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Do I Really Need An ACL?

post #1 of 15
Thread Starter 
After 3.5 days of powder happiness, New England bitch-slapped me back into reality... I slipped on some Ascutney ice on Sunday and severely wrenched my right knee. The first two days, I thought my season was over -- couldn't walk up stairs or apply any laterally pressure on it, but by today (Day 4) about 90% of the the pain has gone away, and I was even able to do a full lower body workout this morning, including about 15 minutes of stationary bicycle.

The Sports Doc told me that I either strained or (more probably) tore my right ACL. He gave me a knee brace, and ordered an MRI for early next week. Now I want to know: can I go out and ski some easy greens sometime in the next 7 - 9 days (letting the brace stabilize the knee), or am I being extremely stupid even entertaining the thought?

Is it true that some skiers can perform without an ACL?
post #2 of 15
post #3 of 15
just make sure you are strong enough...I was on crutches for 12 weeks due do severe bone brusing (microscopic fractures in the tibial plateau) due to the femur and tibia rubbing and crunching together because the acl was not there to prevent incorrect movement in the joint. there is also the danger of tearing other ligaments, lcl or mcl without an acl.

however, i skied with somone last weekend who has been skiing for over 15 years without an acl at all....

dont rely on the brace. they are more of a confidence thing than anything else, so I hear.
post #4 of 15
I skied about 35 days on my leg without an ACL - (initially misdiagnosed as a sprain the first several times I went into the doctor complaining about it.) Despite using a hinged brace it would blow out every five or six ski days. By "blowing out" I mean I would try to turn in heavy snow and the next thing I knew I would be on my butt because my knee would completely collapse/give out. Followed by swelling such that I could barely climb stairs or get in a car. Luckily I managed not to tear anything else and had minimal meniscus damage when I finally could have the surgery to reconstruct it. If I stayed on groomers I probably could have skied without incident, but you never know how your knee is going to react. It's probably worth trying (carefully) if your swelling has gone down and you feel strong. If you can still ski and do everything you want to without an ACL, you're better off not having the reconstruction. Just don't go out there with a brace thinking you're indestructible - It doesn't help all that much. The way my doc put it - if you think you need a brace, you probably need to go to the gym instead.
post #5 of 15
7-9 days? For God's sake man, don't you think you can wait that out? I say don't risk it.
post #6 of 15
Thread Starter 
Originally posted by epic:
7-9 days? For God's sake man, don't you think you can wait that out? I say don't risk it.
Fair enough. I've already postponed my Jan 10 Austria trip to late March (travel insurance saved us). Needless to say, after fantasizing about a decent snow year for the past eight months, it appears that we're getting it back east, and it's tough to sit in front of the computer looking at webcams.

But I will be back...

Thanks to Linda and Altagirl for the info.
post #7 of 15
Ouch! JD, sorry about your knee, and about yor delayed trip to Austria...
I wouldn't risk further damages skiing now, but I see you've
already taken a decision.
post #8 of 15
Can you ski w/o an ACL? Of course.

SHOULD you ski w/o an ACL? Not if you are an aggressive skier.

ryan linked to an article that is super-subjective and not really accurate when compared to my history of ACL injuries and repairs.

1983-1985 I spent 2 seasons of college athletics and skiing with no ACL in my right leg, using a custom-built Lenox-Hill brace. Even with the brace, and with my rabid weight training and fitness training enhancing and stabilizing the supporting muscles, I still could feel the dreaded "pivot shift" that happens when an ACL-deficient knee joint is required to perform at strenuous, aggressive levels of athletics. The femur and tibia articular surfaces slide against each other, rather than merely articulating with the meniscal cushions guiding their (slide-free) movement. The sliding causes microtears in the menisci and eventually those microtears will degenerate, leaving un-cushioned areas of the joint. The uncushioned areas are highly susceptible to arthritis, but do not always become arthritic. They will cause performance problems, though, even if they don't become arthritic.

Every aggressive athlete that I know who has suffered an ACL partial or total tear and didn't get it fixed now has a destroyed knee joint that doesn't perform well at all.

James, your "sports doc" isn't much of an orthopaedic doctor if he couldn't even tell whether your ACL was torn, much less the extent to which it was torn. Good lord, even med students should be able to tell whether the ACL is injured. I suggest you find yourself a top-notch orthopod and stay away from the "sports doc."
post #9 of 15
Hey JD,

Been there, done that. I exploded my ACL on Jan 17, 1999. I skied the entire season without it, including a week of steeps in Whistler. I had a couple minor episodes of the femur sliding forward on the tibia, wich felt like I tripped over nothing, although it was not bad enough to make me fall. And all of theose happened while walking around my office.

If your leg is strong, then a missing ACL can be almost un-noticable. But if they get weak, you start to get problems.

Here's the big clincher as to whether you should or should not ski on it the way it is. If you have any cartalidge damage, then stop everything until you get it fixed. Without an ACL, you could really damage any folded or torn cartalidge. If you do that, you are very likely to get early arthritis in that knee, from bon-to-bone contact, and that will be very painful and stay with you until you do something like a TKR (total knee replacement), which really sucks. If you don't have any damage, then go for it. Bode Miller is winning WC races without any ACLs.
post #10 of 15
James, I'd say wait and fix it first. ACLs do serve a purpose and without it you increase your chances of seriously messing up other knee structures, some permanently. I know it is hard but yeah, I'd say better safe than sorry. Last year I messed up my leg on the first trip of the season in Dec. and it was tough but being 43 and having seen sh*t happen all the time to my unlucky patients it was easier to be patient and play it safe. The other people are right when they mention the unpredictable way the knee could collapse or buckle. You would have NO WAY to prevent this should it occur. It is the main reason I didn't attempt to ski to the gondola right after my accident. I figured I could deal with the pain but if my leg collapsed then everything else would be in jeopardy. Good luck with the recovery. skidoc
post #11 of 15
Sorry man, Injuries suck. My brother took a year off of school to work at a hotel up in breckenridge and he hit a tree snowboarding and tore his mcl a couple weeks ago. I'd look at it this way though, you're absolute number one priority should be a 100% complete recovery. What's worth more, a few days of tentative skiing this season, or years of aggressive, challenging and pain free skiing to come? You only get two knees per lifetime, gotta make 'em last.
post #12 of 15
I am not certain, but doesn't Bode Miller ski without an ACL?
post #13 of 15
James: Is this the same leg that you broke last season?
post #14 of 15
Originally posted by crew cut:
I am not certain, but doesn't Bode Miller ski without an ACL?
yes & so does/did Dybig. so does my frequent alta partner Jaime.

The difference their ACLs are gone, not fixable w/o total knee replacement.

So like gonzo I would say yes you can ski w/o one ( or 2) but if they can/will be repaired dont risk long term pain/injury.
post #15 of 15
Thread Starter 
Originally posted by Lisamarie:
James: Is this the same leg that you broke last season?
Same leg. However, the fracture did not play any role in this injury.
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