WWMD: ACL injury, MRI results, and the next step.

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01-31-2008, 01:46 PM
cold_smoke

WWMD: ACL Tear, MRI results, and the next step.

So,...
Tore my ACL last wednesday, it felt pretty minor all in all aside from feeling the 'pop' Got the MRI yesterday and results today.

Quote:

Prognisis: (truncated)

There is a large effusion

The ACL shows diffuse increased signal and thickening although there may be some remaining intact fibers. The PCL is intact.

No meniscal abnormailities are identified.

Grade 1 injury of the posterior central fibers of the MCL. LCL and popliteus muscle and tendon are intact

The quadraceps and patella tendon are normal

IMPRESSION:
1. High grade partial, if not complete tear if the ACL
2. Marrow contusion medial and, to a greater degree, lateral tibial plateau but no definable fracture identified.
3. Grade 1 injury, posterior central aspect of the MCL.
4. Partial tear at the proximal portion of the medial head of the gastroc.

Sooooo,
I have a tentativly ACL reconstruction planned for next Wednesday (likely Patella Allograft). My knee feels good. I only have slight pain when straightening it all the way. Very little swelling from the beginning, very minimal if non apparent at this point. I can do a full squat with only the bad knee with no pain and feel like I could ski on it no problem at this point and am so tempted to say fuck it... But at the same time my meniscus is A OK and that is how I want to keep it... That is the one thing I could potentailly mess up with major long term consequences. And that is the one thing telling to get it fixed and accept a douched season.

If I could just ski on it another month lightly it would really help to deal with not skiing for a while. I have thousands of dollars on new shit that just arrived from various sponsors that I have not been able to produce for as all this stuff arrived within days of my injury, so I am also feeling guilty about that, but as much as it does affect me I continuosly tell myself I cannot let that concern my decision.
The one thing that bothers me is that it really feels fine although it apparently is not.

So WWMD? Ski for a week, two weeks, a month or get that shit done ASAP?
01-31-2008, 03:19 PM
altagirl

Sounds just like my first torn ACL. I was in the army and they didn't diagnose it as anything other than a "sprain" and wouln't give me an MRI or let me see an ortho for 6 months. So I skied on it a bunch - 28 days I think?

Some days it was fine. I could ski normally, no big deal. Then all of the sudden I'd hit some funky snow or something in the middle of a turn and it would collapse and I'd be on my ass. It would swell up again for a few days, and then go back to "normal", I'd ski for a few days and it would happen again. I was running once or twice a day, going to the gym, and it didn't bother me for any of that - just pivoting stuff. Most of the time it's fine, then suddenly it would collapse on me. By the time I got in to see a real ortho, it had started to give out on me when I was just walking around. I'd turn a corner walking down a hallway and wind up on my ass. And I did end up with a meniscus tear by the time I got it fixed. And I had started skiing more tentatively and developed some weird habits of unweighting the left ski when I shouldn't to try and prevent it from giving out, and that was a PITA to get rid of later.
01-31-2008, 03:45 PM
JimmyCarter

Spend X weeks fixing it now or ski and spend 3X weeks fixing it later
01-31-2008, 03:50 PM
Woodlandclown

I tore mine and I am skiing on it with a heavy duty, yet very comfortable and hardly noticeable brace. My Dr actually said I could, as he did the same thing. I put my surgery off til April 7--tore it Nov 24. I would rather have surgery and recuperate when its lighter and warmer out too. I am taking it a bit easier and not skiing like i used to though. I also cant ski all day. April is a better time to take off of work for me too, so that factored in. If it were me, by your description, I would say get the brace and keep skiing, but take it easier--just enjoy being out there and not stuck at home--sitting inside on a powder day aint too much fun.
01-31-2008, 04:05 PM
cold_smoke

Quote:

Originally Posted by altagirl

Sounds just like my first torn ACL. I was in the army and they didn't diagnose it as anything other than a "sprain" and wouln't give me an MRI or let me see an ortho for 6 months. So I skied on it a bunch - 28 days I think?

Some days it was fine. I could ski normally, no big deal. Then all of the sudden I'd hit some funky snow or something in the middle of a turn and it would collapse and I'd be on my ass. It would swell up again for a few days, and then go back to "normal", I'd ski for a few days and it would happen again. I was running once or twice a day, going to the gym, and it didn't bother me for any of that - just pivoting stuff. Most of the time it's fine, then suddenly it would collapse on me. By the time I got in to see a real ortho, it had started to give out on me when I was just walking around. I'd turn a corner walking down a hallway and wind up on my ass. And I did end up with a meniscus tear by the time I got it fixed. And I had started skiing more tentatively and developed some weird habits of unweighting the left ski when I shouldn't to try and prevent it from giving out, and that was a PITA to get rid of later.

thanks for all of your replies so far,...
Hey AG, any regrets with the allograft? Was your allograft a revision or the first reconstruction on that knee? If you had to do it over, would you have skied on it prior to reconstruction?
My issue is at the level I ski at, I think I would find it very hard to hold back below 100%, especially after 'testing' it out for a couple of days and standing on top of a nice drop on a pow day...
01-31-2008, 04:40 PM
altagirl

Quote:

Originally Posted by cold_smoke

thanks for all of your replies so far,...
Hey AG, any regrets with the allograft? Was your allograft a revision or the first reconstruction on that knee? If you had to do it over, would you have skied on it prior to reconstruction?
My issue is at the level I ski at, I think I would find it very hard to hold back below 100%, especially after 'testing' it out for a couple of days and standing on top of a nice drop on a pow day...

Nope. My hamstring graft was on the left knee, allograft on the right. They both seem to be holding up the same, but I do on occasion get some hamstring pain in the one the graft was taken from. So no regrets on the allograft. Not to mention, the allograft has now held up to two meniscus tears that have had to be fixed on that knee since and still looks good.

Would I do it again? In the situation I was in - It was my last couple of months living in Europe. So yeah - I wouldn't pass on the chance to ski those places. Living here? I'd just get it fixed. Knowing that for me, it gradually kept getting worse, made me develop some bad skiing habits that took a long time to fix, etc. I think I'd just fix it. Though also take into consideration that these days I'd be more upset missing bike season than ski season... If you'd be fine missing doing stuff in summer, it might be worth trying to ski on it and see how it goes. That - and only you know how you react to skiing injured. Are you just going to charge and end up in trouble if it blows out again and you're in a bad area? Can you take it easy/easier and still have fun? Is it going to make you stiff and tentative and take the fun out of it? That stuff is different for everyone.

I guess the question is - is the rest of this season important enough for you to potentially miss even more time if you injure it more, or to accept causing some permanent damage to your meniscus/cartilege?
01-31-2008, 05:09 PM
Mofro261

Sadly, I am all too qualified to add in here.

First off, for what ever reason I have crap knees. Tore one ACL at 18, torn the other one at 25, then retore the hammy graft last year at (sniff) 36. It was mid Dec. and I couldn't bear not skiing. No meniscus damage but significant bone bruising on the tibial plateau (ouch!) So I got the doc to order a Rx brace and I hit the stationary bike like a mad man, 125-150 miles/week. Skied ~10 days after it happened at what seemed like 50% and after 4-5 weeks of steady workouts and continued skiing I got back up to ~90%.

I skied mad powder. I raced in beer league. I had a damn fine season.
I I got more than 50 more days in w/o the ACL, but it was never completely the same. I couldn't get airborn at all w/o pain. Some of the gnarlier lines I had to just plain back off because I couldn't completely rely on the left knee to hold. Where I was usually in top 5 in racing and instead fell back to 6-12. There was only one time where I jarred the knee hard enough that I was worried about further damage, but it was fine.

I had an allograft at the beginning of May, and got strong again with lots of rehab. Lots of rehab. I got the doc's ok to ski again cautiously at 6-7 months. I felt pretty strong, but still wore the brace. After 20 days of some of the best pow in my life and 3 days after my 8 mos knee-versery the knee blew out again on a very small drop (5-10 tops). And though there weren't any "popping" sounds I have this recollection of breaking glass and the instant feeling of broken glass in the knee.

No twist, no fall, with the brace on. Probably just a subtle re-direction on the ski on landing on a twig in the snow and I skied away with a bucket-handle tear of the meniscus and a re-tear of the ACL. I'd like to say the TyroneShoelaces pushed me off there, but the truth is I'd been working up some little drops and had hit at least 40-50 in that range already so it didn't even register as a concern.

Sooooooo........

I had the meniscus repaired 3 weeks ago tomorrow with ortho to remove the catching tear and be able to walk without crutches, then got back on the bike 100+ a week 3 days later and I've skied 4 days so far. Still gingerly, but it's coming around better as we get loads of new snow. Feels almost normal on the groomed and in the pow.

What I've learned:
1. My knees suck for the level of aggressiveness I like to achieve.
2. Skiing last year w/o an ACL was awesome and I am doing it again this year.
3. Allografts for me weren't so kind. I averaged at least 2 hrs a day rehabbing and was judicious at how to push, when to push and worked with my PT to define the rehab program. I won't go the allo route again, as I was a little hesitant the first time.
4. 7-8 months may be enough for autografts and doesn't seem enough for allo. IF I had had the allograft done immediately ~Jan then I would have had 12 months recovery and MAYBE I wouldn't be back here in gimp central so much.

I know many people have had success with them, and I have managed to get both hammy grafts (10yrs old) and allografts (8 months old :( ) to fail. But the bottom line that I didn't come to terms with the first time is that allografts aren't really reccommended for those under 25, and I still think and act like I'm 19 much of the time( my wife would agree). I was trying to ski conservative and I really think I was when it blew, just one of those quirky things.

I'm going to go ahead and use autograft bone-patellar-bone tendon this next time. I'll get the ACL repaired yet again (third times the charm?) sometime in April after a planned family ski vacation to SLC last week in March.

Mofro.
01-31-2008, 06:33 PM
altagirl

They do tell you that your allograft isn't going to be revascularized for a year. So yeah, if you're planning on getting air, etc. shortly after you get back on skis, that might not be the best route. I rehabbed like crazy and was back on skis 5 1/2 months after my allograft with my doctor's blessing, but we're talking groomers, followed by pretty mellow off piste skiing. Definitely no airs or anything that would really be considered pushing it until the next season. I felt guilty just going off piste but it was fine.

I personally have already screwed up patellas, so pulling a graft out of a body part I already have issues with doesn't sound like a good idea for me.
01-31-2008, 08:04 PM
Mofro261

AG, I'm not talking about any type of air I wouldn't let my 9yr hit, or my 6yr old for that matter. Certainly not the psych-yourself-up-and-hit-it type airs or even small 10-20 footers. I'm talking about little in the flow drops. I was cleared to ski at 6 months in early Nov but held out for snow so it was closer to 7 months. I dunno, maybe the 20 days so far, including 14 of the last 19 prior to that day, and a steady diet of powder made me complacent as to what I could and could not do. It was harder snow that day and maybe I was too confident in the knee stability being braced and feeling strong and possibly in the best shape of my life. Accidents happen even when you're not "pushing it" so to speak- this is the third time I've snapped the ACL without the benefit of a fall.

I guess I'm trying to convey to the OP to be realistic about what you want to get out of it and your own ability to self-moderate your behavior with graft choice as well as continuing to ski without an ACL. I chose allo last time because 1) no hammy's left to tap 2) I used to do a good bit of distance running and had heard of incidents of patellar-femoral tracking in runners who choose patella grafts. After all the resent knee problems, returning to running again is less important than skiing as much/quickly as possible.

And my experience just solidifies what I already knew: I apparently suck at self-moderation.
01-31-2008, 08:40 PM
cold_smoke

Wow, thanks for all the input...

I just called the Doc and postponed the surgery for a month. I have a friend who has a new asterisk brace he is going to give me which is a big plus. I think I can handle taking it EASY (as opposed to staring at the mountian all gimped out from my living room). Just enjoy fair weather pow skiing nice and easy with no drops, and enjoying a little bit more of the winter with my wife before I am out. I think working out hard for the next month to gain as much muscle as possible prior to surgery will also help.

I have a hammy graft in my right knee (8 yrs old) that has treated me well. The pluses I see with the allo is no donor site issues, and the surgeon can get a much fatter bone-tendon-bone graft then he can harvest from my patella. He uses them in all his US team athletes with positive results, and said it is the graft of choice for all but one surgeon in town. It is true that allografts take longer to revascularize (up to 2yrs), but AG's thread with the nice pics proves it does happen and I was told it is stronger then the old ACL within 3 months if done properly. But mofro's own case study is worth taking into account if that graft was bomber post surgery.

While bracing with a torn ACL is a no brainer, regarding the post reconstruction bracing, I would suggest not wearing a brace post reconstruction next time... It only takes around 8mm of seperation to tear an ACL which a brace cannot prevent and I think that the false security and letting the brace do some of the knee stabilization compromises the muscles strength and ability to counteract and prevent the tear. But I'm am certainly no surgeon so thats just my 2cents, but it is supported by all of my and friends docs I/they have talked about this with.

Oh yeah AG, were you always securly braced when you were skiing w/ no ACL?
01-31-2008, 09:01 PM
altagirl

Quote:

Originally Posted by cold_smoke

While bracing with a torn ACL is a no brainer, regarding the post reconstruction bracing, I would suggest not wearing a brace post reconstruction next time... It only takes around 8mm of seperation to tear an ACL which a brace cannot prevent and I think that the false security and letting the brace do some of the knee stabilization compromises the muscles strength and ability to counteract and prevent the tear. But I'm am certainly no surgeon so thats just my 2cents, but it is supported by all of my and friends docs I/they have talked about this with.

Oh yeah AG, were you always securly braced when you were skiing w/ no ACL?

The best thing I could find at the time was a hinged neoprene sleeve. (Overseas, couldn't get a referral from an ortho, yada yada...) So no custom brace or anything like I have now.

And I hear ya Mofro. I know sometimes they just don't take too - I've heard of people who don't even get back to sports, no fall, no nothing, it's just gone. It could be a lot of things.
01-31-2008, 10:46 PM
Shepherd Wong

I'm sitting at about 8 months out on my allograft and it feels awesome. I don't really air it too much anymore, but I don't think it would be a problem. It's 100%. Anyway just adding a sample point of someone with good allograft experience.
02-01-2008, 01:43 PM
Woodlandclown

Quote:

Originally Posted by connersw

The only time I really feel it is when I get a little too "bouncy" with my skiing (sort of hopping over big powder bumps or doubling up rollers on traverses)

Me too! and thats the stuff I love! For me its pretty much the groomers--trying to check the speed. You really have to hold back--if you dont think you can, I wouldnt risk it.

I have been wearing a bregg x2k, or y2k--custom brace, which i wouldnt ski without. Although last weekend i got a little tipsy and danced like a mad woman with nothing on at all. i am quite surprized I didnt end up a crumpled mess on the dance floor--thats happened before with an ACL.
02-01-2008, 02:26 PM
Tye 1on

Quote:

Originally Posted by Woodlandclown

Although last weekend i got a little tipsy and danced like a mad woman with nothing on at all.

:eek::D:tongue:

Sorry, couldn't resist...
02-01-2008, 03:05 PM
Woodlandclown

Quote:

Originally Posted by Tye 1on

:eek::D:tongue:

Sorry, couldn't resist...

Ha! i wasnt too far away from that!
02-13-2008, 11:25 AM
SkiBrain

Sorry for the thread hijack. Can’t seem to find a good answer after searching the forum and internet and this seemed like a good place to ask fellow gimpers my question. About 4 years ago I twisted my left knee on a Banff ski trip. Don’t remember the details and if I heard a “pop”. It was just before lunch and I was able to carefully ski down. After lunch it hurt like hell and I could barely put any weight on it. Went to the patrol hut, they had me sit there and ice it for a while. Then they sent me on my way with no indication that I had done anything serious. Took a day off and was back skiing carefully the following day which happened to be the last day of the trip and that ski season. It seemed to heal and get back to normal soon after I got back, but a few months later I felt a similar burst of pain and buckling while playing volleyball, but again no memory of hearing a “pop”. Again, it swelled up and hurt for a while but seemed fine again after a few days. Since then I have re-injured it a couple of times per year, mostly skiing, and never saw a doctor since it never seemed that serious and would usually get better in a few days. This past summer and fall the injuries started occurring more often so I finally got it checked out. Was referred to a sports med doc and my initial MRI came back with:

1) remote-appearing tear involving the ACL and associated laxity of PCL.
2) small peripheral tear in posterior horn of medial meniscus. This appears remote.
3) partial tear involving the proximal patellar ligament
4) joint effusion
5) healing bone contusion involving posterolateral corner of the tibia

That doc said ACL was only partially torn and that surgery wouldn’t be necessary. Started doing PT exercises before the holidays and got a custom donjoy brace to wear skiing. Have gotten in about 10 days so far, every other weekend. Been skiing carefully and doing fine on a variety of terrains and conditions, but haven’t pushed myself to do anything super challenging and will never be one to huck myself off things. Saw an ortho yesterday because I knew something still wasn’t quite right with the knee. Figured I had aggravated the meniscus and wanted to inquire about getting it scoped. Tweaked it a couple of times since the MRI but not since the New Year and starting to ski. After the Ortho examines it, I find out that the ACL is actually completely gone and needs surgery. News to me since I’ve been feeling surprisingly good on the slopes, but he said it was OK to keep skiing as long as I’m careful. He also cleared me to run as long as I stick to flat even surfaces.

I’m heading to Whistler at the end of the month and plan to ski through the rest of the season. It’s my last chance to get good turns for a while since I’m probably going to be moving and starting a new job this August in a place where mountains are scarce.

I know many people have skied without ACLs for a while and I’m wondering what the risks are? Until now, my main fear was tearing what I thought was a partially torn ACL completely, but since it’s already totally torn, what other damage could I do? Seems like there’s a risk of further tearing other ligaments, particularly the meniscus, and injuring the cartilage, but could something so severe happen that the knee would be unrepairable? I really want to ski the rest of the season, but also don’t want to risk completely wrecking the knee for the rest of my life. I’ve been fine so far and since I don’t know when in my series of injuries I actually tore it, I may have been without an ACL for a few years already. I have skied through every season, but usually only get in about 10 to 15 days per year, typically every 2 to 3 weekends.