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Apparently I've been skiing without an ACL the last five years

post #1 of 13
Thread Starter 

I saw the ortho today, and the good news is that (provided the MRI doesn't show too much collateral damage) he thinks it makes sense to try PT and a brace, and still plan to ski at Big Sky in the spring.

 

The original injury was at Brighton -- basically I was being afraid of the fall line because the bad visibility on an open, steep slope, and I caught my tail.  I felt something go out and back, but I didn't even fall.  Took it easy for a couple runs, but skied the rest of the week.

 

But it felt better in a couple weeks and seemed pretty stable, except for one particular wrong type of twist.  About once a year it went out, but only when I loaded it with one particular type of twist, and it didn't seem to be getting any worse.  So I figured I'd just live with it.  Oh yeah, and my General Practitioner manipulated it at my yearly physical and thought it felt stable.

 

But then it went out three or four times last year.  Once was in deep powder at Jackson Hole -- I got a face shot, and thought that was cool so I exaggerated the turn, loading up my tails, to try to force it.  My knee didn't think that was a good idea.  

 

So I was thinking about having it looked at by a specialist.  And then in December I was just edging hard (not twisting) and the knee did something new, sort of went sideways, and it hurt again.  I didn't even fall this time, either.

 

Stupid knees...

 

 

Edit -- not that it matters, but checking calendars I think it was actually just under 4 calendar years, or 3 1/2 ski seasons, not 5.


Edited by mdf - 1/12/13 at 9:44am
post #2 of 13

So what is the final verdict on the knee? ACL shot? 

post #3 of 13
Thread Starter 

Ortho is pretty sure the ACL is shot.  Final confirmation waiting for the MRI (probably next week) but he has this tester that compares the play in your good knee to the bad knee.  More than 3 millimeters difference almost always means the ACL is torn, and my difference was 7 millimeters.

post #4 of 13

You are obviously what they call a "coper" with an ACL-deficient knee.  It's good to work with a good ortho to understand as much as possible about what's going on inside your knee in order to avoid making anything worse.  Not too late to decide to do ACL reconstruction surgery . . . or not.  Plenty of pros and cons.  Every situation is unique.

 

Have you read the EpicSki article on ACL injury?

http://www.epicski.com/a/acl-injury-for-skiers

 

I spent the summer researching ACL injury after I ruptured one in June (not skiing).  Turned up stories of quite a few advanced/expert skiers who don't have an ACL, including several long time members of EpicSki and very experienced instructors.

 

My ACL rupture was confirmed by a MRI taken about a month after injury.  Relatively little damage to anything else, so those issues could heal in a few months without intervention.  Essentially no pain after the first week or so and very little swelling.  Completely stable knee.  My experienced ortho surgeon agreed a couple months after injury that there was no reason for ACLr surgery given what I like to do.  I'm mid-50's and stopped playing sports like soccer, basketball, volleyball, or tennis quite a while back.  Managed to become an advanced skier in recent years but not interested in jumping off anything on or off-piste.

 

I did formal PT for a couple months (1-2 times a week), plus on-going exercises at home and elsewhere to strengthen hamstrings, adductors, abductors.  The work paid off.  Started indoor rock climbing in October (3 months after injury).  Skied last weekend with no knee issues.  Only on the little runs at Massanutten, but enough to have complete confidence I'll be have a great time at the Big Sky Gathering.

post #5 of 13
Thread Starter 

No, I didn't know about the article.  Thanks for the pointer.

The ortho is not ruling out surgery, but wants to a) see the MRI, and b) see how well PT+brace works.

 

In hindsight, the increased frequency should have been a red flag to take action.  Oh well, hope I didn't do too much new damage on this latest incident.

 

The ortho is about my age and is a skier himself.  smile.gif

post #6 of 13

Definitely a plus to be working with someone who skis.  My PT was great, but really had no idea about skiing or rock climbing.  When I went looking for a personal trainer, having some experience on skis was something I looked for.

 

I found this self-assessment measurement tool useful.  The KOOS was developed very carefully and evolved from other outcome measures used in the last few decades.  This online version is easy to use.  Read the questions and choices carefully but don't take too much time choosing an answer.  Can go back and change later if you like.  This scale includes questions related to knee pain, daily living tasks, sports activities, and quality of life.  I was a professional biostatistician working in the pharmaceutical industry before I retired so am familiar with advantages and limitations of measurement scales.

 

http://www.orthopaedicscore.com/scorepages/knee_injury_osteopaedic_outcome_score.html

 

As an example of KOOS values (range 0-100) . . . I estimated after the fact that my score was 38 a month after injury and about 85 after three months and formal PT.  Reached 94 after another couple months of doing knee rehab exercises pretty consistently.  Those who have ACLr surgery usually get to 95-97.

 

I fully intend to keep skiing for decades.  Will get a brace before heading to Big Sky for the Gathering.  But I know it will only protect against hyperextension, not twisting.  But I wasn't the type to ski chutes anyway.  Liberty is enough fun for me. smile.gif

post #7 of 13

Hey, mdf.  That's a bummer.

 

As marznc says, lots of people cope with no acl.  Many ski for years and years with no ill effects.  I'll just give you my own experience - for what it's worth - to add to your info bank.

 

I partially tore my acl here at Jackson Hole in March of 1990.  It was a partial, so my doc suggested I spend the summer trying to rehab it and see how things went.  That worked great until I was running for a fly ball in center field in August (I know, not the best rehab strategy) and stepped in a little indentation.  Pow... the remainder of the acl went.

 

I didn't see the doc again until that December.  He and the MRI confirmed a completely torn acl - but no other damage to the knee.  Now comes the part where I was way too smart.  I wanted to ski the rest of the winter and have the repair in the spring, so I asked the doc if he would prescribe an acl brace for me.  He said "sure", but the brace would not protect other parts of the knee, and since my knee was unstable without an acl, I would run the risk of other damage.

 

Well, I figured there's no way to hurt a knee with one of those braces on, so I got the brace and skied that winter.  Sometime in February, I was skiing down East Ridge and simply weighted that leg to initiate a turn.  No awkward position, no fall, just a normal turn.  As soon as I weighted the knee, I got a searing pain that was far, far worse than anything that was associated with the acl injury.  The knee swelled to about twice its size by the time I got down.  

 

It turned out I did a very bad tear of the meniscus and folded a big piece of it underneath itself.  When I DID have the repair surgery a couple months later, he had to take out a very large portion of my meniscus.  And THAT has resulted, twenty-plus years later, in what is now a bone-on-bone situation that is probably going to require a knee replacement in the 2-5 years.  There's no way to know, of course, if the knee would be as bad now if I hadn't trashed the meniscus, but I'm personally convinced that my obstinacy cost me pretty dearly.

 

As I said, lots of other people have much better results, but my own feeling is that your knee has already proven that's it's unstable.  There's probably a message there. 

post #8 of 13
Thread Starter 

Thanks to you both.  Lots to think about.

post #9 of 13

Kind of a scary situation with these unknown injuries and what can come as a result. 

 

mdf, how exactly does your ortho's knee play tester work?

post #10 of 13
Thread Starter 
Quote:
Originally Posted by east or bust View Post

Kind of a scary situation with these unknown injuries and what can come as a result. 

 

mdf, how exactly does your ortho's knee play tester work?

It's a KT1000.  Pieces strap to upper and lower legs and are connected in a way that includes a motion gauge.  The ortho pulls on a lever attached to the lower leg piece through a force sensor.  I found the manufacturers web page, http://www.medmetric.com/kt1.htm

post #11 of 13
Thread Starter 

I went back for the MRI interpretation follow-up this morning.  Before the MRI, the doc was suggesting PT and a brace, but now he is advising surgery.  There are some meniscus tears, and I'm thinking that is the start of a downward spiral chain reaction.  (And the increased frequency of giving out episodes last year over prior years.)

 

So I'm going to have it reconstructed next week.  No Big Sky for me.frown.gif.  Maybe next year. smile.gif

post #12 of 13

Sorry to hear you'll miss the rest of the season.  Definitely worth getting the knee sorted out completely.

 

What type of graft?

Quote:
Originally Posted by mdf View Post

I went back for the MRI interpretation follow-up this morning.  Before the MRI, the doc was suggesting PT and a brace, but now he is advising surgery.  There are some meniscus tears, and I'm thinking that is the start of a downward spiral chain reaction.  (And the increased frequency of giving out episodes last year over prior years.)

 

So I'm going to have it reconstructed next week.  No Big Sky for me.frown.gif.  Maybe next year. smile.gif

post #13 of 13
Thread Starter 
Quote:
Originally Posted by marznc View Post

Sorry to hear you'll miss the rest of the season.  Definitely worth getting the knee sorted out completely.

 

What type of graft?

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