Can I Still be Active Without An ACL?

[Skibumtress]

I’ve been a member but mostly a “lurker” to this board for a while. I hate for this to be my first real post but after much “googling” and reading others’ injuries threads, this forum seems to be the most helpful. I’m a poster on the Killington Zone board and a friend of Sprite’s and MtnMan’s and know some other Maggots who frequent Killington. Also met other Maggots at the EC mini summit last year at Stowe. And, right now I’m supposed to be at the TGR Summit this week in Whistler with MtnMan and crew but sadly had to cancel due to a knee injury and surgery this week.
Had my initial injury on January 21..... heard, felt something which I assume was that dreaded “pop,” the knee buckled from underneath me and I skidded sideways. Didn’t think I could get up for a moment but I eventually did, skied down and called it a day. Thought it was nothing and I could “walk it off.” Actually skied on it two weeks after the injury with a stabalizer brace but only lasted an hour or two each day.
Finally went to a Doc in February - Diagnosis: Torn Meniscus, intermediate-high grade ACL tear (according to the MRI, not detached), osteoarthritis from an old small meniscus tear, fractured tibia and joint out of place. No PT before surgery because of where and how the fracture was and the state of the joint.
Had the surgery on Tuesday and after the Doc got in there with the camera he found that my ACL was totally ruptured. Apparently the two bones totally separated which caused the underlying bone to fracture. The ACL was in the proper place but apparently just floating there which is why it wasn’t picked up on the MRI.
The dilemma: Doc, said he doesn’t feel it’s necessary right now to reconstruct the ACL. He said he wants me to concentrate on heavy duty PT and building up the muscles more than ever around the knee (obviously PT will be longer than originally planned), said I can go back to skiing next season (and my other physical activities) but under no circumstances can I ski without the derotational brace (yea, no kiddin' Doc). My question is, can I function without an ACL? Little background on my skiing history.... learned when I was in my teens, skied lots and then in my late 20's and 30's it was only trips out west once or twice a year (would have loved to ski more then), I guess you can call me an intermediate skier, do steeps, do bumps and trees as best I can (had been working on getting better last season and this with the bumps and trees) and I’m working on becoming more aggressive. Last two seasons put in about 40+ days (this season, obviously not that many). Active off-season with hiking, biking and running.
I’ve been getting mixed feedback on functioning without an ACL. The folks I’ve spoken to who do not have an ACL are excellent skiers, however they’re males. I was told today that an active female needs an ACL more than a male because of physical make-up. My fear is, if I don’t have the ACL reconstructed and continue to ski and get better and more aggressive, will I be facing knee replacement in a few years and/or be prone to another injury? I know this question will come up but I’m.... well, let’s say somewhere between 40-45 years old.
After my stitches are out and I get the Doc’s surgery report, I do intend to go for a second opinion about whether reconstruction is necessary but in the mean time, just looking for others’ experiences and any feedback. Thanks.

[altagirl]

Does your doctor work with many athletes? And did you express to him that skiing is important to you, you ski hard, or want to, etc.? Because some doctors are used to dealing with more of the couch potato version of the general public so they think "why would this woman in her early 40's want to go through the pain and hassle of ACL reconstruction when she can walk around just fine without one?" Or he's picturing you crusing down an easy groomer and thinking you won't really be putting much stress on your knees. So if that's not you - make sure you get that across to your doctor or get a second opinion from someone who deals with more athletes.

When I was without an ACL, my knee gave out regularly while skiing or other pivoting sports/activities. It wasn't something I could live with long term and really do much of anything other than run in a straight line.

[XtrPickels]

Or he's picturing you crusing down an easy groomer and thinking you won't really be putting much stress on your knees. So if that's not you - make sure you get that across to your doctor or get a second opinion from someone who deals with more athletes.

Well developed hamstrings can take the place of an injured ACl (and prevent injury to it intially) in most people's lives. To do activites above a recreational level (skiing easily on blues) Its probably best to have an ACL in there.

I think altagirl got it right.

[Skibumtress]

Apparently he's a skier (and rider) himself and some of his patients are professional athletes (Jason Kidd being one of them). At every appointment I emphasized about skiing and what kind of skier I am (and want to be) and that I won't settle for being just recreational groomer cruser.
Your experience without an ACL is my fear which is why I do want to get this second opinion. My gut feeling is that I will need to have it reconstructed, however I will have another Doc do it. Not that I didn't like this one that did the surgery on Tuesday, but I just didn't like what he had to say about having the reconstruction. On the other hand, if I have the reconstruction done it would have to be ASAP, 'cause I don't want to miss any of next season. I already missed way too much of this season.
AltaGirl, How long was your rehab (PT and all) when you had the reconstruction?

[Endlessseason]

When I was without an ACL, my knee gave out regularly while skiing or other pivoting sports/activities. It wasn't something I could live with long term and really do much of anything other than run in a straight line.

Exactly. That's how I decided with mine. I simply tried to do my normal skiing without my ACL and found I couldn't enjoy it without that stability. I just couldn't charge as hard without it.

[altagirl]

AltaGirl, How long was your rehab (PT and all) when you had the reconstruction?

I was skiing again 5 1/2 months after surgery with this last one. The one before that (other knee) I was out for about 7 months - but I wasn't living near mountains either.

Here's my journal from the last reconstruction:

http://www.tetongravity.com/forums/s...ht=knee+update

The general rule is that with aggressive rehab you can be back on skis in 6 months. Healing time is generally longer as you get older, but there are other factors too - how good of shape you're in now, genetics, rehab, graft type, any other related injuries or complications, etc. I'm now 32 FWIW.

[Skibumtress]

Exactly. That's how I decided with mine. I simply tried to do my normal skiing without my ACL and found I couldn't enjoy it without that stability. I just couldn't charge as hard without it.

Well so far you're all confirming my thoughts. But yikes, another surgery before next season???
I have a feeling this is going to be a loooong summer.

[Skibumtress]

Thanks for the thread AltaGirl.
I'm physically fit... although can be more. Naturally with the injury, the last two months have killed me in this department.
Started a new job in December and they have a full gym so believe you me, when I start the PT for this surgery, I will be there as often as the PT will allow me.

[roscoe]

IT IS NOT THAT GREAT OF AN IDEA I JUST GOT FIXED FROM ME SKIING WITHOUT ONE AND I LOST 60% OF MY MINICUS AND ALSO PUT A HOLE IN THE BOTTOM OF MY FEMUR. IT WAS NOT FUN AT ALL AND THE SURGERY TOOK 2 TIMES LONGER THAN EXPECTED. GET IT FIXED

[Skibumtress]

AltaGirl, thanks for your link. If I have 1/2 of the determination and dedication you had during your recovery, sounds like I'll be fine. You are inspiration girl!

[Vinman]

There really is only a small percentage of people who can participate in cutting/turning/twisting sports without an ACL after going through an extensive rehab program.

I would echo some of the toughts from AG and Endless, that if you want to be someone that skis off the groom, off piste/BC it is liekly that you'll end up needing to have surgery to reconstruct the ligament.

As for waiting and doing PT to see how things go......meh. If skiing is as important to you as you say then IMHO it would be a shame to spend all of that time in therapy only to have to re-do it in a few months.

If I were me, and I have had 2 ACL reconstructions on my left knee, I'm going to be 34 in less than 2 month and have a kid on the way.... if it were me, and I tore my ACL tomorrow, I'd be having surger ASAP so I would not miss next season.

[Skibumtress]

Vinman, thanks and CONGRATS about the little one on the way.
Yep, from doing research today on the 'net (my eyes hurt) and reading AG's thread and others..... yep, I believe a new ACL is what I need. Have an appointment on the 20th to get the stitches out, I'll get the report from the Doc and then go to a second Doc for his opinion (gonna try MtnMan's doc).
Skiing, blues and groomers for the rest of my life.... ummm, negative... cannot settle for that 'cause I'll go out of my mind. Damn, for 8 years I gave up skiing (aside from a trip or two out West yearly) 'cause b/f hated skiing (that relationship is long gone), and I will not let another thing limit my skiing time.

By the way Vinman, we met last year at the EC mini summit at Stowe.

[PaSucks]

Hines Ward has not had an acl since he was in jr. high and he is the Super Bowl MVP.

[Skibumtress]

Hines Ward has not had an acl since he was in jr. high and he is the Super Bowl MVP.

Yes, but he has been functioning without an ACL for years. Two friends of mine have not had an ACL for 20+ years and they are awesome skiers. Perhaps the body gets accustomed to functioning without an ACL, especially not having one since an early age? I've also read that active females need an ACL more than males because of physical make-up??? Oh hell, maybe I've been doing too much research today.

[altagirl]

Yes, but been functioning without an ACL for years. Two friends of mine have not had an ACL for 20+ years and they are awesome skiers. Perhaps the body gets accustomed to functioning without an ACL, especially not having one since an early age? I've also read that active females need an ACL more than males because of physical make-up??? Oh hell, maybe I've been doing too much research today.

There is a very small percentage of the population that doesn't even notice an ACL is missing. I think it has to do with your bone structure, skeletal alignment, etc. It's not muscle, it's not "go to the gym and train harder and you won't even notice it" - it's really a genetic thing. And I am certainly not one of the lucky ones - back with my first ACL I had really muscular legs but had my knee collapse on me when I walked around a corner going to a class. And again trying to help move a picnic table. You could also probably learn to avoid doing anything that could cause it to give out - I developed some bizarre habits skiing - lifting up my ACL deficient leg when it was the inside ski in funky snow, etc., but it still gave out on me every few ski days until I got it fixed. And those compensating habits are hard to break later. I'd say just get it fixed.

[Skibumtress]

I developed some bizarre habits skiing - lifting up my ACL deficient leg when it was the inside ski in funky snow, etc.,

I can't believe you said that. This knee has always "gone out" on me but would be fine in a couple of days. I had the same habit. Two friends of mine said this to me last season. Couldn't figure out why I was doing this so I tried to learn to break the habit by "driving my skis,".... I know weird term, but in my head, it worked for me.
Yea, I'm leaning towards getting it done. Wonder if I can have another surgery so soon after this one?
Again, will know after the second Doc's opinion..... I'm just getting obsessive with this now 'cause I do not want to miss opening day next season and want to get back on my feet ASAP (oh yea... I don't want to get fat either ).

[altagirl]

I can't believe you said that. This knee has always "gone out" on me but would be fine in a couple of days. I had the same habit. Two friends of mine said this to me last season. Couldn't figure out why I was doing this so I tried to learn to break the habit by "driving my skis,".... I know weird term, but in my head, it worked for me.
Yea, I'm leaning towards getting it done. Wonder if I can have another surgery so soon after this one?
Again, will know after the second Doc's opinion..... I'm just getting obsessive with this now 'cause I do not want to miss opening day next season and want to get back on my feet ASAP (oh yea... I don't want to get fat either ).

Yeah. Funny thing is that with this last ACL (right knee), I didn't ski on it at all - just had the surgery done right away - and I had no bad habits to get rid of with this one. I remember doing video analysis like 2 years after my left ACL and I still had to work on getting that foot back on the snow in crud. But this time I've been skiing for under a year and no issues. (Just did video analysis in Gordy's camp.)

You'll have plenty of opportunities to burn some calories on a stationary bike, elliptical trainer, etc once you're in the swing of rehab. And when you can't do that yet, you might be able to get on those upper body cardio trainers (like an exercise bike for your arms). And at least for me - the pain killers didn't make me want to eat a ton.

[Skibumtress]

And at least for me - the pain killers didn't make me want to eat a ton.

I noticed that..... hmmmm, maybe we're just enjoying the buzz.

I had my Dr. switch me to Vicodin today. I've been on percs for a month now and I was starting to become immune to them (I think)....... however, the Vics ain't doin' a thing. Could be today I either over did the walking and knee exercises (hurtin' like hell now) or could be my mishap this morning. Had to go to the bathroom this morning and in my sleepy state, forgot about the knee.... must have gotten up too fast and I felt the pain and the pulling..... took me a bit to catch my breath... was cussin' like a truck driver. I think I scared the hell out of my dog 'cause she ran like a bat out of hell up the the stairs.

[Vinman]

Hines Ward has not had an acl since he was in jr. high and he is the Super Bowl MVP.

When i said there is a small percentage of people in the world that can function without an ACL, this is the kind of thing I was talking about. In some cases there are people who can adapt to not having an ACL for whatever reason. Someytimes the hamstings take over the function, sometimes the other ligaments in the knee are just strong enough to take over the job. But this is a fairly rare thing to be able to function at such a high degree of skill. For us mere mortals, most of time it simply does not work.

[Skibumtress]

When i said there is a small percentage of people in the world that can function without an ACL, this is the kind of thing I was talking about. In some cases there are people who can adapt to not having an ACL for whatever reason. Someytimes the hamstings take over the function, sometimes the other ligaments in the knee are just strong enough to take over the job. But this is a fairly rare thing to be able to function at such a high degree of skill. For us mere mortals, most of time it simply does not work.

Could this have anything to do with age? I.e., loosing the ACL at an early age, say in the teens? Ward, and the two friends of mine that I'm know all lost their ACL when they were somewhere in their teens. Perhaps their bodies learn to adapt at an early age and learning to compensate without one is easier on the body (easier to build up the muscles, etc.)?

When I was 21 I had experimental surgery on my back (with the experimental surgery, recup time was one week w/PT as opposed to six months and then PT), long story short, the enzyme that was inserted to only absorb the swelling in my disc, completely absorbed the whole disc over the next few years. My body learned to compensate for the missing disc and thankfully I've had no major problems (only PT every once in a while.... it's been fine for the last 8 years or so). Doc said that since I was young and physically fit when I had the surgery, my body was able to learn to compensate without it as opposed to say, a 40-year old having the surgery.

Amazing what you learn when you have an injury. Wish I didn't have learn this stuff.

[Mtn Man]

Hehe, welcome to the Gimp forum, I spent a lot of time here and learned a lot. On the lift ride up last Sat with AD, Lego, and Divegirl, I warned AD that he's on a chair with three gimps. I think that kinda freaked him out

Get the surgery, hit PT as hard as your body will let you, and you'll be hiking up before opening day with us next season like I did!

B)

[Skibumtress]

Hehe, welcome to the Gimp forum, I spent a lot of time here and learned a lot. On the lift ride up last Sat with AD, Lego, and Divegirl, I warned AD that he's on a chair with three gimps. I think that kinda freaked him out

Get the surgery, hit PT as hard as your body will let you, and you'll be hiking up before opening day with us next season like I did!

B)

Thanks MtnMan! My plan is at least opening day and if I'm ready for hiking for turns before the lifts are a runnin'....... even better.
Folks at work were laughing at me today (o.k., so most were looking at me like I belonged in the looney bin) when I told them I was counting the months for recuperation (PT included)....figuring at least six months. Have it done in April...... October; May..... November.

[Kempes]

One friend of mine torn his ACL and possibly another ligament in 1998. He could not stand after injury, his leg was giving away. He used a brace for several months and visited a dozen orto specialist. He had reconstruction sceduled but he decided otherwise. He even has not done much PT.
Now 8 years later he is not actively participating in sports on daily or weekly basis. But he skis 10 days every year. He is not an expert and his technique is far from excellent, but he goes for steep terrain without hesitation. He wears a brace while skiing and feels uncomfortable on skis without it.
My ortho says that he may ruin his knee over time and some 15 years after injury he may have serious issues with it. Otherwise he is fine.
In summary in my view he is a good test. He does not care about his fitness and musle strengh. And he does ski. And his symptoms after a surgery were a lot more serious then mine.
Anyway I am going for ACL reconstruction in 3 weeks. I do not want to test whether I will be able to return to sport without it and possibly miss next season.
Good luck.

[Skibumtress]

Anyway I am going for ACL reconstruction in 3 weeks. I do not want to test whether I will be able to return to sport without it and possibly miss next season.
Good luck.

Good Luck Kempes. Yes, I've made the decision to have the reconstruction done. Appointment with the new Doc is on the 29th (will not have current Doc do it 'cause I feel like I'm having to convince him that I need it done.... don't like that much).
I feel the same way you do.... thought about trying it for a season with heavy duty PT, plus of course the brace (what my current Doc said), but then the "what if" got the best of me. I know I will not be able to go through another season of God-forbid cutting it short. This is my third season of being able to get lots of days in (was only able to ski week trips out West once or twice a year for about 9 years for reasons no need to get into) and no way, no how am I letting anything get in my way. As much as I hate to go through another surgery, if that's what I gotta do, then I gotta do.

[beaterdit]

Skibumtress, I'd second everything here. Get it done sooner than later. I'm about to have my second one and wouldn't consider not doing it. Also you're right about women needing an ACL more than men. Women have wider hips which generally results in an increased femoro-tibial angle (knock knees). This, in conjunction with more leverage exerted by wider hips puts more torque on the ACL, or lack thereof. I believe there are very few athletes out there who live without an ACL and suffer no related injuries, ie: meniscus and other wear related problems. Good luck!