ACL Class of 2012

[bendtheski]

Quick update:

Now 20 days out of surgery. I went to see the ortho for my 2nd follow up yesterday. There's still a fair amount of swelling, pain and numbness just around and below the main incision below the knee. Doc says that's to be expected because that's the site that all the instruments are inserted through, and from which the hamstring graft is harvested during surgery. I've read that one of the main advantages to arthroscopic surgery is less damage to connective tissue, but there is still some damage which contributes to the numbness, pain and swelling. It's far less swollen and painful than it was a week ago, so the good news is, it gets better!

Flexion is around 105, and no real problem getting to zero or a little beyond. Doc did a couple of strength and stability checks and says he's real happy with the progress I've made in less than three weeks!

I've been hitting the rehab pretty diligently and have increased my time on the bike from 5 to thirty minutes/day. All really low resistance stuff at this point, and some of the exercises are more difficult (and painful) than others, but hopefully I'll be able to prevent my VMO/quad from completely wasting away in the upcoming weeks, while increasing strength and ROM.

Doc’s going to have the PT step things up a bit, which is sort of a mixed blessing since as I said, some of the exercises are damn difficult and painful! Just gotta keep my eye on the prize and work through it I suppose.

I'm trying to focus on not walking with a limp, but it's difficult. My calf and hamstring still get pretty sore, 1. because the hamstring is where the graft came from, and 2. because my calf is doing extra duty while I walk around favoring my knee.

I said quick update, didn't I? I lied. Just thought some folks might appreciate knowing what to expect, or at least one possible scenario.

Have I mentioned that the Aircast Cryo-Cuff with intermittent compression is mankind's single greatest invention? Ice>Percocet!

[bendtheski]

Almost forgot; 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 actually seems to make a lot of sense. My knee might now 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.

[bendtheski]

Update from last week:
I went to the PT today and she measured me at 135 flexion, 4 weeks out of surgery. The area around the main incision still feels pretty numb, but the pain is getting progressively better, and the knee more stable and stronger. I'm finally feeling a little less spastic on the balance exercises too. I made a comment the other day about being tired of feeling like I'm walking around on someone else's leg! I'm sure the awkward, clumsey feeling will go away over time, but it can be pretty frustrating being hobbled when you're not used to it.

[aaskybabe]

Hi All,

I've been reading all the ACL rehab stories and I am so glad I found this site...

I tore my ACL, meniscus and fractured my Tibial Plateau on January 8th...I was thrown from my horse. (I really didn't even think it was that bad a fall. Boy, was I wrong.) Anyway, I went to 3 OS before I found one who didn't scare me to death. (One wanted to put plates and srews in my tibia, the second wanted plates/screws and 2 surgeries...to let the fracture heal first, then do ACL surgery...and the third said all I needed was a srew for the fracture.)So I went with the one who didn't want to put a plate in... and he fixed my ACL at the same time (allograft).

I had surgery on Feb. 1st... I got the nerve block before the surgery. Thank gawd for that...I didn't have any pain for 2 days due to that. And I stopped taking Percocet on Sunday. (I do not like what it does to me..ugh. Although it does work great for pain... I question the side effects. And the days pass really quick when your on it)

Anyway, I've been to PT 2x, I have a CPM, and ice packs. I can bend my leg to 90 (flexion) I'm not sure I'm at zero extension though. And my knee doesn't look near as bad as I expected. Although it's pretty swollen and I have no quad muscle left. I can now bear weight on my leg but I'm not supposed to put all my weight on it yet. It's still very tight when I try to bend it past 90... and a little pain. So we will see how it goes.

I can't go back to work at all until I can walk without crutches or a cane...probably no brace either. And I am so hoping I'll be as strong as I was before. I want to do all the stuff I did before (horseback riding, surfing,biking, etc.)...

I have PT tomorrow and I think it's going to be a painful day (sigh)...

[bendtheski]

aaskybabe,

Welcome. It sounds like you're right on target with your range of motion, etc. The tibial plateau is an added complication that I was lucky enough to avoid. A friend had a similar injury and his OS made him wait until the tib healed (4 or 6 weeks) before doing his acl. He did hamstring same leg auto. I don't remember if his tibia required any hardware, but he was on crutches for several weeks post surgery, where I was hobbling around on my own in just a couple of days.

x2 on the percocet. I tried to get off it as soon as possible, but sometimes it's just more important to get a good night's sleep so I used as necessary for about 2.5 weeks. Ice is really you're best friend. It not only releives the pain, but also reduces the swelling that can contribute to more pain.

My OS sent me home with an Aircast Cryo-Cuff with intermittent compression. I highly recommend if you don't already have one and can get your OS to write you a script or whatever. It doesn't quite reach the back of the knee, so I put a reuseable ice pack on the back of the knee and then wrap the cuff straps around to hold it all in place. The whole set-up keeps me in cool comfort for about 6 hrs, and really helps keep the pain and swelling in check.

Good luck with your recovery and feel free to post progress, questions, concerns, etc. I sure as heck don't know all the answers, but someone with a clue might be able to contribute something useful.

FWIW, my friend with the tibial plateau fracture and torn acl was back to skiing 6-7 months later, and pounding moguls within about a year. I don't see why you shouldn't be able to return to 100% pre-injury activity or close to it, but of course it varies from one individual to another.

[ikkin]

i'm in the club. also in the class of 2007. blew right knee just before christmas. same exact way i blew my left knee- playing soccer. injury is eerily similar- clean tear all the way through, no other damage. wrote up a big 'ol thread last time, not sure i'll do it this time. NOT looking forward to surgery, which is scheduled for february 23rd. oh well. we'll all get through it and be back out there soon enough. hiya, class of 2012!

[bendtheski]

PT got me to 142 flexion this week 5 weeks out of surgery.
Should I list the 20+ excercises she has me doing, or is everyone already familiar/doesn't want to ruin teh surprise?

Welcome ikkin!

[aaskybabe]

Thanks for the welcome BTS (Bendtheski) and thats great about 142 ! Is that the same as your other leg?

PT the other day was indeed painful...but today when I went, I almost jumped off the table. It's funny now... all therapist's must have some small sadism thing going. My therapist was trying not to laugh. (HA)

Anyway, he measured my flexion today,it's 124 and my extension is zero. It's hard to be happy about my degree of flexion when it hurts while he's measuring it (My TPF was on the back outer corner... left knee)My right leg(the normal looking, uninjured one measured to 142.)

The therapist said he would get my knee to 142... which is fine, i guess. I can bring my right calf all the way against my thigh if I just reach down with my hand and pull it there. Thats what I would really like... is that possible? I guess I'm just worried if I kneel that I will have one leg that bends all the way flat and one leg that doesn't. (Which would suck...)

And I've stood with both legs straight, weight evenly distributed... and my left leg is still pretty unstable. Especially when I go to lock my knee. Is that normal? To be unstable? I'm hoping it will get more stable... and this isn't something I have to learn to live with.
Bendtheski:
"PT got me to 142 flexion this week 5 weeks out of surgery.
Should I list the 20+ excercises she has me doing, or is everyone already familiar/doesn't want to ruin teh surprise?"

You have 20 exercises??? I have like 4 so far. And I'm not allowed to walk with my brace unlocked. (Ugh) I also have to sleep in brace...which is really, well... it sucks. I might need percocet to sleep. I don't have much pain...Or do you get more pain as you progress thru PT?? Does everyone have to sleep in their brace? I realize I only had surgery a week ago(last wednesday) but I'm ready to lose the brace. (Oh! and this is the long brace...from ankle to thigh)

I walked around the block yesterday(with crutches)...about halfway around I realized this was probably too far. But at least I did it...even with about 2 stops.

BTW, bendtheski, how long have you been going to PT? Did you go right away after surgery?

[ikkin]

so my ortho tells me i'll be walking out of surgery without a brace OR crutches. graft will be allograft. does this sound familiar to anyone? last time i crutched out with a full leg brace, which was set at zero for a week. so the prospect of having no brace immediately after surgery is scary as hell. am i just out of date? is this standard practice these days? please advise!

[bendtheski]

aaskybabe,
Lots of questions... let's see, my other (left) leg must go beyond 142, because it looks like I can flex it at least 10 degrees more than my right, but I've always had really good flexibility that way. I saw my ortho today (six weeks out of surgery) and he says I'm doing great, but would like to see me get 10 more degrees. He just eyeballed it, but said I was probably at about 135. The PT actually used the measuring device last week, but I had also warmed up and stretched a little which would probably explain the difference (she said 142), plus I've been sick as a dog with the crud for the past few days and so slacked on the PT a little.

The day of surgery they fit me with an immobilizer, pretty much just for the trip home. My ortho said he wanted me weighting the surgery knee fully (within reason) day of, and only using crutches if I felt wobbly thereafter. I guess the whole idea of surgery kind of freaked me out so I was pretty hesitant to put full weight on the knee, or attempt to get around without the crutches, brace, etc. but those things are a pain in the ass, and by day 3 I just said fuck it and hobbled around on my own as best I could.

I went back to the ortho on day 4 for follow-up and he gave me the green light to start PT. I think I saw the PT for the first time post-surgery (I had already been going for a month pre-surgery) on day 5. She started me off with some pretty basic stuff, actually more of the same that I had been doing pre-surgery; straight leg-lifts, quad sets, a little bike with no resistance, very light squats, calf and hamstring stretches, and not much more.

Since then she's/I've added;
4 direction straight leg-lifts with up to 4lbs ankle weights.
30 minutes on stationary bike with low resistance.
Squats with low weight.
Hamstring curls with low weight.
Hamstring extensions with low weight.
Rubber band drills: wrap band around leg of table and bad knee, balance on bad knee and flex both towards and away from rubber band anchor point.
Wrap band around good leg and balance on bad knee while pulling against band with good leg in 4 directions.
Wrap band around ankle of bad leg, sit in a chair and pull back against band (hamstring targeting).
Balancing on bad leg and touching floor in front of and 45 degrees to either side of bad leg.
Eliptical with very low resistance.
Treadmill at walking pace, forward and backwards.
Step-ups and step downs.
And finally, my favorite, the balance board; side to side and front to back.

I think a lot of my PT is targeted at rehabing the hamstring since that's where the graft site is. I suppose if I had gone with cadaver, I could have spared myself a lot of the hamstring work and focused more on the knee, but it's not really a big deal, and I probably need to get in the habit of focusing on the hammies a little more anyway. They've been getting progressively tighter on their own as I approach 50, so these excercises will probably come in handy in the future even if the knee is fully rehabed.

So I think that's everything. I actually like the balance excercises the best, although at first they were the most difficult and painful. It's really good to see the progress when they become easier and less painful. The balance board is probably the closest sensation to actually doing something fun like skiing. My brother bought me a Vew-Do balance board for Christmas, but the PT and Ortho say to wait until at least week 8 or 10 before taking on anything that ambitious. What I've been using is just a piece of plywood with a 2x3" screwed to the bottom. The Vew-Do has a rail and rock set-up which is significantly more challenging, but should provide some great balance work when there's less danger of fucking up the graft.

This is the underside. You stand on the other side, duh!



ikkin,
I think I pretty much answered your question above, but just to reitterate; I think it varies depending on your injury, your doctor, your surgery, and maybe a whole bunch of other factors, but yeah, at least in my case, no brace, not really any crutches and pretty much immediately full weight bearing. It just took me a couple of days to get used to the idea.

Good luck with your recoveries y'all!

For those about to tear, we salute you!

[PowderSpectral]

Moved to Jackson to get big balls and instead got big bills. haha. New Years Eve never seems to be a good day for me. Torn Acl completely with Meniscus damage and bone contusion from my leg twisting. Feels a little better everyday. Dr. Rork did it here in Jackson. Had surgery as soon as I could to aid in the Meniscus recovery. Jackson Hole PT is the tits.

Working on setting up the post college career in finance. Not sure if i want to go back to the city though. The couch and gym are getting pretty boring.

[hick]

Joined the club last Thursday. Blew my ACL and more than likely MCL also (I'll know how bad on Thursday when they look at the MRI from today). Did mine sledding, but I always thought I'd do it skiing. Holy shit was that a painful ride out, 16 miles total with 12 of it off trail boondocking and only my partner and my tracks to follow. Nothing quite like riding wrong foot forward with all your weight on a blown knee! Side hill, switchback, sidehill, repeat....Ugh.

Some good info in this thread, guess I'll be checking in quite frequently now.
Good luck all you fellow gimps!

[bendtheski]

Right on Hick. I was skiing LL pass when I blew mine. About half way down.
That ski down to the car on a blown knee (and having it go out of joint a few more times) was by far the worst and most humbling moment of this whole episode, although returning to skiing will likely be pretty humbling too.

Welcome, along with PowderSpectral, and good luck with your recovery!

[gato_loco]

Joined the class of 2012 on Jan 15, left knee. Hit a rock up at Big Sky and popped the ACL. Surgery was on Feb 6th, and since then I've been working on my flexion and extension. Currently at around 110 for flexion, 0 for extension. Back into the PT office tomorrow so hopefully I've been able to get it a little further in the flexion category. Trying to stay positive and hoping to be back to full speed for the climbing season, followed by a full winter of fun in the snow. Thanks for sharing the info, look forward to reading more as my recovery progresses.

[skioride]

Please please please please find a new PT, you should not be pushing through anything. The collagen in tendons actually changes structure and vascularization during tendinosis which can be a serious condition...

This is sound advice: My doctor who does professional basketball players told me that the injury ACL isn't completely healed for 6 months no matter who you are. In the Super Bowl there were 2 Giants that tore their ACL's and their prognosis is that they won't be ready for the beginning of the regular season and that is 7 months away. And we're talking about pro athletes that have much better PT than we can ever expect to get. Range of motion, strength and stretching are all you need to concentrate on. I started taking spinning classes about 2 months post op and that helped with leg strength. Don't be in such a rush to shed your crutches full time. Jelly leg will happen at odd times and I brought my crutches when I was in very crowded places because I didn't want any inadvertent body contact. When you can walk downstairs without any difficulty you should be good to go without crutches. I'm not saying you'll need to use them all the time but they are a safety parachute.
Good luck! I just had my 2nd day on the mountain today 6.5 months post op and it was awesome. No setbacks and only felt pain when I really dug my edge in but I never felt unstable.

[bendtheski]

This is sound advice: My doctor who does professional basketball players told me that the injury ACL isn't completely healed for 6 months no matter who you are. In the Super Bowl there were 2 Giants that tore their ACL's and their prognosis is that they won't be ready for the beginning of the regular season and that is 7 months away. And we're talking about pro athletes that have much better PT than we can ever expect to get. Range of motion, strength and stretching are all you need to concentrate on. I started taking spinning classes about 2 months post op and that helped with leg strength. Don't be in such a rush to shed your crutches full time. Jelly leg will happen at odd times and I brought my crutches when I was in very crowded places because I didn't want any inadvertent body contact. When you can walk downstairs without any difficulty you should be good to go without crutches. I'm not saying you'll need to use them all the time but they are a safety parachute.
Good luck! I just had my 2nd day on the mountain today 6.5 months post op and it was awesome. No setbacks and only felt pain when I really dug my edge in but I never felt unstable.

That's a good suggestion about bringing the crutches along to crowded places. You might be solid as a rock on your new knee, but you're probably still vulnerable and people around you have no way of knowing that before bumping into you.

Hell, I might just bring along the crutches to the next Av's game I go to and see if it gets me any special treatment!

[aaskybabe]

Hi All,

Well I saw my OS on Monday and he told me I did NOT have a Tibial Plateau Fracture... not even a dent!!! (HURRAY) Keep in mind my MRI and CT scan both said I had a tibial fracture... Unbelievable. (Although at some point during all this, I did have someone, a nurse, tell me sometimes MRI's are wrong.) Anyway, I have pictures of my surgery now...very neat. The OS fixed my torn meniscus, and said my femur had a rough area...so, since he was in there he fixed it.

At PT last wednesday, I rode the bike for the first time...that was ok. Until about 530 pm then my knee hurt when I put wieght on it. This lasted for about a day and a half. Told the PT when I saw him next, and he said that was probably the area with the repaired femur. So no more bike for me until that bone is healed... UGH. I can still walk...so I do...around the block.

Today my brace was finally unlocked...so I can walk around somewhat normal with it on... but I have come to hate the brace. I got measured for my "functional" brace on Friday...I'm hoping it will be easier to wear. But we will see.

I'm starting to get a little worried about my knee... it's like it's not my knee. I have to "think" about locking it when I walk. Does that go away? Or does it stay this way?
I did balance exercises today and it was difficult. I actually couldn't do one of them because my knee was so "wobbly." Oh well... on I go, to PT anyway. I'm starting to get bored since I can't go to work... ha (never thought I would say that.)

Anyway, thats my update for now.

Bendtheski, you sure have alot of exercises. I have like 8...do you think you have so many due to the autograft?? (I had an allograft)

[bendtheski]

aaskybabe,

The OS and PT have both told me a bunch of the excercises I'm doing are specifically to rebuild the hamstring after the graft harvest. I don't think it's quite half, and I was warned about having to do additional work to rehab the hamstring, in addition to all the other stuff that shuts down after injury/surgery. From what I've read the success rate is slightly better with hamstring auto VS allo. My OS mentioned something about cadaver tissue, having been frozen and irradiated, having less elasticity than live tissue. Of course it's questionable whether my 49yo tissue has much elasticity left either, but then there was the rejection potential and possible disease transfer associated with allo...
I weighed the options and went with what I was comfortable with, but I don't think there's a right or wrong answer on graft choice, but choosing auto does increase the amount of rehab necessary.

FWIW pretty much every one of my friends who's had acl surgery told me to go with cadaver tissue because they've had great success with that type of graft. I actually took a risk doing auto because if rehabing the hamstring becomes an issue, I'm not going to get any sympathy there!

I posted the same sentiment about the phantom limb sensation. I'm only seven weeks post surgery and people's progress varies, but I can say for myself that it's beginning to feel more like my leg than someone else's. The balance excercises are getting easier and less painful, and the numbness less noticeable. Stability has improved a ton too! Apparently the main incision cuts through a few nerves, and I'm not sure if they ever recover 100%, but I'm guessing it's pretty close.

I hear ya' on the boredom. OS and PT said I can start riding a non-stationary bike at 8 or 9 weeks, and I just put studded tires on the mountain bike! I'm not taking any chances of wiping out on ice and f'ing up my graft, but I haven't gotten any outdoor excercise since I blew my knee on Dec. 2 so I can't wait to get out and ride! (cue record breaking snowfall).
All the non-gimps totally owe me if it starts dumping around week 8.5. That'd put it about March 3rd of 4th. Mark your calendars!

[LoMayn]

Heyo. Long time TGR reader but finally decided to join to start talking to this group. All these threads have been super helpful in navigating my upcoming surgery.

Blew my ACL, MCL, and LCL last Friday skiing in Canada (on my honeymoon...at least I got in 6 good days). Saw a doc up in Vail on Wednesday, and trying to get to surgery next Thursday if I can get to 120 degrees on my knee. He is suggesting allograft, as I already have to heal three things and adding a 4th (hamstring) might be a bit much. He's done a ton of both so he's comfortable if I change my mind. This is my first surgery, period, so I dont know much of what to expect. I ski, road bike, MTB, and trail run. Anyone think I should rethink the allograft? I'm perfectly willing to give it the full 9 months and be careful, so time isn't the issue. Just want to make sure I made a decision that will keep me skiing for 60 more years.

Thanks so much for having this thread - really helpful!

[leroy jenkins]

No worries dude, I have just finally got some things through my thick head this last week, I know what must be done now in my best interest. It is clear but sobering. There is nothing more I want in life than to be a skier again and to do that I have to come to terms with the fact that I might have to give up on the rest of this season. (For sure it will dump now).

A doctor can put a new acl in there and give you stability, you can work really hard at getting your strength back, but there are complications assocciated with the trauma casued by surgery and there is no way to predict how that will affect any given individual.

The best acl graft job in the world isn't worth shit if you can't bear weight on a bent knee without extreme pain after 10 months.

Listen to your body, not the hot therapist or the genius orthopod if they tell you to ignore kneecap pain. LAY OFF IT and do the other therapies that doesn't cause that pain cause you WILL fuck it up for the future.

I know your post was a while ago, youre in bozeman right? Bridger orthopedics right? I think thats the only game in town. I broke a bone in my hand and they were HORRIBLE. First they tried to sell me surgery like it was a used car, absolutely no regard to the fact that less invasive solutions are usually best, then when I decline they put me in a huge heavy cast that obviously torqued my hand into an unnatural position, I tried holding my healthy hand in the same position and THAT was uncomfortable for even a minute. So after a completely sleepless night in tons of pain I went back to get the cast off and not only did no one apologize, I was extremely patient and the dr kept me waiting for 2 hours, when a nurse could have easily just cut the damn cast off, first thing out of the DRs mouth when he finally showed up is how I was wasting his time and he had people with real problems to deal with. He told me he was sure the only reason I was there was to try and get him to write me a bigger scrip for oxy (i was complaining about the pain from the cast) and said he'd do that but didnt want to give me a new cast. A couple minutes of arguing with him and he finally conceded to cut the cast off and give me a brace instead.

Cant remember his name but I will never never go there again. It wasnt just the DR either the nurse who put the cast on was obviously incompetent. The nurse who cut the cast off and gave me the brace was very nice and apologized for the other stuff but still, that place was a nightmare.

And yea, I'm part of the class of 2012 now too. If anyone has any recs for SLC orthos I'm listening.

[tone capone]

Yeah, I guess this is where all the arrogant young docs come to practice on us mouth breathing rednecks before going to a big city where they might actually get sued for fucking you up. Pretty fucking sweet to miss two seasons for acl surgery. I've been sitting around my house doing nothing but p.t. for two months now with no results. Doc from Bridger says no swelling means nothing wrong and I should just ski on it even though it hurts. Too bad my muscles totally shut down in that leg cause of the pain when it's triggered. He even has the nerve to tell me "don't worry, you're not damaging anything".

I went to a new p.t., but I have the sinking feeling already that it's just another case of them wanting me to -believe- what they're having me do is helping. It's getting really fucking old sitting around doing quad contractions and leg lifts with no results, no progress other than the further tightneting of my vastus lateralis and therefore the further aggravation of my symptoms.

Ahhh, Bozeman. "The most liveable city", unless you gimp yourself. At this point I regret ever getting this surgery. I could have skied without an acl before I could ski in this miserable chronic pain.

[LoMayn]

FWIW, a flight to Denver from Bozeman is about $250. Might be worth it to get a second opinion from a great ortho, and get him to write a really clear scrip for your PT. No use in all the work if it's not getting better.

[leroy jenkins]

That is really shitty tone, I hope like hell im not in your shoes in a year. I second waht lomayn says, gtfo of there. Its a great city to live in but you need help those hacks cant give you. Wouldnt hurt to at least have a phone call with some docs in denver, slc, etc.

[tone capone]

Sorry to be Debbie Downer guys, only a 5% chance you'll end up like me so don't let my experience discourage you. I just wish more than anything that I could figure out how to get this thing under control myself by doing p.t. That's all at least 4 medical professionals say is an option for me so far, but I just wish I could figure out either where I went wrong or what excercizes to do to get it better. If I can't get through bike season then something is definetly very wrong and I'll take a flight to a place with real doctors for my next surgery.

[bendtheski]

LoMayn,
I don't think there's a wrong answer. I know plenty of people who've done just fine with allo.

Tone, I don't know if it will help any, but if you haven't already, check out the exercises I listed a few posts back and maybe see if there's some you want to include in your routine. I started doing one the other day that seemed easy before surgery that is now just about impossible (hamstring curl on bench on my stomach). This tells me those muscles are incredibly weak post-surgery and I need to focus more on that particular exercise than the ones that are easy to do. Seated hamstring curls are no problem, so I don't think they're doing enough to specifically target the muscles most adversely affected by the surgery.
Just a thought.

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