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Farewell, ACL - Page 3

post #61 of 81
Quote:
Originally Posted by evansilver View Post

JimS and gonzo have it right. Today is the one year anniversary of my surgery. In December of '03, second day of the season, a skier (not a boarder) ran into me at low speed at the first ETU, knocked me over straight backwards. The classic "phantom foot" injury gave me the unhappy triad -- acl, mcl, and torn meniscus. That Monday I went to see an old friend who's an orthopod who confirmed that I had more than a bad sprain. But he asked "at your age (61) do you really need an acl"? He was a lifelong jock, and told me that he learned only a couple of years earler, when he had his knees replaced (no, he didn't operate on himself) that one of them was lacking an acl! He figures that he tore it 40 years earlier playing high school football.

But two things made up my mind to have the acl replaced. One, I had just retired and wanted to ski a lot more, but more important, I was afraid for my meniscus. Even a month later, after the pain and swelling from the injury was gone and I was walking pretty normally, not one day went by without an episode of "stepping wrong" with a little twist or rotation, and a flash of pain. I knew that every time I did this, I was doing more damage to the cartilege, and, after a while, I'd be down to bone-on-bone. I think this is a product of individual anatomy. Some folks can go for years after losing an acl and not notice it much, some can't. And my knees were pretty stable from a couple thousand miles of cycling annually.

Anyhow, one year ago I had a nice, big Achiiles tendon from a cadaver put in, along with a couple of stitches in my meniscus. I did my PT religiously and was back on the bike in June, did a century in August, and was back at the ETU this December. Knee feels great.

Hi Evansilver,

 

I am wondering how you are doing now almost 11 years from your ACL and meniscus surgery. I am surprised that you mentioned that your meniscus was stitched. I had a very peripheral medial meniscus tear at 43 years old and here is my surgery report after ACL reco :"Probing revealed an inferior surface partial thickness vertical longitudinal tear on the inferior surface of the posterior horn of the medial meniscus. The tear was very peripheral and was approximately 12 mm in length. As it was stable, it was felt that there was little to be gained by trying to suture it, given the patient’s age. "  ... basically too old to suture it/

post #62 of 81
11 years later it's still a complete success. I used a custom Donjoy brace for a couple of seasons after the surgery, not for stability or strength but to keep from suffering a new injury and ruining the repair if I had asimilar accident, but don't bother withit any more. Took glucosamine and chondroitin for several years , but gave it up a couple of years ago and can't tell the difference. Used to take ibuprophen before skiing, but since I rarely ski more tan 4 hours a day I don't usually get sore. I do wear XWave tights. And I've biked more than 2 k miles a year for the past 35 years and I'm sure that helps with knee stability.

As far as the meniscus is concerned, I think I had a small tear that preceded the ACL. When biking I would notice a little catch that would go away after a few hard pedal strokes, probably a flap falling back into place, but after the surgery it was gone.
post #63 of 81
Quote:
Originally Posted by evansilver View Post

11 years later it's still a complete success. I used a custom Donjoy brace for a couple of seasons after the surgery, not for stability or strength but to keep from suffering a new injury and ruining the repair if I had asimilar accident, but don't bother withit any more. Took glucosamine and chondroitin for several years , but gave it up a couple of years ago and can't tell the difference. Used to take ibuprophen before skiing, but since I rarely ski more tan 4 hours a day I don't usually get sore. I do wear XWave tights. And I've biked more than 2 k miles a year for the past 35 years and I'm sure that helps with knee stability.

As far as the meniscus is concerned, I think I had a small tear that preceded the ACL. When biking I would notice a little catch that would go away after a few hard pedal strokes, probably a flap falling back into place, but after the surgery it was gone.

Ok. Thanks for your update. So your ortho at 61 still stiched your meniscus which mine would not do at 43 but my tear is a 12 mm partial thickness vertical longitudional  tear in the medial meniscus part (vascular which is stable). I think the key here is that the meniscus is fine that changes a lot about how your knee behave in the long run.

I have to say this injury is changing my life as I am very active and I am not sure how I should behave going forward. I am really worry about developing creepling OA by the time I am in my 50s

post #64 of 81
Quote:
Originally Posted by fabienzan View Post

Did you have a look about my tear as per mentioned in your previous message ? Also if you had your knee reco in 1996 that is 18 years with no issue that is very good. How old were you when you had your knee reconstruction ?
I don't know about no issues. It's pretty good though. Oddly some of the most frequent pain is during sleeping. Thrash it around at times and wake up with an aching knee in spots.
Was 34 in '96.
I wouldn't stress excessively about this. Certainly I'm not qualified to to make conjecture on your knee. If you run a lot you might want to look into biking instead. We used to have jdistefa who posted here and was a doc i believe. Check with good pt for advice on knee.and what's good.
post #65 of 81
Quote:
Originally Posted by Tog View Post


I don't know about no issues. It's pretty good though. Oddly some of the most frequent pain is during sleeping. Thrash it around at times and wake up with an aching knee in spots.
Was 34 in '96.
I wouldn't stress excessively about this. Certainly I'm not qualified to to make conjecture on your knee. If you run a lot you might want to look into biking instead. We used to have jdistefa who posted here and was a doc i believe. Check with good pt for advice on knee.and what's good.

Ok so if I calculate well you are 52 now. Removing the whole meniscus is never a good thing and pain at night neither. Did you have an xray on that ? Probably a good idea to check. My mother had 60% of her medial meniscus removed 10 years ago (She is 68 now) and is on hydraulic acid which works very well to prevent knee pain and last for 1 year. How is your other knee going ? Any pain on this one ?

post #66 of 81
Well they didn't remove all my meniscus just what was needed

The other knee is like nothing happened.
Well since i had incision the knee and below were numb for years. Just to touch and kneeling was strange and avoided it. Feeling has come back or I don't think about it much.
That was case for both. Not sure if you have that.
post #67 of 81
Quote:
Originally Posted by Tog View Post

Well they didn't remove all my meniscus just what was needed

The other knee is like nothing happened.
Well since i had incision the knee and below were numb for years. Just to touch and kneeling was strange and avoided it. Feeling has come back or I don't think about it much.
That was case for both. Not sure if you have that.

You confirm what I think. The meniscus is a critical part of how well you do afterward. In my case I was mis diagnosed after injuring my knee playing basketball and got 2 small extra lateral tears from keeping on playing. Here is my surgery report. My surgeon said that the medial meniscus damage is key to longer term prognosis. Do you know how much of the medial meniscus they removed from your knee ? How long did you wait to get surgery . I had mine 4 months after the original injury.

I am now 4 months into recovery and I don't have much pain. I feel a sense of inbalance so where my left leg is stronger than my right one. I hope it will resolve slowly as I am strengthening my right knee.

I think if I had only an ACL tear with no menisci tears I would think it is a big bummer but I will be ok .

 

 

Operative procedure

A tourniquet was applied and anthroscopy performed using anterolateral and anteromedial portals. No abnormality was seen in the patellofemoral compartment. In the medial compartment the articular surface was intact. Probing revealed an inferior surface partial thickness vertical longitudinal tear on the inferior surface of the posterior horn of the medial meniscus. The tear was very peripheral and was approximately 12 mm in length. As it was stable, it was felt that there was little to be gained by trying to suture it, given the patient’s age. In the intercondylar notch there was a proximal rupture of the anterior cruciate ligament. In the lateral compartment the articular cartilage was intact. There were small inferior surface and superior surface partial thickness vertical longitudinal tears on the posterior horn of the lateral meniscus . These were stable and were not addressed surgically.

post #68 of 81
Acl was done over 3 years after original injury. Meniscus was done like a week or few days after the injury from no acl. At that time torn acl was observed . Then i think 1 month later went and fixed acl after swelling had gone down.
post #69 of 81
Quote:
Originally Posted by Tog View Post

Acl was done over 3 years after original injury. Meniscus was done like a week or few days after the injury from no acl. At that time torn acl was observed . Then i think 1 month later went and fixed acl after swelling had gone down.

I think you are contradicting yourself here.

Acl was done over 3 years after original injury.... Then i think 1 month later went and fixed acl after swelling had gone down"

 

Also to answer your question about numbness and kneeling. I don't really have this issue. Only a bit of pain at the moment at front of the knee but this seems to slowly disappear. I guess that is why I went to a surgeon who is well regarded here in Melbourne . All our top athlete who need a knee reco goes to him. I understand this is crucial to go with a very experience surgeon as knee reco is a very technical procedure.

post #70 of 81
Think it's due to you had it done through ports and not an incision. Don't think they did that 15 yrs ago.
Nope 3 years. Acl tear never diagnosed No mri Then tore meniscus. Fix meniscus see acl tear. 1 month later fix acl.
post #71 of 81

Ok . Indeed I had arthrscopic surgery.

Do you take any medicine when skiing ?  Can you ski a whole day without knee pain ? What type of skier are you ? I am a blue run skier and I like to ski for 2 continuous week every year otherwise I tend to cycle, do some gym work and I work at a desk so I suppose all this is good for the knee

post #72 of 81
Quote:
Originally Posted by newfydog View Post
 

This is now a 10 year old thread.  I've now gone 20 years with no ACL.

 

I just turned 60, am still skiing just fine, and for my 60th birthday I did a 22 day trek in Nepal, crossing a 17,000 foot pass with a steep 6500 foot descent.  The knee gave me no trouble.

 

Personal experiences will vary, but my knee has done better with no ACL than many which were repaired.  I consider myself extremely lucky in this regard, but if your knee is fairly solid and you keep your legs strong, the option of no operation is certainly a viable alternative.

:beercheer:

post #73 of 81

Thanks for your comment. You are indeed very fortunate. I know someone like you who has gone for 20 years with no acl and is doing fine. I have made the decision to have a knee reconstruction as I have some menisci tear and I understand that the knee reconstruction will give the stability to protect my menisci.

Unfortunately menisci tears are not good in the long term as they are a strong factor of OA which is what is scaring me. Did you have any meniscus tear ? How was your original injury was it a small fall with no bone bruising or effusion as all of this seems to have an impact on the long term health of your knee.

Have you change what sport and activity you do ? For example no running but more bicycle and gym. How much do you ski per year ?

post #74 of 81

Dude, really, stop it.
A tear will give you OA, a partial meniscectomy will give you OA, a full meniscectomy will give you OA, age will give you OA, sports will give you OA. There are so many things that can/will give you OA all this worrying about your surgery is doing you no good.
You hurt you meniscus, millions of other people have too. NO BIG DEAL.

post #75 of 81
Thread Starter 
Quote:
Originally Posted by fabienzan View Post

 Did you have any meniscus tear ? How was your original injury was it a small fall with no bone bruising or effusion as all of this seems to have an impact on the long term health of your knee.

Have you change what sport and activity you do ? For example no running but more bicycle and gym. How much do you ski per year ?

 

Well, let me apologize in advance for not being able to answer all that.

 

I did a really weird fall where I stuck one ski in a drift on a cat track and spun around off the track, catching the tail of my ski and twisting the leg with a loud pop!  Who knows what blew out, I never had an MRI done.

 

I stopped jumping off every cornice about then, but I was also turning 40 so it was about time. At 58 I stopped skiing through the roped climbers on the pearly gates of Mt Hood, but again, it was time to admit I was getting a bit old for that.

 

I have not changed sports at all.  I bike all summer, ski all winter, hike, rock climb, play hockey etc as the opportunity arises. I'm retired and Mt Bachelor is open November to late May.  I do some randonee skiing and XC crust skating into June. I don't do weights and never ran much.  I really suck as a runner but have done a few build ups running for our Pole Pedal Paddle multi sport race.  Still sucked at running after the ACL but the knee did not give me trouble..  I mostly mountain bike and we do an extended tour or three every year.  I avoid moguls but the knee isn't the problem---they trash my back and my skis.  I love ice, and ski a lot of racing skis.

 

I wear a donjoy brace skiing but not for any other sports.  One day last year I put it on the wrong knee.  I must have been pretty fogged that morning, but I took that as a good sign that the knee with no ACL is not that different.

 

I do as much XC skiing, back country, classic, skating etc as alpine.  I don't spend as much time on alpine skis as when I was patrolling, which I quit at 55 because I'm often travelling during fall recertification.  I had no problem hauling massive  tourists in the patrol toboggan.

 

Volleyball doesn't feel all that stable, but I never played that much except at picnics..  Wading a gnarly river fly fishing I have to make sure I have the knee aligned.

 

If I spend a few weeks just eating and drinking with little exercise I don't freak out, but in general I'm off doing something 3-4 days a week.

 

The only time the knee bothers me is after a really long, such as trans-pacific, plane ride.  It loosens up by baggage claim.  The doc didn't see any arthritis on the last xray.

 

Maybe the meniscus is going to finally blow soon, and maybe I'll need a knee replacement sometime.  Maybe I won't.  Lots of people in my family die of cancer before their joints wear out, so I'm not inclined to lose any time recovering from surgery I don't seem to need.

post #76 of 81
Quote:
Originally Posted by newfydog View Post
 

 

Well, let me apologize in advance for not being able to answer all that.

 

I did a really weird fall where I stuck one ski in a drift on a cat track and spun around off the track, catching the tail of my ski and twisting the leg with a loud pop!  Who knows what blew out, I never had an MRI done.

 

I stopped jumping off every cornice about then, but I was also turning 40 so it was about time. At 58 I stopped skiing through the roped climbers on the pearly gates of Mt Hood, but again, it was time to admit I was getting a bit old for that.

 

I have not changed sports at all.  I bike all summer, ski all winter, hike, rock climb, play hockey etc as the opportunity arises. I'm retired and Mt Bachelor is open November to late May.  I do some randonee skiing and XC crust skating into June. I don't do weights and never ran much.  I really suck as a runner but have done a few build ups running for our Pole Pedal Paddle multi sport race.  Still sucked at running after the ACL but the knee did not give me trouble..  I mostly mountain bike and we do an extended tour or three every year.  I avoid moguls but the knee isn't the problem---they trash my back and my skis.  I love ice, and ski a lot of racing skis.

 

I wear a donjoy brace skiing but not for any other sports.  One day last year I put it on the wrong knee.  I must have been pretty fogged that morning, but I took that as a good sign that the knee with no ACL is not that different.

 

I do as much XC skiing, back country, classic, skating etc as alpine.  I don't spend as much time on alpine skis as when I was patrolling, which I quit at 55 because I'm often travelling during fall recertification.  I had no problem hauling massive  tourists in the patrol toboggan.

 

Volleyball doesn't feel all that stable, but I never played that much except at picnics..  Wading a gnarly river fly fishing I have to make sure I have the knee aligned.

 

If I spend a few weeks just eating and drinking with little exercise I don't freak out, but in general I'm off doing something 3-4 days a week.

 

The only time the knee bothers me is after a really long, such as trans-pacific, plane ride.  It loosens up by baggage claim.  The doc didn't see any arthritis on the last xray.

 

Maybe the meniscus is going to finally blow soon, and maybe I'll need a knee replacement sometime.  Maybe I won't.  Lots of people in my family die of cancer before their joints wear out, so I'm not inclined to lose any time recovering from surgery I don't seem to need.

 

Hi Newfydog,

 

Here is my surgery report. I agree with what you say and if I was in your situation with just an acl tear I would take it the same way. Unfortunatelly I have 3 menisci tears and this is driving me crazy as I am reading that they are big factor in developing OA in my knee in the long run.  Menisci tears seems to have a much bigger impact on the knee when cumulated with a new knee reco.

 

Here is my surgey report. The only positive is that all my menisci tears were stable and left in situ nevertheless I am guessing this is likely to mean more surgery in the future . At the moment I am 4 months into my recovery and doing ok but I am assuming knee motion will eventually worsen the menisci tears over time and then I will have trouble on both side of my knee. Just trying to understand as most people posting here only have an ACL tear and not menisci tears (on lateral and medial side) 

 

Examination Under Anaesthesia:

No effusion. 0  Recurvatum to 140 flexion. Lacham 1+ with an equivocal end point. Pivot shift 2+. No collateral laxity

 

Operative procedure

A tourniquet was applied and anthroscopy performed using anterolateral and anteromedial portals. No abnormality was seen in the patellofemoral compartment. In the medial compartment the articular surface was intact. Probing revealed an inferior surface partial thickness vertical longitudinal tear on the inferior surface of the posterior horn of the medial meniscus. The tear was very peripheral and was approximately 12 mm in length. As it was stable, it was felt that there was little to be gained by trying to suture it, given the patient’s age. In the intercondylar notch there was a proximal rupture of the anterior cruciate ligament. In the lateral compartment the articular cartilage was intact. There were small inferior surface and superior surface partial thickness vertical longitudinal tears on the posterior horn of the lateral meniscus . These were stable and were not addressed surgically.

post #77 of 81
Thread Starter 

Well, if you look at the first page, the experts posted:

 

Quote:

 Abscence of a functional ACL is a red carpet invitation to premature degenerative osteoarthritis, cartilage and meniscal tears.whammo true. superbig.

think about it this way: most ACL tears are traumatic with twist components. this usually leaves cartilage damage.

if you are at all athletic or even simply just someone who has to climb more than 2-3 steps at a time, an ACL-deficient knee with extant cartilage damage will just get more damaged cartilage.

damaged cartilage = degenerative arthritis in most cases, and the Q is really one of degree/extent and not existence.

and this
 

Quote:

 

Newfydog - We don't want to hear any whining when you rip your menisci or cartilage and are out of commission for quite some time.

 

So, I guess I believe that the cartilage issues go hand in hand, but don't go assuming they have to.  Deal with it if the issue comes up, til then, get better, and go ski!


Edited by newfydog - 1/25/15 at 6:46am
post #78 of 81
Newfy do you have instability hiking downhill?
Quote:
Originally Posted by fabienzan View Post

Ok . Indeed I had arthrscopic surgery.
Do you take any medicine when skiing ?  Can you ski a whole day without knee pain ? What type of skier are you ? I am a blue run skier and I like to ski for 2 continuous week every year otherwise I tend to cycle,
I would break up your 2 continuous weeks of skiing. At least in the beginning. That's a lot. Though it also depends how it goes. If it feels fine go with it. Not sure I've done 14 continuos days in my life. Did 13 this Christmas.

Also walking in boots on snow can be worse than skiing when you step funny in a hole.
Consider building in breaks. Maybe go to the spa or get some accupuncture. You could use some mellow time.

I used to take ibuprofen before skiing fairly regularly. Don't think i've done it this season. Years back used to take vioxx sometimes. That was great stuff. Really good. Off the market due to possible heart issues.
Been pretty consistent with the fish oil. Good stuff. I seem to get much less swelling and pain post skiing.

Do I ski a whole day w/o pain? Yes, no, maybe. All of those Also depends how one defines pain. Sometimes yes, sometimes no. Honestly doing wedge turns on green terrain for 2 hours is worse than skiing blacks. Gets stiff.
Sometimes it hurts, sometimes it doesn't. My freakin toe was hurting last 2 weekends and affected skiing way more than the knee ever does. I managed to get through it.
Quote:
Originally Posted by jzamp View Post

Dude, really, stop it.

A tear will give you OA, a partial meniscectomy will give you OA, a full meniscectomy will give you OA, age will give you OA, sports will give you OA. There are so many things that can/will give you OA all this worrying about your surgery is doing you no good.

You hurt you meniscus, millions of other people have too. NO BIG DEAL.
Yep. There are people skiing the world cup with way worse knee issues.
When i was 19 and had shoulder surgery (truly if not the stone age than the broze age) the doc told me I'd get arthritis in the shoulder. That had zero meaning at 19, over 30 yrs ago, but thinking about it now, i have less pain than 15 or 20 yrs ago.

Stop worrying about it ! Nothing you can do except take care of it. Get a cryo cuff for icing when it swells - ahhh so good.
Stop posting the surgery report. Your obsessed with your meniscus. It is what it is. Many people way worse off.
Quote:
I went to a surgeon who is well regarded here in Melbourne . All our top athlete who need a knee reco goes to him
Well there you go. He decided to leave it alone. Now somehow you doubt it. Stop.
post #79 of 81

Thanks for your time and answers.

It makes sense . I like when it is black and white nevertheless with my injury there is a lot of gray and it is around the menisci damage. With ACL it was easy for as I had other injury I had to reconstruct it. The menisci are in the grey zone special the medial meniscus as suturing it was not the option taken by the surgeon because of my age and the fact that it is stage therefore there are several options either it will heal partially, not at all, heal completely or extend into a bucket handle tear.

The lateral small tears apparently won't be an issue as they are small and stable and won't extend unless I re injure.

 

I fully trust my surgeon and believe he did the right things at the time of surgery but there is not certainty on how this will progress and this is what is driving me in sain.

 

I completely agree that there are people much worse. I will refrain from posting the same questions :-) Thanks again.

post #80 of 81
Thread Starter 
Quote:
Originally Posted by Tog View Post

Newfy do you have instability hiking downhill?
 

 

  The only instability is when over extended or hyperextended.  Both my knees and elbows bend backwards a bit at full extension.  I ski with a generic Donjoy brace with the biggest extension stop they offer.  If the knee is bent it is strong.. If I step in hole and extend it all the way it feels like it can twist and wobble around a bit.  I've been dealing with it 20 years just fine.  Having fun too!


 

Quote:

Stop worrying about it ! Nothing you can do except take care of it. Get a cryo cuff for icing when it swells - ahhh so good.
Stop posting the surgery report. Your obsessed with your meniscus. It is what it is. Many people way worse off.

Quote:
I went to a surgeon who is well regarded here in Melbourne . All our top athlete who need a knee reco goes to him

Well there you go. He decided to leave it alone. Now somehow you doubt it. Stop.

Thumbs UpThumbs UpThumbs Up 

 

Get better, and go skiing!

post #81 of 81
Quote:
Originally Posted by skier31 View Post

It is not about meniscus wear. It is about the fact that without an ACL, it is more likely that your meniscus will tear. Meniscus tears are difficult to repair. If your meniscus is able to be repaired, it means at least 1 month of no weightbearing and difficult rehab. After an ACL reconstruction, you are weightbearing right away and things move quickly, especially if you are in good shape.

If your meniscus can't be repaired, the risk of arthritis increases dramatically.
Without a meniscus, weightbearing sports such as running, tennis etc. can cause greater knee damage.

I went for 10 years without a problem. In those 10 years, I ran, biked, skied and hiked. I have strong legs and worked very hard to keep in shape. It did not take much. All of our bodies have limits. If you have a good surgeon and do the required rehab and don't try to do too much too soon, most people have great results. I am amazed by people who love to ski and do other sports who won't take advantage of modern medicine.

Hi Skier 31,

 

I am wondering how you are going with your knee now days about 12 years from your knee reconstruction. Have you got any OA or major issue. How big and where were your menisci tear located ? Did they get resected or left in situ ? I had knee reconstruction 5 months ago and I am in a similar position with menisci tears in both menisci and knee reconstruction. I am 43 and very worry about what to do next about keeping a working knee for the longest possible time and trying to delay OA and knee replacement.

How old are you now ?

Do you do specific strenghtening exercise ? I do a log of cycling and leg press.

 

Cheers

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