ACL Class of 2011

[kingdom-tele]

I have no pain in my hip joints or lower back, but my hip joints have been "clunking" alot ever since surgery. Especially if I throw a leg over the bike or something like that. My lateral quad is still bigger than medial though and maybe that is what I need to work on before pushing too hard skiing again. Maybe things are just all bound up on my lateral side overall, do you think my hip popping could be a symptom of that?

I know it's hard to diagnose these things over the net. All my pain feels like lateral patellafemoral pain, only when I am going up and down with body weight at angles between about 45 and 80. The exact angles of skiing to be precise.

Thanks again for chiming in, I know I just gotta do more strengthening and stretching no matter what, I just gotta figure out exactly which excersises and streches will be most helpful.

trying to figure out faulty bodymechanics is not best served by this medium, hopefully you have a good relationship with your PT, it would be a shame if you couldn't just pop in and ask questions, not everything in life should be billable. that being said, clunking could be your body trying to get more motion from the hip because the lower leg joints aren't providing it, it could be hypertonicity in a muscle, usually iliopsoas, so whether the pelvis is rotating on a fixed femoral head or the femoral head is rotating under a fixed pelvic bone there is to much joint compression and your feeling the snap of the femoral head under a tight more superficial tissue. if your pelvic alignment is wonky it only adds to the pissed offedness of the pelvic muscles. there are (8) 2 joint muscles that contribute to hip and knee motion, it goes without saying, if the mechanics on one end are insufficient the compensation is going to have to come from somewhere, the ankle or the hip. a knee issue is never just a knee issue for this reason.

have you been rolling the lateral thigh? any deep tissue work? do your hip move symetrically with the same quality of motion, extension and rotation especially?

[tone capone]

I really appreciate you trying to help me out. I know there is not much you can do, I think I'm gonna have to visit a different therapist soon. I really don't feel like I got the best possible treatment from the one I went to. I haven't been and never did roll my lateral thigh, never had deep tissue work, can't really tell on my own what my hips do and don't do. I need a full second opinion and evalutaion at this point I think.

Just one question for you though, do you think me losing a majority of my lateral meniscus could be what is causing the pain or does that usually take a few years of abuse if you still have good cartilage? That is the question my doc or my p.t. always gives me the runaround about. I feel like it's pretty straight forward, they chopped out basically my whole lateral meniscus, am I just fucked? Should I really be skiing on it if I have what feels like bone on bone pain in that spot?

It would be nice to know if I am just fucking myself up for the future, considering my doctors only advice was to "ski thru the pain and don't worry about it".

Could this pain be a sign that what's left of my cartilage is inadequate for the impact and stress of skiing?

It just doesn't feel like pain I should ski through when all the muscle fatique is in my good leg and I can't bear any weight at all on the bent surgical knee.

[bendtheski]

tone,

Well, it didn't take too long for me to realized I'm probably beyond my depth here. http://www.tetongravity.com/forums/m...p/11268-drmark has posted up some good info around here and might be able to offer some additional insight.

[kingdom-tele]

I know the frustration man, both personally and from a professional vantage. with re: to the meniscus issue, it certainly changes the joint mechanics, but IMO, is a moot point until you get the lateral thigh dynamics balanced out, soft tissue restrictions alter the joint torque so much that it would be impossible to say definitively if it was the loss of the meniscus. either way you shouldn't being skiing through, walking through, or trying to get off the can with bone on bone quality pain, your body communicates, its our choice to listen or not. if you can regain symmetry in the lateral thigh length, hips, and medial thigh stability and still have the same quality pain in the lateral fem. condyle, then yeah, f- it, ski it till you need a unilateral replacement, but that bridge is a ways off.

google foam roll technique, it works for a variety of lower leg tissue restrictions

when/if you get a second opinion, get what you need, bodywork is not a dictatorship

[Mofro261]

I really appreciate you trying to help me out. I know there is not much you can do, I think I'm gonna have to visit a different therapist soon. I really don't feel like I got the best possible treatment from the one I went to. I haven't been and never did roll my lateral thigh, never had deep tissue work, can't really tell on my own what my hips do and don't do. I need a full second opinion and evalutaion at this point I think.

Just one question for you though, do you think me losing a majority of my lateral meniscus could be what is causing the pain or does that usually take a few years of abuse if you still have good cartilage? That is the question my doc or my p.t. always gives me the runaround about. I feel like it's pretty straight forward, they chopped out basically my whole lateral meniscus, am I just fucked? Should I really be skiing on it if I have what feels like bone on bone pain in that spot?

It would be nice to know if I am just fucking myself up for the future, considering my doctors only advice was to "ski thru the pain and don't worry about it".

Could this pain be a sign that what's left of my cartilage is inadequate for the impact and stress of skiing?

It just doesn't feel like pain I should ski through when all the muscle fatique is in my good leg and I can't bear any weight at all on the bent surgical knee.

Tone, on my last round of ACL injury/replacement, I wiped out the majority of my medial meniscus (bucket handle tear). It's been ~3 years post op and my knee still hurts on the medial side, midline of the knee. Not all the time, but all it takes is one good smack and the knee will stay sore for a week. Skiing hard, icy snow can do this to me, running on pavement, even yoga stretching (lotus pose/sitting crossed legged causes pain). Just not enough padding in there to prevent bone-bone contact and potential bone bruising, and then the pain is carried over into everyday activity aka simple walking. Soft snow is not a problem, or more precisely a lack of soft snow is the problem. Like you I went back to the doc at one point and he kind of brushed it off, said I could get an mri if it persisted/got worse.

While there's a chance your pain is from misalignment/ biomechanical, there's a good chance that without that shock absorber in there it's just hard to prevent the pain from re-occurring. I've had multiple ACL tears and have been able to ski without an ACL, and recover 100% from reconstruction previously-hell I took up marathon running in my late 20's after the first 2 without any adverse affects.

But goddamn do I miss that meniscus.

[tone capone]

Not all the time, but all it takes is one good smack and the knee will stay sore for a week. Skiing hard, icy snow can do this to me,

While there's a chance your pain is from misalignment/ biomechanical, there's a good chance that without that shock absorber in there it's just hard to prevent the pain from re-occurring.

Thanks, exactly. There's probly a chance that one is making the other worse, and I'm gonna do all I can to minimize it at that end. The appropriate P.T. and soft snow should be my priority at this point.

It's just so weird feeling like all of a sudden, everthing was gonna be on a positive progression. Mindfucked.

Thanks again for the advice and opinons, it's worth alot to me.

[skioride]

Fuck TC I am at 6 months next week. Doctor has cleared me for all activities although running is still a bit gimpy and hindi squat is still stiff. I hope to at least try and see how the knee holds up on the slopes in a few weeks but I'm not so sure after hearing of your issues. I might give it a shot on a blue groomer in a few weeks to see if the knee feels sound. My doctor is completely against knee braces but I don't think he's a skier. He said knee brace don't necessarily protect you from future ACL injuries because of the awkward nature of the injury. I'm a little confused.

[tone capone]

2 weeks no skiing for me, only doing straight leg raises with some weight, hamstring curls, hip abductor and adductor strengthening. My envelope of function is walking, and that's it. I could do more without pain 3 months post op than now. Pain worse than the last day I tried skiing, can't put any weight on the bent knee at all or it just seems to aggrivate it. I am super pissed at my doctor for A: Giving me the complete b.s. runaround about my meniscus damage, and B: Telling me to push through this pain and blowing it off like nothing. I better not find out I fucked the rest of my cartilage or something else I should have known about instead of getting the 30 second treatment from that meathead.

I really don't wanna go back to him and spend 500$ on a bullshit visit and useless x rays, I really don't know what the fuck to do at this point, this is completely abnormal and unlike anything I have experienced since about 10 weeks post op. I guess I could go blow a grand or more on an mri. to find out if It will be wise to ever ski again or not.

[bendtheski]

FKNA tone, I'd be pissed too. It's not even about not missing much at this point, I think most of us would expect to be pretty much out of the woods by the time we're where you're at.

I really hope things improve for you before you have to sink a whole lot more money into it. This shit gets expensive!

[Cedrik]

That really sucks, tone. Missing some skiing is one thing, being misdiagnosed is way worse. I'm confident you'll ski again. At least the winter has been terrible (well, around here).

[FreakofSnow]

Tested my 9 month and a couple week old ACLR on my right knee over the last 4 days of skiing. It started dumping earlier this week in Missoula and didn't let up until last night. I couldn't be happier with the way my knees held up for rallying all day for 4 days straight, and in the heavy Snowbowl pow.

Here's to squats and lunges!

[tone capone]

Sorry about the tantrum, I am getting used to just chilling now... Just gonna wait it out, wait for myself and the snow to get good. I am in the waiting zone now. If I can skin around and ski me some pow come March and April I'll be stoked agian. If not at least I can likely ride my bike this spring. It's hard those first few weeks, coming to terms with the gimpness again. Kinda like withdrawl or somethin.

[Cedrik]

It finally snowed in Mammoth, indeed it was dumping in Bishop this morning, so I figured I'd inaugurate my repaired knee (now at 9 months post-op).

It felt awesome to ski again, despite the howling blizzard. Although the doc said groomers only for a while, there was so much snow on-piste it was more a mix of 3" to 6" of powder over base and cut up pow.

My Donjoy Armor brace fits well, though my repaired MCL is a bit sore now, like when your hips get sore the first backpacking trip of the season. I could feel the harvested hamstring a little, but it didn't cause any problems. I can't wait for next weekend to do some more!

[Piggity]

Nice cedrik, this weekend at mammoth was my first time going off groomers, felt good to get some fresh snow

[zion zig zag]

I'm at 5 months now and have been skiing a few times. I usually only ski about 4 or 5 runs before I call it and I'm trying really hard to dial it back although it's hard because it feels so good. I did venture into the soft crud yesterday for a few runs and it felt strong. I'm wearing the donjoy defiance. With the complications I started with I can't believe it's doing this well.

[bendtheski]

I posted this in the 2012 thread, but it's probably a better question for the Class of 2011 or earlier.

The ortho talked a little bit about the purpose of PT yesterday. He said my/your original ACL is wired into the brain via nerves. Once you've torn and replaced it, even with your own tissue, the connection to the brain no longer exists.
The purpose of PT, aside from regaining strength and range of motion, is to learn to control your knee, leg, balance, strength, etc. without the benefit of that neural connection.

I guess I hadn't thought it through to that extent, but it seems to make sense. My knee might have some ligament that will function like an ACL, but it's not "factory original". Fortunately, I know a bunch of people that still rip even on their "aftermarket" ACL's! Many of whom have come back stronger, and minus some of the bad habits that might have contributed to their getting injured in the first place.

I can go on forever, but I'd like to hear from some folks who've been back skiing for a while. How much of a setback was the whole experience? Lessons learned, mistakes made, gains made, etc.

I'm sure everyone comes back a little bit different, or a lot. Just thought it would be interesting to know what the full spectrum of possibility is when returning to action, and what advice you guys might have to offer.

[tone capone]

As far as the stability part goes, I thought mine was working as close to 100% as I could be able to tell at 10 months out. I thought I was skiing as good if not better and smoother than ever before, but then this combination patellofemoral/alleged It band pain has got me less functional than 3 months post op.

I will say, my leg felt like a complete wet noodle those first three, four months. I found it hard to believe it could ever be used for skiing again, so don't be surprised if you have those same doubts. I wouldn't have skied very hard at 6 months, either, that's for sure. Overall though I was really amazed and satisfied with how much control and proprioception I gained back by 8 or 9 months. I almost think this made me overconfident and allowed me to aggrivate the shit out of my knee while it was still vulnerable because of muscle imbalance, I think.

As far as set backs, lessons learned etc, just make sure you therapist is doing everything possible to prevent patellofemoral pain and I.t. band pain issues. Make sure you don't push (squat. step up, lunge, leg press) through either kind of pain, and make sure that you understand very clearly the types of imbalances that can lead to those issues before they rear their ugly heads. VERY difficult to get these things under control once they get their grip on you.

Take it from me, the best acl reconstruction in the world ain't worth a shit if you are in crippling pain any time you put weight on a bent knee. Out for three weeks now, no decrease in symptoms, sitting around doing p.t. all day for the second season in a row. You don't want to be where I'm at.

[Piggity]

Bend, there are people on here much more knowledgeable than me on the subject but my guess is your PT is referring to proprioception. (defined as the unconscious perception of movement and spatial orientation) Example, If you're not paying attention and walk off a curb in the dark, proprioception would allow you to anticipate the landing and fire your muscles to avoid sub laxation, rolling an ankle or even falling. You can train your muscles to fire subconsciously, it's the only way I've been able to go so long without my ACLs attached. Again, I'm far from knowledgeable on the subject but that's my best guess at what your PT was referring to.

[kingdom-tele]

pretty much piggity, definitely not a subconscious function though. it is your ability to comprehend the spatial and temporal changes of "body" position. it incorporates structures ranging from single neurons to complex muscle synergies. using your example proprioception would be used to inform your higher control center on limb position so it could make the necessary adjustment in position to prevent the injury, the proprioception is only a component of the protective mechanism, the anticipation is actually another component of motor control from another place in the brain. its really quite a process that occurs in msec's, friggin amazing development really. with regards to the ACL specifically, or any other ligament, a tear disconnects the receptor for that ligament to the brain as bend mentioned. ligament receptors are somewhat unique, they only communicate one way, there are no effector(from brain to lig.) pathways, again, pretty incredible evolution as the ligament is not a tissue that can contract, no wasted effort. haven't read any long term studies that look at the reinnervation, curious now though. no worries though, the receptors inthe joint, meniscii (if you have them), tendons, muscle fiber work just fine, rehab is really trying to make them super efficient. it really is phenomenal, to me at least, the amount of shit happening with every move we take for granted, injury and rehab, while obviously not wanted, is really a time you get to appreciate how intricate the whole act of movement is

ETA: quick lit review, and yep, some type of afferent(lig to brain) pathway is reestablished, 6-18 months p op. as a side note, thought it was interesting that even in a percentage of subjects with torn cruciate's still had receptor function, maybe why some with confirmed tears are better high level compensators, anyway

keep moving.

[bendtheski]

it really is phenomenal, to me at least, the amount of shit happening with every move we take for granted, injury and rehab, while obviously not wanted, is really a time you get to appreciate how intricate the whole act of movement is

This

Great responses from all you guys! Kingdom really sums up what I've been feeling for the past few weeks. While I'd have been just fine remaining ignorant of all the minutia surrounding acl replacement surgery, it's really fascinating stuff and a great way to occupy downtime. I've also been really impressed with my OS's efforts to explain all that's been going on in layman's terms, and for taking the time to do so.

[skioride]

I'm at 6 months now and I'm really hoping for the same results as Zion is having. I'll be skiing in the next 10 days. I'm not going to push it and I expect short days with plenty of extensive workouts afterwards. Hopefully it doesn't hurt too much so I can continue PT after short ski days. I hate it for you Tone it sounds like something more is going on with your knee and for your doctor to say ski through it sounds incompetent.
A second opinion might be on your horizon. Good luck.

[tone capone]

See my thread about transverse femoral implant prominence, aka screw backing out of femur causing i.t. band syndrome-like symptoms.

I am sure now that this is my problem, my symptoms match those in the case studies perfectly. Keeps getting worse despite appropriate p.t., I'm going in there to demand the femoral screw be taken out or I'm going to someone that will. Enough with this bullshit.

[wolfelot]

See my thread about transverse femoral implant prominence, aka screw backing out of femur causing i.t. band syndrome-like symptoms.

I am sure now that this is my problem, my symptoms match those in the case studies perfectly. Keeps getting worse despite appropriate p.t., I'm going in there to demand the femoral screw be taken out or I'm going to someone that will. Enough with this bullshit.

Dang Tone, I never even thought about the possibility of a screw backing out. I can see how that would be extremely painful. My ACL screws are biodegradable, though I don't know how long it will take for them to disappear.

[tone capone]

Actually, it sounds like those are more often the problem ones. It's not very common, but I have all the symptoms 100% right on. Check out this article:

http://www.orthosupersite.com/view.aspx?rid=77621

[Cedrik]

http://www.orthosupersite.com/view.aspx?rid=77621

That's a real bummer. Probably the worst part is how often the article says "avoidable," although it doesn't really go into much detail on how to avoid it. Good luck, man.