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ACL tear, no surgery

post #1 of 10
Thread Starter 

I tore my ACL in February skiing. I had several X rays, two MRIs, was seen by three doctors.

They all independently diagnosed it as a complete ACL tear, MCL strain.

 

At the time of the injury, I heard a pop (does the sound travel internally or something? I had my

helmet on - just wondering now how I heard it!), but there was zero pain or swelling. I got up

and skiied a ways but it felt very unstable so I sat down and waited for the Patrol, just to be safe.

I have not skied since.

 

So now after three months, my O/S tells me the MCL is fine, and the ACL is healing on its own

and he does not want to do surgery, but he will if I insist. I have what feels like a little instability,

but otherwise it feels pretty much ok. Sometimes a little stiff, and I have a bit of a limp, but pretty

reasonable for 3 months out, no surgery.

 

My O/S is an expert knee surgeon and has worked on many athletes and I trust that he knows what

he is talking about.

 

He just had me relax my legs and checked for side to side motion in my knees and was satisfied

that both were equal.

 

At this point he has cleared me for skiing, although he wants me to use a custom brace for one season

first.

 

Does this sound possible? I'm really nervous but he kept telling me it truly was fine - he believes it has

scarred into the PCL and it will be strong as the original ACL (which of course it is!) over time.

 

I'm just looking for comments - has anyone heard of this positive outcome with no surgery?

 

At the hospital - HSS in NYC, they did a paper on non surgical repair in skiers and apparently

in about 15-20% it can happen. It just scares me. I don't want to pop on my first run in October.

 

I am 60 y/o, male, been skiing for 35 years, adv. int to expert level.

post #2 of 10

Why aren't you working with a PT? Since I am not a dr. I can't say anything with authority but as far as I know, an ACL that is completely detached; in this case torn, doesn't spontaneously regenerate.  Are you sure the dr isn't just saying your knee feels stable?  that's different and many people can fore-go surgery as long as the knee is stable.  I would be working with a PT. What are you doing for rehab? 

 

 it is odd/unusual that you had multiple films and 2 MRI's.  You must have very good insurance.  

post #3 of 10

I think the research done by Dr. Marx at HSS referred to in Post #1 is summarized in the following article.  It's specific to skiing injuries and based on HSS patients from 2003-2008.

 

http://www.hss.edu/newsroom_skiers-acl-tear-without-surgery.asp#.VUeA2KYXyFI

 

My PT made a big deal about getting rid of any limp ASAP.  Even with a delay in getting started (was traveling abroad, not a skiing injury), I had no limp by 8 weeks after injury.  Regardless of what decision is made about treatment by an ortho surgeon, PT is really important.

post #4 of 10

When my ortho looked at my MRI he said it looked like one of the ends of the torn ACL had scarred onto something nearby (don't remember what, maybe the PCL) and that was why it was relatively stable.  Not stable enough, but better than it could have been.  So it can happen, but I am not sure it buys that much.

 

I think what you are running into may be a predisposition against repairing older knees.  If your surgeon repairs college-age athletes who "need" good knees, he may figure (perhaps unconsciously) that an older guy is just going to noodle down green runs and then sit in the bar.

 

When my ortho fixed my knee (ACL reconstruction and some meniscus tear cleanup) one of his partners expressed surprise.

post #5 of 10

LOL,, This is why I stopped going to EC doctors many years ago.  The mindset of almost every dr. I saw was that I should stop skiing and biking like I was doing and take up couch surfing.  

 

BTW- I read the article, it doesn't state that Full, complete tears repair themselves.  The majority of the reference is testing using the Lachman and Pivot shift tests and grading the laxity and then grouping them into a point system.  If your knee is stable, and you rehab properly and maintain good health and fitness, you can def' avoid surgery.  

 

 

 

Quote:

Originally Posted by mdf View Post
 

When my ortho looked at my MRI he said it looked like one of the ends of the torn ACL had scarred onto something nearby (don't remember what, maybe the PCL) and that was why it was relatively stable.  Not stable enough, but better than it could have been.  So it can happen, but I am not sure it buys that much.

 

I think what you are running into may be a predisposition against repairing older knees.  If your surgeon repairs college-age athletes who "need" good knees, he may figure (perhaps unconsciously) that an older guy is just going to noodle down green runs and then sit in the bar.

 

When my ortho fixed my knee (ACL reconstruction and some meniscus tear cleanup) one of his partners expressed surprise.


Edited by Finndog - 5/4/15 at 8:26am
post #6 of 10

This was my second season skiing after tearing my acl (43 days last year, 38 so far this year). My doctor who also happens to operate at the HSS didn't recommend surgery. I know the doctor personally & have skied with him in the past so he knows how I ski (aggressively). My knee feels fine & I've never felt any instability with it. I do still wear a brace out of precaution but probably don't need to. It hasn't affected my skiing at all. Occasionally I do still feel a little discomfort in the knee but believe it or not that's mostly when I'm lying in bed, not when I'm active. I'm 58 & weigh 190lbs. I'm happy with the decision my doctor & I made.Good luck with your knee.

 

ps: my doctor also blew out his acl skiing several years ago & elected not to have surgery too.

post #7 of 10

Here is my strongly-help personal opinion of the bottom line:

1)  If it is stable and you are committed to faithfully exercising to keep the surrounding muscles strong, don't have surgery.

2) If it is unstable -- i.e. it "goes out" even once after recovery -- then get it repaired before there is additional damage to the rest of the knee.

post #8 of 10
Quote:
Originally Posted by mdf View Post
 

Here is my strongly-help personal opinion of the bottom line:

1)  If it is stable and you are committed to faithfully exercising to keep the surrounding muscles strong, don't have surgery.

2) If it is unstable -- i.e. it "goes out" even once after recovery -- then get it repaired before there is additional damage to the rest of the knee.

sounds like my thoughts and what my OS and PTsaid as well.  Thumbs Up

post #9 of 10
Quote:
Originally Posted by steamboat1 View Post
 

This was my second season skiing after tearing my acl (43 days last year, 38 so far this year). My doctor who also happens to operate at the HSS didn't recommend surgery. I know the doctor personally & have skied with him in the past so he knows how I ski (aggressively). My knee feels fine & I've never felt any instability with it. I do still wear a brace out of precaution but probably don't need to. It hasn't affected my skiing at all. Occasionally I do still feel a little discomfort in the knee but believe it or not that's mostly when I'm lying in bed, not when I'm active. I'm 58 & weigh 190lbs. I'm happy with the decision my doctor & I made.Good luck with your knee.

 

ps: my doctor also blew out his acl skiing several years ago & elected not to have surgery too.


Always interested to hear about successful copers.  A recent thread includes posts by several copers who ski advanced terrain.  Also posts from older skiers (over 45) who opted for surgery and were happy with the decision.

 

http://www.epicski.com/t/134412/anyone-skiing-without-an-acl

 

I just finished my third season without an ACL (not a skiing injury).  Was just getting into more complex terrain off-piste after starting to ski a lot more after age 50.  Decided that working more on ski conditioning and having high level lessons made more sense for my situation than surgery since the laxity in the ACL-deficient knee was minimal.  Fair to say that I'm skiing better than ever and have no regrets.  Didn't use to go looking for bumps or trees but do now when skiing in the Rockies or in the northeast.

post #10 of 10

My ACL story:

I was playing tennis on Feb 14th of this year and felt my knee buckle. I went down to the ground and my first thought was "Oh sh*t when is my Snowbird trip"?!!! It was exactly two weeks away and was prepaid non-refundable. The knee swelled pretty good but I figured it was just a bad sprain (In total denial). I iced it incessantly, took tons of motrin, wrapped it, and elevated it at night for the two weeks. I bought a good knee brace and headed to Snowbird. My first run was in Mineral Basin in deep snow. I made about 5 good turns, hit a heavy section, and felt the knee buckle again. Down I went and I thought I was done for the rest of the trip. The pain eased and I stayed on the groomers for the rest of the day while my friend enjoyed a foot of powder. The next day was a little better. No buckling and no swelling. My last day was one of the best powder days of the year and I pushed it for most of the day and the knee held up ok.

 

I returned home and rested it for about 4 weeks then returned to easy tennis with the brace on. I ramped up the tennis over the next month and then took the brace off for a doubles match. I jumped for a ball at the net and when I landed the knee buckled again. I finally had it evaluated with an MRI and found a complete ACL tear and severe sprain of the MCL. The ortho said if I wanted to keep doing the activities I enjoy that surgery was the only option. He said I had way too much laxity and that my meniscus would be the next thing to go. He said my menisci look really good right now and it was highly advisable to try keeping them that way so as not to have arthritis problems in my future. BTW, I'm 42 years old. So, I am going to listen to him and have the surgery on June 1st. No tennis/skiing for 6 months which puts me at December 1st. Perfect timing!!!

 

I just wanted to share my story and vent a bit. I think it corroborates with the thoughts above. If stable, try without surgery. If unstable, not much of an option, unless you want to be a couch potato.

 

Agreen

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