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ACL Reconstruction and Meniscus Repair For Long Term Return to Sport

What is your story about?
I injured my ACL, MCL and meniscus playing soccer. I opted for surgery and went for an allograft because I felt that it aligned the most with my long term activity goals. I'm still in the process of recovering, but overall feel good about my decision to undergo this surgery.
How did your injury occur?
I'm a 30 year old female. I tore my ACL and medial meniscus playing soccer. Specifically, my diagnoses were Partial ACL, Grade 1 MCL, Bone Bruise, Joint Effusion, and Complex Medial Meniscus Tear in the Posterior. The injury itself didn't hurt that much; I limped off the soccer field and iced it, but was able to walk.
How did your symptoms evolve over time?
In the days/weeks after my injury I could walk around with a bit of a limp with no pain, but I could not fully straighten my leg and I could not squat or jump/run on my injured leg — that hurt. The meniscus pain was an intensely sharp, nerve-like pain that shot up my body when I triggered it: once by dropping into a squat at the dog park, once by forgetting and jogging after a door that was closing and once by doing a medical survey to see how much jumping hurt on a scale of 1-10 (answer 1000000000). Other than these sharp pains the meniscus injury mostly affected my range of motion. It took ...(more)
What was the diagnosis process like?
My GP told me it was 'probably just a sprain.' I asked for a referral to an ortho and got one, but his appointment was very brief, and ended in a prescription for six weeks of physio before being cleared for an MRI. I was concerned about the wait because I was walking with a significant limp, loss of ROM, and activities like squatting and any kind of jumping/jogging hurt significantly more than the initial injury. I had my GP and the ortho clinic call my insurance company to expedite the process and then I called the insurance company twice a day, every day until my request for an MRI was app ...(more)
How did you decide to pursue surgery?
My surgery was in Nov 2018.
  1. At the time of injury I was 29. My biggest fear is that if I opt to do nothing, my knee -will- be significantly weaker/more vulnerable because of this moving forward, and I'd hate to do something by accident, snap it the rest of the 10% and then need a repair at an older age where recovery isn't as great.
  2. I'm also afraid of the possibility of a second injury due to the weak ACL further shredding my meniscus and losing more arthritis-preventing padding.
  3. Given where my meniscus tear is, there's a chance it can be repaired, and that repair is actually most li ...
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Did you do any prehab strengthening?
I was instructed to do 300 SLRs and 100 quad sets per day as well as RICE leading up to the surgery. These were the only exercises I was given due to the nature of my specific injury so I completed those religiously every day. I was able to activate my quad and complete a SLR with proper form immediately after the surgery, so I do think my limited prehab helped.
What technique did your surgeon use?
I went with an allograft! My surgeon tends to do either BPTB autograft or tibialis posterior allografts as his specialties. After discussing my injury, activity levels, etc. and making sure I understood that an allograft will take longer to go through the ligamentisation process (and that I'd feel deceptively good before it reached full strength) we went with the allograft. To me, the wait time was worth it to avoid compromising more healthy tissue from my own body, so I went with that. No donor site morbidity was a huge plus. I am a runner, I used to compete in track at the provincial level ...(more)
What was recovery like?
Here's a timeline the recovery so far:
  • Week 1-2: I regained full extension and 90 degree flexion
  • Week 3: I drove to the mechanic and the DMV (registration expired, oops), waited in line at the post office, went to PT, and took my dog for a brief walk.
  • Weeks 3-6: I progress from NWB to FWB in my locked brace
  • Week 6: I came out of the brace. Flexion at ~110. Started practicing walking. First time on the bike at PT. Noticeably more swollen this week and stiffer, which I attributed to more walking and sleeping with my legs bent. Very sore calf on my repaired side from walking properly for ...
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Where are you at 9 months post op?
So I have switched PTs to one who focuses on strengthening my quad/vmo/hamstrings as much as possible. I made great strides, but was still struggling with painful extension. When they progressed me to agility drills as a precursor to getting me back into jogging, the day after brought back the very painful anterior knee pain. This happened last week, and I am seeing my surgeon tomorrow. They think that either the meniscus repair has failed, or I have scar tissue impinging the joint. Either way, they think I will need to go in for a quick cleanup procedure, and then back to work :)
Overall, would you recommend this surgery to someone in this position?
I'd recommend the surgery if you want to maintain long term activity levels, and because meniscus repairs perform better when done in conjunction with an ACL recon (it floods the site with blood so can bring blood/lymph to areas of the cartilage that aren't usually vascularized). You really want to keep as much of your meniscus as possible. I'd be nervous about my knee giving during sport and further injuring my menisci. I partially tore the ACL and had the option of just repairing the meniscus. I opted to do both, and am feeling great about the decision.
What advice would you give others with your condition?
You want to get your quads as strong as possible pre-surgery because they're going to atrophy afterwards, and rebuilding that strength in the muscles associated with your ACL is going to be a key part of your recovery.