An impatient’s guide to Knee Surgery – Anterior Cruciate Ligament (ACL) Reconstruction and Meniscus Tear

The story begins many years back, on a beautiful sunny morning in 1997. I was playing cricket in the inter division cricket tournament in my college. I had bowled my quota of overs and we had kept the opposition down to a modest score. Later while batting we were within reach of the target with 10 runs to get and 8 balls to go. 8 balls 10 runs wasn’t easy but I did think we could make it. I took strike, the bowler bowled a delivery that rose to about waist height. I swung the bat in what is known as a pull shot, hoping to get a boundary. My bat moved, my chest and waist rotated in an attempt to generate max power, but my legs did not move. I heard and felt a snap / pop in my left knee and I was down in excruciating pain. I could not even think of getting up, let alone running. After a few minutes of agony, I was helped off the field. We later lost the match.
Disclaimer – I am not a doctor. I am publishing this article a few days prior to the 3rd anniversary of my knee surgery. It is based on my notes and my experiences. However there is absolutely no assurance that any statement in this article is medically correct or up-to-date. The article cannot substitute the advice of a medical professional.

I wasn’t sure, but I dreaded that I had done the same thing that my sister had a few years back while playing badminton; I had torn the ACL ligament in my knee. The knee soon swelled up and I could barely manage to get back home.

Initial Treatment & Doctors

My first doctor was Dr K who ran an orthopedic hospital near my place. He wasn’t very convincing, did not give much of a diagnosis and suggested that we do an arthroscopy before he could comment. I had heard tales of this particular doctor making patients go through expensive & unnecessary procedures. For a second opinion, I went over to Dr. D, a nice man in his 50s. He asked me to have a few XRays taken, but apparently XRays don’t tell much when it comes to muscle tears. He asked me to take some medication for the swelling and then exercise my quadricep and hamstring muscles. He was reluctant to recommend any surgery and felt that I should first recover from the current injury, strengthen the knee and then see how it goes.

I exercised in right earnest for many months. I could barely walk the first few days but gradually I could again walk well, run and even play some sports occasionally. However every few months I would accidentally do something that would lead to my knee getting dislocated. I dislocated twice while attempting to play badminton and several times while getting down stairs & while walking on uneven terrain. In hindsight, it seems rather silly of me to try to play badminton with a bad knee, but I was in college then and I couldn’t resist accompanying friends to such games. I knew I was risking a dislocation but still went ahead.

update – I am told that ‘Subluxation’ is the correct word for what I am referring to and not ‘Dislocation’.

I had about 3 to 4 knee dislocations every year. The thing with dislocations is that while the first disloaction gives you excruciating pain, your body seems to adjust to that and the ones after that are very painful but not as bad as the first one. You also recover faster than the first time. I soon even got the knack of using my hands to manouver my knee into position, immediately after a dislocation.

However after one particularly painful incident, I again went to Mr D. He again asked me to continue my exercises for quadriceps and hamstrings, but this time he also asked me to visit Dr. J in Mumbai. A doctor now very famous as he is the often associated with the Indian cricket team.

Dr J was good at his job. He did a couple of simple knee tests. The Lachman Test in particular can make it very obvious to the patient that something is very wrong inside the knee. During the test, the part above the knee and below it seem to work independently of each other if you have a torn ACL. It’s quite a scary feeling. *Note that 10s of doctors & assistants have tried this test on my knee, and I have found that very few get it right. If the patient does not relax his/her muscles, the knee doesn’t respond and the doctor can be fooled into thinking that the ACL is ok.

Dr J said that no MRI or XRay was required and he was convinced that I had ACL Insufficiency that required an operation. Dr J had an athletic built and a smart & confident manner, making it easier to believe that he is a sports injury expert and is sure of his assessment. I was also impressed by his willingness to give a definite diagnosis, without any arthroscopy or MRI scan.

He added that if I did not want to go under the knife, I could keep exercising my quads and hams and stop all activities that test the knee. It’s beyond me why doctors insist on using confusing words like insufficiency, words that patients cannot make any sense of? I guess it’s similar to us software folk making it seem like developing a web page is a big deal. You stay important, your opinion is valued and the client pays good money willingly.

Having the second option of exercising my way out, made things difficult for me. No one wants to be operated on, so I hoped that I would be the lucky one to just exercise and get through. I did get through a few years, but how could a 18-20 year old not push the knee. I regularly ended up doing things that my knee disapproved of. So not only did I gradually lose confidence in the knee but I now regret having missed out on many activities in college just because I feared that my knee could not sustain them. Also with time, the ACL injury only gets worse. The exercises build up muscles that try to compensate for the ACL, however the ACL does not get better with time. It’s also easier to bounce back from a new ACL injury than an old one (in both the physical and mental sense). A failed ACL also increases your risk of arthritis as there’s friction caused by the knee not moving in it’s proper plane.

658px-Knee_diagram.svgSo if you had a knee accident where you felt a pop/snap, it is unlikely that you have just damaged your ACL but not torn it. As ligaments don’t heal by themselves, your choices are –
1) Exercise – Build up related muscles (quadricep and hamstring) so as to compensate for the torn / damaged ACL. Leg extensions and leg curling using weights will work out these muscles. But just these two exercises don’t suffice.
2) ACL reconstruction Remove a ligament from the hamstring (alternatives to the hamstring ligament exist) and replace the ACL with it.

For many years I was under the impression that I had damaged the ACL but not torn it and I could pull through. Stupid decision in retrospect! I thought that reconstruction wasn’t really necessary in my case. My sister who had to undergo the ACL reconstruction many years back used to dislocate her knee very frequently and so had no choice but to get it operated. As I only dislocated every 3-4 months, me and my family did not take my knee injury as seriously as we should have. We perhaps thought that only if you slip and fall every second day is your ACL torn, else it’s just damaged and will recover over time. Big mistake! How often you fall depends on how strong your quadriceps & hamstrings are and how capable they are at compensating for the ACL.

Based on what I have now experienced and read I now feel that if you are young and active, a surgery is your best bet. It is not only unlikely that you will regularly exercise your knee all your life but you also won’t be able to cut down on activities that test the knee. Although I believe I took good care of my knee, it is pretty much impossible for a youngster to not test the knee. If you are old and not very active, strengthening the muscles might take you through.

I did not go for an operation and sort of accepted the occasional dislocation. I exercised quite regularly and took the 3-4 dislocations an year as a part of life. This went on for many years.

In the meantime, after another rather painful dislocation, I was told by someone to consult Dr S. It’s funny how hope drives some patients to quacks promising miracle drugs while others like me to doctors whom you think will tell you things that you want to hear. Dr S was well known for not recommending surgery. He asked people to walk in swimming pools and recommended seemingly strange exercises. So I went to Dr. S hopeful of learning his magical exercises and sorting out my knee troubles for good.

If I remember correctly, Dr. S hardly touched my knee, let alone examine it. He looked at an old X-ray, did not provide any diagnosis but said that he will fix things. His assistant gave me a photocopied paper that had some exercise diagrams. She quickly told me what those exercises were, I was asked to pay a huge amount in cash (no receipt) and was whisked out in maybe 2 minutes or so. Even if the doctor hadn’t been around, I think the assistant could have managed things just as well. The procedure was simple

a) Note which part is affected b) Give corresponding exercise sheet c) Demonstrate exercise d) Collect big fat sum e) Bye Bye

I did follow the exercise routine for some time, but I wasn’t very committed as I did not think much of the doctor. So, many years after the cricket accident I still had a bad knee that dislocated at will. I am sure it would sound ridiculous to some readers that I wasted 10 years trying to pull through with a broken knee. Honestly, I agree. Things just happened that way.

They say that adversity can be a blessing in disguise. One evening in Jan 07 I was moving about in the kitchen when my knee again shifted and for the first time it did not release, it locked. Normally my knee dislocations felt something like ‘Khat-Khat’ and that too when I was pushing the knee. This time it shifted when I wasn’t doing anything abnormal and now it was locked. I tried to release the knee but I later learned that I should not have done that as I could have caused severe damage to the meniscus. It hurt bad and the knee swelled up. I was worried and mad at myself and all my doctors over the years.

I had recently noticed a new sports medicine clinic that had come up near my place. It was being run by a young Dr. B whose wife was a friend from my school days in Mumbai. It’s strange how life can get you to run into people you least expect. I had faint memories of being impressed on hearing that my friend was marrying a doctor currently in the UK for studies. Apart from getting some occasional info from common acquaintances I had completely lost touch with them. I restored the link and got an appointment with Dr B.

ACL Reconstruction and Meniscus Tear Surgery

Dr B examined my knee, asked me to get an MRI scan done. An MRI scan entails spending a long time in a noisy and annoying machine. Once the MRI reports were in, Dr B was convinced that I should get the knee operated. He felt that the knee had got worse with time and getting the ACL Reconstruction surgery done was the way to go. He did not feel that I could just keep exercising quads and hams and pull through. This was good in a way, as now the option that had held me back from surgery was eliminated. We decided on Dinanath Mangeshkar hospital in Pune as the place for the surgery.

Update – The MRI done usually before all ACL surgeries is essentially to delineate all the deficits within the knee as a prognostic indicator. So that the surgeon can tell you how much arthritis there is pre surgery & that will not recover. and associated collateral damage of meniscal tears.

Countdown to the operation

  1. Day minus 3 – I got my blood, urine and sugar tests done. The reports were normal.
  2. Day minus 1 – I was told to get admitted to the hospital the evening before the operation. As far as I can understand, this served no purpose. My operation was scheduled for 8.30 the next morning. I think it would have sufficed if I had got admitted a couple of hrs prior to the operation.
  3. Day 0 – My leg was shaved at about 7am. I was told to not eat or drink anything since the previous night. I believe this is meant to ensure that you do not throw up on the operation table. At about 8 am I was taken to the operation theater.

Operation Time
Prior to the operation I was asked to change into the ugliest clothes I have ever worn. I do not know why hospitals try so hard to make patients feel sick. Making patients wear drab and humiliating operation costumes that leave the patient pretty much naked makes no sense for a knee operation. I deeply regret that I did not protest and insist that I will not wear the gown or whatever it was. To add to it, the operation table was just 6 ft and so I wouldn’t fit in. My feet were sticking out, atleast till the time I was knocked out.

ACL Arthroscopic reconstruction - Image via Wikipedia

You have to make a few choices before the operation. You need to be take these seriously as for everyone besides you, this is just another operation.

What kind of Anesthesia

  • General Anesthesia will knock you out for a long time. The period when you come out of a GA is especially unpleasant. If you take a GA, the key thing is to not fight the GA. If it wants you to sleep, sleep. One of my worst memories is of the time when I was trying to come out of a GA for a minor nasal surgery I underwent a long time ago. I could hear and understand what was happening around me but I just couldn’t wake up. I am told I talked a lot of nonsense in this phase, which was funny for others but very unpleasant for me. Ask someone in your family to remind you to sleep and not fight the anesthesia.
  • For the knee operation I was to be given a spinal injection. The injection numbs you below the waist. The injection did not hurt much.
  • I was advised by family to opt for a sedative after being administered the spinal anesthesia so as to not feel the stress of the operation. I opted for this, which perhaps was not the right decision. I hate the feeling of being out of control. I could have tried staying awake and if I had felt stressed out by the operation I could have taken the sedative. However this sedative thing was nowhere as bad as a GA. This decision really depends on your personality than anything else.


Other decisions

  • Medical professionals by and large are very reluctant to provide any info or reasons. Unless you ask them why you should do X or Y, they will not tell you. For some patients “because the doctor says so” might work. Certainly not for me. If you have read Lance Armstrong’s book “It’s not about the bike” he talks at length about how you need to work with the doctors and not just wait and hope that the doctors will pull you through. My case was a 1000 times simpler than fighting cancer, but I do think the more aware you are, the easier and faster you would recover. Ignorance is also very irritating. Knowledge keeps that one big irritant away.
  • Ask a million questions and do not expect the doctors to volunteer information. Trust me, they will not, at least not in India.
  • Ensure that the intravenous (IV) is stuck on a shaved patch of skin. It will hurt when they remove the IV a few days later and a 100 hair along with it. I now better appreciate the pain that women go through when they wax their arms clean. Ouch!

The actual ACL Reconstruction surgery

ACL reconstruction is not an ACL repair. A repair implies that you can fix something that is broken. If an ACL is completely torn, it will not heal back together, even if the torn ends are sewn together. In actuality, the tendon almost always appears frayed when visualized after an ACL tear. What does work well, is to remove the torn ends of the ACL and replace the ligament with a different structure (a graft). To secure the graft into the position of the normal ACL, tunnels are made in the shin bone (tibia) and thigh bone (femur), and the graft is passed through these tunnels to reconstruct the ligament. (src about.com ). The graft can be from the hamstring tendon, patellar tendon or a donor/cadaver graft.

The operation lasted for a couple of hours and I was then wheeled out to a recovery room. Apart from the ACL tear I also had a meniscus tear, so I was told that a part of the meniscus was also removed. Immediately after the operation, my big problem wasn’t pain in the knee but a severe pain in the stomach. I soon realized that it was caused because my bladder was full. The reason wasn’t that I had not used the toilet before the operation but because I was given lots of fluids during the operation. The big problem was that as I still had no sensation below the waist, I could not relieve myself. It was very very painful. The doctors on duty at the time had no answers. Like with so many other embarassing things at the hospital, during the hours when I had no control over my bladder, I wet my bed even when I sneezeed / vomited. I couldn’t help it, I had no sensation below the waist. Although I hated the idea of wetting my bed, it did help with the pain.

Recovery

Day 1 was horrible. I knew of my sister’s agony after her ACL operation many years back but was hopeful that technology & medication would have improved since and the pain would not be too bad. I was very wrong. Also there was a medical goof up at this stage. Everytime I was given what was supposed to be a painkiller injection, I puked within 30 seconds. Apparently I was reacting to that particular drug and the drug failed to relieve pain. Strangely no one from the hospital staff thought of changing the injection. Only after I insisted was the injection changed the next day.

Stitches Just Below Knee - 1 week after operation

Night 1 was perhaps my worst night ever. I was up all night trying to find some position and posture where it wouldn’t pain, but to no avail. Along with my knee my back had also started hurting big time. It was agony that I will never forget. For some strange reason I remembered a line from renowned Marathi author P L Deshpande’s book, where the funny but wise character of the old Parsi ‘Peston Kaka‘ says that he believed that “God Is In Suffering Whatever Comes Your Way“. All night I kept telling my wife that I was getting a very close view of God through my suffering. My wife later told me that the night was a traumatic experience for her, as she couldn’t bear to watch me suffer. So if you are undergoing the operation, plan for about 18 hours of agony. Hopefully in your case the painkillers will perform better than in mine.

Things improved significantly on Day 2, I am not sure if it was the new painkiller that did it or the pain naturally subsided. On Day 3, I was allowed to use the walker to move about and I also started some light exercises. I was asked to spend a few more days in hospital. Apart from continuing with my exercises I didn’t do much during these days. I do not think much was achieved by me staying in hospital beyond day 2. Doctors perhaps want to play it super safe and so prefer to keep the patient in hospital until they are 100% sure. However I feel that if you are in good physical condition otherwise, you should talk to your doctor well before the operation on when exactly you will be set free from the hospital. Hospitals are not hotels, it’s better to get out asap.

I had 6 stitches just below the knee and one on each side of knee. Knee swelling is the first problem to be tackled. Although the hamstring seems very far from all the action, it does hurt a bit as that’s where the replacement ligament comes form. Bending the knee and getting it back to normal motion is what all the exercises are about. Exercising using a knee bending machines was much better than human assisted exercises my sister had gone through.

Knee Brace

The first brace that was put on immediately after the operation, stayed on for 3 weeks. This brace stopped me from bending my knee while walking. After about 2 weeks, my swelling had subsided but was not gone altogether. Initially I was not supposed to bear any weight on the knee but after 2 weeks, full weight bearing on the knee was now ok. The knee was now bending a little more than 90 degrees. BComplex tablets were the only medication I was now taking. I had to take pain killer tablets for a few days after the operation, but the pain had subsided since.

After 3 weeks I switched to Hinged Knee Support. I was looking forward to moving on to this brace as with it I was told that I could bend my knee while walking. But this new brace was a big disappointment. Neither could I walk comfortably nor did the brace feel like any support. I read on some websites, that these support braces have more of a psychological benefit than physical, as the brace keeps your brain alert and tuned into the knee’s movements. The first 2-3 days with the new brace were especially bad. Either my skin reacted badly to the neoprene material or because of the excessive sweating caused by the brace, I had a major rash and itch in the area covered by the brace. The itch was unlike any I remember. I repeatedly woke up in the night just to scratch my knee until it was all red and itched even worse. Ice packs and cold water were the remedies that worked best in tackling the itch. After 2 days of this, my doctor prescribed a medicine and I changed the cloth I used under the brace from a sock like material provided by the brace vendor to a more comfortable cotton. I was expecting to be back in action in one month’s time, but that didn’t happen. I could stand on my feet and walk around in the house but couldn’t venture out. The brace that was supposed to let me walk while protecting my knee didn’t seem to achieve much either.

Circle encloses a Titanium endobutton - Rectangle encloses a Bio Absorbable screw. Rectangle denotes the track of the screw. Source - JointAndBones.com

After 8 weeks I had started vigorous exercises that were meant to strengthen my hamstrings, quadriceps and other muscles that control the knee. Exercises using rubber bands (thera band) work well as you can apply pressure evenly and also control it yourself rather than rely on the physiotherapist.

Stairs were a problem area even before the operation and they continued to be even at this stage. For about 2 months, I was climbing up and down stairs using only my one good leg. Getting down stairs was especially tough, I am told that this happens because muscles find it easier to control the knee against gravity than with gravity. I distinctly remember standing on top of a flight of stairs and finding it difficult to believe that getting down a few small steps had become so very difficult.

After a couple of months, it was just regular strength training for the knee. Also I do not know how, but I was told that some other muscles get ‘wasted’ due to lack of use when my operated leg was not in action. So I had to build overall strength of the leg and also had to take up other exercises for core strengthening.

In conclusion

Although I had taken down notes before and after operation, I have been able to actually complete this article only a good three years after the operation. So how has my knee responded over 3 years? Am I glad I went for the operation? Yes, getting the knee operated I think was the right decision. My knee is now stable and it hasn’t dislocated in the 3 years since the operation. Am I back to full fitness, is the knee as good as new? Unfortunately no. Despite a lot of training, swimming & cycling, my knees still hurts at times. Actually the non operated knee hurts more often than the operated one. The doctor feels that it’s because I have been protecting the operated knee and overloading the other knee.

Have I resumed sports? No, except for controlled sports like cycling, swimming & jogging. The doctors say that weight training will get me best results on the knee, however I have found jogging, swimming & cycling are best for the mind, as they make me feel healthy & sporty and I feel like I have overcome the knee barrier. Just weight training does not instill that confidence.

Despite the operation it now looks like occasional knee pains will be a long term irritant for me, and I will have to keep strengthening the knee all my life. I have found that the best remedy to knee swelling / pains is to resume knee exercises. My hamstrings for the operated knee are still not as strong as the other knee. Also as a portion of meniscus was removed during the operation, the shock absorption capacity of the knee I am told has also reduced, I do not feel the difference.

If you are reading this to decide whether you should go for the operation. I would suggest that if you are below 45 and lead an active lifestyle, get operated, get it done with. Getting the ACL repair done early, can get you a near complete recovery & strength and and also save your meniscus.

Hope this article is of some use to someone somewhere struggling with an injured knee & damaged anterior cruciate ligament (ACL). In summary, I would say read up as much as possible, consult multiple doctors and then take your own decision.

Update – 24 July 2010
Thanks a lot for all the comments.
A quick update. I have been quite regular with the exercises. I have mostly used my home gym & therabands for knee exercises.
However my operated leg (left) continues to be much weaker than the right.  My doctor felt that a Vitamin B12 & D3 deficiency is hampering my recovery. My B12 and D3 figures were not satisfactory in a lab test. So took those supplements for a month and increased my exercises. I was also running about 3 kms every alternate day.
That’s when .. trouble struck, again…
A few days back while carrying my 1yr 9m old son & trying to squat to pick something from a low table, my operated knee went cruuunch. This was the 1st such event in over 3 yrs. It felt like the crunching sound you get when you twist your neck at odd angles. I did not fall or anything, but the knee hurt and went very weak.
20 days later, my knee still feels weak. I continue to exercise, but have stopped running. My doctor checked the knee and fortunately thinks that the ACL is ok. He however feels that I need to increase weight training and also continue with the supplements. A scary line he added was that for repairs done a long time after injury, full recovery might not happen.
My weak hamstring (from where the graft was removed) is the problem. Despite all kinds of exercise, the muscle just refuses to regain strength comparable to the other leg. The problem with the hamstring is also that it is a tough muscle to exercise. Unlike say muscles like calf muscles, which you can easily exercise anytime using your body weight for resistance. For hamstrings you need weights and/or machines.
Felt rather hopeless post this event and it seemed like the knee problem is going to be with me for life. But then hope gradually returned and I resumed exercise. 1) Because if I dont exercise, I would be in even bigger trouble. 2) Considering the kind of disabilities people get from accidents or no fault of their own, I guess, the torn ACL lot are much better off.
I hope all readers are having a better time with their recovery. Push Push Push with the exercises.
I am wondering if exercising as if you want to resume competitive sports, and maybe having a personal trainer would be a worthwhile investment.

Tips & Tricks

  1. Crutches are much easier to use than a walker. Even one crutch will suffice.
  2. If you wake up in the middle of the night with a hurting knee, in all probability you exercised subconsciously. Wearing the brace loosely fastened at night might help keep your knee in check.
  3. Turning on the side got me my first proper nights sleep after the operation. My left knee was operated so I could not turn to my right as then my left knee would hang loose. But turning to the left and keeping my right knee on a stack of pillows worked well. This may seem like a trivial thing to provide as a tip, but considering how much relief it brought me, it’s anything but trivial for me.
  4. First day is very very painful. I was unfortunately given a painkiller that my body rejected. If the painkiller isn’t working or you are reacting to it, ask if the injection can be changed right away. You are the only one who feels the pain, the doctors won’t volunteer much info or change of medications without you being proactive.
  5. Never rely on just your family or the doctors to do what is best for you. They do not feel the pain and only superficially understand your case. Make your voice heard if you are in any discomfort due to medications or facilities.
  6. “Depends on the patient’s response” is the most irritating answer that you will get regularly in response to queries to doctors. Ignore. Ask more Qs.
  7. Immediately after the operation, trying to stay calm & patient is the key. Shouting at family & friends will only make matters worse for everyone.
  8. When you try to walk in the first few days, don’t forget to fasten the brace really tight. It will hurt if your knee wobbles. Pulling your knee cap in while taking every step, will also help. If your knee bends / buckles / wobbles, it can hurt quite bad.
  9. Using the toilet on your own will be a difficult task in the first few days. A low seat will make matters worse.
    The way to do it is to bend your good knee and sit down on the toilet seat (your hands also need to take some weight). You can then extend your operated leg and rest the heel on a chair. Keep another support below the calf muscle. You should be able to manage.
  10. Pay close attention to what you eat. You definitely don’t want an upset stomach, constipation, etc.
  11. I have found the kitchen to be most demanding on the knee as you are constantly changing direction and making sudden movements.
  12. If you are a vegetarian, for calcium & B12 drink milk without adding any coffee, bournvita, etc. for flavouring. I disliked plain milk earlier but now happily gulp down a couple of glasses of milk every day.
  13. I would suggest that if you are undergoing the operation, you ask family and friends to not visit you in the first 2 days. Everybody who turns up at the hospital is wishing well for you but it’s difficult to wish well for anybody who stays in your room for longer than 5 minutes. An uncle of mine used to get a magazine and some goodie for me everyday and his was one of the very few visits I looked forward to while in hospital.

Resources

  1. ACL Tears
  2. How To Lessen Risks Of Knee ACL Injuries
  3. ACL Injuries – WebMD
  4. Should I opt for ACL surgery?
  5. Theraband Exercises For ACL Recovery

ACL Videos

  1. Anterior-Cruciate-Ligament
  2. Medial-Meniscus-Injury
  3. Acl Surgery
  • Prashant Joshi

    Hi Harshad,
    Your posting is really impressive and detailed.
    it has provided a lot of information with the doubts on my mind. I am in a similar dilemma whether to go in for teh surgerey or not. Unfortunately, I am at that period of my life when I am no longer able to engage in active sports, but at the same time very much interested to be able to be fit for that occasional chance that I get. I am 45 years old and hence, a bit circumspect about the issue.
    However, your experience will certainly help in making the final choice.
    One final doubt, does not opting for a surgery, and opt for knee braces increase the cahnces of premature arthritis?
    Regards,
    Prashant Joshi

  • DanielYoo

    Great information presented in detail. This article clears most of my queries which were running in mind. Thanks

  • Sports are always going to be difficult, both physically & mentally, as you continue to fear that you will ruin the knee again. However just the fact that you don't have to worry about the knee 24×7, during travel, while playing with our kid… is a huge relief. At 45 you still have many decades of active life ahead of you, so better look at getting the surgery done now.

    However do note that it does take a lot of exercise to get the knee in good shape. The surgery only gets you half way.

    The surgery is said to reduce the risk of arthritis as your knee motion is now better regulated.

  • Thanks Daniel

  • hi dude,

    i got the same thing .., i mean full to same thing operated last friday (2nd april10), and its been just a week and already bored of it. but the prob where i did not face was.., no injection nor tab reacted everything was normal with me.
    i had 3 ligament tear thats what doc said, and they have put screws too which looks scary.
    from the coming monday am planning to go office with clutches in hand.., what u wanna say abt it?
    Man do u have prob if i use ur blog to write mine to…, its almost the same story 😉 ….,
    anyways thanks for the good info and recovery and other tips

  • sameer karjatkar

    Gosh ! You went through hell . Even I had a severe lower back pain . But as you mentioned repeatedly “Exercise” is the only mantra . Whenever I feel bored to do those exercises I say to myself “Hey , you are getting paid for this ” . The pain has subsided up to 90 percent , but still I feel conscious when I try to lift heavy objects . Happy Exercising !!

  • Shayna

    I so feel your pain! I blew my ACl while volunteering on our local fire Dept. It was horrible pain! they told me I damaged my meniscus and it would be fine ins a week or two. i could not out any weight on my leg at all or it would give out immidiately. I used my crutches for support while placing my foot down to get my knee to accept weight again. 2 weeks later i could hobble around the house and small distances. I was sent to an orthopedic surgeon who said my ACL was in 2 pieces. He said since i was not into sprots, he didnt not want to do the surgery. I ride horses and mountain bike and live a fairly active life, just not a give sprot per sey. So finally after several dislocations while just walking in my house, he opted for the surgery. The pain was unbearable when i woke up, i remember panicking and trying to fight the anestesia, now i wish i had just relaxed and slept instead of worrying about getting out fast so my husband wouldnt be bored waiting. I really wasnt ready to leave when I did and really wish I just slept it all off. When I came home, I think i went months without sleep! every postition you tried to move to just hurt eevn worse to the point, you hurt too much to move anymore and hoped youd fall into a pain induced sleep. I lived in faily bad pain for about a year before the pain was bearable enough to not even notice during my daily work activites. I definaltey would have done it again cause my knee is way way way better now, but the recovery wasnt very pleasant. I now enjoy all my regular activites with ease and not much pain. As uncomfortable as it was, my whole life is back on track again, it was worth the year recovery to have my life back! Goo luck to all whole are undergoing this surgery. It really makes the quality of life better in the long term. Stay strong and keep your head up!

  • Nikhil Jain

    @ Harshad…Dude i have xactly the same prob….Got my knee twisted while playing cricket…didnt get knee operated for next 10 yrs….coz of pressure on another knee ( Left knee this time)…got left knee's ACL torn…Recently got Left knee ACL reconstruction….But m getting probs with rite knee now ( torn its ACL 10 yrs back)…..i hear click sounds whenever i bend it beyond certain points….Dude i need ur help pls gimme ur conatct number as well s tat of Doctor's….pls…if doc is in Mumbai or may b Pune area…dont forget to gimme ur number…

    • Sud

      Thanks Harshad for sharing your experience in detail. On 24th Nov 2014, just few hours after I landed in Pune I met a bike accident. A jet lag, tiredness could have contributed to my slow reflex during accident.The heavy moving bike got skid and fell on my right leg causing a big twistful impact in the knee. Few people rushed to my help but for couple of minutes I couldnt even rise. The following day my knee was swolen a lot and the pain was excruciating. The MRI shows complete ACL tear and some meniscus tear as well. I have visted at least 5-6 doctors in Pune so far. Everyone suggests surgery. Initially I was reluctant for surgery but finally made up my mind to undergo at once. I am planning to operate my knee in the first week of March 2014.

      Thanks,
      Sud

      • Good luck. Wish you a speedy recovery!

        • Fabien

          Thank you very much . Do you remember how much of your meniscus they removed and was it in the medial or lateral part ? Was it by any chance on the medial posterior horn as this is the weight bearing part of your knee . How old are you ? Is life back to normal for you ? any pain discomfort anything different to before the op ?

      • Fabien

        How did you go ? I am having my knee reconstruction and medial meniscus repair (posterior horn) on the 14/10. The meniscus repair / trim is the most important part in my opinion as this will set you up for quicker Oesteo arterithis in the future. I know many people with knee reconstructed and no meniscus damage who are doing very well.

    • Sorry I had missed this comment. Hope all’s well

  • Andy

    Thanks Daniel,
    Initially had same misdiagnosis from my Physio. She told me possibly a slight meniscus tear but at least no ACL tear or rupture. I was never convinced and didn't like her suggestion after regaining 98% extension and some strenght that i just go out here play my tennis and if I lock up or fall in pain she might recommend a specialist. Finally after pushing she consulted with another PT and they referrred me to a sports physio specialist and when I mentioned her diagnosis (after his rotaing the lower leg) he raised his eyebrows somewhat and had no hesitation recommending an MRI…..and that told the whole story of ruptured ACL and MRI tear with slight medial strain. problem here in NZ is that while all accidents are state funded (did it playing first game of soccer ever at 48) they are reticent to do the MRI due cost.

    Anyway sitting here after hamstring graft yesterday and doing a bit of surfing to see if my suggested rehab programme ties in with others. Have cyro cuff and keep leg elevated and doing recommended exercises when i can. Pain fortunately very manageable, tried avoiding the painkillers but have succombed. Slept like a baby first night home after day surgery…hope same again tonight. That may well change,

  • Thanks a lot for all the comments. Just added an Update for 24th July to the article.

    Also do check out this page on Thera-Band exercises for ACL Tear http://j.mp/aUF6kM . Have found Theraband's an effective way for exercise without weights. Thera-Band is one brand, I suppose there would be similar bands available under different brand names.

  • Aparanjape

    Harshad – Great indepth blog post. Will be very helpful to patients. Also, this is a good reminder for me to write about something similar on chronic low back-pain!

    Amit

  • I’m so love this blog, already bookmarked it! Thanks.

  • Pravin

    Great blog man i really liked it and now i think it’s one of the best on net. Thanks a lot.

  • Lalit

    Your blog has proved very informative and pertinent to all the doubts in my mind . There is not enuf literature on the net on this from an indian’s viewpoint.
    I had a left knee ACL reconstruction exactly a week back . Doc recommended 3 exercise-,knee presses,straight leg lifts and knee bends sitting on a table.The 3rd exercise i find excruciatingly painful while going beyond 90degrees flexion. Doc says shd get full range of motion within 10 days. But m unable to reach there as yet.
    -Firstly,Cd u pl share ur experience while doing this exercise.
    -secondly my medication and painkillers stopped but m unable to sleep without a painkiller in the nite.Did u also have similar problems.
    -Thirdly, when will the pain subside and when can i put weight on the leg.my doc says not before 6weeks
    Would really appreciate your valuable inputs towards recovery tips regarding the battery of more exercises at this stage.

    • Hi Lalit, Thanks for your comment.

      The exercises will not stay painful for long.
      Yes you will be allowed to gradually put load on the operated leg. You probably would be asked to put on another brace / knee support soon.

      Do push yourself to exercise regularly & go as hard as the doc recommends. Exercise like you have to get back to full fitness & play in the cricket world cup 🙂

      Set some similar goal for yourself, get family involved for motivation.

      Watch out for getting into the habit of putting more load on the good knee! It’s ok initially, but once you can put load on both legs, do consciously try & not load the good knee too much. If that happens, soon the good knee might start hurting.

      Best wishes, you should soon be fine & back to normal. Exercise Exercise Exercise! 🙂

  • Smita

    I must say it is a very very informative article from an Indian perspective. Lalit is my brother. It is kind of reassuring that his treatment is exactly as it should be although unfortunately you had to learn the right course of treatment the hard way. I really appreciate your attitude to overcome your pain. I also appreciate the way you have blogged down everything in detail so that it helps some one else like my brother suffering from ACL tear. Way to Go dude ! 🙂 Take care.

    • Thanks Smita. Apologies for the delayed reply.

  • Prabhakar

    Hi Harshad, thank you for such an informative article. My father undergone ligament replacement surgery three months back, but unfortunately the knee keeps on swelling due to leak of plasma and blood inside. Doctors has operated it again to cure but they could not figure it out. Can you please suggest a surgeon in Pune who I can refer to deal with such a critical situation.
    I will be very grateful for your reply on this.

  • Pisolkaruday

    Hi Harshad , Iliked ur article.My son aged 18 yrs has got an acl tear recently and we are plng surgery.Can u suggest some good surgeon in pune ?

  • Swati A Bhatia

    Hi Harshad,

    Thank you for such valuable information. It helped me to decide to go under this surgery. Like Lalit, I can’t have sound sleep in night due to pain. Can’t help. I can just complain to doctor about it and just can listen that it will be fine. Hope so..

  • Wazzy2

    Thank you for your experience, I had basicaly the same operation done except they used a patellar graft. Hard to explain to people the pain post op. Eight years later and I can’t kneel on it, unrealistic to expect perfection. Best wishes.

  • Abhijit13

    My ACL (+ MCL) tear is now 2 years old. I have met 4 doctors by now. My first doctor was an orthopedic surgon who could not detect that it was an ACL injury, and so did not advise properly, until 2 months later when an MRI revealed the same. After that I have met 3 best known sports medicine doctors in Pune including perhaps Dr S. that you have mentioned. The exercises have lead to some improvement (60% I can say) but the leg is still weak. So now I have referred to a Dr. B who is an orthopedic surgeon. I am undergoing thera-band exercises now. After 18 days of exercises, I don’t feel the leg is any better.

    Questions:
    * Should I go for a surgery?
    * Does ACL tear get cured completely? Should I prepare myself for the fact that I will have to live with a not-perfect leg?
     

    • Should I opt for surgery is a very tough one to answer. I would think it primarily depends on your age and how active your are. The problem with the injury is that unless you exercise hard & regularly, the injury is likely to get worse over time. 

      Also most of us can resolve to exercise every day but very few can actually do so. Yuvraj Singh has an ACL issue but has managed to exercise hard enough & and stay fit enough for cricket. About getting cured? – Kind of. You still have to exercise regularly post operation but the insecurity about the knee goes away and the dislocations don’t happen. As for a not-perfect knee for life: Unfortunately yes. Because even post operation, a couple of months of not exercising the knee and the knee starts making it’s presence felt. ——–It is likely that the surgery techniques will improve or already have, so do check with your doctor.Thera Bands work well. Do push yourself on the workouts.  The thera band website http://www.thera-bandacademy.com is quite useful. Do take a look. 

      • Abhijit13

        Thanks for the quick response :). 

        I am 31. I live a very active life, involving at least 30 km of bike run every day and climbing of steps and normally I am out of the house from 9 am to 11 pm!

        The exercises don’t make me feel better :(. That is what was pushing me to think of opting for a surgery. Any second thoughts after these details?

        • 31 + Active life … 
          I suppose you should consider surgery.  

          Strange that the exercises aren’t making you feel better. The knee should feel a lot more stable after you strengthen quadriceps and hamstrings. 

          Do note that you need weight/resistance workouts for this. Swimming , cycling, etc. does not suffice.

  • CalebBond

    Thanks for sharing your experience Harshad.  I just had my left ACL reconstruction done 7 days ago with a patellar graft and am struggling to stay positive. My progress in flexion excercises has been slow and swelling/pain are a bigger problem than I expected so reading about your experience (and others) gives me hope and inspiration.  I am going for my right ACL reconstruction in 3 more weeks and was just feeling like this is going to be too much for me.  Again, thank you for sharing your experiences online as it makes it easier to have hope and stay positive 🙂

    Going to go do my excercises now!

    Regards,
    Caleb Bond

    • Thanks Caleb. 

      ACL reconstruction on both knees is sure going to be tough, but the best part is that things will definitely get better over time.  So you just have to hang in there, be particular about the exercises and all would be well soon!   Curious to know how you blew both ACLs…

      • CalebBond

        I was walking on a street with no sidewalk near my home, very close to the side for safety and wearing a reflective vest to be seen.  A young lady driving was speeding and reaching for her cigarettes and never saw me.  She hit me from behind at 40 miles per hour.  Knees were not the only problem 🙂

        • Thanks for sharing Caleb. 

          Do try & put down notes or maybe even a blog through your recovery. Will certainly be a big help to many others and might actually also help you through recovery. Do share the blog link with us :)Best wishes for a speedy recovery!

  • Anil

    Hi Harshad,
    It was a very informative article about the ACL injury.
    Few days back I injured my Rt leg knee and I have ACL tear (According to the printed MRI report its Partial tear, however by looking at MRI images doctor said its full tear of ACL).
    One of the doctor has suggested me to go through the surgery, however one another doctor said no need to go for a surgery.
    However after reading your article and comments from other people I have started to prepare myself for surgery.
    I would appreciate if you could please provide me any sports injury doctor’s reference in Pune. And if you could provide me your email address for further communication it will be really great as at this point of time I am looking forward for some advice from an experienced person.
    Not only Harshad, but also I would request to other people to provide their views and doctor’s information in Pune.

    Thanks in advance!

    Anil

    • santaslilhelper

      If ur already done with it then its cool but I was operated on in aditya birla hospital by a Dr Abhay Kulkarni

  • psychoorwat?

    I had to go through the same things post-op first night hurts like hell even with the proper pain medication started playing basketball immediately after 5 months after the surgery and almost got it done up again thankfully it wasn’t a tear but it did have an effect on me psychollogically and I’m in two minds whether to keep playing or to cherio my game and I’m only 18

  • Dev

    very informative . to be honest I think most of us would agree that ACL recon is something that non-athletes like me are not aware of until they have it torn and recon done. For me it was an alien word “ACL” , I dont play regularly like most of the people in IT industry , around 38 yrs and during a fun game of volleybal with my colleagues , I got it torn . Believe me or not, neither I was jumping , nor landing heavily , nor running nor looking to strike the ball . was just standing with legs slightly apart on a normal clayey court and then suddenly had a tearing pain like death . In the worst case possibly my leg was slightly twisted but not to an extent that it should tear something . Am well-built , little overweight though not huge , was into heavy walking daily and very very active in day-to-day life . Doctors after MRI told I had ACL complete tear but meniscus intact . I did lot of google llater. The reason I decided to go for surgery immediately after 3 weeks was because I had zero stability on my knee and it was buckling like any loose steering. well , during surgery the arthroscopy showed I had partial medial meniscus damage , so was partially removed and mild patallar damage ( nothing removed though ) . It shocked me as how could that be if MRI shows only ACL tear ? anyway had to believe on the Surgeon who is a US registered surgeon based in Bangalore and operated on some top cricketers as well …..well , the reason to give this background information is to find out the answer that I still have in mind . How did my ACL tore without falling or twisting so heavily , I think it was a normal twist . And how can I assure myself that I would never twist like that again …. thats a BIG FEAR . I am off to 7 weeks now from surgery , have weakness in my leg , in fact very weak , doing the basic rehab , can bend my leg fully though in 30 days or so . I am confused with one question that most websites say . Mostly I saw that medical websites say that chances of arthritis in knee is more for recon knee …hmmmm ..well my doctor said that if I dont do surgery arthritis is faster . well either way I will have it – faster if I dont do and later if do it ( which my doc didnt tell me , not sure whether for commercial reason 🙂 ) anyway , I had no choice due to instability , perhaps my quad and ham were not great enough to hold my knee without acl ….but I regret one thing …. If I knew that there is something called ACL in my knee before tearing it , probably would have managed not to tear since mine was a unique way of tearing it . I am now a frustrated man and relying more on blogs and forum to see what could be next in life

  • Barboza

    Bro tx a lot for th info man..was so insightful n useful. I just had an cal surgery n was looking for sm useful info as th docs don’t divulge much as u said..tax a ton. Hope ur doin fine now..God bless u man..

    • Thanks! Best wishes for a speedy recovery!

      • Vikram Saili

        Vikram Saili • 3 days ago

        my name is Vikram Saili, 31yrs old 2 weeks ago i slipped from the stairs and hit the glass door with a lot of blood flowing through my right knee exactly under the knee cap,,,i noticed that i can no longer bend my right ,i was able to put weight on my knee but could not bend it..so i walked backwards,,, until somebody saw me and called the ambulance and they took me to the nearest hospital..In hospital doctors did the xrays on my knee, but no fracture was there.,until a orthopedic told me that i have a torn patella tendon…they did the surgery on my knee and now i am at home ,,moving with crutches,,,,with a knee brace on..doctors have told me to not to put weight or bend the right knee… I am quite fit guy and enjoy exercise and want a healthy body…and never had such a problem in life till now.So i am a bit anxious to know what is patella tendon or Ac l tear all about..what should i do to make my knee stronger and will i be able to walk properly afterwards…please explain me,,or email it to me vikram_saili@yahoo.co.in

  • Vikram Saili

    my name is Vikram Saili, 31yrs old 2 weeks ago i slipped from the stairs and hit the glass door with a lot of blood flowing through my right knee exactly under the knee cap,,,i noticed that i can no longer bend my right ,i was able to put weight on my knee but could not bend it..so i walked backwards,,, until somebody saw me and called the ambulance and they took me to the nearest hospital..In hospital doctors did the xrays on my knee, but no fracture was there.,until a orthopedic told me that i have a torn patella tendon…they did the surgery on my knee and now i am at home ,,moving with crutches,,,,with a knee brace on..doctors have told me to not to put weight or bend the right knee… I am quite fit guy and enjoy exercise and want a healthy body…and never had such a problem in life till now.So i am a bit anxious to know what is patella tendon or Ac l tear all about..what should i do to make my knee stronger and will i be able to walk properly afterwards…please explain me,,or email it to me vikram_saili@yahoo.co.in

  • Prince

    Harshad,

    Thanks for sharing such a detailed info on not so familiar area-ACL injury.

    I was a regular badminton player and tore my ACL playing football in 2012 March. My first doctor also failed to identify ACL with Latchman test (I was very tense and my muscles were tight)-but I knew it was ACL after reading more on it later. After a week, I met another knee/joint specialist, diagnosed and did not wait any further for surgery (Injury to surgery in less than 2 weeks) My surgery was using Patella graft and my total hospital stay was 24 hours.

    Had physio support for first one month & after that continued with Gym work outs. Even after 9 months, my operated knee is weak-but has moderate strength to perform most of the activities. Started playing badminton in a lower level (I avoid backward jumps & one leg landing on my injured knee). Has been loosing games with whom I used to win earlier. but I had to start somewhere and hoping for a gradual improvement.Still I am very scared about the possibility of another knee injuries.

    Thanks

    Prince

  • cj Singh

    Hi Harshad,
    Very nice article. I injured my both ACLs within last one year. However now i need to get a replacement for the first one. The only issue being, im afraid to go to doctors in India for very reason that you have posted.

    Is there any good doctor you already know that can fix it without me doing rounds of hospitals.

    Best Regards
    CJ

  • sonam

    I have an ACL tear in my left knee.. I am quite new to pune. can you please suggest some good doctor for operation in pune?

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