ACL Class of 2017

[Marshall Tucker]

Ah Fuckity fuck. After skiing 10-30 days a year for the last 35 or so years...beleive I have finally punched my ticket to this club. On a tiny jump on a wet southeastern slope about 3:00 PM yesterday. Doc drew fluid this AM, said it was bloody and that is pretty damning for either ACL or bad meniuscus tear. waiting for MRI to be scehduled. He said given my age (a litl bit north of 50) recommends Cadiver tissue, doesn't like pateller and hamstrings are for kids in thier teens/20s, so he says.

So i did a little reading, I gather they schedule surgery off just a bit, you work out pretty had bulding muscle before surgery, then lots of PT after. Others go the Cadiver route? continuing to read...

[yeahman]

Interesting advice from the surgeon about the cadaver graft. My doc said if I wanted to be one of those guys skiing into my 70s, get the hamstring graft because the long term success rate is better, even though recovery time is longer. I think he said failure rate of the hamstring is 5%, failure rate of the cadaver is 15-20%. Definitely going to recover faster with the cadaver graft, though, because you don't have the hamstring surgery to recover from in addition to the ACL.

I'm about two years out and feeling pretty close to being back to full strength (and I was able to put in a full ski season the first year back, even though not at full strength, but still skiing hard).

My experiences are in the 2015 thread if you want to look at it. Good luck man.

Edit to add: I was 50 when I did it, in fact it was on my fiftieth fucking birthday. In the stupid terrain park.

[Marshall Tucker]

^ yeah been reading the 2015 thread, and yours/MMP are very similar to mine, great reading very helpful. I'm about 99.9% sold on the hamstring autograft, and it's causing me some concern that my dr was so quick to recommend cadaiver :-/
50 in the terrain park. awesome.

[MMP]

Good to talk to you yesterday MT. To reiterate: my doc said Patella Tendon for a D1 /pro athlete, but arthritis is common despite being a bomber graft. Cadaver for a non athlete, and Hamstring for aggressive, 50 something weekend warriors.

I had no discernible pain from the graft site, no scar, and if you were to ask people that we ski with they'd tell you I'm a relatively aggressive tele skier. My right knee gets tight after big days, but stretching takes care of that.

My doc went to a Duke Medical school and is board certified Ortho doc. His PA's son and 2 of my boys played HS lacrosse with together, and has become a friend that I trust. (I can arrange a call if you'd like)

Based on your running, barring a hamstring that can't be harvested it sounds like a cadaver isn't ideal.

[sparkletarte.]

Hey team.

Feb 6 did what I thought was a grade 1 to acl, confirmed by physio. Hit physio hard, was feeling great, on the bike a lot. Got permission from physio to ride groomers (with no return to sports tests, I didn't even know those were a thing. But they are!) First day did 4 short cautious greens, second day got 5 turns in and my knee went out again. So easily. Ugh. So now I'm back at... I'm going with 'day 3'.

Got my xrays so I could get referred to a specialist. My doc ref'd me to an ortho but I'm going back for a referral to a sports med doc now that it is more serious. I won't be able to see a sports doc until a month or two, then I know any mri and surgery won't happen for months as sometimes the Canadian system is slow as cold maple syrup. I am not too concerned about the delay from a repair standpoint, just more annoying about the double recovery.

In the meantime I have all my physio and bike trainer. I do a lot of massage and am on top of my nutrition- lots of chicken bone broth, protein, good food. Making some turmeric and ginger tea right now. Am going to hit up acupuncture soon.

Feeling somewhat discouraged though and now more paranoid that it's going to pop out like that again. O the good side I only lost a month? And I'm lucky I have the time and stuff I need to rehab.

This is my first major soft tissue injury. I broke my tib plateau years ago so I know about the long haul, the rehab, the mental, all that stuff and am settling in for it.

[yeahman]

^ yeah been reading the 2015 thread, and yours/MMP are very similar to mine, great reading very helpful. I'm about 99.9% sold on the hamstring autograft, and it's causing me some concern that my dr was so quick to recommend cadaiver :-/
50 in the terrain park. awesome.

Your doc probably recommended a cadaver graft because that's the surgery he/she is most comfortable doing. And that's a consideration too, because you want whoever does it to be doing their best work. I have 50-something friends who have had cadaver grafts and so far so good, they are happy with the work and are skiing hard. So...no easy answers, it's a lot of give and take. But definitely talk to your doc more about it and find out where he is coming from.

Another thing my doc told me is when he goes into surgery to do a hamstring graft, he always has several cadaver grafts on hand in case the hamstring doesn't look burly enough or he can't use it for some other reason. I thought that was interesting.

I would stay away from patellar graft though, because based on everything I've heard and read it does more often result in arthritis in the knee. Not always, of course, but the odds are higher. I knew that arthritis was something I did not want, no matter what, and I must say I have virtually no residual pain or achiness in my knee. BUT...I do feel it in my hamstring after a hard day skiing. I need to be better about stretching my hamstring before and after.

[Marshall Tucker]

WHAT GRAFT TO GET?

Offered purely as additonal information for the thread - I figured out a family friend's son is a "young-ish" orthopedic surgeon with a practice in another city. His background is Vanderbilt medical school and 4 years surgical residency with the vail clinic (yes, in the town) studying ACLs, then 4 yrs. private practice in which he’s done about 100 ACLs a year. He spoke to me for about 30 minutes just as a "friend" and This was his advice on the types of repair – perhaps if Dr Mark is still around he can weigh in as well. Family friend fully understands the addiction and skis as well.

Family friend said that in the 25 and under age group that ACLs repaired with donor material (allograft) vs. the patient’s hamstring/Patellar (autograft) that the documented failure rate is 4x on allograft in that age group. So much so that they don’t even mention allograft in 25 and under; patient would have to request it. He said that of hamstring/Patellar that Patellar was superior and “that’s what I recommend in my college football/rugby players.” He said in 40 and older, that there is no statistical validity to the statement an autograft is better than an allograft. The failure rates on both across the spectrum of 40 and older patients is even with neither having an advantage. That leaves a “gray area” between 25 and 40” and “perhaps I’d put a hard charging 50 year old in that category.” He said still, though, that he would recommend donor material for over 40, but qualified that with what he termed “level 5” or “professional opinion” advice, that he believes donor Patella Tendon material is superior to donor hamstring material. I quoted the stat from another thread “hey wait, doesn’t hamstring material from the patient fail at 6% vs. 17 % for donor material?” he had two thoughts.

First, for your body to see something to “reject” it has to see something that is “alive.” He said that donor material is immediately frozen to very, very cold temperatures that kill any living cells in the material, and that he has not seen a case where the body rejected donor material. While he agreed with the 6 v 17% stat, he was quick to point out that those statistics DO NOT consider the patient’s age. He said that the simple failure rate across ALL age groups for a hamstring graft is 6% and donor 15-20%, but that that INCLUDES donor material in 25 and under which is documented to fail at 4x etc. He again reiterated that there is no statistical data that supports hamstring as “better” than donor material in 40-and-overs. He also pointed out that a Hamstring graft presents its own complications. “For example, it’s documented that I gotta have 8.0 MM thickness. If I harvest yours and it 7.5mm then I gotta problem to deal with during surgery.” Not to mention dropping the material.

His bottom line is in a 50 year old plus, he would recommend patellar tendon donor material; but ultimately "what the patient wants is determative."

[MMP]

whatcha gonna do? (other than have the kid do the surgery)

[detrusor]

Sent you a quick pm

[yeahman]

Good luck man. I know it's tough trying to decide what doctor and what graft. Before it happened to me I was clueless about the whole knee "industry." It's a lot to consider.

[meepmoop24]

I'm a little over a week out from surgery on my right ACL. Tore it at Taos on 1/15/17 and had surgery 3/7/17. Did a lot of lifting and cardio before the surgery and it seems to be paying off now. I went with a hamstring autograft, which is what both surgeons I saw recommended.

The downside to the hamstring tendon is that your leg will be weaker when going from 90 degrees to fully bent. However, from what my surgeon says it's only 10-15% weaker and you can make up a lot of that through training hard. It seems like the loss in strength is really only a problem for sprinters or athletes that need to run fast. Contrast that with the downside to the patellar tendon, which is not being able to kneel on that knee and the hamstring tendon was a no brainer for me.

For those going into surgery, definitely invest in an ice machine if your insurance won't cover it. It's basically a cooler with a pump that circulates water through a pad around your knee. It is worth it's weight in gold. Other things to get are a shower stool, laxatives (those painkillers stop you up), and Tylenol (so that you can get off painkillers quicker).

[Marshall Tucker]

^ can you provide a link to an example? not familar with the ice machine you refer to. my surgery will be 3/27 (pretty fired up I got within almost 3 weeks of the event!)

[sparkletarte.]

^ Cryocuff. You put ice and water in a gallon ish water cooler then it sends water into the cuff thats on your knee like an air cast. Some physio places rent them. They are great.


Re patellar... You cant kneel on that knee afterwards, really? Thatd be lame.

[wyeaster]

second cryocuff and the like. as an aside, i had patellar graft and played keeper in soccer for another 15 year landing hard on it many times without problem or abnormal pain.

[Marshall Tucker]

Blog / Timeline of my ACL tear in hopes it helps some folks down the road. 52 yr old @ time of injury.

3/5/17 Landed a small jump immediately knew I’d done something very serious. Collapsed, got back up, skied down, knee mildly buckled stepping off the snow (slush here). In hindsight it was not an awkward landing, just, believe my knee had been very loose for some time based on doctor comments and was an accident waiting to happen. Drove 3 hrs. Home with ice bag tied to my knee, kept swelling down.
3/6/17 Initial Ortho Visit with dr #1. Drew bloody fluid from my knee said that is pretty damning for serious cartilage damage or ACL tear
3/11/17 MRI
3/14/17 2nd visit Dr #1 go over MRI, clean 100% tear of ACL, other ligaments intact. Evidence in scan of radial Meniscus tear. Recommends Cadaver tissue (see post about what graft to get). +- this time consulted with Orotho Surgeon #2 who is a family friend in another state (again see other post) (ex-stedman clinic vail). At this point I’ve figured out Dr #3 is the ACL stud muffin of this Dr #1s 90+ doctor mega-practice. Told Dr #1 I want Dr #3 to do surgery,
3/16/17 Initial visit with Dr #3, surgery scheduled for 3/27.
3/6/17 to 3/27/17 Hitting gym pretty hard emphasizing quads & Hamstrings, stationary bike, eliptical. Build muscle mass before surgery.
3/27/17 Surgery early AM. Cadaver material, tendon from the front/top of your ankle, as reco by Dr #3. Anterior tibilitus or some such. Dr #3 finds a lot more meniscus damage that he expected, particularly medial side. When he gets done he describes it as almost “bone on bone.” Also found a decent amount of arthritis (I’d had a bucket handle cartilage tear in this knee repaired in 1995). “You were in major denial.”
3/27-4/3 week 1 post surgery. Doing great Day 1; about mid-day day 2 the nerve block fully wears off and holy shit this thing hurts. Oxys dull pain a little. Day 3 AM is first dr visit post surgery. Drew a great deal of bloody fluid off my knee but says reapair looks fine. Choice comments "you gotta 30 yr old mindset and 60 year old knees. your brain better catch up or we're gonna get to know each other pretty well in the coming years" "We've done nothing to compromise your canadacy for a partical or full knee replacement 5-10 years out" . Started daily PT 3 days out. Went off crutches @ start of day 4, pretty much stopped walking with a limp at 6 days, stairs totally suck. Did i say this thing constantly fucking hurts bitch bitch bitch. got 67 degrees flexation 3 days out, complete circle on bike 5 days out. Standing for any period of time just sucks.

Week 2 post surgery. Noticed what I think is a bunch of dead blood from swelling in my knee that if i stand long enough moves down to my ankle, if I put my leg up for a length of time moves back to my calf/knee. huge issue start of week 2 lesser so towards the end of week 2 but still noticeable. Riding bike to 15m at level 5, PT person ok'd elipitcal stepper for 5m @ end of workout. Movements that are a total bitch 1) standing facing a rail, and bending the ACL knee raising my heel up behind me. can only get to 90 degrees with a pretty bad pain on the inside of my knee. 2) sitting on floor, back against wall, with non-operated leg out straight, and raise up the (acl busted) knee pulling heal along floor towards my dick. can get my heel a couple of inches inside the flat leg knee but that hurts balls. Overall walking slowly but pretty normal. thing continues to feel gimpy as shit. Cannot even envision actual running yet, or any quick movement.
Week 3 big improvements. Up and down stairs normally. Can get out of car normally (this was a bitch before). Sleeping better/less pain. Gaining range of motion. Generally feeling "popping" inside the knee, but I think that's normal. Starting to do "normal" gymn leg excercises. Some lateral movements with the PT guy but none on my own. Between the Bike/Eliptical, before the operation was doing abut 500 calories a workout. Now up to about 200 and gaining.
Weeks4-7, mostly doing balance stuff and weight machines. Specifically bosu ball, flat side down, standing on one foot / bad knee, see how long i can balance; turn it over, both feet on flat side, deep knee bends. Interesting excersie in which smaller (maybe 8 inch diamter) 1/2 balls are placed like stones accross a stream, I have to step from one to the other balancing on one leg. then another where those 1/2 balls are set up in a circle, you stand in the middle, touch your "good" toe to each standing on the one bad knee. etc.

[uglymoney]

^ Cryocuff. You put ice and water in a gallon ish water cooler then it sends water into the cuff thats on your knee like an air cast. Some physio places rent them. They are great.


Re patellar... You cant kneel on that knee afterwards, really? Thatd be lame.

I'm a few days out from one year on my patellar autograft acl and I can kneel on the knee fine and it feels solid as fuck. In fact I put 100% of my weight on the knee on a hard rough surface last night at work bending over to grab a box and it was fine. I'm 45. Skied 25 days this winter and the last few days I had some moments where things were working really good. Still working on strength in my quad but that is a forever process.

The patellar tendon choice did slow my recovery down a little because of anterior knee pain that made squats more difficult and waiting around for the patellar to recover was a drag but...no regrets. The anterior knee pain was never bad and just an annoyance, keeps fading away and the knee keeps getting stronger. I think going with what I was comfortable with was more important that comparing allograft to autograft stats. I know several 40 somethings that went allograft and blew them because they felt better sooner and were too aggressive. That scared the hell out of me. Also my friend blew his native acl the year before me, he is 55 and ripper, did patellar and he is 100% back with zero pain (arthritis free dude) on his second winter. He was pretty slow last year but that is how it goes. My acl led to many, many enjoyable days skiing at a slower pace with my wife and kids. Also to a lot of frustration when I was just surviving or had to quit skiing powder after a couple hours but again that is how it goes.

Another friend of mine did a patellar in his 40's and just did a allograft on his other knee in his 50's. Same doctor as I had. He seems stoked. All about what you feel comfortable with.

Also good luck Marshall and Sparkle! I missed thread till now but I did read about Sparkles injury on the BBI thread.

[MWatcSKI]

As a 2 time winner of ACL reconstruction surgery I wish you luck! As a Certified Athletic Trainer and Strength and Conditioning Professional I would be happy to offer my thoughts on rehab

[yeahman]

I was just checking out mtnbikerskierchick's blog...she's had 3 ACL surgeries (most recently this winter) and has written a series of articles about her experiences in surgery and recovery. Worth checking out.

https://14erskiers.com/blog/2017/03/...-knee-surgery/

[Marshall Tucker]

Everything going fine, PT session friday, saturday did a long workout, everything exactly as the PT guy said friday, included some upperbody back/lats stuff too. Sunday. holy. fuck. woke up in a decent amount of pain, and had a committment that required I stand a decent amount. (maybe 45 minutes total) that morning. Thing hurts like a mother fucker. seem to have lost some range-of-motion. I know there are good days and bad, but this sucks!!

[yeahman]

^^Haha, that does suck. Just keep your eye on the prize--next ski season is what it's all about at this point. You'll be ready to rip if you keep up the PT. And nice job on the upper body stuff--I took advantage of the gym time to do the exact same.

I hated flying on planes for a few months after surgery, and long car trips too. Not being able to move around, just getting stiff and achy, it really got to me. Had to drive my kid all around Montana for soccer games and I f'ing dreaded those drives. I guess I could have put more of it off on my wife, but then there's the boredom factor too--at least it got me out of the house.

[Marshall Tucker]

Not being able to move around, just getting stiff and achy, it really got to me.

This is exactly where I'm at (not that I really have room to complain 8th day out from surgery); so this stopped being an issue 3? 4? months out? BTW thanks for link to chic's expereinces, good read. Remember when she was active here.

[yeahman]

This is exactly where I'm at (not that I really have room to complain 8th day out from surgery); so this stopped being an issue 3? 4? months out? BTW thanks for link to chic's expereinces, good read. Remember when she was active here.

Yeah, in 3 or 4 months the achiness goes away, maybe sooner for some. I think by 6 months I was hiking to the top of Mount Helena again, which is about a 1,200 foot climb/descent and 3 mile round trip. For me that was a huge milestone and I did it incrementally by going higher and higher over several months.

Other people recover faster than I did. I felt like I was kind of slow, and I didn't push it either because I was worried about overdoing it and causing later arthritis or whatever. I never really worried about the ACL failing, just the joints that were affected by working out too much.

It's a balance you'll be trying to figure out the entire time. I just went with my gut feeling on how much and how hard to work out, and once I was able to hike that became a primary rehab tool. I would do things like hike up the hill putting all the weight on my calves for as long as I could stand it. My calf muscle really seemed to lose the most mass so I was focused on that.

[meepmoop24]

I'm 5 weeks out of surgery tomorrow and wanted to post a quick update. Swelling has gone down significantly and my leg feels pretty stable. I still wear my sports brace (DonJoy Defiance) when I'm exercising, but for errands around town I'm weaning off of it. I still have to ice after workouts and PT but it seems to get better every week. My ROM is 0 degrees (maybe a little more, like -2) to 130 degrees or so, and I'm about to do bodyweight squats with a counter weight.

Went on a 2 hour plane ride last week and it wasn't too bad because I got a seat with extra legroom. On the plane I did a bunch of calf pumps and quad sets, which prevented the swelling from getting too bad. If you have to sit with your knee bent for a while it's not going to be fun though, I still need to sit in the front seat on long car rides.

[Marshall Tucker]

my sports brace (DonJoy Defiance) when I'm exercising, but for errands around town I'm weaning off of it.

INterestingly, ANY type of brace (other than the immobilizer after surgery) has not come up even once in my treatment. not from the doctor, PA, PT guy, not once.

[uglymoney]

INterestingly, ANY type of brace (other than the immobilizer after surgery) has not come up even once in my treatment. not from the doctor, PA, PT guy, not once.

I went back to work 2 months post op (difficult back breaking job pushing stuff around) and my doctor and company made me wear the full rom brace at work for 4 more months. Fuck that thing but I will say that it saved my ass a few times when I slipped or tripped. Better would have been waiting another month to go back to work and concentrating full time on PT like I did for the first 2 months but my FMLA ran out so it was play or most likely get let go. Doing hours of PT everyday and working and taking care of kids and my life ended up being more or less impossible so the PT suffered but after a year things seem normal again. Merica' fuck yeah!

I skied all winter with no brace (per my surgeon) and have no desire to ever wear one again. Ymmv.