Travelling Magette ACL help/advice.

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Originally Posted by m64d85

Since you're traveling around the West, it might be a good idea to look for ortho surgeons in the areas you'll be passing through or staying in for a while. I've heard good things about the medical care in Salt Lake City, so it's worth exploring options there.

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Tell us you haven't read the thread without telling us you haven't read the thread...

JONG

Sent a PM because I’m in the medical field in SLC/PC and don’t want anything to get back to certain surgeons.

Get a pressure/cryo icer. It has been poo-pooed by nursing and PA’s in our case but allowed my daughter to take no oxy’s and PT says they really speed recovery by keeping swelling down.

^^that, robaxin and NSAIDs should limit the need for narcotics


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I've had my left ACL done 2X. The first at 21 with a hamstring graft. The second at 51 with an allograft.

I highly recommend the allograft. The recovery is much easier without damaging another structure within the knee via harvesting the graft tendon. I found the allograft surgery and recovery to be 80% easier than the 1st go round 3 decades earlier. Of course, my first doc may ha e been a hack.

As many have suggested above, I would recommend getting the surgery at home. Heck, you have lots of great options within an easy day's drive from Maine. Rehab is pretty straight forward, but PT is very important the first couple of months. Good PTs really help get the knee bending and straightening, which is vital.

Plus, keep in mind life without an ACL varies greatly from individual to individual. Some lose a great amount of stability without it, while others can perform at a high level without an ACL. Unfortunately, I fell into the 1st category. Mrs. S. could be somebody who can recover an perform at nearly 100% without an ACL. Just food for thought.

Best of luck.

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Originally Posted by MagnificentUnicorn

^^that, robaxin and NSAIDs should limit the need for narcotics


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I took the 6 days of hydro morphine post surgery but I couldn't handle the Tramadol the doc prescribed and did ok with just extra strength IBU's , took the Tramadol back to the pharmacy to be disposed of

DON"T forget to take a laxative with Hydro morphine

maybe the cryo cuff i borrowed ( just ice and water) sucked but I didnt find it any better than a bag of frozen peas so i only used it once so YMMV as they say

OP is there to help his partenr but it was beginning of winter i had a whole bunch of getting ready for winter that i needed to get done before i was on cut-on

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Originally Posted by MagnificentUnicorn

^^that, robaxin and NSAIDs should limit the need for narcotics


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Have you heard any data on nsaids slowing the healing of tendons? I’ve heard that from a few sources but don’t know if there’s anything to it study wise

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Originally Posted by mcski

Have you heard any data on nsaids slowing the healing of tendons? I’ve heard that from a few sources but don’t know if there’s anything to it study wise

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There’s one doc that I work with that buys in but I don’t think there’s any real good study to suggest avoiding NSAIDs.

There’s a lot of dogma and superstition in medicine fwiw.


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Originally Posted by XXX-er

I took the 6 days of hydro morphine post surgery but I couldn't handle the Tramadol the doc prescribed and did ok with just extra strength IBU's , took the Tramadol back to the pharmacy to be disposed of

DON"T forget to take a laxative with Hydro morphine

maybe the cryo cuff i borrowed ( just ice and water) sucked but I didnt find it any better than a bag of frozen peas so i only used it once so YMMV as they say

OP is there to help his partenr but it was beginning of winter i had a whole bunch of getting ready for winter that i needed to get done before i was on cut-on

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Tramadol is classified as a narcotic. Methocarbamol(Robaxin) is a muscle relaxant and is available OTC in Canada. A lot of the discomfort with injuries and surgery is due to muscle spasms. Patients often discount it’s effectiveness because they don’t keep taking it. You need to maintain a serum level for optimal effect.


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I had Dr. Heiden look at my shoulder 8yrs ago. He's straight up, said it was gonna suck, but he recommended AGAINST surgery. Said my damage was as bad as could be and not get surgery. I was 100% in a year. He could have easily cut me and gotten a nice paycheck, so I totally respect his office.

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Originally Posted by MagnificentUnicorn

Tramadol is classified as a narcotic. Methocarbamol(Robaxin) is a muscle relaxant and is available OTC in Canada. A lot of the discomfort with injuries and surgery is due to muscle spasms. Patients often discount it’s effectiveness because they don’t keep taking it. You need to maintain a serum level for optimal effect.


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It was a prescription 3 yrs ago, the pharmacist did mention something about it changing classification when i gave it back to him

The hydro morphine was doable but I didn't like Tramadol cuz it made me really jumpy , not much of a drug addict i guess

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Originally Posted by beaterdit

Five knee surgeries here with each ACL done, see avatar haha. Have been treated at U of U and they are excellent. Was treated many years ago for a complicated femur fracture at Steadman Hawkins in Vail and they were excellent. However both of my knee surgeons, in southern CO, and here in SLC, are Steadman Fellows and they are everywhere. Great credentials to look for. Also ask them how many of these things they do and on what patient population. Be very up front about expectations and intentions ie: "skiing hard for decades to come".

All that said, your wife will want to 'prehab' for 4-8 weeks to get that knee back in shape. There's swelling and pain that causes shut-down of muscle firing and proprioception, muscle atrophy, and severely reduced ROM. Any good surgeon will put her on this program and it's good to be in formal PT 2-3x/week for at least the first few weeks. She'll work to get the swelling down and get ROM back, then work on strength and stability. She should be feeling mostly back to normal for day to day activities and have close to 100% of her strength and ROM back pre-op. They'll have stationary bikes and weights machines etc. at PT and they might let her go in on her own when she doesn't have formal sessions. She'll want access to this stuff every day one way or another.

I did my first ACL at 24 and was ski patrolling full time at six months out. My next was at around 35 and was much harder. My expectation of skiing at 90% six months out was not even close. I returned my season pass and redoubled my rehab efforts. Then by nine months I was feeling pretty good and bought a spring pass.

I'm 50 now and would not want to do it again but plenty of people do. Your wife will do fine but it will take a lot of determination and also patience. Good luck you guys!

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This is all great advice. If you decide to go Steadman route in Colorado (not just Vail anymore), there are a few of us that have used their services here.

Thanks to all for the advice, experience, and support.

We met with the Orthopedic doc in Bozeman today… ACL is torn, but some unknown portion is still attached as seen with MRI imaging. Everything else including Tibial Plateau will be fine with time and rest. Weight bearing allowed as tolerated and range of motion exercises encouraged as tolerated.

Mrs. single is obviously done skiing for the season and will wait to fly back East in mid-March as originally planned. We will then eventually have the knee scoped and see if ACL replacement is warranted depending on how much ACL is intact. No rush to perform surgery and our situation is stable.

Thanks again Mags! This is a great community with many of you reaching out to offer help. Much appreciated.

Sounds to me like the right call and best outcome given the situation. Hopefully she can still enjoy the rest of the trip and you get some skiing in still. Good luck on the rehab!


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Originally Posted by singlecross

Thanks to all for the advice, experience, and support.

We met with the Orthopedic doc in Bozeman today… ACL is torn, but some unknown portion is still attached as seen with MRI imaging. Everything else including Tibial Plateau will be fine with time and rest. Weight bearing allowed as tolerated and range of motion exercises encouraged as tolerated.

Mrs. single is obviously done skiing for the season and will wait to fly back East in mid-March as originally planned. We will then eventually have the knee scoped and see if ACL replacement is warranted depending on how much ACL is intact. No rush to perform surgery and our situation is stable.

Thanks again Mags! This is a great community with many of you reaching out to offer help. Much appreciated.

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Ms Duff is in a very similar situation, mostly torn but some anterior fibres still intact on MRI. Notable laxity on exam ,so plan was prehab extensively and reassess in 6 weeks. Surgery right away didn't work for her anyway due to life schedule, similar to you guys, and she felt good and had full ROM so the Prehab route made sense.

In 2 months regained 85% of quad strength compared to intact leg, full ROM, stability improved significantly on Lachmans testing. Even skiied about 6 groomer days braced with the kiddos. Ortho recommended pushing it a bit to see how she felt. But when she ramped up more intense activity, didn't feel confident in the knee and is having significant pain, possibly from the ACL instability or from the small lateral meniscus tear that happened at the same time. She still doesn't feel confident in the knee , fears it will just give out at some point , and wants to go back to full activity with no restrictions long term, so decided for a similar approach , scope to repair or clean up meniscus, assess remaining ACL and then either attempt a repair with an internal brace vs quad reconstruction if absolutely necessary.

Like others said - don’t underestimate the value of pre-hab. I’d find a good PT wherever you are and start going 3x a week ASAP. Hope she heals up quickly!


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