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No ACL, no surgery, no problem - My new normal as a Coper

Sorry I haven't read this whole thread and maybe it's been mentioned, but watching racing this weekend they mentioned that Carlo Janka is skiing on the World Cup with no ACL.
Interesting. I don't follow ski racing much.

There are a lot of advanced/expert skiers with no ACL. Before MRIs and ACL reconstruction surgery became established, some didn't even know they were missing an ACL for years. When EpicSki was active, I must have run across at least a dozen and skied with a few. They were mostly hard chargers who like steeps and chutes at places like JH and Snowbird. But there is no way to tell by watching someone ski, or even walk, and most ACL-deficient skiers don't talk about it. Probably because it really doesn't make much difference. Especially if a brace is not worn. Even with a knee brace visible, lots of people who have a brace are not ACL-deficient.

There are a few football and basketball players playing at a college or pro level without an ACL. Also rock climbers, tennis players, soccer players, and ultimate frisbee team members. I easily found examples when I researched the topic in 2012, the summer after I popped an ACL (not skiing). That was part of my decision process for not doing ACL reconstruction surgery.

This thread is mainly about my personal experience, with a few posts from other copers. For other topics related to ACL injuries, there are other threads.
 

asherz515

Diva in Training
I am new to this forum and consider myself and advanced intermediate skier. I skied a whole season without an ACL (without my knowledge) I had one of the best seasons of my life. I hit POW, chutes, you name it. I attribute it to heavy rehab and getting stronger after my crash.
When I found out (after an unrelated crossfit accident) I seriously debated not getting surgery. Which I am still not sure I am happy I got it. We will see how I ski again. Its easily possible, but I decided I didn't want to risk more cartilage damage so I went ahead with it.
 
I am new to this forum and consider myself and advanced intermediate skier. I skied a whole season without an ACL (without my knowledge) I had one of the best seasons of my life. I hit POW, chutes, you name it. I attribute it to heavy rehab and getting stronger after my crash.
When I found out (after an unrelated crossfit accident) I seriously debated not getting surgery. Which I am still not sure I am happy I got it. We will see how I ski again. Its easily possible, but I decided I didn't want to risk more cartilage damage so I went ahead with it.
"POW, chutes, you name it" isn't usually associated with "intermediate" around here. Sounds pretty advanced to me. Most likely, you'll be fine after solid rehab as long as you give the bone time to heal fully before charging down the steeps.

My personal trainer popped an ACL teaching a class. She's over 60. Was working on being a coper but since workman's comp was going to cover ACLr surgery and rehab 100% within a specific timeframe, she went ahead with the surgery. It gave her piece of mind.

I started my coper threads mainly simply because it's hard to find stories online about successful copers. There is no one way to deal with an ACL injury. Every knee injury is different and what works for one person may not for another. Consulting medical professionals while researching options is what's important.
 

asherz515

Diva in Training
"POW, chutes, you name it" isn't usually associated with "intermediate" around here. Sounds pretty advanced to me. Most likely, you'll be fine after solid rehab as long as you give the bone time to heal fully before charging down the steeps.

My personal trainer popped an ACL teaching a class. She's over 60. Was working on being a coper but since workman's comp was going to cover ACLr surgery and rehab 100% within a specific timeframe, she went ahead with the surgery. It gave her piece of mind.

I started my coper threads mainly simply because it's hard to find stories online about successful copers. There is no one way to deal with an ACL injury. Every knee injury is different and what works for one person may not for another. Consulting medical professionals while researching options is what's important.
Haha this is true, I ski in Utah with mostly ski racers, so I am comparing myself to some of the best. I did have surgery last September, I skied the season before without it. So two rehabs! I am hoping to ski this Friday, but yes I am scared shitless, even more so now that I know and have been through the surgery, because its brutal. I plan on sticking to groomers and the bunny hill, but man we have had a lot of powder, its going to be hard. I just want to be able to ski until I am in my 60's so I will take it easy. I think its great to hear there are others out there successfully skiing without an acl. I am pretty sure if I do it again, I will just opt for not doing surgery. Most medical professionals just want to do surgery, though my first surgeon told me I was "to old" (42) and to leave it alone.
 
Most medical professionals just want to do surgery, though my first surgeon told me I was "to old" (42) and to leave it alone.
When I was actively researching the options, I found that approach taken in Canada, Europe, and Australia is quite different than in the U.S.

Read many recommendations on finding a surgeon who was a skier. Not that easy for me in North Carolina, but my surgeon supported the idea of working at being a coper given how stable my knee was when he checked it out after having the MRI results. That was about 6 weeks after injury and I only had done a few weeks of PT. He knew I intended to keep skiing.

42 . . . doesn't come close to qualifying as "old." I remember my mother getting tired of having doctors in their 30s when she was over 75. Quite healthy but she started going to a doctor who was interested in working with seniors. She lived to 95 and was on only one medication in her last few years.
 

asherz515

Diva in Training
I wonder why the US approach is so different? I did opt for surgery, I have experience from it (my daughter also blew her acl and patellar tendon at 13) but it seems most drs won't even consider leaving it alone. Since my knee was stable (I skied a whole season) I probably would have just left it alone (in hindsight) because now I have even more pain, and I haven't even skied yet.
I agree 42 isn't old, I found a different dr who was my age and took in account my activity level. Your mother sounds like my hero. Its great you've had good success without surgery. I would be more cautious next time. I am hopeful there is new research on better ways, like stem cells and such that there will be better alternatives.
 
I remember my mother getting tired of having doctors in their 30s when she was over 75. Quite healthy but she started going to a doctor who was interested in working with seniors. She lived to 95 and was on only one medication in her last few years.
@marzNC this is off-topic, but what age bracket was your mother's doctor in? I think that's great.
When she got tired of younger doctors, the new doctor wasn't old herself. But her specialty within Family Practice was gerontology. Was great for a few years, but then she moved away because her husband got a job elsewhere. By then my parents had moved to an independent retirement community so we looked around for a new doctor closer to where they were living. I was providing transportation for medical appointments by then since they were over 85. First one didn't turn out to be good. There were issues when he tried to treat her high BP. Then the Duke Health system built a new facility nearby that included a Family Practice unit. Went with a Nurse Practitioner and that worked well. That office had a focus on seniors. There were a few retirement communities in the neighborhood.

As for the high BP, the solution ended up being acupuncture. Needed weekly treatments for a couple months, then every 2-3 weeks. Solve the problem far better than any drug because my mother had a very sensitive system and tended to have adverse effects to medication. So over age 93, the only medication she was taking was Synthroid for hypothyroidism. Took her several years to get that diagnosed when she was over 70 and to get on the right dosage. Needed a specialist for seniors for that too. Afterwards it was the same dose for about 20 years.

Fair to say that I learned a lot doing eldercare for my parents when they were in their 80s and 90s. Luckily really didn't need to do much until their last six months. They were both professors but very different in how they approached their health. One reason my mother made it my job to take my father to his medical appointments even when she was still driving. Men. :wink:
 

lisamamot

Ski Diva Extraordinaire
My daughter is 18 and blew her right ACL in October 2017 playing high school soccer - it was a full contact injury where she got a knee to the side of her knee at speed. She had patellar tendon reconstruction surgery in November 2017 and absolutely rocked her recovery - she worked with her amazing PT and then followed that with a sports fitness trainer 6 days a week. She was cleared for full contact at the end of the summer and played as the center back at her college this year. Sadly she just blew her left ACL at the end of this October in the final minutes of the last regular season game. She was hit from behind on her right shoulder while shielding a ball out the last couple of feet and when she went to catch herself she planted her left heel in an awkward position and it gave. She has a former teammate who is also a defender that blew hers in the same manner. Rotten luck. Patellar tendon ACL reconstruction surgery is this week.

In the first she also had a partial MCL tear, an LCL sprain, a mild buckling of the PCL and a small lateral meniscus tear; bone bruising showed that the outside of her femur bounced off the inside of her tibia and she had a bone indentation from the impact. Her knee was not stable even in a straight line.

With this second one it appears she has a medial meniscal tear (they will know the extent when they get in there but they believe it is minor), and a sprain of the MCL/LCL, but minimal bone bruising. Her knee is stable enough if she goes in a straight line but any side to side or pivot and it gives.

In both cases she had immediate swelling but little to no pain. The first one she said she thought "wow that is going to leave a mark" as she fell, but more from the point of impact and not the ACL - she had a doozy of a hematoma. The second one she had no pain but just knew immediately - when you have done it before you know what it feels like.

With a very active young person there is little question about performing reconstruction surgery, at least in the states. At my age if I blew my ACL I would rehab and see if we could keep it stable before resorting to surgery.

Watching my daughter go through it once and getting ready for the second is brutal. She is a warrior.
 
With a very active young person there is little question about performing reconstruction surgery, at least in the states. At my age if I blew my ACL I would rehab and see if we could keep it stable before resorting to surgery.
I agree completely. The research going on in Boston is mostly to help young athletes in the future. Especially those young enough that their bones haven't finished growing.
 

lisamamot

Ski Diva Extraordinaire
I agree completely. The research going on in Boston is mostly to help young athletes in the future. Especially those young enough that their bones haven't finished growing.
My daughter goes to MGH - the Chief of Sports Med did her 1st surgery and is doing her 2nd. Amazing surgical team and the ACL PT team is phenomenal as well. It is a haul and a $10 garage fee for each PT but so worth it.
 
Watching my daughter go through it once and getting ready for the second is brutal. She is a warrior.
Oh wow. I didn't know. SO sorry!! :frown:

Been there. DS had his first ACL in February (quite a few years ago), surgery in April. Second ACL in December (TEN months later!), surgery January. He also had patella tendon graft. Alas, the patellas start to be a painful problem a number of years down the road. Kneeling is tough for him.

Totally with you, re: the warrior label. He had 2 ACL surgeries in 10 months. Yikes.

We thought we were all good to go. Then 2 years later, DH blew his. :doh:
( I AM NOT NEXT.)
 
The 2018-19 season is going to include a lot of ski days, mostly out west but also a couple of ski safaris in the northeast. I've got both the MCP and Ikon, based mostly on trips planned to Taos, Big Sky, and Alta. However, having Ikon is influencing where I'm going exploring in the northeast. For assorted reasons, I was able to do a fair amount of ski conditioning during the summer and fall, including working with my personal trainer.

I started skiing the week of Thanksgiving given the early snow in the northeast. As has been my family's habit for the last few years, we spent Thanksgiving week in Boston instead of having my daughter fly home to NC on the busiest days for airports. I skied a day at Killington, as well as at Wachusett with my daughter and a local Diva after her break started. Next skiing trip included a Diva meetup at Sunday River in mid-December and exploring in NH. Just finished up the first of two Taos Ski Weeks.

NH ski safari plus Sunday River Dec. 15-17, 2018

TR Taos Ski Week Jan. 20-25, 2019 with intermediate Divas

My plans for the rest of the season include Big Sky in late February and Alta in April. Will ski the northeast somewhere in early March, but won't decide exactly where to go until much closer to the date.

After the experience in May, I concluded that fixing my left turn would take care of the issue that started last season with my right calf. I did a private lesson with the resident Examiner at my home hill in early January (Massanutten in northern VA). We worked on the short green and the easy blue. Took a few runs, but I finally managed to do the right movement and could feel the difference in my hip flexor. We kept doing runs while the instructor followed. By the end, it was clear how much smoother my rhythm was and he said my linked turns were clearly rounder in general. He gave me a few key ideas to remember. He said to focus on one at a time and cycle thru them while practicing. Last week I could easily replicate the feeling of good turns on the Taos groomers. What was even better was that the new habit was becoming ingrained enough to work most of the time on easy bumps, at least at slower speeds.

In short, the issue with the right calf has very little to do with my right leg being ACL-deficient. My left turn has been the weaker turn every since I started skiing.
 
After another Ski Week at Taos, already up to 26 ski days for 2018-19 with half at TSV. Last week included powder days and plenty of soft bumps (blue, black). Left turns continuing to work much better.

Had the opportunity to hike up and head out the Highline Ridge for the first time. A lot easier to say "yes" to the idea when following one of the most senior instructors at the TSV Ski School. Got lucky and had Stephanie for most of the week. Even though the group was more advanced than my group in January, the average age was probably 55, if not 60. I was in the middle age-wise and ability-wise out of the six students. The youngest, a middle-aged woman, was the only one who had not taken a Ski Week before.

Did a little adjusting for my boots. The re-molding of the Intuition liners from my previous boots seems to be okay. However, it turned out my footbeds were starting to crack so I opted to get new footbeds made at the Boot Doctors. That shop has 4-5 boot fitters on staff and they deal with both Intuition and Zipfit liners. By the end of the week, everything seemed to be working pretty well. Current boots should be good for another few seasons.

There are a few pics in the trip report of my group skiing in deep powder after the hike. Took 30 min or more to get to where we put our skis on for the last bit on the Ridge before dropping into the trees. Hiking at over 11,000 ft is tough. Meaning knee deep for tall people and thigh deep for me. Have gained enough powder experience in recent years that I don't worry about using my Stormrider 85 skis in deep powder. Wasn't considering renting powder skis at all.

TR Taos Ski Valley, Feb. 2-9, 2019, including advanced Ski Week

Heading to Montana soon . . . and it's snowing there!
 
Got very lucky for the trip to Montana in late Feb 2019. Ended up deciding about a week before I flew to SLC that skiing at Grand Targhee before heading to Bozeman made the most sense. My ski buddy, Bill, picked me up in SLC and we skied GT for a couple days, Bridger for three days, followed by a week at Big Sky. We caught powder storms at all three locations. Haven’t ever skied that much deep powder in one trip.

The tweaking of the Intuition liners seemed to have worked. Between getting boots sorted out and continuing to practice proper left turns on groomers, I was in pretty good shape for enjoying deep snow and challenging terrain in general.

Had a semi-private lesson with Bill at Bridger with an instructor I worked with in 2012 and 2013. We worked on a few fundamentals on steep groomers to start with. Then Ric Blevins decided we were up for what I call an “adventure run.” We did a double-black off the Bridger lift that started by going thru the gate to Avalanche Gulch. The traverse was quite an adventure with two steep down-and-up sections that required keeping up speed. I linked more than enough turns for the steepest section at the top of the run before reaching the point where Ric had stopped. There was no fresh snow and full concentration was required. I guess all the bump lessons have added up, together with off-piste mileage at Taos and Alta in recent years.

TR Grand Targhee, Powder Days Feb. 17-18, 2019

Mini-TR in the Montana 2018-19 thread:
https://www.theskidiva.com/forums/i...ridger-whitefish-etc.23167/page-3#post-383825

Big Sky, MT in late Feb 2019, cold and snowy

Spent a week skiing around the northeast in March, mostly in New Hampshire (before picking up daughter for spring break). Definitely get tense on icy slopes, which can mean tweaking my right calf muscle (ACL-deficient side) when I rush a left turn because my left leg/foot is lazy and doesn’t lead properly. But after the Jan lesson working on the proper movement for left turns, I don’t think the issue is that related to missing an ACL. I’m skiing more challenging terrain than before and in a greater variety of less-than-ideal snow conditions.

Heading to Alta in early April. Planning on exploring other places around SLC based on having an Ikon pass before old friends show up at Alta Lodge mid-April.
 

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