Yet another ACL question

There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal

Sylvain.Fauvel wrote:
There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal


I am one of those who ruptured his ACL, while at the same time ripping
tendons & cartilage and tearing some bone from under the patella, all
in one memorable/loud event but I had surgery. The injury occurred in
a basketball game when I did a pivot move near the hoop without knowing
that the defender accidentally had his foot on my pivot foot. My upper
body moved 180 degrees or more without my foot moving.

Without any details of your case and I am definitely not a doctor, I
would recommend surgery if that is an option. One concern that I have
is the definition of 'ok' by some doctors especially if it is in
reference to the average person. Make sure you go to a sports related
orthopedist that specializes in injuries to active people.

My knees fear the type of falls which might occur on a narrow and curvy
trail while carrying a heavy pack more than any of my much higher speed
falls on groomed trails while skiing at speed or in a race.

John

I ruptured an ACL at 15 playing baseball, back when ACLs were thought to be vestigial. I didn't find out about it until arthroscopy 33 years later, following overdoing a race walk at a charity event. Over the years, I'd get swelling when first starting up a period of exercise, then it would be ok. The problem is that cartilege depends on the ACL for support, so that's a risk. Pushing off the side of a swimming pool did it for me three months after the initial injury. You can ski w/o an ACL, but having a stable knee is important, especially with a heavy pack and on downhills, and the lack of an ACL makes descents and twisting movementd more difficult and costly, in terms of swelling. The doctor may be thinking this is going to repair itself sufficiently over time, or he's taking a 'very conservative' approach, outside the mainstream. I'd get a second opinion.

Gene

"Sylvain.Fauvel" wrote:

There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal

I XC-skied for 20 years on a torn ACL when I lived in Winnipeg. I had
to give up sports like badminton, tennis, and basketball (i.e., those
that involve twisting on a planted foot) but otherwise I was able to
function normally (although the knee was prone to swelling up now and
then). However, in 1997 I retired and moved to Canmore, Alberta (in
the Canadian Rockies) and that knee started to be a huge problem --
climbing big limestone peaks and telemark skiing put a lot of stress on
the joint, which, lacking an ACL, was stabilized only by muscle. I felt
like I was walking on a time bomb -- without warning the knee would
swell up and be very painful, putting me out of action for a weeks at a
time. Then one day as I was preparing to hike down from the base of an
ice climb the knee failed completely -- with my feet anchored in the
snow by crampons I casually tossed my pack (~30 lb) up onto my
shoulders, in the process putting a torque on my bad knee; an
excruciating pain shot through the knee and I collapsed in a heap.
Several months later I had ACL surgery (and to trim the meniscus that
was torn when the knee failed in that final incident). After 4 months
of rehab (plus a lot of swimming, to maintain my aerobic fitness) I was
allowed to start classic skiing -- no skating or telemark skiing that
winter -- and 6 months after the operation I skied the 42 km Cookie
Loppet in Kananaskis Country. I am now 7 years post-op and my knee is
completely OK! So if you really want to crank hard on that knee I'd
strongly suggest getting the ACL fixed surgically. There is no denying
that the rehab is long and painful, but the payoff is immense.

-Everett

Gene Goldenfeld wrote:
I ruptured an ACL at 15 playing baseball, back when ACLs were thought to be vestigial. I didn't find out about it until arthroscopy 33 years later, following overdoing a race walk at a charity event. Over the years, I'd get swelling when first starting up a period of exercise, then it would be ok. The problem is that cartilege depends on the ACL for support, so that's a risk. Pushing off the side of a swimming pool did it for me three months after the initial injury. You can ski w/o an ACL, but having a stable knee is important, especially with a heavy pack and on downhills, and the lack of an ACL makes descents and twisting movementd more difficult and costly, in terms of swelling. The doctor may be thinking this is going to repair itself sufficiently over time, or he's taking a 'very conservative' approach, outside the mainstream. I'd get a second opinion.

Gene

"Sylvain.Fauvel" wrote:

There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal

Sylvain.Fauvel wrote:
There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.

I share many similarities w/ others who've replied here. I tore the
cartilage in my knee playing soccer at age 14 and had those pieces
surgically removed. 6 years ago I tore the ACL in the same knee and
probably also did some damage to whatever substance grew where the
cartilage used to be - I feel it "catch" every now and then.

I foot, bike and ski race (skate and classic), do pretty well and
generally feel quite stable, thanks to religious leg strengthening
exercises. The "plant & torque" situation others mention are also true
with me - I wear a fitted, hinged knee brace when I mountain climb or
mow the lawn, which for me is actually the worst possible "plant &
torque".

That said, I probably will have reconstructive surgery in the next year
or so; I am undecided about the choice of a patellar or hamstring
tendon graft though. I can feel the instability in common everyday
movements - walking up stairs, getting up from chairs, mowing, snow
shoveling, etc. I also feel some gait compensation strain in my calf.
I agree with the advice about getting a good ortho doc, find one who is
skilled in sports medicine.

Regards -
Bob

I take it your knee is not too bad off from the cartilege damage. Last time I checked, a few years ago, docs still weren't doing ACL repairs on arthritic knees (bone on bone) because studies showed it wasn't worth it in terms of symptoms and stability. It would be nice to get the petri dish cartilege operation, too, but there's not enough circulation there to support regeneration past about the age of 30, unless something new has been developed.

Gene


" wrote:


Sylvain.Fauvel wrote:
There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.

I share many similarities w/ others who've replied here. I tore the
cartilage in my knee playing soccer at age 14 and had those pieces
surgically removed. 6 years ago I tore the ACL in the same knee and
probably also did some damage to whatever substance grew where the
cartilage used to be - I feel it "catch" every now and then.

I foot, bike and ski race (skate and classic), do pretty well and
generally feel quite stable, thanks to religious leg strengthening
exercises. The "plant & torque" situation others mention are also true
with me - I wear a fitted, hinged knee brace when I mountain climb or
mow the lawn, which for me is actually the worst possible "plant &
torque".

That said, I probably will have reconstructive surgery in the next year
or so; I am undecided about the choice of a patellar or hamstring
tendon graft though. I can feel the instability in common everyday
movements - walking up stairs, getting up from chairs, mowing, snow
shoveling, etc. I also feel some gait compensation strain in my calf.
I agree with the advice about getting a good ortho doc, find one who is
skilled in sports medicine.

Regards -
Bob

Gene Goldenfeld wrote:
It would be nice to get the petri dish cartilege operation, too, but there's not enough circulation there to support regeneration past about the age of 30, unless something new has been developed.


There is something (not so) new - microfracture via key hole surgery,
which my neighbor just had done. I understand the petri dish route is
expensive and insurance carriers balk at the cost.

He is a few years older than me (early 50's) and he had the
bone-on-bone situation. As I understand it, the ortho doc drilled
several holes thru the top of the bone, down to the marrow. The marrow
oozed out to the knee joint and "scabbed over". He had to remain
totally of the leg for several weeks until the scabs hardened, using a
CPM / ROM machine to guard against muscle atrophy. Apparently this
"scab" has bearing and wear properties similar to cartilage.

I googled it quick -
http://kneeindia.com/view_procedure.asp?procedureid=13

- Bob

Hi Sylvain,

I completly ruptured my ACL when I was 18. That was 29 years ago. I haven't
had reconstructive surgury. I may not be the best, but I have been XC skiing
since I moved from UK to Canada 18 years ago. The lack of ACL has not
hindered me. Torn cartalidge has and had arthroscopic surgury two years ago.
I have only worn a brace since the surgery more for peace of mind than for
any other reason.

Getting reconstructive surgery might be a good idea. It is less invasive
thatn when I first tore mine.

Tony
Ottawa

"Sylvain.Fauvel" wrote in message
ups.com...
There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal

Sylvain.Fauvel wrote:
There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal


If you sufficiently strengthen your quadriceps, it's quite possible to
have a stable enough knee to do most activities, including skiing,
without an intact ACL. Some surgeons are more conservative than others,
and I would advise you to seek a further opinion from someone who
specialises particularly in sports medicine.

If you opt for surgery, there are two main options - using a segment of
your patellar ligament/tendon, or using hamstring tendons. The
advantages of the latter are that it can largely be done
arthroscopically, and ultimately you will not be sacrificing any
hamstring strength. Using a patellar tendon graft will leave you with a
less robust extensor mechanism, though the practical importance of this
is questionable.

People with total knee replacements get around just fine with (by
definition) no ACL(s), and instability is uncommon. An orthopaedic
surgeon I know is in his 60's and has been skiing on his bilateral TKRs
for years without difficulty.

The best option will depend largely on just how unstable, despite muscle
strengthening, your knee becomes.

Kind regards,
Chris Cole

In article . com,
"Sylvain.Fauvel" wrote:

There has been lots of talk about ACL injuries on RSN but most
people who had ruptured ACL had surgery and reconstruction.
In my case, the surgeon/orthopedist says i will be ok with
physical therapy and a brace. I would like to know if people
with ruptured ACL have been able to keep XC-skiing without
surgery and without getting other knee injuries.

I am not into performance or racing but ski often with a
heavy pack in narrow winding trail.

Sylvain
In Montreal

Even with the ACL replacement surgery and being in great condition,
I have "tweaked" my knee a couple of times while skiing. From my
experience, I'd be very concerned about skiing on a narrow, widing
trail (presuming steepness is also involved), especially with a heavy
pack. At the very least, I wouldn't do it alone and/or in a remote
location.