Partial ACL tear options

Hey Rip,

I'd like your sage advice for literally a friend. I've tried the search feature and the case doesn't quite fit.

30 yo female partially tore her right ACL a year ago. I don't know what grade tear. She has some pain and instability and can feel the edges of the tear catching when the knee bends. So far she has had at least 3 dr appointments about it and they are saying the decision is her's whether to get surgery as it is in a grey area. It is mostly functional but she is also not pushing it hard in the way she would like to (marital arts, etc) and used to.

I think I know your stance on hamstring harvesting for a graft (no fucking way) and an allograft does not seem to be an option for her (insurance restriction).

Between the last appointment and now, her Dr told her to push it as much as possible to test its actual stability. That involved a week of martial arts classes. The result was again middle road. Pain and soreness but no actual instabiilty but also she indicated due to being out of shape and rusty, she didn't really think she pushed it as hard as she'd like to.

Also, the Dr. is changing his story/suggestions. It started off 'do it', to 'we can go in, look at it, and decide whether to clean it up or repair it then' to 'we can't just go in to evaluate it, you need to decide, I can't tell you want to do' and because of that she has another consultation this Wednesday with another Dr.

I've suggested heavily to her she should DTFP to strengthen the joint but I suspect you know the response. She's thinking mobility exercises and high rep BW will strengthen it. Mind you, she DID ask me to look into it and is actively seeking advice so I was not just proselytizing lol.

Would you please weigh in? Leave it alone, rehab of some ilk, do clean up surgery, do full graft surgery(hamstring), or 'other'.

Thanks Rip.

If she were my client, I would already have her deadlift up over 200 and her knee therefore more stable, and she would understand that stretching makes a joint unstable and that high reps means light weights which doesn't mean strong. If she were my client and she wanted an allograft, we would figure out a way to get her an allograft.

Quote:

---

Originally Posted by Mark Rippetoe

If she were my client, I would already have her deadlift up over 200 and her knee therefore more stable, and she would understand that stretching makes a joint unstable and that high reps means light weights which doesn't mean strong. If she were my client and she wanted an allograft, we would figure out a way to get her an allograft.

---

Thanks.

With that in mind, if you were 30 years younger, would you go for surgery (allograft) or strengthen and see what that gets you? Any take on the clean up procedure?

You would still have her squatting, correct? Or not?

My complete rupture was repaired with an allograft, which subsequently ruptured. Repair a complete rupture, train through a partial. I'd have to know more about the injury and the proposed clean-up process before I could comment. And yes, deadlifts as well as squats.

Did you also have a hamstring repair? I thought I'd read that.

It was damaged doing an obstacle course where she missed a step and went down when her knee caved. She didn't even know it was torn for about 4 months, thinking it was a persistent sprain that would not go away. She estimates her daily pain about 3-4. Better some, worse others, spiking when pushed. They have not told her the degree of the tear.

What more can I tell you about the injury or have answered by the surgeon on her upcoming appointment.

All i know about the clean up is that they would go in and trim out the torn ends of the tendon.

How did your repair rupture? Just 'natural' failure or were you doing something that damaged it? Is the recovery/rehab about a year as I've read?

No hamstring repair. There is a tendon involved? My repair ruptured several years later, soccer and a horse wreck.

If the partial tear causes laxity, I might suggest speaking to the surgeon about doing an ACL augmentation with an Arthrex Internal Brace.

Quote:

---

Originally Posted by Mark Rippetoe

No hamstring repair. There is a tendon involved? My repair ruptured several years later, soccer and a horse wreck.

---

Sorry. My bad. Ligament. ACL after all.

Quote:

---

Originally Posted by Will Morris

If the partial tear causes laxity, I might suggest speaking to the surgeon about doing an ACL augmentation with an Arthrex Internal Brace.

---

Thanks. I'm mention that.

Quote:

---

Originally Posted by Mark Rippetoe

.. a horse wreck.

---

Lil Tommy voice, "Horse gonna be OK Uncle Rip?"