ACL Class of 2013

^^Thanks for the info all. Ya the doc is the head surgeon at the University of Colorado Sports Medicine facility. They explained the potential complications of both. She works with kids and is kneeling a lot. So that's why we were leaning towards hamstring but she is active. Skiing, hiking, backpacking etc so I want her to be able to enjoy those things as well.... It's the first major injury that either of us have had to go through so its all kind of new to us. 1 week out until the operation. She is walking pretty well and can ride the bike (low intensity). My main worry is muscle deterioration. The big hurdle for us will definitely be the mental side. She does ok with pain but gets down on herself easily. That will be my main focus I guess.

^I got hamstring; no complaints. Maybe a little extra rehab, but what the hell, she'll probably be at the gym a bunch post-surgery anyway.

As far as the mental part; I mentioned this a few times in the 2012 thread and will update: It wasn't nearly as bad as I thought it would be. I tried to apply the same determination to getting my knee strong that I would to trying to improve skiing or biking. It didn't hurt that I picked a lousy winter with an early spring to blow my knee up. By the time I was really burning out on the gym; about 3.5 months (4.5 if you include prehab) weather and roads were good enough to get out on the bike a lot. Being able to rehab outdoors; biking and hiking went a long way towards improving my outlook. I appreciated and enjoyed cycling more than I have in a decade!

Something else I found coming back to skiing has been a new appreciation for things that I had taken for granted, or had become mundane; first run post-surgery, first day skiing natural snow, first tour, first air, first run on all my favorite shots at Loveland...

I think if she can keep things in perspective, and not just focus on what she's missing out on, she might just find the whole recovery process to be an uplifting one.

Best of luck to all.

How's your swelling from the slip Willie? My knee is finally starting to resemble a knee again. The swelling hasnt been this small since before my accident back in late March. Even my kids were saying my knee looked a bit normal again. Stoked.

Progress is slow. It's a totally different show dealing with the MCL and meniscus, rather than just an ACL. Funny I never thought I would envy somebody with a 'simple' ACL tear, but like most things in life, it can always be worse. On the up side, I am getting better at online chess. Not much win in that.

Two more weeks and hopefully I can begin to hobble about without crutches. My knee is feeling much sturdier. A week ago the though of bearing weight was like nononono. But now it sounds do-able. It is amazing how the body regenerates itself. Stay positive all, it only helps.

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Originally Posted by ate'em

Funny I never thought I would envy somebody with a 'simple' ACL tear, but like most things in life, it can always be worse.

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I realize how lucky I am not to have had a meniscus tear. Although the mri didn't show any damage I was still concerned that they would find some hidden in there. The surgeon told me I kept asking him over and over again whether or not there was any meniscus damage ... I don't remember any of it.

I had a majority of the medial meniscus removed from my other knee 18 years ago so I can relate to the short and long term challenges meniscus damage presents. It seems like surgeons make a lot more effort to repair/preserve the meniscus now then they did back in the day. That bodes well for you.

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Originally Posted by rmnpsplitter

^^Thanks for the info all. Ya the doc is the head surgeon at the University of Colorado Sports Medicine facility. They explained the potential complications of both. She works with kids and is kneeling a lot. So that's why we were leaning towards hamstring but she is active. Skiing, hiking, backpacking etc so I want her to be able to enjoy those things as well.... It's the first major injury that either of us have had to go through so its all kind of new to us. 1 week out until the operation. She is walking pretty well and can ride the bike (low intensity). My main worry is muscle deterioration. The big hurdle for us will definitely be the mental side. She does ok with pain but gets down on herself easily. That will be my main focus I guess.

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If she works with kids or if you think you might want to have kids at some point, I would lean against the patellar autograft. My friend who had it said it really impairs her ability to get down and play with her kids.

On the morale and post-surgery stuff, the recovery really varies if it's a simple acl or if she also needs meniscus repair or if any of the other ligaments are damaged, which they can't always tell until they get in there. Ate'em and I had the same surgeon and both had multiple ligaments replaced and meniscus repair, and as he said, the rehab and pain level from that is much higher. If it's just the ACL you are often bearing weight and on the exercise bike within a week. Getting into a good pt clinic within a day or two post surgery is also really helpful, it can get swelling down faster and prevent scar tissue from forming in the joint. I don't know if you like to cook, but eating a healthy diet with lots of lean protein and fruits and vegetables can help post surgery. It can help bring down inflammation/swelling and counteract the negative effects of the narcotics. Also make sure she eats something before taking pain medication, it helps prevent nausea. If you don't cook make sure you find someplace with healthy takeout. A little high quality chocolate never hurts either.

As she's recovering try to notice the milestones she hits in the recovery process and think of things you can do together. At the beginning that might be Netflix and massaging her leg, but pretty soon she will probably be able to start swimming and light biking. Might be the summer to plan a beach vacation rather than an adventure one, if you like that sort of thing.

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Originally Posted by valli

My friend who had it said it really impairs her ability to get down and play with her kids.

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How so? LaPrade thought that with proper rehab, there should be no compromise in this regard with the patellar autograft. You have me a bit concerned, and I hear this anecdotally from other people as well. I spend a lot of time squatting and kneeling in my work, and communicated that to the doc pre-op. I sure hope I do not have long-term issues in this regard.

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Originally Posted by ate'em

How so? LaPrade thought that with proper rehab, there should be no compromise in this regard with the patellar autograft. You have me a bit concerned, and I hear this anecdotally from other people as well. I spend a lot of time squatting and kneeling in my work, and communicated that to the doc pre-op. I sure hope I do not have long-term issues in this regard.

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Well, my friend who has really complained about it had her surgery at Kaiser (HMO) and was generally unhappy with her experience, so I would hope your results would be better with LaPrade. The doctor I saw at Stanford who used to be a Steadman fellow also said there is higher risk of knee pain, but I'm not sure if he was talking specifically about women, since we have somewhat smaller knee caps. I do know it's supposed to offer higher strength faster and is generally the choice for professional athletes, so there's some clear advantages.

I'm curious, are you local to LaPrade, and are you having any issues with followup care? I'm having some minor issues with getting emails about rehab responded to by his PA, and also with getting followup appointments, although I guess part of that is his travel schedule. It looks like they won't be able to get me in until 11-12 weeks post-surgery, which is much longer than they had initially told me he recommends. He's an incredible surgeon, but it's a little harder than I anticipated doing the follow-up care long-distance. His assistant also just told me that they don't confirm any appointments more than 2 weeks out because of his travel schedule, which was news to me and makes it difficult to book flights.

Me: 18 Yrs old
When: March 7th
Where: Mount Rose
What: Partially Torn Right ACL, some sprains all over.

I was just curious if anyone else has had the partial (70-75%) ACL tear diagnosis and opted to not have surgery. I've had two orthos opinions and they've both gone in wildly different directions. I have zero instability, but am working with a physical therapists several days a week to regain a full range of motion. I am at about 80% right now and just got back to biking a lot again. I have had none of the typical symptoms, in fact I finished my run that afternoon, then headed home, it swelled up and lost some movement, but due to the several sprains acquired, not the ACL. On the Lachman's test my knee is 4-5mm looser than my good knee which is the main concern at this point.

So my question to all you, If I were to opt out of surgery, by your experience, would I be able to ski again and be back to normal activities without fear? As stated by my first ortho.

or

Will I be the "time bomb" that my 2nd ortho claimed, stating that if I opt out I am very likely (he actually guaranteed me) to re-injure myself and tear more than just my ACL the next time, creating a larger problem.

I'm getting a third opinion in 2 weeks, in hopes to clear some of this up, but it's good to hear from those with personal experience as well.

If you aren't currently having instability, or pain, your chances are probably decent at being to rehab without surgery. There was a recent long term double blind Swedish study that compared the outcomes in young active adults from immediate ACL surgery, delayed ACL surgery (post 2 years), versus no surgery. They found half of the group that did not do immediate surgery were able to return to active functioning without surgery, and that there were not significant risks to the group that delayed or opted not to do surgery. Some people are able to grow enough scar tissue to stabilize their ACL, and others seem to be able to cope without one. All bets are off if you also have a rupture of a second ligament, which generally requires surgery, but that doesn't seem to be your situation. I'd look at the epicski site, there's some references to this study and others there, and marznc regularly posts there and chose to do rehab instead of surgety. She's back skiing black terrain without a brace and has no pain or instability.. On the flip side I will add that it can be hard to tell if it's a partial or full tear on MRI. The first knee surgeon I saw told me I had a 40-50% tear, and like you I was able to ski down and even skied the next day. Turns out I had a fully ruptured acl, high grade tear of the lateral collateral ligament, and a substantial tear of the medial meniscus, all documented via photo during surgery. Who woulda thunk it?

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Originally Posted by valli

I'm curious, are you local to LaPrade, and are you having any issues with followup care?

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While LaPrade put me back together after a complicated surgery much of my recovery success is due to my physical therapist. If she didn't know something she would reach out to his team and they seemed quick to get back.
The 8 week (which ended up being 9-10 weeks) follow up was a 5 minute visit, probably because everything they wanted to know was in the pt report. That would suck if I had to travel for that but maybe they spend more time with you if you aren't local or your PT doesn't have a lot of experience with this type of injury.

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Originally Posted by valli

If she works with kids or if you think you might want to have kids at some point, I would lean against the patellar autograft. My friend who had it said it really impairs her ability to get down and play with her kids.

On the morale and post-surgery stuff, the recovery really varies if it's a simple acl or if she also needs meniscus repair or if any of the other ligaments are damaged, which they can't always tell until they get in there. Ate'em and I had the same surgeon and both had multiple ligaments replaced and meniscus repair, and as he said, the rehab and pain level from that is much higher. If it's just the ACL you are often bearing weight and on the exercise bike within a week. Getting into a good pt clinic within a day or two post surgery is also really helpful, it can get swelling down faster and prevent scar tissue from forming in the joint. I don't know if you like to cook, but eating a healthy diet with lots of lean protein and fruits and vegetables can help post surgery. It can help bring down inflammation/swelling and counteract the negative effects of the narcotics. Also make sure she eats something before taking pain medication, it helps prevent nausea. If you don't cook make sure you find someplace with healthy takeout. A little high quality chocolate never hurts either.

As she's recovering try to notice the milestones she hits in the recovery process and think of things you can do together. At the beginning that might be Netflix and massaging her leg, but pretty soon she will probably be able to start swimming and light biking. Might be the summer to plan a beach vacation rather than an adventure one, if you like that sort of thing.

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Hey thanks for the info. Surgery in two days, just found out that her MCL is torn from her femur and she has "suspect" looking meniscus in the other knee, the other weird thing (according to the doc's PA) is the amount of bone bruising in her knee cap. So we will hear from the surgeon what, if anything, they will be doing for that as well. Wednesday is a complete ACL reconstruction and fix of the lateral and medial meniscus (so far)... Her MCL is also gone in that knee but they said it will heal on it's own as its still attached on both ends. Friday we begin PT.

I do like to cook, any favorite recipes?

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Originally Posted by rmnpsplitter

I do like to cook, any favorite recipes?

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lots of steak or fish for protein, cooked pretty rare. definitely makes the body feel good.
lots of veggies and salad for the constipation. not joking.

recipies-
wife makes a good salad dressing with olive oil, balsalmic vinegar, tahini, honey, and miso paste. mix the ratios depending on how sour/sweet/salty you like it.

good meat/fish glaze is chicken stock, soy sauce, vinegar, sugar, cornstarch. ratios are key, try 4:2:1:2:1/2. mix together and pour in the pan once the meat is cooked.

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Originally Posted by rmnpsplitter

Hey thanks for the info. Surgery in two days, just found out that her MCL is torn from her femur and she has "suspect" looking meniscus in the other knee, the other weird thing (according to the doc's PA) is the amount of bone bruising in her knee cap. So we will hear from the surgeon what, if anything, they will be doing for that as well. Wednesday is a complete ACL reconstruction and fix of the lateral and medial meniscus (so far)... Her MCL is also gone in that knee but they said it will heal on it's own as its still attached on both ends. Friday we begin PT.
?

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Perhaps I missed it, but which surgery is she going with? Autograft? Allograft? Hamstring? Patella?

Just curious.

Sending +vibes to Mrs. Splitter for a successful surgery.

Im nine weeks out. it gets better every day.

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Originally Posted by rmnpsplitter

Hey thanks for the info. Surgery in two days, just found out that her MCL is torn from her femur and she has "suspect" looking meniscus in the other knee, the other weird thing (according to the doc's PA) is the amount of bone bruising in her knee cap. So we will hear from the surgeon what, if anything, they will be doing for that as well. Wednesday is a complete ACL reconstruction and fix of the lateral and medial meniscus (so far)... Her MCL is also gone in that knee but they said it will heal on it's own as its still attached on both ends. Friday we begin PT.

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Thinking a bit about what all is going on with the lady's knee, maybe it is worth getting a second opinion? I initally saw Dr Cunningham at Vail Summit Ortho, and as his evaluation of my injury got more complex with the MRI results, I went for a second opinion with Dr LaPrade at Steadman Clinic. The cost of a dr visit for their opinion of the best way to reconstruct the injury is pretty minor in the big scheme of things (~$200). Getting another opinion may shed a lot of light on the injury, and may help you to better understand the probabilities of various reconstruction options. Vail Summit and Steadman Clinic are both widely regarded as some of the best ortho surgeons in the world, particularly with regards to ski injuries. Sounds like your lady is dealing with a pretty complex injury, it was really confidence inspiring for me to see someone like LaPrade who deals with these complex injuries all the time. He is the guy that 'normal' orthos from around the country refer their patients to when the injury reconstruction is particularly difficult.

Particularly with the MCL tear, from what I learned, it may or may not heal itself despite being attached at both ends. IME, Dr Cunningham though 50-50 chance mine would (it was fully torn but attached at both ends). Dr LaPrade thought no chance it would heal satisfactorily for an athletic lifestyle in a young patient. Surgery is pretty rough, I would definitely not want to have to go back for a second procedure six months down the line. There would be nothing lost by delaying the surgery and week or two to get a better understanding of the best possible surgery procedure. It might result in a much better outcome long term.

Just my 2 cents, however you proceed I wish you and the lady the best possible recovery.

I agree with at'em. I saw five top knee surgeons (including LaPrade), got two MRI's, and had five somewhat different opinions. First doc thought I had a partial ACL tear, second thought I needed the whole posterolateral corner reconstructed, third wasn't sure, fourth thought just ACL, and LaPrade thought that my lateral collateral ligament was also damaged and that if I didn't replace that with my ACL the ACL graft had a very high chance of failure. It was confusing, to say the least. The LCL is a fairly rare injury, and what it came down to was that I wanted a surgeon that had a lot of experience doing LCL reconstructions if that's what I needed, not someone who had done a handful. The meniscus was a surprise to everyone, but I thought LaPrade did an excellent job repairing it and if they repair it with the ACL there is better blood flow and a better chance of success.

I was very stressed about making last minute changes in surgeon choices, and travelling to the Steadman clinic. In the end I think LaPrade nailed it, mainly because of his experience and the fact he really relied on the clinical evaluation of my knee, not just the MRI. They took photos during surgery so I could see what they found in my knee and how they fixed it, which was reassuring. I wanted to just have a simple ACL recon and faster rehab, but it wasn't what I needed and it would have sucked to do the surgery and rehab and then have the ACL graft fail once I started back in sports. My understanding is that the MCL has better blood flow than the LCL and a better chance of healing, but it doesn't always happen. One option is to overnight the MRI cd to LaPrade, he reviewed mine the next day for no charge and gave me an initial opinion, based somewhat on my unusual pattern of bone bruising.

On food, chicken vegetable soup is very comforting, and you can make a pot and then freeze portions, adding noodles if she likes them. Jewish penicillin, cures all ills. Grilled grass fed beef is great and you can use the leftovers to make salads, and I also like grilled fish and roast chicken. We stayed in Vail for a week and got takeout from Terra Bistro, which was great. I really craved fruit as well, and fruit popsicles. If you are open to alternative stuff there's some evidence that sublingual arnica the night before surgery can reduce swelling. I tried it and my swelling was definitely less than normal and went down fairly quickly.

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Originally Posted by valli

There's some evidence that sublingual arnica the night before surgery can reduce swelling. I tried it and my swelling was definitely less than normal and went down fairly quickly.

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Have you continued to use arnica post-op?

I have been using an arnica salve that seems to reduce the swelling at times, but oddly increases pain sometimes concurrant to the swelling reduction. Havent taken any sublingually, though I have a bunch of arnica tincture on hand.
Generally speaking I am a huge advocate for arnica, but have wondered if it is really useful for the major trauma of reconstructive surgery.

Appreciate the thoughts everyone! So we are actually on our 3rd opinion and have found a doctor/clinic that we both really like. Diagnosis from all have been pretty similar, timing and treatment have varied a bit but for the most part it was about how the doctor interacted with us and word of mouth from others on who we ended up choosing.

She is going with the hamstring, I think autograft? Is there a difference between auto and allograft? The other nice thing about this doctor is that he is close to home and almost every pt person I've talked to has worked with him and seems to think he is good. We got news that they will wait to see how her right knee responds on its own before attempting any sort of procedure. He thought she might have meniscus issues that would need addressing but for now will only be working on the left knee. So little bit of good news in all this.

The main thing really is that she has found a doc she can trust and is happy with that situation and is going into this with a very positive attitude. For that I'm happy. Thanks for the vibes all!

Edit: def doing the autograft. They said a person her age (24) will respond better to her own tissue.

The allograft is from a cadaver, the autograft is from your own tissue. Sometimes they do a mix of the two, Flounder's wife did hamstring autograft but didn't have enough of her own tissue to harvest, and they augmented with cadaver. I'm 44, so they recommended allograft for both grafts. Sounds good they are waiting on the right knee, I can't imagine doing them both at once.

On the arnica issue, I'm not taking it now, although I have some traumeel that I occasionally massage on. I had major abdominal surgery a few years ago, and the surgeon recommended arnica, and I had less swelling than the norm then too. This could either mean arnica is helpful or just mean I'm not much of a sweller. That's the problem with anecdata.

had my 9 week post op with surgeon today. good news is knee looks like a knee and feels great. bad news is I am STILL not at 0 degrees of extension despite going to PT 3 times a week for that very purpose. Frustrated? a little.

Doc told me that scar tissue may have built up around where the graft meets the femur. May require knee scope to clean out the scar tissue. If I don't get to zero degrees of extension (symmetry with other knee) I will need another surgery.

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Originally Posted by Wildman

had my 9 week post op with surgeon today. good news is knee looks like a knee and feels great. bad news is I am STILL not at 0 degrees of extension despite going to PT 3 times a week for that very purpose. Frustrated? a little.

Doc told me that scar tissue may have built up around where the graft meets the femur. May require knee scope to clean out the scar tissue. If I don't get to zero degrees of extension (symmetry with other knee) I will need another surgery.

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Have you tried putting a hot pack on it and then flexing it on the floor to get more extension? Some pt clinics only recommend ice, but my pt puts some heat on it first and then works on getting full extension and flexion. I also find I have to keep doing it a few times a day, it reverts back to being stiff otherwise. How far off are you? My surgeon actually would prefer I not get as far as the other leg, because all of my joints and ligaments naturally hyperextend. I think he's hoping I stay at 0 or -5 rather than matching the other leg.

I read through this thread and see so much support. It's really cool to see the community come together here.

I've finally figured my situation out, and set up a surgery date. 5/23.

valli and ate'em, I don't know if it made it better or worse for me to follow your experiences, but here I come... acl, meniscus, remove random floating thing in knee, etc...

I shall be posting on here soon, because I probably won't have much else to do. Maybe it's about time I start watching tv... hahaha I hear game of thrones is pretty good.

Cheers.

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Originally Posted by valli

Have you tried putting a hot pack on it and then flexing it on the floor to get more extension? Some pt clinics only recommend ice, but my pt puts some heat on it first and then works on getting full extension and flexion. I also find I have to keep doing it a few times a day, it reverts back to being stiff otherwise. How far off are you? My surgeon actually would prefer I not get as far as the other leg, because all of my joints and ligaments naturally hyperextend. I think he's hoping I stay at 0 or -5 rather than matching the other leg.

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Yep. The problem for me hasn't been getting to 0 it been staying there. I can get to 0 but it pops back up after i stop flexing the quad. My right knee has been at 5 degrees of extension pretty much since the surgery. Just this past week it dropped to 3 degrees. PT has been using lasers, ultrasound, soft tissue massage, as well as weighting my ankle while lying prone on the table.

I've been using heat and cold and riding the bike alot. The knee feels great but my surgeon's concern is that I am not symettrical. My left leg gets 0 degrees (I have never been able to hyperextend). Guess I'm wound up pretty tight. Gonna talk to my PT about it before making a call.

Good to see everyone progressing. We are 3 weeks post op with mrs. Flounders. It seems she was pretty lucky with just the ACL repair. No meniscus damage and the MCL strain seems to heal quite well pre surgery.

After 1 week she was at 100 and at 120 by the second week. Extension is 5 at least. She is quite type a and goes non stop. The PT guy had a talk with the surgeon because he's nervous about how fast she is progressing. They cut PT to every other week because she is exercising and now back on the bike. She went back to work half days last week and full days this week. She really swelled up yesterday because she was trying to do everything she normally does. The kindergarteners have been great, they are always trying to help. They think the ice cast is pretty cool.

Best of luck to all. Hopefully everyone heals well and is back doing what they love. I know Mrs. Flounder can't wait to get back climbing. Hopefully by late summer.

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Originally Posted by ate'em

How's your swelling from the slip Willie? My knee is finally starting to resemble a knee again. The swelling hasnt been this small since before my accident back in late March. Even my kids were saying my knee looked a bit normal again. Stoked.

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One month post-op now and one-week post-fall-down-the-stairs and things are going well. Had my one-month follow up with the doc and the PTs at the hospital and they all agreed that I'm on schedule if not slightly ahead in my recovery. Very stoked about this. Only evidence of last week's fall is a big bruise on the inside of my right (non damaged) knee. I do feel that the fall set me back about a week, but apparently hasn't caused any major problems.

Still have significant swelling which I'm going to tackle with a neoprene brace during the day but the doc didn't think it was a big deal - said some people have some swelling as much as 6 mos. post op. Still get some pain from the outside-rear area of the joint. Totally forgot to ask the doc about that... Also, not getting full extension yet. I'm to about zero but they want me to go beyond zero and match my right knee which gets several degrees of negative extension. PT at the doc's office had me use a device that's designed to stretch the knee into negative extension and it's basically just a piece of bent tubing with some webbing. I could make one out of 1/2" EMT at work and use duct tape for the webbing.

Walked down a small flight of shallow stairs with no issues yesterday, which was kind of a surprise. The taller stairs at my house are still a bit of a challenge and the big steps on the scaffolds at work are too much.

Joined a gym yesterday, will be riding the stationary bike and beginning shoulder pre-hab before work each day starting tomorrow. Pre-surgery consult with shoulder doc next Thursday and hoping to schedule the surgery for week of June 3.

Good to see everyone seems to be doing well!

Hey Wildman, a few things that helped me get to full extension that you might want to try if you aren't already doing them

When walking "kick out" your leg to get it straight and really reach to step heel to toe.

Stand on a slanted board, standup straight and straighten your leg as much as possible (hyperextend if you can) this stretches out the whole back of your leg.

When I'm sitting at my desk some of the time I try to sit with my foot on a bucket so that my knee is hanging and naturally extending. I think this is similar idea to your PT having you lay prone with a weight on your leg.

Hopefully extension will come naturally and you won't need additional surgery