My mother just called me to say that her persistent knee pain has been diagnosed as a torn ACL. Her doctor told her that surgery in a person her age (63) is not an option, but couldn’t give a good reason other than the recovery would be difficult.
I’m suspicious of this. Knee replacements, which seem much more involved to me, are done on people my mom’s age. So why not surgery to repair an ACL?
I’m not asking for specific medical advice, just some information on whether a second opinion would be warranted.
As for a torn ACL, I am not sure why this would be the case. I know someone aged 40 who just had his ACL replaced. I could make a guess with all the usual disclaimers, I am not a doctor, I am not your doctor, etc. Part of anchoring a new ACL is drilling a hole in the femur and another in the tibia, and older women can have problems with osteoporosis which might make this difficult.
The other question is, the meniscus might be torn, and that can be very difficult indeed to repair with passing age. One account I’ve read compares it to trying to stitch together wet tissue paper.
My understanding is that it is possible, but usually not done because the level of expected activity doesn’t warrant the surgery. I have no idea how active your mother is, but I would say in general, a 63 yo person isn’t playing soccer or basketball or another sport where they would need the stability, so they usually don’t do it. I had my ACL repaired, and it was a very painful rehabilitation. I was in high school at the time, with a lot of anticipated activity, so it made sense.
Thanks for replying. It’s been awhile since I took high school anatomy, but I was under the impression that the ACL was a necessary to normal motion, and that if it were not repaired, she would lose the ability to walk. But if it is, as you say, just a matter of stability and not mobility, then I feel somewhat better. She doesn’t play soccer or engage in strenuous sports, just walking for cardio.
I am no doctor, nor even a very good med student, but if all she is doing is walking, she should be fine with no surgery. It sounds like the doctor is advising against the surgery due to the cons outweighing the pros here. It sounds like the doctor didn’t do a very good job of laying out the reasons though, which is a shame.
As for ACL required for walking, often people, even very active people, will wait months to get it repaired if they can’t fit it in their schedule. If she’s in pain, however, they should be treating that.
It’s not necessary for everyday walking, but it is for doing athletic stuff, but probably not as much so as you might think.
At 16, I partially tore mine, and my orthopedic surgeon decided against reconstructing it- it wasn’t bad enough to warrant the surgery and recovery, if I could just wear a brace in the future, which I’d have to do anyway if I had the surgery.
21 years later, I haven’t really even bothered with the brace for about 10 years, so I doubt that an ACL tear in an elderly woman would be worth the pain, trouble and possible complications, unless she’s in the Senior Olympics or something like that.
Knee replacements are easy. The rehab is painful, but the restrictions are minimal, and usually doctors want the patient to move. Bones heal pretty quick and solid (relative to ligaments)and almost any motion the patient can tolerate is good. Some people need Physical Therapy because the healing requires more panful motion at the end of range then the patient can force their own self to do, but they don’t usually need it long.
ACL repairs are just as painful, and require months of messing around with knee braces, crutches, precautions about weight bearing and motion. The skilled Therapy time is longer, and the damn ACL usually stops hurting right at the time the graft is weakest.
Some people damage or destroy the ACL and have normal lives without really thinking much about it.
I hadn’t even thought about the rehab AFTER the surgery being possibly too demanding for someone who wasn’t super-active in the first place. Would be silly to do the surgery, only to have it be wasted if the patient can’t carry out the rehabilitation afterwards. Good to know!
When I tore mine, the surgeon laid it out as an option: either don’t do active things (sports, strenuous hiking), or do the surgery+rehab. Easy choice for me at the time (cut me, baby), but for many 65 year-olds, I suspect the choice is pretty easy the other way.
Of course, the surgeon also said everybody’s knee is a little different, and it’s all about dealing with the symptoms: there are people with no ACL left who are stable even during strenuous things, and there are people who would get instability just walking down the street. But if the knee isn’t buckling or giving out during normal activities (including sports if that’s a normal activity) then there’s really no reason to go through the hassle of surgery.
Oh, final thought. If the ACL is just partly torn, it can regrow and mostly fix itself. So if that’s the case with your mother, I would think surgery would be pretty much ruled out as unnecessary.
When I destroyed my left ACL, the doc basically told me to get used to it. I’ve done rehab to strengthen the knee, but he noted that since I looked like the only execise I got was getting up to get another beer, surgery wasn’t necessary.
John Elway played for years in the NFL at the highest level with a torn ACL. DeJuan Blair of the San Antonio Spurs has no ACL’s in either knee. He’s one of the top rookies in the NBA this year.
That’s close… what they told me is that it was more like underwear elastic- stretch it past a certain point, and some of the little rubber threads break, and it doesn’t go back to the way it was, but it’s still there. The joint’s just somewhat looser, that’s all.
One point to add. The expected activity level of the aging population is a moving target. ‘Well at your age you have to start slowing down,’ is a outdated medical assumption. If she has the motivation, a geriatric sports medicine friendly doc is probably available.
Thanks for the responses, everyone. I’ve forwarded the information and suggestions I’ve gotten here to her. I’ll have wait and see what she decides to do
The key is that he can’t give her a response other than recovery would be difficult. A second opinion may confirm what he said, but may not, but at least there is a chance that an explanation could be given. Some doctors have guide lines they go by and will not explain them or modify them due to specifics of a certain case.
When my husband’s knee finally gave entirely out, 15 years after getting it patched up after an accident shredded it, he was told by several doctors that the only thing to do was to replace it, but replacing it was not something they would do in someone so young. He had lived without the ACL for most of those 15 years.
He knew from information we had from when he injured the knee that the adhesive and artificial joints just did not last long (five years estimated in 1987) and typically knee replacement could only be redone once, if at all. In the mean time he had developed the added complication of metal sensitivity. We found a surgeon who was willing to do the surgery if he could find a knee my husband would tolerate. He had discussed pure platinum, but not long before the target date of the surgery, they came out with a zirconium knee. The doc installed the zirconium knee (rated for 30 years), and the knee itself is doing fine nearly 8 years later.
The points of all that are:
Some people live fine without an ACL, she might too
If the doctor won’t explain why they won’t do surgery, there is likely another that would be able to explain.
Not all doctors have the same guidelines.
Technologies change
If my husband took the advice of the first doctor he saw, he would still be waiting to be old enough for surgery, unable to walk without crutches and unable to use crutches because of other health issues.
Here is a cautionary tale. My grandmother found out she had a lump in her breast when she was 67. She found out because she changed doctors and the new one asked her about it. She had it biopsied, and fortunately it was benign, but when asked why he did not tell her, the first doc indicated that she was old enough he did not think it would make a difference in any case. She lived for another 16 years and was well most of them, her mother was even older when she died. Her first doctor saw 67 as almost dead.
I also suggest a second opinion, and you might go to a doctor who specializes in sports medicine for it. They have an affinity for knees and shoulders.
I second the suggestion that she go to someone specializing in sports medicine. The surgeon who cleaned up my husband’s knee in 1987 and got him walking again without the ACL was a sports medicine surgeon. He wanted to do the surgery on my husband because it was like a common football injury.
I’ve forwarded the information and suggestions I’ve gotten here to her. I’ll have wait and see what she decides to do