So I tore my ACL. Yayyyy.
For those of you who don’t know, the anterior cruciate ligament is in your knee. When you hear so and so blew their knee out, normally this involves tearing the ACL. The most common time you hear of torn ACLs are in NFL players. It’s an injury that has ended many of careers and crippled many of knees.
I decided to write about my experience dealing with my torn ACL. I also tore my meniscus. Double yayyyy. But I’ll write about that later. The ACL will take priority for now.
This is an insanely deep topic so writing about it will help me organize my thoughts. Hopefully it will help others who, in some way shape or form, have experience with this as well.
I think it will also be a great way of examining how much thought I think people need to take into consideration before opting for ANY surgery. As opposed to letting their bodies be cut open like they’re freakin’ science experiments. Or thinking they’ll get cut open, you know, no biggie, then walk away completely fine and go on with their life. Surgery is never that simple. Anyways…
This first post is going to be brief. The first element I want to write about is do you have to have surgery? I want to address this because of my experience with the various surgeons I’ve talked to.
From talking to some surgeons you would think that if you didn’t immediately have surgery your leg might as well be amputated. That’s how crucial some surgeons make this surgery out to be.
This is bullshit. I will delve into specifics in coming posts but just know if you’re talking to surgeons about this they should be having an open dialogue about your options. One of which should be whether surgery is beneficial for you. The first surgeon I saw said, “Yeah, you tore your ACL, you need surgery. I’ll send you over to so and so and she’ll schedule you.” Uhh, thanks, asshole.
The main thing I want to address in this post is when it comes to torn ACLs some people cope very well without surgery. In fact, some people cope so well they wouldn’t even know they had an issue unless someone told them they did. These are referred to as copers.
Copers seem as if they almost have no need for an ACL. They might completely rupture the ACL, but after the swelling and such goes down, there off as if nothing ever happened. It’s like they just had a sprain and needed to let it rest a little while.
This is compared to some others who, after their rupture, can’t step off a curb without their knee giving out to the point of face planting. These make up the non-copers.
One of the leading researchers in the area of copers versus non-copers is a woman named Lynn Mackler. While this is a fascinating and deep topic, this quote from Lynn says it all:
“I have spent the better part of 10 years studying true copers – those who can compensate fully for ACL rupture and even decades after injury have no OA (osetoarthritis). They are remarkably rare. Most people are non-copers.”
Found in this roundtable on ACL injuries: http://www.orthosupersite.com/view.aspx?rid=2568
Again, a fascinating topic but the fact of the matter is copers are outliers. By definition you are probably not one. If you’re reading about ACL injuries you’re almost assuredly not one. You would have no reason to suspect you have a torn ACL if you were a coper. You’d be too busy playing sports while the rest of us give you the finger out of jealousy.
If people are interested enough at some point I’ll write about what seems to differentiate a coper from a non-coper, but at the end of the day it’s just not very well understood. Lynn Mackler has research suggesting if your knee has had a giving way sensation one time since you tore your ACL, you are put into the non-coper group. A group where surgery may be suggested.
Therefore, rather than focus on the outliers, I’m going to focus on the majority. A majority I am a part of. By definition of us being non-copers we are possible candidates for surgery. What makes one person a better candidate for surgery than another? Is ACL surgery even beneficial? I feel a lot of ACL posts are about to come up….
Tracie
May 11, 2016
I’m very interested in copers vs non-copers. Briefly, 40 y/o highly active female, have ‘knee locking’ several times per year. Recent knee lock was over 2 hours as opposed to the usual 20-60 seconds. First time it locked was a few years ago. I’ve just called it my ‘wonky knee’.
The 2 hour lock worried me enough that I went to a sports doc. Yep…torn ACL. Based on movement evaluation, he seemed just as shocked as me. I ran a half marathon autumn 2015 (1800 foot elevation climb in the 9the mile, then back down the mountain again) squat and deadlift my body weight, and have no pain or issues (no limping, no probs withstairs, no wobble, no ‘give way’) unless it’s locked. When it is locked, it’s excruciating and feels like my leg is going to snap. Doc said my meniscus might be getting ‘pinched’.
Ortho appt next week, then probable MRI. It’s going to be tough to weigh pros and cons of surgery, but I’m worried about future OA or other issues. You mentioned a possible subsequent article going more in depth on copers vs non-copers. Did anything come of that? Thoughts on benefits/drawbacks of surgery given my history?
I can’t even think of when it might have torn except one bad fall in college (over 20 years ago). Could I really be this active and (mostly) pain free with a torn ACL?
reddyb
May 13, 2016
Hey Tracie,
I didn’t get a chance to directly go into more depth with copers vs non, but did hit on it indirectly here: http://b-reddy.org/2013/08/07/a-different-explanation-for-adrian-petersons-amazing-acl-recovery/
Where some people can perform at the highest level with no ACL. So yep, you could have been that active without having the ACL. Even more so as what you’ve referenced doesn’t involve much change of direction. Sports of this nature is really where a lack of ACL will make itself obvious. (Though again, some get away with it then too.)
I’ve gone much more in depth on surgery vs non-
http://b-reddy.org/2011/11/29/reconstructive-acl-surgery-is-it-beneficial/
https://b-reddy.org/2011/12/05/reconstructive-acl-surgery-is-it-worth-it/
Definitely see an orthopedist as a non-ortho rarely has a good feel for this stuff. Overall, does sound like your meniscus is getting in the way, causing the knee to lock. Very common sensation with mensical tears. I cover surgery on this below-
http://b-reddy.org/2014/03/05/more-evidence-against-knee-surgery/
http://b-reddy.org/2015/09/21/your-knee-just-locked-on-you-what-do-you-do-the-fickleness-of-the-meniscus/
Please keep me updated. Would like to hear how things go for you. I imagine surgery will not be an easy decision considering how functional you are. Furthermore, if a surgeon goes in there, they may want to do the meniscus and ACL, where it will be an interesting decision considering how long you’ve likely gotten away with no ACL. However, an ACL recovery is much, much harder and longer than only a meniscus.
Tracie
May 17, 2016
I saw the ortho today, and he says he is 100% sure my ACL is NOT torn and my meniscus is fine. He says it’s a patella chondromalacia and could be fixed with physical therapy. He said I have exceptionally loose joints, and that I would DEFINITELY know if I had torn my ACL at some point in my life.
My trainer and the exercise doctor disagree with the ortho diagnosis and want me to get a second (third?) opinion. The ortho only took xrays, and he said they’re perfectly fine (bones look good).
Next step – getting xrays from ortho to give to exercise doc, and seeing about an MRI??
What do you do when two “experts” who approach medicine from very different angles disagree???
reddyb
May 19, 2016
The orthopedist is going to be a much more valuable opinion when it comes to whether the ACL is torn. Their hands are usually pretty damn good in this regard.
Meniscus wise though is a different story. They could very well assess that and not truly know. Menisci are fickle. (Talked about in link in previous comment.)
A MRI can be helpful. If you’re exceptionally lax, there is even the (albeit small) possibility of being born with no ACLs.
I’m not sure what an “exercise doc” is (not really a specialty for MDs), but I’d be leaning towards the orthopedist opinion when it comes to your ACL more than any other. Doesn’t hurt to go see another ortho and see which opinions are matching up. A radiologist will give another opinion for a MRI as well. You can read their report yourself. You can get the orthopedist to look at the MRI with you and show you exactly where the ACL is and how it’s doing. (While the meniscus is again harder in this regard. No guarantee you see exactly what’s going on.)
Tracie
May 19, 2016
I went ahead and wrangled an appt yesterday with my primary care physician (Doc Osteopathy who’s been my doc for about 15 years). He said it could be a number of things (again with the exceptionally loose joints), so he said “let’s just get the MRI and take a look”. Doc #3 (primary care) says it’s “most likely” a torn meniscus flapping, since the knee “LOCKS” instead of the “CATCH” that happens with the runners knee.
It’s also my Osgood Schlatters knee, so I’ll get to see that on the picture, too! 🙂
THANKS for the responses! I’ll be happy when I get the MRI and have a better idea what’s going on in there! As a side note – MRI at a hospital here (Colorado) = $3,300. MRI at a standalone imaging center = $600. Glad I get to pick where I want to go, and my PCP will send the orders to my selected place.
reddyb
May 20, 2016
Me “Hi there, I’m looking to schedule a MRI.”
Imaging center “Ok, how’s such and such date?”
Me “That works. What will the cost be?”
Imaging center “Uh, well, um, that depends.”
Me “On what?”
Imaging center “On your insurance for instance.”
Me “I don’t mean what’s my cost. I mean what do you charge for a MRI?”
Imaging center “Oh, that, well, it depends.”
Me “On???”
Imaging Center [seemingly agitated at the question] “We change things based on what insurance you have, what’s the plan, what company is it”
Me “My plan is such and such. Can you tell me what it will be?”
Imaging Center “I’m not sure. I’d have to look that up, talk to someone else…”
Me “Ok, never mind. What’s the cost if I pay in cash?”
Imaging Center “$400.”
Me [shocked it’s only $400 after knowing they will bill thousands for one to insurance] “Christ, that wasn’t so bad now was it. I’ll do that. Bye.”
Tracie
May 20, 2016
TOTALLY! I got that response from one center, but since I had firm quotes from three others, I just hung up on them. They said “We can’t tell you the price until we bill the insurance company and they renegotiate the price, then you’ll pay 20% (my copay) of that.” ARE YOU KIDDING ME?
reddyb
May 20, 2016
It’s a bizarre way of doing things for sure. You’re left with some sense of “Do they just make up the prices as they go along? They can’t really be doing that? What am I missing?” But they genuinely do that!
I wanted to see where the numbers came from for my hospital bill (also when dealing with my knee). Took three weeks, four different phone numbers, 7+ plus people, an auditor, for them to tell me a $1500 was for “checking in with the nurse.” I asked them, “Ok, so what is that nurse’s hourly rate then? Because I was with her for 10 minutes, and that’s an astronimical rate. Like if I go to the mechanic I know how much I’m paying for labor and for the parts. What’s your labor cost?”
“Well, you’d have to talk to the CEO about that.”
“I need to talk to the CEO of the hospital to know what I’m paying for??? You’re the auditor for the billing department and you don’t know?”
Even funnier is I personally trained one of the ER doctors at this very same hospital. Very smart woman. I asked her about this. “Oh, I have no idea what anything costs. They just pay me.” Then I told her what my bill was. Her jaw dropped.
Yet there is a bill from the hospital which says “Doctor’s fee.” 1) They somehow know they labor cost for the doctor 2) Yet the doctor’s don’t even know what the doctor fee is.
It is an insane system. I only bring it up because those who go through an ACL tend to get more intimate with it than they want to be.
Tracie
May 21, 2016
It’s important information. Unfortunately, we have to “shop around” almost like buying a car when seeking medical care these days. Your post about the difficulty getting quality, reasonably priced health insurance following ACL reconstruction was particularly enlightening.