ACL&MCL, dammit

[Chica]

Day one of five,at Canyons, knee deep in light Utah powder and "POP". In what is looking to be an epic snow year, I am bummed. I am scheduled for surgery the 13th, and physical therapy pre-op, while they find me some "nice tissue". Any experienced advice?

[divegirl]

Bummer, Chica!

Hope you feel better soon!

I don't have advice, but I hear the patellar route works for most maggots - versus a cadaver.

[fez]

that sucks Chica, welcome to the rapidly expanding club i guess.

[Huckwheat]

I am going to have to counter Divegirl.

I am personally a big cadavear (Allograft) fan. I just had my ACL done in Apr, and I would definately stand by the cadavear decision.

There is lots written on this, and every doc will tend to tell you the one they are most comfortable with. I talked to lots of people (include pro skiers from Squaw) and I think the tide is turning and people are switching to Allograft.

[Tyrone Shoelaces]

I am going to have to counter Divegirl.

I'm countering all of you..... I had the hammy graft and I'm pretty much rockin out over here.

But if I had to do it again...I'd probably go cadaver.

Just listen to your doc and together decide what's best for you (and him).

[Vinman]

Cadaver may be less painful but over time the autograft is still the gold standard for ACl reconstruction. An autograft will regain blood supply and remain as living tissue that can heal from minor injury and remodel itself over time. Allograft can do neither of those things.

[truth]

Chica, so so lame! You'll bounce back in no time. I too would vote against the allograft.

Things I'd make sure I had post op:

1. Iceman (not Joe) or similar cold therapy machine
2. CPM machine for the 1st 2 weeks post op
3. An indoor bicycle set up
4. A shower with a hand shower
5. A SEAL-TIGHT cast cover
6. Moocho dvd's / books
7. wireless internet and a laptop
8. scantily clad servants (m/f is up to you)

[Chica]

Thanks everyone

Truth, thanks for the list.

[Chica]

I love your way of looking at it, looking at PT as my sport for the season.

I've had an epidural, I'll pass this time. I had such a bad reaction. I was so itchy, I thought I was going to lose my mind. Thanks for all of the good pointers.

Aside from listening to Doc/PT, and the rest of the technical stuff, my own thoughts are ask for an epidural as opposed to general anesthesia. The general wears off much more quickly and many docs push for this, but there is some indication of lingering CNS effects in some instances, and given my limited capacity to begin with I wanted to avoid any further impairment.

If you do get a spinal, bring some books to read while it wears off and try to arrange with the nurses to get them brought over to you while in the recovery room.

I also personally felt like I was freezing to death in the OR the first time, but didn't take the obvious step of asking for a blanket until someone offered one. Feel free to ask.

The sodium pentothal drip can effect how much recall you have of the op. Talk to them before hand about your recall preferences, also let them know if you feel anxious or are already calm.

Clearly understand with your doc and PT how they want you to walk at first with the brace and crutches. I was both impatient in terms of pace and frankly, somewhat afraid as well to weight the post-op leg, so resorted to walking with one leg & crutches often. I then had to work not to develop a distorted gait, it would have been easier if I had just listened the first time.

Talk to your doc/search here re: cadaver, hamstring, and patellar graft options.

Finally, PT can be kind of fun. Lots of neat wobble boards & stuff over time, weekly goals. PTs are generally pretty fun people, too. Do make sure to select a PT who has sports rehab as at least one primary focus. If you view PT as one version of a sports "season," it's not so bad.

Good luck!

[rideit]

Just read your ACL/Canyons/Pissed off patroller TR....bummer.
Hang in there, I blew out my ACL, PCL, and MCL in one shot a few years ago. That knee is actually probably stronger now than the 'Good' one! (Hamstring, FWIW)
Treat PR like having a totally committed personal trainer...it is a luxury to many people!

[here2day]

Sigh... a dubious welcome to the club. If there is any good news it's by the time next season rolls around you should be ready.

The list Truth posted is good. To it I'd add the pain pump your Doc may offer (if you can stomach narcotics). It should keep you pain free for about 48 hours after surgery; pretty good buzz too.

My OS said if you're in your 20's choose the Patellar graft, in your 30's it's a toss up, over 40 go with the allograft.

Vin, I was told an allograft would "re-vascularize".

[altagirl]

I can't even fathom having an epidural - knock me out, thanks!! One of the guys in my office just had a knee replacement with an epidural and said he would never have gone that route if he knew what it was like beforehand. I just need to request anti-nausea drugs and I wake up from general anesthesia feeling fantastic.

And regarding grafts - I went with a hamstring graft on my left knee, but an allograft (cadaver graft) on my most recent one on my right knee. MUCH much easier recovery, and it seems to be holding up well. The other day I forgot which knee I had surgery on last. That's a good thing for sure! Anyway, my doc recommended against a patellar graft because I'd already done some damage to the back of my patella. I know a lot of women (especially your size) don't have a wide enough patellar tendon for a good result. With a cadaver graft, they can order one just the right size for you based on your x-rays.


To Truth's list, I'd add:

1. a cooler next to you filled with ice, food and drinks so you don't have to get up.
2. a bag to carry food and drinks from the kitchen to the sofa while on crutches.
3. clear a nice wide crutchable path from the couch to the bathroom.
4. collect a list of phone numbers for good food you can order in.
5. protein powder and frozen fruit for smoothies - so you can get a good amount of protein in your diet when you're not in the mood to really eat much, but your muscles need the nutrition.


Personally, I've never used a CPM machine - my docs thought they were unnecessary unless you had something more major, like a full knee replacement. But I know some people use and like them. I'd go with whatever your doc recommends on that.

[LaramieSkiBum]

if you are in slc / pc I can hook you up with my old knee cooler - it's slick and a must. circulates cold water around your knee, kicks so much ass. They will likely send you home with one, but if you think you can save a few bucks, let me know.

welcome to the club (hammy and ski harder than ever) Try and get to rehab ASAP, things atrophy so fast it's unbeliveable. It was only a matter of days before my calves and quads were skin and bone.

[Vinman]

Vin, I was told an allograft would "re-vascularize".

Not that I know of.

1. it is dead to begin with (hence the cadaver)
2. it then gets irradiated (i think could be worng on this part) to kill any potential biohazardous stuff

So revascualrization of an allograft is not very likely.

[Chica]

Not that I know of.

1. it is dead to begin with (hence the cadaver)
2. it then gets irradiated (i think could be worng on this part) to kill any potential biohazardous stuff

So revascualrization of an allograft is not very likely.

I just finished my first PT and she said that the cadaver tissue will revascularise in about a year. Starting at about 6-8 wks your own cappillaries start fusing with the tissue and literally grow through it, eventually it becomes just like your own tissue. Pretty fn' amazing.

[Chica]

Laramieskibum- Thanks for the offer, I'm in L.A.

Altagirl- Thanks for all the great tips, I know that you are a pro at this.

[Vinman]

cadaver tissue will revascularise in about a year.

I stand corrected on this. I did some research as well and in fact it does revascularize. I did not know this.

This article abstract highlights some of the key points with allograft

http://ajs.sagepub.com/cgi/content/abstract/14/5/348

graft selection abstract
http://www.jaaos.org/cgi/content/abstract/13/3/197

[dbldmnd]

Good luck with the repair. I had the hammy done last may and I've been back at it for 6 weeks, no brace, no support, no nothing. I'm pushing harder every week and it is holding together. Don't slack on the Pt/recovery, it makes all the difference.

And discuss blood clots with your doc. Statistically they do happen and suck. I got a pulmenary embolism from my surgery and lived to tell about it.
Know the warning signs and seek immediate help if they appear.

[caddah]

My situation is a little different. total knee dislocation, blown out viens and arteries and other complications. all of the recommendations for PT and setting yourself up to heal are definately true. As for allograft vs autograft....For me just becuase of the amount of grafts i will need(blew out atleast three ligaments), my doc thinks allograft just becuase of the material needed. So for multi ligament tears, i would say allograft is the way to go. for a single tear an autograft may be worth the extra rehab.

good luck with everything

[yogachik]

Thanks for those lists, truth and ag -- I will personally make sure that she is well-stocked in movies, ski porn, yummy food and drinks.

[here2day]

chica, i'm in LA (PV), had surgery last May. used south bay sports medicine for PT and south bay ortho for the op. don't know where in this megaopolis you are but it sounds like you're setup with a doc and PT. if not and you have questions about surgeons or PT let me know.

was at mammoth last weekend but still not strong enough to ski (I blame it on age and high stress job). i lived vicariously through my kids and spent time riding flat out on a polaris sled. that felt great.

good luck with your recovery and add a new road bike to your list.

[LaramieSkiBum]

good call on blood clots, my friends mother died shortly after her ACL repair, settled in her brain

[WestCoastPDR]

Im joining the tread a lil late. but jan 5th the castle opened after 3 weeks of being closed. baiscally i hucked the 1st cliff i could find and then pop. acl and mcl. Stand and try to ski down and then tear the lcl. surgery is feb 9th
Docs at Duke University sports medicine are doing the job. Mom is a doc out there in ER. Id say that they are in the top ten docs in the world to do the surgery. Ill send you my pt schedule from my doc there. Pretty rigourus. Same program carson peterson is going to be on! Thats pretty much what happend to me.

Also Anesthesia is the best 2 minute high you will ever have. If it where on the street it would cost 10x more than pot or your next favorite recreational drug of choice

Good luck to all with their injuries.

"drop cliffs not bombs"

Jay Peak Resort
355" natural snowfall
The most natural snow in the East
Vermonts only Tram

[Chica]

Bad idea the whole ski down part.

Thanks Eastcoast, would love to see the schedule.

[yogachik]

Bump to wish Chica all the best on her surgery on Monday...