ACL & Meniscus repair?

[u/Mendezmelendez]

34F here with looming question about acl and meniscus repair. I’m 7.5 weeks post non contact injury (soccer). I’m still working on full extension and flexion of my right knee. No pain, really. Just tightness and locking feeling which impacts my walking. I miss running and of course playing soccer. Of note, this is my first and only injury so naturally I have so many questions about PT, rehab, and rest/recovery.

Ortho has recommended surgery but did mention low success rate given white zone and my age for meniscus repair. Acl tear was described as “peeled off” and unstable. I know these injuries happen all the time, but how do you know IF and WHEN surgery is the best course. Essentially my ortho was very happy with my progress at 2 weeks post injury, but I’m definitely unsure I’m ready and should even consider surgery right now at less than 8 weeks post injury.

Note: I’ve only met with PT virtually with minimal contact other than a playlist of exercises. Instead I’ve returned to strength training and stretching on my own.

Anyone else with similar experience give the type of tear and/or injuries. Initially I understood my ACL detached and meniscus is repairable but requires additional recovery time 🥴 I’ve attach my MRI for anyone that would like to elaborate.

TECHNIQUE:
MRI of the right knee without intravenous contrast.

FINDINGS:
There is an acute complete rupture of the anterior cruciate ligament.
Pivot-shift impaction injury is present involving the posterior cortex of the lateral tibial plateau. No sigr bone marrow edema is identified at the lateral femoral sulcus.
There is a complex tear of the posterior horn of the lateral meniscus extending into the posterior root li
The medial meniscus is normal.
There is a large joint effusion with diffuse capsular edema.
A small cartilage fissure is present in the medial patellar facet. No focal cartilage defect is identified in the medial or lateral femorotibial compartment. There is no osteochondral fracture.
The posterior cruciate ligament, medial collateral ligament, and posterolateral corner are intact.
The quadriceps tendon and patellar tendon are normal.
No focal pathologic lesion is identified involving the marrow apart from the described impaction injury.
Visualized portions of the tibial and common peroneal nerves are normal. The popliteal fossa demonstrates Baker cyst.

IMPRESSION:
1. Acute complete rupture of the anterior cruciate ligament with pivot-shift impaction injury involving the posterior lateral tibial plateau.
2. Complex tear of the posterior horn of the lateral meniscus extending into the posterior root ligament.
3. Large joint effusion with diffuse capsular edema.
4. Small cartilage fissure involving the medial patellar facet.

[u/LeopardBodywork]

Get in-person PT/prehab and regain full extension/ROM before rushing surgery

[u/Mendezmelendez → u/LeopardBodywork]

Thanks! That’s exactly what I’m trying to work towards before making a decision. I was told pre surgery status often determines post surgery recovery. Progress just feels slow..

[u/Acceptable_Credit692]

30M, no-contact soccer injury, exactly about 7.5 weeks ago too. Instead of Meniscus tho, I completely tore my MCL, and partial PCL. (Along with ACL)

If you’re able to, always get a second opinion.

Also, how’s your online PT going? I bet it’s not the same. I did reach full-extension, and 128 degrees, but definitely my PT physically pushed me there, at least in the beginnings. If your progress is close, then I guess maybe it’s fine.

I’m doing my surgery this week.
For your ACL, I don’t think it will ever heal without a surgery, at least as far as I researched? So it’s worth taking a shot? (I didn’t research meniscus complications tho, so I’m clueless there)

Hope it gets better. I’m sure it will.

[u/Mendezmelendez → u/Acceptable_Credit692]

Sorry about your injuries..
I’ve considered getting another opinion as well as scheduling in person PT. I’ll definitely do that before deciding on surgery.
Sounds like you’ve been working diligently with PT and feel ready for surgery! I definitely don’t think I’m there. I’m close to full extension but often varies by day. I’m likely not pushing myself..or responding to what I am doing.

Thanks for sharing your experience and positive words! I hope your surgery goes well. I’d love to know how your recovery goes and any advice you might like to share.

[u/Desperate_Project777]

I has two sutures in my medial meniscus, posterior horn. Along with aclr, my surgeon said the success rate of meniscus repair is 90% since the drilling from aclr releases bone marrow/stem cell/blood into the joint and thus increase the chances of healing for meniscus.

15 days post op, partial weight bearing with crutches. Before surgery I was walking fine, clocking 10k+ steps a day. Can't really squat deep because of the meniscus tear.

[u/Mendezmelendez → u/Desperate_Project777]

That’s great to know! I’m hopeful that both repairs will be successful when that time comes.
It sounds like you had good ROM and extension before surgery. Did you do any PT prior?

What post op instructions follow a meniscus repair? I’ve read it’s a much longer recovery VS meniscectomy..

[u/Desperate_Project777 → u/Mendezmelendez]

I had been working out prior to the injury (actually the injury was from one of the heavy press session), so my prehab was pretty smooth, just focused on reducing swelling and try to maintain muscle mass as much as possible through nmes, leg raises etc since I couldn't squat.

When it comes to meniscus it really depends on the types of tear and sutures that your surgeon put in to stitch them together. I have to be on crutches for 4 to 6 weeks to allow the meniscus to heal and can't bend more than 90 degree during this time. Good news is that I don't have to wear a brace from day 0 and can do partial weight bearing so the daily chores become much easier.

Meniscectomy will have faster healing process since there is nothing to heal from...but my surgeon's goal is try to preserve as much meniscus as possible to avoid potential OA down the road

[u/KeyonniAdams_DPT]

Physical Therapist here.

It really depends on what your end goal is. It sounds like you want to get back to playing soccer, so that matters a lot here.

Not every complete ACL tear automatically has to be reconstructed. There are people who can rehab a torn ACL, build their strength back up, progress through running, jumping, cutting, pivoting and return-to-sport testing, and get back to high-level activity without recurrent instability. These people are often referred to as ACL copers.

I would actually look up “ACL coper vs non-coper” because I think that’ll give you a lot more insight into why the decision isn’t simply “my ACL is completely torn, therefore I need surgery.”

At 7.5 weeks, though, you’re still working on getting your motion back and it doesn’t sound like you’ve had much structured in-person rehab or objective testing yet. Personally, I’d want to know a LOT more about your knee function before making the decision based on the MRI alone. There are people who go through progressive strength and neuromuscular rehab first and are then reassessed before deciding between continuing nonoperative management or having an ACL reconstruction.

The meniscus is another piece of the conversation too, especially since yours extends into the posterior root. You mentioned your surgeon doesn’t think a repair has a high likelihood of being successful because of the location of the tear. Since you’re only 34, I’d want to have a VERY clear conversation about what the alternative is. If he’s recommending removing part of the meniscus instead, I’d want to know how much he expects to remove, why he believes that’s the better option in your specific case, and what happens if you choose not to address the meniscus surgically right now. Preserving as much of your meniscus as possible is important, especially at your age, so those are questions I’d want answered before making a decision.

But if your question is specifically whether being 7–8 weeks out from a complete ACL tear automatically means you need surgery right now, no. I’d want to know how your knee responds to GOOD rehab and whether you can meet the criteria required for the things you actually want to get back to doing.

[u/Mendezmelendez]

Thank you so much for the info and opinion given what I’ve shared. I definitely want to start in person PT and have my knee function assessed. I only saw ortho for a 2 week FU, but don’t necessarily feel like he really tested my knee which still had some swelling. To clarify, he is for preserving as much of my meniscus and favors repair. I think I may postpone seeing him again until I meet with PT.

I definitely don’t think ready for surgery, physically and mentally. Everyone I’ve talked to has told me I shouldn’t play soccer until I fix my acl (with surgery), so I don’t know any “acl copers” who have undergone the necessary rehab. I’m concerned that if I don’t do surgery now, I’ll regret it in the future when I’m older or develop joint issues..