UKC

I was unfortunate to damage my ACL Last week whilst skiing (caught a small tree under deep snow) binding set at 7 but didnt release due to slower speed at the time.

Insurance finally got me to a doctor down the valley in Borgosesia 2 days later. Doctor there was great & after draining a fair amount of blood & fluid from my knee notes instability in the lateral collateral ligament & suspects strong suspicion of complete lesion of Anterior cruciate ligamnt.

Now back at home with splinted knee brace & awaiting MRI Next week once swelling back to normal.

Im hoping to ski next season but i guess that all depends on the outcome of possible surgery.

Anyone had this & how did your recovery go re timescales ect & did you get back to skiing?

Any advice appreciated

Ouch. That sounds rather like my accident when a binding didn't release. Torn ACL and MCL, damaged LCL and meniscus. 

Accident on the 25/12 (Xmas evening in hospital...) then six weeks on crutches and with an articulated knee brace to allow the LCL to heal but not to loose too much muscle by being immobile.

In the end I didn't have a ligament reconstruction as the physio was working well and my review of the literature came to the conclusion that an operation wouldn't necessarily give a better outcome.

For example this article gives a good overview of who might not need surgery: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546284/

I had 9 months of physio and guided strength training with three two hour sessions per week plus work at home. This was then followed with another six months of strength and conditioning.

I know other people with a similar injury who didn't do as much work and took two to three years to be happy with skiing again and they didn't regain the same level.

I started running after six months and was happy trail running downhill after eight or so.

One year later I'm happily skiing (piste, off piste and touring) and don't even think about the knee. Thanks to all the strength and conditioning I'm actually far better off piste in bad snow than I was before the accident...

So basically, if you put the work in and have a good physio then next season is entirely possible. 

I've had the pleasure of heading under the knife now twice...

First time it was full rupture of ACL and also extensive ruptures on meniscus. ACL was reconstructed and meniscus mainly stitched back to one piece (small trimming required).

The second time, again meniscus damage and again sown back to one piece.

Standard ACL reconstuction is actually not a major thing. But realistically you will be active in often a months time. So you'll be soon at it, certainly next season.

Meniscus fixation (as it is called, when they try to put it back together) is a more recovery requiring operation. It was pretty much immobile for 3 months and proper recovery work plus training at around 6 to 9 months. No limitations after 12 months. But as said, basic ACL job is a lot quicker.

Oh, and swelling doesn't the MRI from being taken. You should just get it taken ASAP so that the ortho's can look at it an see what is required.

And yes, I've been skiing and climbing after both accidents. The first one (3 months, in a cast) had a significant affect on my leg muscles. So full recovery took close to 1.5 to 2 years (building muscle took a while). But after that 2 years, I've been back to my old antics... in fact I've had my biggest skiing (and climbing) days after the first surgery. And the second one, was a breeze in comparison.

Still gettin' better at this skiing (and climbing) thing, albeit being mostly desk bound at work I do need to keep my park skiing at reasonable levels... the muscles are just not there any more. But I guess that goes along with gettin' older.

And I agree with HeMa regarding the MRI - there's no need for the swelling to go down before getting a scan. It's the first thing you should do.

Ewan R.. HeMa.. Great advice & All sounds very positive.

I was lucky enough to see a consultant yesterday so the wheels are in motion. Will check out the Article for advice re when i can start some strength training, biggest concern was muscle/strength loss. 

I did smash my left knee 13 years ago, climbing not skiing, physio helped & basically got back out as soon as able. Had an Arthroscopy last year on that knee just to clean up some cartlage fragments and now fine.

Like you say age can be an issue so il see what the MRI Shows & try and get the best advice i can as to weather an op is the way forward or not.

The good news from the Italian doctor who climbs said after it has settled should be ok to climb, albeit easier stuff. Our Italian guide said hed done both ACLs in the past!

Thanks again

Lee

I had a an ACL reconstruction (hamstring graft), medial meniscus repair and lateral meniscus removal in January 2021. 
I was back on my turbo trainer at 6 weeks, riding outdoors at 10 weeks, running at 12 weeks and climbing again at the 6 month mark. I was back on skis almost a year to the day after the surgery and I’ve skied a total of 5 weeks since. I haven’t noticed any impact on my performance and don’t even think about the injury anymore. 
the key for me was being meticulous with the rehab (twice daily exercises and a weekly visit to the physio for 8 months post-op). 

For info, I don’t have a working ACL in the right knee. If you have function and strong muscles it may not cause any bother. It never bothered me with hillwalking, skiing, climbing or anything else when I was really active except after when I had a torn cartilage trimmed op. That op caused some instability until I got the strength back into the muscles.

I was told by the consultant it is not always necessary to operate. Of course your consultant will be best placed to advise what is best for you.

Hi Steve

Sounds like i just need to get through this initial phase and see what the Scan & Consultant says. After that and once i have some stability back & the physio/exercise regime starts just keep at it and take it from there.

To Add to the general positive theme, I tore my ACL (a good few years ago now) - full rupture.  Accident was in Early January, and operated on early March (from memory) with a fair whack of physio ahead of the op to strengthen the leg as much as possible before the op as apparently gives better recovery.  Physio will give you an exact program to follow but I was hillwalking again in May, alps in July and able to ski again the next season.  A few pit falls during recovery where new ligament weakens and you need to reduce training to compensate that are counter intuitive.  Key for me was getting a really good sports physio who was focussed on getting me back to "performing" and could guide through these pitfalls.  Aggressive but well managed program that they put together worked very well.  Do the research on physio in the area, get advice from the consultant on who to speak to as well as they might know who the best people to speak to are.  Consider private if that's the only way to get someone you think is suitable (if affordable!).  Be wary though that private does not necessarily mean good.....  I had a bad shoulder injury last year after coming off my bike and got treatment through my work's private scheme but the physio I was sent to was a one person business that took on loads of work experience students so you got very little time with experienced and qualified physio.  

I actually think I was at the fittest I'd been in years after rehab!

I've known a few people with the same injury who struggled with physios who were only looking t get them back to a day to day level of fitness (walking down the street, to the shops etc) - much longer recovery for them so make sure physio understands what you need to get out of recovery.

Hope recovery is quick and successful for you!

Sounds like you've done something very similar to what I did 5 weeks ago. I've a complete rupture of the ACL, and partial tear of the medial collateral ligament (MCL: the opposite collateral ligament to yours). Like you, the binding didn't release - we assumed it had frozen up but perhaps it's actually because it was relatively low speed.

The docs in Italy were all for operating the same day, but my insurance declined to pay for it. Probably a good thing... it turns out this is one of the things that the UK are better at.

I'm in an articulated knee brace for another week or so, and then I can start weaning out. That's to ensure everything stays straight whilst the MCL heals itself. I ditched the crutches all together after about 3 weeks, when they started becoming more trouble than they were worth and I decided I needed to focus on walking straight.

For the ACL, it's going to be an intensive programme of physiotherapy, to retrain the knee to work without an ACL.  Hopefully I'll regain good enough function to not need surgery.  If I do need surgery, all the physio will have served as pre-operative "prehab" to get in good shape for it.  Both the Orthopaedic surgeon and the physio have been very clear that physio is super important: if you don't do the physio, and therefore don't regain knee function, then they won't consider you for surgery because it would just be wasted effort (because you need to do lots of physio post-op too). Unfortunately there isn't a way of telling early on who will or won't need surgery.

As it happens the physio who's currently seeing me at the hospital is someone I already know from the climbing club. Currently the exercises are all about strengthening the muscles, and also getting the knee to go properly straight (to ensure the MCL doesn't heal too short). As I understand it, as I progress, I'll move to the gym with circuit-style sessions where they progressively increase the complexity: walking / jogging / running in a straight line, then big circles, then tighter circles, adding in more sudden movements, etc. If you get stuck at a certain point despite proper effort, that's when they'd send you back to the surgeons for consideration of surgery.

They've told me that many people do just fine without surgery, and indeed there's a physio in the department who has no ACL in either knee and skis steep stuff just fine. So that's reassuring.

Oh, and they're super keen on cycling as part of the physio/rehab process. Like, really keen.

From what they've told me, it doesn't feel ridiculous to be thinking about skiing next winter.

The girlfriend ruptured her ACL a few years back skiing. I know quite a few people over here in Norway with ruptured ACLs also. A couple of them are physios. None had surgical repairs, so a shorter recovery. Lots of conditioning. Repair seems to only be recommended for the young, elite types over here.

Quite a high rate of rerupture following repair. The problem as I understand it is that it's difficult to assess the readiness of the graft to return to high activity. The standard tests aren't adequate and there's often a degree of unscientific 'feel' about when the knee is ready.

In reply to All: Many thanks for taking the time to offer your advice & experiences. All sounds very positive. Interesting to see a fair few havn,t opted for an operation, i guess with all ops it can either help or hinder in each individual case.

I have a scan booked in for sunday (Good Old NHS) hopefully this will be followed up next week with the consultant. From what most are saying, and from my own experience with my left knee some years ago, seeing the right physio is key. Cycling sounds like a good start though i guess care is required (did anyone cycle with a brace on or off?)

Cant over estimate the need for a good physio, last time i used an excellent private one to sort out an impinged rotator cuff shoulder issue which she sorted in 4 visits where the doctor gave steroid injections which didnt appear to do anything. 

Thanks again

Lee

This is what I do for a living and you’re correct - there is no set ‘return to play’ test. Even for some of the gold standard tests you can achieve symmetry in results (e.g. how far you’ve jumped) but by utilising very different movement strategies. Your body has an amazing ability to adapt and compensate for the injury. 
 

@ Lee - As others have said, work hard but don’t rush things. The probability of a re-rupture decreases by 50% per month after about the 9 month mark. Skiing after a year is reasonable but if it’s now, end of season, crap snow you might be better off skipping a season and coming back as fit as possible. Good luck and send me a message if you have any questions. 

Ive got no plans to even attempt skiing again this season, just focusing on the physio & getting strength back. Some very useful information here & many thanks for the kind offer for contact.

Had the MRI today so hopefully get back to the see the consultant later this week & see what they say, and take it from there. Ive always considered myself a coper so certainly have the will to get back on the horse, though ive been told im not the best patient ! Guess its something you cant rush as you say.

Thanks again

Lee