Ruptured ACL and multiple ligament damage

[RiderInSurrey]

Hi all
I was kicked badly a couple of weeks ago, it dislocated my knee and tore all the ligaments and the ACL is completely ruptured. It was too swollen for surgery last week, so it’s being done in Jan 2022.

Has anyone done something similar and they’re now riding again? How long did it take? Is your knee stable again? There’s the option to rebuild the ACL, but my surgeon said it might not be needed. Has anyone not had the ACL repaired and they’re riding again? Any issues with it? And for the people who did have the ACL repaired / reconstructed, what was your experience with it - rehab, duration of recovery etc, and getting in the saddle again.

I would appreciate hearing everyone’s experiences as I’m feeling quite sorry for myself at the moment.
Thanks in advance!!

 

[AmyMay]

Absolutely no experience. But wanted to wish you well in your recovery x

 

[LEC]

I am not the best example. I ruptured mine playing rugby and my knee was ok until I needed to rely on it to change direction and then it would go again. I did get it repaired. I wasn't really riding at that stage as lived in London and playing sport. After my knee surgery I came back to my parents for a couple of weeks, I got bored and decided to sit on the horse to hack out. My knee was never impacted riding. Probably because the issue wasn't mechanical but in twisting and turning which on a horse its doesn't really do. I did manage to lose the horse about 3 weeks post surgery having got off to do a gate and had to run across the field chasing the horse as it legged it towards the A38. I could't decide what I was more worried about - my knee or the horse! Anyway, we all lived.

Other friends have had to wait longer. They invariably didn't adhere to full Drs advice to get on the horse sooner but friends with the most severe ruptures have had to wait around 3 months before being back.

 

[RiderInSurrey]

I am not the best example. I ruptured mine playing rugby and my knee was ok until I needed to rely on it to change direction and then it would go again. I did get it repaired. I wasn't really riding at that stage as lived in London and playing sport. After my knee surgery I came back to my parents for a couple of weeks, I got bored and decided to sit on the horse to hack out. My knee was never impacted riding. Probably because the issue wasn't mechanical but in twisting and turning which on a horse its doesn't really do. I did manage to lose the horse about 3 weeks post surgery having got off to do a gate and had to run across the field chasing the horse as it legged it towards the A38. I could't decide what I was more worried about - my knee or the horse! Anyway, we all lived.

Other friends have had to wait longer. They invariably didn't adhere to full Drs advice to get on the horse sooner but friends with the most severe ruptures have had to wait around 3 months before being back.

Thank you LEC, I appreciate you sharing your experience. Due to mechanism of the dislocation, they said it’s more common in rugby and football actually. I won’t explain what happened as it will make everyone cringe with horror!
Well three months isn’t too bad. I’ve had doctors and physios telling me 9-12 months! So you’ve given me hope!
Sorry to hear you had to chase after your horse while injured, I’m glad you were both reunited again. Was it your left or right leg?
For me it’s my left knee - so I’m wondering how it will be one day when I go to mount, ie putting my left leg in the stirrup and having to swing my weight through that left leg / knee to get myself and my right leg in place.

 

[RiderInSurrey]

Absolutely no experience. But wanted to wish you well in your recovery x

Thank you so much!

 

[LEC]

Thank you LEC, I appreciate you sharing your experience. Due to mechanism of the dislocation, they said it’s more common in rugby and football actually. I won’t explain what happened as it will make everyone cringe with horror!
Well three months isn’t too bad. I’ve had doctors and physios telling me 9-12 months! So you’ve given me hope!
Sorry to hear you had to chase after your horse while injured, I’m glad you were both reunited again. Was it your left or right leg?
For me it’s my left knee - so I’m wondering how it will be one day when I go to mount, ie putting my left leg in the stirrup and having to swing my weight through that left leg / knee to get myself and my right leg in place.

In rugby we always used to say 6 months before coming back and playing fully again. The biggest issue with rugby was building up the stablising muscles again to help support the knee and TBH they do a bigger job after surgery than they did before as we take them for granted. One friend has taken longer - 6 months to be riding again but it probably depends on a lot of individual variables. Lots of friends haven't bothered to get surgery. Those who have chosen surgery tended to be really compromised or have a very unstable knee.

Mine was my right knee - so my dominant side for playing rugby and easy for dealing with horses.

 

[oldie48]

Go for the best repair you can get unless, like me, you are old and a bit decrepit. I had a bad tear following a skiiing accident but even at 60 I was offered a proper repair. I decided against it, which I now regret because I do have instability although I did a lot of rehab. In the great scheme of things, a few months is neither here nor there put your health and fitness first! Good luck.

 

[Arc]

Sympathies on your injury - such a shock to be suddenly stuck on the sofa - but mine is a good news story to share from non-surgical rehab! My injury was from skiing - no MRI but they were confident I had ruptured ACL and multiple ligaments torn in my right dominant knee - I was in Canada at the time and they started me on a non-surgical rehab protocol.

My rehab went like this (supervised by a knee clinic):

• range-of-motion (ROM) solid knee brace worn 24/7 for about 6 weeks - giving ligaments time to heal and strengthen without over extending
• rehab in ROM brace - multiple short daily sessions on stationary bike
• once the doctor removed the brace - rehab was program of exercises from physio to build stabilising muscles to support the knee
• recovery was straightforward - physio was great and I just went straight back to my fun activities, mostly horse riding and hiking, starting at lower intensity
• I was back to multi-day hiking up and down mountains in less than 6 months (just wore a stretchy brace for hiking for a bit until i was sure the knee was stable enough)
• I did have a consultation with a surgeon about 9 months following injury (my knee as "mostly normal function and 85% better" by then) - surgeon thinks ACL scarred onto something and so is still providing stability - he said he could do surgery and maybe take it up to 95% (but he would have to take me back to zero first!) - the thought of another six months of recovery made me shudder and he agreed there was no real need for surgery unless the knee started to becomes unstable.
• I still wear a specialized knee brace for skiing - more for extra peace of mind really
• Long term - it has been six years - knee is still going strong - i would say its 90% long term - no pain or instability - still skiing, hiking and riding horses - I try to keep up with exercise to keep stabilizing muscles strong

How long after injury before riding horse again?
About 6 weeks (as soon as the doc freed me from the ROM brace) - initially it was only flat riding on my very sensible horse for first couple of months. The doctor did have concerns about risks of falling off and also pressure on the knee getting on and off - so I got on/off using mounting block for a couple of weeks and slid down carefully onto my good leg only for a bit. Probably started jumping again about 4 months after the injury. My totally-unproven theory is that horse riding was good for my knee rehab as it uses muscles that seemed to support the knee. The knee itself has always been totally fine for riding. But injury and a recovery period of favouring my good leg left me wonky in my body (and wonky in the saddle) - which has needed quite a bit of work to get right.

Each injury is different of course - mine was pretty textbook example of a good outcome with non-surgical rehab. My only recommendation would be to ask questions about the odds of needing surgery later for your injury. Since surgery takes recovery time clock back to zero again and it would be depressing to have all the non-surgical recovery time turn out to be "wasted time". Good luck for a speedy recovery.

 

[RiderInSurrey]

Sympathies on your injury - such a shock to be suddenly stuck on the sofa - but mine is a good news story to share from non-surgical rehab! My injury was from skiing - no MRI but they were confident I had ruptured ACL and multiple ligaments torn in my right dominant knee - I was in Canada at the time and they started me on a non-surgical rehab protocol.

My rehab went like this (supervised by a knee clinic):

• range-of-motion (ROM) solid knee brace worn 24/7 for about 6 weeks - giving ligaments time to heal and strengthen without over extending
• rehab in ROM brace - multiple short daily sessions on stationary bike
• once the doctor removed the brace - rehab was program of exercises from physio to build stabilising muscles to support the knee
• recovery was straightforward - physio was great and I just went straight back to my fun activities, mostly horse riding and hiking, starting at lower intensity
• I was back to multi-day hiking up and down mountains in less than 6 months (just wore a stretchy brace for hiking for a bit until i was sure the knee was stable enough)
• I did have a consultation with a surgeon about 9 months following injury (my knee as "mostly normal function and 85% better" by then) - surgeon thinks ACL scarred onto something and so is still providing stability - he said he could do surgery and maybe take it up to 95% (but he would have to take me back to zero first!) - the thought of another six months of recovery made me shudder and he agreed there was no real need for surgery unless the knee started to becomes unstable.
• I still wear a specialized knee brace for skiing - more for extra peace of mind really
• Long term - it has been six years - knee is still going strong - i would say its 90% long term - no pain or instability - still skiing, hiking and riding horses - I try to keep up with exercise to keep stabilizing muscles strong

How long after injury before riding horse again?
About 6 weeks (as soon as the doc freed me from the ROM brace) - initially it was only flat riding on my very sensible horse for first couple of months. The doctor did have concerns about risks of falling off and also pressure on the knee getting on and off - so I got on/off using mounting block for a couple of weeks and slid down carefully onto my good leg only for a bit. Probably started jumping again about 4 months after the injury. My totally-unproven theory is that horse riding was good for my knee rehab as it uses muscles that seemed to support the knee. The knee itself has always been totally fine for riding. But injury and a recovery period of favouring my good leg left me wonky in my body (and wonky in the saddle) - which has needed quite a bit of work to get right.

Each injury is different of course - mine was pretty textbook example of a good outcome with non-surgical rehab. My only recommendation would be to ask questions about the odds of needing surgery later for your injury. Since surgery takes recovery time clock back to zero again and it would be depressing to have all the non-surgical recovery time turn out to be "wasted time". Good luck for a speedy recovery.

Thank you so much for this great answer. I appreciate the time you’ve taken to write it.
It sounds like a similar route that I’ll take. I also worried that surgery in a month will set the clock back to zero as you said.
Thanks for the detail about the rehab program and duration. It gives me an idea of timings. I’m so glad that you successfully improved the strength without surgery. Interesting to know about the wonkiness in the saddle afterwards. Thanks again!

 

[Cob Life]

I have a lot of knee issues, though probably not as serious as yours!

It started with my ACL and had that been treated correctly when I first injured it I likely wouldn’t have as many issues now! We didn’t actually find out it was an ACL injury until I saw a phsyio when I was still in pain and struggling to walk far 9 months after the original injury, initially doctors just said RICE and gave strong pain killers. Since this injury 6 years ago I have had a lot of instability in my knee and reinjure it a lot, it’s not unusual for it to just give way!

They said I may have mildly torn my LCL early this year, I was on crutches for 6 weeks and gradually returned, first few rides were just a little in walk. I’m now back to riding fully although still get a lot of pain. Again hospital weren’t good with the initial injury and advised RICE and strong painkillers, refused to do any scans despite me not being able to walk…

All injuries were on my left so I get on from the right, and i dismount onto a block, long distance running can be an issue, I do a lot of no stirrup work if my knee is in a lot of pain. But I think should you have a good doctor and phsyio you will end up with a better knee than me!

 

[Arc]

A couple more things that helped on the way
- ice therapy for swelling (I was lucky to borrow a knee ice therapy machine from a friend but an ice wrap would be fine too)
- brace I used to start hiking (https://www.bauerfeind.com.au/collections/hinged-knee-braces/products/genutrain-s-knee-brace#) - not cheap but worth it

In regards to ending up with a wonky body for riding - I didn't get on top of it during recovery because it wasn't on my radar at all (so focussed on the knee) - in retrospect it could probably have been kept in check through different physio focussing on body straightness

 

[Marigold4]

I tore my ACL and the medial collateral while skiing. I was advised it was just swollen by GP, so I rode very gently after a week. Best advice is to buy a really high mounting block to get on without twisting your knee - once onboard I felt OK to do flatwork and by six months I could do full range of riding and jumping. I've never had it operated on and it's fine to ride but I can't walk long distances and have given up running. A scan after 6 months revealed the damage by then I couldn't face surgery as I could do most things. I wish it had been properly diagnosed at the start and operated on. Good luck with yours.

 

[RiderInSurrey]

I have a lot of knee issues, though probably not as serious as yours!

It started with my ACL and had that been treated correctly when I first injured it I likely wouldn’t have as many issues now! We didn’t actually find out it was an ACL injury until I saw a phsyio when I was still in pain and struggling to walk far 9 months after the original injury, initially doctors just said RICE and gave strong pain killers. Since this injury 6 years ago I have had a lot of instability in my knee and reinjure it a lot, it’s not unusual for it to just give way!

They said I may have mildly torn my LCL early this year, I was on crutches for 6 weeks and gradually returned, first few rides were just a little in walk. I’m now back to riding fully although still get a lot of pain. Again hospital weren’t good with the initial injury and advised RICE and strong painkillers, refused to do any scans despite me not being able to walk…

All injuries were on my left so I get on from the right, and i dismount onto a block, long distance running can be an issue, I do a lot of no stirrup work if my knee is in a lot of pain. But I think should you have a good doctor and phsyio you will end up with a better knee than me!

Thank you for sharing this. I’m so sorry to hear you now have chronic issues with instability. Interesting that you get on from the right, I bet that took some getting used to! This sounds like good justification for actually getting the surgery, I’ll keep it in mind, thanks again.

 

[RiderInSurrey]

I tore my ACL and the medial collateral while skiing. I was advised it was just swollen by GP, so I rode very gently after a week. Best advice is to buy a really high mounting block to get on without twisting your knee - once onboard I felt OK to do flatwork and by six months I could do full range of riding and jumping. I've never had it operated on and it's fine to ride but I can't walk long distances and have given up running. A scan after 6 months revealed the damage by then I couldn't face surgery as I could do most things. I wish it had been properly diagnosed at the start and operated on. Good luck with yours.

Thank you Marigold. It seems like the people who didn’t have surgery, still have residual problems. Thanks for sharing your story. I guess if I have surgery in Jan, it will be a set back but at least then I could hope to avoid instability and pain in the future. I do like walking long distances and do a bit of jogging, it would be nice to be able to keep that up. Very helpful, thank you ?

 

[RiderInSurrey]

A couple more things that helped on the way
- ice therapy for swelling (I was lucky to borrow a knee ice therapy machine from a friend but an ice wrap would be fine too)
- brace I used to start hiking (https://www.bauerfeind.com.au/collections/hinged-knee-braces/products/genutrain-s-knee-brace#) - not cheap but worth it

In regards to ending up with a wonky body for riding - I didn't get on top of it during recovery because it wasn't on my radar at all (so focussed on the knee) - in retrospect it could probably have been kept in check through different physio focussing on body straightness

Thanks. Yes the surgeon recommended that I hire a Game Ready (can be found in Google) unit which is £300/month. It ices and compresses in one, and he highly rated it and said it can reduce painkillers faster and reduce swelling twice as fast too. I’ve had it for one week now, using it daily 4-6 times per day and it’s working a charm, although does have huge ice requirements to keep it going. It has reduced pain and swelling significantly. The worst is nighttime, the pain intensifies at night and I can’t sleep, can’t get comfy with this rigid leg brace and the pain. Thank you for the brace recommendation. ?

 

[LEC]

Thanks. Yes the surgeon recommended that I hire a Game Ready (can be found in Google) unit which is £300/month. It ices and compresses in one, and he highly rated it and said it can reduce painkillers faster and reduce swelling twice as fast too. I’ve had it for one week now, using it daily 4-6 times per day and it’s working a charm, although does have huge ice requirements to keep it going. It has reduced pain and swelling significantly. The worst is nighttime, the pain intensifies at night and I can’t sleep, can’t get comfy with this rigid leg brace and the pain. Thank you for the brace recommendation. ?

i don’t know what kind of bed frame you have but I propped the end up on breeze blocks as propping my knee on a pillow led to discomfort so kept it raised!!

 

[Arc]

I also suggest try one of those long pillows intended for pregnant women - a but weird but it was helpful to get enough support to sleep.

Although to be honest I found sleeping in the brace to be hellish - so hellish I wanted to have a ritual burning of the evil brace at the end of 6 weeks - but sadly couldn’t because it was rented (and its tough to explain that at the returns desk )

 

[Cowpony]

I snapped my ACL skiing about 15 years ago. The surgeon wouldn't operate for about 2 - 3 months until the swelling had gone down, then I had 6 months of physio before they'd let me ride again. I was in my late 40s then, and I'm sure a younger person would heal more quickly.

Riding counts as a contact sport because of the risk of falling off, and they did say that the repair is at its strongest after 6 months. Or rather, the surgeon said that was the case with dogs and rather resentfully said "They won't let us cull you guys to check if it's the same with humans!".

 

[dottieh]

I fully ruptured my ACL playing netball 2 years ago. I was incredibly fortunate that my knee was actually very stable. I saw one physio who was keen on the surgery option but my surgeon had said that I may not need surgery if the knee is stable enough and I wasn’t wanting to play elite level netball. I was devastated as thought I’d require surgery which would put me out of the saddle for months. However, I found an amazing physio and I was back on a horse within 5 days. In the saddle, it didn’t effect me at all, I was just very careful getting on and off so I didn’t land heavily. I tried to avoid Pushing side ways off that leg at all and concentrated on keeping the foot forward. The key to recovery really is a good physio and regularly dping your exercises and building up the muscles around your knee to increase stability . I was back at a show within a month and was back doing my yard of 10, riding and mucking out after a week! I have had no problems at all with mine and have 15 horses in, ride 10+ a day, I run, swim etc. happy to chat if helpful.

 

[eggs]

I ruptured my ACL skiing back in 1989 - at that time I opted to just have the torn cartilage removed. It was OK for some years and although it was not fully stable it did not stop me carrying on with my life and was never an issue riding although I did ski in a knee brace. It started to become more of an issue and I had a reconstruction in 2000 after a nasty fall on the stairs when it gave way. I wasn't allowed to ride for 12 weeks - my surgeon was very strict on this (he had agreed to delay doing the operation until after my ski hoilday!). I then started going on short walk hacks on my mare who I trusted. It took a while before trotting and cantering as rising trot in particular was quite uncomfortable.

Since then I have not had any issues but do find Flex-on stirrups a God-send.

 

[Cowpony]

Yes, I second Flex-ons!