Three risk factors for a second ACL injury

Imagine you are a high school basketball player or an adult who plays recreational soccer. You land from a jump awkwardly and feel your knee buckle. It swells up immediately and you struggle to bear any weight on that leg. After a trip to see an orthopaedic surgeon, you learn that you tore your ACL.

Now you face surgery, 6-12 months of physical therapy, and a long Torn ACL and PCL in the intracondylar notchAll of those scenarios are frightening, but also imagine the possibility that after all of that work after surgery, you could tear the graft or tear the ACL in your other knee when you return to play. Is that a real possibility? How likely is it? And what increases an athlete’s chances of that outcome?

Also read:
When is an athlete ready for sports after ACL surgery?
Can “prehab” improve outcomes after ACL surgery?
Neuromuscular training programs can prevent ACL injuries and save money

New study looking at risk factors for ACL reinjury

A study presented last month at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Seattle, Washington examines the incidence of anterior cruciate ligament reinjury and the risk factors involved. Given that surgeons perform approximately 200,000 ACL reconstructions each year in the United States, a better understanding of these risk factors might have us prevent some of these injuries.

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Authors from the Multicenter Orthopaedic Outcomes Network (MOON) consortium collected data from almost 2700 patients in the MOON database who underwent ACL reconstructions between 2002 and 2008. They obtained follow up information for over 80% of the patients more than two years after the surgery. They analyzed this data to identify the incidence of reinjury to the ACL graft or a tear of patient’s contralateral ACL.

Rates of second ACL injury or injury to opposite knee

At two-year follow up, 4.3% of the patients had torn the surgical graft in Patellar tendon ACL graftthe injured knee, while 3.6% of them had torn the contralateral ACL.

Also read:
Reinjury more likely among athletes after ACL surgery
3 less known reasons athletes don’t return after ACL injuries

Among graft options for the initial ACL reconstruction, the odds of a retear of the graft did not differ between patellar tendon autograft and hamstring autograft. On the other hand, patients who received an allograft were 4.69 times as likely to suffer a second injury compared to the patellar tendon autograft patients.

Younger age and higher activity levels at the time of the initial ACL reconstruction were predictors of graft reinjury as well as injury to the contralateral normal ACL.

The lead author of the study, Christopher C. Kaeding, MD of the Ohio State University, summarized the MOON group’s findings. “The study highlights that younger age, higher activity levels at time of injury and what type of graft used (allograft) may increase risk of same side ACL injury within two years. With individuals having higher activity levels and lower age re-tears on the opposite leg were more prominent,” he noted.

Take home points

What can athletes and their parents learn from this study? First, it seems worthwhile to have a thorough discussion with the orthopaedic surgeon about the options for the graft to be used in the ACL reconstruction. Discuss risks and benefits of patellar tendon and hamstring autograft, and at least consider using autografts instead of allografts if the patient is young and very active in sports or athletic endeavors.

Also read:
Is return to soccer likely after ACL surgery?
The most important question to ask before ACL surgery?
Surgery, rehab often not enough after ACL injury

Next, discuss with the orthopaedic surgeon and the physical therapist after surgery about exercise programs that can be ACL knee brace soccerlearned and performed regularly to minimize the risk of reinjury. While no exercises can guarantee an athlete that she will not suffer an injury to the graft or to the opposite knee’s ACL, these programs might decrease that risk somewhat.

“Our research suggests that a few risk factors such as, age, activity level and type of graft utilized may point to the possibility of re-injury,” Kaeding concluded. “However, with better education about adjustments that can be made, based on these risk factors, patients may be able to minimize re-tears…Physicians and physical therapists need to better educate our patients about continued neuro-muscular training even after the immediate rehabilitation process has ended to help prevent future tears.”

Also read:
Video: ACL reconstruction surgery
Ask Dr. Geier – ACL Grafts
Ask Dr. Geier – Graft options for ACL surgery

Do these results surprise you? Have you suffered a second ACL injury? What type of graft did you use? If you treat athletes with ACL injuries, what advice would you share with patients preparing for ACL reconstruction?

Reference:
Kaeding CC, Pedroza AD, Reinke EK, Huston LJ. ACL Injury after ACL Reconstruction: Analysis of 2695 Primary ACL Reconstructions for Risk Factors. Presented at the 2014 American Orthopaedic Society for Sports Medicine’s (AOSSM) Annual Meeting.

93 Responses to Three risk factors for a second ACL injury

  1. I am 55-yr-old female. I have torn my acl 2x ea knee! I train, I could teach pt by now, I am considering giving up skiing tennis and any torquing sports. I don’t know what else I can do to prevent retears, to which I seem prone. I am 6 wks post acl patellar autograft surgery, getting stronger and fit slowly this time

    • I am 57 yr-old Female. 50 weeks post ACL using my hamstring. Was trimming branches from my porch. Stepped awardly. Have totally retorn the ACL MRI also showed substantial arthritis. I have been crazy about rehab. Continuing to go to gym 5-6 times week even after rehab over. Should I do another surgery? I will be 58 in two weeks. 5’10, 169 lbs, active. We hike. I had already given uo tennis and decided no more skiing. I was nit wearing a functional brace. Didnt think I Would need one. So distressed. Thoughts? By the way, I am in Charleston 9/3-9/10. Would happily get officiaal opinion. Thank you.

    • Sir i have been torned my acl due to an accident and i didnt done my acl surgery…it has been past 4 months..does it create a problem sir plz tell…

  2. I tore my ACL a year ago and I’m barely getting my surgery next month. Does that put more pressure to my opposite knee and be more likely to tear my acl or damage it ?

  3. My 17 year old son tore his ACL in wrestling Dec. 2014. We went with the allograft trusting surgeon knows best. After a year of physical therapy he felt he was ready for the mat again just to re tear it again. We are two week post surgery of a second allograft. Now I’m worried after reading this we should have insisted on using his own tissue. 🙁

    • Thanks for sharing your experience. I think more and more sports medicine orthopedic surgeons are getting away from allografts for primary ACL reconstructions.

      • Good to know. My 17 year old daughter is on her 2nd ACL tear in just less than a year. Tore it the 2nd time as she was just getting back into softball, and it happened in a way that didn’t seem a bit risky — like it was already extremely fragile. The first time around, her surgeon had planned to use her hamstring tendon rather than patellar as she’s a catcher. However, once getting in there, he didn’t feel her tendon was sufficient to do the job on its own so supplemented with donor tissue. It’s just hard to know if she’s just going to be susceptible or if something went wrong the first time around.

  4. I have done my ACL SURGERY n its have been 4 months,doctor said I can run but whn I start running thr is pain n I scared I might torn again

  5. HI, I had ACL reconstruction in september 2014 using my hamstring tendon. my initial rehab was going very well – until I over stretched for a tackle cuasing it to go again. I have an admission coming up to get this fixed again… my concern is that they will have to take my hamstring tendon from my opposite leg and therefore have a longer recovery time.. would this be the case?

    • There are many different options for grafts in revision surgeries, including the patellar tendon from the opposite knee, the patellar tendon from the involved knee and allografts.

  6. Hello I am a professional squash player and I did my ACL surgery 12 years ago, I am playing at such a high level and I wanted to know if grafting the hamstring muscle for the ACL reconstruction is more harmful than that allo graft or the patellar tendon as nowadays I am getting sudden spasms in my semimembranosus and semi tendinitis and the aductors during playing all of a sudden without any prior signs. I’m based in the United States and none of the doctors could give me any sufficient answer for what I am doing right for it not to happen or what I am doing wrong for it to happen as Sunday is it might happen and some other days it might not happen .

  7. I have an artophy in my right hamsring muscle do you to the graft they did I want to know if there is any way I can avoid those spasms which goes all the way up into my hips and hip bone attachments.
    Thank u

  8. When I was 16 I tore my ACL my sophomore year playing soccer, dr used my petellar tendon. Everything was great and it was senior year and I was back at it, even considering playing in college. Until I tore my meniscus mid season, continued playing, and tore my ACL again during our first tourney game. Just got 2nd surgery last Wednesday, dr used an allograft. I am 18 and am worried I won’t be able to live an active life without tearing it for a third time. Is it true that the allograft isn’t as strong? If I plan on being a runner or a lifter or cycling, are the chances a lot lower for me to tear it again? I need reassurance haha, thanks!

    • Allografts tend to take much longer to incorporate into the knee and have a higher reinjury rate. They can be options, though, in revision surgeries.

  9. I am a 16 year old teenage boy that (used to be 3 sport athlete looking to playing college sport) on my 2nd ACL reconstruction in the past year, one playing basketball and one playing football. I tore it on November of 2014 and had surgery in December. I also had 2 meniscus tears as well. One was very small and the other very large and long. Doctor stitched both up and felt that he did a efficient job. My graft was taken from my hamstring the first time. I finally returned to sports (full contact) in July of 2015 with no setbacks. I practiced for the first month and played in my first 2 games with no troubles or pains at all, making myself very confident. Started my third game back and on a regular play I had ran over 500 times all year, I got tackled and fell to the ground in pain, knowing/remembering the pain I have felt before. I had torn my ACL for the 2nd time and done more/excessive damage to other parts of my meniscus. (A huge root tear and a small tear next to my last tears from the last surgery) I had surgery on October 29th (Quad graft) and I am almost 3 and half weeks post op and I can honestly say this is the hardest/most pain enduring thing I have ever gone through. Although it is so much about pushing your body to the limits to heal correctly and to get back to where you were at before its so much more of a mental game than anything. I am no way in the state of mind that I will never be the same athlete before but a better one. You can all say that my decision to be back for the fall football season in 2016 is crazy, but really the only thing this injury has taught me is that I can still be the same person. I know all the risks for playing a high contact sport with 2 ACL surguies. Ive heard it all from plenty of doctors, but theres no going back to high school sports once youre out of high school. I once had a dream to play college sports, but that dream is fading away slowly. Some colleges have already gave up on me, but that just gives me more motivation to work harder and prove them wrong…

    • Thanks for sharing, my son tore his ACL (non contact) on the third day of football practice his Jr year and then in his senior year he tore his other ACL during the second football game. His dream of playing college football was crushed. He shared with me today that his would like to play again but afraid of a 3rd injury. Is it true some people are prone to ACL injuries than others. When should an athlete call it quits.

  10. In May of this year I had a complete tear of the ACL. I opted to do the physical therapy which was successful . But I still from time to time have issues with stability and my knee locking up on me. I just wasn’t sure if surgery was the greatest option for me but now that I possibly re injured my knee that could be a possility for me. This is by far the most excruciating pain to go through.

  11. Hello Dr,
    My name is Diptiman.I am 23 yrs old.I had a full acl torn 3 yrs ago.that time didn’t go for operation.I knew that my knee is not stable.in last October i injured my knee and felt that i need a operation.I am not playing high level games..but i want to run,jump and want to do my full activities ad before.My question is,after acl reconstruction is that possible for a 2nd acl torn while running or swimming?because of the delay i am scared.

    • Hi Dr,I had an ACL repair 7 years ago and have had problems ever since. I developed RSD and have never felt completely stable on that Left knee. Because I’ve never felt completely stable my right knee, the good one is showing signs of a similar pain. The original injury on the affected ACL tear knee happened in just a freak accident , as I am not an athlete . Is it possible to be prone to tearing ligaments ? Can someone be born with week and easily stretched ligaments ? I’m contemplating seeing an orthopedist but am embarrassed to describe pain without a specific injury except overcompensating by not feeling stable on the knee that was surgically fixed . All of this probably sounds dumb but do you have any recommendations . Thanks in advance Karen K

  12. i underwent ACL Reconstruction two weeks ago my weight is 124 Kg ,can I start walking with out support and what physio therapy I have to take and at what interval and please let me know what precautions I have to follow

  13. I will be 16 next month and I have two weeks until I have acl reconstructive surgery on my left knee. I tore it skating trying to ollie a stair set. I came down on my front leg which is something that happens quit often in skateboarding when not doing a trick right. I am afraid that I will never be able to do big gaps again without high risk of re tearinv my acl. I also think I may have torn my meniscus the othet day chill skating when I came down on the front leg and my knee locked up and started swelling. By getting back into skating a year from now how high are the risks for re tears, keeping in mind ill be jumping off things at high speeds up to like 5-6 feet on an average day. sometimes bigger.

  14. I had my first ACL repair in my knee 4.5 years ago and its given me no problems. I feel I may have just reinjured it though. I have the instability and popping but no pain (except for the one twist/step when I think it hsppened) and no swelling. If there’s no swelling, is an ACL tear likely? I’ve pulled out my old PT exercises to get those started again for strengthening.

  15. When I was 14, I participated in track, doing long jump.. Long story short I landed wrong and tore my acl. So, around may 2015 I underwent my first acl reconstruction surgery on my left knee. With a compete tear and slight meniscus tear. After surgery my doctor had told me that he could not find the meniscus tear, so he could not stitch it up. I was in probably 2 months of therapy. (I am a high level athlete looking to go to college and play) I worked extra hard, doing everything on my own outside of pt. I got released right around 3 1/2 months post op. So coming up on 2015-2016 season of basketball, I played maybe 8 full games, had no problems what so ever. On dec. 28 of 2015 I tore my acl for the second time and a meniscus tear, now surgery is scedualed for the beginning of February. I was just wondering since the doc didn’t find my first meniscus tear, that could have resulted in the second time?. Prayers for all you recovering and going through this!

  16. I have been a gymnast my entire life. I practiced with my surgeon’s daughter and he was there when I tore my ACL (along with my PCL and meniscus) , the first time in 2009. My patella was used for an autograft for my ACL.
    Two nights ago I slipped in my garage and found out today that I will need my ACL rebuilt. THANK GOD for this- I’ll be going for the hamstring I guess this time around since patella is gone, and now have zero interest in using a cadaver.

  17. I am 29years old. I tore my left ACL in 2012, I then tore my right ACL in 2015. I play high level field hockey. What are the chances of re-tearing an ACL (either left or right) if I return to play again? Thank you

  18. I am 34 years old. I tore my right ACL. In mri scan it shows as grade 3. Doctors suggesting a surgery, is it really needed.

  19. In November of 2004 I had surgery on my ACL. I completed physical therepy and went back into high scool sports. I am 26 now and after 3 kids and getting a little older I have to admit that I am quite out of shape. So my husband and I took the kids to the park and had quite a workout. We were sore and realized this might be a good way for us both to start getting back into shape. So we bought a basketball and took the kids out to the park again. Since I am short and have never been good at bball we decided to plase horse. At some point I ran to catch the ball and whn I stopped my knee buckled almost as if to kinda go back an in. At first it didn’t hurt and I went to run aound with my kids. Then at home after about 2 hours after the buckle my knee started to become sore. And later that night it was hard to put weight on it. There was only a slight swelling so little that nobody else noticed it. By the next day when I woke up it seemed fine a little sore but it didnt really hurt to walk on it. After about 3 hours though it was right back to hurt with weight put on it and it had started to popwhen completely bent. Now about 3 weeks since this happened the soreness is gone but the poping and occational sharp pain from weight is still there and while resting there is a dull ache…. Ideas.. My firts thought was that I retore it.

  20. Hello, I am 27 years old andI tore my ACL for the 4th time in my left knee. The last reconstruction done was with the left patella tendon. I recently tore it by slipping down steps (3 years post surgery). I do not know if I should get another reconstruction or if it is even possible at this point. I am a very active person and do not know if I can deal with a shaky knee for the rest of my life, but do not feel confident of the surgery even working.

  21. I had surgery oct 2014. I went to a concert last night and i feel messed it up again. I had total acl minisicus repair at unc chapel hill. Even like 6 months ago my knee still buckled up sometimes. Now it is just swollen. I still havent been able to run jog play soccer anything. It just never felt 100% it hurts behind my knee cap on the backside. It’s weird i dunno. I can walk on it but just feels kinda bruised feeling. I’m 33 years old and tore it july 2014 playing soccer with my friends. My left leg stayed straight as i swung with my right to kick the ball right leg did a 180 around my left and made a tearing sound like paper ripping. Any help would be beneficial. I Dont know if i should call the dr i had fhe surgery from or just get another mri. Here we go again. Thanks so much. John

  22. Hello I have torn my acl twice same knee playing soccer. If I do undergo surgery again what are the chances of tearing my ACL again. This next repair will involve a donor tissue instead of tearing part of my other hamstring. I just want to give up playing soccer and focus more on regular activities like walking,jogging,and maybe running. But nothing to the extreme. Any insights please.

  23. I’m a 17 year old female rugby player, tore my right ACL in April 2014, surgery with quad tendon in July 2014, when back in April 2015 and tore the left in June 2015 with quad tendon surgery done in July 2015. I’m starting up rugby again now (almost April 2016) and I’ll start full contact in a few weeks. I’m nervous about it but I had one of
    The best surgeons in Canada and they’re both 10x tighter than pre-injury!

  24. Tore my ACL 8 years ago playing rugby. Used my patellar tendon for the reconstruction. I am now 34 and just tore the new ACL also playing rugby. As it’s a 2nd tear, my orthopedist is pushing cadaver. The tear marks my retirement from rugby and I’m now looking for an alternative to the surgery.

  25. Hello my name is Angelo Ramos and Ive torn my Acl twice in the last 6 months. I first tore my Acl on November 11th 2015 due to a game of basketball. I had received surgery on December 22nd 2015 using a hamstring graft. My physical Therapy after post surgery was doing very well and I was 1 month ahead of schedule. I had finally gotten clearance from my orthopedic doctor that I can start light jogging on the treadmill. I gave it about 2 weeks to start jogging. As soon as i hopped onto the treadmill i heard a pop in my knee again and from there i knew that my nightmare had started all over again. It is April 6 2016 and this happened on March 24th 2016. I schedule surgery again this Thursday, and will most likely go with the patellar graft. The hardest part about an ACL recovery is not the physical therapy, nor the surgery, and not even the pain; it is keeping your head up and knowing that no matter the struggles you will be able to conquer them. I had a hard time grasping this concept the first time i had to go through recovery and fell into a depression, but with support around me i was able to keep my head up and get through it. Now this time around i know what to expect and I will bounce back and be stronger than ever. If anyone has questions please feel free to contact me on my email @ ajramos5794@gmail.com

  26. Thank you for this article.

    I tore my right ACL in 2008 (I was 21 that time and I was playing football) and replaced it with the LARS synthetic tissue. Last year I tore it again after unsucessfull paraglide landing and now I’m waiting for a two-stage surgery: first they are going to take out the titanium screws and fill the holes with my own bone, and after several months of recovery the regular ACL autograft surgery shold be done.
    Could you please share any studies on replacing broken artificial tissue with an autograft, or maybe any other treatment in similar case?

    • Hi Mikhail,
      Did you find an alternative surgery procedure or would you be undergoing the two stage surgery procedure? Could you please let me know? Because even I’m suffering ACL tear for the second time and doctor has suggested me the same two stage surgery process mentioned by you.

  27. I’m a 44 yr old female who is very active in softball. 5 Yrs ago I tore my ACL and last summer during our championship game I retore it again. Had surgery on January 20, 2016. Having physical therapy but seems to be good but slow. I want to return to active softball but everyone is telling I should give it up. What happens is I injured it again?

  28. EEEEEKKKK 3rd tear!!! Hi! Glad I found you. Please help lol! Playing soccer I had Right torn acl in 1992 & meniscus. Then while wakeboarding I did tear the same acl in 2006, cleaned up arthritis & meniscus. Had an allograft. A few years back, 2014, started having a lot of swelling and pain. Had an X-ray and things were still intact, so did a cortisone treatment. Then August 2015 recieved Syndisc. During 2015 had chronic sinusitis and was basically on antibiotics for 9 months. Felt as if the gel only lasted approximately 4/5 months. Just had an MRI last week and somehow ithe same acl is torn again. Still trying to wrap my head around it. I did not feel it like the past two. I’ve had it band problems. Constant knee swelling. Pain always. No pops or bad accidents. I’m 42. What are my best options? I’m a caretaker for my father going thru cancer. I don’t have time for me to be laid up. Oy vey.
    Thanks

  29. I am a 21 year old semi active female who tore her ACL in her left knee in October of 2015. I had surgery October 19, 2015 where the surgeon used my patella graft. Took physical therapy serious and had a pretty stable knee after about 3 months. Now 6 months later now we are in April of 2016 I had taken a pretty hard fall on concrete straight on to the front of my knee yesterday. My ROM is still good, and I am still able to walk at times without no pain. Sometimes though it does feel weaker and tight mainly where I had fallen. You can see the scrape exactly where my scar is. Just wondering if you had any input on the likely hood that I retore my ACL. Thank you. I also scheduled an appointment to go see my physical therapist, and if he thinks I need to go see the surgeon he is going to tell me. Thanks again.

  30. I’m a 19 year old female, tore my right ACL first in June 2014 playing rugby and had a hamstring graft. surgery in Sept 2014. Got cleared 6 months post-op to play contact sports again and within 3 games I completely destroyed the graft. Got my second surgery in Nov 2015, this time a patellar tendon graft and my recovery time has been much quicker but more pain in my knee. I believe my rugby career is over, unfortunately as I was scouted for a university rugby team.

  31. I’m a 40 year old female, tore my left ACL playing soccer with my son in October 2015 and had surgery January 2016 with a patellar autograft. Things were going great and I even started light running this past week. Today at PT I slipped and landed on my left leg off-balance, and felt that familiar pain although no pop. My PT did some tests and said it seems intact, so likely I injured it but not a full tear. There is some light swelling now and it feels weak/sore but not unstable. I will call my surgeon, but any idea how long to take it easy and whether I increased my chances of retearing it?

  32. My acl is torn 1.5 years ago.But i came to know about it now.and now my age is 14years.i shoud get surgery or not please tell me really confused .some doctors said that your age is small and you should wait for 2-3 years .so that you shoud be of age 18.

  33. I tore my ACL during basketball. I’m 17 years old and currently at 3 months since surgery. My knee feels amazing and my strength and stability is outstanding for where I am. I have been cleared to run track nothing side to side but straight forward stuff I’m fine. Although it’s really nice to be this far ahead it’s kinda scary. Any advice?

  34. Hi I am a 17 year old female, i tore my first ACL last year from basketball and did my surgery in June using my hamstring graft. i returned to football in nine months after intense physiotherapy only to tear the ACL in my other after 11 months post-op. however i tore it when i was making a tackle and the situation wasnt risky at all. Had I gone back too soon and is my football career over after my second ACL reconstruction surgery

  35. I’m a 17 year old female. i had my first ACL tear in my right knee and operated on it June 2015. after intense physiotherapy i started playing football 7 months after surgery. soon at 8 months i was doing intense training. however 4 may 2016 i tore the ACL in my left knee after playing only five games during my football season. i was wondering how long should i wait before it was completely safe to go back to football. another question i had was if it is even possible to go back to football on a higher level after tearing my ACL twice within such short periods.

  36. I tore my acl back in the summer of 2012 from a rigged up motorized scooter it was one of the skateboard type scooters rigged with a lawn mower motor. Basically an accident waiting to happen it was my bf’s and it didn’t have brakes and he would zip around on it and it looked like so much fun. So of course I had to ride it and I was riding it around the apartment complex but like I said it had no brakes so you had to let off the gas which is what I thought I was doing as I put my foot on the concrete to help me stop because I was going downhill and head for a concrete barrier and my bf was hesitant on letting me ride it because he kept saying I was going to wreck it and screw it up and break it. That was on my mind but as I put my foot on the ground I hit the gas instead of letting off turned the handle the wrong way and snapped my knee and was going faster for the concrete barrier I got to the barrier and stopped just in time but my leg was hurt and I couldn’t put pressure on it or walk. I had tore my ACL completely in half and had to have surgery and a graft put in now I think I have damaged that somehow my knee hurt me all night last night and now it’s swollen really bad. My insurance had expired after one day of physical therapy so I had to do therapy on my own.

  37. I tore my right acl landing from a jump in sport almost 6 years ago and had hamstring autograft. Just over a year ago I tore my left acl and am 9 1/2 months post op from that with a hamstring autograft again landing from a jump in sport. I went back to sport at almost 8 months and landing from a jump my knee collapsed under me, felt the same as previous times but no pop or crunch. It was at first diagnosed as a sprain, even my surgeon tested it and said “your ligaments feel fine”, however an mri revealed a re-rupture and a small cartilage tear! I have a further appointment with my surgeon next week to go over my options.

  38. I tore my right acl in Nov of 2014 and had it fixed the next month. I tour my left in Feb 2016 and had it fixed soon after. I’ve increased my exercise regimen and am determined to build strength. It’s a very scary process though considering both my tears were noncontact. One merely pivoting while walking.

  39. I am two weeks postop 2nd acl reconstruction (patellar tendon autograft), partial medial meniscectomy, and ALL allograft. Have experienced much less pain than the first ACL procedure 3 years prior (ACL autograft with hamstring). Advice I would give to anyone preparing for surgery is to strengthen your quads as much as possible. Also be prepared for some of the rarely discussed side effects of general anesthesia (i.e. Brain fogginess, depression). Postoperatively, find a reputable physical therapist and become best friends with your ice pack.

    • Was it the same knee?
      I am 57 yr-old Female. 50 weeks post ACL using my hamstring. Was trimming branches from my porch. Stepped awardly. Have totally retorn the ACL MRI also showed substantial arthritis. I have been crazy about rehab. Continuing to go to gym 5-6 times week even after rehab over. Trying gomdecide. Should I do another surgery? I will be 58 in two weeks. 5’10, 169 lbs, active. We hike. I had already given uo tennis and decided no more skiing. I was not wearing a functional brace. Didn’t think I would need one. Thank you.

  40. Hello Dr.

    What are the potential complications for hamstring graft for primary acl reconstruction where no other damage in terms of the donor site and reoccurrence rate (I exercise regularly but do not do any activities that require pivoting/ twisting).

  41. i tore my right acl and am 4 weeks post op i was throwing a ball and felt a slight click or buckle to the back of my knee lower hamstring and fell to ground. I just have slight pain to back of my knee at the moment and no swelling is there any chance I may have re ruptured my new ligament that soon?

  42. I am 13 and have torn my ACL 2x. (Possible 3) both of my knee injuries there was clear evidence of me tearing it. But this time they are unsure, as it may be a tear or be a kink. Is there any exercises or tests I can do at home to see if it has torn again. Thank you.

  43. Hello sir,on 10 fab 2016 i had ACL surgery in both knee…
    From last 5 days i run in morning..but i got sudden severe pain in left knee…
    When i take declofenac+paracetomol tab..i feel good…
    What is their any chance of graft injury….
    And one thing more that sometime during expiration i feel pain in knee.

  44. Tore Rt ACL and meniscus playing soccer in college (I’m a keeper and jumped for a save, landed, and another player took me out). Had repair done June of 2012 with donor graft and cleaned up meniscus tear. December 2012, tore Lt. ACL playing a pick up game of volleyball at the gym (had sports brace on the Rt). Waited until June 2013 for surgery due to finishing college. Again, repaired with donor. Now couple years out, have had knee cap issues in Rt and random pains in left. Every 6 months or so, I find myself having to do the basic strength exercises from back when surgery was first done. Figure I have just lost a lot of quad strength due to not playing anymore and just coaching. Exercises seem to help get everything back in balance so knee cap and other random pain doesn’t occur.

  45. I was born without the acl in my left knee. Tore my meniscus at age 7 but was able to do high level sports figure skating etc didn’t need an acl until I was 21. I tore my meniscus again so we thought it was a good option . Used a hamstring autograph just the Semi-T as I had strong long hamstrings . 6 years later my graft had disappeared without any sign of trauma and it was stable until then . Not a fiber existed . The meniscal roots had torn but miraculously scarred together revascularized and my joint is pristine with zero arthritis . I had a second acl done a year ago . Unfortunately there was osteomyelitis under the tibial screw . It never spread to the knee but it fractured my tunnels (divergent tunnels stacked screws )….fast forward to 3 more surgeries that year to clear the osteomyelitis which is now gone but the tunnels are huge and my graft is INTACT but there’s 18mm of anterior tibial translation. Just had hardware removal bone biopsies and again the surgeons were surprised there was zero cartiledge damage no arthritis pristine menisci etc …..so now I’m prepping for acl #3 and knee surgeries #7 & 8 .
    I realize I’m an odd case : hopefully the next one doesn’t have an infection and is in the right spot ! Considering my patellar tendon except it’s like the only normal ligament in my leg or the contra lateral patellar tendon ….hard choice . I’m extremely tiny with hypermobile joints . I think my rom surgery leg i.s 7-8 degrees hyoerextension and 152+ Flexion .
    There’s not pain in the knee it’s just the most unstable joint that’s around 3b Lachman , equivocal pivot shift , grade 3 FCL /varus (no it’s never torn it’s just hyperlax ), a pcl that has a segment distally orirntated , and I’ve chronically torn the mcl just from walking 👍 never hurt my other knee …it’s totally normal . Anyways I was wondering if you have seen any patients with true aplasia of the ACL ? And if so how did you go about repair ?

  46. Hello , I’m 37yrs old 3.5 weeks post op right ACL reco (hamstring) and meniscus repair ( cut ). I have had a great recovery up until today when I felt a twinge in my hamstring, it feels very much like a tear. What happens if it is a small tear is this just a set back in recovery time or would it require more surgery ? If it is just a set back is it common for things like this to happen

  47. I am 17, i tore my ACL and meniscus on November 5th 2015 at my basketball tryouts while doing a layup. i had my surgery on February 15th 2015. 4 months after my surgery i was shooting around and my friend showed up and we started playing one on one basketball and i was doing a layup and i landed and i felt my knee slide and i couldn’t walk on it for a couple minutes. I thought i had torn it again but I’m not 100% sure. My leg is always swelling up, my knee cap feels like it slides around and i have pain on a regular basis and I’m on my 6th month post op, i don’t know if this is normal and I am wondering if you think that my acl or meniscus is re torn?

  48. I am female and tore my right ACL in 1997 at 15 playing basketball. 8 days after being released from that surgery, tore my left ACL at 16 years old, again playing basketball. Both injuries were while running down the court for a layup. Both were repaired using tissue from my patellar tendon. Did not play sports after second surgery, but landed akwardly from a jump at age 19, heard a pop, and fell. Left knee again felt very unstable and had swelling and pain. I did not seek treatment at that time as I wasn’t planning on playing sports and had been told by the surgeon that they didn’t typically repair ACLs for people who weren’t leading active lifestyles (running,cutting, pivoting). Now at 34 I am suddenly having much worse knee pain, much worse instability, unable to go down stairs leading with my right foot. This sudden onset happened after a massage where the massage therapist mentioned tightness in my left hamstring and worked to relieve the tightness. Have an appointment with ortho in a couple of days and I will be glad to know the diagnosis and treatment options.

  49. I have torn my acl 3 months ago
    my doctor suggested me to take some rest.
    Now i feel a slight pain in my knee often but the major pain is reduced.
    i want to know that wheather my torn acl has recovered or not.
    please suggest some ways
    Also at many times during walking my knee snaps or creates a sound which is similar to sound produced when the fingers of hand are snapped.
    I want to know what is the reason behind it and is it anything serious or not.
    Please reply i really need your help.

    • Punyadeepa

      I am 27 year old male and I completely tore my ACL playing soccer over a year ago. I am currently on a waiting list to have reconstruction (I live in the UK). After resting for a few weeks I found that I could walk reasonably well although I had a terrible cracking coming from the knee. I have to say although uncomfortable, this cracking subsided after a few months (at one stage I thought it was never going away). The cracking was due to the muscles in the knee having shrunk as well as some other swelling, but it wasn’t serious. One year on I still have no ACL, however my “bad” knee is actually STRONGER than my “good” knee. I have zero pain and zero instability. I have also returned to playing soccer although I do not play at the 100% energy level that I used to for fear of overdoing it. However, my knee feels so good that I am considering not getting the operation. I do pilates regularly and find that my injured knee is far stronger than the other knee which is very strange.

      • drdavidgeier

        What would you advise on the above? My knee feels so good and strong and I have never had any instability, yet the MRI showed a complete ACL tear. Should I get the reconstructive surgery anyway?

        Matthew

  50. Yesterday morning I was playing a traditional game of Native American stickball in my Native American Studies class. While trying to make a goal, a guy slammed into me and threw my knee out of place. It popped right back in, and we put ice on it. It’s been over 24 hours and the swelling shows no sign of dissipating. I’m a 15 year old girl, and me and my father were wondering if we should go ahead and get it checked out by a doctor. My sister has had similar injuries, but none were from a traumatic cause like mine was. We have a brace on it and are keeping it elevated, but I’m still worried I might have torn something.

  51. last year when was 15 i was playing in a freshman football game and i cut when i was running with the ball and my knee bent in and popped. i had a allograft put in. Just last week i was playing in another varsity game and i planted my right knee to throw and my knee twisted and bent in once again and it was another complete tear. now im going to get my patella tendon put in. now at 16 years old and a sophomore in high school ive tore my acl twice in my right knee.

  52. Good day sir/doc! Last october 25 ill go to my sergion to reconstuct my acl. my proceedure is hamstring outograft. And now im worried that ill gonna re tear may acl becouse of the excercises that they teached me. Im gonna ask you if it is possible sir ?

  53. I will be going for my second ACL surgery in s few weeks. I am 55 year old male the knee gives out and different times the brace helps some, Is there more rehab for the second one ? I had shots in it nothing seems to help. I will get a allograft cadaver one just like the first one I hope the last too

  54. I am a 39 year old female that is very active (running, P90x, P90x3, etc). I had my ACL reconstructed when I was 13 using the patella tendon method. I have been having a great deal of pain in this knee post workout that radiates down my leg. I understand that I put this knee under a great deal of stress. But, I was concerned and wondering if ACL reconstruction is similar to a knee replacement, as in their need to be to be redone. Is this something to be concerned about being I had this surgery done well over 20 years ago?

  55. hi dr David

    I had my acl repaired last Friday and since then my dog bumped into the side of my knee while I was standing today an di felt pain and still feel pain in the area just behind my knee but a little bit down from it. How likely is it that this could have caused it to re tare?

  56. I already had an acl surgery for my left knee but the grafting is lose and surgery was unsuccessful…now i have a menuscus tear in right knee and i have pain inboth legs while walking

  57. My son tore his right ACL on Dec 22 2015, wrestling, had surgery Jan 28 2016, rehabbed and made it back for football in Sept. Now injured left ACL wrestling, His DR says there is a tear but MRI did not give a clear pic if it is a complete tear. Been rehabbing for 2 weeks now and knee is feeling better. He is talking about wanting to try and wrestle yet this season with the tear. He is a senior and state ranked. Weighing the risk???

  58. I am 24 year male and First time, I tore my right knee ACL in june, 2015 while playing football and had a surgery 12 oct 2015. But this time I again tore my ACL in right knee. Whether I should go for surgery for the second time or I should quit playing and go for rehab

  59. I had ACL (rupture) injury, that resulted in meniscus being ripped off and lodging behind my knee aswell. The knee has never fully recovered to same flexibility but have concern now about my other knee. How often does the knee that has not had the injury end up damage after ACL has occurred? Is this something to with walking different ; supporting the original injuried knee?

  60. At 32 is it worth going through with a 4th ACL surgery on my left knee?

    I just scheduled surgery for February 9th, and after 3 unsuccessful attempts I am feeling like it is pointless. I do yoga regularly, and most of the time my knee is fine. It’s been retorn for about a year, but as of the last two weeks it started giving out and getting caught hinging back and forth. So I decided it was time, and now I’m getting nervous about the recovery time versus being able to deal with this until inevitable knee replacement. Thanks.

  61. What should be considered on a revision ACL surgery whether to choose from the same patella or the other patella? The first surgery was patella on the knee that was injured and was done 1 year ago. Would the first patella tendon have grown back from the first surgery 1 year ago? What is the recovery like on the good knee if patella tendon is taken from there?

  62. I suffered my first ACL tear in the last game of my high school football career, went through surgery and was going through spring football with my college team and suffered my second tear on the opposite knee. I just recently suffered my third tear on the original knee and i am skeptical of getting back on the field, like you said “nobody would blame me if i don’t.” I believe i can play again and I am just seeking some advice. What is the best way that i can prevent my knee from getting injured again?

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