I’d definately get it fixed.
I tore my left knee playing indoor soccer a few years ago. After about a month it didn’t get any better so I saw a doctor. Yup, torn ACL. I spent a year scoping out the scene finding the right doctor & procedure, and finally settled on a knee specialist in DC.
There are three basic methods to fix a torn ACL. All of them require removing the old ACL, drilling holes in your leg bones, threading an ACL replacement through the holes and screwing the ends down.
In the first method the surgeon harvests a long, little-used tendon from your thigh, braids it into a thick rope about 4" long and screws that into place with big washers. It’s good because the ligament is yours and it’s live, but bad because the braided ligament is more elastic than your original tendon. Also, since the tendon braid isn’t terminated with boney bits it takes longer for the bone to grow around the ends and fuse in place. Early attempts at using this method sometimes failed because the tendon pulled out of the bone. My doc ruled this out for me because I’m heavy and have really strong legs (weigh over 210 lbs; used to be a pretty decent velodrome racing track beast).
The second method is a little wierd, but apparently it works pretty well. The doc cuts a long strip out of the middle of your patelar tendon (the strap that ties your kneecap onto your lower leg bones) and takes two bits of bone along with it - a chunk from your kneecap and a chunk from your shin bone. Now he’s got a real ligament that terminates on both ends with a little boney plug. When this gets threaded into place he puts screws in to jam the boney bits against the boney sides of the holes and this bone-to-bone fusion is really solid. The downside of this approach is that your patella tendon has a hole in it. Eventually the two sides of the tendon grow together and everything is back to normal, but in the mean time your kneecap isn’t all that solid. And there is a chance that the patellar tendon will heal crooked and give you bad mechanics. The doc ruled this one out for me because I have very short legs and therefore a high Q angle. (I had to give up track racing because my quads got so strong I developed patelar tracking problems)
The third method is basically the same as the second, except that the patella tendon is harvested from someone else. (Preferably a clean-living football linebacker from Iowa or Nebraska who was driving too fast.) They essentially bleach the donor tendon to remove all the living cells so what is left is basically a collegen matrix (the tendon) that ends with calcium blocks (the boney bits). The upside is that your patellar tendon is still intact and the resulting ACL repair will eventually be plenty strong, but there are a couple of downsides. The first downside of this approach is that there is a slight chance the donor was HIV positive - I think it’s 1 in 16 million at the moment - so you’re rolling some very favorable dice. The second downside is that it isn’t living tissue. If you are rough with it it will tear a bit and the tear won’t repair itself. Keep that up and you’ll be back in the operating room as a repeat customer. It takes time, but it does eventually become living tissue. In 6 months your body will have grown blood vessels out onto the collegen matrix, in 12 months the outer surface will be colonized with collegen-reparining cells, and in 18 months it will be fully living tissue to the core. This is the method I chose.
I “walked” out of the hospital 5 hours after I went in. The surgical team was excellent. My mom, who picked me up, was amazed that I could put my full weight on my leg. So was the surgical team. Apparently I have thick bones, so even though there were some big holes in them there was still enough bone around the holes to support my weight. I never needed crutches. It hurt like a *$&%) to walk, though…
The next two weeks I spent flat on my back with a machine that bent my leg back and forth slowly to keep it from stiffening up. My knee swelled up until it was bigger than a football. This is apparently normal. My lower leg was one giant bruise, and it swelled up too. Also apparently normal. The lymph channels from the lower leg get shut off by the swelling in the knee, so fluid (and blood from the operation) accumulate in the lower leg. I also had a water-jacket around my knee with icewater circulating through it. My folks were great- they put a fresh bag of ice in the cooler about every two hours. Man, that ice jacket was NICE! You’re going to need a place to stay and really good friends for at least 2 weeks, minimum. 3 would be even better.
The worst part was rehab. Physical therapists are inhuman sadists. 'Nuf said.
I was on my feet hobbling in one week on walks of about 60 steps. In two weeks I could walk, and made the 20 hour trip back to Germany sitting in airplanes, standing in line, dragging luggage up staircases, etc. It sucked, but I could do it.
In one month I was walking more-or-less normally, though the year wait had severely attrophed my left thigh. I wasn’t walking symmetrically. In 6 weeks I could run to the commuter bus with a sack of books on my shoulder. In 3 months I was walking smoothly and had a nearly symmetric gait. I asked the doc if I could go skiing and he said yes, as long as I took it easy. (Re-doing an ACL isn’t a great idea because they can’t get it right the second time.)
I asked him if I needed a brace and he said, “Only if it makes you feel better. It’s mostly psychological.”
In 6 months the swelling was completely gone and I had nearly a full range of motion. In 12 months it started feeling strong again. In 24 months it stopped clicking and clacking, which meant that the bones and ligaments had reached some sort of agreement on how big they should be and how they should be aligned.
Now, after almost 4 years, my left knee is stronger and more stable than it was before I wracked it playing soccer. It’s actually better than my right knee now. The only signs left from the operation are a 2.5" scar just below my kneecap and a numb spot of skin where the nerves never grew back. It was well worth it.
The doc said that my recovery was unusually fast. He said that my shin bone was one of the densest bones he had ever seen, and the donor was similarly dense (probably a 300 lb football player who drank a gallon of milk a day growing up). He said that the new ligament was mechanically strong enough when he screwed it into place that I could have gone dancing that night. (Chyuhh, riiigghhhttt!!! It hurt like a *&%(#) Good thing they give out decent painkillers!)
But there is one bad part I haven’t mentioned.
Because of the swelling it was impossible for me to flex my knee enough to ride a bike. My foot just wouldn’t come over the top of the pedal stroke. And straightening it was a bitch, too. It was at least 6 months before I could sit and spin on a bike, and more than a year before I could get out of the saddle on a climb. It might be a long time before you can ride your uni again.
That’s actually why I bought this damn 20" Uni in the first place. I used to balance in the hallway and rock to strengthen my left thigh. I couldn’t complete a full circle, but I could “idle” and build muscle. Now that my leg is 110% I looked over at that damn uni and said, “I bet I could ride that thing now.”
Which is why I’m here in this newsgroup writing this absurdly long note.
Good luck, and I hope you decide to get the operation. It will eventually bring you back to 100%.