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Thread: MY ACL SAGA - a blog
04-08-2012, 07:40 PM #1
MY ACL SAGA - a blog
It all started when I came down HARD to a flat icy landing, putting almost all my force on my right leg (subconsciously protecting a sprain on the left, I suspect). I washed out the landing but there was no twisting and my skis stayed on. There was no popping, nor any swelling but after a run or two later through the park (including a full pipe run and switch take off stuff etc) I could tell I wasn't 100%.
I woke up the next morning and things were stiff, I couldn't get out of bed and walk to the bathroom without some serious effort. Yet there was still no swelling or bruising. I went to the physio and they couldn't find a "stop" to the knee using the Lachman (?) test (although my knees are naturally pretty lax and my muscles were "protecting" (I had a false positive lachman test before at the same physio, different leg) and suggested the ACL may be gone. I had an MRI that day and got the call from my GP saying the radiologist report suggested that that my ACL is partially torn but he is no knee dude and refused to translate beyond that and booked me an appointment with a knee specialist for Thursday, when the knee dude works at my GP's hospital.
I was supposed to be flying to Valdez on Friday so I needed a diagnosis before Thursday if I were to cancel flights and have any chance of selling my seat on the heli so I had a friend book me in with a ortho on Tues. This ortho comes out and tells me my ACL is fully torn before any physical checks, so I guess he figured that out from the MRI. Meanwhile I am still limping (though still no swelling or bruising) and I do know that there is "liquid in the knee" (general swelling), a sore MCL, and some bone bruising in the leg. As such, I cancel Valdez, sell my seat and start looking for surgeons.
Thursday rolls around and I remember my appointment with the knee guy my Doc suggested. I wasn't going to bother going but I thought, what the hell, and went anyway. Now the new doc comes out and tells me that he isn't convinced the ACL is even torn and if it is "he has seen pro footballers play on less" and (for some reason) he thinks it could be from a previous injury anyway (no swelling?). He does the lachman and seems happy with it. I am happy but still a bit concerned, who fukked it up?
Since then I had the radiologist report translated as best I could (there is almost no person on earth who can translate a radiologist report of a possible knee injury from one language to another. Those few people who are absolutely fluent in both languages also have to understand what an ACL, PCL, Meniscus etc are; stuff we only know because we ski and medical experts didn't major in language... Anyway, fellow mag, KoM, tells me that the radiologist report thought there could be a torn ACL but qualified their assessment with obfuscating factors such as swelling and what not.
Now, a week later as the stiffness abates, I am retaining my full ROM, feel strong and just spent 3 days shralping pow (in an Asterix brace) on my sled (avoided skiing for knee reasons). I have not had my knee "slip" (I have never experienced this so I am not sure I know what to look for but I am told I would know it if it happened) and am only experiencing the pain I would expect from impact.
Now I am left with the problem of what to do next? Believe the best news and return to normal (maybe jump on a last minute AK trip)? If he is wrong do I risk tearing a partially torn ACL that could be rehabbed to strength? Do I book another opinion and go for a majority? Do I rest a bit and see how it goes? H&B? Der Poopenheuser?
04-09-2012, 08:47 PM #2
Candidate for prolotherapy or stem cells, stunts.
Both have knack for fixing weird shit like your knee.
04-09-2012, 10:31 PM #3
The MRI results can be burned on a disc so you can send it to some other experts for review. Since you have full ROM and can actually do athletic activity maybe your ACL is still there.
In my case, the emergency room doc, in about 3 seconds, diagnosed full ACL and MCL rupture. I could not put any weight on the leg or it buckled and I'd fall down (which happened several times touring out of the backcountry) and there was definite swelling and stiffness. There was no way I could do any athletic activity. The MRI pretty much confirmed the original diagnosis, though there was a question about the MCL, until surgery confirmed a full rupture.
Get another opinion and in the meantime do some ROM exercises, stretching, balance, strength stuff and see how the knee feels.
ACL Class of 2011
04-09-2012, 10:58 PM #4
I have the MRI disk in my pocket but don't know who would interpret it. There are a lot of Japanese characters on the annotations though...
I am not sure I can get weird shit easy here in Japan, although the first ortho who diagnosed the full tear literally wrote the Japanese book on stem cells and he recommended surgery without a blink.
A few more days since the last update and my knee feels pretty normal. It still hurts but I did cause some trauma in landing (as the bone bruising can attest to) but nothing I would expect from a big landing. There is no stiffness in the back of the leg or pain inside the knee (it is mostly the sprained MCL that hurts now) or anything else I have read re. symptoms of an ACL tear. I should add that I have massive tree-trunk legs and do heavy, DEEP squats and deadlifts to keep it that way so maybe my led structure is supporting a broken knee?
04-10-2012, 07:56 AM #5
SC, my experience was almost identical to Cedrik's. My knee had never come out of joint prior to the injury on Dec. 2nd, but did so several times after the initial impact/tear landing a massive 3-footer.
I had x-rays the day of injury and saw the ortho two days later. He did the Lachman and confirmed what I already suspected; ACL gone. He left it up to me whether I wanted to have an MRI to confirm further, but also told me that even an MRI can be inconclusive, as you seem to be finding out.
I guess I'd say if your knee never went out of joint and you didn't hear a pop and don't have any major pain, swelling, or instability issues, you might not have torn your ACL, or it might only be a partial tear. From your description it doesn't sound as though your injury is holding you back much, so I don't think I'd be rushing into surgery if I were in your shoes. If problems persist you might want to consider Splat's advice for a non-surgical solution.
One word of caution, my ortho told me he's work on a bunch of knees that have been ACL deficient for years. Usually they're a mess. Apparently the additional laxity in the joint can lead to additional cartilage damage and put additional strain in MCL, etc. I've know a few people who skied without ACL's for years without much trouble. My knee dislocating several times told me I wasn't going to be one of those people. FWIW, I never did get the MRI.
Huh, no pics. Does that mean it didn't happen?Wag more, bark less
04-10-2012, 07:58 AM #6
Contact JimS here on the board, stunts.
He might give your disc a read if you FedEx it to him.
04-10-2012, 09:28 PM #7
3rd opinion tomorrow with a respected knee surgeon. Wish me luck!
04-11-2012, 11:07 AM #8
04-11-2012, 11:08 AM #9
04-11-2012, 07:47 PM #10
I got the final opinion from top knee and orthos in Tokyo (2 guys did the assessment, a young knee surgeon and the head of orthopedic surgery). There is a partial tear, as shown in the MRI but they can find no sign of instability in the knee after having to sedate me to do the Lachman etc tests(I have very big legs). Any symptom of pain or stiffness they can find can be attributed to the lesser injuries I sustained and the bone bruising. The knee is more "lax" than the other knee and they had a hard time finding a "stop" but they did and they think I do not need surgery. They suggested that it could even heal on its own over time. They didn't even recommend special PT, only telling me to keep my legs strong. I would look into alternative healing if I thought I could find someone reputable to do it in Japan but I doubt I could.
04-14-2012, 05:29 AM #11
After doing some web research, I cannot find much information the eventual outcome of my diagnosis. There seems to be a school of thought that even a partially torn ACL can never heal up and that I now just have a time-bomb in my knee. Others have suggested that a partially torn ACL will heal with time. I don't know how torn my ACL is, only that the physical tests suggested I am pretty stable and I sledded last week and skied this week (in a brace) and have had no issues.
04-15-2012, 07:29 AM #12
IMO and in my experience some partial tears will be fine, others will feel unstable. It all depends on how much is torn and how stretched out the remaining fibers are. If your knee feels stable with change of direction you may be fine in time. You may also have another injury down the road that Finishes things off. Until then take the Orthos advise and keep your legs, especially your hamstrings strong.
If you already have a asterisk brace then that may also be helpful, But it does not replace keeping your legs strong, don't just rely on the brace because no brace will protect you in all situations.
04-15-2012, 01:08 PM #13
My buddy hick had the basically the same exact situation this winter. He had what sounded like very bad full tears of acl and mcl, complete with major swelling, instability, and loss of motion. After a few doctors opinions, he found it to be basically a strained acl and a patial of the mcl. He began recovering and by 6 weeks or so he was sleeding and easy skiing. It's been like two and a half months now and he's doin pretty good, maybe not 100% yet, but definetly not unstable. It was confusing at first cause of how fucked up he was, but once the swelling went down in became clear that he didn't have full ruptures.
I did the same thing in 2001 and was pretty dumb about it, skied again in 3 weeks before it was fully healed and had alot of pain if I got caught backseat. I did recover completely from that in about a year though and had an intact acl in that knee for 10 more years. I did another patial in the same knee in 2009 and took a three week tropical vacation on that one, still had a full recovery, ymmv. I still don't think those partials/strains is what caused me to eventually blow it up cause nothing would have held my knee together for what finally blew it. You know you blow the acl when it sounds like canvas ripping inside your knee. Best wishes, you sound strong but just be careful for a couple months for sure."The skis just popped me up out of the snow and I went screaming down the hill on a high better than any heroin junkie." She Ra
04-15-2012, 05:42 PM #14
Thanks for the advice and experiences.
I sledded (including an accidental 10ft drop to flat) and skied this weekend with a Asterix brace (just groomers and the baby jumps in the park) and I would say the knee feels close to 100%. Any discomfort can be attributed to the other injuries I sustained (bone bruising and strains, no laxity). I am also back on my weight regime and was squatting 100% of what I was pre injury. I am beginning to think it possible that the partial tear could have come from a precious injury due to the fact that I never had any ACL type symptoms
Whatever the case, due to the dearth of info on the webz on partial tears with no laxity, I will try and keep this thread up to date (assuming it doesn't just blow out in the next few weeks) This being Japan, I have access to cheap and readily available MRIs so I could even go in and get MRIs every quarter or so to see if a partial tear can actually heal or not.
05-03-2012, 11:36 PM #15Registered User
- Join Date
- Jul 2010
I thought I would weigh in here as you seem to be in a similar boat to me.
A couple of years ago now I landed a 3 a bit dodgy and had a very slow backwards twisting fall. Felt a slight 'give' in my knee, instant pain but not huge amounts of swelling.
Knee is slightly lax - one ortho reckoned the end-point was dodgy at best while the other reckoned it was pretty good. I had real issues with not "guarding" (muscle tension?) when they were trying various things with it.
I have only experienced occasional instability with it, and never a complete collapse. The biggest issue I have is (I think it's called...) AP glide - my bad knee can slide quite a lot more fore-aft than the other.
After much too-ing and fro-ing with various physios, doctors and orthos, including an MRI, they concluded that I had probably at least partially if not completely torn one bundle of the ACL.
The conclusion going forward was that I should just carry on with it as long as it can handle my usual activity - which it can, with Ibuprofen and Diclofenac after I've been railing on it (skiing, or playing softball). One ortho said that if I put enough force on it in the right direction to tear the remaining ligament then I would probably tear a complete one too. They also reckoned that I had similar stability to the average reconstructed ACL, so replacing it might not gain me a thing except 6 months out of the game.
I'm 2 or so years and probably ~100 ski days down the track. I still get some stiffness and pain if I've been skiing hard or if my pitcher is having a shitty day and I spend some long long innings catching at softball but it's never stopped me doing either.
It took about a year to feel normal while I was skiing, so either they do heal themselves to a degree or perhaps my muscles just learnt to support it better.
Hope this helps...