 Poster: A snowHead
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Can I join the club? Just ripped ACL today above Meribel. I know nothing of the consequences, just peed off at the moment
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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?
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@AndyB64, Welcome  Sorry about the circumstances. How did you do it ?
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You need to Login to know who's really who.
You need to Login to know who's really who.
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@AndyB64, well, sorry to welcome you to the club… not surprised you're peed off… but, really, the thing to keep in mind is that - unless there is something very unusual and complicated going on - it's *really, really, honestly, truly* not as bad as it seems right now. If you opt to get it fixed (recommended from my experience and other people in the club but of course we don't know your personal situation right now) then it sounds daunting, but you really don't have to go all out crazy on the rehab etc. to be skiing next season no problem. Good luck and keep us updated - you have the advantage of joining the club at a time when we now are very lucky to have Jonathan Bell on the forum, who has always seemed more than happy to offer his highly valued professional advice.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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I'm not really sure how it happened. I was on the 4th turn of the day, taking things very easily, came to a stand still, toppled over, and twang, heard an felt the ligament go.
I skied down to mid station gondola - Rhodos, took gondola down to Meribel, hobbled to med centre. They took x rays and diagnosed ripped ACL and small fracture to top of tibia.
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You'll need to Register first of course.
You'll need to Register first of course.
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To Miranda - many thanks for your reassuring words. Doc said the ligament couldn't be repaired, I would only ever ski again with a brace.
I guess I'll have to wait til I'm back in uk to find out
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@AndyB64, definitely get in touch with Jonathan Bell!
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@AndyB64, did he say why it couldnt be repaired?
Another vote for reconstruction - well worth it.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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He said that it wasn't possible to reattach the end of the ligament to the tibia - no reason given.
He also said that in the future, sports like road cycling or running that involved no twisting or dynamic movement of the knee would be ok, and I could only ski in future with a leg brace if I was a skier with very good technique
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Who is Jonathon Bell? And how do I get in touch with him?
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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@AndyB64, Without doubting what you were told, (and with no knowledge whatsoever) there are a few people on here who have had that fracture repaired so perhaps a 2nd opinion in order
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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.
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I had a little dabble last weekend, deepest powder I have ever skied😉 there is facebook evidence
@AndyB64 happy to help if you want.
Priority is to confirm diagnosis, then assess if any other damage with a scan. Then to talk to someone who will explain the pros and cons re reconstruction vs non op treatment. Is is possible to get you back on skiis next winter.
Jonathan Bell
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You know it makes sense.
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Jonathan Bell, and others,
Ok many many thanks for replying to this thread.
I'll be marching myself into the fractures clinic at Tameside General on Monday morning for scans and diagnosis.
At the moment it feels that the target of skis next winter would be a miracle!
I'll keep in touch with you on this forum (if that's ok with you?) and let you know how I get on.
Again, thank you.
Andy
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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@AndyB64, the whole thread started because people were being told they had this damage to their knee but were not really sure what to believe from all the various things you can read on the internet, differing personal views etc. and just wanting to get some sense of what the recovery and future process held and what the best approach was… so really, please do keep us updated because talking about your experience on this thread will help others as much as it (hopefully) helps you. And - sorry if I put you in a position there Jonathan Bell but you have always been very generous with your advice and it's always been so gratefully received - it's not just us knee-injury sufferers who are reading what you post… there are actual professional knee experts too!
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Poster: A snowHead
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| AndyB64 wrote: |
He said that it wasn't possible to reattach the end of the ligament to the tibia - no reason given.
He also said that in the future, sports like road cycling or running that involved no twisting or dynamic movement of the knee would be ok, and I could only ski in future with a leg brace if I was a skier with very good technique |
Ah - I think understand this is a terminology thing. I am sure they are quite correct in that it can't be "repaired" by reattaching the existing ligament. What we have all had is a "reconstruction" of the ACL. Mine was achieved by taking a several strips of my hamstring to create a "new" ACL. That is termed as a hamstring ACL-R. Other methods include using some of the patella to reconstruct the ACL. I met somebody who had one done in the states which used and ACL from a kadava and in the past I also met somebody who had a synthetic one (when I met him was after the sythetic one was removed and he was re-habbing to then be able to have a hamstring one done as the synthetic one had failed.
Another good source of info is www kneeguru.co.uk
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| miranda wrote: |
| @AndyB64, the whole thread started because people were being told they had this damage to their knee but were not really sure what to believe from all the various things you can read on the internet, differing personal views etc. and just wanting to get some sense of what the recovery and future process held and what the best approach was… so really, please do keep us updated because talking about your experience on this thread will help others as much as it (hopefully) helps you. And - sorry if I put you in a position there Jonathan Bell but you have always been very generous with your advice and it's always been so gratefully received - it's not just us knee-injury sufferers who are reading what you post… there are actual professional knee experts too! |
More than happy to respond.
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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?
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| NickyJ wrote: |
| AndyB64 wrote: |
He said that it wasn't possible to reattach the end of the ligament to the tibia - no reason given.
He also said that in the future, sports like road cycling or running that involved no twisting or dynamic movement of the knee would be ok, and I could only ski in future with a leg brace if I was a skier with very good technique |
Ah - I think understand this is a terminology thing. I am sure they are quite correct in that it can't be "repaired" by reattaching the existing ligament. What we have all had is a "reconstruction" of the ACL. Mine was achieved by taking a several strips of my hamstring to create a "new" ACL. That is termed as a hamstring ACL-R. Other methods include using some of the patella to reconstruct the ACL. I met somebody who had one done in the states which used and ACL from a kadava and in the past I also met somebody who had a synthetic one (when I met him was after the sythetic one was removed and he was re-habbing to then be able to have a hamstring one done as the synthetic one had failed.
Another good source of info is www kneeguru.co.uk |
Repair vs Reconstruction
Repair:It is rare to actually repair the ligament. The results if this is done routinely are consistently poor in numerous published papers.
In spite of this i see it carried out on skiers who injure themselves in Austria and have immediate surgery. IMO immediate repair/reconstruction in a hospital near the resort is both unnecessary and inappropriate.
Reconstruction: Most of the time the ACL is reconstructed ie a new ligament is fashioned and placed in the knee.
Most ACL reco's are hamstring. However patella tendon has been around longer as a graft choice. Those surgeons' that learned how to use patella tendon may have stuck with that as they are familiar with it. Getting the hamstrings is quite fiddly if you aren't used to doing it. Some surgeons use cadaver ligament ( donated tissue), im not sure why but it may be that they want to avoid the fiddle factor of harvesting the hamstrings.. Synthetics should be confined to history but sadly are still occasionally offered. I do about 85% hamstring and the rest patella tendon.
Results from different grafts
Hamstring and patella tendon are comparable in outcome but there is a little more morbidity ( side effects) from using patella.
Cadaver consistently have worse outcomes than hamstring or patella tendon.
I wouldn't have synthetic put in my knee
Jonathan Bell
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You need to Login to know who's really who.
You need to Login to know who's really who.
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The guy I met who was rehabbing after having all the failed synthetic stuff relayed that when it was done it was being recommended but also then found loads failed I wasn't trying to recommend it just high light the difference that I had encountered. Your explanation is rather better than mine.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Thanks again for the replies.
I think I'm starting to get a better idea of what is involved with regards a reconstruction. However, I still have a few questions.
What would happen if I did nothing?
How long will it be until I can take off the leg brace?
Is the reconstructive surgery funded by NHS?
Is there a long waiting list?
How long is the recovery from surgery?
And finally, I work offshore on a boat in Angola. How long will it be from now before I can go back to work?
Sorry for all the questions, I just don't know what to expect. I'm also aware that there is no definitive answer to many of the questions.
Cheers
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You'll need to Register first of course.
You'll need to Register first of course.
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@AndyB64, There are some rehab diaries here which may suggest answers to few of your questions:
http://snowheads.com/ski-forum/viewtopic.php?t=91354
On that note, if anyone else would like to add their diary \ notes to that post let me know ? When I set it up the idea was to try and document a broad spread of experiences.
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@AndyB64, I was told I needed to get the swelling down and regain full extension before I could have the reconstructive surgery. So by the time I had the surgery it was feelings lot better... Although still unstable while a walking (the amount of instability reported seems to vary from person to person).
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@AndyB64, I ruptured my ACL years ago, and managed to rehab it to the extent that I really had to think which knee I had injured. But another fall two years ago, left it more painful & very unstable. It got to the stage where it was collapsing every 3-4 weeks & I couldn't rely on it for simple things. I had seen a surgeon after the initial fall but he had been reluctant to operate, due to my age (52 at the time), but then I heard about Jonathan Bell & did a bit of research. He performed an ACL reconstruction (hamstring) at the end of last April, and am just on my way home from a 12day ski holiday. I can't begin to describe the difference the surgery has made to me. I no longer have any pain in it, no swelling, and it is completely stable. Apart from being able to ski again, everyday life has improved enormously. I wish you well with whatever you decide to do.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| AndyB64 wrote: |
Thanks again for the replies.
I think I'm starting to get a better idea of what is involved with regards a reconstruction. However, I still have a few questions.
What would happen if I did nothing?
How long will it be until I can take off the leg brace?
Is the reconstructive surgery funded by NHS?
Is there a long waiting list?
How long is the recovery from surgery?
And finally, I work offshore on a boat in Angola. How long will it be from now before I can go back to work?
Sorry for all the questions, I just don't know what to expect. I'm also aware that there is no definitive answer to many of the questions.
Cheers |
Rough stats for non op treatment
Approx 10% full recovery
15% unstable on daily activity
Everyone else will have some potential for episodes of instability ie the knee gives way
If your knee is unstable on day to day you should have a reco.
IMO the ACL ruptures that end up really good without surgery are almost always hyper extension injuries and I can pick those up at an early by the pattern of injury.
For the 75% who will experience some episodes of instability your outcome will depend on what you want from your knee. If your main sport is jogging in a straight line you are more likely to get away without surgery than someone who does a sport that involves change of direction.
I only brace knees that have a significant MCL injury but you should take advice on that as obviously I haven't examined the knee.
ACL reco is available on NHS
I have done a number of anterior cruciate reconstructions on people who work overseas in oil/ security industry including offshore Angola. So it is possible.
I would recommend that you try and have at least four to six weeks before going back to work. Return to work will depend on your job and the environment. You will not be safe to do manual work for approx three months
Your priority at the moment is to get the swelling down, achieve full extension. if it is an isolated ACL rupture without fracture or additional ligament tears then I would also want to see the knee bending but you will need to get it checked.
Jonathan Bell
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Hey all, I am currently 4 weeks into the NHS queue after (possibly) snapping my Medial and ACL on the Snowheads Bash in Livigno, my MRI is booked for this weekend (15th feb). When I get the results and have a further consultation (24th march) I have been told that I will be given the option of whether to have surgery or not. Just wondering if anyone has any other advice for exercises etc in the mean time as I am a bit worried about my leg muscles wasting away somewhat.
Dan
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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@DanMcDan, have you been referred to Physio? They should be best placed to give advice on exercises.
However one which is certainly worth doing are straight leg raises, both with your toe pointing straight up and then with your toe pointing at 45degrees outward. Don't neglect the "good" leg when doing these ..... It is embarrassing when Physio asks you to lift your good leg for comparison and you discover how one sided you have been 
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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.
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@DanMcDan, there is a Primer on the exercises that you can carry out yourself, including some videos, on the Knee Guru site: http://www.kneeguru.co.uk/KNEEnotes/courses/cruciate-ligament-rehabilitation-course-lesley-hall-msc-mcsp
While you are waiting for a definite pathway decision, you should also get yourself some good prehab physio to get you knee in as good a state as possible before any surgery. If you ask around there maybe a specialist sports physio in your area who can help. Even if you have to go down the NHS route, getting good preparation and using the Choice programme for your specialist, you should augment it with really good regular sessions of focussed physio. The NHS physios are fantastic as a rule, but have way too many clients at any one go to actually be able to give you what you need to make a full recovery in time for next season. Two of my nieces are physios with the NHS so I know from them how frustrated they and their colleagues get with their patient loads and the time they are allocated. Torn between the desire to give the best possible service and also meet their targets.
Good luck, as a 5 timer repeat offender I know how hard it is but it ain't life threatening so that is something to be grateful for! 
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Interesting editorial in a recent BMJ:
The evidence base for orthopaedics and sports medicine - Scandalously poor in parts. L Stefan Lohmander. Ewa M Roos. BMJ 2014;350:g7835 doi: 10.1136/bmj.g7835 (Published 2 January 2015)
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The evidence base for orthopaedics compares unfavourably with other fields of medicine. Only 20% of procedures are estimated to be supported by at least one low-risk-of-bias randomised controlled trial showing that surgery is superior to a non-operative alternative.
In both orthopaedic surgery and sports medicine, it is unclear whether some surgical interventions are better than non-surgical alternatives or better than placebo in the form of sham surgery. Recent examples where surgical interventions were shown to confer no benefit over non-operative alternatives or sham surgery include arthroscopic surgery in middle aged and older people with persistent knee pain, surgical reconstruction of acute rupture of the anterior cruciate ligament in young active adults. |
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You know it makes sense.
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| DanMcDan wrote: |
Hey all, I am currently 4 weeks into the NHS queue after (possibly) snapping my Medial and ACL on the Snowheads Bash in Livigno, my MRI is booked for this weekend (15th feb). When I get the results and have a further consultation (24th march) I have been told that I will be given the option of whether to have surgery or not. Just wondering if anyone has any other advice for exercises etc in the mean time as I am a bit worried about my leg muscles wasting away somewhat.
Dan |
MCl and ACL
The priority is to get the MCL to tighten up.
then to get the knee straight and finally to get the flexion back.
You will loose muscle what ever you do as a result of the pain and swelling.
As the movement return you may be able to commence some strengthening.
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:
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Thanks all, will be hobbling down to the Rowing blub and playing with the ergo on the easiest setting it seems
Dan
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Poster: A snowHead
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| Quote: |
hobbling down to the Rowing blub
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don't cry, it'll soon be better. 
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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I'm so glad I was able to read @Jonathan Bell's long and fascinating response to @Jonpim before it disappeared!
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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?
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****LONG POST ALERT****
@Jonpim, what is really interesting is that more than one of the studies that Lohmander and Roos mention in this article were conducted either by themselves or their research group. (The more times your work is citied in medical journals the better your "citation index" is, used as a measure of how good a researcher you are...)
In the ACL paper (Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial BMJ2013; 346 doi: http://dx.doi.org/10.1136/bmj.f232) they took 121 young adults with an isolated ACL injury and sent them all to rehab. 62 were meant to have their ACLR within 10 weeks and the rest only if they had problems with the knee down the line. They do not include a "power calculation", so they have no idea whether this was a big enough sapmle to show a difference in their primary outcome of interest, which was "change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score".
Aside from the priomary outcome, what I think is quite telling is that 51% of the delayed group wound up haveing a reconstruction, meaning that regardles of the change or otherwise in their scores, these people basically had a knee that they couldn't live with.  It also means that when you analyse the data in the groups they were originally put in you're not comparing operated with unoperated.
So they may not have found a difference between the rates of change in knee injury scores (or x-ray changes or rates of mensicus injury down the line) BUT
they don't know if they did a big enough study
in both groups the range of change in the scores was huge and included outcomes of "got better and worse" (the "confidence interval included 0)
50% of the "unreconstructed" group had a reconstruction - so that knee was functionally no good for them and it would mess up the maths
What this needs is either a mega trial with three arms (rehab+early repair, rehab and repair at some point, rehab only) looking at functional outcomes as well as late arthritic changes and further ligament/meniscal trauma or, more likely a meta-analysis, gathering together all the papers looking at this and re-analysing the data to get meaningful outcomes for the same end points. Don't hold you breath.
So, in the mean-time, what would I do if it were my knee? 
Based on that one, small flawed study, I'd get myself reffered, take advice, go see the physio and see how I went in the knowledge that I've probably got a 1:2 chance of the knee being rubbish without surgery.
Interestingly, some 10 years prior to this paper, and on the advice of surgeon and physio, this is exactly what I did. The surgeon was pretty confident I'd be back for reconstruction. I haven't been (yet) and on discharge from clinic he wasn't sure clinically which knee it was.
I'm still skiing and not having problems with it. [finds a bit of wood to touch] I count myself lucky and atypical. @Jonathan Bell's stats of 1:10 in this position sound much more realistic, almost certainly based on a case series of 1000's, not 120 in the study above.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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@skiinghamster, Out of interest, how old were you when you had the injury. I wonder if age at the time of injury may influence your ability to regain muscle bulk\strength to support the ACL less knee.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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I was about 26, and although I had previously done a fair bit of sport (competitive fencing and ballroom dancing) I had had about 4 years off sport almost completely. The swedish study I was talking about above has a mean age at injury of 26.
Rehab-based recovery may well be a function of age, but also one of the original injury and many other factors.
It has worked (so far) for me, but I'm pretty sure I'm unusual. Also, clinically the other knee has lax ligaments (intact on MRI) - so maybe I've always been used to having "odd" knees.
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You'll need to Register first of course.
You'll need to Register first of course.
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@AndyB64, For what it's worth I am 7 weeks post complete ACL rupture and heading into reconstruction. The first two weeks were very depressing. You will lose a lot of confidence as you will feel weak and vulnerable (and question your skiing competence). But then you will realise that no one has died, it is very common, there are many top sportspeople that perform at amazingly high levels afterwards and you probably had very little of your ligament left anyway when you snapped it. This is a chance to get a new one!
I have found that the most important thing is to choose your advisors based on what you want to do in future years. If you want and are prepared to return to a high level then choose people that are experienced in getting people there. There is no point talking to an inactive GP for too long. If you are not so concerned, then go down the mainstream route. Maybe contact the physics at Sale Rugby as they see ACL injuries all the time and understand what motivates sportsmen.
Gpd luck and keep posting. There is always someone else having the same issues for whom our experiences are very reassuring.
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| Pedantica wrote: |
| I'm so glad I was able to read @Jonathan Bell's long and fascinating response to @Jonpim before it disappeared! |
I did it in a rush and noticed it has loads of grammatical errors.
when i have more time ill repost.
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| AndAnotherThing.. wrote: |
| @skiinghamster, Out of interest, how old were you when you had the injury. I wonder if age at the time of injury may influence your ability to regain muscle bulk\strength to support the ACL less knee. |
Teenagers with ACL rupture do extremely badly without reconstruction.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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@Jonathan Bell, despite my screen name, I really don't care about grammatical errors!
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FAQ
