The snowHeads ACL rehab club !

A snowHead

@Grizwald, Yep, with the best will in the world the NHS physio wasn't ideal when I did mine. They didn't seem to know the rehab protocol and I was discharged at around the point I felt I needed most guidance on what was appropriate.

I'd look for a physio perhaps, with one of your local pro football clubs. Footballers also tend to suffer ACL injuries...

A snowHead

@Grizwald, where are you based? Lots of know excellent sports physios who 'get it'

Well, the person's real but it's just a made up name, see?

@holidayloverxx, I'm based up in the Lake District.

It doesn't set a good president when the guy is 15-20 minutes late each apointment and then have 15 mins with him for an appointment Im told should last 45 minutes to an hour.

I suppose you get what you pay for!

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@Grizwald, what a pain! Maybe it would be a good idea to pay for some additional physio and see if you have more confidence in the new person.

I've had the go ahead for surgery - it will be next Friday - I have enough ROM now thank goodness and the obvious instability of the joint made it really quite an easy decision. I have re-read all the previous pages of this forum so am not looking forward at all to the first few days but clearly it's a decision for the longer term. In the meantime I have the go-ahead to drive now - but only until the op so I'd better make the most of it!

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@Grizwald, you need the full 45 minutes. Complain and pay for a few privates

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@Grizwald, what a beautiful part of the world. Shane about NHS service. Re physios, even at 12 months my physio is still amazing me at how she can home in on an issue or imbalance and help me move forward. You can't pity yourself through the op and risk put advice.

How about

Put a message on this and the Piste forum for a recommendation in Cumbria and Lancashire

People on here ask their physios for recommendations

Ask your Rugby connections. There will be good facilities in Blackpool because of the football and Fylde Rugby. It's worth the drove once a month and certainly worth the money.

Then you can post your own questions or snow reports...

@22 dropout, ..even at 2.5 years for mine.

After all it is free

She can't help me type better though...

@legalista, Best of luck with your op on Friday - it ain't that bad - you will be fine - Rehab is the hard bit I think

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Hey @barney2, - thanks! Keen to get going, I have to say

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@legalista, good luck tomorrow. Good to get it behind you and on your way.

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Oh yes @legalista, best of luck with the surgery Smile

A rather belated joiner to the Rehab Club here - posting as I'm trying to decide whether to go for a second opinion. I tore my ACL and MCL on 24 Jan (a knee twist on my first day) and was well looked after abroad and a Breg knee brace and RICE.

After return, I went via A&E to Fracture Clinic at my local hospital, had an MRI the same day. It took a week or so to see a doctor, who confirmed that I had a Grade 2 ACL tear. He suggested conservative rehabilitation, physio and 'wait and see' - I asked to speak to the consultant to check this, as I am an experienced skier who hopes to return to the slopes, and he went through the risks of operating and the success of conservative rehabilitation. Anyway, that's what has happened.

I have a great NHS physio who has given lots of advice and exercises. The Fracture Clinic appointments have been less helpful - One clinic letter states I also have meniscal damage: this has never been mentioned to me. Another gets my age wrong. The last consultant I saw began the consultation by saying, 'Of course you've had a reconstruction before, haven't you?' and no I haven't! He then looked through my noted to check! He also stated 'If you were a 20 year old footballer and very active, we'd operate, but as you are in your sixties, it wouldn't be the plan'.

I pointed out that I'm a skier and want to be able to ski steep slopes, bumps, etc. and asked if would I be able to do this again. He spoke of more intensive physio (and I have now been offered attendance at a weekly lower limb group) but was rather vague. Then I had to ask about the knee brace that I am still wearing, worn now for over 12 weeks and on an 80-10 setting. He said, oh you can change that to 90 degrees - so I asked him to do it: he said no, ask the physio, as they do that! So another week before I got it altered.......(though she's shown me how now). The physio thinks the 10 degrees is a problem as I can't straighten my leg and it's causing muscle shortening and doesn't think I should have the brace still. She is contacting him to discuss, so hopefully, it won't need to stay the extra 4 weeks that he has indicated.

Anyway, sorry for the ramble, I think I'm going to ask for a second opinion. If Mr Bell is around I'd welcome his view.

You know it makes sense.

@pandora205, sorry to hear of your woes. Suggest you pm Jonathan bell so he sees your post

Otherwise you'll just go on seeing the one name:

Thanks holidaylover will do

A snowHead

@pandora205,
That all sounds frustrating.
You've been in a brace for quite a while to treat the MCL. It sounds like you are now struggling to fully extend( straighten) the knee. It is crucial with ACL rupture to get the knee moving fully: both straightening and bending. The straightening is the one that is more urgent.

Once the is moving fully you have a number of choices after ACL rupture:

1) you can strengthen the leg. Try to return to full activities an test the knee to see if it behaves in a stable way. This may take upto 4 months.

2) you can elect to have surgery to reconstruct the crucial element ligament. You may need arthroscopy to deal with the meniscus tear any way.

3) if option 1 doesn't work you can switch to option 2.

I'm afraid if you don't feel that you are getting anywhere you should seek out another opinion from a recognised knee specialist .

Jonathan Bell

A snowHead

I'm home! Surgery went well, glad to report. This thread has been so useful in letting me know what to expect - e.g. most pain at this stage from hamstring tendon extraction; first three days are the worst etc. I woke up in the recovery room to the sound of somebody whimpering pathetically and then realised it was me! I'm a bit spaced out but glad to be on the way now. @pandora205, I will add my voice to the others - definitely get a second opinion.

Thanks for all the lovely support - really appreciated.

Well, the person's real but it's just a made up name, see?

Thank you for your views Jonathan. I'll give the options some thought.

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@pandora205, Sorry to hear about your injury! Aged 51 I was also told I was too old for reconstruction, then 8 years later following a further injury & increasing knee instability, I met @Jonathan Bell, who did the reconstruction - 2 years ago now & I haven't looked back. Definitely get a second opinion from a knee specialist - preferably one who skis!

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@pandora205 i had exactly the same as you, grade 2 ACL and MCL injuries diagnosed by MRI and physio. I ended up having @Jonathan Bell's option 1 recommended to me by a local knee specialist and went with that. After 6 months of Phyiso (12 sessions) and daily exercise it worked for me, it's a lot of work and a year later I still exercise every other day which is a push as I like to sit and google.

However, I've been skiing twice this year and its all been good, granted I'm an early intermediary and I'm not yet hammering it but I now feel more stable than ever before, have better balance and stronger legs (I'm mid 40's).

Having said all that it took the knee specialist to go through the options before I knew that was the right choice for me, good luck

p.s. The specialist also got me to get out of my braces as soon as possible to get the leg moving again properly, I still ski with them though just to be safe Smile

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Thanks genepi and djf, your experiences are helpful. I think I'll give it a big longer and get out of this heavy brace, so that I can move more. I am absolutely committed to exercising as I need to strengthen up no matter what happens. If I don't feel it's going well after another couple of months I'll definitely go for a second opinion.

After all it is free

@pandora205,
You situation has a high chance of just dragging on without significant progress or a decision being made on how best to manage your knee. It can be a long enough recovery so you want to avoid unnecessary "drift".

You will struggle to make progress until the knee is totally straight ie within a degree or so of the other side. If that isn't achieved with 2-3 weeks of regular ( 1/2 per week) Physio. Go for a second opinion on the management if your knee then.

Jonathan Bell

Thanks Jonathan. I suppose I won't really know how well I'm progressing until the leg is straight, which means not wearing the brace and continuing with the straightening exercises (as well as the rest). The physio has given me exercises to do at home three times per day, as well as weekly/fortnightly sessions in clinic, and now attendance at a weekly group. I'm going to give it a few weeks and see whether I am getting back to normal and able to do more strenuous exercise. At the moment I am hobbling around, so it's difficult to walk very far.

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@pandora205, I had a dog related knee injury in November 2014. My leg was broken, and I had mcl damage. My MRI showed that I had no ACL but I was not told. I went skiing the following March. My knee collapsed back in the UK in April, and upon return to hospital I was informed that I had no ACL. And another broken leg, due to the force of collapse. The NHS refused to repair it and advised me to modify my lifestyle as I was 61, and too old. I went down the private route and had a repair with a donor ligament. Rehab was challenging, but I am sat replying to you after a week on skis. I was given permission to ski by my surgeon, and physio. But to ski only in good conditions and on nice snow. (No off piste or slush, bumps...) I have skied blues and reds for about two hours a day, plus had a lesson. And I feel great, and inspired to return to an even better state of fitness. You are never too old. In Austria they repair at any age according to my instructor, who is about 70? And cycled to London last summer in under a week. Good luck

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@margaret, glad to hear you are on your way back

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@margaret, great to hear you are back skiing again.

@margaret, indeed - that's an inspiring story. However, two relatively low trauma leg fractures are a worry. Have you had bone-density tests? (I did, after I fractured my pelvis, and my bones aren't great).

You know it makes sense.

@margaret, thanks for sharing your story. It's amazing how many of us older skiers have been in this situation. I wonder if there is an element of NHS practitioners basing their decision making on cost rather than surgical need, although surgery is a serious option and not without risks and long recovery time.

Otherwise you'll just go on seeing the one name:

@pam w, my first leg trauma was a five stone dog hurtling as fast as he could into my leg. My second one was a hefty giving way down hill,I heard the crack. Both were undisplaced and not large fractures, in fact the second fracture was only discovered on the MRI that I had as a run up to my reconstruction. My doctor does not think that a bone density test is necessary unless it happens again.
@pandora205, I think my lack of help from the NHS was a cost decision and not surgical. My consultant who operated saw me as a person, he recognised that I still had much to do in this life😄

A snowHead

Hi everyone! I'm feeling a lot better today now I've stopped the opiates. One question - I took off the wound dressing at the right time, but was surprised that once it was off, there are no plasters, steristrips etc underneath - just the stapled up incisions. They all look perfectly clear. However, I was sent away from hospital with some big plasters - am I meant to put these on the wounds, or should this only be if they are still bleeding (which they're not) ? What has everyone else done?

A snowHead

@legalista, I was told to put the plasters on the wounds. Mine were waterproof ones and I was told I could have a shower once they were on.

Well, the person's real but it's just a made up name, see?

@NickyJ, Thanks! They probably told me to do this at the hospital but I was a bit away with the fairies I think!

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@legalista, it was same story each three knee ops and after my shoulder op. The extra practice I have had helps me remember Happy

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@margaret, Great news to hear you have been back skiing.

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@barney2, how are you doing? I was very cautious, and only did a few hours a day before the snow became slush. I was told not to do slush. My biggest problem was my head. Very Happy

Now it is back to the gym to carry on the good work......

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I had a complete rupture of my left ACL back in 2007. I haven't had any surgery as with intensive physio I've had good stability in the knee and it hasn't really given me any issues - apart from being a bit sore if I do a lot of walking/running down steep hills. However, my right knee has become increasingly bothersome and I spent half term skiing on a swollen knee with the aid of ibuprofen. I saw a consultant last week who did some basic tests on both knees and he is puzzled by the left knee as the Lachman's draw would indicate that my ACL is intact. He said I do have some pivot/side slide movement. He seems to think the missing ACL re-attached itself onto another part of my knee.

Now I'm sure that my original MRI showed the ACL completely missing - it was done some weeks after injury as at the the time opinion was divided as to whether it was ruptured or not and I've never heard of it spontaneously repairing. The consultant is going to try and dig out my original MRI and see what he can make of that. In the meantime I'm left pondering. Is it possible? Anyone heard of anything like this before? Can anyone explain what might have happened?

After all it is free

@margaret, Hi Margaret - doing fine - But yeah - its the head for sure! Walking is just about normal even up in the forest - biking is fine - So next season before I get back on the snow - still haven't decided whether to invest in new bindings maybe like knee bindings - to help give a bit more protection - or get some cross country/skating skis and go up to Scandinavia and do some cross country skiing first just to get back into it and should help improve fitness and confidence - What a chew eh?

@snowlamb, it happened to a friend of mine. Apparently it is not uncommon that it re-attaches to the Posterior cruciate ligament. He is fine, reckons it blew playing rugby when young and didn't realise. Now skis at a high level but got meniscus problems. It was then he found out the ACL had ruptured and attached itself to the PCL. Had the meniscus done and still skis at a high level.

This would seem to bear out a pattern. You don't need an ACL or a reconstruction, but not doing so could hasten other knee problems down the line. The ACL would not have been missing of course, just wafting around like a piece of frayed rope as opposed to a nice taught ligament.

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@legalista, plasters on and keep them dry if possible. One way to do this is to cut a hole in a plastic bag and put your leg through the hole. Use a small bit of micropore to attach the bag to the leg above the plasters and let the bag hang down. It works really well. Best of all, it gives you something to laugh about in those early days!

Help!!

The snowHeads ACL rehab club !

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