So here's the long version I posted to my friends on Facebook:
I returned to the orthopedic surgeon on Tuesday to review the results of the MRI. It only confirmed what I already knew (but didn't want to believe) when I felt my knee pop.
Bad News: High Degree ACL Tear
Good News: Meniscus intact. Other ligaments intact. Good range of motion. Minimal pain. Minimal swelling. Full weightbearing. Slight limp. Hasn't "gone out" since the initial injury.
Surgery? But we haven't answered the surgery question yet. What I'm discovering is that it is a lot easier to decide when you actually need surgery versus when you might be a candidate for the non-surgical route. If I had other damage (such as a torn meniscus, other torn ligament, or a fracture), then I definitely would have ACL reconstruction. In those cases, the decision is pretty much made up for you if you want to do any physical activity in the future.
To Ski or Not To Ski: He asked if I wanted to continue skiing, even though I had just started up again. After just being back on the slopes for a few days, I know I just can't give it up. I was having too much fun with my niece and still haven't had a chance to ski with my nephew. I was already making plans for a season pass and lodging options for the 2013-14 ski season. The mountains are always where I've felt most comfortable and where I belong and fit in. I caught the bug again and I don't want to lose it. I just need to figure out how to break my addiction to moguls....
Luckily, there is no harm in delaying a decision. Also, there is no harm or time wasted by doing physical therapy.
Physical Therapy: The doctor prescribed physical therapy 2-3 times a week for 4-6 weeks. Unfortunately, I can't get into physical therapy until March 4th and I am on the wait list. But I have quite the list of exercises to do until then based on some ACL reconstruction protocols I've been reading. Essentially, there are a set of exercises to do every hour for strengthening, flexibility, and conditioning.
If the knee goes out during PT, I need surgery. If it doesn't, we're still not sure.
Real World: After physical therapy, we'll reassess things. We will test the knee with other running and cutting drills that simulate the same motions of skiing. If it feels stable, then he wants me to test out "real world" activities--including possibly skiing. The doctor and I agree that I don't want to find out that my knee won't hold up the first day on the slopes next fall. So, we're willing to give it a test this spring so I can have surgery promptly, if needed. Being in Colorado has advantages to be able to test this out. Most ski areas close April 14 or 21. However, we do have one area that is open until May or June.
Risks: The biggest risk to not having surgery is tearing my meniscus (and possibly other ligaments) in the future which would make my knee even more unstable going into surgery and reducing the chances of the best outcome.
Nothing is cut and dry so I just need to figure out how to turn my mind off and just concentrate on rehabilitation now.
The Magic Questions for Me:
1) To ski or not to ski? Should a 45 year old, overweight, out of shape skier be on the hill? Of course, I've been losing weight and getting in shape. Why else would I be on this board?
2) Am I delaying the inevitable knee surgery since I will have a higher probability of tearing my meniscus and other ligaments down the road? Could I be heading towards osteoarthritis or a total knee replacement? Life won't be perfect with an ACLr, but it's not going to be perfect without it either.
3) Isn't having surgery after physical therapy and conditioning putting me in the best spot for a successful ACL reconstruction since I have no other damage in that knee? I do get 26 PT visits per year with my medical insurance and that number resets on 10/1.