ACL Class of 2013

[DictatorShooter]

Please register me for the ACL Class of 2013:

Me: 45 Yrs old
When: February 16th
Where: Moonlight Basin
What: Torn Left ACL and Segond fracture of the tibial plateau
How: Slammed on the brakes to avoid a stump. Caught left leading edge and ski didn't release until it was too late. Likley contributor was tech boots soles in non-tech bindings.

Diagnosed at the Big Sky Medical Clinic the evening of the accident with a likely torn ACL. The "segond fracture" is a dead giveaway, as 95% of those bone chips involve a complete tear. Was put in a brace and started doing pre-surgery rehab I found on the web, together with icing. After the first week, the knee area looked like this:




Finally got in to see the orthopedic surgeons at Bridger Orthopedic in Bozeman last Thursday, 2/28 for their initial diagnosis. Was trying to get in with the top dude - John Campbell, but he met with me and informed me he was retiring at the end of March and it would be bad medicine for him to do it, without the ability to follow-up with him later...so his partner Alex LeGrand took over. Both docs said they didn't even need to do an MRI, because it was clear I had a complete tear. LeGrand was concerned that my swelling was too bad and range of movement insufficient and wanted me to do PT for a couple of weeks. He told me to immediately lose the brace, as it was slowing me down. I was hoping to get it done more quickly, so got a 7am appointment the next morning at PT and started doing stationary bike and pre-surgery stretching. Was able to bend me knee to 122 degrees by the end of the session and scheduled the surgery for 4 days later, which was yesterday (3/5). In the meantime, I rode my old mountain bike on a trainer 3 times a day and prepped like a mo-fo and got rid of all the swelling/brusing and had great range of motion going in yesterday.

Dr. LeGrand installed a cadaver achilles tendon (allograft) at 2pm yesterday - hopefully from a 25 year old Austrian ski racer who had an unfortunate fall over the weekend. So far, all is well. No sleep last night as the femoral nerve block wore off and the Oxy was just starting to work....but off to a good start. Looking forward to getting on the bike as soon as possible, but expecting to be taking it easy and staying on the constant motion machine for the next week or so.

700 good days of skiing followed by 1 stupid turn. Overall, not a bad run. Hard to look out the window at all the great snow these past couple of weeks, but I'm planning on being 100% by next season.

[tone capone]

That does not look trivial, I feel for ya dude. Sounds like you got it ready for surgery quick, that's a good sign that your body deals with trauma pretty well. If it's any consolation LeGrand did mine, I've put it through the wringer and it's solid. He's a super good guy who takes pride in what he does and stands confidently by his work. He was very helpful and reassuring while I was goin through some tough times in the rehab journey. You might not be 100% when you think you should be but you'll get there. The big picture is 18 months and he will tell you that straight up.

[Wildman]

Had my ACL reconstructed yesterday by Dr. Paul at Boulder Surgery Center. Honestly I can say it was a very smooth experience. Actually went in to surgery 30 minutes early (doc was running ahead of schedule)...since when does that ever happen!!!

Had a nerve block and GA. all in all the patellar tendon Autograft & meniscus repair (doc was able to keep 100% of meniscus) took 2 hours and I was home
On the couch. Got to 50 degrees of flexion using the CPM.

The Meds kicked my ass yesterday so some nausea and vomiting, but had a good night sleep with the game ready ice machine running all night.

Swelling is minimal and am non weight bearing till the nerve block wears off.

All in all super impressed with the medical care and experience so far.

Hang in there fellow ACL gimps!!!

[DictatorShooter]

Tone - great to hear that you had a good experience with LeGrand. Now exactly 48 hours post-op, I'm feeling it quite a bit and just trying to get to the next phase. How long was it for you before you were back on skis? I'm hoping that January 2014 is realistic for me for a mellow return, and plan on biking quite a bit all Summer.

Wildman - I'm on the CPM right now and up to 60 degrees today. No issues with that or the straight-leg strap device. I don't have an ice machine but am taking the wraps off in a couple of hours, so the ice packs should do a better job. Had the fun experience of yanking out the drain tube yesterday. Hang in there and keep on top of your meds. I woke up last night in a world of hurt, which is not a huge surprise...but keep those suckers handy. I was hoping to ween off the Oxy today, but think I'll need to wait a couple more days, at least.

[tone capone]

Yeah, that drainage tube part is fun, huh. I think I was on the Oxy's for like 5 or 6 days? January is a reaonable goal, just progress in careful increments in both the quantity of time you spend skiing and the level of intensity. If your good leg quad is fatigued and you are having some knee pain in the involved leg, it means you need to spend more time in the gym strengthening and less time doing dynamic movements. Beware that 6-10 month period, you can really have a setback if you don't get it up to full strength before you start trying to go all out. You might feel great on the bike, but it's nothing like the cutting, pivoting and leverage forces involved in skiing.

[bendtheski]

^This, hiking steep terrain is probably a little closer to skiing than biking, but actually skiing will be the real test. I eased into it on groomers early-season at about 10 months (October), and am still skiing like a little bit of a pussy. I'm OK with it though, it's just good to be skiing again.

Tone, glad to hear things have improved for you. I just want to survive the ski season injury free at this point, and am looking forward to biking/hiking season so I'll be stronger next year. Right now my knee's probably in a lot better shape than my lower back, so I've got that going for me, which is nice.

Anybody know a good neurosurgeon?

[Wildman]

6 days from surgery. I experienced little to no pain since the surgery (using game ready and CPM) UNTIL I went to my first PT session yesterday. I am at 90 degrees of flexion, but not yet at 0 for extension. My PT did some massage and just walked me through what I should be doing (quad sets, straight leg raise, side lege raises, stomach knee curls, toe pointing, RICE)...I couldn't make 1 revolution on the bike...scary.

I felt fine leaving PT, but everything changed last night. I barely slept...I know exactly why in retrospect. During PT I actually spent time "reconnecting with my knee", this coming into awareness also helped me to become more aware of the pain. In truth I haven't felt my knee since the trauma of surgery, as my brain most likely shut it down as a form of preservation. Re - establishing this connection really caught me off guard.

I'm still 50/50 weight bearing due to the meniscus repair and am getting sick of crutches fast. Getting my stitches taken out on Thursday and PT session #2. Stay Tuned.

Pesto- good luck tomorrow! rest assured your in good hands...

[pesto]

Thanks Wildman.

I had my pre-op appointment this morning so I'm ready to go tommorrow.

I was reading over the doctors rehab protocol and a line under the section for 6-12 weeks postop made me laugh: "Outside biking (bike - yes/falling - no)"

[DictatorShooter]

Wildman - I'm exactly 1 day ahead of you (7 days out of surgery now), but don't have my first Ortho follow-up and PT until Thursday. I'm still in that "disconnected to my knee" state. Can't really feel it and when I try to walk on it, feels like a dead noodle. Really my whole leg from thigh to ankle feels like a dead noodle. I guess that will change with PT, which makes me more anxious (in both ways) about that appointment. Just been doing my 6 hours on the CPM, extension torture straps and ice each day.

Are you still on the pain meds? I'm down to just the 800mg Ibuprofens at this point.

Good luck, pesto.

[snow gypsy]

Just a recovery note to prove it does get better! I tore my ACL almost exactly 12 months ago and posted my slow progress and setbacks on the 2012 boards.

Almost a year post op and I finally found the balls to tackle my first true huck since my accident - actually on the same run where I first blew my knee out.

Did I land it? Not quite.
Was it big? Not really.

But it felt so good to soar in the air, even for just a brief second, with skis on my feet. That moment (and bruise) is going to stick with me. As will the five or six smiling kids from the freeride team that fist pumped me afterwards.

All smiles. It gets better. The knee works. It was all worth it.

Big props to the lovely ladies of shejumps for helping me find the courage to tackle my demons and for helping me rediscover the innate joy of rolling about in powder.

[Wildman]

DS- what are the torture straps (extension)? Other than the day of surgery and last night i haven't taked any meds though I have scrip for Hydrocodon.

I took two pills so i could sleep last night was fine during and immediately after PT, but at night my knee began ACHING in a manner that I was not used to. less pain today, and have been doing my exercises (up to 110 on the CPM). Its likely I may need to medicate again tonight as i had a rough time last nite...

SG- Thanks for the positivity...I can't wait to SENDIT again...maybe smaller...but still. The big issue will be hucking where the injury occurred...not sure how im gonna get past that hurdle. but hey, that's a long time from now

[Wildman]

Also a quick tip - for anyone using a game ready ice machine...fill the tank 1/2 way with water and instead of using ice (i dont have an ice maker) buy 12 pack of mini water bottles (8floz) freeze them and use 6 at a time. way more time efficient than making ice manually / buying bags of ice...that machine is like a morphine drip for me right now...

[snow gypsy]

DS- what are the torture straps (extension)? Other than the day of surgery and last night i haven't taked any meds though I have scrip for Hydrocodon.

I took two pills so i could sleep last night was fine during and immediately after PT, but at night my knee began ACHING in a manner that I was not used to. less pain today, and have been doing my exercises (up to 110 on the CPM). Its likely I may need to medicate again tonight as i had a rough time last nite...

SG- Thanks for the positivity...I can't wait to SENDIT again...maybe smaller...but still. The big issue will be hucking where the injury occurred...not sure how im gonna get past that hurdle. but hey, that's a long time from now

Wildman, heal quick! It was a long road but it was all worth it in retrospect. Medicate as needed. It took a long time to work up to that point where I could even look at that run without my legs turning to jelly. I actually posted in the 2012 forums of a moment when I just froze and couldn't even will myself to turn. I went back and did a few retreats with some rippin' ladies that helped me work up my confidence, build on my technique, and remember what I loved about skiing in the first place. Once the technique, confidence and love was there, sending it was easy. Just count and go.

Plus, the fact that I fell pretty spectacularly and nothing bad happened just upped the confidence even more. Not only can I ski, but I can fall again with confidence. The PT is not going to like this.

[DictatorShooter]

Snow gypsy - great to hear that you're back at it and can huck again, fall hard and be fine. Especially the ability to fall again with confidence. If you could send Lynsey Dyer my way to help with rehab it would be much appreciated.

Wildman - "torture straps" are the extension device. Seems like I can only stand about 20 minutes in that thing before the knee starts twitching. I'm only at 90 on the CPM (sticking with 5 degree increments/day), but will crank it up now and see if I can get close to your 110. Nice work!

[pesto]

I survived. The nurses, surgeon and anesthesiologist made the whole process easy. They have a great team at the Boulder Surgery Center.

Best part: No meniscus damage :-)

I just spent a couple of hours in the CPM and now I'm just hanging out letting the ice machine do it's thing

[gholman12]

Pesto, sounds like we were under the knife at the same time yesterday brother. Got mine done at USC's Keck Medical Center - all went well except the thing is swollen like a damn watermelon. Same as you in terms of other damage, clean as a whistle in there. Which ice machine are you using? Here's to a fast recovery and riding again next fall!

[pesto]

I'm impressively swollen as well.
I have a Game Ready machine it circulates cold water and applies compression on a programmed cycle. I'm loving it.

[gholman12]

One of my nerve blocks just stopped working. Bring on the Norco.

[Wildman]

8 days out. Had my sutures taken out today & had PT. Rode the bike (stationary) now in considerable pain...Norco FTW!

[shekat]

Terrible Triad, unhappy camper...I'm not sure if I am in class of 2012 or 2013. Snowboarder ran into me/over me on Dec. 26th in Breck and I knew in an instant that my knee would never be the same. Diagnosed with torn acl, torn mcl, torn medial meniscus and avulsion fracture, right knee.

I have seen two Dr's. Both are renown for ACL reconstruction, they both gave me opposite opinions. One says, yes, torn, have unstable knee on exam, need acl reconstruction (his preferred method is allograft for my age of 53; but agreed to autograft, my preference) His preferred autograft is patella tendon. I have surgery scheduled with him March 26th.

I have been doing PT to heal the MCL and my knee feels ever so much better and its almost hard to believe that I need surgery except the meniscus hurts.

The other docc I saw for a second opinion says my exam is a little unstable, MRI is hard to read and he advised "conservative" treatment. I told him I am an active woman, want to return to my sports. I am a slalom waterskier, a weekend warrior snow skiier, play tennis and swim....he said I could do all that except serious bumps with a scarred acl. That I should do PT and see how it goes, if not too well, he would scope me, fix meniscus, says ACL is sprained, not torn necessarily.

So I sent the MRI to steadman Hawkins Dr. Hackett; he says meniscus, ACL, MCL, all torn, need surgery. Don't even think about trying to ski, waterski or anything; I will end up dislocating with more injuries if I do. He broke the tie, so I scheduled surgery with the original doc.

I am not sure I want the patella tendon autograft vs. hamstring autograft? Is there any difference for people over 50? I already have anterior knee pain due to the meniscus and seriously do not want chronic anterior knee pain. On the other hand, is there any way to know how useful my hamstring tendon would be prior to surgery?

Also, should I have another doc who can examine me give me another opinion since there is some doubt in my mind because one of the docs thinks I can get away without surgery? Or find someone who has experience and is willing to do the hamstring autograft?

And what is the current best treatment? Using a CPM? bio screws, titanium?

This has been a frustrating and confusing 2013, glad I found this forum, and am hoping for any light that can be shed on my situation...

Thanks!

[shekat]

Do you rent these game ready things or buy them? Where? My doc just says ice, ice, ice and when I asked if they have packs or anything at my pre op appt. they said not anymore because of liability issues. And no CPM either...should I run to another doc?

[snow gypsy]

shekat,

So so sorry about your injury. It's definitely the exact opposite of a good time. The best advice that I can give is to research what's going on in your own body. Go through the 2012/2011 forums and learn as much as you can from other people's experiences. Decide what you want for your knee and what you are comfortable with. Then, find a doctor who specializes in that and whose values and goals align with yours.

It's strange that they don't have any packs for you. I didn't use any machines, but I did purchase a compression ice pack from my PT. Are you seeing a PT? What is her/his opinion? First and foremost, educate yourself and then, find a doc who you trust and believe in. Don't settle. It's your knee, and from your tone, I didn't hear a lot of faith in the person doing your procedure.

[hoarhey]

My wife had ACL reconstruction with hamstring autograft (32 years old).
Post-surgery, we were given a Polar unit one by the surgical center.
It is a cooler into which you put ice and water, and a pump is built the lid which is connecting to tubing and a sleeve that you wrap around your knee (put a compression sock or something between sleeve and skin, or else you can get burns from the cold).

My wife swore by the Polar unit post-surgery. Had it on almost all of the time for the first week or two.

I find it strange your doc won't give you one.

We went for PT pre-surgery and the physical therapy place had a bunch that you could sign out.
If you go to PT pre-surgery (I'm guessing you may not with terrible triad), you should ask them.

All the best to you in your journey, shekat.

[miahw2828]

Well, looks like I'm signing in for the class of 2013. Saw the Ortho on Wed. and he said he's 95% sure it's the ACL based on a Segond fracture shown on the Xray and his physically evaluation of the knee. MRI early next week to confirm/deny and potentially identify anything else, status of meniscus, etc.

Injured the knee on Sunday, and hurt like hell and swollen for 2 days after, but has felt dramatically better since then. Easing off the crutches and bearing weight for short times/distances. Flexibilty to about 90 degrees and swelling is going down quickly.

No script for PT pre-surgery, but he walked through a bunch of stuff to be doing - static quad contractions, straight leg raises, floor slides, hamstring and calf stretches. Stationary bike when I'm up for it.

Anything else anyone recommends, particularly to try and build hamstring strength?

Docs preferred method is Hamstring autograft, which I am totally fine with.

Stats:
Me: 34 Yrs old
When: March 10
Where: Loveland
What: Torn Left ACL (assumed, waiting confirm from the MRI) and Segond fracture of the tibia based on the Xrays, hopefully that's it
How: In some cut up pow on Jelly Roll caught a shark underneath (probably a rock but based on hazy discussion with two guys near the crash site might have been the ski that one of them was searching for) and went tumbling. Ski did not release. Knew my knee was fucked before I came to a stop.

[gholman12]

Update: Day 3 post-op

No more nerve blocks, no more norco, and amazingly, almost no more pain! I can walk around pretty easily with the brace, and fairly well, although very cautiously, without it. Range of motion on the constant motion machine is up to 65 degrees with no pain, haven't pushed it past that because why rush things. Aiming for close to 90 degrees by post op visit on Tuesday. Extension to -5 degrees was the easiest part. Sleeping through the night again and beginning to regain my independence around the house, which feels great. Icing constantly throughout the day when I'm not on the constant motion machine, taking 400mg of Ibuprofen every 6 hours for swelling. The first day or two is the worst, but it DOES get better!

Edit for thruthiness: I had a large (previously undiscovered) novacaine-toma that had developed around my femoral nerve, and thus I had novocaine action long after I pulled the second nerve block. Now that it's worn off, I have mild pain. Can still walk, still at 65 degrees. Onward.