Knee injury, diagnosis, and goals for next year

[Bruno Schull]

Hey folks,

Early in the week I started a thread entitled "Cosmic irony" about the horrible (yet ironic) fact that both my wife and I injured our knees in the same season.

https://www.pugski.com/threads/cosmic-irony.9457/

To those who responded, thanks for the words of encouragement.

I have since had an X-ray, a MRI, and been examined by two orthopedic doctors.

-I partially but not completely tore my ACL
-I sprained my MCL
-I strained my gastocnemius
-I did not damage my meniscus

Most importantly, the doctors don't think I need surgery. I have been advised to gently start exercising, and see how it feels. If it remains stable (as it seems like it will) I will not need surgery. If I feels inherently unstable (still possible) I will need to have surgery.

So that's that.

This actually places me in a gray area--to have surgery or not? Can a partial ACL still provide sufficient support? Can a partial ACL ever heal? Two doctors have advised me that surgery is not the best option now, so I'm clear on that, but I do wonder if I am putting my kee at more risk by trying to recover my prior level ability with a damaged ACL.

I have set myself two goals for next ski season:

1) Come into the season with stronger legs muscles than ever before
2) Get regular professional instruction at least 2-3 times during the season (for example, beginning, middle, end) to improve my skills and reduce my chance of falling.

I live in Switzerland, and it's actually harder than you might think to find good ski technique teachers. Most of the instructors at the popular resort areas subscribe to the "Follow me and do what I do," school of thought. As a very experienced ski guide I spoke to said, "To give you appropriate feedback, a teacher actually need to watch you." So the search begins. I will post on the ski school thread for ideas/suggestions about finding a teacher in Europe.

OK, all the best,

Bruno

 

[Pequenita]

This actually places me in a gray area--to have surgery or not? Can a partial ACL still provide sufficient support? Can a partial ACL ever heal? Two doctors have advised me that surgery is not the best option now, so I'm clear on that, but I do wonder if I am putting my kee at more risk by trying to recover my prior level ability with a damaged ACL.

I think a lot depends on your age and why the two physicians advised you against surgery. I partially tore my ACL, sprained my MCL, and tore my meniscus skiing when I was 15. I did not repair the ACL but they stitched up the MCL and trimmed the meniscus. I wore a brace for a couple of years when doing active things before ultimately not using a brace for 12 years, at which point I completely tore the ACL while playing soccer. I believe it is possible for a partial ACL to be conditioned to handle the load of a full ACL, particularly if the muscles surrounding the knee are strengthened and maintained. But, I also credit my ability to be super active for 12 years with a partially torn ACL to being pretty young at the time.

 

[eok]

The Medical Express website is a great resource that pulls together medical articles/papers & makes 'em easy to search. Most of the articles are more like a synopsis, but links are usually included so you can drill down into the source material.

So, here's a bunch of articles related to current thinking/developments on ACL rupture treatments and ACL healing:

https://medicalxpress.com/search/?search=acl+heal

 

[Bruno Schull]

Thanks for the replies--@ Pequenita, I'm 45, so my chances of healing are probably somewhat lower than if I was 15! But I can get strong. @ eok thanks for the link--that's a great resource.

 

[Wade]

Hey Bruno. I’m sorry to hear about your injury.

It’s 5 years since my tibial plateau fracture / complete MCL tear / partial ACL tear skiing injury, I also had no meniscus damage. I got lucky in that the fracture didn’t displace, so the recovery from the fracture wasn’t complicated. My doctor also recommended no surgery - the advice I received from the doctors I saw was that the MCL was the only ligament that could heal itself due to the amount of blood flow to that area (I guess it scars up and attaches itself back together as well as to other nearby parts of the knee) and the ACL was in tact enough to still be somewhat functional. I was 42 at the time of the injury.

I had a a long hard 7 months of 3 or 4 times a week physical therapy, on top of the exercises they gave me to do, and progressed to a more normal strength training leg workout after that process was complete. I worked my ass off the entire time.

I had my first day back skiing 10 months after the injury, although it was probably 2 years before both of my legs felt pretty much the same again.

After getting through all of the range of motion, strength and stability stuff so that my injured leg was fully functional again, the biggest challenge for me was getting the muscle mass back where my leg had basically atrophied in the few months after the injury. By the 2 year point, my legs functioned similarly and both felt strong, but I could still see a difference in muscle mass. By year 3, it was tough to tell any difference in size. At year 5, I struggle sometimes to remember which leg was injured.

I was in good shape before the accident. I lifted 4 times per week and ran 2 or 3 times per week. I worked as hard as I possibly could during my recovery. I was definitely ready to ski safely and effectively the next season, but for me, my legs being stronger than they had ever been by the start of the next ski season would not have been a realistic goal.

I don’t say that to discourage you from your own goal. I think having your legs be stronger than ever before is an excellent thing to aim for, and people are different, so perhaps it is perfectly achievable for you. Rather, I say it to let you know that if you work hard to achieve your goal, and you make great strides towards it, but don’t quite get there, you’re not alone and you shouldn’t necessarily view it as a failure.


Good luck with your recovery and please feel free to hit me up if you have any questions on the recovery process.

 

[PTskier]

Here's some good information:
https://orthoinfo.aaos.org/en/treatment/acl-injury-does-it-require-surgery/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519562/

My suggestion is to find a very good physical therapist who evaluates more than just your knee. If they evaluate your foot, ankle, knee, hip, and gait, they may find something else to address that will help the knee rehabilitation.

I once had an orthopedic surgeon, looking at my images, who said, "there's nothing we can't make worse through surgery."

 

[Bruno Schull]

To Wade and PTskier--that's great advice--thanks. I love the quote from the surgeon.

From what I read, it seems like doctors might be moving somewhat away from "Is the ACL partially/fully torn?" to "Is the knee stable or unstable?"

Based on how my knee feels right now, I think it will be stable, especially with more strength work. But I guess I'll just have to see how it feels as the pain and swelling continue to subside, and I return (gently) to some more activity.

Thanks again.

Bruno

 

[mdf]

From what I read, it seems like doctors might be moving somewhat away from "Is the ACL partially/fully torn?" to "Is the knee stable or unstable?"

Valid, but make sure the doctor assesses it in the context of skiing. If you are older, the standard expectation is that you are going to be walking the dog, maybe playing a few rounds of golf (with a cart) and MAYBE skiing a few easy groomed runs. Another doctor in my orthopods' office questoned why he was fixing a knee on an old guy like me (55 at the time).

 

[VickieH]

From what I read, it seems like doctors might be moving somewhat away from "Is the ACL partially/fully torn?" to "Is the knee stable or unstable?"

That was my doctor's approach. MRI showed that the ACL was damaged. After the bone healed (proximal tibia fracture), he manually tested both legs. He was very surprised that he could not detect any laxness in the affected side.

He prescribed a hard Donjoy brace for skiing - and only for skiing - in order to support and preserve the remaining ACL.