Hello Doctor,
I am a 30 year old, semi-professional, and at times a fully professional soccer player who also enjoys playing recreational flag football. My R foot is my dominant feet. I have had various knee and ankle injuries before (on both legs), some requiring surgery, some just physio-therapy.
I tore my L knee ACL in 1999 during a soccer game. It was a self-inflicted injury, involving my L planted foot and a twisting lateral motion. No other major meniscal or major ligament damage was reported from the subsequent MRI scan. 5 months post injury, I underwent ACL reconstruction surgery, the graft taken from the same injured knee's patellar tendon. After 2 months of physiotherapy, manual tests conducted by the surgeon made him suggest that the surgery was partially successful: the knee was slightly loose according to the surgeon but strong enough, and muscle building to support the knee is essential from there onwards.
So I proceeded to work hard during physio-therapy and was back in action: in competitive NCAA soccer training sessions 5 months after surgery (with Donjoy's knee brace), then in competitive soccer matches 7 months after surgery (without any knee brace). I have been playing ever since, for approx. 10 years without any problems on this L knee.
(Note: I have also had my R knee scoped once due to torn and pinched meniscus in 2006. My L ACL reconstructed knee has ever since felt the "stronger knee" thereafter, with less arthritis pain and better movement).
On March 2, 2010, during a competitive soccer match, I twisted my L knee laterally again, this time with some weight bearing of another player on me. The diagnostic indicated a tear of the reconstructed ACL graft. The pain is much less now though, and the swelling is also much less. I wouldn't have thought it was another ACL injury if it wasn't from the subsequent MRI scan results.
Truth is, I cannot imagine myself not fully functional again in sports at just 30 years of age. Hence, I would like to reconstruct the ACL for the 2nd time, if and only if the advice is to do so. I really appreciate if you could assist in providing me some guidance on what course of action I should take to get back on track. Some people say do nothing but workout my thigh and calf muscles, and it could be able to support my ACL-less knee. I find that hard to believe especially at cometitive level. I might be wrong...
Here are some of my questions:
Q1: What is the success rate/probability of success of the 2nd reconstructive ACL surgery versus the 1st? Is it history related or is it entirely just back to square one?
Q2: How much difficulty on doing the 2nd reconsructive surgery compared to the 1st one?
Q3: How tough is the post-op physiotherapy for the 2nd reconstructive surgery compared to the 1st one? How soon can I expect to get back to competitive level after the 2nd reconstructive surgery on the same knee? My surgeon here said up to 12 months!!! (versus only 6 months on 1st surgery). Is this true?
Q4: Which grafting technique would you advice? I am inclined on opting for the patellar tendon graft taken from my R knee. Or is it better to take an external graft from someone else? Or is it better to take it from my hamstring? From the same leg or different one?
Q5: If the answer is "YES I should do another reconstructive surgery", when would be the best time to do it? Now just after the injury, when my muscles are still strong, and my fitness is still good? Or wait 1-2 months after it so that the swelling reduces and allow time for me to increase muscle strength for post surgery rehab? Will it affect much if I do it during off-season (August: 5 months post injury), allowing myself to be mentally prepared for the post surgery physiotherapy?
I hope my questions do not burden you much. I do have team doctors and independant surgeons I speak to for advice, but I want to ensure I get a thorough opinion before I act this time around. Thanks for your time and looking forward to your reply.
