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)
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Gary:
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!

Please help! I have injured my knee!

"Hi Gary Me again! My old knee injury (sprained or damage to the anterior cruciate ligament & medial collateral ligament) appears to have flared up so was wondering if you could recommend anything to help with the inflammation? and whether you think i should go back to physio?

It is pretty minor compared to what i experienced years ago & was at its worst on Monday but has calmed down a bit thanks to wearing a stocking all day/night. The inside of my knee seems a little swollen & it feels tight at the back to the point that it is hard to completely straighten or kneel. I could still run quite happily on Tuesday but after realising my knee was a bit swollen have decided to stop until its back to normal. In terms of the cause I am not sure as have not had a sprain as such. However, my knee did start to 'click' a lot more (& is clicking quite a bit now) when I started to do single leg extensions where my leg/knee is at a 90degree (sitting on a gym machine) & I lift a 5kg weight with toe slightly pointed out.

This exercise is part of the program that my trainer at the gym (Chek Practitioner with Diplomas in Rehabilitation & in Sports Medicine from Otago Uni) designed & apparently works to strengthen the inside of my knee. She also just started me on a new exercise with the swiss ball where my torso is on the ground but lifted up in the 'bridging' position & my calves are on the swiss ball & i have to lift one leg up at a time & hold it for 5 seconds so as to apparently strengthen my core, butt & hamstring. i have found this exercise really hard & pretty much strain the balancing leg so i can keep the lifted leg up in the air.

The trainer is convinced that these exercises could not have caused my knee to flare up unless i was incorrect in my technique & suggested it might be a hamstring insertion (whatever that is!)& thought i should try antiflam cream & seeing a physio in a few days if it had not self-corrected. but as she has overrided my old physio exercises & your advice to do 1/4 squats (she got me doing full squats with minimal weight)

I'm now confused as don't know if i can trust that she knows what she's talking about or who i should ask....except you! all i know is that my knee has been fine for the past 5 years & now its not!

Pretty gutted as i ran 9k for the first time in 5 1/2 years last week! any suggestions would be greatly appreciated."
"R"
Gary Moller comments:
"R", The swelling is telling you that your knee has been injured somehow and the swelling is your body's way of restricting movement.

Knowing your history of knee injury, it is possible that the damage to your knee ligaments previously and possibly to the knee cartilage makes the joint vulnerable to further damage.

It is possible that some of the exercises that you describe doing could have irritated the knee joint.

Your anterior cruciate prevents forwardsliding of the tibia on the femur, especially when the large quadriceps contract. The medial ligament prevents the knee from buckling inwards. Between all of them, the ligaments hold the knee joint snug and secure. The articular cartilages form a shock absorbing dish between the bones of the knee joint (tibia and the femur). It is possible that you damaged one or two of these cartilages when you sprained your ligaments.

When you are doing any kind of strengthening exercises using the big thigh muscles you should be weight bearing. This is because the knee bones are held firmly in place in the dished cartilages. If you do leg exercises such as leg extensions on a leg extension weight machine, the lower leg will be hanging free, gapping the joint and throwing stress on already damaged or stretched ligaments. The joint cartilage is vulnerable to further damage as the joint is gapped and twisted.

I would be very careful of the Swiss Ball bridging exercise that you describe because the knee could gap and twist. If you want to work the hamstring and butt, do standing dead-lifts with a barbell or dumbells; but make sure you get expert instruction in safe technique, lest you do your back in!

Stick to weight-bearing exercises such as squats and never go beyond right angle knee bends when under pressure. Deep knee bends may strain the ligaments and pinch the cartilages. The best machine in the gym for you for strengthening the quads is the incline leg press. Avoid the hack squat, including wall squats with a Swiss Ball behind your back. These throw excess strain on the front portions of the knee, including the undersides of the kneecaps. You don't need this.

Always get professional instruction by a weights expert and review your technique regularly.

Ice may help with the swelling but I am not a fan of it. Elevation, plus rhythmic exercise is best. Massage the knee, thigh and calf.

Exercise in warm water to manage swelling and to maintain strength, endurance and flexibility.

Take a glucosamine and chondroitin formulation and MSM and take generous doses for as long as there is pain and swelling. Use these in preference to pain killers and anti-inflammatories. Add 2,000mg of vitamin C per day. Copious amounts of fish and flax oil and especially Evening Primrose Oil have natural anti inflammatory qualities while not compromising healing. These natural supplements will assist healing. Continue normal doses for at least three months after the knee has settled.

Contact me if the knee does not settle significantly by next week.