ACL & MCL torn, but MD wants to wait 2-3 months for surgery: Is that reasonable?

[bc]

As posted in my Once is Enough thread, I happened to tear my ACL & MCL. It seems odd to me that my MD wants me to do physical therapy for a couple months and then (maybe) do surgery. Should I be pushing for surgery ASAP? Or is it OK to wait a while? And is there any way to know who a good surgeon is? (limited to Kaiser Permanente in California, so I probably don't have much choice)

I'd really like to get surgery soon so that I can still take my New Zealand trip. The plan was to spend July and August there and get quite a bit of skiing in... But now I'd still like to spend those two months in Dunedin... And I can get PT from the instructors at their PT school for $30NZ or from the (supervised) students for $10NZ, so I'd be all set for the recovery process...

Thanks for the advice!

[NEngineer]

Waiting will also give your MCL time to heal and time to get you legs strong before the ACL replacement. The stronger you are before surgery, quicker the rehab.

Hate to be the bearer of bad news but even if you get the ACL replaced today, I doubt you will be able to ski in August. Talk to the doc and a good physical therpist about this. I was told (by the doc and PT) that the graft innnitially gradually weakens for the first 2 months and then starts to strengthen again. During this weak phase, you can tear the graft relatively easily. I'm not a doc but this is what I've been told.

Good luck......

[Vinman]

My guess is that he wants to let the MCL heal. But 2-3 mo does sound long to me.

If you are not comfortable waiting that long it would probably be a good idea to get a second opinion.

[descender]

Is the doc going to do anything to the MCL? Maybe based on evaluating how well it heals? I had a similar injury and waited a while, but more for scheduling reasons. MCL healed on its own, ACL was replaced. I went into surgery pretty strong from cycling, but lost all quad strength after a few weeks. You probably want full range of motion and the ability to ride a bike well before surgery, otherwise the road afterwards may be worse. PM me if you want to know some good SF based docs (not kaiser though).

[splat]

You got a rock-solid diagnosis (and second opinion) that you need replacements of both the MCL and the ACL?

[irul&ublo]

Compared to the the other ligaments, the MCL has a much better blood supply and can heal on its own when other ligaments could not. That may be one reason your doc wants to wait.

[Theodore]

Listen to your docs! It needs return to normal as much as possible and you need to keep the ROM in the meantime. I mangled my knee on Dec 5th, went to the doc on the 7th and had surgery on the 26th. I still had a lot of swelling then. I don't know if its associated with that or the injuries I incurred, but my ROM isn't back to what it used to be. After reading the tread about Evan Raps I wouldn't rush much. You are talking about the quality of your knee's comfort for the rest of your days versus a vacation... If you are worried about it get a second opinion. Even if you get it checked out by the other doc it doens't mean thats where the surgery has to happen. In the end its your body and your decision.

[tarkman1]

1) Get a second opinion. If I listened to the first doctor that I saw less than two months ago, there is no way in hell I would have been at the Mammoth Mini this past weekend after shredding the PCL and MCL.

2) Are you a lock for surgery? How severe was the ACL injury? The doctor may be giving time for your MCL to heal itself before checking the ACL stability. At that time the doctor may make a decision on the necessity an ACL procedure. For instance, the doctor may decide bracing the knee is good enough.

3) Don't rush to surgery. You can always rebook the New Zeland trip, but you can't undo surgergy.

4) Seriously question any decision to do surgery on the MCL. Current wisdom is leaning towards the MCL heals best on its own.

[bc]

Waiting a bit

Waiting

if you get the ACL replaced today, I doubt you will be able to ski in August.

Yeah, I must have been unclear on this in my question. I have no intention of skiing in August, but I still don't want to miss out on seeing my potential girlfriend in NZ--by then it'll have been 4 months since we've seen each other.

get a second opinion.

Makes sense. Might be hard to do with Kaiser, though...

You probably want full range of motion and the ability to ride a bike well before surgery

Funny, I'd thought that whole "ability to ride a bike" thing was going to come after surgery... Didn't realize that maybe it should be before...

You got a rock-solid diagnosis (and second opinion) that you need replacements of both the MCL and the ACL?

Got 2 opinions that they are both torn--but not necessarily that they both need to be replaced.

MCL...can heal on its own when other ligaments could not.

Sensing a pattern here... Sounds like lots of you think that waiting for the MCL's sake probably makes sense...

It needs return to normal as much as possible and you need to keep the ROM in the meantime.

Guess I'd better be doing all my PT stretches. I have a pretty shitty ROM right now...

Don't rush to surgery.

You had a lot of good points. Will definitely have more discussions with my docs...

Thanks all for your helpful advice. I'd had a misconception that quick surgery was best because I friend of mine had surgery less than a week after tearing her ACL. Good to know that's not always true.

[Theodore]

Single ligament tears are a very diferent beast than multi ligament tears/other damage...

[here2day]

I had a complete ACL, grade II (partial) MCL, crushed LCLs (not torn) and a couple other issues on April 1, 2005. My doc also wanted to wait 8 weeks but he ended up doing the surgery after 7. He wanted the swelling to come down, my ROM to improve and the MCL to heal up a bit.

He said "stiff knee into surgery, stiff knee out and maybe stiff knee for life..."

I took his advice. The way I looked at it I was in for a pretty long rehab and a few extra weeks were no big thing.

1 year later I can do most cutting sports (skiing, tennis, etc) at about 80% of max.

Good luck.

[1wsguy]

I had a MCL tear about 10 years ago. The doc said the tear was "a 2 on a 1-3 scale", may need surgery, may not. Started PT/rehab right away it was so frking painful.

A couple of months of rehab and all was good; no surgery, and 10 years later, I'm not even sure which knee it was!!!?? Bad memory.... (bad habit in college), but the point is, no pain/MCL problems.