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ACL Recovery without surgery?

post #1 of 86
Thread Starter 
So I tore my ACL back in February at Breckenridge...just an unfortunate accident. My left ski got caught in thick powder mid-turn on the Lake Chutes, and I sorta twisted it in the turn and fell on top of it. :-(

Anyways, I didn't get surgery immediately because at first we thought it was a minor partial tear, and because my knee was more stable than ACL injuries typically are. An MRI last month revealed that my ACL is torn at least 80%, and possibly completely.

That being said, my knee has continued its unusual stability and improvement. It may have helped that I swam competitively for six years up until last summer, so I do have strong legs. Still, I've been shocked by the progress I've made in physical therapy and rehab. I was biking, swimming, and kayaking again a month after the injury, and they even allowed me to try skiing starting this past Saturday (almost exactly two months post-injury) basically a "test" to see how stable it was.

After starting out on the bunny hill on Saturday and working my way up, I was confidently doing black groomers (albiet at Eldora, so the terrain is comparatively easier than usual for CO) by the end of the day. I also did some bumpier stuff and some light powder (<3") at Breck today on black groomer-level terrain.
I won't do moguls again until my PT gives me permission to, but my knee has felt stable on every turn, even in variable snow conditions or bumpiness. I didn't fall either day, so I can't tell how it would behave if that happened. However, there have been several times (not while skiing) that I've slipped and have had to put all of my weight (sometimes awkwardly) on my injured knee, and it's supported it.

Anyways, what do you all think about the possibility of returning to a level where I can confidently ski extreme terrain like Breck's Lake Chutes again without surgery and only with intensive rehab and PT? Thanks in advance for your advice!
post #2 of 86
Interesting question that perhaps only you can answer. I've had two acl replacements. My first acl was gone for three years before I actually knew it. Two different doctors had said it was fine and I had just partially torn and mcl. Three years later the knee just went out in a ski turn necessitating athroscopic surgery. (well it's really "removal" )

I will say though that the knee did not feel stable in the three years intervening. I just sort of thought this was the way it was goint to be. Wouldn't play anything like basketball or tennis in that period because it just didn't feel right.

It sounds like your legs are in very good shape so that helps tremendously. I take it you're not using a brace. I think generally the feeling is that braces are actually somewhat useless but I'm not sure.

I can't actually answer your question and I'm not sure anyone can. That includes doctors. I would certainly get opinions from doctors and find out as much as you can. You definitely want sports orthopaedic doctors because they understand people actually do things like well, sports.

I guess my feeling is you should repair it when the time suits you. For skiing this means about now actually. But do a lot of research. There may be new techniques that are much less invasive that you would be a good candidate for. You could always do it next year at this time. Since you're ok without it for now use the time for research.
post #3 of 86
Thread Starter 
First off, thanks a bunch for your thoughts!

You are indeed right...I haven't been wearing any sort of brace at all since two weeks post-injury...I asked my PT if I should get one for skiing, and she said it probably wouldn't really make a difference, like you said.

What do you mean that your knee didn't feel stable, though?
While I feel confident that my knee will hold my weight during ski turns and related activities, I can sometimes feel my joint moving in an odd way that my healthy knee doesn't. It doesn't feel unstable, but I just feel like my joint turning or compressing in an unusual way. I guess it might be partially because I'm still only 9 weeks post-injury, but it's still slightly concerning. Was your feeling similar, or completely different?

I'm definitely planning to get as much information and as many opinions as I can. I'm also optimistic that I'll be able to give moguls a shot before the end of the season to see how they feel with more rapid changes of direction than simply carving over smooth snow. I really am lucky to have A-Basin open for another two months.

Oh, and if it makes a difference, I am fairly young...I just turned 19 earlier this month...I'd imagine that makes PT/rehab go that much better.
post #4 of 86
Sounds like you had a bad grade 2 sprain (significant partial tear) of your ACL. However, I wouldn't rely on an MRI as a form of definitive diagnosis.

Has your knee assessed by someone skilled/experienced? You need to have someone do a pivot-shift test on both knees to compare, and the standard management of grade 2 ACL sprains also involves serial KT-1000 tests (google it) to objectively assess the rate of 'tightening up' over time.

All partial ACL tears will tighten up as the secondary restraints (knee capsule, etc) heal, along with the ACL scarring. What's most important is the resulting stability of your knee, especially with plant and pivot / change of direction activities. Sometimes a partial tear will result in an unstable knee (due to intrinsic stretching / plastic deformation of the ligament) which will still require reconstruction.

Lastly, IMO you shouldn't be skiing this soon after a significant knee injury.
post #5 of 86
I tore mine in 1995. It got swollen, got better, and I never had the MRI done, thinking it couldn't be that bad. I was biking in ten days, and did a ski-xc ski bike -run kayak race two months later.

It never seemd perfect, but not bad. I stopped jumping off cornices, but am am over 50. I still hike, climb. ski hard, take patrol togoggans down with 300 lb guests.

A US ski team doctor diagnosed it three years ago when I had some patellar tendonitis. She said keep skiing, don't have it fixed, and thought a brace was a good idea. She said I showed classic signs of compensation to support the knee.

Every knee is different. Some knees are pretty stable without it. I've know others who couldn't make one turn without the knee floating every which way.
post #6 of 86
That Kt1000 test is interesting. Never in 2 acls did I have that done. I consider the standard test where the doctor pulls on your tibia and compares each knee as somewhat dubious. Way too subjective and how does one really know if patient is relaxed? Anyway, it failed with me on one knee and that was with two different doctors. (Mri's at the time were very expensive and both docs were convinced acl was ok)

jswim,
The "instability" I felt was usually doing things like a sudden stop or pivot like one would do in basketball or tennis. I could pretty much feel a wobble. It was kind of an obvious sign that that activity was not good.

I will say that the next year I did a 3 week wilderness course in wyo. which involved hiking with packs in the 50lb range. I was however very careful. Downhill is by far the worst.

I would agree with jdistefa and say you probably should not ski right now.

Really, it's not worth it. Realize that if you're knee gives out you will damage cartilege at the least. There is currently no repair of that. (there may be some experimental stuff but it requires like six months of no weight) Arthroscopic surgery just removes the damaged cartilege and you deal with it.

In some ways acl reconstruction is better, its far more intensive and rehab is worse but when it's over the knee can be better than before. With cartilege you just get rid of the ripped pieces. You have less now.

So look, there's plenty of skiing to be done at another time. Do something fun that your pt or doc says is good for you.
post #7 of 86
Thread Starter 
I would like to clarify one thing real quick...I didn't just go skiing on a whim...both my orthopedic and PT suggested I go to see how it felt. I was worried about what you said, Tog, that if I fell or it gave out that I could reinjure it or injure other parts of my knee, but my doctors said I'd be fine. It did strike me as odd, though, that I could be skiing again only two months after such a severe injury.

I'm definitely looking into a getting second opinion though, and I want to share these results with my PT and my orthopedic before I do anything further.
post #8 of 86
Many people do just fine without an ACL. However, the ACL serves a purpose and without an ACL you may more likely to suffer a meniscus tear. Meniscus tears can only sometimes be repaired. If you are 19, you have a long athletic career ahead of you and you need stable knees.
Get the surgery.
post #9 of 86
On July 18th last year i obtained the following from an out of control skiier on the home trail:

ACl Rupture
MCL Rupture (Grade III) near proximial
Grade I - II LCL Injury
Diffuse injury to posterior horn lateral miniscus
Patrial tear to distal vastus medialis muscle.
(Excuse the medical lingo, and no i cant translate!!)

I thought i was destined for immediate surgery however contracted a blood infection (shin of injured leg) that required mega anitbiotics plus my surgeon said he wanted the swelling to go down. Was in a brace so i could "get around".



Long story short i am now 95% mobile without any surgery. Knee is still tender but so is the "uninjured" one (i am 53). My surgeon saw me (no pun intended) initially every 2 weeks, then every month and i am going back at the end of this month for hopfully my final visit.

I did about 5 phsyio visits and then went back to the gym doing light leg work and building my strength.

Surgeon said that one of the benefits of getting old is that ligaments can reattach themselves and it looks like mine have done so as my leg feels stable. At my last visit he told me that my leg was as good as if he had operated on it and thus there was no reason to put me through the inconvenience and pain (and cost) of surgery.


Moral of the story is i suppose not to be so quick with the drill.
post #10 of 86
Thread Starter 
Hokoyo, your story is very encouraging...I'm glad you've been able to do so well after injuring so many different parts of your knee. I suppose you can't really tell yet how your skiing ability is now, though...I imagine you're in the southern hemisphere, yes?

How has your knee performed for more normal activities that require an ACL, like cutting while running and such? Have you done any of that yet?

Sort of what I'm thinking is that I may wait a year, see how my knee improves, if I can get my skiing ability back up to where I want it to be, and if it doesn't, look into the possibility of surgery next summer.

Skier, I definitely understand what you're saying too...I've heard that ACL-deficient knees can sometimes be at greater risk of arthritis...I'm definitely going to factor all of that into my eventual decision on whether to get the surgery or not.
post #11 of 86
Hi jswim,
Yes i am in Australia, hoping to go skiing in July or may save up and go to Japan in December.

My knee is stiff in the morning but soon gets back to normal! I can run on it but have not done much cutting though i am going to have a game of tennis this weekend which will give it a work out.

This is the original diagnosis (sorry dont know what language it is written in!!):

post #12 of 86
Hokoyo, I'm curious as to how your knee was assesed as being as good as if it was operated on.
(by the way, what's up with that foot? It looks like there's issues...)

jswim, I copied this from the Steadman-Hawkins website:
since you're in Boulder and they're in Vail and I believe Denver perhaps you should get an opinion from them.
-----------------------------------------------------------------------------

Patients who do not do well with non-operative treatment are usually described as:
  • younger or active patients
  • those who like to participate in pivoting sports
These patients are more at risk for reinjury. For these people, the likelihood of further damage to other ligaments or cartilage is quite high. A common reinjury is tearing a meniscus, which can lead to degenerative arthritis in the years to come.
-----------------------------------------------------------------------------
http://www.steadman-hawkins.com/acl/overview.asp

you'll have to page through that link.
post #13 of 86
Hello Tog,
The surgeon did various tests to look at the flex and movement and decided it was "as good as if he had operated" I am going to see him again on the 30th so i will give you an update. Anything in particular i should ask him?

I had an accident whilst working underground 25 years ago and have a lot of scar tissue on my ankle hence my foot appears to be tilted to the left, if that is what you mean. And yes i will use this to blame my erratic skiing!

Oh, and I thought i had a really handsome foot.....
post #14 of 86
My husband tore his ACL about 6 weeks ago. It was less than a week before we left for Austria (yes, for a ski trip) ... he didn't make it to the doctor until the day before our flight.

The doctor suspected an ACL tear, but when he found out DH was about to go to on an international ski trip, he shrugged, drained the knee, gave him a brace, and said "don't overdo it, and ice a lot."

DH did quite well -- never skied a full day, but did go one day off piste where it was somewhat strenuous, with all sorts of snow conditions and hikes and traverses. Since then, he has skied twice.

He had the MRI when we returned, and sure enough he has a complete ACL tear as well as tears in the lateral and medial meniscii. But he has had such stability in the joint, the doctor (who is a knee and sports medicine specialist at Panorama) wants him to strengthen it and see how it does before operating for certain.

He is 42 and, frankly, probably in the worst shape of his life ... and still has had surprisingly little issue so far. So the hope is that if he can strengthen his legs, he might not need the surgery. He has been restricted from squash, obviously, and he's on orders to use a cart when he golfs, and ski season is pretty much over, but we'll see how it goes. I'm almost more worried about the meniscus tears, one of which is described as "prominent."
post #15 of 86
Quote:
Originally Posted by Hokoyo View Post
Oh, and I thought i had a really handsome foot.....
well we'll leave that for the ladies to decide though their opinions on such matters are usually ignored.
You might want to post a picture in the boot fitter's forum to see about special considerations for footbeds. I bet jdistefa has some opinions on the matter.
I take it you were/are a miner?

Seg, you might want to look into the cryo cuff for dh's icing. Makes it soo much easier and you can do it anywhere when you take the cooler. Like even in the golf cart if you skip a hole.
All you need to take it anywhere is a store that sells ice.
I used to hate the concept of icing. Then after surgery I realized ice is better than ibuprofen for the pain. Ice was really good but difficult and annoying. Then I found the cryo cuff and that was great.

http://kneebrace.biz/aircast/knee_cryo-cuff.htm
post #16 of 86
Quote:
Originally Posted by Tog View Post
well we'll leave that for the ladies to decide though their opinions on such matters are usually ignored.
You might want to post a picture in the boot fitter's forum to see about special considerations for footbeds. I bet jdistefa has some opinions on the matter.
I take it you were/are a miner?

Seg, you might want to look into the cryo cuff for dh's icing. Makes it soo much easier and you can do it anywhere when you take the cooler. Like even in the golf cart if you skip a hole.
All you need to take it anywhere is a store that sells ice.
I used to hate the concept of icing. Then after surgery I realized ice is better than ibuprofen for the pain. Ice was really good but difficult and annoying. Then I found the cryo cuff and that was great.

http://kneebrace.biz/aircast/knee_cryo-cuff.htm
Yeah, we have one. (We've been through four knee operations and a foot surgery between the two of us already. Hmmm, four of the five are my fault.)

I also have a couple of these Pro Series bags, a knee and and ankle version, which are easier to use when you're mobile (throw in the tennis bag or fill with snow after skiing).
post #17 of 86
Had my three month check up on Wednesday.

Prognosis was fine but he has now recommended i go to a phsyio to build up the muscles that will help strengthen the knee. Confirmed that you cannot strengthen ligaments but they will get stronger/heal over time.

I asked what had happened inside my knee to make it relatively stable and he said he did not know! But he did not want to mess with it as surgery can damage (stretch) ligaments that were previously fine.

My knee is still a bit stiff and he said this should loosen up in the next three months or so.

I will report back what the phsyio says and does!
post #18 of 86
Final check up with my surgeon, lachman test fine, pivot test, still a bit sloppy. Movement (flex), 99% of my left leg.

Prognosis on skiing, go for it!

What he did way that i thought was interesting was to do balance exercises, as well as leg strengthening, good balance may prevent a fall, plus exercises improve the "fast twitch" reflexes in the leg.

We talked about confidence and he said one of the issues with knee injuries was that nerve endings were damaged and thus your brain may not know where your knee was, which would affect your confidence. He said the best exercise to do was any exercise with a ball (probably not soccer!!) as you concentrate on the ball and not on the knee, thus re calibrating or teaching your brain the knee location by moving around (not sure if that makes sense the way i have written it)

I mentioned stiffness in the kneecap and he said that he could sort that out if it was bothering me but it is not a big deal at the moment.

Obviously the chances of re injuring the knee were greater so if i go skiing will set my bindings a lot looser until i have confidence. We have snow over east at the moment so will try and get over there before the end of August to give it a go.:

If it works out okay and i have the funds may head to Canada in February
post #19 of 86
Hopes its OK to resurrect this post. I was just diagnosed with a "near complete tear" of the ACL. I am 44, a tele skier and beginning my first year on Ski Patrol. Also, I am long-time serious cyclist doing a bit of racing as well.

My tear is where the ACL connects to the bottom of the femur. I had very little to no swelling after the tear, and after less than a week I was walking fine with good support. The doc felt that it was loose and I had an MRI. The MRI showed the tear.

Since I have good support, no buckling and no pain, the doc is recommending 2 months of PT and then a brace for skiing. I will then try skiing and see how it goes. I am hoping I can get through this w/o surgery.
post #20 of 86
Sorry to hear it telecarve. I suppose two months of pt will still have you skiing this year. Then comes the decision time of should you have it reconstructed? If cycling is really important than you have to take that season into account too as rehab is probably a good 6 months though you'd be able to do cycling as part of it. Racing is probably another story though?

A "near complete tear" ? Probaly won't repair itself right? I really don't know. I suppose you could see how it goes and decide next year though damage from blowing out the knee could be worse than an acl recon.
post #21 of 86
I had "double bundle" ACL reconstruction almost 2 weeks ago after a complete tear almost 6 week ago...I mention this because I was told that the ACL is actual two intertwined cords.

You may want to ask the Doc which cord was torn as it is possible to tear one and not the other. From the sound of it, you may have torn one completely with the other partially torn (or hopefully intact).

The short cord helps more with side to side stability while the longer cord helps with front/back stability. With a typical (single bundle) reconstruction, they put in a single graph close to where the long cord was while cheating a bit towards the short cord.

I rehabed fine from a partial MCL tear 16 years ago (on the other knee), but opted for surgery here as the ACL does not heal itself and I did not want to be worried about how it would perform and further injury (especially to the meniscus, which I ended up losing about 20-25% of).

Good luck...Matt
post #22 of 86

What happens if you fall and don't have an ACL to tear?

Telecarve,

To me you're recovery seems incredibly quick. I'm jealous. I was on crutches and then a cane! For more almost 2 months! I'm only 4 years older than you so I'm guessing your cycling and skiing put you at a much better place to start from (i.e. legs are stronger).

I too have a nearly complete tear of the ACL. The OS thought it was completly torn but when I was scoped he said there is "continuity". My ACL hasn't been replaced yet and I'll be skiing with a brace this year. Will decide in the spring whether to have the surgery or not. The OS thinks that if I stay on track with what I'm doing, I won't need the surgery.

At the mountain I ski at, one of the racers (around 55?) hasn't had an acl for the last 9 years and still races.

So I'm wondering what will happen if you don't have a usable ACL (I have continuity but it is useless) and you have a fall that would normally cause an ACL tear. Jump up and say "I meant to do that.", is it just as painful or do you tear or break the next thing in the chain?

Since there is still some acl there for me to tear, I would expect it to tear the rest of the way accompanied by swelling. Then the only thing to do is wait for the swelling to go away?

Is anyone familiar with any instances like this?

Thanks,
Ken
post #23 of 86
Ken,

I tore my ACL on March 10th of this year. I skied out of the spot where it happened and my knee subluxated (dis-located)...painful... one time. Skied for 2 more hours (groomers only) then called it a day/season. I had very little swelling. So little that my primary Doc said he thought I did not tear it.

After getting home, over the following 4 weeks before surgery, it subluxated 3 more times while working it too hard. Had surgery (4x hamstring autograft) April 10th.

As has been mentioned, some knees are stable after ACL tear, some are not. Mine was not.

There is NO WAY I could possibly ski where and how I prefer without an intact ACL. Doing so, for me would guarantee torn meniscus minimum, catastrophic damage likely.

Sure, many folks out there ski without an ACL...I would imagine it is more because they have no insurance or cash to cover the surgery, as opposed to thinking its just not important.

My opinion...DO NOT SKI ON TORN ACL. Its possible to end up limping and in pain, not to mention unable to participate in many activities...for the remainder of ones life. Not worth it.
post #24 of 86
Snowfan,

Everyone is different indeed. Everyone I talk to about ACL surgery and the pro/cons all give me different reason for their answer.

The OS I'm seeing is on the conservative side and is a skier. It was his idea for me to ski with a brace this year. His presciption for the brace came with a stern lecture on "No bumps, no tree skiing and no jumps." He's also the one that suggested I might not need the surgery even if I keep on skiing; just wear a brace. I would prefer to have an intact ACL but as the OS said, "There is no reason to rush. ACL surgery doesn't go on sale."

I'll be on the groomers this year wearing a brace. I also think that for the way "I'll" be skiing this year, that will be OK. My plan is to be the "Sunday Driver". I'm sure that's how I'll start out and as things progress I'll keep stepping it up.

The person I talked about that races without an acl does have insurance that would cover. Each person and each knee needs its own decision. I don't doubt that you have made the best decision for your knee as he did for his.

Now, after saying all that, I may very well go out the first time, come back with my tail between my legs kicking my self in the butt with the one leg left. Hopefully not but I realize that is one of the scenarios.

Ken
post #25 of 86
A little update. I had my first PT appointment. I got a very thorough exam and muscle work. My PT is on the same page with the doc and thinks I will be skiing fine with a brace and w/o surgery. She tore her ACL a few years ago and is fine. The only thing she really advised against was soccer (that's how I got in this position to begin with).

After PT, I had my patrol shift on the MT. Of course I was in aid room and not on the hill. I met a fellow patroller who has been skiing w/o an ACL for 9 years.

I will stay on course, work the PT, listen to my doc and see how things go. Thanks for all the input, its time for my PT home work.

Enjoy the snow,

Joel
post #26 of 86
Here's an update: I got my brace and today I skied a few hours in the AM. My knee felt great. My tele turns seemed mid-season smooth. I am sure all of the PT, strength and flexibility work I have been doing is part of the reason, but I was surprised at how good I felt and could ski. I stayed on the blues per Dr orders but I did skied hard at times and put effort into it all the time.

For now its continuing with the PT/strength/flexibility work and I see the doc next week for an update. My patrol director thinks we may put off sled work until next year, but I hope to be working on the hill (and not in the aid room) in a couple of weeks.

Thanks for the advice, experience and good thoughts.
post #27 of 86
hello friends.i have injuired my acl.how can i recover it without surgery.plzzzzzzz plzzzzzzzzz guide me????????????/
post #28 of 86
Go and see your doctor and get a referral to a surgeon, they will be able to advise you of your alternatives.
post #29 of 86
Definately see a doc. As was stated multiple times in this thread, each knee and each person is different. 

Here is my update. I skied the rest of the season. I got on the snow as a patroller. The S&T (ski and tobogan) trainers got me up to speed and I got signed off in a few weeks time. Even with an abbreviated season, I got close to 40 days with a combination of recreational skiing and patrol work. I skied great (I think), the knee felt great and I took some sleds down when needed. 

This spring and summer, I kept up on the strength work and it has improved my cycling, bonus! I wear my brace when skiing, shoveling snow, hiking and playing soccer with my kids. No issues, but I will keep up the strength work and wear the brace when needed.

 

Here's to a great 09-10 ski season.

post #30 of 86
Quote:
Originally Posted by TeleCarve View Post

Definately see a doc. As was stated multiple times in this thread, each knee and each person is different. 

Here is my update. I skied the rest of the season. I got on the snow as a patroller. The S&T (ski and tobogan) trainers got me up to speed and I got signed off in a few weeks time. Even with an abbreviated season, I got close to 40 days with a combination of recreational skiing and patrol work. I skied great (I think), the knee felt great and I took some sleds down when needed. 

This spring and summer, I kept up on the strength work and it has improved my cycling, bonus! I wear my brace when skiing, shoveling snow, hiking and playing soccer with my kids. No issues, but I will keep up the strength work and wear the brace when needed.

 

Here's to a great 09-10 ski season.


Good to hear it is working out.  This will be my 15th season without an ACL.  I plan on another 70 days of XC and Alpine, though I won't be doing any patrol work this year (nothing to do with the knee).  I did a 1000km mt. bike trip across BC to keep it strong.
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