ACL, MCL, and menisci tears

[Jeb McHardman]

I found a couple older threads dealing with this issue, but nothing recent, so I figured I'd start a new one.

I fully tore my ACL and lateral meniscus and partially tore my MCL and medial meniscus in a fall on April 6th. The medial meniscus is peripherally torn at the posterior horn, and the lateral meniscus is radially torn at the posterior root. I've been doing PT for about 2 and a half weeks and have regained nearly full ROM.

From the limited research I've done, it seems that meniscus repair (i.e., suturing) has become both more common and effective, especially for tears at the posterior root or horn. Has anyone here had this procedure and want to comment on how it went for them? Everything I've read about meniscectomies has scared the shit out of me, and I'm really hoping to avoid one.

I'm also interested in folks experiences in general with compound knee injuries: how long until you were biking or swimming again? running and skiing? climbing? Any long-haul issues that never resolved? Should I just sell my skis and go back to school (again)?

[stealurface831]

paging OG to the white courtesy phone.

[XXX-er]

the "coming off ACL reconstruction " is pretty good/ pretty accurate IME, you are looking at surgery & 9 months of rehab for the ACL (AKA not being a dumb ass) you might ski again next year

[Jeb McHardman]

the "coming off ACL reconstruction " is pretty good/ pretty accurate IME, you are looking at surgery & 9 months of rehab for the ACL (AKA not being a dumb ass) you might ski again next year

Yeah, I've been reading that thread pretty closely and have found some good nuggets in there. I'm honestly not too concerned about the ACL (maybe I should be?) as it seems that the surgery and recovery is relatively standard for that injury. The menisci worry me more, and it seems like there's less info and testimonials out there regarding surgery and recovery for athletes.

And yes, definitely taking the process as slowly as necessary--I'd happily forego all of next season and more if it's the difference between still skiing or not when I'm 70+

[XXX-er]

I thot the ACL was the more important part of the knee?

I never skied on a completely torn ACL but I did bike on it, the knee was way more painful with the completely torn ACL, right now I use no Meds I have NO pain, I would definately get AC reconstruction ASAP and i would use the same guy if i had to do it again

I believe they just trim away the damaged meniscus, i don't think they can reconstruct it altho I think meniscus repair is getting better ?

Buddy fixed the ACL & trimmed away some meniscus, I wasn't given the option on meniscus, he is a skier/ biker who also has a reconstructed ACL and sez i should be skiing with no brace this season

in the Canuckian HC system a new ACL is free but it takes longer to get an MRI & book the pro, it was about 8 months including COVID lockdown and then of course 9 months rehab,

IME/IMO get it done ASAP and you could be skiing next season

[thefortrees]

Wife fully tore acl and partial meniscus tear skiing in the first week of January. Surgery mid February. Hamstring graft of the acl and Suture repair of the miniscus.

Recovery coming along well, about 12 weeks out from surgery. Her leg can reach nearly full extension and flexion. Got off the couch as soon as possible and start doing core strength/upper body stuff. Just last week was approved for lightweight deadlifts, stationary lunges.

Doing easy road rides multiple times a week already ( 10 miles, flat/moderate climbs around 500ft). Easy mountain biking likely in a month.

Do as much pre-surgery strengthening and ROM as possible. spend focused time every day on the prescribed exercises. Push your surgeon and pt a bit and listen to your body... don’t be dumb but the docs will likely be extremely conservative in rehab treatment.

Still a long way out from full recovery but the level of activity she’s able to do without pain or rom limitation should give you some hope!

[splat]

I agree with you that the meniscus can be the sketchier of the repairs. I was basically crippled when the doc took 40-60% of my medial meniscus without first checking to see that I am bowlegged. I retore it five months after a bucket handle had been sutured when I jumped off a moving bike onto that leg. The result was devastating. Had I not gotten stem cells injected into that knee, I'd have had a TKR by now. I have heard that the meniscus will smooth itself out over time. I imagine that depends on the tear. ACL recovery was a piece of cake in comparison.

[XXX-er]

I told the PT a big auzy former rugby player/ skier/ biker I had dbought a Fat bike to rehab on "NO MATE, don't do that ! Have you got a stationary bike ? " he asked 3 times in 5 min and he gave me the stats on how many people wreck the knee surgery just putting one foot behind the other to pull off a shoe

" So what I hear you saying is that I have merely become an incubator for a piece of patellar tendon trying to become an ACL ? "

yeah! yeah mate !

I figured he was serious about no facking up the surgery so the last 7 months may have been facking boring but its been a text book rehab and i have no regrets

[Jeb McHardman]

Ha, that's a hell of a way of looking at it, XXX-er. I've been road biking for prehab but am planning on getting one of those funny conversion stands for rehab--no need to make the recovery more tenuous than it already will be.

Fortrees, that's all good info and very encouraging. Sounds like a similar injury to mine, so it's good to hear that they went with the meniscus suture rather than the meniscectomy. Was her tear near the posterior part of the meniscus? And yeah, I've been prehabbing as consistently as possible: 30 min bike ride, 30 min PT, and 30 min ice every morning and evening. Has made a huge difference so far in terms of strength and ROM.

Splat, that's my fear with the meniscectomy: 5 years (or less) to a TKR. Stem cells and PRP are intriguing, but I'm almost certain my insurance doesn't cover either treatment, so I'm really hoping the repair is viable

[XXX-er]

ACL rehab would be a very good reason to buy a stationary bike stand

the gym has been closed with covid but my PT has a leg press & stationary bike I was able to use for free all winter and its real close so I used their equipment just about every day some weeks

I tried to get out of the saddle yesturday on the road ride but my knee couldn't do it, my hills suck so badly i was 100's of meters behind the coach she said yeah hills are the first thing to go,

it was a tough ride ... the road back is sucking

[splat]

Ha, that's a hell of a way of looking at it, XXX-er. I've been road biking for prehab but am planning on getting one of those funny conversion stands for rehab--no need to make the recovery more tenuous than it already will be.

Fortrees, that's all good info and very encouraging. Sounds like a similar injury to mine, so it's good to hear that they went with the meniscus suture rather than the meniscectomy. Was her tear near the posterior part of the meniscus? And yeah, I've been prehabbing as consistently as possible: 30 min bike ride, 30 min PT, and 30 min ice every morning and evening. Has made a huge difference so far in terms of strength and ROM.

Splat, that's my fear with the meniscectomy: 5 years (or less) to a TKR. Stem cells and PRP are intriguing, but I'm almost certain my insurance doesn't cover either treatment, so I'm really hoping the repair is viable

Don't overtrain in any way that tears it again. XXX is doing it the way I should have.

[MagnificentUnicorn]

If they repair the meniscus it’s more successful when combined with a ligament reconstruction. There’s all kinds of inflammatory response and healing properties that happen with reconstruction. It sounds like the medial meniscus can be repaired but the radial tear laterally likely won’t heal if repaired. There’s no blood supply in the body of the meniscus.


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[Jeb McHardman]

Talked to my surgeon this morning. His read of the MRI is that neither meniscus is fully torn, so I'm hoping he's right and the radiologist is wrong. He also said he wouldn't even consider a meniscectomy for someone of my age (26) and background (competitive runner through college) unless it was totally necessary, which was interesting to hear. He recommended the patellar graft for the ACL because it includes bone on either end, which speeds up the graft/healing process, and it has the lowest long-term failure rate. Surgery will be sometime in the next couple weeks.

[Djongo Unchained]

Some of my ACL/Meniscus/MCL stories are in the other thread that XXX mentioned.
A lot like your scenario.

My Doctor pointed out that his read on the MRI is the only one I needed to heed. Not to belittle the radiologist but that's the deal.

I second the don't charge too hard, too fast on the rehab. Going slow will tend to heal best, going quickly will not only open the door to premature damage but a longer heal time as well. I skied carefully, but daily at 7 months.
This past season was my second on it and although it was decidedly better and stronger, it still wasn't as strong as I'd hoped it was. My fault for not working it out harder last off season.

And don't whack it on anything. I did at the end of both seasons and have put myself into reverse a bit.

Take the PT seriously, as in the do it at home part. 2 days in, I told my Therapist I wasn't gonna be a good homework type and she upped my visits to 3 days a week for 6 weeks. It was best for me and my insurance covered it.

Blew it out after 40 years skiing, doing a simple sideslip on a flat surface. Just tough luck for me. Not a big deal.
Yeahman and Nest were looking at me like get the fuck up and let's go. So we did.

And to be honest, today I almost feel better for it. I spent a deal of time this winter working on my agility, overall body position and finessing my turns more than muscling them. Hard to adjust but feels like a genuinely finer turn.
So I got that going for me...

[splat]

Blew it out after 40 years skiing, doing a simple sideslip on a flat surface. Just tough luck for me. Not a big deal.
Yeahman and Nest were looking at me like get the fuck up and let's go. So we did.

Dood. I don't think I heard you mention how you did yours, though you probably did. Totally brutal.
As I was tumbling down the top of the paranoids at Mammoth after snagging a rock, I said to the mags above me as I came up to the top of the spin cycle, "I just blew out my acl." When they got to me and I asked for a little help, they said they thought I was joking.

[XXX-er]

every accidnet and every knee is unique , the pro doesnt know till he goes in there,

the PT thot the ACL didnt really feel completley Fubared while the surgeon said it was completely fubared from looking at the MRI but he also said I got really good knees,

still he wasnt gona fix anything that didnt need fixing, cuz in the end the guy going into the knee is what matters and the surgeon was right cuz the ACL was completely facked

[Djongo Unchained]

[QUOTE=XXX-er;6316013]every accidnet and every knee is unique , the pro doesnt know till he goes in there,

/QUOTE]

Agreed, 100%. He also told me almost exactly that.

~~~~~~~~~~~~~~~~~~~~

@Splat - here's the lite version...

Yeahman, Nest and I met up for some laps while I was visiting Harry at Big Sky.

We got to the summit to ski The N. summit snow field. Had to wait for about 20 minutes. Time to go, Nest leads us down the almost flat sidewalk of snow which was a bit scraped and slick.

As I'm approaching Nest, I realize I'm not getting much purchase. Going like 3 mph now, did a hop flick to change my slip direction, still not much and sliding towards him. Flick it back and then just decide to flop down before I bump into him. Don't want to bang my guide over into some scree field.
Classic bending backseat and a little off to the side.
I sez, dang that hurt, go to get up and ouch, that hurts too. YM slides down and asks me if I want a hand up. After I regroup, he helps me up, ( a bad sign already). They ask if I wanna go up or down. I sez lemme look at it.
Clouds are rolling thru and weather is impending. NS snowfield looks really good, piles of soft so we go for it.
They lead me down, stop in a hut and roll down the cattrack. That's where I felt it the most. Flat ripples were painful. They ask if I wanna do a Headwall lap. I sez, no I'm going home. To Harry's? No, Jackson...
Left Harry a message that I was bailing. Sent it to the wrong number. He didn't know wtf happened for some time. Methinks YM filled him in.
It was quite the morning. Glad it was my left leg and I don't drive a stick.

[Jeb McHardman]

Absolutely. I won't really "know" shit until I wake up after surgery and the doc tells me what he did.

And I knew for certain I had fucked something after my accident. It was the last run of a very warm day at Sugar Bowl, and I was skiing down the Nose way more aggressively than I should have been. Hooked some glop with one of my tips and took a long tumble until my binding finally released, way later than it should have. Stood up, tried to make another turn and crumpled immediately. Got myself down through a combination of one-legged skiing and long traverses. Was able to drive home but woke up the next morning with the leg essentially locked in place. First serious injury after 20+ years of skiing