My ACL Tear Story 9 Month Update

How I tore my ACL

One night in September, I was playing in a beer league football game and decided to go for a header. Unfortunately, this decision led to me tearing my Anterior Cruciate Ligament (ACL). As I went up for the header, I received a slight shove in the back, causing me to lose my balance and land awkwardly on my left leg. I remember watching my leg bend unnaturally as I landed and then heard a loud snap accompanied by a sharp pain in my knee. I screamed and fell to the ground, needing help to get off the field. Although my knee started to swell, the pain was manageable, and I could put some weight on my leg, which led me to believe that it wasn’t so serious. However, when I went to see a physiotherapist, I discovered that my ACL had been torn. Later, an MRI confirmed the injury.

What is the ACL?

To better understand my situation, let’s first discuss the ACL, its function, and why it’s so important. The ACL or Anterior Cruciate Ligament is one of two cruciate ligaments located in the knee, the other being the PCL or Posterior Cruciate Ligament. The ACL is located in the front, while the PCL is located at the back. These ligaments connect the tibia and the femur. In simple terms, the ACL prevents the tibia from slipping forward, while the PCL prevents the tibia from slipping backward. The cruciate ligaments help to provide stability to the knee, and losing one of them can lead to an unstable knee.

Treating a full ACL tear

There are two main approaches to treating a fully torn ACL. The first is a conservative approach, which involves physical therapy and training, without surgery. The second approach involves a combination of surgery and physical therapy. In the surgical approach, there are two options: early surgery with minimal physical therapy beforehand, or delayed surgery after extensive physical therapy, also known as prehab.

There are benefits and drawbacks to both approaches. With delayed surgery, you have the opportunity to determine if you’re a “coper” - someone who can function fairly well after a torn ACL, with little or no instability or pain. As a coper, you may not need surgery. However, if you opt for early surgery, you won’t have this option. The downside of delayed surgery is that if you do physical therapy for several months and then decide to have surgery, your total recovery timeline will be longer. It typically takes 9-12 months post-surgery to fully recover.

The ACL surgery

ACL surgery is a type of reconstructive surgery that does not involve repairing and reattaching the ligament. Instead, a graft is taken from another part of the body such as the hamstring tendon, patellar tendon, or quadriceps tendon. This means that a ligament is replaced with a tendon, which is generally not as strong as the original ligament, but still better than having no ligament at all. It is important to note that re-tears of the ACL are more likely to occur in operated knees due to the fact that a tendon is not as sturdy as a ligament. The surgery is done with a keyhole technique, which leaves a minimal wound compared to a normal surgery. After surgery awaits a full year of rehab, where the first time will be spent on crutches or some other form of walking aid. How long that time is will vary depending on if there were any other injuries repaired at the same time, and how well the individual responded to the surgery.

The first weeks of my rehab after an ACL injury

After providing some background information on the ACL, let’s refocus on my personal journey. My ACL tear happened at the worst possible time - my partner was pregnant and in week 38, which meant I only had a couple of weeks to recover before our son was due. In the first few days following the injury, I could barely walk and my knee was very swollen. I took rest and applied ice for the initial days, but on day three, I started doing some gentle exercises, such as quad sets and heel slides. A quad set involves lying down on the floor and trying to contract the muscles in your quad and holding for some time, then repeating the process. A heel slide is when you sit down on the floor, put a towel underneath your heel, and try to slide your leg toward you. I did these two exercises frequently throughout the day, and they helped to rebuild my strength and flexibility, which were both compromised after the injury. I also started incorporating some sessions on the exercise bike, which were great for my knee and cardiovascular health. I was making a lot of progress fast, and was really hopeful that I was going to make a really good recovery just by training.

Denying surgery and going too hard

A week after our son was born, my orthopedic surgeon contacted me to confirm that my ACL was torn and asked if I wanted to have surgery. At that time, I didn’t plan to have the surgery because I wanted to try a conservative approach first and also because the timing wasn’t right with a newborn at home. Three weeks post-injury, I was almost back to walking normally, and in the second month of rehab, I got a little bit of hubris and started doing barbell back squats and deadlifts like nothing had happened. I also started jumping and practicing landing way too early. The result of this was a lot of pain. I think I may have injured something else in my knee during this time, as I had no problems with pain at all before this, but I guess that won’t be confirmed until I eventually have my surgery, as no new MRI will be done.

Deciding to have surgery

I had initially planned to give rehab and the conservative approach six months to see where it would lead me. However, at the six-month mark, I realized that the stability in my knee wasn’t at the level I had hoped for. Despite engaging in strength training on and off for the past few months, my strength was fine, but I didn’t feel like I was making any real progress. The only improvement was in my flexibility, which was almost back to 100% at this point. I decided to visit my physiotherapist, with whom I hadn’t spoken much since my injury. He explained that the instability in my knee wasn’t going to improve significantly and recommended surgery. I had also come to the same conclusion myself, so I was hoping for that recommendation. He referred me back to the orthopedic clinic, and I went for another examination and got the surgery approved. At the time of writing this, I’m waiting to get my surgery time slot. It probably won’t happen until after summer, which is a bit unfortunate as I kind of just want to have it over with at this point. But on the other hand, it’s nice to be able to enjoy the summer. I’ll provide another update when I know more about my upcoming surgery. Until then, stay safe and protect your knees!