First trip after ACL op, and knee brace advice, please?

A snowHead

Hi Snowheaders - I'm back after a long absence. I couldn't bear to look at the site last season, as I was off after knee surgery.

The knee is still not quite back to normal, due mostly to muscle weakness, this despite training. Whilst I continue to work on this, I have to accept that this season I will not ski to my usual level, and I will need to use a knee brace.

Google is just throwing up a load of advertising and nonsense, so I thought I would ask directly: who has used a custom knee brace for skiing after knee surgery (ACL), what have been your experiences, and where on earth did you get it from? Plenty available to buy, but i want one custom fitted. The Ossur website seems impenetrable, and I can't seem to fins a Donjoy fitter. Also, how long does manufacture take? I appreciate I could probably call some stockists, but would like proper advice rather than sales/marketing.

Stats - I am (or was, I should say) an expert level skiier, and love powder and moguls, and who spends piste time on short race skis. In terms of this, am I just going to have to accept that I can't do all this stuff, and buy a pair of sedate all mountain planks, and go easy on the knee? Or can I use my old kit, just take it easy?

I am heading out to the PDS for 3 months Jan-Feb, for another season (lucky me!), so intend to ski regularly, spending some time initially doing "little and often" to get back to it after two years out. I have got married and had a newborn baby since my last season in 2013-14, so won't be skiing as much as I used to. But I want to get back to the sport and frankly, I am a little worried. This accident has made me realise that I am fallible, and I really do not want to go through this all again - it has been painful and inconvenient, as many others with the same injury can attest to! A brace seems frankly necessary in case of a fall - but any general tips on how to ease back in would be really welcome. Luckily I have most of a season in order to do this, so hopefully slow and steady works, rather than just having a week or too to try to get back to my past abilities.

Yours gratefully,

A Scared Snowhead.

A snowHead

@Harry Flashman, where are you based?

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

I got myself an Asterisk brace when my knee flared up a few years ago. I would thoroughly recommend. They are not custom made but fit like they are. Not cheap but I picked one up for well under RRP on eBay

In the meantime, you have 3 months of rehab time before the season gets going so I'd be cycling as much as you can. I find that makes a massive difference whenever my knee feels bad

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I used a Donjoy Armour brace after ACL recon. It wasn't quite custom fit. I lasted 2 ski days with it before I decided it was getting in the way, skied about 50 days that winter and 100 the next.

Never used it again.

Would consider selling if anyoen needs a L XXL.

Anyway, snowHeads is much more fun if you do.

Thanks chaps. @holidayloverxx, I live in London, but will be based in Morzine for the season.

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@Harry Flashman, http://serenastubbs.com at wimbledon. She will determine if you need a custom or not.

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

@HarryFlashman First post/response so here goes. Wrecked my ACL on day three of my skiing journey (3 years ago next Easter). Was back on skis 9 months to the day after recon surgery, almost a year to the day after my original injury (back almost to the very beginning but was determined to go back). My surgeon is a firm believer that if the surgery has done its job and rehab has been done well that once he gives the go ahead there should be no need for a brace but he could understand my early return and my psychological issues meant I needed the reassurance/extra support. I ended up with a Mueller HG80 hinged brace. I'd actually used a Donjoy one prior to surgery as my knee was completely unstable and I kept falling over but wanted a more lightweight, comfortable brace. The Donjoy served its purpose but was big, cumbersome and to be honest, I couldn't imagine skiing in it but can accept this may be my level of skiing. The Mueller was great, lightweight, strong, felt supportive and now after 4 skiing trips I am ready to ditch the hinges and just use the neoprene brace ( ACL is great but the rest of the knee is showing significant wear and tear). Im hoping that I can lose the brace completely by the time my three year anniversary comes around. Its easy to get on and off even when fully clothed, fits under all of my ski trousers and the hinges are removable so the whole thing goes in the wash. Its also a bargain compared to other hinged braces. Its a personal choice thing but thought Id offer my experience.

After all it is free

I snapped my L ACL a few years back and had an early repair. I asked a few knee specialists about a brace and none seemed very enthusiastic. Luckily it happened at the end of the season so I had the summer to rehab. As I was still working full time I certainly didn't work as hard on the leg as I should have. Hence the following winter I still had significant muscle bulk loss on that leg. Managed to ski a full season (and every one since) despite that. I used to teach evidence based medicine and I could find no conclusive evidence that a knee brace lessened the chance of reinjury. So I didn't use one. I agree with @Arno, cycling is great for knee rehab. as are wobble boards and motivation and "encouragement" from from a knowledgeable physio.
One thing I did do was dial down my DIN settings and avoid "no fall" terrain. Probably helped my skiing to ski "light" and actually had almost no pre-releases.
Good luck!

Welcome back.
Braces: as far as I know the CTi Ossur and Donjoys are the only true custom ones, but do you really need a custom? After all, you get it fitted pre season, still building up muscle, then put on more muscle and, hey presto, your leg isn't the same size any more...
I struggled to find anyone who fitted Donjoys, though some physios apparently do; ditto Ossurs (I phoned, I think, or used their website). In London it should be easier, but if your physio doesn't know, maybe phone Wimbledon Clinics, else it's Google. Look on the Donjoy main website for what's available just for ideas. There's everything from reassuring warming support to full-on RoboCop.
There is a firm - https://www.technologyinmotion.com/knee-bracing/acl-brace/ - who fit and stock several brace makes, UK wide, but they do charge an up front fee I think.

My consultant was also anti brace, but I didn't have surgery, just trying to do without.

Return to skiing carefully, and build it up slowly and steadily, as you say: and be prepared for (hopefully small) set backs and rest days. Invest in ice packs and hot wheat bags, tubigrip and whatever else you find has already worked for you. Skiing isn't much different to any other strenuous sports or leisure activities (yeah, it is, but generally what's going to hurt or set it off will do so whatever you try), so try as much as you can and know how your leg and knee react.
I can't say how you'll be, nor can you. Your physio/doctor may be able to advise, but it's very individual. As an expert skier you'll know what you're doing, and when it's time to stop or rest. Stick to easy stuff and build it up slowly. No reason not to do powder or moguls once you've established that you're OK on groomed, but again it just depends on how your knee and muscles react. It really is just time if there's no other clinical issues or injuries.
Any skis which you know you can ski should be fine, although taking it easy is still the game at first. Maybe avoid the FIS SLs until you have full confidence and strength (says she who tried them as the first ever time back on skis, and then spent the first season after injury doing idiot level Pennine and Scottish skiing as I didn't dare go abroad).
Build up the confidence head-wise too. Fear of falling is realistic, especially at first. But, hey, chances are you'll be fine and back to at least near normal pretty soon.
Best of luck Very Happy

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@Grizzler, Serena Stubbs that I Iinked to was recommended to me by Jonathan Bell at Wimbledon Clinics. That was for post TPF and MCL though not ACL

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Thanks all. My op was done at Wimbledon clinics (Adrian Fairbank), and I was going to go back and have a chat with them anyway (they are brilliant, by the way).

I think a lot of this is in mh head, and also due to the fact that due to doing a house refurb and having a baby since the op, I frankly have been too lax with my fitness/rehab. I am genuinely scared of falling - I have never had this before.

I guess I am lucky in that I am doing a full season, so have some time to burn with short sessions, trying to rebuild my confidence, fitness and skills. A 6 month old baby means that I will be unlikely to spend a few days on the hill anyway...

I would really like to hear any and all stories from people who got back to our favourite sport after this injury. The ACL rehab thread akes for scary reading - I'd love some optimism!!

snow reports

@Harry Flashman, Why not book onto the return to ski day that Wimbledon Clinics organise

https://www.eventbrite.co.uk/e/return-from-injury-ski-day-24-november-2018-registration-49175654707

My wife got her brace and some really good advice through firstaid4sport. She had a chat and a fitting with them at the Ski show last year and following on from that got a smaller lighter brace than the ones she'd originally been looking at.

Would recommend them, and if you can get to the ski show they do some substantial discounts and free consults if you book a session there - well worth the price of admission.

You know it makes sense.

@Harry Flashman, I think there is much optimism on the various ACL threads, both currently running and past - especially from those who had and advocate surgery.
I was an utter gibbering, tearful, terrified granny (that's how Mr G described me) at first. Utterly embarrassing (and that's before the usual embarrassments of my skiing quasi abilities wink

) Utterly lost my bottle. Took me a long time and a lot of courage (Gods, Woman! You utter wimpy coward!) to make that first pathetic launch off the top of Chill Factore.. Thought that a snowboard would be better - until I slipped and went over whilst punting along a traverse, so now I'm more terrified of that than skiing, I think.
I was also scared of riding my motorbike and anything else which might result in more pain or injury.
Still carry some fear of falling, but it diminishes each time, pretty much back to where I was indoors, and enjoying a lot more ungroomed terrain outdoors - and that's without mega days' of time on snow. I think that with your level of ability and experience already you should be absolutely fine: just accept that it will take time for body and head, and that both are understandable.
Best thing was actually doing a couple of small and then bigger falls and realising that I was OK afterwards. As long as no-one hits me again: that's my real fear, and I'm very nervous on piste now.
Oh, I also moved house, lost exercise routines and all the rest of it, so never got as strong as I'd like either: but a bit of skiing soon put that to rights!
Other thing that got me through it was just reminding myself that I was here to enjoy it and to smile and grin: even if that was at my own idiotic inadequacies. I do what I can do, but I want to have fun doing it. It actually did me the power of good going to places where I was struggling with conditions (technically - e.g. Pennine combat skiing and early season Scotland) because I just had to laugh at my own madness

Anyhows, given what your plans are, I am highly optimistic for you.

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

@Harry Flashman, if you want a comeback story... I did my first skiing (not entirely in line with medical advice) 4 months post op. It was very chilled out - just sliding around on a green run with an absolute beginner- but it was great to feel like I could still ski.
Did a bit more challenging skiing by the end of that season including my first post op fall which went ok.
Now, I am a few years down the line. I am probably more conservative in terms of skiing in control than pre Acl but am certainly as strong technically and have done much more interesting and challenging skiing since the ACL than before. That’s partly because I did my ACL at the end of a season which improved my skiing greatly but also because I concentrate on quality more than quantity now. I don’t feel the need to ski “bell to bell” if conditions aren’t good and my knee does feel a bit beaten up at times but I am planning trips to La Grave, Lofoten and Greenland this winter and have every expectation that my knee will be a minor factor in the success of those trips
Good luck and have a great season

A snowHead

Yep. Serena Stubbs is your best bet. She operated out of Bounce for a while.

Returning to skiing is mostly a head thing. You can return to your best but unlikely in year one. Your confidence will be gone initially and assume you will be starting all over. Some of your technique will need to be revisited as well (the "new" leg won't respond in the same way as the old one). From year two it will be more about whether your head will allow you to do the same things in fear of falling badly. it will all return though, and through trial and error you'll come to realise that your accident was largely a random occurence and that the new leg is as strong, if not stronger than the old one.

I wore a brace for all of year one. The beginning of year two and never since then. It is very reassuring but not strictly necessary. If you have the money, get one. Also, your insurance might not cover a knee injury if you don't.

Have a great season.

A snowHead

Have you looked at the Ski Mojo (www.skimojo.com) - they have plenty of happy post-ACL customers [Declaration: I know because I have recently done some work for them]

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

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Thanks everyone - I have booked an appointment with Serene Stubbs (£175 just for the consultation! But better than re-injury).

Anyway, snowHeads is much more fun if you do.

And any insurance ideas gladly welcomed. I used MPI brokers on my last season...

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I ruptured mine in mid-March of this year and, as some know, I opted not to reconstruct. My doctor felt it might be a good idea to get fitted for one before skiing whereas my PT, who worked with me 1-2 times a week, felt it would be purely psychological and probably would not do anything for me. Still debating what to do. I will bring sleeves with me to keep my mind focused on good form and not going too crazy but may bring a non-custom brace with me, as well. I have a nice collection after two knee injuries, one of which was the ACL rupture.

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

After all it is free

@Grizzler, snowcard were great for my claim

Side note: Doing some research and it seems like there are quite a few fans of using motorcycle knee braces for skiing. Asterisk, Aplinestars and Pod are the three I see mentioned. Any personal experience? Trying to see how well they would work with a ski boot.

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So guys, thread update. I saw Serena Stubbs this morning. It's an expensive service, especially as despite the consultation I ended up with an off the shelf Ossur brace. However, I do feel that she looked in some detail at my knee, my muscles and how it worked, and that the decision that an off the shelf one fits properly and will work was made by someone who knew what they were doing.

I ended up with an Ossur CTi. I'll be skiing a whole season, so cost will be somewhere under £8 a day. I am hoping that it is a temporary thing, and that I get my leg tone back, meaning I can use it only when tired or doing a long day by the end of the season...and being an off the shelf, I'll probably sell it if I feel I don't need it any more.

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@Harry Flashman, great - that's what I got too. it is very comfortable. You will be able to sell it no problem

snow reports

@holidayloverxx, thanks - were you happy skiing with it on and off-piste? And what about bumps? I am going to avoid jumps and big air unless it is a genuine, waist deep powder day and I am back to full strength - but I would like to get back into the moguls sooner rather than later!

One useful bit of feedback was that whilst I feel that I am weak, Serena told me that I am a lot stronger than a lot of returning skiers that she sees. Good for the confidence that I am on my way to skiing like I used to again, one day.

@Harry Flashman, I only ski on piste really - my off piste is very slow and in short bursts. Bumps are fine - I like bumps (although not hard icy ones!).

Sounds like you are well on the way!

You know it makes sense.

@Harry Flashman, good news, good luck. I think you'll be bobbing down those moguls pretty soon.
I haven't found specific problems on moguls or non pisted, but it's a personal knee thing for everyone. Does challenge the muscles though. Only thing I found, and still do, is that somehow I just don't or can't react as fast or aggressively as I did pre injury; can't whip the feet around as fast as I used to be able to. But I'm not you, and I don't know if that's lack of ligaments or muscle related or post trauma or what.

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

The anticipation is killing me... really wondering what I'm going to find when I hit the slopes without my ACL. Aside from the occasional pain and soreness, I don't often feel like anything has changed much but I haven't gone skiing, yet. 4 1/2 months to go.

A snowHead

Detached my ACL from the femur in December 2016 and also got a small fracture in my tibia. Season over after only 3 days. 2017 was a rubbish snow year anyway Wink

I went to private knee specialist in Edinburgh, got CT scan which confirmed the bad news. I ended up not having surgery as I had to do 3-4 months of rehab before they would do the op. After rehab consultant told me he couldn't guarantee as good an outcome as I had got to through my own rehab (this was private so he was turning down £6k) and I was sick of being laid up injured and couldn't wait to get back on my motorbike and MTB I decided to see how I got on. The idea of another 9 months of rehab/recovery was too much to take.

I had a Donjoy knee brace fitted by a specialist and used that when MTBing and on the moto. Did lots of cycling as well and got myself skiing at the local dry slope in October 2017, all felt good with knee brace and after the early season heavy snow falls of 17/18 I was back to my regular ski home, Engelberg in Switzerland to kick off 4 days of epic deep powder skiing at the end of November/December 2017.

My first run was thigh deep powder, just awesome. I also head planted after catching a big rock and double ejected. The knee brace held everything in place. I was out to the Alps on 4 different trips last season and had little issues with my knee or knee brace.

I also toured a bit last season, in the Alps and Scotland using the knee brace and had no issues on 2 hour skins.

The knee brace is superb, I will ski with it again this season. Even if it is a placebo I am happy with that, it doesn't hurt .

Use the brace and take it easy for the first few days, and take the DIN down a bit. I had mine at 11 when I did my ACL as was skiing steep couloirs and wind blown chalky stuff and didn't want to come out. I am on DIN 7 now.

Last season I did tend to ski shorter days, I would finish off around 3pm going for quality runs and hiking or skinning to get fresh snow.

You will be fine, ski half days at first and build your confidence back up on some smooth pistes. That's what I promised myself on my first trip but there was just too much fresh snow...

A snowHead

Good stuff - thank you. Very helpful. I've learned over time to use a private instructor the first 2-3 days to help with technique and to serve as a guide so I think that will help, as well. Planning to visit Saas-Fee which should keep me on piste and out of trouble to start.

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@Harry Flashman, I also have a CTi which I have used for almost 20 years now. My first ACL injuries were partial tears about 38 years ago (I'm now almost 70). They were not when skiing, just playing with my children. I started wearing an elastic support for hill walking after my first injuries. I got the CTi on the recommendation of one of the Edinburgh knee specialists when I had partly torn the ACL and PCL and he said if I didn't get a brace and damaged anything more I would not be able to walk. I did eventually tear the ACL completely and had it repaired. Then I had a small tibial plateau fracture and I have since had 2 cartilage tears (these not from skiing). I had arthroscopy this summer to tidy up the cartilage so hopefully all set for skiing again this winter. I wear a neoprene support for swimming as my left knee is definitely not as stable as my right even after surgery and rehab. I can cruise on a blue without a brace but that's not much fun. Once I put the brace on I forget its there and can ski whatever I want. I ski all slopes and love moguls (just retired from judging international mogul skiing). I decided that in my 70s my skiing would be for me not watching others when judging athletes so this will be my first season when I can ski whenever I want, wherever I want. Bring on the snow....

Anyway, snowHeads is much more fun if you do.

@Harry Flashman, I also have a CTi which I have used for almost 20 years now. My first ACL injuries were partial tears about 38 years ago (I'm now almost 70). They were not when skiing, just playing with my children. I started wearing an elastic support for hill walking after my first injuries. I got the CTi on the recommendation of one of the Edinburgh knee specialists when I had partly torn the ACL and PCL and he said if I didn't get a brace and damaged anything more I would not be able to walk. I did eventually tear the ACL completely and had it repaired. Then I had a small tibial plateau fracture and I have since had 2 cartilage tears (these not from skiing). I had arthroscopy this summer to tidy up the cartilage so hopefully all set for skiing again this winter. I wear a neoprene support for swimming as my left knee is definitely not as stable as my right even after surgery and rehab. I can cruise on a blue without a brace but that's not much fun. Once I put the brace on I forget its there and can ski whatever I want. I ski all slopes and love moguls (just retired from judging international mogul skiing). I decided that in my 70s my skiing would be for me not watching others when judging athletes so this will be my first season when I can ski whenever I want, wherever I want. Bring on the snow....

You'll need to Register first of course.

"Once I put the brace on I forget its there and can ski whatever I want. I ski all slopes and love moguls (just retired from judging international mogul skiing). I decided that in my 70s my skiing would be for me not watching others when judging athletes so this will be my first season when I can ski whenever I want, wherever I want. "

This is so great! Very inspiring!!!

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

@Harry Flashman, I also have a CTi which I have used for almost 20 years now. My first ACL injuries were partial tears about 38 years ago (I'm now almost 70). They were not when skiing, just playing with my children. I started wearing an elastic support for hill walking after my first injuries. I got the CTi on the recommendation of one of the Edinburgh knee specialists when I had partly torn the ACL and PCL and he said if I didn't get a brace and damaged anything more I would not be able to walk. I did eventually tear the ACL completely and had it repaired. Then I had a small tibial plateau fracture and I have since had 2 cartilage tears (these not from skiing). I had arthroscopy this summer to tidy up the cartilage so hopefully all set for skiing again this winter. I wear a neoprene support for swimming as my left knee is definitely not as stable as my right even after surgery and rehab. I can cruise on a blue without a brace but that's not much fun. Once I put the brace on I forget its there and can ski whatever I want. I ski all slopes and love moguls (just retired from judging international mogul skiing). I decided that in my 70s my skiing would be for me not watching others when judging athletes so this will be my first season when I can ski whenever I want, wherever I want. Bring on the snow....

After all it is free

@Harry Flashman, I also have a CTi which I have used for almost 20 years now. My first ACL injuries were partial tears about 38 years ago (I'm now almost 70). They were not when skiing, just playing with my children. I started wearing an elastic support for hill walking after my first injuries. I got the CTi on the recommendation of one of the Edinburgh knee specialists when I had partly torn the ACL and PCL and he said if I didn't get a brace and damaged anything more I would not be able to walk. I did eventually tear the ACL completely and had it repaired. Then I had a small tibial plateau fracture and I have since had 2 cartilage tears (these not from skiing). I had arthroscopy this summer to tidy up the cartilage so hopefully all set for skiing again this winter. I wear a neoprene support for swimming as my left knee is definitely not as stable as my right even after surgery and rehab. I can cruise on a blue without a brace but that's not much fun. Once I put the brace on I forget its there and can ski whatever I want. I ski all slopes and love moguls (just retired from judging international mogul skiing). I decided that in my 70s my skiing would be for me not watching others when judging athletes so this will be my first season when I can ski whenever I want, wherever I want. Bring on the snow....

Not sure what has happened to my computer - it keeps reposting!

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@Harry Flashman, Mrs Ski has done both. Now skis with CTI braces. To reduce the sideways load on the knee she now teles half the time. Has the benefit os being better for the knee and gives your legs the workout they need to rebuild those muscles.

Help!!

First trip after ACL op, and knee brace advice, please?

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