OT: ACL Injury

[climbgdh]

Totally off topic but I'm sure there are plenty of people here that have had ACL injuries. I did mine in 8 days ago. I believe I did a partial tear several years ago skiing and then doing some easy hiking over Labour Day weekend my knee totally popped and gave way with me collapsing in a heap in a HUGE amount of pain. Anyway....... lots of rest, ice & elevation the last week. Had an MRI last Thursday & should get results early this week to confirm what my family doctor and PT expects..... ruptured ACL. So...... what are all you experiences? Anyone ruptured their ACL and elected not to have surgery? I have no idea at this point whether I will need surgery or not but I expect I will. I'm an AVID skier so hoping I can get enough stability in the knee to ski this winter (with a brace) but only time with tell. Pretty bummed about all of it to tell the truth. When you are used to exercising & being active everyday it's hard to do NOTHING. I had to take last week off work since I couldn't get around very well at all and my knee was HUGE!! Not looking for any medical advice...... just personal experiences with ACL injuries. :(

Luckily....... recovery will be lots of cycling once I can get some ROM back. :)

[djg21]

I've been through multiple ACL reconstructions, revisions and am leaving shortly to meet with my surgeon about a full replacement.

The allograft (cadaver achilles tendon) was the fastest recovery. But, my knee is not as stable as I'd like. I couldn't have an autograft (patellar tendon) due to the arthritic changes to my knee. If you can, this is the way to go but the recovery will take a little longer.

I've also been through a quadriceps facia lata pull-through but this technique isnt used anymore.

[Keith A]

ACL reconstruction for me about ten years ago. Blew it out on a bad landing while riding a skateboard on a ramp. It was definitely a downer as I am an active person and not being able to participate in the activities I enjoy was not much fun. Anyway, I went with the patellar tendon as my surgeon felt like this was the gold standard. I know a lot of people are now using the hamstring instead.

Recovery was rather lengthy and it took me a while to get all the strength back in my quad. It didn't take too long before I was back on a bike, but this was on a trainer at first as I didn't want to risk taking a fall and injuring my knee. It took about six months before I surfed again.

I am able to do everything I could before, but my knee isn't the same. Not sure exactly how to describe it, but it just feels different. However, I would make the same choice again knowing what I know now.

I do have a friend (who just happens to be a doc) and he doesn't have an ACL in one knee. He injured this long ago before they were as good as they are now in doing the repair. He is also a cyclist and he has no problem riding, but he doesn't do any types of activities that would cause a quick cutting motion since his knee is now "loose" and doesn't have the necessary support for this type of stress on the joint.

[CaptStash]

I haven't had a left ACL since 1980. I get along just fine, except I can't downhill ski or play basketball. Of course, I never could play basketball...

But seriously, the only reason I didn't get a reconstruction was that they weren't any good at it back then. Since you say you are a dedicated downhill skiier, it sounds like it would be worth getting the repair.

I have gotten along very well over the years because I was a competitive rower at the time I bust up my knee, and continued competitive rowing at a relatively high level throughout my adult life (I finally "retired" in 2008). Rowing in particular built a strong set of muscles around my knee to stabilize it. I am not sure if cycling will do the same. At any rate, I have lived with my knee this way for so long I automatically stop myself from moving in ways and directions that would injure it. Since you are already an adult, it doesn't seem like a great option to leave yours un-repaired.

Good luck!

Saul aka CaptStash....

[jmeloy]

I also blew mine out MANY years ago and did not get it fixed which was a mistake. Very little skiing and no basketball for me either. I also put mine off because it was the big procedure back then and I didnt want to miss work.

My daughter tore hers 4 years ago and she had it fixed and she does everything today she did before. If you are a youngun, get it fixed if it needs it!


I haven't had a left ACL since 1980. I get along just fine, except I can't downhill ski or play basketball. Of course, I never could play basketball...

But seriously, the only reason I didn't get a reconstruction was that they weren't any good at it back then. Since you say you are a dedicated downhill skiier, it sounds like it would be worth getting the repair.

I have gotten along very well over the years because I was a competitive rower at the time I bust up my knee, and continued competitive rowing at a relatively high level throughout my adult life (I finally "retired" in 2008). Rowing in particular built a strong set of muscles around my knee to stabilize it. I am not sure if cycling will do the same. At any rate, I have lived with my knee this way for so long I automatically stop myself from moving in ways and directions that would injure it. Since you are already an adult, it doesn't seem like a great option to leave yours un-repaired.

Good luck!

Saul aka CaptStash....

[Keith A]

Just a FYI, I wasn't youngun and I still had mine fixed :)

[climbgdh]

Thanks for all the replys!! I don't consider myself old (but not young either)!! 47 YO is the new 20 isn't it??? I expect I'll end up getting it fixed. I'm extremely active with backcountry skiing, rock climbing, hiking, mountaineering, cycling & alot more so I need my knees to be working properly. I'm now waiting to get into see a orthopedic surgeon for full assessment. Lots of physio too.

[CaptStash]

I guess I should have added, that I have no prblem freestyle (Skate) cross country skiing. I think you'll do great!

Saul

[FlashUNC]

My step mom blew out her ACL a couple years back. She's back playing tennis with the best of them.

Its a very fixable injury these days.

[Keith A]

If possible try and find an OS and a PT that specialize in sports medicine. They are used to dealing with athletes and I think you would have a better experience with them.

[93legendti]

I partially tore mine in 1992. I had pretty good stability and did nothing. I sought out 3 doctors and got varied opinions. The doctor's whose opinion I followed was the one who wasn't sure what was wrong with me (my knee was locked), but suggested arthroscopic surgery to see what ws going on. He found a small bone chip in the joint, which caused the lock and found a partial ACL tear. He said my stability was good and recommended against surgery.

When I skied after that I used a custom brace. I've had few problems since. In 1992, the issue was stability of the joint. One of the doctors I saw, the surgeon for the Detroit Lions, told me that 1/3 of people with torn ACL's need surgery, 1/3 don't and 1/3 don't need immediate surgery, but may in the future.

In '92, my surgical options were patella tendon, gore tex or cadaver ACL. I didn't like any of the options and was glad I had good knee joint stability, so I could "buy" time for better procedures to be introduced and/or quicker recovery times.

[Birddog]

I completely severed my left ACL and partially tore my right over 40 years ago. I was mis diagnosed for over 20 years. When I finally met with a surgeon after the 20 years, after consult I elected not to have surgery. I have been an active skier for over 50 years and haven't had a problem with either of my knees in years. I took up cycling partially as a means to strengthen my knee joints. All that said, if I was in your shoes, I'd have the surgery. Use the brace only for a year or two max, it's just a crutch.

[Alchemy Rider]

I completely ruptured my right ACL five years ago while playing indoor soccer. My surgeon asked what level of stability and range of motion I wanted to have post-op. My request was for as much of both as possible.

Hence the double loop hamstring graft, which is apparently stronger and more stable than a singe loop or a patellar graft. Note that a search through the literature on this subject shows a significant range of views on which technique is better.

My advice, no matter which replacement option you choose, is to follow your pre and post-op physiotherapy regime strictly and to the letter. The range of motion and stability of your knee will largely depend on the physiotherapy work that you do.

The physiotherapy will hurt, but for me the outcomes - full range of motion and a very stable knee - were definitely worth the pain.

Good luck and I hope you ski again soon.

P.S. i was 50 when I trashed my knee. Started cycling as a form of therapy and didn't stop.

[climbgdh]

So..... i got the results of my MRI yesterday. Complete tear of ACL, lateral tear of the radial meniscus plus extensive bone marrow edema of the tibial plateau (whatever that means!!). :mad:

thanks for all the comments. now waiting to get into see an orthopedic surgeon. physio at least has me back on stationary bike as of tomorrow to improve range of motion.

[Keith A]

Well that's both good and bad, this way it's completely gone and can make your decision about surgery a little easier. If it was only a partial tear, then the decision to operate is a little less clear cut.

BTW, if you decide on a particular type of reconstruction method, make sure you find a surgeon who is competent (or possibly prefers) the same method.

[alper]

I do have a friend (who just happens to be a doc) and he doesn't have an ACL in one knee. He injured this long ago before they were as good as they are now in doing the repair. He is also a cyclist and he has no problem riding, but he doesn't do any types of activities that would cause a quick cutting motion since his knee is now "loose" and doesn't have the necessary support for this type of stress on the joint.

I'm hoping I can get away with this. I tore my right ACL 8 days ago while rock climbing. The doctor said I can go for a surgical procedure later as well, so I might as well see how stable I can get it without first.

I'm not sure how long I should stay off the bike though. The doctor said 5 weeks of wearing a brace and I could cycle if I wear it… so now that the pain is almost entirely gone I'm tempted to at least get back on the road bike again.

[schwa86]

I tore mine, after lengthy discussion went with cadaver graft. I don’t think I would have really needed it for cycling (I tore skiing in February but put off til after cycling season over) but wanted it for other outdoor activities. My surgeon was pretty conservative re wearing a brace, so the first summer after was not that fun, but since has been pretty stable and I’m satisfied.

In case others interested, this research/approach which repairs the torn ACL is gaining steam — https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431773/ — the rationale is that it may avoid downstream complications like arthritis.

[Hakkalugi]

Full rupture during PSIA* Level III exam in 1998, classic slam-and-pivot-behind-heels move, complete with loud pop but no pain. Hamstring tendon replacement, skied on it 6 months after surgery. It’s been bombproof through 24 years of being a coach/official/crew chief/courseworker, etc. Absolutely no issues on the bike.

It hurts like hell and is completely debilitating every time my wife suggests hiking though. Really weird how that happens. Maybe I’ll ask my doc about it sometime.

*(Pretty Skier, Insufficient Angles)

[wc1934]

I completely ruptured my right ACL five years ago while playing indoor soccer. My surgeon asked what level of stability and range of motion I wanted to have post-op. My request was for as much of both as possible.

Hence the double loop hamstring graft, which is apparently stronger and more stable than a singe loop or a patellar graft. Note that a search through the literature on this subject shows a significant range of views on which technique is better.

My advice, no matter which replacement option you choose, is to follow your pre and post-op physiotherapy regime strictly and to the letter. The range of motion and stability of your knee will largely depend on the physiotherapy work that you do.

The physiotherapy will hurt, but for me the outcomes - full range of motion and a very stable knee - were definitely worth the pain.

Good luck and I hope you ski again soon.

P.S. i was 50 when I trashed my knee. Started cycling as a form of therapy and didn't stop.

This ^. Great advice.
Also, they should send you home with a movement machine that will gently flex your knee while you are asleep.
Good luck - speedy recovery!

[Spdntrxi]

ACL,MCL meniscus trim back in 2012. Cadaver for the CL's and lost 85% of my medial meniscus. When I sprint my ACL kinda feels funny so I have to back off at times, it's totally random. Sometimes its no issue at all. The medial meniscus on the other hand is something I have to keep in mind at all times. Running sucks and I limit myself to 5k tops ( I still do the occasional Tri)

ACL/MCL tore playing basketball.. heard a pop, no pain but a heat sensation in my knee. Keep playing like a dunderhead and then my meniscus let go because of instability. So dont do that ! Surgery was the only option since my tear was so bad, I could not walk remotely normally.

[DMC707]

tore my ACL when i was 33 racing motocross --

wasnt a crash, was navigating an off camber turn and my foot accidentally contacted the ground - big pop - then agony.
I hobbled around on crutches for 2 weeks and did my best to rehab it and build up the surrounding tissue , but the lack of lateral stability eventually took its toll

Just had a total knee replacement last year at age 48


- best thing ive ever done - recovery was weeks rather than months

I had also had band aid fixes on the knee like meniscus repairs , steroid shots and the like over the years but putting in fresh hardware did the trick

[randomduck]

So..... i got the results of my MRI yesterday. Complete tear of ACL, lateral tear of the radial meniscus plus extensive bone marrow edema of the tibial plateau (whatever that means!!). :mad:

thanks for all the comments. now waiting to get into see an orthopedic surgeon. physio at least has me back on stationary bike as of tomorrow to improve range of motion.

Good luck!

As a fellow Orthopedia Adventurer who also coaches alpine ski racing, I'm all-too-familiar with ACL and MCL injury and recovery. My advice is to never, ever put off the surgery!

Bone marrow edema suggests a bit of bone-on-bone contact, the tibial plateau likely coming loose from the ligament failure and subsequent collapse. TP breaks are common in the ski injury world in combination with ACL and MCL injuries.

An allograft will likely serve you well. The big thing: make sure both your ortho and your physical therapist know your athletic goals. That way your recovery plan can be tailored to what you want to do.

When I had a total hip replacement in 2017 I went into the surgery stating that I wanted to return to high-level skiing and cycling endeavors. I was blunt and honest about the goals and the entire orthopedic and PT team helped me get there. I followed their plans to the letter (i.e. didn't rush things, which is tough when patience isn't in one's natural quiver of tricks) and came back super fit and, if anything, stronger than I was before.

GOOD LUCK and keep us posted!

[Tickdoc]

tore my acl/mcl at 38yoa playing soccer. It's actually what brought me back to cycling!

I chose cadaver graft and the surgery was easy. Recovery sucked, but I had the goal of returning to soccer right after surgery and never actually did. Quit soccer and rediscovered cycling instead.

It took me 6 months before I trusted that knee to any great extent. I am always amazed at how quick the pros get back on their feet following surgery.

Best of luck and just do what they tell you. The surgery is so routine and the healing so quick these days that you should be fine.

As a bonus, you can tell the weather after!

[randomduck]

I am always amazed at how quick the pros get back on their feet following surgery.

It helps that they're paid to play - there's incentive to returning early. Given the shelf life of most professional athletes is really short, they can't afford to miss much time outside of the field of play - time away is money not earned.

If you check out most of these pro athletes after they retire they regret rushing their rehabilitation. Most end up getting either revision surgery or full-on knee or hip replacement less than a decade out from retirement.