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Boot fitter after ACL surgery?

post #1 of 10
Thread Starter 
Hi there,

I had my ACL replaced about 10 weeks ago and last year had a lot of work done on my boots by a boot fitter (Jeff Bokum) last fall. Is the surgery going to alter my stance enough to warrant a return for more work?

Thanks
post #2 of 10

I wouldn't think so, but**

Your ACL is a ligament that helps to control the rotation of your knee.

An ACL repair WILL NOT affect any alignment that is going on in your leg.

An ACL repair WILL maintain the mechanical integrity of your knee.

Go ski, and if you need adjustment, it will most likely, but not absolutely, have nothing to do with the ACL repair. Slight tweaking may be needed, but that is highly unlikely.

**If you had been skiing with a blown ACL and had the boot work done with the blown ACL, the fitter may have made adjustments to the boot to help limit rotation and mechanical loading. **

Still, the boot will probably be fine and may require very slight tweaking. I'd make sure your skis are tuned properly, that will insure that you don't hook edges or teeter-totter on base and re-injure yourself.

Also, give your body sufficient time to heal, and don't push your limits until you are 100% in muscle strength, ROM, and pain reduction.

Happy trails!
Ben Goldstein
post #3 of 10
Thread Starter 
Sounds good. Work was done before the ACL tear, so I'll just see how things go this season. Thanks.
post #4 of 10
what was said plus, after surgery if the leg is weaker or less knee range of motion things might need to change.

but really, go see and see what it feels like
post #5 of 10
You'd be surprised. There are often subtle changes in proprioception (the ACL has nerve supply, the dead tendon graft doesn't), as well as weakness and muscle firing pattern changes/retraining.

You need full ROM and >90% strength of the good limb before returning to easy (green run, groomed) skiing. It is worthwhile getting Cybex testing at 6 and 9 months post-op to more objectively assess your power & symmetry and guide/adjust your training program. We generally don't like our patients to ski before 9 months post-op.

You won't need any major boot alignment changes, but elite skiers often need a hint of adjustment in cuff or canting to compensation for changes in balance/perception/motor skills.

Hope that helps .
post #6 of 10
Thread Starter 
I've got full ROM now and am working on strength and balance. The PT told me I was way ahead of the curve, but she could just be trying to make me feel good. Whats Cybex testing?
post #7 of 10
Probably overkill to Cybex test, but that's what we do for athletes on return to snow protocols (NOT before 6 months).

Practical - and totally reasonable - testing includes lunges (looking for symmetry and balance), single leg press, single leg vertical jump, and squat symmetry.

Cybex info:

http://www.isokinetics.net/links/cybex.htm
http://www.youtube.com/watch?v=RNLJM3zSDmM

Also:

http://ajs.sagepub.com/cgi/content/abstract/21/5/690
post #8 of 10
Do not let your fast progress influence your back to ski so that you do something stupid. Back to ski should be very gentle and slow testing to determine how everything is working.

Lou
post #9 of 10
Thread Starter 
Quote:
Originally Posted by Lou Rosenfeld View Post
Do not let your fast progress influence your back to ski so that you do something stupid. Back to ski should be very gentle and slow testing to determine how everything is working.

Lou
Thanks skiing is still 4 months away and then it will be the white ribbon of death for a bit. I plan on taking it pretty easy on the first few outings. Do they still bother with knee braces for folks these days? Prob a better question for my ortho next month.
post #10 of 10
Quote:
Originally Posted by wa-loaf View Post
Thanks skiing is still 4 months away and then it will be the white ribbon of death for a bit. I plan on taking it pretty easy on the first few outings. Do they still bother with knee braces for folks these days? Prob a better question for my ortho next month.
Custom knee braces are used (if at all) for pre-op and 6-9 month post-op stability and protection. There is no good evidence that knee braces offer reliable protection against a repeat tear after graft integration and return to normal strength. A brace will certainly protect against a knee dislocation but that is a significant - and rare - event. There are ample case reports of patients re-tearing their ACL while wearing a brace. A simple neoprene sleeve will offer similar proprioceptive benefits to a brace. You simply have to accept the fact that the lifetime re-injury rate is 10% (on either knee) once you've had your first ACL tear.
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