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ACL, MCL & Meniscus - destroyed knee.

 Poster: A snowHead
Poster: A snowHead
I have wrecked my knee

So, consultant this morning. I have a ruptured MCL and snapped ACL, as well as meniscus damage.

As the MCL has started to heal in a stretched position, they have to wait for it to heal, and then operate to put a new tendon in there to give it some tension, and repair the meniscus at the same time.

I then have to wait for it to heal before they do the ACL, and I can start rehab.

Certainly not skiing next year, and he has doubts I will ever ski the way I used to again (heavy off-piste, park etc).

Gutted isnít the word. And has anyone else had such a complicated knee injury? If so, what advice can you offer? He described it as "a bad one" and stated that the snapped ACL is by far the least of the problems.

To think that when this happened (doing a rail in the Avoriaz Park) I strapped it up and skied down to the Ardent gondola on one leg, got a transfer to Geneva, lugging all my kit, went home (I had a friendís fatherís funeral the next day). I should have been carted off by the medics and gone straight into hospital for immediate surgery. The fact that it is partially healed has caused more complications. What an idiot.

I will search this forum to see if anyone can give me some hope, but please post on here if you have any idea if this will one day be OK. Sad
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Oh no, although you will find some experience here - I would also recommend looking at the forum on here

http://www.kneeguru.co.uk

Best of luck
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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?
You selling your Defender?

Seriously, unlucky, what a bummer. I did my MCL and have to watch for slippery floors and be careful taking off certain shoes.
Skied on it but was paranoid about catching an edge, on waiting list for repair, but lots of non driving ( working ) time post op.

Bad luck.
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Thanks.

Defender went some time ago - but my sports car will now go as I can't drive a manual and won't for a while!

Something automatic with a suitably big V8 in the front so I don't feel to depressed about being incapacitated.
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Hmm something suitable, V8 and automatic... Perfect!

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@Richard_Sideways, Harsh. Laughing
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Harry Flashman wrote:
And has anyone else had such a complicated knee injury?


My mum, she's never skied again... well to be honest she's never skied full stop. She did it rolling on a pine cone.
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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!
@blahblahblah, WHAT?!? It's good in traffic, plenty of room in the back, and he won't get stung for parking at the hospital.
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You'll get to see more forums and be part of the best ski club on the net.
@Harry Flashman, A lad I coached suffered the same "Terrible Triad" and it took him about 14 months to get back playing again. Another 12 months on and he has just signed a terrific deal with a Premiership rugby side. Yes it will be hard work, but there is a very good chance you will ski again at your current level.
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Thanks Frosty.
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@Harry Flashman, My sympathies. I understand "gutted". Though I'm obviously not as expert or experienced as you, just a mere mature piste rat, I had great plans for doing a lot more in the coming months and years, both on snow and otherwise (e.g. climbing/mountain walking) until I had my ACLs and MCLs taken out (I'm told not menisci, per MRI). I have also discovered how many things I love doing as hobbies or socially require good funcitoning, rotating, pain-free knees!
I was told at the time, when the MRI was done, that I had completely ruptured ( as in torn apart) both ACLs and badly "ruptured" (which seemingly can mean all kinds of things from strain to tear to utterly gone in various ways) both MCLs badly. Blinking painful and swollen, anyways: though could balance and weight bear, could not bear anything touching my knees at all and couldn't bend or stretch them at all for several days to weeks.
I was told that the MCLs will heal in time, but that the ACLs won't. Back home, however, I am starting to hear occasional tales about ACLs healing or attaching to PCLs or other knee structures. I am also struggling a lot more with very sore medial and lateral knee structures than anything else, but I am continually being told that most MCLs do heal, even if badly torn: but it will just take a minimum 12 weeks to do the basic healing and then really still healing and regrowing for many more months to years. Just a case of exercise, stretch, don't overdo and so on. Obviously I don't know how bad your MCL injury is, but I'm surprised that they've decided to operate rather than sort by physio and see how it goes; although there are some MCL ruptures which are so bad that they will warrant surgery, I'm sure. (Not sure how it's already healed itself in a stretched position; how long ago was this? Mind you, the Austrians told me not to move beyond 60 degrees bending for 3 weeks, then only to 90 for 3 weeks - and then the UK physio and Ortho surgeon and Registrar all basically said poppycock - so opinions vary, clearly.) The meniscus is something else though, and probably does need repair (I think that they call the ACL, MCL and meniscus the "unhappy triad" - don't know why.) and it may interact with or influence the suggested ligament repairs. Also surprised that they can't do all at once, but different surgeons have different ideas and different injuries warrant different approaches, and I'm no expert on anything.
Yes, look at the Knee Guru forum - although to be honest it is a bit depressing and I think that they tend to attact a lot of problem cases rather than the many good stories which you'll find elsewhere.
Have they done MRIs or diagnosed just by presentation and manual testing? Have you thought about seeking a 2nd opinion, seen a physio, etc, etc? Strongly would recommend the latter, especially if specialist, but ultrasound is a lovely thing from anyone. People on SH will also refer you to Jonathan Bell who's on SH and an Ortho knee surgeon, I believe - he's very helpful if PMd.
I'm still in the waiting stage, getting on for 6 weeks post injury now and due to see Ortho consultant in a week, and facing dilemmas about whether to try and carry on with a decent (expensive!) solid brace on both knees and lots of strengthening (my physio's option), or whether to push for ACL surgery either reasonably soon or in a year or so after having seen how it goes - and then end up with still lots of strengthening, rehab, etc, etc, with no promises of whether it'll turn out better or not (though hopefully it would): and probably still wear braces anyway, and still (some say irrespective of whether there's ACL reconstruction or not) be exposed to an increased risk of osteoarthritis and meniscal damage etc. In my case there's 2 knees involved as well, of course. In my case currently the MCLs (and laterals and other bony bits) seem to be by far the most painful and annoying and limiting things, but they're just letting them get on and settle and heal as far as I can tell. Physio is happy for me at this stage to do any exercise or activity that I can, not let the pain get beyond 7/10 by doing so and don't do sharp or fast movements, turns etc (as if I could!)
I am finding it very slow going, and sometimes very stiff and/or painful still, but I am getting back to somewhere near normal; if a sometimes shuffling robotic walk counts as normal (well, it's better than it was!). I can do some exercises, I can go up and down stairs unaided, I can now walk outside again (on rough grass and gentle slopes) with some neoprene braces on, for a short (for me) distance, if I'm careful (more that I don't trust what could happen rather than any problems which are happening). I can now sit on my motorbike again, I can operate a car's controls and most of the time I can fully extend and fully bend back my legs. A few weeks ago those seemed like very far-away goals, so whilst there's still a huge annoying list of once-everyday things which I can't yet do, or can't do without pain, I'm still feeling positive that there's a lot which I can and will be able to do and will get better at doing as time goes on. Things are definitely healing, and as long as I take it easy and listen to what they tell me, they seem happy to carry on doing so (I hope!). I've been looking at the ACL-protective braces (CTi and Donjoy) and researcing them and trying them on where I can find them; at least I then know someting of what might be one possible way forward for me, annoying as it is even to have to contemplate it (and the reason for it).
I'm not good with uncertainty, and I'm not good at waiting: so I've spent far too much time Googling and researching over the last few weeks - and just ended up with noting but all sorts of conflicting (and both positive and negative outlook) advice, research studies and outcome reports (mainly re ACLs, to be fair). My only conclusion is that we're all different and that we all heal differently, and what we can do with or without an ACL and with whatever other knee damage is there is and will also be different, now and in the future. And only time will tell - which I find a really, really annoying thing to hear, so apologies if it annoys you too. owever, a lot of advice which I'm getting given is to wait and see rather than risk surgery in the short term and undergo the irritation/infmallation healing all over again if I don't need to. But that's all dependent on how much I trust my knees and how stable they feel as they heal (bearing in mind that whilst they do now, they must still be pretty swollen inside); and how they stand up to the strenuous activities which I want to put them through (i.e. mountains/hills and ski/board). I've also been advised that surgery immediately (which I was offered in Austria) is not generally regarded as a good idea.
It is a real head/minf-f**k, as you feel permanently changed and potentially deprived of your future plans and recent abilities, and at best uncertain as to what to do and when (in my case, at least). But it's something that, one way and another, we have to come to terms with in our own ways; adapt, be determined, change, cope, hope for the best, hope that it can all be put right again... Accept that it's life and all which it entails (OK, that's me in an unusually-positive mood today because it's sunny and I've just been able to get out and enjoy it for a bit).
I reckon that there's a pretty good chance one way or the other for you to be able to get back to being able to do most or all of what you now do and what you want to do in the future. It might just take time and pain and patience and a bit of changed ways of doing stuff until you get there. I can only take comfort from the large amount of sportspersons, including skiers and well-known top UK boarders (and SHds), who have been through it and been able to carry on.
Anyhows, I'm waffling. Hope that something I've said is helpful.
All the best Smile
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And love to help out and answer questions and of course, read each other's snow reports.
I am based in France so don't know how helpful this will be to you, but when I snapped my ACL (fortunately for me it was a simple break) I was recommended an excellent surgeon in Annecy by our local ski instructor friend who had absolutely wrecked his knee... it really was a total mess, ligaments, meniscus, everything...

He is definitely skiing at the same level and, knowing what this surgeon achieved with our friend, I don't know if it's worth getting a second opinion, at the very least from someone like Jonathan Bell.

Could always give you the details of my surgeon too if you were interested - my UK-based father-in-law has certainly emailed him x-rays and scans for an opinion on his knee replacement, although you'll need a physical exam obviously so an Alps-based doctor possibly not that useful for you... but don't lose heart just yet - it's worth the time and money to get second opinions on what your realistic expectations for future skiing and sports should be, in my opinion.
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@Harry Flashman, IIRC Lindsey Vonn ruptured her ACL, MCL, meniscus and fractured her tibia in one awful crash; after ACL/MCL reconstruction she then came back in a vain attempt to make the upcoming Olympics, but quickly retore her ACL again in practice. She then had further reconstructive surgery and after the rehab came back to winning world cup races. There's plenty of info online including a nice video of her comeback called "the climb" I think. Anyway, best of luck to you...
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 You know it makes sense.
You know it makes sense.
@Harry Flashman,
Unfortunately this is a common pattern of injury. Don't despair it should be possible to get most of these back
Skiing.
Post more detail or pm me if you want more help.
Jonathan Bell
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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 did similar damage to my left knee in May 1987 I separated the medial collateral and both cruciate ligaments. I was skiing [ very carefully ] at Christmas 1987.

I am still skiing on the same knee so there is hope.

I did the damage after landing a hang glider and bunny hopping across to get out of the way of another pilot landing behind me. A molehill was involved.

I was lucky, by chance I went to the Queens medical center in Nottingham and was operated on by someone who was under the supervision of the top knee surgeon in the UK, the guy who fixed the footballer's knees. Initially I got a full leg plaster but again through luck they took that off and fitted me up with a custom made fibre glass one with complex articulating joints at the knee and ankle. BITCH WHINE AND WAIL TILL YOU GET ONE.

Listen to the physical terrorists and do what the say. Get into formal sessions with all the kit if you can. DOING THE PHYSIO REALLY MATTERS NB you can not do it in a full leg plaster and after 6 weeks in plaster you have much less chance of a good outcome. You need that flexible lightweight cast.

I was totally gobsmacked when I realized that most people in my physio class hardly worked at the exercises even though the physiotherapists made it clear that they had one chance only to come back to walk on that knee. I remember one young lady who just lay there and whimpered saying it hurt and wasn't there a machine to do it for her. The physiotherapist made it clear that if she did not put in the effort she would likely be on crutches or at least a stick for the rest of her life. No good she just lay there and made no effort at all.

So do the physio BUT DON'T OVERDO IT. I got a real bollocking for doing my leg lifts with double the recommended ankle weight.

So good luck to you and pray that the NHS comes through in your case.
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 Poster: A snowHead
Poster: A snowHead
@Jonathan Bell, I will send you a PM. Thank you.

Thank you all for your stories and tips - appreciated.
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
I don't want to go on that knee forum - it's terrifying!

Here is the text of what the consultant surgeon (who is not currently Mr Bell, but seems pretty capable and has dealt with colleagues) has said.

For background, timescale:

Sunday 9th April - accident happens. I put neoprene brace I was using on other knee (old sprain injury) onto the knee, compressing it, and ski down to the gondola on one leg, avoiding further damaging the knee. I fly home - but putting weight on the knee as I have no crutches. Plenty of inflammation, but little serious pain.

Wednesday 12th April - see my GP, get X-Ray. No fracture shown but a soft tissue "fusion"

Thursday 13th April - I see a knee specialist, who sends me for MRI that day.

Friday 14th April - I swap the neoprene brace I have been wearing for a rigid metal one, allowing me to set degrees of movement.

Wednesday 19th April - specialist diagnoses me with snapped ACL and severely disrupted MCL. Refers me to consultant knee surgeon. I state that I need to be in the USA for work from Sunday, he says fine if no pain, bit wear rigid brace with no more than 30 degrees movement.

Thursday 4th May - I see consultant knee surgeon, who diagnoses as above but also the meniscus issue. He says that this is "a bad one", which rather freaks me out. His subsequent e-mail (received Sunday 7th) is below.

I spent about 5 days in a neoprene brace before buying this proper, rigid metal thing I now wear.

Because I was in little pain, I thought things not too serious. That will teach me.

I also waited to deal with work commitments before getting on and seeing the surgeon - another mistake.

From now on in, I want to do things correctly. This is the surgeon's e-mail from yesterday:

Going through the imaging further - I'm concerned there is a peripheral split in the meniscus cartilage . These are notoriously 'missed' on MRI but the injury mechanism and the appearances - make it very difficult to exclude with confidence . The instability we identified stressing the inner medial ligament is concerning - especially the laxity in the extended / straight position of the limb - suggesting the ligament is significantly damaged .

The elapsed time since the injury is my main concern

As we discussed - we could let everything settle and then reconstruct the ligament as a delayed procedure . This would mean two separate spaced surgeries - give that we would deal with the ACL at a second stage .

I'm fairly sure there is going to be a significant problem if the medial ligament and meniscus are not addressed - and on balance and having deliberated - it may be easier if we do in fact do something 'sooner' rather than later despite the weeks that have already elapsed . Examining the knee now with a camera - would clarify the issue with the meniscus - very accurately ( more so than with MRI).

If we repair as much as possible now ( and even augment the ligament as necessary at this stage ) - it will mean a more rapid recovery overall . We would need to immobilise the leg in a brace for a 2-3 weeks - but on balance I think we may achieve a more stable knee longerterm if we at least try to repair things now . You would then be recovering from the surgery in the same time period as recovering from the actual recent injury - if that makes sense
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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?
Harry Flashman wrote:
Something automatic with a suitably big V8 in the front so I don't feel to depressed about being incapacitated.


I've got a 1975 Corvette looking for a home...
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Hah! My wife, already annoyed with me, may well kill me.

I need to bring practicality into it, so will be seeing if I can fit this gimpy leg into a few year's old Merc C63, or one of those older V8 BMW M3s.

If I am going to be in pain, I am going to compensate myself.

I actually may not be very good at manual cars in the future full stop, so I suspect that when I sell my beloved manual 2 seater, I may never buy another. As a car person, I find this a bit sad!
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
If I can't for a while ski, board or do serious hill/mountain stuff, maybe not easily ride the bike either, I'm toying with getting a nice sports car to play in... Do let me know if anything beloved and reliable comes up Smile
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Grizzler - want mine? Aston Vantage 4.3 Manual coupe. I came to the reluctant decision to sell it last night as I won't be able to drive it for at least a year (heavy clutch, small cockpit, and I live in London so a lot of stop-start driving), and look for something fast, a bit more practical, and automatic.

*sob*

This isn't thread advertising. It's me feeling sorry for myself. I suspect there will be a lot of this wallowing over the next few months...I absolutely love this car, and am very very annoyed with myself that I have injured myself sufficiently to necessitate getting rid of it. Among the many other reasons I am really angry with myself at the moment. If I just hadn't gone into that damned snow park that last damned time, on the last damned day of s ski season. I should have been with my mates, having an end of season beer at Changabang in Avoriaz. Instead of behaving like a ****.
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@Harry Flashman, hmmmm - probably a tsd big for little old me, sadly.

Don't give up yet Smile - I know all this wallowing, doubt, anger, worries, etc, etc. I've just got my motorbike finally set up for me, all blinged up and all, and now I can't ever see me being able to bend at least on of my knees enough to get it on the pegs without stiff agony. But I'm not selling it yrt; not that my head's not been full of alterative possibilies- ditto if I csn't ski, board, hike, climb... yah de yah de yah.

Give things some time before you know where you'll be in a few months or years - it's early days, or so they keep telling me Confused
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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!
So I have had the first op (last Tuesday), which was removing the snapped ACL, cleaning up, trimming cartilage and fixing up worst ruptures in MCL.

General anaesthetic, but in and out in a day. Very weird as now the knee is less stable than it was untreated, but range of motion is better. Back in crutches and brace rather than just brace. Doing physio exercises, rest, elevation and icing.

Swelling not too bad and pain has been uncomfortable rather than bad, with spikes of pain meaning taking stronger medication (codeine). Bearable though. Very bored at home - sitting around is not really my thing, and wife has to stop me from trying to do stuff around the house. Have spent most of the week doing interior design stuff and ordering paint/panelling/tools for future tools. We are at the end of a house renovation with all the design/decoration to do, so I worked on that.

First step done - a few more to do. See the physio on Tuesday to set up a programme.

BUPA have been great so far - responsive and easy to deal with. Hope it continues. Had the surgery at The Wimbledon Clinic (Mr Bell's practice, as recommended on this forum), who are ski people. Very slick operation, and the surgeon (not Mr Bell - his practice partner) had an excellent and optimistic manner and attitude, as did the whole operation - so far, so good...but early to start getting too excited. A long way to go!
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You'll get to see more forums and be part of the best ski club on the net.
Just to throw in a note of positivity ...
I ruptured my ACL [with all the normal associated ligament damage] in Whistler about 6 years ago.
I bought a very expensive Donjoy brace [$1000] the day after and had three sessions of pyhsio in the days before my flight home. The prospect of being unable to ski again was not an option.
When I got home I was back at work and lifting stuff within a couple of weeks ... jogging within a month.... all with the assistance of the excellent brace.
Had my op after a couple of months [NHS]. I stressed firmly to every medical practitioner that I was absolutely determined to get back to the same level of skiing I achieved before the accident, and didn't care what it took to do it.
Somewhat arrogantly my surgeon [Mr Bliss, chosen after some research] said he could get me back to 100% but was sorry he couldn't do better!
The results of the op [hamstring graft] was much more painful than the original accident.
Then began the literally tortuous physio.
Surprisingly soon [days] after the op the physio [who I named Vin Diesel for looks and attitude] was making me do stuff on my bad knee I couldn't do on my good knee .... continuously hopping up and down on benches and the like. At the end of the sessions you could wring the sweat out of my towel.
This went on for a couple of months.
I was advised not to ski the following season which I complied with ... it broke my heart but we went diving to the Maldives instead which somewhat softened the blow ... but my wife says that I still moaned!
Six years on ... I am a better skier now than I ever was ...did a hilly half marathon last weekend with virtually no knee pain, certainly no more in the 'bad' knee which is now, I think, stronger than the other .... the only time I EVER know I had an injury is if I do a long run downhill on concrete with heavy impact, then I can just tell which knee was damaged.
I only get very minor knee pain skiing. I am 57.
There IS hope for ACL rupture.
I do think it made a difference heavily stressing that I was desperate to ski again and was prepared to work as much as it took to get back to where I was.....
Have as much heavy physio in a gym as you can take!
Keep pushing as much as you can, not to a ridiculous level, but don't let the injury define you.
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@Harry Flashman, I had a similar injury - ruptured MCL, bucket handle tear of meniscus and snapped ACL. I got up and skied down as I didn't want anybody to think I was a wuss and I didn't realise what I'd done.

I tried physio for a few weeks after I'd got home but when there was no improvement I toddled off to consult a surgeon. MRI scan revealed the interesting new arrangements and he sharpened up the knives. Following morning I had the meniscus repaired but we decided to leave the ACL alone. I walked out of the hospital that afternoon with the aid of crutches and put a lot of effort into building up the quads and hamstring. I skied the following few seasons with a brace but left that behind. I ski harder and better now than I did before.

I'm sure you will be fine - just put maximum effort into rebuilding the muscle mass.
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