Hi everyone! Thank you as always for all the great questions you send. While many of you use the Contact form on this site (which is great), please know that you can also use Facebook or Twitter. If you want to ask a question on Twitter, as Courtney did below, make sure you mention me so that I will see it. And I will do my best to answer it there or in an Ask Dr. Geier column or on The Dr. David Geier Show.
As always, please remember my disclaimer that I cannot and will not offer specific medical advice on my blog, on my show, on my social media pages, or by email.
Courtney Sanders asks on Twitter:
Hey! @DrDavidGeier just found out I have been running w/o an ACL for almost 10 yr and now have torn meniscus and arthritis stage 3. Will I run pain free again?!! I’m only 26. ;(
That is actually a more complicated question than you might think. First of all, it is certainly possible to run without an ACL. Sports like soccer, football, or basketball that involve rapidly changing directions, twisting, cutting, and landing from jumps are next to impossible without an ACL due to rotational instability. Running, however, is a forward motion. I have known several runners in their thirties who decided not to have surgery and were able to run without much change.
Having said that, if an athlete, even one who doesn’t play a cutting or pivoting sport, is having the knee give way or buckle, we usually recommended surgery to reconstruct the ACL. And having a meniscus tear probably makes sports medicine surgeons more inclined to treat the knee surgically, as the pain from the meniscus tear usually limits the patient’s activity. These are generalizations, so much of the decision is based on the specific symptoms.
As far as returning to sports and exercise after ACL surgery, it is a long process. As I have described elsewhere on this blog, the rehab process involves 5-6 months of physical therapy. First the patient and therapist work to restore full knee range of motion and then lower extremity strength. Gradually the therapist will allow the patient to start some exercise, such as stationary biking and then possibly an elliptical trainer. Jogging is usually withheld for 10-12 weeks to avoid repetitive stress on the ACL graft. Roughly around three months after surgery, the patient starts more functional training that involves plyometrics, balance, proprioception, and other skills that will get the athlete back to sports successfully.
Now unfortunately nothing is ever guaranteed with surgery, and that fact is especially true after ACL surgery. While most sports medicine surgeons do feel that return to sports is likely, there are some recent studies that show return-to-sports numbers closer to 60-70% instead of the 90% or so that we usually cite. I will discuss this data in an upcoming post, but many factors might be involved. Most important to these lower return-to-sports numbers seems to be psychological factors and apprehension about reinjuring the knee. Now these issues might not be as important in returning to jogging, which does not involve rapid twisting and landing from jumps. But it still must be remembered that return to a sport at the pre-injury level is never guaranteed.
Lastly, the presence of a meniscus tear and arthritis changes can be important. What specific treatment is needed for the meniscus can have a large effect. Most meniscus tears cannot be repaired (meaning sewn back together). The vast majority of meniscus surgeries involve trimming out the torn part, as the tear configuration and location is such that a repair would not heal. In theory, removing some of the meniscus, which acts as a shock absorber in the knee, could lead to arthritis changes down the road.
Also, the presence of arthritis changes at the time of surgery could suggest that the athlete will have some pain even after he or she has returned to full activity. As we have talked about in other posts, surgeons can look at the degenerative changes to the articular cartilage and try to smooth them out with a shaver. But this does not restore them to normal cartilage. While we have some treatments that might help small areas of cartilage damage, we have nothing reliable that reverses more diffuse changes back to normal cartilage. That doesn’t mean that the athlete cannot run, but it is important in a long-term sense.