Torn ACL

[Guest thefishinmagician]

Got the news from the Doc yesterday - my ACL is torn and will need reconstruction from a bad plant/twist injury during a soccer game 2 weeks ago. And I was hoping to get in a good season of boarding this year... oh well. I'm hoping to have the reconstruction done early next year. Have any of you had this procedure done before? How long before you were back on the slopes?

Post your trip reports and pictures here... I'll be carving vicariously through you.

~Adam~

[lonerider]

Was your ACL completely torn? I sprained/partially tore my ACL 2 months ago playing ice hockey. The first doctor I saw was Arati Dunbar (www.docdunbar.com) and she wanted to do surgery after an initial 30 second examination of my leg, I asked for an MRI and she still recommended it after looking at the MRI.

I was pretty much in acceptance of my diagnosis, but I went for a second opinion just because they always tell you to do that. Plus I didn't really search around much before finding the first doctor. The second surgeon I went to was Gary Fanton (team surgeon for the SF Giants and Stanford college teams and consultant to the 49ers http://www.orthoconnect.com/gfanton.html) said he didn't believe that I needed surgery and was rather surprised that the first doctor was so adamant about it. It is probably due to a difference in treatment philosophy (aggressive vs conservative) but I ended up going to Dr.Fanton's suggestion of physical therapy over surgery. I figure surgeons love to perform surgery, and that a if a well respect surgeon (used by professional athletes) doesn't think I need surgery, then I probably don't need surgery.

So after 5 weeks of physical therapy I'm going to start my season this week with clearance from my physical therapist. I'm hopeful that I should be able to have a full season (albeit taking it easy the first few months).

I too would like to here about other people with similar injuries and what their decisions were. Am I correct in believing that snowboarding isn't particularly stressful on the ACL? I will be wearing a brace regardless.

[Rob-CanCarve]

Thefishinmagician:

Is your ACL partially or completely torn? I completely tore mine about 13 years ago and had an artificial replacement (polyprop/kevlar) installed.

I best suggestion is to really spend some time researching the surgeon and his method of replacement. I would recommend finding a surgeon that works with elite athletes - usually employ techniques that a more effective and have short recovery periods.

Do NOT accept the first surgeon you meet - shop around - if he/she screws up it will follow you for life.

On a positive note, 2-3 weeks post surgury I was ridding a road bike gently and I have had no problems with my knee since the surgury was completed.

Hope this helps,

Rob

[Guest thefishinmagician]

The doc thought it was completely torn from looking at the MRI, and once the MRI office faxed over their report from their reviewers, it said the same.

According to the doc, the MRI was not taken at an optimal angle - the PCL showed up very clear, so the MRI slices were aligned with that rather than the ACL. Still, he said the ACL should show up in the picture(s). He pointed to where it should be and where it should connect to the fibula, and there appeared to be no ligament fibers there in any of the images. It appeared that there were some loose, disorganized fibers at the end toward where it should connect to the femur. The doc/MRI reviewer though it was a complete tear.

Even at the wrong angle, it seems to me that the ACL should have at least shown up in sections in consecutive slices of the MRI if it were still connected/partially connected. But the Doc agreed, it wasn't a great MRI. I think I should probably get another, hopefully better MRI before going under the knife. If I tell the MRI Technician to look specifically at the ACL, I'd think they should be able to align everything better.

Still, the symptoms seem to point to a torn ACL - loud pop hear by my friends when I twisted it, plus I felt my knee twist/pop well out of place. Now, 2+ weeks later, I can walk on the leg tenderly, but it feels unstable if I straighten or bend my leg too much with weight on it. Any type of twisting motion hurts and feels very unstable too.

Fortunately, the MRI showed no damage anywhere to the meniscus. No grinding/sticking of my knee has suggested the same.

The doc I found specializes in sports related injuries and seems to be very good. A second opinion is never a bad thing though.

~Adam~

[Brian]

Adam

I have some info concerning your torn ACL. You can email me and I would be happy to make a suggestion for another opinion and doctor in San Diego. aloha

Brian

[Guest thefishinmagician]

Yo Brian. Would love to hear what you have to say. Please e-mail me with some contact info. You seem to have the PM and E-mail features disabled in your options on this board.

Thanks,

~Adam~

[Brian]

Adam

Not sure if the BOL email notification is correct, but you can contact me at balbert747@hotmail.com. aloha

Brian

[Jonny]

Sorry to hear about your injury, but don't be downhearted, you'll be riding before you know it.

I tore my ACL windsurfing in 1993, and the second guy i saw (Bert Zarins at MGH) thought that with a really good carbon-fiber brace i could do most anything i wanted to. he did say that eventually the joint would become too loose, and that then surgery was the way to go, but that surgical techniques were steadily improving, so that by the time i really needed the surgery it would be a better procedure.

I rode, windurfed, skiied, everything, for about 5 years, and then had reconstructive surgery, replacing the ACL with a hamstring. Rehab was damned uncomfortable, but I was on stage (I'm an actor) within 6 weeks and out sailing in about two months. The knee is now fully recovered.

Go with a surgeon who deals with athletes, and make sure you're comfortable with the diagnosis. Good luck

[lonerider]

Ah... ok, yea... the popping sound is the ACL rupturing. My MRI showed a "severe grade" tear , although the ACL was partially obscured like yours should they couldn't tell for sure. However they were pretty sure I didn't completely tear it because my knee was not very loose.

I didn't feel a pop, just that my knee hurt very slightly. There wasn't any swelling and I could function pretty much normally, or so I thought. I played 4 more hockey games over two weeks and finally went to the doctor to take a look at it because it felt "weak."

[Bobby Buggs]

I have been through 4 scopes of my left knee as a result of a partial ACL tear. Right now you dont know what is wrong so if you can get another MRI then do it. It still may be inconclusive.

Discuss with the Doc about a scope and if it is torn to replace it with a hamstring graft, Not a patella tendon graft.

Also during the scope they may find your ACL is attached enough to heal itself. ACL has good blood supply and can heal. Did your knee get really swollen after the injury?? Most of the time that is idicative of ACL or a Rim tear of miniscus.

Your feeling of instablity when fully extended and deeply bent is because you still have fluid or blood in the joint and it feel strange and binds during those movements.

Let us knnow what happens and how it works out for you.

One thing to remember, Most people have crankey knees as a result of Miniscus damage from joint instability. If your ACL is bad and you keep popping out your going to do more long term damage and pay when you are older like me. So get it fixed RIGHT while you are young and enjoy your future.

DR Buggs

[sic t 2]

Hope its not your front binding leg since getting off the lift always puts incredible stresses on it. And there is always the moment when the board sticks on the ramp and launches you over the nose (while your ankle is basically immobilized by a stiff hardshell racing boot). That is the defining moment of ACL "hyperextension" stress. Ask me about the green astro turf that Hunter Mountain allows to stick through every year on their main unload ramp. Under those conditions one healthy ACL isn't even enough. When you are boarding with a weak one I am terrified when I have to unload on a bad ramp.

And soft boots tend to put pressure on an injured lead leg if you do a jump and land on something that sticks your board. Like a hole or just bad ground. That force wants to displace the knee sideways back towards your rear binding. Again, the front leg is a problem.

So I hope its your rear leg. It will make all the difference. Obviously, mine was my front leg, lol. Point being that if its your rear leg you may be able to still board with a weak and/or healing knee forever. If its the front one then the stresses placed on it will be great.

And braces do next to nothing except prevent another gross hyperextension of the knee and give you false confidence everywhere else. As for rotation injuries and side displacements I found it completely useless. So don't have any high hopes for the brace. Yes, mine was a custom fitted, high end brace.

Just some observations from another ACL survivor. Hope it helps you decide what course of action to take now when you analyze the ortho's opinions. They don't understand the sport and "which leg" you injured and why that's so important to us.

sic

[Bobby Buggs]

I must agree on the brace. I had side exits while wearing the brace and yes Its my front leg also.

How can you hope to stop bone from moving when you are attaching to the outside soft tissue.

If anything the brace is a comfort thing. I love when I see the NY'ers at Strstton wearing them OVER their pants, Yeah on the outside of the pant, like thats gonna do you alotta good:eek:

[lonerider]

So I hope its your rear leg. It will make all the difference. Obviously, mine was my front leg, lol. Point being that if its your rear leg you may be able to still board with a weak and/or healing knee forever. If its the front one then the stresses placed on it will be great.

Yep it's my rear leg (so I was worried about tweaking it while driving my hips through a carve, does that happen?) Yea, I didn't think the brace would help with twisting motions that much although it looks like it gives my knee some lateral support which might help keep my knee from slipping out side to side (although I've yet to experience much if any "looseness"). Many doctors don't seem to think the brace helps that much.

Ok, so no switch landings (backside 180s) for a while. Has anyone else here suffered a partial tear to their rear leg? I'm wondering how long my ACL will take to heal... 6 months? 9 months? A year? Never?

[ncermak]

I completely tore my rear leg ACL in 2000. Rode '01 with a brace (CTI2) then rode brace free for '02. I had My surgery done (Dr. Moran, Concord Orthopedics, Concord NH; He did several USST bump skiers knees) about 3 month after the injury and missed the best season NH had had in ages while in rehab (after which I needed a different type of rehab - it sucks spending a whole winter in the bar while everyone comes in covered in powder, grinning from ear to ear).

anyway, I went with a Patellar Tendon Graft, due to chronically tight hamstrings, and the knee is now rock solid. I did get my 2nd opinion though, and he concurred immediately. Rehab Sucks, but you should definitely run the entire course of treatment and continue strgthening after.

No problem with the rear leg powering through turns, or anything like that.

Good luck!

[sic t 2]

any ortho surgeon should be able to grab your leg, manipulate it for a moment, and immediately conclude the degree of damage your ACL has (or doesn't have).

If your knee is not "loose" then you really don't have any ACL problems regardless what anybody says. My only caveat here is that its so soon after your injury that tissue swelling alone may be distorting everything.

If you choose to let it heal (as I did -- and if that is possible for you, damage minimal enough) I would recommend this:

#1. Whatever you do allow that thing to heal properly. Exercise/therapy will not do it any good right now and will only cause damage to it. Liken it to exercising a broken bone. It makes no sense right now. I was casted for 6 weeks. Then a surgical brace (not a sports brace) for another few months.

#2. After you are released from the doctor's care the best thing you can do for you weak knee is to lift weights with it often in the gym. As long as your voluntary muscles are always "sore and tight" they will act as ACL "helpers" and will help hold your knee together further protecting the healing ACL. But this means never letting them relax. You have to be in the gym every 2 days. Its not the amount of muscle but their constant state of soreness and tension that holds the knee together. Some of my worse displacements afterward were watching TV. Put you leg up on a pillow and relax all voluntary muscles and BANG out it slips. Yet you can board all day and not have a problem yet in a very calm moment you injure your ACL. So keep the hamstrings and quads always in a state of recovering from a hard gym workout and they will help protect it even when you are not consciously activating those muscles.

#3. My knee doesn't displace anymore at any time. I would say it took about 5 years for that to happen. But it does feel weak and I try never to forget I only have a partial ACL. So I always sit on the right side of the chair at Hunter Mountain and miss the astro turf and the ramp. That and I try not to endo my motorcycle anymore (which is what did it).

http://www.acemotocross.com/closeparty_2003/Pb010031.jpg

I hope it all turns out well. From the sounds of things you have a non-surgical chance here. And its your rear binding foot. So at least lady luck is on your side.

sic t 2 (#62)

[Bobby Buggs]

That was some great advise. Im no expert but I agree with a bunch of what was just stated. If you are not going the surgical rout, Rest right now for a good 6 weeks then start training but try not to go far beyond 90 degree squats. I use the Bike and you can as soon as you have no pain, just keep the seat high when you first start, and as long as you have no pain when you are riding get that puppy up to 30 minutes a day.

Ice 20 mins on 20 mins off is the best thing.

[ncermak]

And another thing -

In terms of strengthening, Leg extensions (i.e being in a seated position, and exending the leg to straight in front of you) Put the ACL at a disadvantage. better to do leg press, or squats (but not too deep)

-NBC

[Guest Randy S.]

I've partially torn both my ACLs. First one in 1986, second in 1987. I continue to have problems because I have very little cartilage left. Its a bummer. I have learned something over the years about braces. I've tried 3-4 different ones. By far the best one I've found is made in So Cal not too far from you (in Irvine, I think). Company is called Innovation Sports and the brace is a CTI2. Isports.com They also make a special ACL strap that keeps your lower leg from shifting forward and causing more problems. Get the custom fit one with a prescription from your doctor.

BTW, I've used the same doctor as lonerider. (Fanton). He's awesome. If you are in the Bay Area, I'd strongly recommend seeing him. He's not always inclined to cut you open as the first course of action, which is a pleasant surprise from a surgeon. Plus the clinic has a bunch of other specialists you can see for stuff like Osteo Arthritis, Shoulders, wrists, etc.

[Guest thefishinmagician]

It is my rear leg.

For those that asked, the knee was very swollen from 2 days after to about 1.5 weeks after the injury. Since then the swelling has been going down slowly.

The doc was unable to do the twist test (Lachman test, I believe it's called) because I was still very swollen and too sore for me to be able to relax the leg for him. He tried with the other leg to see if I could relax that one enough to let him perform the test and that knee did exactly what it's supposed to. I'll be setting up another appointment with him once the swelling goes down and I'm sure he'll try the test again at that time. According to statistics I found on the web, that test is just about as reliable as an MRI in predicting a torn ACL (around 80-85%). Just from walking on it and moving my leg around in general, my right knee feels much looser than my left. Basically, it doesn't feel like it has the proper resistance against any type of torque to my lower leg. Not a good feeling.

Even if I can ride without the reconstructive surgery, that's not all that's important to me. I love backpacking, soccer (how I injured it), rock climbing/bouldering, and other sports where I'd need both knees to be reliable. So surgery would be my preferred option if the ligament will not recover fully.

Bobby, Why do you suggest a hamstring graft over the patella tendon graft?

Jonny, Why did you choose the hamstring graft?

The patella tendon graft is supposedly stronger and creates a more reliable knee joint. I understand that there can be some tenderness and bruising after exercises requiring flexion of the knee beyond 90 deg. for quite some time after the surgery with a patella graft, but that doesn't sound like a significant problem.

Thanks for all of your replies... good info.

~Adam~

[lonerider]

I'm the guy with the more minor ACL partial-tear.

After you are released from the doctor's care the best thing you can do for you weak knee is to lift weights with it often in the gym. As long as your voluntary muscles are always "sore and tight" they will act as ACL "helpers" and will help hold your knee together further protecting the healing ACL. But this means never letting them relax. You have to be in the gym every 2 days. Its not the amount of muscle but their constant state of soreness and tension that holds the knee together. Some of my worse displacements afterward were watching TV. Put you leg up on a pillow and relax all voluntary muscles and BANG out it slips. Yet you can board all day and not have a problem yet in a very calm moment you injure your ACL. So keep the hamstrings and quads always in a state of recovering from a hard gym workout and they will help protect it even when you are not consciously activating those muscles

Huh, interesting... I would not have thought of it that way (about beign continualy sore and tight). I have chronically tight hamstrings and the physical therapists has had me strengthening and streching my hamstring. I have been working out legs pretty much since 3 weeks post-injury. It is now 9.5 weeks since my injury (4.5 weeks of PT) and I'm probably going to go snowboarding for a day this weekend. My PT cleared me to go so long as I take it easy and stop if my knee start bothering me (i.e. use common sense).

Cal not too far from you (in Irvine, I think). Company is called Innovation Sports and the brace is a CTI2. Isports.com They also make a special ACL strap that keeps your lower leg from shifting forward and causing more problems. Get the custom fit one with a prescription from your doctor.

How much is that brace? My doctor already gave me a DonJoy lycra brace with velcro straps ($130). Here is a link to what it looks like http://www.donjoy.com/products/DonJoy/physdistrep/detail.asp?id=29 Should I go to him again and ask for a prescription for the ISports brace?

[Jonny]

The patellar tendon graft has a somewhat higher risk of morbidity, apparently, and also introduces the risk of failure of what remains of the P-tendon, which is a very nasty injury - it comes up quite often in the NFL with players who had that form of reconstruction. The big problem with the hamstring graft is that you're stuck rehabbing both sides of the leg, but that's over in a couple of months.

I reinforce what Noah said about presses - in fact it's probably safest to do only closed-chain exercises (leg-press is OK, leg raise is not). My favorite rehab tool was the ski exerciser callet the Pro Fitter.

It sound to me like you're going to want to get this fixed. You do too much stuff which stresses the knee - pick your least favorite 10 weeks for sports and do it then. The CTI brace is what I used betwen injury and operation and it's excellent.

[Bobby Buggs]

Patella graft causes alot of trama to the knee that is unnecessary. Back in the 90 when that was the first choice people had more rehab issues as a result of the harvest of the graft and the trama from the harvest.

I dont know if that has changed in recent years but if you understand what happens to get that graft it seems like its alot of trama to a already troubled area.

I am not up on the latest tecniques so please let me know what is being done. I can only speak from what I have seen in the past.

[Guest Randy S.]

Originally posted by lonerider

How much is that brace? My doctor already gave me a DonJoy lycra brace with velcro straps ($130). Here is a link to what it looks like http://www.donjoy.com/products/DonJoy/physdistrep/detail.asp?id=29 Should I go to him again and ask for a prescription for the ISports brace?

Lonerider: I don't know how much they cost these days. They are very expensive, but insurance usually covers them as Durable Medical Equipment. The Donjoy is crap in my opinion. Fine for lower impact, lower twisting sports, but the CTI offers real protection.

[Brian]

Adam

I might suggest a second opinion from an orthopedic surgeon in San Deigo, he is one of the team doctors for the Chargers. I had my ACL reconstucted two years ago and the knee is strong and healthy. Here is my email balbert747@hotmail.com the BOL PM/email features are not working. aloha

Brian

[Rob-CanCarve]

Here is my $2 cents!!

My surgeon used a slightly different approach - utilized a artifical ligament (polyprop and kevlar) in combination with a patellar graft. This produced a strong and solid ligament (artifical) encapsulated by a small part of my actual pateller tendon.

This resulted in minor complications from removing the patella tendon, but provided a strong base from the artificial.

End result - strong and stable knee from day 1 that gave the living tendon time to heal and gain strength. Because there was not long-term studies on this at the time, my surgeon believed that if the artifical tendon began to fail, you had the living tendon wrapped around it to take over.

Hope this helps,

Dr. Rob