ACL Class of 2017

[Yonder_River]

Is everyone getting cadaver acls these days or is harvesting back in fashion? Any other technique options to consider?

If it's a complete tear and proximal to the femur, then find an ortho who is experienced with the internal bracing technique. It's less than a decade old but is looking good long term and no graph of any kind needed. My wife tore hers in February, surgery in May and is going to ski this winter so the recovery is much faster and less painful.

[Duffman]

If it's a complete tear and proximal to the femur, then find an ortho who is experienced with the internal bracing technique. It's less than a decade old but is looking good long term and no graph of any kind needed. My wife tore hers in February, surgery in May and is going to ski this winter so the recovery is much faster and less painful.

Looked into the literature on this (the BEAR technique) and philosophically it makes a lot of sense for a mid-ligament tear, but the small number of providers doing it limits the long term data on success and longevity of repair. I'm not even aware of any substantial numbers being done in our area (Philly) which is full of teaching hospitals .

[bodywhomper]

No acl, torn medial meniscus, and partially/slightly torn mcl. Right leg. Deferring surgery. Skied last season w/ similar problems without issues while wearing an over the counter high stability hinges brace until I destabilized stomping a jump in the park at the end of season. Currently, skiing again (including in uniform) with custom donjoy brace.

Currently, don’t intend for any surgery for a while, possibly years. I’m trying to maintain a high baseline of leg strength and stability as rx’ed by my pt. The meniscus injury is annoying.

My reason for delaying surgery… I want to see how functional I can become with just PT exercises. I’m pretty functional now. I live in the sticks with wife, pets, and 3 kids. Being out of commission (can’t drive) for even a few week will be a hardship. It’ll be different when the kids can drive themselves. My side hustle job at the ski hill pays for my family’s passes. I’m not sure we’d be able to afford to ski otherwise. I was advised to follow the route that I’m following by a sports med doc (2nd opinion). I was also advised to follow a different path (limit activities until after surgery) by a different sports med doc (3rd opinion).

[fastfred]

I got no acls blown them and replaced them and blown them
look like forrest gump as a kid when I go skiing
pretty much aok without them
hike bike ski
about once a month a feel a pop or have that sick feeling as I twist and turn and things move the wrong way
over all stablity is 95% or better
unfortunately I have bigger health issues than missing knees
dwelling on shit only gets you deeper moving forward exercising and taking care of yourself gets you somewhere fast

[Yonder_River]

Looked into the literature on this (the BEAR technique) and philosophically it makes a lot of sense for a mid-ligament tear, but the small number of providers doing it limits the long term data on success and longevity of repair. I'm not even aware of any substantial numbers being done in our area (Philly) which is full of teaching hospitals .

Bear is a different technique than what I was referring to. I think there are a few. Internal brace is the one. I think it may be a little more common place. Sport ortho guy here in Seattle has done a bunch with a good track record.

https://youtu.be/i5BNnmQVgag?feature=shared

[bodywhomper]

Thanks for posting that, Yonder_River!

[Duffman]

Anyone know why the internal brace repair is much more common in Europe than the states?

[bodywhomper]

I blame espresso

[Duffman]

Any brace advice for ski and or pre-hab use? What's the lowest profile one thats still effective?

[hawkgt]

Any brace advice for ski and or pre-hab use? What's the lowest profile one thats still effective?

I wear a donjoy and been happy, had it fitted for my leg though. hardly notice wearing at all skiing, playing disc, mtn bike, etc..
https://www.donjoystore.com/donjoy-a...rcepoint-hinge

edit to add: I wear brace over the ski thermals and no issue vs on skin. I was worried it would slide down, no issues.

[bodywhomper]

I wear a donjoy and been happy, had it fitted for my leg though. hardly notice wearing at all skiing, playing disc, mtn bike, etc..
https://www.donjoystore.com/donjoy-a...rcepoint-hinge

edit to add: I wear brace over the ski thermals and no issue vs on skin. I was worried it would slide down, no issues.

Same experience so far. Felt like the right decision.

[Duffman]

Saw the surgeon for my wife, she has had zero symptoms over the past week, but she felt the knee and definitely felt instability on the Lachmans test and looked at the MRI and felt despite the read of a near complete proximal tear, it wasn't truly an avulsion from the femur attachment and more of a proximal mid substance tear, so is recommending reconstruction with a Quad tendon graft. This Ortho does quite a few repairs and discussed both internal brace and BEAR , but said that she is super selective with who she does those on and unless it was a pure proximal avulsion she doesn't love it for someone who is an active fairly high level skiier. Said she would consider it for a blue / green family groomer cruiser, but that the long term data just isn't there to guarantee it would hold up to the skiing activity she wants to do, and that the reconstruction is still the gold standard for return to sports. Wife is not happy but understands.

The issue here is timing. Due to her work schedule needs, me going to Euro BBI Feb 29th, ski trips we already have schedule w the family, it seems near impossible to have the surgery right now (surgeon said she could do early Feb if we wanted but that prob doesn't work for those reasons). Since the surgeon said repair isn't the best option, there is no timing issues with the reconstruction surgery, other than risk of further injury that exists in any situation without good ACL function.

We asked about deferring till April while doing PT pre-hab / rehab and skiing and working out non aggressively in a fitted ACL brace . She said that this is totally an option and even discussed ACL Copers who do that long term and never have surgery, but she thought it was unlikely the wife would be happy with that option at all and may not even like it in the short term. Also warned that even if braced there is still always a risk of further meniscus injury without surgery (she has a very small vertical lateral tear from this injury, no other ligament issues )

For those of you who had good knee movement without pain and deferred , either voluntary or involuntary while waiting, were you able to ski much at all? If we have to wait till April for other logistical reasons, she really doesn't want to have to punt on the entire season and beginning of next one. If you could do it, any advice or bracing / PT recs? It's hard to find a PT who knows much about higher level skiing in this area .

[bodywhomper]

I ski. In and out of uniform. I’m at 80% and not going off jumps (though I’ve made plenty of jump turns and energetically ski moguls) while I gain confidence with the brace. As confidence grows, I’ll be opening my turns up more in weird snow. I’ve done it a few times and it was all good. So for me, my inhibitions feel like it’s just a head trip.

I’ve had one awkward fall that I know would have hurt a lot without the brace and it felt all good. I tele and I think the tele turn dynamic is a little easier on that part of knee stability than an alpine turn. Sometimes when I’m making hard carving high angulation alpine turns, I can feel a slight pull and opening of my knee joint during turn transition that doesn’t happen on the good knee, but the brace keeps things in alignment (so far) and nothing feels unstable.

My knee always looks a little bit swollen even if I’ve rested for multiple days. The knee is always a little bit uncomfortable.

I’m staying on it with PT. It took me a lot of searching and trial and error to find a PT by me that understood me, my needs, and goals. He’s an athlete and understands the dynamics and forces of skiing.

[neufox47]

Not sure this is the right place but, it does involve an ACL injury. About 10 years ago my knee inexplicably blew up, swelled right under the patella so bad until I couldn’t bend it for a week plus. No injury.

3-4 times over the past 10 years a very similar thing has happened. Usually for no known reason, but recently because I stupidly front squatted 225 full depth in lifting shoes after not front squatting for years (obviously dumb and yes I do other lifting).

Back in October I banged my knee on a rock wall and the next day I woke up with a sore knee. It then blew up, almost 3 weeks of not bending it, then I went for a bike ride and it blew up again, then I hit it on a post before Christmas and it was another 8 days….

I finally got a MRI and this is the result:

Normal patellar tendon. Mild distal quadriceps tendinosis with mild focal partial intrasubstance tear of its distal anteriormost fibers measuring 1 cm with underlying mild reactive bone marrow edema in the superior aspect of the patella and with mild adjacent prepatellar bursitis. Moderate chronic partial ACL tear with attenuated appearance, otherwise normal ligaments. Normal lateral meniscus. Normal medial meniscus. Normal medial compartment cartilage and underlying osseous structures. Normal lateral compartment. Normal patellofemoral joint. Normal popliteus. No knee joint effusion. Small Baker's cyst.

Haven’t seen the ortho or any doctor yet. Anyone had similar or otherwise care to share some knowledge of what that likely means?

I did ski today, with mild discomfort, no blow up yet at least.


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Well according to the ortho it sounds like my acl and quad tendon tears are incidental and unlikely to be causing the bursitis. He thinks bursitis is what is causing my knee to swell to the point of not being able to bend it. Maddeningly he said, “it’s hard to tell because it’s not swollen now. If it comes back message me and I’ll try to get you in asap”. I’m like dude I begged your office staff for an earlier appointment, I got this referral two months ago.


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[bodywhomper]

Well according to the ortho it sounds like my acl and quad tendon tears are incidental and unlikely to be causing the bursitis. He thinks bursitis is what is causing my knee to swell to the point of not being able to bend it. Maddeningly he said, “it’s hard to tell because it’s not swollen now. If it comes back message me and I’ll try to get you in asap”. I’m like dude I begged your office staff for an earlier appointment, I got this referral two months ago.


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Sounds like some good hard skiing days are in your future so you can see that doc soon

[JimmyCarter]

Quick ortho visit indicates ACL class of 2024, though I need an MRI in a few weeks to confirm.

Supposed to be hitting Park City in a month or so - anyone have luck skiing without an ACL but using a knee brace? Bad idea?

[hawkgt]

Quick ortho visit indicates ACL class of 2024, though I need an MRI in a few weeks to confirm.

Supposed to be hitting Park City in a month or so - anyone have luck skiing without an ACL but using a knee brace? Bad idea?

Only you can call that, I do ski with a buddy with blown acl after surgery repair. He is braced up like a robot and works out shit load, he makes it work but I could not pull it off

[mcski]

Quick ortho visit indicates ACL class of 2024, though I need an MRI in a few weeks to confirm.

Supposed to be hitting Park City in a month or so - anyone have luck skiing without an ACL but using a knee brace? Bad idea?

Read upthread for many testimonies of people skiing w braces instead of acls. I’m in the same club and will be testing out a brace in the coming weeks

[uglymoney]

Only you can call that, I do ski with a buddy with blown acl after surgery repair. He is braced up like a robot and works out shit load, he makes it work but I could not pull it off

This.

There was no way in hell I was ever going to ski again without an ACL but everybody's knees are different.



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[yeahman]

This.

There was no way in hell I was ever going to ski again without an ACL but everybody's knees are different.



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Same. Couldn't even fathom skiing after I tore mine. Just walking was a challenge.

[Djongo Unchained]

I was back to skiing faster with an acl repair than if I had foregone it. I'm damn sure of that.

I wasn't in any shape to ski for the two weeks between tear and knife.

Woulda been slower and way more work to get the supporting muscles to overcompensate for a non functional ligament.

I skied down the hill and got in the car and drove home. That had it's hurdles. Crossing the road, removing boots, getting gas, 3 hr drive home, swelling and some pain, first toke and almost passing out...

I skied with the big brace maybe 2 days and ditched. Got a smaller elastic knee wrap with a criss cross strapping and it helped immensely.

[SeatownSlackey]

I’m one of the lucky ones I guess. R acl torn opening day ‘09 season. Was able to ski full season no brace but did have some occasional pain and minor instability thus had surgery late spring to avoid additional damage.

Tore my left acl 3 yrs ago. This time just a bit of initial swelling and ache but flew down to az that night and golfed 36 holes. Probably wouldn’t have had I known it was fully torn. When I went in to see ortho he didn’t think it was gone based on the manipulation tests but MRI showed it completely torn but no meniscus damage.

Rehab was a big chore for my repaired right knee (hammy auto) that required scoping debridement two years later for scar tissue build up. So since my L knee feels 99% I opted for wait n see approach.

I think it’s all based on luck of anatomy. Some small minority of people like me still have stability sans acl but most do not.

Been skiing hard for three years on it and, knock on wood, haven’t noticed at all. Repaired knee has been barking and creaking a lot more of late. Prob could use another scope and clean out


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[Djongo Unchained]

^^^
Which reminds me, I had a bucket handle tear of the meniscus and a partial Mcl tear. Those were complications adding to the equation...

[Duffman]

How active one can be in the subacute post injury phase definitely seems to be related to other damage in the knee joint ,not just the ACL. Wife is now 3-4 weeks out from injury and almost can't tell it happened, but the Ortho did note significant laxity on exam , so surgery is almost certainly in the near future. She skiied today for the first time post injury braced on the local bump with the kids so easy terrain and not going hard, but it was nearly 50 degrees and somewhat variable and gloppy , and she had no issues. The big concern is the risk of further injury without the stability from the intact ACL. She's starting Prehab PT Monday, so we will see how that goes and will be again skiing carefully with the kiddos in VT next weekend.

But her ROM has been 100% 1 week post injury and no significant pain also , so YMMV.

Our well regarded Ortho still thinks that for the level of skiing she wants to continue doing, she won't be happy without fixing the ACL, so that's probably where this is heading

[yeahman]

Maybe it depends on how the injury happens? I landed on the icy flat from 10-12 feet in the air, super hard SLAP and SNAP, and there was no coming back from that injury without the repair, I am 100% convinced. But I do know people who have skied with a supposedly torn acl for years. Even with all the high tech imaging it still seemed to me that they weren't certain about the extent of the damage until they got in there and had a look.