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Old 10-09-2003, 09:01 AM   #1
Ryan Atkins
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Between 1993 and 1996 I had the misfortune of having both of my ACLs torn. When I had them confirmed by MRI the doctor gave me a list of options:

1. I could stop practicing certain sports
2. I would have to wear these huge knee braces while playing sports
3. I could have surgery

Option #1 was, IMO, a joke. Option #2 was impractical – I don’t think I would find many training partners willing to grapple with me while I was wearing a huge plastic brace (in mixed martial arts (mma), the legs are frequently used as levers against an opponent’s head, body and limbs when applying submissions). Option #3 I didn’t want to have done because I have heard a couple of horror stories about people who had undergone the procedure.

For the past couple of years I choose deadlifting and squats as my form of therapy (this was before I found about O-lifting almost a year ago). It has worked reasonably well. Although both of my knees will slip ‘out of joint’ occasionally, it has happened a lot more often during the times I had taken a break from lifting. As long as I pay attention to certain technical issues (keep the knee aligned with the toes, don’t allow the knee to traverse to far over the toes, keep heels flat, etc.) I am able to perform the lifts used in Crossfit with no threat of re-injury. The problem has arisen during my stand up classes in mma. My right knee has become more of a problem. While doing certain footwork and kicking drills it will pop ‘out of joint’ with only a small amount of pressure. In addition it has taken longer for it to pop back into place (up to a minute) during which time no weight can be placed upon it. Up until recently, when it did pop out of place, there would be a second or two of pain, it would pop back into place, and I could continue as normal.

Because of these recent events, I’m reconsidering option #3. I’m hoping that the techniques/success of this procedure have improved in the past couple of years. Does anyone know? Has anyone who routinely Crossfits, O-lifts, or practice mma and/or gymnastics had this operation performed? If so, what were the results? I do have an appointment with my physician set up, but I was hoping I could get some informative views from people more familiar with the physical activities I practice.

Thanks a bunch,

Ryan

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Old 10-09-2003, 01:07 PM   #2
Roger Harrell
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I know many that have had ACL surgury. Mixed results, but typically the poor results have been in those that have not done the rehab sufficently or properly. I know of one instance where a guy had ACL surgury and he's better off now than he was before the injury. He wasn't in terrible shape to begin with either, but was really dedicated to the PT and rehab.

Keep in mind you will have a significant amount of downtime with the surgury option.

With your joint destabilizing it sounds like the situation will get worse with time. The connective tissue will get more and more stretched out.

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Old 10-09-2003, 03:35 PM   #3
John McCracken
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I would recommend asking the orthopedic surgeon about his/her success rates with the procedure.

Additionally, there are issues with regards patient confidentiality, but you could inquire about speaking with his/her patients who have gone through the surgery and post-op recovery about their experiences.

Here are some more articles for your reading pleasure that should be helpful:

The Complex Challenge of Treating Knee Instability
http://www.aafp.org/afp/20011201/tips/7.html

Knee Braces: Current Evidence and Clinical Recommendations for Their Use
http://www.aafp.org/afp/20000115/411.html

The Natural History and Tailored Treatment of ACL Injury
http://www.physsportsmed.com/issues/...9_01/evans.htm

ACL Reconstruction With Autografts
Weighing Performance Considerations and Postoperative Care

http://www.physsportsmed.com/issues/2003/0403/grant.htm

A Perioperative Rehabilitation Program for Anterior Cruciate Ligament Surgery
http://www.physsportsmed.com/issues/...shelbourne.htm

Hope this is helpful

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Old 10-10-2003, 10:00 AM   #4
Ryan Atkins
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Thanks for the feedback gentlemen.

Roger- Hopefully, I can be as dedicated to the rehab program as the individual you mentioned. I think your right when you say the injury will get worse with time (the third link that John referenced would seem to confirm this). The downtime part doesn't bother me to much - it will give me more time with my kids and allow me to focus on pull-ups and HSPUs,which are two of my weaknesses.

John- Thanks for the links! They really helped to clarify and confirm some of the issues I've been dealing with lately.

Before posting this thread, I had briefly checked out a couple of sites on the subject. One of them gave me the impression that rehab consisted solely of leg extensions. Nice to know that this is not the case. Also the realization that I may be causing or have already caused damage to the meniscus and nearby ligaments has swayed me more torward the surgery option.

On a side note - the second article listed kind of surprised me when it said that some NFL players will wear a brace during practice but not during a game because they feel it limits their performance. Don't you think that by giving a muscle/joint support for the majority of the time and then taking away that support when you need to perform under maximum duress (i.e. game time), that they may be setting themselves up for injury?

-Ryan
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Old 10-10-2003, 01:34 PM   #5
John McCracken
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Ryan,

Once again your instincts are right.

I agree. Training with the brace and not using it during times of maximum performance would potentially increase your likelyhood of injury.

The American Academy of Orthopedic Surgeons (AAOS) also agree.

If you follow the link in footnote #5 from that article (http://www.aaos.org/wordhtml/papers/position/1124.htm) you'll find the AAOS Position Statement on the Use of Knee Braces.
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Old 10-10-2003, 03:07 PM   #6
Gary
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Ryan,

I haven't had ACL surgery but I did have surgery in March 2002 to repair cartilage damage and remove a bone spur that had completely moved the knee cap out of its track. I also have a lot of football and soccer buddies that have had ACL surgery. Some have had great success while others haven't. Following surgery I did exactly what both sets of my ACL buddies had told me: follow the surgeon's advice exactly on recovery and rehab. I took recovery very slowly and was able to be back squatting and deadlifting in about three months. Five months later I was back on the football field (I'm an official) with a strong knee, no knee brace, and no reservations.

I had one regret with the whole episode: I let the knee problem go too long and had damaged the articular cartilage as well. Unlike the meniscus it will not heal.

One other piece of advice that served me well. Find a surgeon that understands sports - and hopefully your sport. Mine played football and works on nearly half the knees in the area. Having someone with that kind of insight pays dividends in the overall success of the surgery and the recovery.

Good luck with that knee. And - please don't let it go too long.
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Old 10-12-2003, 10:52 AM   #7
Ryan Atkins
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Thanks Gary,

I'll definitely look for a surgeon with the traits you mentioned,

Ryan
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Old 10-12-2003, 09:14 PM   #8
Gary
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Ryan,

Please keep us posted on your progress.

Gary
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Old 11-22-2003, 12:16 AM   #9
Carrie Klumpar
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So, Ryan, did you make a decision? Are you having the reconstructive surgery?

I'm glad this thread came up. (And thanks to John McCracken for the links to those articles.) I'm facing the same issue--only one knee though (thank god) and a more recent injury (this past summer), so I'm really curious about other folks' experiences. I'm committed to pre-surgery strengthening and post-surgery rehab, but I'm still a bit freaked out by the idea of surgical tampering with my joints--and really bummed about the long recovery and having to be laid up and then conservative with it for so long. It's even harder to imagine going through the rest of my life with it being delicate and unstable, though.

So, just wondering where you're at with the decision...
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Old 11-22-2003, 10:09 AM   #10
Ryan Atkins
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Carrie,

I had MRIs done on both of my knees within the last two weeks. My next appointment with the surgeon is in early December for a clinical evaluation. Although the radiologist reports give a laundry list of problems with both knees, right now I'm only dead set on having surgery on the right knee - it's so unstable now that it'll pop out of joint occasionally if I just change direction the wrong way. I really have to pay attention to keeping my toes in line with my knee at all times to prevent this from happening. For the time being, I've postponed my FSF practices until post rehab. I have has absolutely no problems the past few months with my left knee. Fortunately, I can still do the WODs. The exercises presented in Crossfit do not bother either one of my knees when executed with proper form with the possible exception of one-legged squats.

-Ryan

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