ACL reconstruction in older people

**Laurene** · 05-23-2007, 01:52 PM

Hello,

First of all, this is my first post,and thanks for this forum. I'm trying to learn as much as possible as I'm sure you all did..

I'm gonna be 46. tore my acl almost 7 months ago. I just had surgery April 20,acl was not repaired..It never showed up on mri, my dr felt possible meniscus tear was reason for my knee giving out, since my knee is tight with flexion tests.. after surgery he told me my meniscus was fine, but acl was at least 95% torn.

As of today I do have 100% rom on that knee. I swim and am walking 3 miles a day. Returning to dr, I told him I wanted reconstruction surgery. he wants me to build up surrounding muscles and is worried that my age will lead to the knee freezing up. I injured it during a simple exercise during my self defense class, and really want to return to that and other strenuous activities for the rest of my life.. I'm getting a second opinion in 2 weeks and would like to schedule the surgery if I get it for possible 4 months due to financial reasons..

I want all your opinions because I don't want to feel like I can't be active person anymore just because I'm over 40. I was told that most reconstructions are for ppl under 30.

Any advice would be appreciated.. I look forward to reading responses, by for now, I have to leave for work!!

**drmark** · 05-23-2007, 04:10 PM

I do ACL surgery on patients that age all the time.

My conclusions are based on an accellerated rehab program that not all docs do. (Don't ask me why not)

Our experience is that if an person, young or old, is started weightbearing, and on ROM exercises immediately, they loose NO motion, and have NO other problems resultant from the reconstuction, beyond what would be expected of the teenagers.

In fact something about burying one or both of your parents, going through a divorce(s), having a kid(s) with ADHD, and losing one or two jobs, make the reaction to knee surgery negligable.

(This is in stark contrast to the teenagers who never suffered anything worse than a breakup of a three week old relationship)

For that reason, the post op course is far easier in the older folks.

**Vinman** · 05-23-2007, 04:55 PM

I agree if you want to be active and you are mentally prepared for the surgery and rehab then go for it. If your current doc won't do the surgery then go find a different doc.

**flatlander420** · 05-23-2007, 11:05 PM

"I was told that most reconstructions are for ppl under 30."

I had mine done at age 39. I am approaching 9 months P.O. I returned to Sunday league soccer around 6 1/2 months. I am not as quick as I used to be, but every time I play it feels better ,stronger and my confidence goes up a bit. I was told not to ski until next season though so I can't comment on how that feels.

**Laurene** · 05-24-2007, 01:21 AM

Thanks for everyones' encouragement! Dr. Mark yours was one of the very first sites I found on this subject. so I thank you very much. I wonder why other doctors aren't as progressive as you are?

**drmark** · 05-24-2007, 06:39 AM

Most docs do less than 10 of these cases per year. The have little confidence in what they do, and try to butress their insecurities by slowing down the rehab, but in fact, the rehab is the most important part of the mix.

I have done way over 2000 ACLs, (about 2 per week over 21 years)and have developed confidence in the stability that I achieve on the operating table. My experience has led me to know that that stability doesn't dissapear with a functional rehabilation program.

Maybe you should visit me.

**amyzilla** · 05-24-2007, 08:11 PM

My surgeon told me my ACL didn't necessarily have to be reconstructed because my knee was so stiff that I wasn't having a lot of instability issues. I decided to have it done because I'm young and I want to be as close to 100% as I possibly can be. After I made that decision, and a week before the ACL surgery, my knee locked up during a leg press exercise because my frayed ACL ended up blocking the joint motion. It was a scary moment that made me realize I'd made the right decision!

**Endlessseason** · 05-24-2007, 10:43 PM

Can't say that I'd call it old but, I had a full hamstring replacement of my right ACL at age 47. I was skiing the next month (I wouldn't recommend it but I had to). I stopped wearing the brace after 6 months.
The post-surgery pain has never completely gone away almost 4 years later. It was a most miserable, painful, horrible, awful recovery, but I'd do it again for the strength and mobility it provided me.
I highly recommend it.

**Big E** · 05-25-2007, 12:58 PM

Originally Posted by drmark

Most docs do less than 10 of these cases per year... I have done way over 2000 ACLs, (about 2 per week over 21 years)...

I think that's one of the most important things to take away from this thread. You want a doc that does ACLs all the time. On my first surgery, I'm honestly not sure how often that doc did them - I was still so shocked that I'd torn my ACL that I don't think I was asking many questions, at least not the right ones, at the time that I had the surgery. Fortunately, he still did a good job on it. When I had the other one done, the first doc I saw was in that same docs practice (original one had since retired). While I was waiting to see him, I realized that most of the patients at that ortho clinic were much older and just wanted to be able to walk again and play w/ the grandkids w/o pain. Then I saw the doc, and he seemed really pumped to be able to do an ACL. A bit too pumped. I ended up going elsewhere, to a doctor that worked with multiple pro and college teams and did nothing but knees. I felt a lot more comfortable having him do the surgery. Based on drmark's comments, perhaps it's no coincidence that my rehab regimen was a lot more aggressive w/ him than it was on the first go-round.

Good luck. The first month or so of rehab really sucks, but it's definitely worth getting it fixed.

**Hook** · 05-25-2007, 03:43 PM

Originally Posted by Endlessseason

Can't say that I'd call it old but, I had a full hamstring replacement of my right ACL at age 47. I was skiing the next month (I wouldn't recommend it but I had to). I stopped wearing the brace after 6 months.
The post-surgery pain has never completely gone away almost 4 years later. It was a most miserable, painful, horrible, awful recovery, but I'd do it again for the strength and mobility it provided me.
I highly recommend it.

Sayyyy, I'd be very interested in hearing more about this pain not going away thing.

Me; 46, torn ACL, abraded meniscus, possible lcl damage.

Bring on the recovery horror show as well, I'll buy you a beer.

**Hook** · 05-25-2007, 03:53 PM

Originally Posted by drmark

Most docs do less than 10 of these cases per year. The have little confidence in what they do, and try to butress their insecurities by slowing down the rehab, but in fact, the rehab is the most important part of the mix.

I have done way over 2000 ACLs, (about 2 per week over 21 years)and have developed confidence in the stability that I achieve on the operating table. My experience has led me to know that that stability doesn't dissapear with a functional rehabilation program.

Maybe you should visit me.

I think I'm going to have my knee whacked on in July, you take Aetna?

Seriously

**drmark** · 05-25-2007, 04:55 PM

Yep, we are on Aetna.
Email Yvonne at yjumawan@sandersclinic.net to get it all set up.

**Hook** · 05-25-2007, 05:08 PM

Originally Posted by drmark

Yep, we are on Aetna.
Email Yvonne at yjumawan@sandersclinic.net to get it all set up.

How would that rapid P.T. work long distance? I'd want to leave Houston right away, especially in July. I'm very self motivated and active, and am a member of a good gym.

While we're at it we should do a ACL repair T.R. complete with pictures. What say you Doc? Seriously.

**drmark** · 05-25-2007, 08:02 PM

People fly in on Monday in the early AM, have the surgery Monday in the afternoon, do rehab with us on Tues, do rehab on their own on Wed, and Thurs, do rehab with us on Fri and sometime on Sat in the AM. They all go home on Friday or Satureday. On Fri we start the stationary bike and folks continue on that at home. We exchange emails and videos of what every next step is in rehab, so it not like we are far away, even if you are in Singapore. Some folks go to a PT or a trainer for further rehab, but its up to them and not entirely an absolute necessity.

So far, the only out of town people that we have had to see again, and the folks that wanted me to do their other side.

What does T.R. mean?

**Hook** · 05-25-2007, 10:20 PM

T.R.= Trip report, like on the main page. It's the photo's of peeps ski adventures that get everyone stoked. (in between the drama)

I'd really like to look at pics of my operation.

I'm leaving for Alaska in the A.M. I'll shoot you an e-mail when I return.

Thanks Doc

**drmark** · 05-26-2007, 05:24 AM

You got a strong stomach, right.......

**cherry** · 06-27-2007, 01:54 PM

Hi,
I am a mad 46 yr old having acl reconstruction surgery (skiing accident) on 13th july. Will I be able to fly to my hols in the sun on the 21st july (8 days later)? If so, do I need to take any anticoagulants - warfarin? asprin?
Anyone know?
Thanks a lot,
Cherry

**saltwater.freshpowder** · 07-02-2007, 09:17 AM

Hey, I tore RIGHT ACL when I was 38, young doc implied I was too old for reconstruction (aka:: life sentence to sofa) -- he changed his tune upon tears falling when he said without ACL I could not ski again.

Now at 41 tore LEFT ACL --woman doc (my age) said --yee haw, let's rebuild that sucker so you can get back to activity!

Family (and nonskiiing friends) believe I should retire "the girls" (my kick ass pink skis).

I've worked as ski-instructor @ Keystone Colorado for seven seasons, grew up skiing Keystone, and fill up heart+soul in summit county (live in Florida). As I sit here recovering from surgery (doing boring leg lifts + heal slides) I am fearful of skiing and have repeat dreams of accident (not a fall, ACL popped when I was simply skiing to the side of run to take a picture).

So, I don't know what to tell you, I'm going to ski again and if I tear up my knee again, so be it.

Or, I can be under house arrest and blow out my butt instead of knee :-)

**attwater** · 04-16-2010, 12:27 PM

Dr. Sanders,

Tore my ACL two weeks ago yesterday, with a tear of the posterior horn of the medial meniscus extending to the inferior articular surface. I was at Grand Targhee on the last day of my last trip of the year in 21 inches of fresh (best day of the year), and it happened at 12:15 instead of at 4:15. Gentle slow turn with little or no edging in the powder, no wreck, but at the end of the turn, there was loud pop with knee pain that disappeared when I took off the ski. Had trouble getting the ski back on without pain until I got it lined up such that there was absolutely no side to side torque on my knee, skied the remaining 1,000 feet of vertical on one ski (all those lessons and exercises have finally paid off). Had X-rays and MRI in Idaho Falls that evening which confirmed the diagnosis.

I am an agressive level 9 skier who is 58 years old, and living in League City get in at least 20 days on mountain each year (averaged around 50 per year when I lived in Idaho). I want to pick right up skiing at that level or above next December and continue every year until I am at least 85 (will be returning to reside in Idaho in a few years or perhaps sooner with the Obama plan for NASA). Visited a colleague of yours of good repute down in the Clear Lake area, and he was quite hesitant to reconstruct my ACL due to my age. He has me doing six weeks of rehab and will revisit the potential of surgery at the end of it.

You seem to not have this hesitation. I was taken aback by a surgeon not first asking when I wanted to schedule my surgery.

Would it be worth my time and battling the Houston traffic to visit you? Can you identify with my dilemma?

Mark

**Mr. Multiglisse** · 04-16-2010, 04:40 PM

See full story in [ame="http://www.tetongravity.com/forums/showthread.php?t=189676"]this thread[/ame].

I am an "active outdoor person" but not an athlete by any stretch of the imagination. Short version, tore my ACL at 46. Did rehab, was skiing 2 months later, got a Donjoy brace, continued skiing (alpine, tele, XC), snowshoeing, paddling, portaging, hiking, throwing frisbee, etc. etc. OK, I gave up snowboarding and learned to be careful (most of the time). This year, at 52, I got it fixed. No one suggested I was too old, everyone suggested, "ït's about time."

Now, at the advanced, geriatric age of 52, my surgeon tells me that I "am healing ahead of schedule." And that is without Dr. Mark's accelerated program, just my own motivated rehab and the work of a skilled surgeon.

**surfbill** · 04-16-2010, 04:49 PM

all i can say is thank goodness for my allograft knee reconstruction, i am back to work and doing the insanity workout video with no problems. i had my ALLOGRAFT on august 18th 2009 and now 8 months later i almost as good as new. this is because of proper prehab and determined rehab. me old i can run circles around half the 30 year olds. old shmold its all a state of mind. just my 2 cents

**drmark** · 04-16-2010, 07:17 PM

And that is without Dr. Mark's accelerated program, just my own motivated rehab and the work of a skilled surgeon.[/QUOTE]

Accelerated rehab isn't so special. It doesn't take much more than motivation and a pint of sweat.

**hocky88** · 04-22-2010, 01:54 PM

DrMark I sent Yvonne an email and asked for some feedback. I'm in philly and am trying to find a good surgeon but really would strongly consider a trip to houston if my insurance covers the surgery. I play hockey on ice and on foot and ruptured my left acl on 3/12. I am getting my leg in good shape, riding a bike about 30 minutes a day, strength training as much as it will tolerate. I'm definately considering doing autograft patellar... 2 Questions here...Does the technique of the surgeon have a strong effect on the likelyhood of chronic patellar pain afterwards or is it more unexplainable? And second, After surgery what holds everything in place while the patellar bones grow togetherin thier new home? I think my doc that I am considering puts patients in a brace fully extended for as long as 2 weeks. That scares me as I worry about the atrophy for that long of a timeframe...I am going to see him on Monday and plan to ask a lot of questions about the rehab. Again, isn't there worries in the first few weeks that you should not move around too much? Thanks for posting here! Maybe I'll be on a plane soon...

**telepariah** · 04-23-2010, 11:14 AM

I was 48 when I had my acl (patellar tendon autograft), 70% menisectomy, chondroplasty, and microfracture surgery. My doc placed me in a CPM machine from the first night and I had full range of motion and could walk without a limp in 4 weeks. I ran at 12 weeks and I skied (tele on sand dunes) at 4.5 months. Whenever somebody tells me I can't do something because of my age (now 53) or for any other reason I get this fire in my gut that I won't stop until I prove them wrong.

Just had two shoulder surgeries in the last year and now I am starting to get myself back in shape for next season. Not only that, I have a goal forming to run the Leadville 100 mile footrace next year. It's your life. Don't let somebody who doesn't know you put limits on what you can do.

**bsmetana** · 05-13-2010, 07:03 PM

46 is old?? What the hell? I tore my ACL, PCL and MCL at age 43 and also had them repaired at the same age. The first orthopedic doc I saw kept saying "If you were an NFL player, I'd do surgery right away, but..." Well fuck that! I found a new doc who scheduled me for pre-op on my first visit. I may not be in the NFL, but I am back in Tae Kwon Do and back to running ( at age 44 - gasp!), and I plan to do those things and more until fate stops me - however that might be. You should have seen my 81 year-old Dad's oncologist's face when asked, " Have you had any falls recently?" and my Dad answered, "Well, just one when my Gator ( small vehicle) slipped out of gear while I was cutting trees in the woods and was headed right for me and I had to dive out of the way". Priceless!
You go, girl and tell that doc what he/she can do with their idea of old!