THE CLINIC: ACL Repair and Return to Running

Thu, 13 Sept. 2012 - 1:21 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I am a 120-lb female in my 50s and I have been running for 13 years. I average three to five miles once or twice during the week, then a longer run on the weekend, totaling about 15 or 20 miles. I have run 15 marathons in the last 5 years, using the run/walk method, with finishing times of 5:00 to 6:00. A month ago on a ski vacation, I fell and tore my right ACL. My orthopedic surgeon recommended physical therapy three times a week instead of surgery; he stressed that if I participated in sports such as basketball or tennis, surgery on my knee would be necessary, but that running would be possible without an intact ACL. At times my knee feels unstable and as though it will never heal. Is it simply too soon to know? Should I give up marathoning and stick to shorter distances? Is it even possible to run without an intact ACL? At my age, how dangerous is ACL surgery versus the more conservative physical therapy approach?
 
Josephine Moore
Palmdale, CA
 
ANSWER:
I feel your orthopedic surgeon is correct, since you must rehab your knee prior to any surgery. This takes at least 90 days, so you are worrying a bit ahead of schedule. An ACL repair can be performed successfully at any time up to one year, so there is no rush.
 
Robert Erickson, MD
Canton, OH
 
ANSWER:
If after a year you have instability in the knee you should have reconstruction of your ACL. I believe that while recovery from ACL reconstruction is a challenge, you should be able to recover and run without difficulty. If you tear your meniscus, you won’t be able to run; instability in the knee will likely lead to a torn meniscus. An allograft reconstruction can be done arthroscopically in about 20 to 30 minutes. It’s possible to be off crutches in three to five days and out of all braces within a week.
 
Warren King, MD
Palo Alto, CA
 
ANSWER:
You can run without an ACL; tennis, racquetball, and activities that require a start/stop or cut/turn will give you problems. Your orthopedist is right—give yourself at least three to six months of evaluating your limitations, then go back to your doctor and review the options. An arthroscopic allograft reconstruction works for a lot of people in your situation. While your knee recovers, time on the bike, stair stepper, rowing machine, and the like can keep you in great shape and extend your patience.
 
Larry Hull, MD
Centralia, WA

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(RUNNING & FITNEWS® April/March 2006 • Volume 24, Number 2)



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