UKH

I have just got my MRI scan back and I have a grade three tear of the acl and meniscus damage.  This happened 6 days agao, i was bearly able to walk two steps for the first two days but am now walking around with barely a limp and the knee feels reasonably strong. The doctors here says the acl definitely needs surgery The reason I am posting here is that I am living in China and thinking of coming back to the U.K to get medical treatment, I have a daughter and wife here so its difficult for me to get back but I need to get it fixed,  the cost here for treatment is really more than I can afford.  If I get back to the U.K what is the likelyhood and timescale I would be looking at to get surgery on the acl.   Any help advice greatly appreciated. Thanks, Ben. 

I am about to contact my G.P in the U.K and see if it's possible to have an online or phone appointment.  I guess this should be my first step

I had mine fixed on NHS, same diagnosis as you. The waiting list took just over 2 years. Glad to have had it done now that recovery is over but that takes a long time as well. 

I have no idea whether they're right or not, so take this with a big pinch of salt..  but if you're willing to put a lot of work into keeping it strong, here's an n=1 data point for you on what is possible without:

https://www.theguardian.com/sport/2024/mar/25/jasmin-paris-interview-barkle...

“I was also doing strength sessions as well, which were a big help,” she adds. “Most people probably don’t know, but I’ve got no anterior cruciate ligament in my left knee, because I tore it when I was 17 and never had reconstructive surgery. I know some medics who are quite surprised I can do so much off-road terrain running. But I’ve really strengthened my leg up and my knee is really great at the moment.”

Sorry to point this out, but if you're living in China you probably aren't entitled to NHS care (unless you're also spending several months of the year living in the UK). Entitlement depends on where you're residing rather than being a UK citizen. You'd need to move back and be "ordinarily resident".

https://www.gov.uk/government/publications/help-for-nhs-to-recover-costs-of...

To be honest you'd be waiting months-years anyway so if it's something you wanted an opinion on quickly I'd look up someone privately and see them. 

Never knew that, wow!

I've been waiting over a year for ACL reconstruction on the NHS. I've seen about £7.5k quoted for private.

My knee currently feels very stable; I can carry heavy weights, ride bike, etc., but I haven't done any running/twisting on it.

The advice I got from the specialist was that if I just wanted to run and cycle I could probably treat conservatively, but if I want to get back to bouldering, heel hooks, drop knees, etc. it would be best to have the operation, and to avoid any running/twisting till the op to avoid any further damage.

It was the falling from height bouldering that particularly concerned them.

Hi Ben

Some useful info here

Best of luck

https://www.ukhillwalking.com/forums/skiing/acl_skiing_injury_recovery_times-7...

Was having a casual conversation with my physio while getting treatment for my ever aching achilles the other day about my colleague who tore her ACL, apparently treatment has moved on a lot over the past 10 years and 30% (could even be higher) of people's ACL repairs  itself so they don't all get operated on nowadays. Sorry I can't be of more help I was getting therapy at the same time and can't quite remember. 

thanks everyone for the replies, it's really made me feel better to hear other peoples stories, .  looks like surgery is not gonna happen for me probably like that is for the best.  if you google acl tears every article says it cant heal and surgery is essential, if you go on youtube and search acl injuries, all the videos suggest that rehab is probably the better option.   along with the price of surgery I think I will go for rehab

im surprised how strong my knee is feeling, just 7 days later and im not really getting any pain any more, is that quite normal?  I have injured this knee several times before and I feel it was longer to recover before.  That seems like promising news that I will recover this time

Surgery definitely isn’t essential, and it does carry risk. I lost my ACL skiing in 2019. Went rehab route. Don’t notice any difference in my knees now, do plenty mountaineering, mountain running, offpiste skiing/ touring etc. However, I do regular strength and proposition and stretching exercises and these are important - possibly essential. My physio (who worked with GB national athletes in various sports) reckoned that before the ACL surgery became popular, loads of folk (including elite) didn’t have ACLs and didn’t necessarily know they didn’t have them… 

Hey, new research has demonstrated approx 30% can heal. 

British journal of sports medicine 57 (2), 91-99, 2023

On another note there's lots of research on people rehabbing ACL tears with no surgery and returning to elite sport. The upshot of all this new research is you don't need surgery immediately. Rehab it well and you can always re-evaluate in 1-2 years. 

They found me a cancellation, so just had the reconstruction done; just over a year's wait. Probably could have had it done sooner but I chose not to allow them to look for space with other hospitals/surgeons as mine came with a very good reputation.

Well let you know how the rehab goes

As people have already mentioned, conservative management is increasingly supported by research. 

My advice would be to buy a gym membership and get started seeing a physio who is experienced/knowledgeable with ACL rehab. Dedicate at least 1 - 2 hours of rehab every other day in the gym and be patient.

I ruptured my left ACL 20 years ago. Assumed I'd need reconstruction and argued with my consultant who pointed me to rehab for it. So no surgery in the end. Still do maintenance exercises but run, climb and mountaineering as before. Do wear a brace skiing and more cautious skiing than used to be. Interestingly I had an MRI on the left knee for something else recently that reported an intact ACL. When I questioned it they indicated it was thinner but continuous. There are recent papers from Australia reporting some spontaneous repair of 'ruptured' ACLs. The working theory seems to be that the smallest remaining intact fibres may be sufficient to support spontaneous repair.

I've seen research indicating that reconstruction may reduce the likelihood of arthritis in the joint later in life though?

Anecdotally I've heard a few people say they rehabbed conservatively and continued playing high level sport, then ended up with chronic knee pain later.

.  It's now 2 weeks after the injury  and the knee has continued to improve, at the end of a long day on my feet I start to feel a tiny tweek while walking but most of the time walking is totally pain free and even going up and down stairs is fine.   This is now quite confusing to me because everything I read online is that after grade 3 tears and meniscus damage you are looking at a minimum of 6 months without playing sports.  my knee just doesn't feel like its going to need anything like that long before I can start easing back in to sports.    So I am interested if this is quite normal for me to be so pain free, is it really good news or am i just lucky that I dont have pain but the damgage is still just as serious and therefore I should expect to wait just as long as everybody else.   Thanks for all your replies, Ben

Curiously these points are both the direct opposite of what I’ve heard. 

I played a very good standard of Rugby for quite a few years without an ACL. Lots of Quads and Hamstring strengthening, and bike work. Taped up for the game, with a neoprene support over the top and lots of pain killers afterwards, unfortunately. My injury started with a Cartlidge tear, then gradually got worse over the years, it did result in an operation to fix the ACL in the end, but never played again after it. 

I'm recovering from a knee replacement at the moment due to all my injuries over the years, but wouldn't have changed a thing with regards my Rugby.

Interesting, have you got links to this research? It's generally accepted that an invasive procedure to any joint will likely have a negative impact on the development of degenerative changes. An interesting way of describing it would be the concept of "joint age", and an invasive procedure would increase this supposed age.

To your second point, it's hard to comment on individual's experience and their chronic knee pain could be so multifactorial. 

To the OP: this article is interesting. Good quality rehab can increase your likelihood of managing without ACLR. The way I sometimes describe it, you'll be doing rehab for a year at least, regardless of if you have surgery!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546284/

Was about a year ago I was looking at it so don't have any links, but looking around again I remember that it was related to the fact that I had no other damage to the knee.

It seemed that having the graft would reduce the chances of doing meniscus or cartilage damage later, both of which indicate a higher risk of arthritis than the ACL tear in isolation.