Torn ACL

[PLC]

So, having spent the past six months getting into the best shape of my life in preparation for "the summer of Paul" (I have six weeks vacation to use between now and November), I just completely destroyed my knee playing soccer yesterday.

 

Anyone have any idea how quickly I can get back to climbing after tearing my ACL, LCL, and miniscus? The doc says I'll need surgery in about 30 days and then 4-6 months of rehab. Anyone done it faster?

 

Good knee docs?

 

How can I keep my cardio fitness up without using my legs?

 

This sucks.

[ericb]

Just had ACL reconstruction with Richard Zorn 6 weeks ago....excellent surgeon and specializes on the knee...does like 150 ACL reconstructions a year. He's the Sonic's Ortho. He does hamstring graft typically.....Larry Holland in the same practice is the Mariners Ortho....he does Patella mostly. I have had an excellent recovery with Zorn. You pick a method usually when you pick a surgeon so do some research to figure out which graft is best for you. I've also talked with several people who had Larson at the UW, and raved about him.

 

As far as cardio fitness...not sure if you mean pre or post surgery. Once things settle down and muscles stabilize the knee you might be able to do stationary bike and/or swim with a pull buoy pre surgery. Post surgery, I was on the excercise bike within a week and swimming within four weeks, but I had ACL only, no LCL or meniscus.

 

I was told 9 months typically to return to all pre-injury activities - namely skiing and plant/pivot sports, but not sure how climbing would rank. Probably more risk on the approach than climbing itself.

 

Feel free to PM me if you have more questions.

Edited May 9, 2007 by ericb

[Sherri]

That does suck. Sorry to hear it.

 

Somewhere in the "Workout Splits" thread people have posted links to cross-training stuff that can be done while injured...if I get a chance I'll look around for it and post the link.

 

Hang in there.

[layton]

Get the surgery done faster, and don't miss a one of your rehab appointments. Start the rehab the DAY after surgery, yes there is a lot you can do the day after.

[Fairweather]

I had a hamstring graft to replace my ACL about 8 years ago. Also some minor muniscus damage that was cleaned up. Dr Robert Yancee in Gig Harbor. A somewhat arrogant Harvard guy that is a fantastic surgeon. He does only hamstring grafts - but will do allografts (cadaver) on sedentary or overweight patients. When I asked about a patellar tendon graft he replied that he considered it old-school with unnecessary compromise. I was running straight line after about 4 weeks post-op, and went climbing in Alaska about 6 months post-op. Certain sports like tennis or basketball still caused minor swelling until about 1 year post-op.

 

Today, I can't tell there was ever an injury. I would rate my strength in the repaired knee at about 150% of original. Rock solid. The hamstring tendon he took still goes unmissed.

 

I think the early part of your summer is shot. Sorry. Keep your weight/diet under control while you're down and your return to fit will be very, very short. Focus on rehab and plan on some moderate late season trips that don't involve descents down 5000-foot talus slopes. Ski poles will help too.

 

My two cent.

 

[rbwen]

I would heartily second the recommendation of Dr. Holland. He did my ACL three years ago (autograft patellar tendon) and my knee feels stronger than ever.

 

rbwen

[ken4ord]

That sucks!!

 

Well I have done the same, except my triage was acl, mcl, and 3 patella tears. It took me 5 month of recovery time, could have gotten out sooner, but decided to hold off. Definitely reccomend getting done as soon as possible, instead of dragging out your time that you are laid up. I had mine done 4 days after my accident. I had a patella tendon graft for the acl, this is mainly because I had torn both of my hamstrings a couple of years prior in a snow boarding accident. From what my doctor told me he said that hamstring grafts take less time for healing. The mcl was left as is. I had two tears trimmed out and one stitched, if you wait long you won't have the option to stitch a patella tear. As far as I can tell the stitch has held up.

 

Hit PT and stick to it. I was lucky because I was sponsored by one of the top centers in the country Orthopedic Associates (Portland, Maine) they worked on a ton top atheletes (football star and olympian skiers mainly from what I could tell by all the signed posters everywhere), I was also sponsored by Healthsouth therapuetic associates. So I got top notch care. I was in PT 3 times a week and they picked up the slack after my insurance company stopped paying and let me keep going. I hit the gym 2-4 times a week to lift (upper body even when I was still on crutches). My cardio fell by the way side for the first several months mainly because I bought an oz. smoked all the time instead of taking pain killer and it help alleviate the boredom. Later I was doing pool work outs and cycling on the stationary bike. So when I got out for the first time I hopped right on grade 4+WI then followed by grade 5WI ice climb. I felt fine but nervous about slipping or falling.

 

Don't get down, get up and get better. My goal (after a few days of depression) was to come back stronger than I was going in, within 6 months. It worked.

 

Good luck!

[ericb]

Good advice here....but a couple comments. Most surgeons will have strong opinions about PT, when to begin, and how fast to ramp up, and will write a prescription accordingly. I think most good PTs will temper the prescribed protocol some based on personal progress, but may not deviate dramatically for liability reasons. My surgeon is very conservative and had me starting PT at 3 weeks (on the late side) but said I could start on the bike after 6 days (early side). Again...ask questions about what their protocol is in the consultation. You will get a pretty good sense of where they fall on the aggressive -> conservative spectrum.

 

Also - many good, right-on comments about getting surgery scheduled early....less time for quads/hams getting weak due to post injury limitations. That said, don't make a decision on surgeon based on how quickly they can get you in. Good surgeons are busy surgeons, so I'd be a bit alarmed if a surgeon had a lot of near term availability. +/- two weeks won't ultimately make as much difference in your recovery as finding a rockstar surgeon - especially given the LCL and meniscal tears.

[layton]

There are PT procedures that can be done EARLY.

Cold Laser, Microcurrent, KinesioTape, and low amplitude mobilization. I'd highly reccomend the cold laser to drastically speed up the healing time.

[ericb]

not familiar with the cold laser....any links that would discuss the application to post ACL surgery. I'm not sure how common the technology is in your average PT clinic. Who in Seattle area is using it?

[ryland_moore]

I had a complete tear of my left knee ACL in May 2003 while descending Denali to pick up a food cache at 9,700'. I did not realize this tear and continued climbing to the summit and back down. When I got home, I completely forgot about the knee injury, even though I heard a pop when I caught my ski tip and fell. Fast Forward t the Spring of 2005, I got into triathlon and decided I was going to do the Pacific Crest 1/2 ironman for my first race. I was doing a ton of running and my left knee started to hurt and feel sore. I stopped a run on a Thursday night 1/2 way through and decided to rest it becasue I was going bc skiing in Spray Park on Rainier over the weekend. Well, just as I was about to drop down onto the glacier, I simply turned around to pick up my pack and my whole knee colapsed. I thought I had just oeinjured the same knee like on Denali and it would pop back in, but it didn't. After hopping out to the road and my buddies carrying my pack and skis, then driving back to Portland, word was it was a torn meniscus. No MRI and surgery was two days later. After surgery they told me the meniscus was fine and just trimmed it up but that I had a complete tear of my ACL that had defined scar tissue and had been there for several years. They said I could get it fixed or just leave it but because I like to climb and ski, that it could happen again in a place where I cannot get out as easily as hopping for several miles. I said fine, but it was right before summer and even though the 1/2 ironman was out, I figured why not enjoy the summer sans ACL and get it fixed in the winter. So I spent all summer climbing, fishing, hiking, doing everything I did between Denali and the present without an ACL. I climbed Rainier in July with no problems and then had the ACL surgery in December. My doctor was with the Portland Knee Clinic who works on active atheletes all the time. He told me that the hamstring will take 2+ months longer to recover, but you will have less complications later in life and your knee will not be as sore. I chose the patella surgery and was in the gym 10 days after surgery and running within a month. My quad had atrophed quite a bit, but I just worked out regularly and no problems. I did not usea personal trainer or use rehab, but I was also training for the 1/2 ironman I missed the year before so was riding about 150 miles a week and running about 40 miles a week. I did the Vlue Lake Olympic triathlon firs weekend in June, 6 months after surgery and the 1/2 ironman in Sunriver 2 weeks later.

 

My opinion is that the surgeon is what helps the most with recovery. I have a friend who had to have an ACL replaced 10 years ago and it started bothering him again. He went in to a knee surgeon and they took out too much, had to have reconstructive surgery again, and is still on crutches. he had the first reconstructive surgery in December and is still on crutches today (I know b/c he borrowed mine). The doc told hi he wopuld be back on his feet in two weeks. Now there is a malpractice lawsuit pending. I also met a young guy in the gym my first night back (10 days post op) and he was doing knee exercises. he had ACL surgery and was on crutches for a month and in a leg brace for 4 months. he said he could not run for 6 months and had the hamstring surgery. He said it still hurts and that he has trouble a year later. he was a fit 22 year old male who played AAU and college basketball. he could not beleve that I was up in the gym 10 days after surgery.

 

Find a good doctor who comes highly recommended. Talk to people about post -op and find someone who will push you. That is how I found my doc after talking to friends who had ACL surgery. Three of them recommended the doc I went with and none had complications after surgery and recovered the fastest out of all those I surveyed. For Portlanders, his name is Dr. Richard Rubinstein. As for timing, that is up to you. I gave you my story to show that you can live without an ACL. I climbed skied, did everything without it. yes, when I pushed too hard, it cause my overstressed meniscus to tear, but I lived for 2 1/2 years without the ACL and still did everything I like to do. Good luck!

[PLC]

Thanks everybody - your anecdotes definitely helped. I had been literally making myself sick with stress over the thought of never playing basketball or soccer or skiing again... After reading everyone's stories, I'm not so worried.

 

My doc seems to think it is best to wait about a month before surgery, to let things "calm down". After reading Ryland's story, I might talk to the surgeon about pushing this out to September...

 

Anyway, thanks everybody!

[ryland_moore]

PLC, you will play soccer again as well! I play for two over-30 leagues in Portland and one open league. Three games a week and he knee gets a little sore every now and then, but I had the patella (quicker recoIvery, will bothler you more than hamstring later on), but not enough not to play. No knee brace or anything. The main thing to remember is to constantly stretch it as much as possible as soon as possible. You sdon't want the scar stissue to hinder your flexibility duriong the healing process. yes, it hurts, but you have to do it.

[i_like_sun]

OK, so I don't PERSONALLY have any experience with ACL problems, nor am I a surgeon..... However, a buddy of mine blasted his knee snowboarding 2 years ago up at Baker. Basically, he got caught in wet slab avalance and got swept into the trees. His knee got wrapped around a tree, and he ruptured his ACL, PCL, MCL, dislocated his patella, and tore his Medial Miniscus.

 

He snowboarded all this season and is doing fantastic. I hope that helps you somewhat.

 

I have been through serious orthopedic injuries in the past (almost had my wrist fused 2.5 years ago...) so I know what kinds of battles your mind is having. My best advise: SLEEP. And try not to get too negative. Knee surgeries are fantasically dialed these days. Hang in there.

 

 

 

 

[ken4ord]

There are PT procedures that can be done EARLY.

Cold Laser, Microcurrent, KinesioTape, and low amplitude mobilization. I'd highly reccomend the cold laser to drastically speed up the healing time.

 

Yeah my early PT was freaking dull and consisted of the stuff up above, except for cold lazer. WTF is that any ways? I started 4-5 days after surgery, we waited that long mainly because they wanted me to get used to my crutches before going to the clinic.

[layton]

Boring, yes....but better than nothing.

Cold Laser is the latest "big thing" in the conservative treatment of injuries.

The laser penetrates 5cm in depth below the skin where is reacts with your cells to stimulate repair. It's too late and I'm too busy at the moment to find the research. So far it's shown amazing results and is replacing ultrasound as the deep penetrating modality of choice.

 

I've used it on my own shoulder labral tear and noticed a HUGE improvement. My patients have also noted a huge improvement in plantar fascitis and meniscus tears.

 

There are a few types of cold laser out there so bear that in mind if reading the research. One company, "Arconia" claims that their cold lasers (which operate just above a laser pointer frequency) are the best, but I'm very skeptical. The ones that have the best research are the medical grade lasers that can blind your ass. They cost roughly 5grand, so you won't see many clinics with them. I'm trying to get one.

[i_like_sun]

Will Chiropractors be able to use that modality in Washington???

[layton]

Yes, it's allowed. And all the other ones should be soon (how soon I don't know)

[i_like_sun]

Hummmm. You've seriously got me re-evaluating chiro. over PT school......

[layton]

go observe each in practice, they should let you. Ask around 1st to see who's good, who's bad

[fenderfour]

(almost had my wrist fused 2.5 years ago...)

 

Let me guess - you found a stack of pron and couldn't help yourself?

 

 

I just wrapped my knee around a soccer goalpost while playing Ultimate Frisbee. I was terrified that I had wrecked it after reading this thread. Turns out I bruised the deuce out of it and strained the LCL.

 

Good luck on recovery.

[i_like_sun]

(almost had my wrist fused 2.5 years ago...)

 

Let me guess - you found a stack of pron and couldn't help yourself?

 

 

I just wrapped my knee around a soccer goalpost while playing Ultimate Frisbee. I was terrified that I had wrecked it after reading this thread. Turns out I bruised the deuce out of it and strained the LCL.

 

Good luck on recovery.

 

Yeah, I really get into my passtimes! Actually, I was pretending to be superman and decided that taking a headfirst roll into the ground from 20 feet was a good idea of fun. - It was. Just not later, after the ex-rays came in showing a completely obliterated Scaphoid, 4 broken ribs, a third degree shoulder seperation, and a concussion.... (well, the ex-ray didn't show those last things...)

 

I hope your LCL feels better! The good news is that the collateral ligaments heal super well.