CLINIC: Can I Run Without an ACL?

Wed, 5 Sept. 2012 - 12:21 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I am a 56-year-old female, 5’ 4”, 120 lbs, and have been running for 13 years. I average 15 to 20 miles per week, usually three to five miles once or twice, then a longer run on the weekend. I also do strength training, stationary biking, and yoga several times a week.

 

I enjoy long distance running, doing the run/walk method mostly on concrete or asphalt. I have run 15 marathons in the last five years (averaging three or four a year), with finishing times of 5:30 to 6:00. On training runs we average about a 13- to 14-minute mile pace. While on a skiing vacation a month ago, I fell and tore the ACL in my right knee (confirmed by MRI when I got home). My orthopedist recommended physical therapy three times a week to strengthen the knee instead of ACL repair surgery, in part due to my age and the risks of surgery as one ages. He explained that surgery would be necessary if I participated in sports; I stressed to him that I wanted to be able to run again. He said that it’s possible to run without an intact ACL.

 

I’m finishing my second week of rehab and noticing some improvement. The knee still feels unstable, however, though I’m told to be patient. I’m wondering should I give up marathoning once it heals and focus on shorter distances? Can I realistically expect to run at all with a torn ACL, even after rehab? I just want to return to running as I was before.

 

Jane Forrester

Baton Rouge, LA

 

ANSWER:

Yes, you can run long distance without an ACL. However, you will probably have more difficulty with tennis and other racquet sports, along with most activities that require stop, start, cut, turn, and stress. Your orthopedist’s advice is the general rule for most people aged 56, but you are much more demanding of your body than most people at that age, and so this may not be the best advice for you. Generally I would recommend giving it three to six months and see how you feel, what limitations you have, and whether you are comfortable with them. If not, return to your doctor and examine the options. 

 

I have some 50+ patients who sound a lot like you who have been much happier after an ACL reconstruction. I often suggest an allograft. This requires less surgery and is almost completely arthroscopic. It is quicker and less painful, with a smoother recovery, and the results are equally good to autograft hamstring or patellar tendon grafts.

 

There is a risk having an unstable knee from an ACL tear that, since more stress is applied to the medial and lateral meniscus, you’re more likely to wind up with a cartilage tear—then your knee would become worse. A loose ACL plus torn cartilage would most likely require surgery. 

 

While your knee is recovering, some time on the bike, stair stepper, rowing machine, and the like can keep you in tip-top shape.

 

Larry D. Hull, MD

Centralia, WA

ANSWER:

You must rehab your knee prior to any surgery, therefore your surgeon is correct in this conservative approach. This takes about 90 days, and the ACL repair surgery can be done anytime up to one year from the tear, so there is no rush. One of the nice things about being over 50, by the way, is that the knee tightens up in over 70% of the cases without surgery.

 

Robert Erickson, MD

Canton, OH

 

ANSWER:

If you have instability, you should have a reconstruction of your ACL. While recovering from an ACL reconstruction is a challenge, you should be able to recover and run without difficulty. If your knee is unstable, you will likely tear your meniscus eventually, and then you won’t be able to run. I agree that an allograft reconstruction, performed arthroscopically in about 20 to 30 minutes, is indeed the best procedure to choose. You want to be off your crutches in three to five days and out of all braces in a week. The Achilles tendon allograft is the strongest, and you can get a sterilized allograft so there is no risk of infection.

 

Warren King, MD

Palo Alto, CA  


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(RUNNING & FITNEWS®March / April 2008 • Volume 26, Number 2)




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