Thread: ACL Class of 2012

To begin, I'd like to personally welcome D-Rose (the hubby is a native chicago-ian and isnt' taking it too well) to the ACL class of 2012
Ahead of time, sorry for the freakishly long post. BUT I've been slowly coming to terms with the fact that single track is probably out this year, and have been scouring the forums, but I haven't found much on arthofibrosis so here's a bit of what I've learned the hard way thus far:

1. Physical therapy is a must. It's painful and I both hate and love it. Each session takes between 2 and 3 hours (2x a week). The purpose? To get my knee to bend and straighten so that the scar tissue doesn't invade those joints and permanently inhibit motion. We're not even talking about full ROM or even getting strength back. We're talking about working it an hour to get it to go to 0 and an additional hour to get it to bend to 95 - it also requires the PT to MAKE it bend/straighten (break through the scar tissue). That hurts as much as it sounds. The PT place is strategically placed above a beer and pizza joint. It makes it worth it.
2. Graston Technique is awesome. It hurts. I'm still black and blue across my entire quad from my last session, but its helping little by little. Apparently this is something new in PT? At least that's what the doc says. She knows it from working on the US cycling track team and has been using it on her patients. Seems to be helping. Theory seems sound. Anyone have long term experience with/beta on this?
3. Acupuncture is double-ly awesome. Regardless of whether or not it does much physically, it helps mentally.
4. Walking is awesome. Do you realize how complicated the act of walking is?
5. The pain and swelling isn't going away and wont stop until the reaction (building of scar tissue) stops. This sucks. The pain meds over the long term suck a lot more. Dealing with it is an art and it involves ice cream and beer.
6. The scar tissue at first dislodged the graft and compromised it. Now, it's actually helping the graft to heal quickly and more strongly. Who would have thought?
7. This can suck. Friends and happy thoughts are a must. Beer also helps.
8. If I would have known this would have happened, I would have still gone through with the surgery (seems worth it to be able to ski/bike/run for the next 30 years), but I would have prepared myself mentally for how difficult and long the recovery would be. I would also have made sure ahead of time that insurance would cover a second possible surgery to remove the scar tissue if PT fails and I lose complete ROM

My surgeon said that she would have debated the operation and suggested other options if we would have known it would be this bad. That's definitely not what I wanted to hear. But we're still optimistic, just going to take a lot longer than we had planned to be back 100%. All in all, would do it again a hundred times over if it means being able to do the things that I love with my grand-kids down the road. But it's a tricky thing to work through and I'm currently hoping for a PT miracle that sets everything back on track. My knee and I have had a heart to heart. Hopefully it'll chill out and realize that I'm just trying to help it.
5 weeks in and here's to happy knees, happy spring, and a happy recovery to everyone!

Originally Posted by snow gypsy

2. Graston Technique is awesome. It hurts. I'm still black and blue across my entire quad from my last session, but its helping little by little. Apparently this is something new in PT? At least that's what the doc says. She knows it from working on the US cycling track team and has been using it on her patients. Seems to be helping. Theory seems sound. Anyone have long term experience with/beta on this?

I don't have any direct experience with "Graston Technique," but I have been "scraped" with hard plastic instruments on-and-off for a few years now to combat the long-term tendonitis in my wrists from overuse in rock climbing. It is the ONLY thing that I've found to help (though I use it in conjunction with eccentric loading.) I think it's definitely worth the pain. It appears this is indeed a bit different than Graston Technique (though I'm not sure what the practical differences are), but it's what my hand therapist uses (and apparently it's more common in the Asia, which is where she's from.) Anyway, as the scar tissue decreases, the scraping itself gets less painful and less bruising occurs afterwards. Definitely be sure to drink TONS of water afterwards, and consider adding a hydration supplement (I use Nuun).

The last few times I've been scraped, I've actually had to ask them to go harder, as it doesn't seem to cause the type of response as before. Guess that means I'm finally ready to be done with therapy!

Best of luck. Sounds like this has been quite the battle for you. Vibes!

I think I've been pretty lucky as far as scar tissue. My ROM was at 0 and 90 within a few weeks of surgery, the CPM might have helped. Four months later it's around -2 to within 5 degrees of my good leg (around 140 I think). I still get some swelling around my knee and ankle if I sit for an entire shift (10 hrs) without elevating.

I was seeing my PT once a week for the first 2.5 months, and doing about 90 min workouts/PT on my own 6 to 7 days a week, half an hour of which was spent on the exercise bike. I don't know if that might have helped prevent scar tissue build-up, but I don't think it could have hurt.

Gypsy, I think you've got the right perspective; I hate the gym and my PT workouts are boring and sometimes painful, but it's an investment in my future and things like skiing and biking are too much fun for me to give up! I want to be able to do everything I was able to do pre-injury so I keep plugging away at it. Realistically I may always have some lingering issues with my surgery knee, but I'm becoming more optimistic that they will be minimal, or at least that's the goal.

I've pretty much accepted that biking alone won't be enough to prepare for ski season anymore, and at least part of my PT routine will need to be included to strengthen and hopefully prevent future injury.

On a positive note, I was able to jog a few laps around the gym last night without too much trouble. I've also started working on some jumping on the trampoline, two things I kind of doubted I'd be capable of just a few weeks ago. Then I went home and ate half a pepperoni pizza from Mtn Buzz and washed it down with some delicious Ranger IPA. Probably a good idea to set realistic goals and reward yourself every once in a while.

A few weeks back I was handed off to one of the Jr techs at my PT. Not trying to be too critical, but there was a world of difference between what the new PT was doing with me VS the previous one. After one session I was ready to throw in the towel and just do my workouts on my own. Out of the blue I got a call from the original PT asking me if I would like to re-schedule my next appointment with her. Apparently I wasn't the only person not thrilled with the new PT, and I'm glad they are aware of the problem and are taking steps to resolve. I should be released by my PT and ortho within the next month or so, and hopefully my PT will give me some more valuable exercises to get me as close to 100% as possible between now and next ski season. Bottom line; I'm glad to be back working with a PT that I have confidence in.

I suggest that if anyone doesn't feel as though they're getting enough out of their PT; try another to see if their approach is significantly different. As I just learned, there can be a world of difference between physical therapists, probably more so than orthopedic surgeons.

Hey I had ACL recon March 8th and my OS gave me this video. I had a double bundle allograft

I thought I would post this up for your viewing pleasure. it shows him inserting the allograft and then pulling it into the drilled holes in my femur. its not gory, its very cool.

you have to use this link to view

http://www.youtube.com/watch?v=hWG30...&feature=email

^^ Very neat! Particularly him pulling the graft into the drilled holes.

That was cool BoatBound! I'll have to ask my ortho if he has video of my surgery.

I for one am thankful that medical science seems to be keeping pace with my ability to break myself. Micro-lumbar discectomy/laminectomy 9 years ago and an ACL this year, and will most likely return to skiing next year with little to no limitations. (other than being old and washed-up)

this was surgery #8 for me. so not counting other damage like this crash I dislocated my shoulder and sprained "high sprain" syndesmosis sprain ankle, I am very tired of being a moron and breaking stuff. I will be ready to ski next season; a bit older, a bit more worn but still like a little kid. BTW I had surgery and rehab in steamboat. those folks know their shit for sure. I had my knee straight in a week and over 100 degrees in under 2 weeks. I was doing quad flexes and leg straightening excercises in the recovery room. I did a femural and spinal and a cocktail of drugs. I think it really helps in a faster recovery.

I had massive swelling issues that prevented my ROM from progressing. I had the knee drained twice, tht sucked.

Bend- My PT and my sister who is a PT both told me that quad extensions are the worst exercise you can do for a recovering ACL...FWIW

As for rehab and dark days...it stinks. You'll recover physically but the mental part of skiing again is the hardest part. I was able to "ski" from the top of peak 10 @ 6 months...but it wasn't pretty, my quad was wicked weak, and it probably wasn't smart but that was a goal I had and I made it happen. My first year back skiing was a mixed bag. Started out very weak and no stamina in my quad but it got better. The days my quad was weak and I couldn't crush pow i had teh sad. Stay positive and know it's a process and it'll come. Work on the mental part, work on trusting your procedure. Crush your rehab and do TONS of squats...make your quad tired and then keep going. By the second full season back, I was back to normal. Strong and over the mental part. This year, the 3rd year post injury, I ditched the brace and have no lingering effects mentally or physically really.

Good luck.

you mean the seated on a machine with your knee at 90 and then you straighen the leg? yah! they are terrible for anyone.

Originally Posted by montanaskier

I had massive swelling issues that prevented my ROM from progressing. I had the knee drained twice, tht sucked.

Bend- My PT and my sister who is a PT both told me that quad extensions are the worst exercise you can do for a recovering ACL...FWIW

As for rehab and dark days...it stinks. You'll recover physically but the mental part of skiing again is the hardest part. I was able to "ski" from the top of peak 10 @ 6 months...but it wasn't pretty, my quad was wicked weak, and it probably wasn't smart but that was a goal I had and I made it happen. My first year back skiing was a mixed bag. Started out very weak and no stamina in my quad but it got better. The days my quad was weak and I couldn't crush pow i had teh sad. Stay positive and know it's a process and it'll come. Work on the mental part, work on trusting your procedure. Crush your rehab and do TONS of squats...make your quad tired and then keep going. By the second full season back, I was back to normal. Strong and over the mental part. This year, the 3rd year post injury, I ditched the brace and have no lingering effects mentally or physically really.

Good luck.

I'm 7 weeks post hamstring graft, with a miniscus trim.

Full range of motion. My healthy leg overextends a huge amount, and the gimp leg hasnt gotten that back but I dont think its important, the healthy one is probably too lose anyways. I can go from about -3 all the way to my heel touching my ass with the knee bent with just about zero pain. I had extension to 0 at about 2 and a half weeks, flexion to what they consider 'full and normal' at about 4 weeks.

Doing PT once every two weeks, trying to get onto the exercise bike 2 times a day for 2 10 minute sessions each time with some of the other strengthening exercises in between. Right now I work my way up to about a 6/10 resistance at about 90rpms for a minute or so once or twice during those 10 minutes. Also trying to get into the pool for an hour or two once or twice a week.

Pain has been a 1-2 for the past three or four weeks but as Ive been working it more its gone up to a 3-4 the past few days, I am really unsure what pain I should be pushing through and what I should be resting. So far if it feels better after a few minutes on the bike I push through it but sometimes it feels pretty sore afterwards. Decided to take this afternoon evening off and just ice it and do some ROM and it feels better.

Do you guys take rest days/half days after going hard for a few days? Should I just push through the pain? Should I push through thepain but just do very mild workouts when it has been hurting?

Starting to feel my cardio and general fitness come back a tiny bit, as well as my appetite, feels good. Hoping to be fighting forest fires next summer.

Damn Leroy, that ROM is impressive!

My PT finally got my heel to touch my ass last week and I'm 4 months post op. I still have some residual swelling which is inhibiting greater ROM, but not a major concern at this point.

Thanks for the heads-up on the quad extensions MTskier and BoatBound. I'll take them out of the routine, although I've been doing them for four months at this point already for good or ill. I think overall my PT has been really productive and I was fortunate to have a schedule that allowed me to get to the gym every day. The gym is upstairs from my cubicle so it was pretty hard to make up excuses.

As far as pushing through the pain; I don't know if there's an easy answer. We all have to push through some degree of pain; it's a painful procedure/recovery. I guess I pushed harder through the things I thought couldn't set me back too much; the bike, leg lifts, quad sets, hamstring curls, and backed off on things like squats and lunges if I felt too much grinding, pain or instability. My ortho and PT were both really good about giving feedback on what to or not to push too hard on, and what could or couldn’t negatively affect my graft. Don't be afraid to take an occasional light or even down day. You're going to be at this for a long time so an occasional day off isn't going to set you back much, whereas working out a sore and inflamed knee might make a workout the following day just about impossible.

I only have one more visit with the PT and ortho before being released. The PT has given me more agility stuff to work on for the next few months; a lot of cutting and running in all directions, and some more jumping. I'm sick of the gym and running in circles indoors makes me feel foolish. I realized the other day that I could probably accomplish much of the same hitting a tennis ball against a wall or actually playing someone, with the possible additional benefit of eventually sucking less at tennis.

On the confidence issue; I was mountain biking Friday and lost traction on a mildly technical section. All my weight was going towards the side of my surgery knee and I was forced to put my foot down somewhat unplanned and placed some pretty good force on my right leg/knee. Pretty much as expected it held, didn't hurt and felt nice and stable. I'm kind of pussying out on technical sections to avoid this scenario right now, but it's always a possibility even on easy sections, and at least for this one instance my knee was able to handle it. I imagine there will be a lot more of this trial and hopefully no error confidence building with my return to skiing. I've said it before, but the timing is actually really good for me. By the time Loveland opens again I'll be at least 10 months post surgery and I doubt there will be anything more challenging than blue groomers for the first few weeks. I should have plenty of time to test my knee, how it reacts to skiing; vibration, torque, small jumps, etc. before attempting to take on anything more demanding/challenging.

Is anyone else experiencing any numbness around their surgery? My knee feels fine, albeit a little swollen and sore at times, but my shin from the main incision scar down 4" or so still feels pretty numb. It's probably not a big deal and my PT seems to think it will improve over time, possibly caused by a nerve being cut from the incision, but it just feels weird and I'm wondering if anyone else has experienced anything similar? If it never clears up at least I won't have to worry about shin-bang on my right side anymore...

2-5" in the forecast above 9000ft tonight. Hope somebody gets after it and then we get back to some ideal cycling weather! To think; this time last year all I was concerned with was getting my (ski) day count above 120! I've already been not skiing for longer than I went between seasons last year. This season for me will forever be remembered as "The Ski Season that wasn't", or the surgery/PT season that was.

I'm only 2.5 weeks post-Allograft from hamstring but I also have the numb spot.

I was told it's very common and typically permanent for about 1-2" below the incision because they just can't avoid whatever nerve endings are there when they harvest the hammy.

I'm at full zero with extension to 100ish so I'm pretty happy with that. I just got the brace changed to allow flexion which is great - a lot closer to being useful since I can bend it during the day.

Only problem is that if I make the brace tight enough to not slip it either hurts like heck or restricts flexion... It's a bledsoe g3 set to 10-110. Any tips?

It's been a real pain because I know walking and firing the muscles is important but I feel like the brace fit just isn't working right.

flyman,

I'm not sure why, but my ortho didn't want me using a brace at all post-surgery. Your ROM sounds great for 2.5 weeks. I guess I'd go with whatever your ortho suggests.

I was given a donjoy brace right after my injury for stability before surgery; neoprene with four velcro straps and metal siderail hinges (not sure of the model). I used it for about two weeks and then went without for another two pre-surgery as my knee started feeling pretty stable. I used it again for the first week or so post-surgery with hinges unlocked for some added confidence getting around on snow and ice covered surfaces. I might use it again when I go back to skiing in the fall, but my ortho has been saying all along that I don't need it. I'm guessing that whatever you mess up in your knee along with your ACL might dictate whether or not you need a brace post-surgery, crutches for some folks, weight bearing, non-weight bearing, etc. For me it's been a confidence issue; once you've experienced your knee coming out of joint a few times (day of injury) you probably won't want to experience that feeling again anytime soon.

I wouldn't worry too much about your muscles firing at 2.5 weeks. Obviously you want to start the strengthening process as soon as possible, but you also don't want to over-do things and risk a set-back either.

I'd say go with whatever your ortho suggests, but don't be afraid to ask questions. Tell him/her about the fit issue and maybe ask if you can ditch the brace entirely? I didn't really trust my knee at first without the brace, but it turned out my ortho knew what he was doing.

So I'm thinking that numb spot would be a pretty good location for a sweet tatoo? Maybe a large band-aid shaped tatoo?

sounds like you need to be re-fit for that brace.

2.5 weeks is just the tip of the ice berg so be patient. 8 weeks for me and I still have some swelling especially behind the knee and all the muscles don't always fire at the right times but this is normal. the more you use, the better off; its not about the weight or resistance for you at this point. its movement. Keep up the good work

Leyroy, only your dr and PT know you and your needs so don't take our advice on the pain vs progress thing. When I push it will swell and get achy.

Yesterday I was officially released from care by my PT. Still have a way to go but this kind of feels like a major milestone.

Fly-
Know its been a while since you posted about the brace, but I wanted to chip in. I had a full length brace that didn't fit well for 6 weeks. When I went in for my 6 week check they asked where my functional (athletic) brace was. I said I hadn't received one. Apparently I should have been using it after 3 or 4 weeks. I bring this up because it led to a limp that I just am getting rid of after 10 weeks. I think I was slowed up because I wasn't fully bending my knee on a regular basis. It pissed me off. I have been going braceless for about a week now and after a great PT session on Thursday I feel I'm finally making real progress and the lingering pain is going away for the most part.

Boat - you and I had surgery on the same day. How is your progress coming? I think that the 8-10 week point is a real turning point. A week ago I had doubts about skiing in the fall. Now I feel more confident. Wish I could recovery for Mt Hood in July or August but I don't see it happening.

MArch 8th? Very cool! things are great with my knee, when I crashed I subluxed my shoulder out the back, then out the front and also sustained a "high ankle sprain" which as it turned out I also have a impinged nerve in the ankle or fib area where the Peroneal nerve splits and goes over and under the ankle. so I had a cortisone shot and PT is doing some different therapy (glide therapy) to get the nerve to calm down. Its heading in the right direction at this point although when I flex my foot, it still bulges at the top of the ankle. Hopefully, it won't affect my boot fit. Otherwise, the knee is really doing well. I am really trying to biuld the leg back up now. I had my 10 week test where I had to do a one-leg squat slowly and in complete control over 90*. I got to 95 so I passed that landmark. I would be better without the ankle issue.

Bendtheski- CONGRATS! how many months in rehab? I read above you have been riding your mtn bike? I was told no way for 6 months. Damn.. I am dieing to ride again.

BoatBound,

Surgery was Jan 4, so just about 5 full months, but I started mountain biking at 4. Still being a total wuss about anything technical, but otherwise doing really well!

Clicking out of the SPD feels a little weird, but no problems otherwise.

I'm part-timing at a local bike shop and noticed some real discomfort test-riding bikes with the seat too low. The knee seems to prefer full extension.

holy shit! your doctor released you to mtn bike AND with clipless??? I am told no mtn bike and no clipless (at all) I can ride a road or town bike only. I am at 12 weeks tomorrow. Riding 15-20 (doing 20 tonight I hope) miles now on a rails to trails packed cinder. the clipless will create a lot of tension and torque on that graft........ warning..... just saying....

Originally Posted by bendtheski

BoatBound,

Surgery was Jan 4, so just about 5 full months, but I started mountain biking at 4. Still being a total wuss about anything technical, but otherwise doing really well!

Clicking out of the SPD feels a little weird, but no problems otherwise.

I'm part-timing at a local bike shop and noticed some real discomfort test-riding bikes with the seat too low. The knee seems to prefer full extension.

Not busting balls but its an autograft if the graft was harvested from your own body, its an allograft if it was harvested from a cadaver

Originally Posted by flyman683

I'm only 2.5 weeks post-Allograft from hamstring but I also have the numb spot.

I was told it's very common and typically permanent for about 1-2" below the incision because they just can't avoid whatever nerve endings are there when they harvest the hammy.

I'm at full zero with extension to 100ish so I'm pretty happy with that. I just got the brace changed to allow flexion which is great - a lot closer to being useful since I can bend it during the day.

Only problem is that if I make the brace tight enough to not slip it either hurts like heck or restricts flexion... It's a bledsoe g3 set to 10-110. Any tips?

It's been a real pain because I know walking and firing the muscles is important but I feel like the brace fit just isn't working right.

Originally Posted by bendtheski

Is anyone else experiencing any numbness around their surgery?

I'm at 13.5 months out. The shin area on the repaired leg does have numbness, but it's really not noticeable in normal daily activity. Feeling seems to be coming back a bit more after I increase exercise intensity. For example, there was mild discomfort in that area in the days after the 20 mile run, but several days later, there seems to be a little less numbness. The hamstring harvest leg has no numbness. The numbness does not help if I ram my shin into the corner of the bed in the middle of the night.

The scars have healed very well, indeed the ACL scars are almost unnoticeable. The MCL incision and the harvest incision are the biggest, but they're very faint. From fairly early on the PT recommended I massage the scar areas to break up the scar tissue and that seemed to really help, though sometimes there was some serious discomfort, well, ok, pain.

The only area that has occasional mild pain now is where the metal pull rod came out, on the lateral upper leg ~6-8 cm above the repaired knee, but it's not enough pain to warrant taking anything.

I started following this thread last week after my surgery on 5/21. Torn ACL skiing at jumping off a 15' cliff at Snowbird on 4/15. My PT was able to squeeze me in last Friday (4 days post op) and my flexion was at 77 and extension at 0. He gave me a few exercises to work on at during the week and also gave me a TENS unit to help firing my quad muscles. He definitely kicked my a$$ today with deep tissue massage and my flexion and measured me at 113 degrees. He also cleared me to start riding a stationary bike so I'm super excited with my progress considering last week was pretty discouraging.

Glad to see everyone's progress and hope to be able to ski late next season!

Originally Posted by BoatBound

Not busting balls but its an autograft if the graft was harvested from your own body, its an allograft if it was harvested from a cadaver

I'll blame the drugs. Or admit honest typo. Either way - meant to say autograft.

Doing much better now that I'm onto the functional brace, but minor see back after pulling the grafted hamstring at about 4 weeks.

Words of wisdom: if they do hamstring graft don't try and help lift something heavy, especially while leaning forward or bending a bit. Even if it is your pregnant wife.

Originally Posted by Clfjmpr

Fly-
Know its been a while since you posted about the brace, but I wanted to chip in. I had a full length brace that didn't fit well for 6 weeks. When I went in for my 6 week check they asked where my functional (athletic) brace was. I said I hadn't received one. Apparently I should have been using it after 3 or 4 weeks. I bring this up because it led to a limp that I just am getting rid of after 10 weeks. I think I was slowed up because I wasn't fully bending my knee on a regular basis. It pissed me off. I have been going braceless for about a week now and after a great PT session on Thursday I feel I'm finally making real progress and the lingering pain is going away for the most part.

Clifjmpr,

I can relate. My problem was ortho has different program than the PT. PT wanted to put me in functional but ortho wanted the long one for full six weeks.

Switched over at 5ish, and been much happier - the comfort difference makes the day much nicer, and I agree it let's you keep the movement up.

Only downside is its almost "too freeing" and I need to remember not to go lift something heavy, run after kids, etc.

Glad you got rid of the limp, still working on mine but doesn't sound as set in as yours.

Really want to get stable/strong for river fishing and rainbow season - wading is dangerous enough without acl/meniscus problems.

I wore the full brace for 3 weeks, fully locked out for 1st week, then 60* the second and then at week 3, I switched over to a custom Donjoy Defiance I had made prior to surgery. this brace actually provides more protection to the ACL than the Bregg's full leg brace. Its great to be able to get out of the Full leg thing. I wore that for another 3 weeks. Protecting the graft is the issue, it really has nothing to do with the knee itself. Not wearing a brace when the knee is unstable or when you are out where someone can knock into you or on ground that is not flat is dangerous and you are taking a risk of tearing the graft. No way I was going to risk the best possible recovery and permanent outcome.

I found that some of my limp was "in my head" and I just had to be aware of it and correct my gate. Walking heel-to-toe is also a great way to get back to a normal gate.