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Knee Injury -- Recovery Time?

post #1 of 18
Thread Starter 
I blew out my ACL and MCL skiing on an epic day at Snowbird this last year. After all the boo-hooing and going to an orthopedist, I wanted fellow skiers who have had this happen to them give me an idea of the following:

1. Post surgery - with some diligent rehab and training, how long before you were confident on your skis again? (on let's say average conditions and such)

2. Does scar tissue make all of the sensations of skiing feel a little imprecise?

3. After a good day of skiing, does your knee use 4-letter words that night and the next day?

Thanks for your advice
post #2 of 18
Ok, I did the exact same thing, acl + Mcl....

Post surgery: dr. said wait one year. I was a little under a year, and the first day was absolutly ZERO confidence. I was sure that every run was going to be the end of the new acl...second day out, I fell, and nothing happened. so I felt more confident. Ive skied for a whole season now, but still dont have total confidence back yet. but I think that is a good thing, its more cautious than anything. I even did some moguls on my last day and I was feeling pretty good about my knee...just that you always have the whole thing on your mind.

Helps to watch the Vermont Ski Saftey video. (often) it gives you an idea how to fall, and that in turn gives you a little more confidence,

2. Scar tissue: Doesn't feel the least bit different' when skiing properly. In fact, it feels STRONGER than the good )(non-involved) knee.

I think you may be MORE precise in your skiing, as any incorrect form feels TERRIBLE. If you dont track your knee the proper way, you know it. it forces your tecqnique to be perfect, or at least nearly, on that leg.

Its a little more sore than normal the next day, i think, hard for me to tell really, becausse after a year off skis, my WHOLE BODY was using four (and five!) letter words after a day of skiing, it was hard to tell if the knee hurt because it had surgery or if it was just blending in with the rest of my body.

I think i am most amazed at how much it DOESNT feel any different. I think you just be a little more careful, and aware of the position and trackin of your knee) you take it easy the first season, no hucking huge cliffs or any of that cool warren miller shtuff....but you will start to push the envelope after a few times out. Dont rush things, and listen to your knee. if it hurts to move it one way, dont move it that way!

its hard to imagine all this, though, when you are post surgery - and four months after that.

but your knee will return to fairly normal! really ! i swear!

Hope this helps
post #3 of 18
oh, and i wanted to add:

it felt TIRED earlier than my other knee. the key to this is QUIT WHEN IT FEELS LIKE THAT. Dont push it, if its tired, its probable you will reinjure.

If i were to do it all again (and knock on wood I will not) I would start with buying half-day tickets. after three or four ski days, go with full day, but on second half of day, spend it on green runs, working on teqnique. If you get tired STOP. dont ingrane bad tecqnique because of fatigue.
post #4 of 18
Here's a bunch of info on ACL injury:

As for loss of sensation, there is research being done now regarding injuries to one side of the body. It has been speculaated that the injured side will have less innervation from the transverse abdominal muscle, as well as loss of proprioception.

This is why its important to do a rehab prograam that will enhance balance and proprioception.
Good Luck!
post #5 of 18
I had ACL reconstruction with meniscus repair a few years ago. My doctor also said wait a year for skiing so the graft can fully heal - my surgery was in October, so it worked out well that way and I was non-weight bearing because of the meniscus repair or in serious PT during most of ski season and skiing was out of the question. I did sneak in one day at Snowbird in May - only did a few runs and was skiing with my sister who was out to visit, so I definitely was taking it easy.

Getting back into things the next year wasn't too bad. My initial problem was that I was fighting to stay slow by making a billion turns and was tiring myself out very quickly. After a few days though I was able to relax and ski normally. And before I knew it I was improving and skiing better than I had before surgery. I never noticed a problem with scar tissue inhibiting feedback.

I never had adverse reactions to skiing afterwards (though I did ice it a few times, generally nothing even serious enough to warrant a pain killer.) This year (my second season post-op) I started getting more clicking and shifting mid-season and ended up with a locked knee and new meniscus tear in late March. My doc suspects the first one never fully healed or never healed correctly. This time I just had the torn piece removed and it's now feeling great.

Anyway, I don't know how the torn MCL fits in to rehab time.

As far as your ACL goes, I'm positive you'll be feeling ready to ski before you should be doing it. The problem is that it takes a year for the graft to really heal and become part of your knee. (This may vary depending on the type of graft, I'm not sure - I had a hamstring graft.) You can be up and running and feeling great, but a fall can rip the graft back out and you're back to square one. That's the hardest part of rehab - patience when you're feeling good.
post #6 of 18
I did do a lot of balance work in rehab - and noticed this year that skiing on one leg is easier on the leg I had surgery on than the one that's never been injured.
post #7 of 18
God… I’m having flashbacks… As some of you know, I suffered the same injury a little over two months ago. The first month I thought I was going to die… The pain and the simple chores like, getting a cup of coffee and hopping it back on one leg from the kitchen to the living room (not much coffee left in the cup after all that hoping around), putting my clothes on, etc… simply excruciating.

I graduated from using two crutches, to one and then... to walking normally w/o help. My MRI showed severe bone bruising (the femur going over the tibia in a lateral movement which partially torn my MCL and subsequently my ACL). Edema galore… but no meniscus involvement or at least that’s what MY FIRST OS seemed to think. The verdict was… NO SURGERY… or so I thought!

I went for a second opinion… A big Chief of Sport Medicine at a Famous Hosp here in NYC… The guy says “Hello!” to me and then the next few words that rolled out of his mouth like a curse were “My God, your knee is in really bad shape!” He immediately opted for surgery… patellar tendon graft for the reconstruction of my ACL. Mind you, my ACL is not completely torn. There was no discussion as far as an alternative therapy… I left his office so upset… I didn’t know what to think anymore.

Since then, I’ve gone for a third and a forth opinion. I work as a Post Anesthesia RN and so I get to see some of the OS’s affiliated with my hosp. Two of them told me that I didn't need reconstructive surgery and that at most they would do an arthroscopy where they’d clean up around (remove the torn tissue, etc).

How do I feel right now?? I have full ROM and I walk w/o any problems. I am a walking barometer however but that’s expected… I can tell you the weather forecast for the rest of the year [img]smile.gif[/img] I joined Balley’s and work out my quads and my hamstrings regularly. What I noticed is that occasionally, my knee gives out (but not all the way) and I blame this on my muscle atrophy which significantly reduced the mass of my quads during the time when I didn’t use my leg at all. I have some clicking and some pain when I do certain moves but I think, given the short time span since the injury, I’m improving. I opted to not have surgery… I still have a choice since my ligament is not totally torn. I know I’m in for a long and exhaustive physical therapy but that’s life and I’m prepared to do whatever it takes.

I’ve been encouraged by many on Epic Ski to not give up by offering their experiences with regards to this type of injury… I was told to do “hamstring curls until I puke”… Well, I didn’t puke yet but diligent PT and regular exercise will improve the muscle strength which is paramount in these cases. The loss of innervation to the affected area and subsequently the loss of proprioception,is a true fact. I experienced this a lot especially when I first started my PT. What’s really amazing is the ability of your brain to rewire the injured pathways so that you’ll make up for the loss.

Surgery or no surgery… PT is THE KEY TO SUCCESS!!! For the rest of your life you will have to hit the gym regularly. The minute you slack off and the bad luck catches you tired and on your skis one day, that’s’ when another mishap will happen. You'll need to stay in top shape as long as you perform high impact sports.

Now, let’s talk braces… I posted a thread a while ago asking what brace is the best for an ACL/MCL tear especially when skiing. Everyone seemed to have developed a different opinion on this matter… Some think that a brace is absolutely useless while some will swear by it. I think there’s a psychological facet to this which probably works to skier’s advantage. One should never substitute exercising the injured limb for the use of a brace no matter how high-tech it may be.

I have a whole summer to shape up ... I really want to get back on my skis next season and I hope to have enough confidence and strength to do it.

I wish you all the best and most importantly patience and vigor to go through this. Don’t give up!!!

[ April 28, 2003, 08:43 AM: Message edited by: Euclide ]
post #8 of 18
At the risk of opening up a highly controversial issue, most CLUEFULL Sports Med docs will advise against the leg extension machine for ACL patients. There is even some theory going around now that that particular machine can predispose you to an ACL injury.

As far as doing any exercise "till you puke" that implies working till you are working in bad form, which is not really helpful.

An alternative to ham curls are Dead Lifts and stability ball bridges. Last year, Linda A was not able to do hamcurls, but she was fine on the ball bridges. I was at a sports med conference at the time, and one of the presenters, when I told them about her, said that she should stick with the bridges.
post #9 of 18
I think if you're going the non-surgical route with a partially torn ligament, a brace is probably a good idea in combination with a solid PT program.

When I had my ACL reconstructed my OS was very against wearing a brace, since my knee was repaired and stable. He felt in that situation braces are only used as a crutch and if you felt you needed it after ACL reconstruction you needed to hit the gym instead.

However after my recent partial menisectomy, my OS has prescribed a Donjoy brace. With part of the meniscus gone, my knee can't be as stable as it was before. (Though it feels fine now at 2 weeks post-op.) I'm definitely planning to wear it for DH mountian biking, riding my dirt bike, and probably skiing. Anything that doesn't involve risk of serious wrecking I won't be wearing it.

Also: I've got to second Linda's comments. There will be times shortly after surgery where you start to wonder if you will ever be able to walk normally again, let alone do anything difficult, like skiing. But have faith - everyone goes through that and before long you'll be back to doing sports with confidence and won't even notice that there was anything wrong.
post #10 of 18
1. Post surgery - with some diligent rehab and training, how long before you were confident on your skis again? (on let's say average conditions and such)

My last acl repair (pat. tendon graft) was done in early April. In the third week of March the next year I was staring down a race course at Cannon on a very steep trail(Avalanche). What concerned me was the foot of new snow that had fallen the night before. I'm thinking this is not good, less than a year on a new acl and if I go out of the track I'll hit those piles of snow...
Well the goal was just to get down it...What made me happy was actually getting almost 2 seconds faster by the third run.

I tell that because it indicates that by that point in the season I was pretty confident in the knee to even attempt such a thing. Of course I probably had forty days on snow by then.
Still, even in January I was making turns with really high edge angles and at high speed. I didn't set out to do them they were just part of running gates at the time.
You start a little slow and it gradually comes back. No special pain at all.

I know someone who had acl repair this Feb. and booked a ski trip to South America in August. Now that's a little quick if you ask me, but this is someone who skied a whole season without an achilles tendon.

If your meniscus is all right, be glad it's not that. Arthroscopic surgery is usually just removal of tissue and eventually we'll pay for it. Yeah rehab from acl repairs is longer, but at least you won't be missing a part of your knee anymore.

2. Does scar tissue make all of the sensations of skiing feel a little imprecise?

No, the weird thing is the front of your knee will pretty much be numb for a few years. When does this matter? Pretty much only kneeling on the floor. At first you won't be able to kneel on that knee because of the scar tissue, then it will just feel really weird because(i guess) the nerves haven't reestablished connection.

3. After a good day of skiing, does your knee use 4-letter words that night and the next day?

No, again, I think meniscus repair is worse in this department. You will be susceptible to weather influences for a while but this goes away. The only odd pain I've had is actually -walking- in ski boots. Occasionaly my heel will drop down too far and this will cause pain. This is getting better though. I think conditioning can prevent this.

I've never used a brace skiing except those compression sleeves. While they certainly don't do anything structurally, they do make you feel better (at least your knee thinks you're taking care of it) and supposedly it improves the reaction time of the muscles. Upshot? Save the close to 1000$ and buy an excercise machine or a bike or join a gym etc....(or book a ski vacation!)

Hell, if you use all of lisamarie's stuff on this site you'll be in great shape next year.

One recommendation- get the Cryo Cuff. It's a cuff that goes around your knee and you fill it with ice water from a little cooler. Once it's filled you can detach the hose. It works great and will allow you to ice up easily anywhere since in America almost everywhere sells ice. Trust me, ice is better than drugs...you'll see.
post #11 of 18
Lisa... the reference to puking was just a figure of speech. [img]smile.gif[/img] However, I wanted to ask you something; how is it possible that I can do hamstring curls benching 100+ lbs and see no difference in strength between the good and the bad leg and w/o discomfort whatsoever, but when it comes to actually flexing the bad knee forward using my quads against say 30+ pounds I can barely move it and that’s not w/o painful grimaces. The pain I feel is right in the middle of the knee in a precise area. On the good knee I can bench 3 times the weight on the same forward motion. For some reason, I thought that ACL injuries would make exercising hamstring curls an excruciating task. I didn’t experience that at all!!! Weird… But then again, that’s the story of my life [img]smile.gif[/img]
post #12 of 18
If you do a search in fitness for a thread entitiled "More ACL Info", a friend of mine, who is a physical therapist discussed that issue. Basically, different types of surgery will make it either easier or more challenging to use the leg curl machine.
post #13 of 18
yep, hammie grafts make it harder to do hammie curls.

the short answer, vegas777, is that it depends ENTIRELY on two things: (1) your surgeon and his/her PT regimen; and (2) your earnest participation in PT post-op.

my OS is convinced that PT post-op is the most critical factor - but that's because he has the leading ACL recon technique in the USA... the most stable, the most like the original ligament. in fact, he's so sensitive to post-op PT fidelity that he won't take any patients that are not seriously athletic OR who are not interested in difficult, agonizing PT to regain strength and stability.

the only "general rule" applicable to ACL recon is the one that most everyone else has stated -- the graft doesn't fully incorporate until about 1 year after surgery.

LM made some interesting comments on nerve recruitment. one thing's for sure -- you will have numbness wherever there's scar tissue. scar tissue is primarily collagen and doesn't enervate when it forms, so you get an odd "numb" or "dead" sensation across the length and width of the scar. also, the scar is more than the scar you see on the epidermis. usually it's like an iceberg - wider and longer below the epidermis. so, the sensation of numbness or deadness might be over an area that's larger than the visible epidermal scar.
post #14 of 18
Based on other comments I have heard, my reflections on both of my ACL reconstructions are an oddity. My first ACL tear was accompanied by a torn MCL as well. My MCL was isolated for about three weeks and then I moved on to some PT for two weeks to get my range of motion back before surgery to repair my ACL. 10 days after my hamstring graft, I walked out of the doc's office, no brace, no crutches. I had 96% strength at about 12 weeks post up and began running at 15 weeks. At 16 weeks I had full ROM, full strength, and felt like I could resume normal activity. Luckily I held off until 20 weeks, when I got on skis again. The first run was a groomed run and I took it slow and tried a variety of turns to see how the knee responded. Of course, it was a powder day, so my second run was much more challenging. After my third or fourth turn, I had enough confidence to ski it as I would have pre injury. The only thing that I hesitated doing was going air born, but that lasted for about a month.

My second ACL surgery was on January 2, 2001 and I skied clsoing weekend at Alta that year, the end of April.

I think I was a very rare case in terms of recovery time. I know my doctor would have liked me to slow my rehab done to allow the natural healing process to occur, he said I was way ahead of where I should be in terms of ROM and strength. I have had no knee problems since. I highly recommend following your PT's therapy program. If you do, there should be no problem in recovering and returning to skiing.
post #15 of 18
I like many others I know were skiing within 9 months after surgery with no ill effects or brace. Did mine in late February one year, operated on in early March, was running GS and SL in mid October.
Everyone is different, and it depends on how strong you were before the injury and how hard you're willing to work during recovery. It also depend on the method used to repair the ligaments. I had one the the hamstring tendons rerouted, and not the patellar tendon which is quite common. The MCL was only a partial, and healed by itself over time (well, it doesn't bother me and my knee is stable).
post #16 of 18
I couldn't bear to read through this whole thread so if this is a reun I apologize.

A) PT, PT, and even more PT are the keys to a successfull recovery from ACL surgery. (I don't know nuthin' bout no MCL surgery.)

B) Although the experts are mostly skeptical about skiing with a knee brace, I wholeheartedly endorse using the best one you can possibly afford. My resoning is that (as mentioned earlier) your operated knee may (in my case did) tire more quickly than your unoperated knee. When you are at the top of Blackcomb Mountain and your knee poops out the support that your knee brace provides will be worth every dinero that you paid for it and then some. Under normal circumstances it makes no difference, but when you need that extra bit of support-YOU NEED IT!

C) Your insurance company will try to cut off your PT before it should be cut off. Appeal. You can almost always get an extra month's worth of PT, you can almost never get more than an extra month's worth. It is up to you to continue conditioning after PT is over.

Geez, it's been 8 seasons since I had my 2nd surgery (one on each knee). Hard to believe. I can honestly say however that PT can put you back into the best shape of your life if you go about it seriously.

Good luck!

Did I mention PT, PT and then PT some more?

Edit: Oh, recovery time. Dec 13th (never ski on the 13th), torn ACL, Surgery Jan 2, Martes lift Sept 2. 9 months, but the docs reccomend 12.

[ April 29, 2003, 01:50 PM: Message edited by: teledave ]
post #17 of 18
Good on ya" for mentioning PT! Can never say that too much! But, as Teledave says, the insurance maay stop paaying for it. Post rehab, in that case, is extremely important. Many fitness trainers are also liscensed physical therapists or athletic trainers. Some trainers speciailze in post rehaab.
Plus, there are a gazillion topics in the Health and Fitness Section, complete with pics, and in some cases video.

Most of all, prevention is the best kind of med. Check out the Ultimat Ski workout, and stay safe next season! [img]smile.gif[/img]
post #18 of 18
Most ins. companies have rebates and incentives for joining a gym. You can continue your exercise on your own once you know what to do. I hit the gym at least 3 times a week for a least two hour workout.

[ April 29, 2003, 11:06 PM: Message edited by: Euclide ]
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