I suppose that most people who undergo knee repair do so soon after damaging it originally. When this is the case, they go from having a knee that is 100%, to one that is terribly swollen, painful, and unstable after their accident, to one that is still swollen, painful, and unstable after their surgery, and then they gradually work their way back to a knee that's pretty serviceable.
In these cases, the surgery isn't seen as a setback. The knee is already screwed up, and the person might feel that surgery is necessary in order to make any progress from there.
My case is a little different, in that I went for 10 years with my torn ACL before getting it fixed. Because of this, I think I have a good idea of just how much recovery one can expect from non-surgical rehab... and what life it like with an ACL-deficient knee.
How I Tore It:
Back around 1995, I was riding my motorcycle down the street and was coming up to a left turn. So, I changed into the center turn lane and started applying brakes. I didn't think of it at the time but, since people don't drive as much in the turn lane, that's where the loose gravel tends to accumulate. So, as I was applying the brakes, I started hearing a rumbling sound. This was the front-wheel of the bike, now locked, riding across a patch of gravel.
If you've ever locked the front wheel on a bicycle or mortocycle, then you know that the vehicle begins to pitch over almost immediately. It's like the thing has been patiently waiting, all this time, for it's one chance to cast you to the pavement. My case was no different, as the bike quickly began to pitch over to the left. So, in desperation, I stuck out my left leg and planted it, locked, on the asphalt and used it to sort-of "pole-vault" the bike upright.
Well, it worked! I didn't wipe out. Problem was, it felt like I had just been shot in the knee. Like most other ACL-tear reports I've read, this was the most painful thing I've ever experienced in my life. It was all I could do to ride to the curb, stop the bike, and fall to the curb, clutching my knee in agony for 5-10 minutes.
(In retrospect, I'm astonished by the fact that) I was able to get up and walk normally on the knee. It felt a little "slippery" inside, when I'd turn in certain ways, however... as though things were sliding around a little more than they were supposed to. It wasn't necessarily painful. It was just... "squishy".
A few hours later, however, and the knee was swelling up to the point where I couldn't bend it more than about 90 degrees. By the next day, I could bend it even less, and I could put almost no weight on it. So, I hobbled into my HMO to have them look at it and make sure I hadn't broken anything. They x-rayed it and found nothing... so the doctor concluded that I probably had a "contused meniscus". Uh, yeah... that's just the start of it, pal. (Knowing what I know now, I know that I had torn the ACL and had torn the medial meniscus cartilage, and that this torn piece of cartelage was still out of place, keeping me from being able to extend the leg fully).
The problem with HMO's, I've come to believe, is that they control who you get to see. Everything has to be through the referral of your primary-care physician. So, if they can just get him to avoid saying words like.... oh... I dunno... like "surgery", then they can save $30,000 or so while you get to walk around with a trick knee.
So, what they prescribed for me was a bunch of rehab. The physical-therapy people, however, suspected that I has a torn ACL, so they gave me a much of exercises to strengthen my leg muscles to get them to try to hold the knee in place and do what the ACL used to. They had me take lots of ibuprofin and apply ice often to minimize swelling and scar formation and told me to keep doing stretching exercises to gradually get my range of motion back (which wasn't going to happen as long as the cartilage was out of place).
After a couple of months, the knee was still a little tight. I still couldn't straighten it all the way and could bend it about 80% of what the other leg could. At this point, I decided it was time to see if I could return to playing my favorite sport: roller hockey. Figuring that it would go easier on the knee, I decided to just play goalie for the first season, to see how things went.
The first few weeks went okay, and it seemed as though the range of motion was getting a little better. The whole time, however, I was paranoid about anyone hitting my knee in the wrong way, because it clearly wasn't 100%. So, in the third or fourth game, there was a big scuffle for the puck in front of me, I dropped down to my knees on my pads, and then some player crashed into me, forcing my upper body all the way back and forcing my knees to bend all the way so that by butt was between my heels.
I felt something move in my knee, accompanied by a twinge of pain... but it wasn't anything like when I first tore it. Still, my brain was thinking that I had just screwed it up even more. Since the game was still going on, however, I decided to see if I could get up and stand on it. I could. Then, I decided to see if I could still bend it as much as I previously could. I could do that, too. Then, I checked to see how far I could straighten it. I could straighten it all the way! Today, I now know that what had happened was that the meniscus cartilage had just popped back into its proper place for the first time since I damaged it month ago!
So, if it hadn't been for hockey, I'd have been spending month after month, stretching my knee.... all the while, forcing the end of my femur to press against an already-torn piece of cartilage.
After the hockey incident "fixed" my knee, the range of motion improved more dramatically and the swelling continued to go down. Eventually, the knees looked and felt identical. Most of the time, I couldn't tell the difference between the knees.
However... I became acutely aware of the difference the first time I went out to play softball. I was able to hit, run, etc. but, on a close play, I had to field the ball and throw it hard from the outfield. On the run, I fielded the ball, and then planted my left foot and felt the knee give way. I may have been able to tough through it, but... in situations like this, I think the default reaction is just to stop making any structural demands upon your body... so I just relaxed and collapsed in a heap in the grass, clutching my knee.
After a minute, I discovered that I could still walk, so I went straight home and started icing it. That was the last time I played softball.
Repeat the same kinda story for: basketball, raquetball, and tennis. Everything felt swell, until I felt the knee "give", at which point I stopped, went home, iced the knee, and swore off that sport.
Each time this happened, the recovery was quicker. The first time, the knee was a little tight and sore for a few days. The next time, it was a day or two, and even less swelling. Eventually, I got to the point where I wasn't playing any sport but hockey. Most people think that hockey would be the worst for the knee, but it's not... because there's no way for you to plant your foot pointing forward and stop your lower leg, because you're on wheels. All turning, propulsion, and stopping in hockey comes with the leg trying to extend, so all force is lengthwise through the knee.
Still, every now and then, I'd be skating and I'd catch the toe of my skate, or some big dude would knock me off my skates and I'd feel a tweak in my knee. I'd gingerly skate back to the bench to assess the situation, conclude that no structural changes had taken place (no cartilage moved, nothing new tore, etc), and was able to go out there and finish the game. I'd go home, ice it and, by the next day, there was no noticable swelling or tightness.
The two points that I want to make with this are: 1) Yes, I'd periodically do something that would make the knee "give", but the recovery time after each one was shorter and shorter. It's almost as though by body had just accepted that this is the way that knee worked. 2) I ended up giving up quite a few sports (everything but hockey). For me, hockey is my favorite sport, so it wasn't as much of a sacrifice as it could have been. If I couldn't have played hockey, then I probably would have opted for surgery very early on.
So, fast-forward 10 years to February of 2006. I was in a hockey game and got a penalty which I didn't agree with. So, I went into the penalty box and just threw a complete tantrum. While doing so, I climed up on the dasher boards and jumped down onto the floor, trying to make noise. Unfortunately, I landed with my knees locked and I felt that familiar "give" in the knee. Only, this time, I couldn't straighten the knee afterward. What had happened is that the meniscus tear, after being dormant all this time, finally popped out of place again.
So, I did what I always did. Went home and iced it. When I got up the next day, I still couldn't straighten it past about 10-15 degrees. Uh oh. Throughout the week, I kept icing it and kept trying to stretch it (probably a bad thing...possibly tearing the meniscus even more). The next week, I went back to hockey and played goalie. Just like when I originally tore it ten years ago, there was a scrum in front of my net, I somehow fell over, felt something give in my knee, I got up, and found that I could straighten it again. Wierd. But I'm glad that something could fix it.
The wierd thing was, it would really kinda hurt when I'd be walking on it when I'd be straightening the knee through the point where it previously locked up. Once I was passed that, it felt better... but getting through that one 10-15 degree spot would really get your attention every time. I had to deliberately work the knee right through it. This would gradually subside over about 4 days.
Later that week, I was on my knees fixing something and I sat back wth my butt between my heels. I went to sit up and, as I did so, I felt something move in the knee. As I tried to stand, sure enough, I couldn't straighten it again.
Again, next week's hockey game fixed it. I just had to make sure to not kneel anymore. Then, I popped it out while squatting. Ugh! Playing goalie fixed it again. All the while I tried to mimic whatever it was about playing goalie that fixed it while at home. I'd have my girlfriend pull on the leg while twisting it or tweaking it... to no avail.
At this point, I went to an orthopedic surgeon to see, definitively, what the hell was wrong. While waiting for my appointment, I bent the knee wrong again and moved the meniscus. This really sucked, because hockey season was over, and I couldn't play goalie for three months. Having the knee in this condition was so irritating, I'd probably have chewed my own leg off before three months was over, so... I did the only thing I could think of. I strapped on my goalie pads and played an imaginary hockey game on my kitchen floor.
Finally, after 15 minutes of flopping, dropping, and kicking, I finally figured out what it was that made the knee pop back. Although the knee would ache for a few days after popping it back in, it was such a relief to be able to straighten it again.
A few days later, was my first ortho appt. He ordered MRI's but told me that it looked like I had an ACL tear with a torn medial meniscus. "No way.... REALLY? Ya think!?!?!". Still, it was good to hear a professional have the same opinion as the one I had been convinced of for many years.
An MRI and a few visits later, I elected for arthroscopic ACL repair, using an auto-graft from my own hamstring tendon.
It is my hope that my knee will be better than it has been in 10 years (I'd hate to think that I'm suffering through all of this just to get it back to the way it was). It'll take at least 6 months for use to find out.