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ACL Series Part 1: Pre-Surgery

Manny Tharrington

I just tore my ACL now what?

Right now, I am 1.5 years post Anterior Cruciate Ligament (ACL) surgery, but 3.5 years post ACL injury.  I will be recalling my experience starting at the time of injury all the way through my individual Physical Therapy experience.  This will be a multi-part series that tells my story, plus various research facts and personal details along the way.

How I tore my ACL

First up, the injury: October something, 2017, adult league soccer game.  I was playing right wing and the ball was hit from centerfield over the last line of defense to the right corner of the field.  I leaped in the air and stretched my right leg out in front of my body to trap the ball out of the air.  As I came down, my right heel hit the ground first.  I must have landed hard because I felt my knee shift and buckle underneath me.  It felt like my thigh and my lower leg were disconnected for just a moment.  I tried to get up but all I saw were spots and all I felt was nausea.  I laid there for a few minutes before rallying up the courage to limp my way over to the bench. I remember feeling some pain, and I remember thinking “uh oh I hurt my knee” but I also remember thinking “if this were an ACL tear, surely I would know it and I’d be in even more pain than this…right?”  As I am sitting there on the bench, I try to keep my knee moving but I continue to get bouts of dizziness.  By the time the game was over, I was feeling much better systemically, though my knee was throbbing and swollen.  I was able to walk across the field, up some steps, and drive myself home. 

That night, I slept horribly, and my knee was stiff and swollen but I knew I needed to start some type of movement as soon as possible.  I set my normal 5:15 am alarm for the gym the next morning and went to my CrossFit class.  I knew there was no way I would be able to do the workout of the day but at least I would be in a setting that forced me to do something.  When I went to work that day, I had one of the PT’s look at my knee.  Honestly, it was too swollen, and I was too guarded for any of the special testing to be reliable.  Regarding knee injuries, most do not require surgery right away, if at all (keep reading to find out why).  Knowing this, I decided that I would start Physical Therapy but as soon as I stopped seeing forward progress, I would get imaging done.

Over the next 8 months, I was able to fully return to all my Crossfit workouts with no modifications.  The only thing I was not doing was aggressive lateral cutting movements.  This was partly because most of my workouts do not really call for these types of movements, but in hindsight, I think I was subconsciously too nervous to try.  This is not to say I did not do any lateral movements at all, but I know I was not practicing at the intensity I had in the past.  At this point, I was extremely happy with my progress and the efforts I made to restore my strength.  I also speculated that based on tissue healing timeframes, if there was any sort of partial tear anywhere in the knee, not just ACL, that might have been able to heal on its own, it likely would have by now.

June something, 2018.  I went on a family beach trip where we did workouts on the beach just about every morning.  It was probably the 4th or 5th day.  By this point I was hardly thinking about my knee, if at all.  Squats and lunges by the water? Sure, why not! Shuttle runs in the sand? Sure, why not!  Except now I can tell you why not.  The first cut I made, my knee buckled and shifted just as it had 8 months ago.  This time, slightly less pain but same mechanism of injury, nonetheless.  I went to the ground and cursed like a sailor.  I blamed this incident on many things.  Maybe it was the sand; Maybe I would have been “more healed” if I had waited until 9 months instead of 8; Maybe if I had been doing more shuttle runs and cutting movements on flat ground, I would have been more prepared.  There were so many excuses I used to deny the fact that I may have an ACL tear.  So, what did I do?  Started back on my PT program.  This time things moved quicker.  The swelling diminished earlier, and it did not take as long to restore my strength.  Again, returned to my workouts and active lifestyle with minimal hitch.  This time I was deliberately avoiding aggressive cutting movements and I was going to give myself longer than 8 months with more gradual progressions into lateral directions – and certainly not testing it out on sand.  Should I have gotten some imaging here?  Probably for peace of mind, but still not necessary.

The Final Decision to Replace my ACL

The final straw: September something 2019.  15 months after the incident at the beach.  I got a text from my old teammates asking if I wanted to play again this season.  This time I felt ready.  I had been practicing and progressing to about 90 percent intensity levels with most cutting drills.  Still, before responding, I went out to the soccer fields with my husband and ran some drills.  I needed to work up to 100 percent effort for my mental solidity and confidence.  I made sure my warmup was sufficient and I appropriately increased my intensity.  We were out there for about an hour working on various movement patterns.  I felt great.  Strong and ready to play.  As classic as it gets, I told my husband, “One more shuttle run, just to make sure.”  My knee gave out and I was on the ground cursing, once again. 

The next day I sent a text message to a surgeon I routinely connected with via mutual patients.  I was able to get in the next day.  He took one quick look at my knee and immediately said “yep looks like an ACL tear.”  I made an appointment for an MRI to be sure.  Yep, ACL tear. 

One month later I went in for surgery……

Q&A:

1.      Do I need to have ACL surgery?

Check out our previous blog post by Seattle Sports Medicine Surgeon Dr. Wahl on how to determine if you are a good candidate for ACL reconstruction:

2.      My surgeon and I have determined that I am a good candidate for ACL surgery, should I have surgery right away?

See this content in the original post

An ACL reconstruction is not an emergency surgery and does not need to happen right away.  This study analyzed the 5-year Knee Injury and Osteoarthritis Outcome Score (KOOS) regarding comparison of outcomes between early ACL reconstruction plus exercise therapy and exercise therapy with the option of having a delayed ACL reconstruction.  KOOS is a self-reported measurement of the patient’s health, symptoms, and functionality of their knee.  This analysis showed that patients who participated in exercise therapy alone experienced less knee symptoms at 5 years post-injury compared to those who had early reconstruction before exercise therapy.  In this study, early reconstruction was considered to be within 10 weeks of injury.  It is suggested that patients who are considering ACL reconstruction should initiate Physical Therapy first to allow the acute signs of injury to diminish and improve post-surgical and long-term outcomes. [i]

3.      How do I improve my post-surgical ACL outcomes?

·  Reduce Swelling at the Knee

  • Rest (relative to previous activity)

  • Ice

  • Compression

  • Elevation

·       Restore full active knee range of motion of Knee

  • Heel slides

  • Heel prop

  • Quad sets

  • TKEs

·       Normalize gait / Walking pattern

  • Part-to-whole

  • Visual Feedback

  • Heel to toe mechanics

  • Hurdles

·       Restore lower extremity strength

  • Squat

  • Hinge

  • Lunge

  • Push

  • Pull

  • Carry

·       Enhance proprioception and balance

  • Unilateral

  • Agility

  • Plyometrics/landing mechanics

  • Reactive/perturbations

  • Multi-tasking

  • Visual elimination

Stay tuned for ACL Journey Part 2
I dive into specifics of my surgery experience, ACL graft selection and ACL first week post-op.

More Blogs & Webinars

 

AUTHOR:

Manny Tharrington, PTA, CSCS, CFSC

CONTRIBUTORS:

Dr. John Rusin
Personal Trainer & Physical Therapist
Dr. Bob Adams, DO
Frm USA Track & Field Head Medical Physician
Dr. Christopher Wahl, MD
Frm UW & Chargers Team Physician, Sports Medicine Physician & Orthopedic Surgeon
Ben Wobker, PT, MSPT, CSCS, CFSC, SFMA
Founder & Director LWPT

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