Torn ACL - Help!

About a month ago I twisted my knee while riding my muni in a parking lot after a good off-road ride. I already had made all my plans to attend California Muni Weekend, so I took it easy for the next few weeks and hoped for the best. On the first day of Cal Muni, actually the first hour, I twisted it again and was out for the rest of the day, but managed to ride (painfully) the next 2 days including most of the Downieville downhill.

Today I went to a sports surgeon and his diagnosis was torn ACL and possible cartilage damage. He scheduled me for an MRI on Thursday, and will do surgery the following week if the MRI confirms the diagnosis.
He said about 20 percent of athletes are able to function without an ACL intact. It depends on the sport, and I think muni would be one that would be a problem because of all the dismounting on uneven terrain.

After the doctor left I asked a technician how long the recovery period would be until I could do sports again and she said 6 MONTHS! I am hoping this was an overly conservative estimate. If anyone out there has gone through this, or knows anything about it that might help me, I would love to hear from you. Since I am self employed I have to be at work no matter what, and with my high deductible insurance and copay, this will cost me at least $3000. I just want to be sure I know all my options, and what to expect if I have the surgery.

Thanks for any input.

Bummed out,
Scott

Wow Scott, that really stinks.
Hopefully Jason from Alaska will see this, I’m sure he could share some useful information with you. I’m pretty sure that his knee injury was worse than yours. If he dosn’t come across this thread, try PM’ing him.
Sorry to hear the bad news, but keep in mind, plenty of world class athletes go through this and are still playing.
Take it easy,

  • Frank

Yes, I just did a search and found that thread about Jason. Jason’s knee
I told him 6 months wasn’t really that long, what was I thinking? I think his injury was worse than mine since they told him they would eventually replace his knee.

Thanks,
Scott

Hmmm…

Internal component of Unicycling device…
Ligaments, Meniscus, Cartilage, Tendon, Qceps…

Hope your component’s full and fast repair.

That sucks!!!
When I saw you go down I was reminded of my sister’s torn ACL, but thought I’d be cruel to mention at the time, then it left my head. She tore her’s about 8 months ago, and had surgury about 6 months ago. SHe has regained nearly all function, and the only reminder of it for her is the 2 massive scars on her knee. She did it playing soccer, and decided she still wanted to play, so she got surgury. If you don’t get surgury, the injury could become recurrent, is what she was told, but as long as you only run in straight lines (no high speed cuts and stuff that put lateral strain on the knee) then you don’t need the surgury. Talk to the physician, and tell him what you will be doing, I think you don’t need surgury for the simple act of riding, but your knee could be severely weakened if you fall at a bad angle. You could also do some heavy physical therapy, and that could really help you heal, and also strengthen the knee in the long run, especially combined with surgery. Also, to brighten your hopes, my sister was completely off crutches 2 months after the surgery, and felt 98% at the 3 month mark is what she told me. She feels her knee is stronger now, because she went through extensive physical therapy to help her change her posture so that she didn’t stress her ACL as much. So basically, it’s up to you wether to get knee surgery, depends what you think is neccessary, but physical therapy is probably a MUST, and you should do some heavy consulting with your doctor to make these decisions. Also, if you really do the PT excercises correctly and regularly, you could probably take 2 to 6 weeks off the recovery time.

My 2cents.

Hi Scott,

I’d definately get it fixed.

I tore my left knee playing indoor soccer a few years ago. After about a month it didn’t get any better so I saw a doctor. Yup, torn ACL. I spent a year scoping out the scene finding the right doctor & procedure, and finally settled on a knee specialist in DC.

There are three basic methods to fix a torn ACL. All of them require removing the old ACL, drilling holes in your leg bones, threading an ACL replacement through the holes and screwing the ends down.

In the first method the surgeon harvests a long, little-used tendon from your thigh, braids it into a thick rope about 4" long and screws that into place with big washers. It’s good because the ligament is yours and it’s live, but bad because the braided ligament is more elastic than your original tendon. Also, since the tendon braid isn’t terminated with boney bits it takes longer for the bone to grow around the ends and fuse in place. Early attempts at using this method sometimes failed because the tendon pulled out of the bone. My doc ruled this out for me because I’m heavy and have really strong legs (weigh over 210 lbs; used to be a pretty decent velodrome racing track beast).

The second method is a little wierd, but apparently it works pretty well. The doc cuts a long strip out of the middle of your patelar tendon (the strap that ties your kneecap onto your lower leg bones) and takes two bits of bone along with it - a chunk from your kneecap and a chunk from your shin bone. Now he’s got a real ligament that terminates on both ends with a little boney plug. When this gets threaded into place he puts screws in to jam the boney bits against the boney sides of the holes and this bone-to-bone fusion is really solid. The downside of this approach is that your patella tendon has a hole in it. Eventually the two sides of the tendon grow together and everything is back to normal, but in the mean time your kneecap isn’t all that solid. And there is a chance that the patellar tendon will heal crooked and give you bad mechanics. The doc ruled this one out for me because I have very short legs and therefore a high Q angle. (I had to give up track racing because my quads got so strong I developed patelar tracking problems)

The third method is basically the same as the second, except that the patella tendon is harvested from someone else. (Preferably a clean-living football linebacker from Iowa or Nebraska who was driving too fast.) They essentially bleach the donor tendon to remove all the living cells so what is left is basically a collegen matrix (the tendon) that ends with calcium blocks (the boney bits). The upside is that your patellar tendon is still intact and the resulting ACL repair will eventually be plenty strong, but there are a couple of downsides. The first downside of this approach is that there is a slight chance the donor was HIV positive - I think it’s 1 in 16 million at the moment - so you’re rolling some very favorable dice. The second downside is that it isn’t living tissue. If you are rough with it it will tear a bit and the tear won’t repair itself. Keep that up and you’ll be back in the operating room as a repeat customer. It takes time, but it does eventually become living tissue. In 6 months your body will have grown blood vessels out onto the collegen matrix, in 12 months the outer surface will be colonized with collegen-reparining cells, and in 18 months it will be fully living tissue to the core. This is the method I chose.

I “walked” out of the hospital 5 hours after I went in. The surgical team was excellent. My mom, who picked me up, was amazed that I could put my full weight on my leg. So was the surgical team. Apparently I have thick bones, so even though there were some big holes in them there was still enough bone around the holes to support my weight. I never needed crutches. It hurt like a *$&%) to walk, though…

The next two weeks I spent flat on my back with a machine that bent my leg back and forth slowly to keep it from stiffening up. My knee swelled up until it was bigger than a football. This is apparently normal. My lower leg was one giant bruise, and it swelled up too. Also apparently normal. The lymph channels from the lower leg get shut off by the swelling in the knee, so fluid (and blood from the operation) accumulate in the lower leg. I also had a water-jacket around my knee with icewater circulating through it. My folks were great- they put a fresh bag of ice in the cooler about every two hours. Man, that ice jacket was NICE! You’re going to need a place to stay and really good friends for at least 2 weeks, minimum. 3 would be even better.

The worst part was rehab. Physical therapists are inhuman sadists. 'Nuf said.

I was on my feet hobbling in one week on walks of about 60 steps. In two weeks I could walk, and made the 20 hour trip back to Germany sitting in airplanes, standing in line, dragging luggage up staircases, etc. It sucked, but I could do it.

In one month I was walking more-or-less normally, though the year wait had severely attrophed my left thigh. I wasn’t walking symmetrically. In 6 weeks I could run to the commuter bus with a sack of books on my shoulder. In 3 months I was walking smoothly and had a nearly symmetric gait. I asked the doc if I could go skiing and he said yes, as long as I took it easy. (Re-doing an ACL isn’t a great idea because they can’t get it right the second time.)

I asked him if I needed a brace and he said, “Only if it makes you feel better. It’s mostly psychological.”

In 6 months the swelling was completely gone and I had nearly a full range of motion. In 12 months it started feeling strong again. In 24 months it stopped clicking and clacking, which meant that the bones and ligaments had reached some sort of agreement on how big they should be and how they should be aligned.

Now, after almost 4 years, my left knee is stronger and more stable than it was before I wracked it playing soccer. It’s actually better than my right knee now. The only signs left from the operation are a 2.5" scar just below my kneecap and a numb spot of skin where the nerves never grew back. It was well worth it.

The doc said that my recovery was unusually fast. He said that my shin bone was one of the densest bones he had ever seen, and the donor was similarly dense (probably a 300 lb football player who drank a gallon of milk a day growing up). He said that the new ligament was mechanically strong enough when he screwed it into place that I could have gone dancing that night. (Chyuhh, riiigghhhttt!!! It hurt like a *&%(#) Good thing they give out decent painkillers!)

But there is one bad part I haven’t mentioned.

Because of the swelling it was impossible for me to flex my knee enough to ride a bike. My foot just wouldn’t come over the top of the pedal stroke. And straightening it was a bitch, too. It was at least 6 months before I could sit and spin on a bike, and more than a year before I could get out of the saddle on a climb. It might be a long time before you can ride your uni again.

That’s actually why I bought this damn 20" Uni in the first place. I used to balance in the hallway and rock to strengthen my left thigh. I couldn’t complete a full circle, but I could “idle” and build muscle. Now that my leg is 110% I looked over at that damn uni and said, “I bet I could ride that thing now.”

Which is why I’m here in this newsgroup writing this absurdly long note.

Good luck, and I hope you decide to get the operation. It will eventually bring you back to 100%.

Bevan,
Yes, I was thinking ACL when I went down also, but good call on realizing it may not be the thing to say. I hope your sister has a great recovery.

Cyberbellum,
Wow, thanks for taking the time to relate that. That really answered a lot of questions I had. I must say that ACL reconstruction seems so common that I really assumed it to be a much simpler operation than it is. In reading your post I went from “oh, that’s good” to “oh, that’s bad” several times over. Overall, I think you scared the crap out of me. If it wasn’t for the fear of doing more damage, I would probably try to survive without the surgery. Beyond the problem of not being able to ride after surgery, it sounds like I will even have problems just getting around my shop and office for a few weeks.
I know a little more about what to ask my doctor now.

Thanks,
Scott

Thanks for the good story, cyber. Whew!

Naw, you’ll be able to get around. It will just hurt like a &$(#)$. Find a way to keep your leg elevated, and use the ice-cooler jacket and you’ll be fine.

When you stand for a long time, does your knee kind of slide apart so you have to shift postions a bit? Can you go up stairs without favoring your weak knee? In my case I couldn’t stand for long periods of time, and I was favoring my weak knee on stairs. I couldn’t ride or get any serious excercise. After a year my left thigh was really weak. I was definately handicapped. It was either get the operation or slowly become a cripple.

Part of the reason my cycling recovery was so long was that my left leg was so weak to begin with. The doc said that if I had had normal strength in my thigh I would have been on my bike a lot sooner. He said the optimal time to get the operation is 2 to 6 weeks after the injury - after the initial swelling is gone, but before any degenerative processes have taken hold. I was way late.

Also, when they do the MRI they can’t really tell how badly broken the ACL is. They can’t tell diddly about your cartilage, either. (I had several doctors tell me that I had arthritis, cartilage tears, etc. When they opened me up I everything was 100% textbook perfect. I got photos to prove it, too!)

On the MRI the ACL will either look tight, which is normal, or slack, which means it was damaged and is now too long. But thay can’t tell if it is partially or fully torn. The only way they can know for sure is if they stick a probe in and take a look. (In my case it was 100% torn.) If it is still together, and hasn’t been broken long, they can sometimes tighten it orthoscopically (I think they zap it with sound or heat or something so that it shrivels a little). That saves you the holes in the bone, the screws, etc. and you should be back in condition much quicker.

However, the swelling comes from the orthroscopic surgery, so I don’t think you can avoid the sadists. Find a good one, be VERY nice, and with any luck they won’t have to peel you off the ceiling after the “theraputic” massage. Remember to ask for a bullet to bite on during the massage… (If it wasn’t for the gleeful cackling and the wild look in her eyes as she drove her thumbs into my lower leg, or the, “Hey Sue, come take a look this. See how he convulses and passes out when I poke his leg here? Isn’t that cool!” then I might not have realzed that they only got into the PT business to torture people…) Too bad those massages really worked. For a day or so after the massage my leg felt almost normal. Then it started to throb again and I had to go in for another massage. (Ohh, did I mention the electroshock machine? That seemed a little gratuitous…)

The doc did say that the speed of recovery is contingent on your ability to tolerate pain. Apparently, when the knee is opened up it produces some kind of hormone that triggers the ligament repair cells to go into repair mode. This makes the ligaments surrounding your knee somewhat plastic and they try to tighten up. The main purpose of the physical therapy is to try to prevent this from happening. The more you can stretch them out while they are trying to shrink the less PT you’ll need later and the quicker you’ll be back to full range of motion when the swelling goes down.

If you really push it in the first 2-3 weeks of PT like I did, (and you don’t wait a year to get the operation like I didn’t), then you could be one of those guys who are back to full ability in 8-10 weeks. Just don’t risk tearing it again. If you do it twice your knee will never get back to 100%. Do it three times and your knee will be really ugly and it won’t work very well. Do it four times and they probably won’t be able to fix it again.

There are people who don’t push it and wind up with a permanent limitation in their range of motion. Those folks sometimes have to go through surgery again to have ligaments cut. That’s not an outcome you want.

Since the original injury is only a month old, and I rode and did quad exercises after that, my leg is as strong now as it has ever been. The reinjury 10 days ago has left my knee “loose” and very sensitive to any twisting at all, stairs are very difficult, and I don’t stand on it. The swelling went down a few days ago, and I have been wearing a knee brace most of the time since I injured it, and it really does make it feel better. Many years ago I stretched my MCL pretty badly, but got by without surgery and had 100% recovery. I was in a full immobilizing leg brace for a month, and afterwards had a sample of the excruciating physical therapy of which you speak. It is awful, and it feels like they must be doing more harm than good. And no, the pain does not seem to bother them a bit. I like to think I will tough, but who knows.

Scott

Those were just the facts. The good story was the layover at de Gaul airport in France.

I had just spent 7 hours on a plane from DC with no ice on my leg. This was exactly 2 weeks after the surgery and my lower leg was still puffed out at least a half inch. It was tollerable, but not comfortable.

We got off the plane and started marching through the airport. I had a 20 lb laptop sack, which threw my weight off a bit. They marched us for at least 300 yards before we came to the first checkpoint, which was the EU passport control desk. 20 minutes of waiting later, I got through that barrier.

After another couple of hundred yards of walking we went through customs. That was another 20 minutes of standing. I was beginning to be in a rather bad mood.

Then they marched us at least another 500 yards, including a couple of up and down stairs, then it was time to stand in line for security. We had been marched outside the security perimeter. It’s now about an hour after we left the plane and I’ve been standing the whole time with a brick of a laptop on my shoulder. My leg hurts and I’m in a really foul mood.

After about another 20 minutes in line I’m standing on a staircase waiting for my turn to go through the metal detector. I can see the plane I just got off parked at a gate no more than 150 yards from where I was standing. Why the hell did they march us around the airport? I’m in a REALLY foul mood now.

So I get to the top of the stairs, get the stuff out of my pockets and slam it in one of those stupid cups, glared at the security dude in his stupid French hat, put my laptop on the belt and stomped through the metal detector like a petulant 4 year old.

Fortunately it didn’t go off, because if it had I would have gone off.

I snatched the stupid plastic cup and promptly spilled the contents onto the floor - some change, a metal lighter, a keychain with a 3" knife on it, my wallet and a bottle of pills.

The French security guard that I had just dissed smirked a bit and said, in perfect english, “Sir, you dropped your weapons.”

The French can be so cool sometimes! He must have known I was having a bad day because he didn’t give me any grief. I’m sure he could have hauled me off and made my day even worse.

Anyhow, that’s the good story.

Scott, hopefully I’ll have some good news for you tomorrow after I hear from Jen. At least, if you do need require the surgery, you’ve got the best Dr. for the job! Good luck and I’ll give you a call as soon as I get back in town

Re: Torn ACL - Help!

Wow, Thanks for taking the time to describe your recovery. It is one of the
most articulate descriptions of knee repair I have seen. It makes me want to
wear a knee brace all the time just to avoid the injury in the first place.

My wife is recovering from some knee surgery. She put off the surgery long
enough that her supporting muscles had gotten weak. I think this and some
attempts at testing her leg too soon may have slowed her progress. Now she is
able to ride the tandem bicycle with me but we have to keep the mileage down
to under 30 miles per day instead of some of the centuries we used to do. (the
upside of this is that I have been able to ride my Coker more).

JD

>I’d definately get it fixed.
>
>I tore my left knee playing indoor soccer a few years ago. After about
>a month it didn’t get any better so I saw a doctor.

Where there is a wheel, there is a way.

Hey Scott,
If you need a set of crutches, I’ve got a new pair that you can have for free:)

Greetings Scott,

First let say how sorry I am to hear about your accident. A torn ACL is indeed a bummer but it’s also something than can be repaired 90%-95% of the time with excellent results which I regard as excellent odds. In my opinion Cyberbellum did an outstanding review of your options. Good job! I’m currently recovering from a second knee surgery on my knee which ‘in part’ involved repairing my torn ACL through reconstruction (unfortunately I have other issues too). I’m at six weeks post op right now and generally feeling well without pain our swelling.

The down side to a torn ACL is the length of time it takes to recover. It takes anywhere from 12 to 18 months for the graft to ‘completely’ heal. Most doctors will allow you to participate in sports at 6 months but usually require you to wear a sports brace to protect the ACL. At six weeks my graft is at it’s weakest point since surgery because it has been starved of nutrients since being removed from the harvest site. At six weeks the graft is starting to re vascularize (sp?) and thus starting to grow strong again. For my torn ACL I opted for what is considered the “gold standard” in ACL reconstruction which was to use my own patellar tendon rather than a donor patellar. Cyberbellum accurately pointed out that problems can arise at the graft site, namely what is known as patellar tracking. You knee cap my not have a proper glide after surgery and requires some rehab to get it back in line. This usually doesn’t have long term consequences. The graft site will also lose some feeling which usually returns in six months to a year but sometimes does not return.

The real issue to be concerned with is whether or not you have sustained cartilage damage and to what extent. The reason my knee is so poor is because 16 years ago I smashed all the cartilage to little bits which were floating around and needed to be removed. The cartilage is the knee’s shock absorber and protector, without it you literally grind your femur to your tibia in your knee joint. After 10 years or so, this sets up premature arthritic conditions, your bones become deformed from the wear, pain sets in, mobility issues occur etc. The next thing you know you looking a total knee replacement. In my case the surgeon reshaped my bones by shaving them with what essentially amounts to an orthoscopic dremel tool. This will buy me some time, but the knee replacement is inevitable unless technology comes up with an alternative solution. Fear not though, most cartilage damage to the knee occurs to the lateral (outside portion) of the meniscus in the form of a ‘partial’ tear. Doctors usually can’t repair this and instead trim as little as possible to make it smooth again. That way you still have your shock absorber and the pain is gone.

There are many excellent sites on the internet that can describe all that we have mentioned. You can even download video clips of the surgery (which may or may NOT be a good idea) :wink:

Good luck and I wish you a speedy recovery.

Jason,

I am glad to hear your recovery is going okay.
Like Cyber’s post, yours gives me a little more insight. I have done research and seen step by step descriptions with pictures. I chose not to watch the video.
Right now I am dealing with timing and cost. I have to do it all in the same year to keep from paying the deductible twice. I may have surgery the week after next.
I hope the rest of your recovery goes well.

Thanks Kenny, I have some old ones but they need the rubber replaced, I may take you up on it.

Scott

Good call, Scott.

I had a fair bit of anxiety before my surgery, but in hindsight the only thing you really have to worry about is when you are waking up. There are a few minutes there where the drugs are still in effect and you’re neither awake nor asleep.

Be VERY, VERY careful at this moment! Things are NOT what they seem.

(Not that I would have any experience with this, mind you…)

With any luck you’ll be dreaming about a nice downhill run, or winning the Tour de France on a unicycle, or flying a psychadelic bomber with John Wayne as your co-pilot. DO NOT, repeat DO NOT make the mistake of waking up in the middle of a B-movie harem scene.

No matter how real it seems, that nurse standing next to you is NOT one of the harem girls; and even though it LOOKS like she is fanning you with a big feathered fan, she is NOT a part of your dream. She’s adjusting your IV drip. It’s a TOTALLY different thing.

(Not that I would have any experience with this, mind you…)

Whatever you THINK she might want, you are WRONG. It’s best to just pretend she’s a vampire. Or a velocorapter. Stay very, VERY still, don’t make any noise, and whatever you do, DO NOT reach out to touch the OR nurse.

(Not that I would have any experience with this, mind you…)

DO NOT - repeat, DO NOT - reach for the OR nurse! She knows you’re guy, she knows you are groggy, and she knows all about pressure points. You don’t stand a chance.

Just trust me on this one. When they’re putting you under just pretend you’re godzilla stomping a Japanese village, or Sosa playing baseball in the world series, or Harper counting peanut-butter covered sheep skating on frozen motor oil.

DO NOT fall asleep thinking the OR nurses are hotties. Even if they are.

It’s not safe.

Tim

Tim,

I just want to point out that my OR nurses were “hotties” and I made this observation BEFORE I was administered anithesia. Lucky for me I’m a happily married man or I would have proposed to one (or more) of them sometime during surgery. :roll_eyes:

Cheers,
Jason

and THIS, sir, u consider safe?!?
:thinking: :frowning: :angry: :astonished: :sunglasses:

Gild, you needn’t worry – this scenario is obviously flawed. At the temperature which freezes motor oil, the peanut-butter would be VERY stiff – making it impossible for the sheep to move their legs. Since they would not be able to move their legs, they would not be able to skate.