Second ACL Tear, 12 years after First

[Skigrrrl2008]

Hi all,
In January 2011 I had my first ACL tear. It was first read as partial on MRI, but surgeon said it was full tear. Been skiing with a donjoy brace ever since save last 2 seasons where it didn't fit under my ski pants, lol, a mistake! I did rehab then no surgery, and was able to return to full activities which includes advanced salsa dancing which is very much a pivot activity without knee instability or giving out.

Fast forward to March 2023, where my partner and I get tangled up before loading on a chair and I do a backwards fall, bindings don't release. Felt a pop. My knee has always been lax since first tear, but surprisingly 2 weeks ago after injury it did not swell at all though it was unstable. First 2011 MRI showed tear at attachment to femur, this new tear is in the middle, "mid substance" and my surgeon and research so far says those tears don't heal. It's slightly possible some scar tissue may have helped stability at femur for first tear, but unclear. now, Also a small horizontal tear of meniscus. I am using my old donjoy for stability, and will get a new one. Will start rehab slowly this week as no swelling or pain, save I can't bend down, though I have had some internal instability just getting up from couch without brace, ugh.

Read much of marzNC's thread of NO ACL NO PROBLEM, and seems I have also been a coper for 12 years!
Unsure of where this will go and if I will be able to regain stability without surgery. I don't mind skiing with brace, but would like to dance without one.
Anyone out there have any stories to share about not having surgery, outcome?
Any other Coper's out there?

 

[MaineSkiLady]

We know someone who was a 20 year+- coper - and the arthritis became such that he finally had to have a full knee replacement. The sooner one has ACLr surgery after the injury, the better the chances are for full knee function recovery. Even a few months' delay can change the outcome. My family of 6 knees total has seen 3 ACLr surgeries. Despite DH's being mighty quick following the injury (less than 1 month), at his age, the arthritis is starting to kick back in (much was removed during surgery 14 years ago). Ortho surgeon told him that he'd probably need knee replacement by age 75. Few years to go yet...

 

[marzNC]

Read much of marzNC's thread of NO ACL NO PROBLEM, and seems I have also been a coper for 12 years!

Fast forward to March 2023, where my partner and I get tangled up before loading on a chair and I do a backwards fall, bindings don't release. Felt a pop. My knee has always been lax since first tear, but surprisingly 2 weeks ago after injury it did not swell at all though it was unstable. First 2011 MRI showed tear at attachment to femur, this new tear is in the middle, "mid substance" and my surgeon and research so far says those tears don't heal. It's slightly possible some scar tissue may have helped stability at femur for first tear, but unclear. now, Also a small horizontal tear of meniscus.

Sorry to hear of the new injury. Check for a PM (envelope icon).

In general, the status of the meniscus is a key factor in relation to timing of the onset of arthritis.

There are plenty of successful copers who have skied for decades without an ACL, with and without a brace. The knee is a complicated joint and every situation is unique. Getting a second opinion when considering options with medical professionals is usually a good idea.

 

[MaineSkiLady]

In general, the status of the meniscus is a key factor in relation to timing of the onset of arthritis.

Not necessarily true. DH’s meniscus was fine prior to the injury that necessitated the surgery. Surgeon said the arthritis had been forming for years, possibly decades. He took many pictures of it through the scope.

The ACL is tight and intact, meniscus is fine, but the arthritis has returned, giving him minor discomfort - but this is 14 years hence, and he IS 70 years old. And arthritis heavily runs in his family.

Given the condition of many people that we know who are our age (or younger), we are glad to have what we have.

Warren Miller: “It’s not what you’ve lost that counts. It’s what you do with what you have left.”

 

[floatingyardsale]

I think research shows that there's no difference between those who have surgery for an ACL and those who don't, with respect to developing arthritis. It seems to be independent of the decision to have surgery, and more about the stability of the knee (with or without ACL.)

I'm ten weeks post injury myself, and doing everything except skiing, and the surgeon thinks it's reasonable for me to hold off a few months and see how my knee is doing.

 

[marzNC]

I'm ten weeks post injury myself, and doing everything except skiing, and the surgeon thinks it's reasonable for me to hold off a few months and see how my knee is doing.

Have you heard of the book by Dr. Marx about ACL injuries? It's a little dated in terms of treatment options but probably still worth a read.

Amazon.com

There is ongoing research related to what the optimal delay could be for patients who opt to do traditional ACLr surgery with a graft. Here's an example but I haven't done a careful search. Pretty clear that the age of a patient is a major factor to consider but there are other key factors as well.

March 2022

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[floatingyardsale]

I have read so much about this. (Nothing to do while missing the season!) Basically, the US bias is toward surgery; the Australian bias is toward physical therapy first and surgery as a last resort. This is mostly due to different payment structures, but the side effect is that Australian researchers are finding that a significant number of people with torn ACLs do just fine - including skiing - if they commit to good physical therapy.

My surgeon (does 100 per year) said that I'm definitely not in the group that needs surgery to live daily life (knee is stable), and we won't know whether I need my ACL to ski until I try skiing. So I'm going to do PT for three months and follow up, and then probably try a couple of days next season (no pass for me tho) and keep biking and lifting and what seem to be absurd amounts of jumping practice. If I want surgery at any time he'll do it, but he thinks I might be able to manage without it.

So now I'm doing "return to sport" PT. Jump jump jump.

 

[MaryVA]

I have read so much about this. (Nothing to do while missing the season!) Basically, the US bias is toward surgery; the Australian bias is toward physical therapy first and surgery as a last resort. This is mostly due to different payment structures, but the side effect is that Australian researchers are finding that a significant number of people with torn ACLs do just fine - including skiing - if they commit to good physical therapy.

My surgeon (does 100 per year) said that I'm definitely not in the group that needs surgery to live daily life (knee is stable), and we won't know whether I need my ACL to ski until I try skiing. So I'm going to do PT for three months and follow up, and then probably try a couple of days next season (no pass for me tho) and keep biking and lifting and what seem to be absurd amounts of jumping practice. If I want surgery at any time he'll do it, but he thinks I might be able to manage without it.

So now I'm doing "return to sport" PT. Jump jump jump.

This is encouraging to hear! Can I ask how stable your knee was immediately after the injury? I tore mine yesterday (no MRI yet to confirm the damage, but the Alta clinic was pretty certain), and my knee has buckled on me several times even in the brace. I cannot walk without crutches. Not looking forward to months of recovery but hopeful I’ll be back for next season.

 

[floatingyardsale]

Immediately after it buckled once, and then I didn't put weight on it for a week. MRI confirmed a torn MCL and revealed a torn ACL plus associated bone bruise/LCL strain.

I had another microwobble at week 2 and it's been stable since. Negative Lachman test at first until the surgeon managed it. I tore the MCL completely too, but it healed in about seven weeks. If you can get on a stationary bike, I highly recommend it.

 

[marzNC]

If you can get on a stationary bike, I highly recommend it.

We had a basic recumbent exercise bike in the house. Once I got the okay from my physical therapist, I used it as part of knee rehab. As I remember, initially I was pedaling backwards instead of forwards. Helped to increase Range of Motion (ROM).

 

[JaneB]

Have you heard of the book by Dr. Marx about ACL injuries? It's a little dated in terms of treatment options but probably still worth a read.

Amazon.com

There is ongoing research related to what the optimal delay could be for patients who opt to do traditional ACLr surgery with a graft. Here's an example but I haven't done a careful search. Pretty clear that the age of a patient is a major factor to consider but there are other key factors as well.

March 2022

AAOS Login

I developed arthrofibrosis after being rushed into ACL surgery by the surgeon.
It is a devastating condition; it ruined three years of my life.

I am very fortunate in that I found a specialist who was able to fix the mess before I became disabled .

 

[floatingyardsale]

We had a basic recumbent exercise bike in the house. Once I got the okay from my physical therapist, I used it as part of knee rehab. As I remember, initially I was pedaling backwards instead of forwards. Helped to increase Range of Motion (ROM).

I asked the doctor in the Snowbasin clinic whether it was okay to bike (we thought it was just the MCL) and he said it was the best thing for it. Apparently the motion helps the repairing ligaments line up properly. I was on my bike with eye-watering amounts of initial stiffness about three days after the injury. The surgeon thinks that's why I'm doing so well.

I still don't have the last few degrees of flexion back but it's getting better.

 

[Skigrrrl2008]

Hi all, update 4 weeks out from injury. I am quite functional and working on rehab/prehab, but doing so well wonder if I need surgery since I survived so many years without it, and no arthritis. Started the exercises 2 weeks post injury: stationary recumbant bike, leg lifts, hamstring machine and others. I am walking my dogs on uneven fields, doing house work, up and down from a rotating chair at work a lot, and thinking less and less about guarding my knee. Moving a lot less slowly. Walking still bothersome I think because of bruising on tibia/femur will take 4-8 weeks to settle.
KOOS 3/31: 72
KOOS 4/8: 79.2
KOOS 4/14: 86.3
So, definitely on the mend from functionality perspective. Only 1 buckling episode 4/6
Need to ask my doc about the implications of the meniscus tear since he didn't even really bring it up at the appointment. I would love to avoid surgery, as last year I fractured some fingers and had non displaced fractures in my jaw due to a mountain bike wreck that left me restricted through August...would like to have a summer I can enjoy! I can always consider in mid-later summer early fall, though that would likely take me out for the next season..will be a tough call.

 

[floatingyardsale]

Fwiw week 10 is when I saw a lot of improvement (with a bone bruise.). And also, $0.02: I decided that whatever I decided re: surgery, I was going to assume next season was a loss.* If one needs surgery a year is optimal before returning to cutting sports; and I didn't want to rush back to save a ski season.

*Meaning I might go once or twice in February but no season pass next year.