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Monday, April 28, 2014

Advice sought about an old Anterior Cruciate Ligament Injury (ACL)

"I am 42 years old and currently having ACL sport injury since 2000, and occasionally I got some sudden twist and gives me a very painful situation, my question is, as I have seen your video, I notice that maybe you can help me to oversee and any remedy for my problem, the orthopedic said at my age now surgery of my ACL is not advisable because there is no deformation of my legs, so what will I do and please let me know what are the possibilities for me to do and how to run even if I am having ACL injury"
(Name supplied - living in the Philippines)

I can identify with your concerns, having had two operations on one knee, as well as an ACL injury that did not require surgery many years ago.  Fourteen years of ongoing problems with your knee is 14 years too long in my opinion,  The simple rule of thumb with knees is this:

"Any pain that is felt within the knee joint, that is ongoing and/or results in swelling, must be taken seriously"

Pain and swelling within a joint tells you that damage is being done to delicate structures that have little capacity to heal.  If this damage is repeated once too often, then irreversible arthritis is pretty much inevitable.  While you can take products like glucosamine and chondroitin, these are of little value over the long term, if the harm is still being repeated.  Its a bit like trying to treat a burn while the hand is still on the hot plate.

Anterior cruciate ligaments (ACL) prevent the knee joint sliding back and forth which is what a knee MUST NOT do!  If you have suffered a rupture of the ACL, I do not think there is any alternative to having it surgically repaired.  Golly-gosh - I would not be waiting for there to be any deformity of the knee - unless your surgeon is recommending a knee replacement!

It may be that your surgeon is working with more information than supplied in this inquiry;  But it may also be that there are differing criteria in the Philippines for knee reconstruction surgery than here in New Zealand.  In New Zealand this kind of injury would be corrected surgically with little hesitation.  It is said that New Zealand has many of the leading knee surgeons because of our obsession with sports like rugby and netball.
My advice is to not give up on the surgical option but to seek one or more second opinions from other orthopedic surgeons.

With regards to running, I would be inclined not to do any running or, if you do, only on the condition that there is no discomfort or swelling.  You would be better off doing activities such as walking, rowing, cycling and swimming - at least until you have a solution for your ACL injury.  These activities will, later, become valuable as part of your rehabilitation, should you undergo surgery on the knee.  So get into them now!

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