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partial ACL tear - surgery or not? - Page 2

post #31 of 48
Thread Starter 
Bob - thanks for the good news re microfracture effectiveness. And yes, I'm taking gluco/chon/MSM supplements (though my doc's not a believer, there's plenty of reasonable people who are...). Going to be hard to stay off the leg -- but clearly it will be worth it.

And newfy you're right, it's better to have a lot of info out there. Actually even before I hurt my ACL I would read the ACL injury threads - focussing on prevention and building strength / balance. Not that it ultimately did me any good in terms of prevention but I'm hoping the exercise I was doing even before the injury will make the recovery go quicker. (Certainly my PT says I'm good now in terms of flexibility and strength for this point in the recovery, so I'm hoping that will continue.)
post #32 of 48

Just had Healing Response Procedure done for my partial tear

I tore my MCL and ACL at the end of January at Squaw. I had to wait for the MCL to heal before getting the ACL surgery which is normal. Then my doctor thought I was healing well enough on my own and didn't need surgery. Then upon final check he decided I did need reconstruction because be knee was still too loose. I opted for the cadavre option. Then something very odd happened....

When I woke up from my surgery my surgeon told me that my ACL had still been partially attached. Instead of replacing it, he had performed something called the healing response. I had never heard of this procedure and we had never even discussed it as an option.

I wasn't too happy when, without my consent, my recovery went from being able to walk in days to not being able to bear any weight at all for 6 weeks. I was even more unhappy when I started researching the procedure only to find that it's been performed maybe 500 times and that many doctors don't believe it has any value.

Had I been properly educated about the procedure ahead of time, I may have still chosen to give it a try even being aware of the associated controversies and relative newness. Cutting edge can be a very good thing. However, having the decision made for me while I was already under the knife was just not cool at all so perhaps I've felt unreasonably mistrustful.

Obviously I want this procedure to be successful so I'm following orders 100% and will keep an open and positive mind for at least 6 months. My doctor is either brilliant and I am lucky to have him or I've just been used as a guinea pig and will end up being very, very angry Let's hope he's brilliant. I chose him specifically because he had been the OS for the US Ski and Snowboard team and had studied with Steadman prior to moving to Stanford which is conveniently local for me.

Okay...now that I'm done ranting....did anyone on this post end up having this procedure done? I'd really love to connect with someone who has had this procedure performed so that I could compare notes and maybe gain a comfort level that everything is going to be just fine. My surgery was just 5 weeks ago. I still have a long rehab ahead of me before I will know if it's been successful or not. If anyone is thinking about this procedure...also feel free to contact me. There aren't many of us out there so I'm more than willing to share information or experience.

Thanks

Miss Mel
post #33 of 48
Hi, Miss Mel.

First off, welcome to Epic. I'm sorry your first post has to be about something unpleasant like this, but I hope you'll join in for lots of discussions.

That's a very interesting experience you just had. On the face of it, I think I would feel much the way you do. I'd be pretty upset if I went into surgery understanding one thing and came out having had a completely different procedure done.

One extremely important component of rehabilitation is having faith in the course of treatment. I'm of the opinion that your attitude has a great deal to do with how well you recover. It sounds like you're approaching this very well under the circumstances, so I hope you keep up that outlook.

One other suggestion... this is the first time I've heard of "Healing Response" and I sort of thought I kept fairly up to date on ACL stuff. You might consider starting a new thread specifically to ask for input from other Epic members about this procedure and what kind of results any of our members may have had with it. It's a different enough topic that I'd like to see it discussed separately.

This partial-tear, fix-it-or-don't question comes up constantly and if Healing Response is a good alternative for that, I think a lot of people would be interested in learning more.

Good luck with your rehab.

You should give some thought to joining the Epic Ski Gathering at Tahoe next winter.
post #34 of 48
Thread Starter 
Miss Mel -- Welcome, and as Bob said, sorry it has to be under these circumstances!

Sounds like you've done ample research after the fact. I learned a little about the healing response surgery back when my diagnosis was partial tear, not full, and I thought it sounded promising. In fact I was hoping to have it - seemed preferable to use what was left of a good ligament, instead of slicing and dicing to reconstruct or do an allograft. Turns out it was not an option for me, but one thing I always wondered is about the timing -- has it been shown to be effective several months after the injury, as in your case?

How is your hurt leg feeling strength-wise after 5 weeks on crutches? I'm 2 weeks in -- doing lots of leg lifts and range of motion stuff, it's feeling OK but I'm told to expect a fair amount of atrophy.

It's bad enough playing a doctor on the internet so I won't play lawyer. But I'm having a hard time finding any "informed consent" in your story. Which makes it very tough to be the patient. I was not informed either of the potential for microfracture procedure, BUT (1) I had informed the the surgeon and his assistant that I was experiencing inconsistent symptoms and was concerned there was other damage beyond the ACL, and (2) I had specifically requested they clean up ANYTHING they saw was a problem. I also had read about microfracture technique on the Steadman website and elsewhere before going in. SO while I was thinking they might address meniscus damage, I wasn't surprised or upset at the different outcome when I woke up. In your case though, "not cool" is an understated way to characterize the decision - and pre-op communication. I'd expect it to come out fine, but I hope you've discussed with your doctor how mistrustful you are at this point.
post #35 of 48
Quote:
Originally Posted by MissMel
Then upon final check he decided I did need reconstruction because be knee was still too loose. I opted for the cadavre option. Then something very odd happened....

When I woke up from my surgery my surgeon told me that my ACL had still been partially attached. Instead of replacing it, he had performed something called the healing response. I had never heard of this procedure and we had never even discussed it as an option.

I wasn't too happy when, without my consent, my recovery went from being able to walk in days to not being able to bear any weight at all for 6 weeks.
Thanks
Miss Mel
Unfortunately, Neither the Lachman test or the MRI are 100%. The true test is what the Doctor finds when he goes in, and it's generally understood that he will base his procedure on what he finds. You were told you were getting reconstruction, and should be happy that your ACL was still intact since your rehab is going to be easier. As I mentioned earlier, I skied for 6 years (120 days a year) with a 60% torn ACL without problems, and even if this Healing Response works minimally, you should be in a lot better shape, recovery-wise, than if reconstruction was done.


On a personal note, I was a little upset when my doctor went in for reconstruction and "cleaned up the maniscus" while he was in there. I had 2 previous MRIs over the previous 10 years, and they all said "partial tear of the posterior horn on the medial maniscus"(IIRC), that never bothered me, and he cleaned up that same spot! He saw it while he was in there, and decided it was the best course. If I wasn't sleeping at the time, I would've told him to leave it. Oh well....
post #36 of 48
Thread Starter 
UPDATE - and hopefully a closing note. I had my first two days sking last weekend after ACL allograft and microfracture surgery last June. About a week past the six-month mark post op.

Runs 1 - 4 were a little shaky psychologically but the knee was fine. As Yogi Berra said, 90% of the game is 50% mental. Or something like that.

Runs 5 - infinity were great; my new knee is stronger and just as stable as before, and no awareness at all of the injury, operation, or post-op weakness and pain. No pain during or after skiing. I was religious about rehab, strength and balance work - I'd say it paid off, if anything I felt better than before.

Still it generally seemed easier on the knee to ski a longer turning stable mid-fat; less so on a short radius slalom ski, though maybe that's just the lousy manmade slush and dirt I was skiing.

All told, very reassuring. Still will follow doc's orders to stay out of bumps and be a little risk averse this season but I'm DEFINITELY full speed ahead now.

Thanks to all who contributed to this thread and eased my decision to do the surgery and the words of encouragement after.
post #37 of 48

whtmt

Ditto Ts01.

I have had exactly the same experience starting in Spring 05. Totally blown ACL in my left knee while enjoying the bumps of Taos Ski Valley.

I'm very active 12 months of the year in some very rigorous activities, so I assembled a great PT team and found a great young sports surgeon, who had a lot of experience with skiing injuries and ACL's in particular. I followed the surgeon's advice to the letter and today I'm whole again and skiing like normal. My left knee is even stronger then my right at this point.

Staying with your PT, however is the most valuable thing you can do. Be methodical and tenacious and you will find new life in those knees. I work at it harder now then before I was injured, even though I was in great shape the day I was hurt.

Today I'm smarter for the experience thanks to a lot of very good people and a surgeon that has become a good friend, who doesn't like to cut unless it's absolutely required. His best comment to me mid-stream in my PT recovery, say 7-8 weeks in was, "you're light years ahead of guys ten years younger then you". You can only imagine how that made my day.

So, best of luck with your PT & skiing this season and get back into the bumps next season. That's where I am right now. Can't wait.

whtmt & Mackenzie 911
post #38 of 48
Thread Starter 
Quote:
Originally Posted by whtmt View Post
Staying with your PT, however is the most valuable thing you can do. Be methodical and tenacious and you will find new life in those knees. I work at it harder now then before I was injured, even though I was in great shape the day I was hurt.
Thanks whtmt. Appreciate the feedback and example to follow.

On the PT front unfortunately my insurance company just denied further physical therapy so I'll have to be methodical and tenacious in the appeal process. But either way I'm going to keep working the knee and have no doubt it's going to pan out.
post #39 of 48
When my insurance ran out the place I was going for PT offered use of their facility and equipment in a semi unsupervised environment. You could come as much as you want and could use any equipment so long as you were not interfering with other patients. They charged $35.00 a month. Less than my co-pay was. If they were not busy they would help you if you needed it. Same people that I had be seeing for the past 5 months. It was good. University Sports Medicine at UB.

You might see if something like this is available to you.
post #40 of 48
Thread Starter 
Thanks Skiboats. Good idea.
post #41 of 48

ACL tear

Hello I'm new to this form, I found it while doing a search about ski injuries to the knee, I'm hoping this thread is still alive and that Breckview is still around. My son took a tumble while skiing in Breckenridge where he's been living for the last three years. He's telling me his knee hurts so bad how he was going over a jump that the Breck employees gave him a thumbs up to hit it and a woman just stopped and stayed while he was flying in midair, needless to say the woman felt bad she was bruised and my son could hardly move, and that the ski patrol right off the bat told him he blew his ACL and that he'll for sure need surgery. He's having an MRI taken Thurs. I live in OK and hate to see him just jump into surgery. He's 23 yrs old and of course is more upset about not being able to ski or play basketball anymore this season than surgery.
I'm hoping that Breckview or anyone in that area could give advise as to where he should go and with hope not have to go the surgery route. Thanks in advance. Jvonna
post #42 of 48
Dr. Peter Janes
360 Peak One Drive Suite 180
Frisco, CO 80443
He is very good.
post #43 of 48
Thanks for the reply skier31 is this Dr. in Breck?
post #44 of 48
Awesome thank you I'll send my child. Jvonna
post #45 of 48
Quote:
Originally Posted by Jvonna View Post
Hello I'm new to this form, I found it while doing a search about ski injuries to the knee, I'm hoping this thread is still alive and that Breckview is still around. My son took a tumble while skiing in Breckenridge where he's been living for the last three years. He's telling me his knee hurts so bad how he was going over a jump that the Breck employees gave him a thumbs up to hit it and a woman just stopped and stayed while he was flying in midair, needless to say the woman felt bad she was bruised and my son could hardly move, and that the ski patrol right off the bat told him he blew his ACL and that he'll for sure need surgery. He's having an MRI taken Thurs. I live in OK and hate to see him just jump into surgery. He's 23 yrs old and of course is more upset about not being able to ski or play basketball anymore this season than surgery.
I'm hoping that Breckview or anyone in that area could give advise as to where he should go and with hope not have to go the surgery route. Thanks in advance. Jvonna
Go see John Gottlieb at Vail / Summit Ortho. http://www.vsortho.com/doctors_gottlieb.php

He's absolutely the best.

Peter Janes is a great doc and a friend but he's more of a hand/wrist guy and who I'd absolutely recommend if that were your son's injury. He'll do knees but if you want the best in the country for knees, trust me, you want John Gottlieb.
post #46 of 48
Hello all.

I just read all of the posts in this thread and hope someone can help me with my problem. I have a problem with my left turns, left knee doesn't fell stable. Just feels like there's no stability when making a carved left turn. It's doesn't hurt as much with a GS turn as with a slalom turn.

It doesn't hurt, just feel more unstable than pain. There is pain but not much.

Also, im in the jersey area, is there a dr. that can take a look at this for me?
post #47 of 48

ACl

Personnally I'd suggest you hold off on cutting until allother options are fully explored. A lot can be done with therapy and support before you cut.
post #48 of 48
Quote:
Originally Posted by Jvonna View Post
I'm hoping that Breckview or anyone in that area could give advise as to where he should go and with hope not have to go the surgery route. Thanks in advance. Jvonna
I am in the area and just had double bundle ACL reconstruction with Dr. Rick Cunningham of Vail Summit Ortho 8 weeks ago. I think there are lots of good, experienced surgeons in this area who get a lot of practice, but went with Dr. Cunningham because he is the only one doing the double bundle which doesn't have a super long track record but seems intuitively better to me as it more closely resembles your original ACL.

I have been happy PTing with Ron at Avalanche in Frisco and he seems very knowledgeable.

While I have heard of some good results without surgery, I wanted to get back close to my old level and was worried about lack of stability and the potential for further injury if I tried to ski and play basketball without an ACL.
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