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No ACL and doing fine?

 Poster: A snowHead
Poster: A snowHead
@Weathercam, I think the real answer is that, never mind subtle or gross differences in the specific injuries sustained (ACL only or plus other things), we are all very different in the way that our bodies react to those injuries, how quickly we recover, how fully we recover, how much we can do in the meantime... etc, etc. I have no clue why; not sure that the experts do either.
In my own case, what you quote above as an expert's opinion doesn't apply in almost every aspect. I suspect each expert has his or her own version as well.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Iíve had complete tears both sides, one years ago and one more recent but still a couple of years back. Canít remember which was which.

I got back skiing to same level as before without surgery, and was going fine until... well, see my other thread!
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
I'm about 5 weeks out from the rupture... doing PT once a week any my therapist alluded that he thinks I will be able to ski next season, even without surgery. Most of the exercises he has me work through are quite doable. There may be discomfort at times but not a lot of pain although each day it feels a little different (and sometimes it feels like nothing has happened). Spent this past weekend attending a MotoGP race and did a lot of walking both days. No issues, no pain, just not being stupid when it comes to running or jumping. Long road ahead and but the road seems manageable.

I did find wearing a neoprene sleeve helps with comfort and confidence at times... seems to be particularly helpful when working out our going for a long walk. Did not wear it this weekend and was still OK. Would recommend one, though.
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About 7 weeks in... PT still going well. Therapist had me working on some plyo work last week to see how I was landing and if I was favoring my non-injured leg over the other and it didn't seem like there was an issue. This was back and forward hops as well as side to side hops. Have tried a bit of jogging on a treadmill and on grass and that's OK... pavement still feels harsh (when doesn't it?). More PT tomorrow before I return to my doctor Friday for a check in. So far so good.
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@ItaloSkier, glad to hear itís going well! I opted for the reconstruction op as was concerned about long term stability. How is the lateral stability? After the rupture mine was soon ok again in a normal stance eg skiing/squatting but kicking a football with the side of my foot (for example) felt much less comfortable.
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@BobinCH we haven't truly tested lateral stability. The only real instances of some kind of lateral movement have been exercises like this:


http://youtube.com/v/0epJubn3_iA


http://youtube.com/v/rls0lz6rd0E (but not quite as an angle because we were testing if I was favoring the leg with the ACL)

I have tried kicking the football a bit with my son... I don't know that I'm comfortable yet but it seems to be improving. Marathon, not sprint Smile
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@ItaloSkier, kick the football with your foot to gain faster improvement Toofy Grin
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After all it is free Go on u know u want to!
I am sorry to rear about you ACLs and thank you for sharing your experiences. I had meniscus tear which is non issue compared to ACL. We only ski up to 20 days a year due to small children.However we fell/ultra run in mountains and prioritise sport activities over everything but children. It will always be surgical solution for ME unless I am too old(?) or dead.
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Well, decision made, no surgery for me. I saw my surgeon last month where I explained that I had had no incidents of instability and that other than skiing I was doing everything I did pre injury. I still have some soft tissue soreness and stiffness which he said would take 5 months + to heal completely, I notice this when doing yoga. He said if I had no ACL instability symptoms then it would be unwise to have surgery to solve a problem I did not have!

I do still have to work on my muscle mass, not long after the incident my VMO muscule looked as if it had been surgically removed. My physio says I should build my legs back to 110% of what they were, so to be safe I am looking at the full 9 months rehab work. To be honest some of the work he is giving me has improved my overall balance skills from what it was pre injury.

So, success or a curse? Time will tell. Now looking at braces for testing out on indoor ski slope to get back in the saddle. I think this is a confidence things and from what I hear from other skiers the brace will ditched at a later date. Hey ho life is fun. Many thanks to all who have contributed to this topic, itís good to feel you are not alone.
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@ttrucwy, sounds a very sensible approach. After rupturing the ACL I found I was still able to ski with a brace - it definitely feels like it gives some extra stability and security. Last time I was much stronger at the start of the ski season due to the rehab program. Target is to be even stronger this time 💪💪💪
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@ttrucwy thank you for your insight. Your experience sounds similar. I have the same bit of soft tissue soreness and stiffness but ROM is quite good... not 100% but quite good and near equal on the two legs. Been going through similar issues with the VMO muscle but seeing improvement. Leg strength feels good but the tone, as my therapist said, is "good" so we're getting there.

Yesterday's PT session included adding more weight to some of my "favorite" exercises. Also tested out Y-balance again and found my injured leg is now at 108% of where it should be based on my leg length. Was able to get lower on a pistol squat on the front test than my April 4th test. Was able to do some somewhat tame jumping lunges earlier in the week without pain or stability issues.

Tomorrow I meet with my doctor to see what he has to say.

BTW, for every day workouts and such, this is a great sleeve ... https://www.amazon.com/Physix-Gear-Knee-Support-Brace/dp/B0734YZBB9/ref=sr_1_4?ie=UTF8&qid=1525961886&sr=8-4&keywords=neoprene+sleeve+knee&tag=amz07b-21
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
On the VMO issue, one physio whom I saw recommended me to clench/activate it (touching it with your finger or hand seems to focus attention on it if it's feeling reluctant) and make sure that I could maintain that clench constantly and fully throughout the entire ROM - first by having leg extended then bent on a couch (sliding foot), then leg handing loose whilst sitting, then in squats. Sounds easy; wasn't. An exercise you can practice whenever you have a spare 30+ seconds, whatever your body position or activity, couch to gym to skiing. Took a good while for mine to remember what it was meant to do throughout its range and under load. Still isn't perfect but it's a lot improved.
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
@Grizzler - trying to visualize this exercise. I did come across this after your suggestion, though...

http://sportskneetherapy.com/the-best-vmo-exercises/

Pardon the Ronaldo picture... Mad
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 You know it makes sense.
You know it makes sense.
@ttrucwy, think that's utter nonsense. 9 months to make your muscles strong enough? That's the same rehab period as for a reconstruction. Why spend 9 months rehabilitating something that can never be as good as new when you could spend 9 months rehabilitating something that should be as good as new?

I often think that when surgeons give their recommendation on treatment based on current strength, they are completely discounting the future weaknesses that come from general aging and lower exercise levels. Your muscles might be strong today but that's because they were built on a strong skeletal foundation. As soon as your skeleton becomes weak through age your muscles will no longer support it and then you only have your ligaments to rely on. If your ligaments have gone, where does that leave you???

I have had some pretty complicated problems with my ACL but massive problems with my shoulders. There is no question that if I had my time again I would insist on a surgical reconstruction for all of them.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
I have been "studied" ACL for the last 10years as I raptured my right ACL (10 years ago) and left one year ago.

When it first happened I was just over 40 and 'they' didn't like to do reconstruction on NHS once you were over 40 but when I eventually saw the knee consultant (as opposed to registrar) I was lucky that he also liked skiing and recommended reconstruction after arthroscopy (as I understand cleaning up torn meniscus and tidying up). I read a lot about ACL and learnt that physio and building up strength is crucial before and after the op. It took ages to get NHS physio so I went privately after the reconstruction to make sure I am doing the right thing. It took me over a year to get back on the skis but following that have done some amazing skiing and off piste etc.

10 years later, April 2017, I raptured my left ACL. From experience I knew what to do. I started physio as soon as I could and exercise while waiting for the referral. I went for the first consultation, last May, ready with MRI to save time. My consultant kept saying from the start that most people don't need ACL reconstruction. I was not too happy about his attitude. I did have arthroscopy very soon after that, beginning of June to repair meniscus etc.

I was told that I should be able to get back to my usual activities providing that I follow up with physio and so on. I had been following the advise as much as I could regularly exercising strengthening my knee muscles and working on balance. I asked the consultant to tell me in writing that he doesn't have objections for me to ski and not to discharge me yet.

In December I went on PSB (7 months after the injury, 6months after arthroscopy) starting the week (very nervous) with a private lesson. I regained my confidence with Gavin and the rest of the week is a history as they say. I try to make sure to engage my muscles when I ski or do anything else for that matter....While i am very mindful of keeping my legs strong (i do exercises most days including yoga, HIT, swimming ) I went on the EoSB month ago, again a bit nervous at the beginning of the week. I did feel a bit of tightness in my no ACL knee sometimes but never pain. I had a great week if it wasn't for the burned face.

So I have one knee with reconstructed ACL and one without. I can't say I feel the difference.. I am an everyday cyclist (commuter) for the last 20 yrs and do like swimming and I was back doing both as soon as the swelling went down. Breast stroke was a no initially but it is all good now.

I do have an appointment in June and I want to go for the 'check up'.

As I mentioned above I wasn't too happy about the attitude at first but it looks like he has a point there confirmed by a study http://bjsm.bmj.com/content/51/22/1622 published November 2017. It is obviously down to individual case as Jonathan Bell says, whom I also contacted.
And that's my story so far with and without ACL. Hope it adds somewhat snowHead
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 Poster: A snowHead
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@Budgie Snuggler, I didn't realise you had done the other one. Glad to hear you are doing ok. Do you feel any instability on the 'new' one ?
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AndAnotherThing.. wrote:
@Budgie Snuggler, I didn't realise you had done the other one. Glad to hear you are doing ok. Do you feel any instability on the 'new' one ?

To balance it out Confused I guess. I don't feel instability, one of the arguments against the reconstruction. It is a little shaky when I stand on one leg (e.g yoga tree pose) but people with ACL have that too and it seems to get better. When I went skiing both times I keep waiting for the knee to pop out but it didn't. I do wear elastic knee braces. Apparently keeping knees warm helps too? But I do try to keep it working and engaged. It supposed to help in old age too Laughing
I hope your knee is ok.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
@ItaloSkier, The very simple point which the physio was making was that in rehab, a lit of people do static VMO clenching/activation, but that the VMO very quickly looses its muscle memory as well as its strength ( summat like that, anyway), so whatever exercises you do, make sure the VMO is actively engages throughout the full range if movement of the exercise. I was told to end up doing it in normal squats, but to build up to it, so start 'training' the VMO by moving the leg from full extension to full flexion whilst lying or sitting with leg out in front, and then sitting on sofa or chair.
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@Budgie Snuggler, re your shaking leg, that is the only issue I have albeit the problem is becoming less with time. My surgeon said that was down to the quads not being strong enough. It is also down to proprioception where the ACL, being absent, is not telling your brain where your leg is. My injured leg could often go into a tap dancing routine trying to make sense of its position. All the balance exercises, enhanced with eyes closed, start to build an alternative pathway for the brain. More importantly you do not regain this sense with ACL reconstruction.


Last edited by You need to Login to know who's really who. on Fri 11-05-18 19:44; edited 2 times in total
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@Raceplate, October makes sense for me. I have a couple of extensive cycle tours this summer so doing anything silly on an indoor ski slope me be somewhat foolhardy. You have a point but I prefer to start my prep for next season after the nine month point.
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ttrucwy wrote:
It is also down to proprioception where the ACL, being absent, is not telling your brain where your leg is. .... More importantly you do not regain this sense with ACL reconstruction.


That's the bit I forgot how to call, I read and consulted about it. It is that message to the brain that gets lost.
Anything that can enhance the exercise is a (literally) good move, I do find closed eyes bit still challenging. I always use stairscases and personally I found that leaping/skipping 2 stairs going up is a good version of a lunges. When I go for walks I try to do some lunges walking (looks weird) which proves quite hard work after 20/30. A lot of yoga poses work the balance. The non ACL knee initially wobbled, now is shaking a little if I am getting tired. The other big difference for me was not being able to sit on my feet in yoga class. It took me months if not over a year to do it after the reconstruction. I almost there with my post arthroscopy but not reconstruction knee, if that makes sense. Basically bending the knee. I also started to run (never did before) after my last arthroscopy using 5Krunner app to train. Which was great for Xcoutry skiing.

The article http://bjsm.bmj.com/content/51/22/1622 says:
These findings strengthen the possibility that commencing exercise therapy and enabling the acute signs of injury to subside prior to considering ACL reconstruction may benefit long-term outcomes. Surgical reconstruction of the ACL causes iatrogenic damage to knee structures, which may increase the likelihood of experiencing future knee symptoms compared with management with exercise therapy alone. Components of ACL reconstruction including surgical incision, graft harvesting and bone drilling may contribute to long-term complaints including numbness and altered sensation, kneeling difficulties and patellofemoral pain
All I can say that I was really keen on having reconstruction again but any op is invasion that your body has to deal with (I had a hamstring graft) and although I wasn't happy initially that I wasn't send for the reconstruction straight away with my left knee I am experiencing the other 'side of the story' . In both cases you need to do your 'homework' pre and post ops.

I was also very lucky with the surgeon, Mr Dowd , RIP, who was the knee guru and I met some patients who were referred to him after not so successful reconstructions. My reconstructed ACL knee does feel a little different and I do have some numbness on my shin.
I am not sure what the answer is, time might show, but both my knees are still allowing me to ski and do other sports. But you DO have to work at it.
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ttrucwy wrote:
More importantly you do not regain this sense with ACL reconstruction.


Why not ... ? I can't see that there is much difference between a reconstructed ACL and no ACL in terms of nerve reconstruction ?

My physio was very focused on 'control' when I was doing my rehab. The classic was stepping or hopping off high step and being able to control the landing.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
@Budgie Snuggler, The reconstructed one is probably better than the 'good' one but my big skiing focus is to be centered and balanced, especially in iffy snow.
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@AndAnotherThing.., check it out with your Physio. The new ACL is purely a mechanical thing held in by screws and not connected to the nerve roots, it possibly still thinks itís a hamstring
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@ttrucwy, Yes, but you old acl is not connected or gone, so there is little or no difference between ACL reconstruction or not in terms of regaining proprioception.
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@AndAnotherThing.., I think that it's the actual receptors that get lost, not just a simple nerve connection/fibre. The receptors are the things that detect and send the signals, not the things that carry the message to the brain and back.
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
@Budgie Snuggler, The findings of that study which you reference were mentioned to me by my old knee specialist physio too. He had had one ACL reconstruction (as a young man) and then did in his other ACL (still young) and went 'conservative' with it. He was a basketball player so high risk ACL group. Said that he would never go for surgery as his first choice now. His version on the study findings was that if you'd already traumatised the knee once, why re-traumatise it all again if you positively didn't have to ( i.e. no instability or other problems indicating surgery); that any trauma was likely to set off inflammatory responses which might lead to more OA and other future problems, so best to minimise deliberate trauma.
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 So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
@Grizzler, very wise words of advice. This weekend has for me seemed like a step change where the stiffness, which always seems to come back, has gone away. I cannot imagine going through it all again with the risk of it staying with me.
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 You know it makes sense.
You know it makes sense.
ttrucwy wrote:
. I cannot imagine going through it all again with the risk of it staying with me.


Exactly.

I hope that your stiffness continues to ease. Mine took a long while to go completely, then came back a bit, eased, came back with vengeance, eased, came back, disappeared completely and... You get the picture. It (they, actually) might never be perfect again, but I can cope with how I am now. And still, 14 months and one UK season on, it's getting better with each challenge.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Spent 15 minutes kicking the ball with my son two nights ago... never felt bad whereas two weeks ago, 3 kicks would be the limit.
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About 12 weeks from injury. Both doctor and physical therapist said that I should keep working on leg strength, agility, etc but PT is officially done and I've been given the green light to go skiing next year. We're planning on a March trip so there's plenty of time to get ready both mentally and physically for (most likely) Courmayeur and the nearby resorts. Very Happy
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@ItaloSkier, hi, great to hear you are doing well and positive about skiing next year. My physio has just signed me off on the basis that I keep on working on muscular mass and building my sensory pathways and I only see him if I have a problem. Also committed to leading for the Ski Club of Great Britain for the 2018/19 season. I am investing in a brace to get me back on the slopes, will be testing things out this October on the local indoor slope. So glad I have turned things around.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Sounds like a very familiar set up... good luck to you. It is encouraging to find like-minded individuals who want to do whatever it takes to get back on the mountain. That was priority #1 (and 2 and 3) for me and I'm glad it looks like it will happen.
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