The Infamous ACL Tear: Part 1
By: Tyler Citrin
Tags: Surgery, Soccer, Optimism, Recovery, Health

Life isn’t over

Preface

I am writing this article to share my experience after tearing my ACL, to give people hope and understanding about getting through recovery optimistically, and at the right time. Feel free to reach out if you have any questions — I will work on future articles to share updates about my recovery progress.

Intro

I had been playing soccer a few days a week, working out, running, and everything in between to stay active and enjoy the warm weather after a winter spent mostly on the slopes and in the pandemic. I was in the best shape I had been in after quite a while, what else could I have asked for?

At 25 years old, in the shape I was in, the diet I was on, the daily care I put forth to keep my body limber through stretching and extra healthy with vitamin consumption, I never would have thought that I could tear my ACL. Before this, I never had a serious injury that set me back more than 2–3 weeks of some R+R, but low and behold, no one is impervious, not me nor professional athletes, especially not soccer players.

And then it Happened

But then after one bad play, I went down and I instantly knew something wasn’t right. I felt and heard something I never had before — I couldn’t even put weight on my leg, and that is when I knew — I definitely tore something.

The next 2 weeks I spent making calls, having a few doctor visits, getting X-rays and MRIs, until I had the lifechanging facetime with a sports Medicine Specialist who said the words I had been praying I wouldn’t hear — “You tore your ACL.” So yeah, I cried a little, this was a new feeling and realization I didn’t know how to deal with. I went from playing soccer minimum 5 days of week, among other physical activities, to not having a day in sight wherein I could return to what was my normal life.

Post Realization

After I received the news it took a little while for me to really “accept it.” I sat for a few days, or rather laid on the couch immobile in pain, trying to play back the incident and conceptualize how it could have happened, if it was real or just a bad dream, and if there was anything I could have done to prevent it. This quickly became futile and harmful — and once I recognized this I realized I had to move forward, there was no going back and no gain in dwelling in the “what ifs”

I mustered up the strength to start my research, reach out to physical therapists, sports medicine specialists, and surgeons, and get the ball rolling. It was far too early to know when any next steps would occur, but I couldn’t waste time on being equipped with knowledge and starting the healing process, knowing it was going to be a long and uphill battle.

Before the Surgery — Requirements

You have to be “cleared” for surgery, which is dictated by satisfactory reduction of swelling and a sufficient Range of Motion (ROM) replenished. This is critical as it makes the surgery more complicated with these disturbances, so ideally you start physical therapy right away to focus on these.

Pro Tip: always stay in touch, even weekly, with your surgeon to monitor progress

After some time with physical therapy, I followed up, went in for a checkup and was now “cleared.” I overcame the first hump — getting physically ready for surgery.

Pro Tip: I did PT with a specialist 3x a week, at home 10x a week. This drastically sped up the pre-surgery prep time

I asked the surgeon coordinator what dates were available, wherein she told me only Wednesdays. I next had to take on the hardest part of the journey prior to surgery, deciding when to have the surgery.

Build Support Network

This is definitely a tough time and not one you want to go through alone. Be honest with yourself and your friends, as well at work. Take some time for mental health and seek help whenever needed. I am super grateful for my family and friends that have been supporting me, as well my boss Yanir and co-workers that continue to lend a hand when and where needed.

Considerations because “There’s no perfect time”

Cleaning out your closet, getting a gym membership, starting a new hobby, investing, buying yourself a gift, asking out your crush…. there’s no perfect time. The same holds true for the surgery, there really is no perfect time. “The sooner the better” is often a good prescription, but there are many things to consider, so at the end of the day you have to decide when is right for you, if ever.

The best time to plant a tree was 20 years ago. The second best time is now.

At least a day or two prior to the surgery, you will probably want to take off from work.

You will have to fast before the surgery

You may be on pain killers and anesthesia that will prevent you from returning to work for a few days

Your appetite and bowels will be off for a few days

You may have difficulty showering for a few days

You will be on crutches for minimum 2 weeks

You will be in a hard brace for a few weeks after that

Now that you’ve digested the period immediately after the surgery, there are some other things to consider. For me, I had several travel destinations in mind I was planning to visit in the months following my anticipated surgery window, but given the time it takes to really “heal,” I simply could not do them all. Waiting a few weeks for one, would delay the surgery, which isn’t inherently bad (will discuss more later), but would put at risk going on later trips. I had to select what was more important to me — certain trips with friends and some more time for prehab, or faster recovery and trips with family. It was tough in the beginning, naturally I wanted to do everything, but that would have been a Herculean feat I wasn’t looking to run the risk.

In the long run, the travel and getting back to soccer, which are huge parts of my life, was good enough reason to start the countdown timer. I looked at the calendar, I gave myself a little buffer for both a few more fun weekends, and plenty of days to do physical therapy and prehab, and locked in a date.

Mentally, this motivated me more than ever, because I “had” to “be ready” for the surgery. I made prehab my second job and got my fitness back to a local maxima, which greatly improved the outcome of the surgery and the start of the recovery period thereafter.

Do you need surgery?

I am not a doctor, so I strongly encourage you reach out to a professional physician for final say, but I can give you things to consider to help you aid in your decision. You first need to decide what you are looking for in terms of tear life, which is quite simple.

The Truth: If you fully tore your ACL, are under the age of 40, and/or want to return to an above average athletic life with activities that utilize the ACL (lateral and balancing movements) — you should most probably get the surgery.

If you go through with it, you can delay it quite a bit — as long as you aren’t constantly doing activities that could cause major imbalances, there isn’t a lot of research done on the effects of waiting for the surgery

— as long as you aren’t constantly doing activities that could cause major imbalances, there isn’t a lot of research done on the effects of waiting for the surgery Did you fully tear it? If not, you are in luck, and it is certainly possible it could heal on its own.

Can I live a normal life after? Yes, you can, just be aware some activities will be difficult. If its fully torn, “the damage is already done,” but you could cause imbalances depending on the lifestyle you have.

There isn’t such thing as “waiting too long” — it depends on your goals, however if you don’t have a reason to delay it and are planning to get it, you should.

Regardless of the nature of the tear, getting surgery done (at a minimum PT) will help to reduce scar tissue, promote ligament repair, and most importantly decrease the risk of Arthritis in the knee

Prehab

This is exactly what it sounds like — it is rehab before your surgery.

You’re probably asking yourself, and rightfully so, why on Earth would you do rehab before surgery for your leg, when you’re not going to be able to use the gains and be bedridden after the surgery? You are right to be perplexed, and many Sports Medicine specialists are switching to this model because

after years of recent research it has been statistically proven that both the surgery and recovery have better success correlated to overall leg fitness.

This is simply an extension on the need for physical therapy before surgery to reduce swelling and increase Range of Motion, but with greater emphasis on fitness and strength. Different specialists have different opinions on how long, how much, and what types of Prehab to do. It is not a requirement, but could be very beneficial if done safely and helps with your goals.

Pro Tip: Collect multiple opinions and find a physical therapist that understands your goals.

Once I started physical therapy, about 3 weeks after my injury, I would go 3x a week, coupled with 10 total times of at home PT per week. After doing this for 2 weeks, I started to continue to increase the difficulty of my PT (at home and in the gym).

My physical therapist and I agreed I was “ready” for the surgery, in that I had met the pre-reqs, but I wasn’t satisfied with my fitness level and wanted to raise the bar. For roughly 5 weeks after that, I started adding in weekly full leg routine, slightly adjusted to avoid ACL-intensive exercises, but nonetheless, I was doing non-negligible amounts of weights and resistance. This also included a few days per week of light cardio on ellipticals, bikes, and stair-masters. By the end of 5 weeks all swelling had dissipated, I had a full range of motion, and I had quite a bit of new muscle growth and definition.

If you looked at my legs, you couldn’t tell a difference between the two, and based on my workouts and mobility, you definitely wouldn’t have suspected I had a torn ACL. This is where the mental game became increasingly difficult. Barring a few motions and acute isolated exercises, I felt “fully recovered,” which on paper I was, again, barring the ability to do those things.

However, I reminded myself that it was the very things I could not do, that were among the most crucial. So I could squat, deadlift, leg press, etc., but I couldn’t do the two things I cared the most about — pivot on a dime for soccer and slide across the dance floor after completing a 360 (I can write a whole separate article about dancing, but I will spare you that). With this in mind, I was now mentally ready.

Types of Surgery

Granted, once I told the Surgeon I was ready and picked a date, I didn’t think I would have to make any more decisions. Unfortunately, that was not the case, but fortunately, the following question, as daunting as it was, is becoming increasingly easier to answer as technology and research improve.

The question was as follows, “what type of graft do you want, autograft or allograft?” So first I am thinking, what the heck is a graft? A graft is simply a “sample” (segment) of bone and/or tissue from somewhere else, that is used in transplant surgeries. In this case, translated from Latin roots, auto means self and allo means other, and that’s what these are — you can get a graft from somewhere else in your body or get a graft from someone else.

At this point I had no idea how to make a decision so I did some research on the pros and cons of both, and I strongly encourage you to do the same.

Note: Graft adoption is the process by which the body accepts the new ligament/tendon/etc. and works to re-incorporate into body itself, similar to how stem cells work.

Autograft

Pros:

higher success rate of adoption

They are “cheaper”

Lower risk of infection

Cons:

You are getting “2 surgeries” (there’s the additional cut to remove the graft, albeit small depending where it comes from)

You may have to do extra work in PT and it may take longer to heal overall depending on the location of the graft

2. Allograft

Pros:

You only have the need one for one surgery (incision)

You are more likely to heal faster (overall, depending on quality of graft and surgery)

Cons:

They are more “expensive”

You need to trust and rely on your doctor to obtain a high quality graft

There is lower risk of adoption and higher risk of infection

So what is the verdict? On paper it look like Autograft is a clear winner, but this is definitely between you and your surgeon. In my case, my surgeon, who I strongly recommend you connect with if feasible, recommended the allograft for the following reasons:

As an athlete, he didn’t want to disrupt other parts of my body so I could heal faster

He directly works with the sourcing of Allografts for his practice

He has had great successes with his grafts

I took his recommendation and in less than a week I am already comfortably walking, albeit slowly, and making great progress on my ROM. It is early, but I am optimistic and look forward to sharing updates in the near future

Reminders

Stay positive: its going to be okay

its going to be okay Stay motivated: you dictate your recovery by how hard you work on your PT

you dictate your recovery by how hard you work on your PT Stay educated: do your research, and ask a lot of questions

do your research, and ask a lot of questions Stay connected: reach out to friends and professionals for any questions you have

reach out to friends and professionals for any questions you have Find yourself a PT and Surgeon practice that works before for you

My Doctor

As I mentioned, I had a phenomenal experience from start to finish with my Surgeon and highly recommend him. He is extremely well-educated, with many years of experience, in and out of the operating room, with thousands of surgeries under his belt.

His name is Doctor Stuart Fischer, and you can learn more about him and his practice here!