time are really an amazing healer both for function and pain, whether you go down a surgical route immediately or otherwise. And whether you have surgery or not (and whether you have an ACL or not!) it's vital to keep your quads and hamstrings strong and balanced to prevent injury. Best of luck!