 Poster: A snowHead
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I just tore my right ACL during the snow storm last week in meribel. am on crutches for the next 10 days...any snowhead keen to share similar experiences? Should I do surgery or not? And would it be nuts to ski again in 2 months (as I have already booked another trip!)
Cheers
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| Quote: |
And would it be nuts to ski again in 2 months..
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Yes, I don't think you will be able to - claim off your insurance. A friend of mine did in her ACL last year, had to have an operation and was subsequently on cruches for quite a while. She needed quite a bit of physio as well.
Anyway, hope you get better soon.
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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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What degree ACL damage? 1st, 2nd or 3rd? Partial tear, complete tear, or avulsion?
So many factors, so little time.
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No experience to share, just wanted to offer some sympathy. Hope you make a quick recovery.
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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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Spacegirl, It all depends upon the seriousness of the tear/rupture. Scream and scream at the doctors until you get a MRI and then take their advice ..... your ability/time to recover will depend upon a) the severity of the injury b)whether you need an operation or not ( I'm of the 'Do what the doctor says' school) - and if knackered you will have no option) c) Your own commitment to physio. d) Your personal attitude to risking it!
Sorry I can't be of any further help !!
(A regular hospital visitor for many years with anendless succession of knee injuries before they became fashionable, who suffers today with braces and support )
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You'll need to Register first of course.
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Spacegirl, several factors are important in the advice here:
How old are you?
Are you fairly physically active?
Are you "small, medium or large?"
Assuming this is a complete tear, that you are fairly young (i.e. younger than me!), physically active and not too overweight, you need an ACL repair. There is increasing evidence that the repair decreases the amount of long-term damage to the knee (i.e. the osteoarthritis which you are going to get now that you have had the injury will appear later).
Also - if the tear is complete - you will not be able to ski in two months time. Although the swelling will have gone, you will not be able to rehab the knee enough in the timescale, and you will very likely injure it further early in the holiday, and what is now a single ligament damage may then include a meniscus and another ligament. Sorry, don't do it, just claim on the insurance. 
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Spacegirl, Has the tear been properly diagnosed by MRI scan? If not, how have you got the diagnosis? Injuries like this are incredibly difficult to correctly diagnose without a scan.
6 months ago (after 2 years of knee problems and knee collapses) i was diagnosed by a GP and an NHS physiotherapist as having a ruptured ACL & PCL. Through my private health care cover I then saw a specialist sports injury physiotherapist who confirmed the ruptured ACL & PCL and said that i also appeared to have a tear to my MCL. I was stopped from doing all impact sports and referred to an orthopaedic surgeon for advice on having a full knee reconstruction. These diagnoses were based on the Pivot Shift test, Anterior drawer test and the Lachman test.
I eventually got the appointment with the surgeon and he sent me for an initial MRI scan to confirm the damage.... the result? All ligaments intact, no ruptures or tears. It seems that a combination of my ligaments being a bit stretched from an injury and me being quite flexible anyway had given all the previous professionals a completely false result.
After being scared half to death about the prospect of having my knee reconstructed from my hamstring and a couple of months in a full metal knee brace and about 8 months of rehabilitation it turned out that i have a completely different condition which does not require surgery.
I have just returned from a weeks skiing (albeit wearing a couple of decent knee straps) without any major jip to my knees at all.
My message - DON'T PANIC! Get a scan and see a knee specialist who knows what they are doing, i.e. not just your GP or physiotherapist.
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1. Ensure the diagnosis is correct - so vist GP, take everything from the French docs when you go. This will almost certainly result in referral to Orthopaedic Surgeon - ask your GP who to go to. If you have to battle through Choose and Book you have my sympathies, it's worth the £150 or so to see someone privately.
2. Take the advice of the experts regarding treatment. It is obviously sensible to tell them you wish to ski.
3. magic_hat's story is unusual, to have positive draw tests anterior and posterior without significant pathology. MRI or arthroscopy or both needed for absolute confirmation of the state of your knees.
Good luck and wishing you a speedy recovery,
DrE
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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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Hi all
Thanks loads for the advice and for words of sympathy - i did feel very sorry for myself indeed and it was bl**dy hard getting up in the morning and looking at all that lovely fresh powder on the slopes...sigh...
I am going to see my GP tomorrow and will def ask for a referral for an ortho to do the MRI. The French doc diagnosed the ACL tear very quickly by asking me to lie flat and checking the range of motion of one knee to another. He mumbled something about the injury being easy to tell as it was fresh and not swollen.
But I agree with most of you that i need to assess the degree of damage before deciding on best treatment. I am (fairly) young at 31 and love active sports so I want to be 100% better if poss. I heard from friends that some ACL injuries result in one not being able to stand at all...i can sort of put some weight on my right leg (tho I am trying not too) so hope its a good sign...
and yes, am resigning myself to not ski till next winter.... 
S
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Spacegirl, you should be able to avoid weight bearing in orbit. 
Hope you have a speedy recovery!
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Spacegirl, a few snowHeads have gone through the same injury Russell went through this last season. Get well soon.
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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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You have my sympathies Spacegirl.
I had a bad skiing fall on Christmas Eve 2005. I saw a French doctor within an hour and had an X ray and many tests done. Diagnosis - sprain, rest and gentle skiing when I felt like it.
I skied on the knee for 8 days.
When I returned to the UK my knee wasn't healing well. I took all the doctor's stuff from France, the X ray, etc. I explained that I'd skied on it. I was told that it was just a sprain. "But as you've got private health care, I'll do a referral".
I saw a knee specialist. He read the French stuff, looked at the X ray, did a load more tests and concurred that I had a sprain. "But the MRI's free this afternoon - and as you've got private health insurance it's worth being sure".
The MRI came back and showed MCL damage, possible ACL damage, 4 significant radial fractures at boot line and numerous micro-fractures. The consultant's advise was to not ski, rest up and it should sort itself out.
The radiologist's report came in a few days later indicating 70-80% ACL tear; 50% MCL tear; and PCL damage.
The consultant wrote to say that he disagreed with the radiologist. That there wasn't any serious tearing and that rest should do it.
Four months later my knee still wasn't healing, so I went back and had an arthoscopy. That revealed that the consultant was, indeed, correct. But that I had an extra ligament in my knee, that the consultant had never seen before, with almost a complete tear. He took out the liagment (after consulting "the text book" and taking some photos to send off to the text book people...). I also had numerous other bits of soft tissue damage.
By the time I started physio - in June - I'd lost 80% of one part of the quad in that leg.
Moral - get the operation done - it's the only way that anyone will be able to tell you what's going on in there. If there's nothing wrong then you'll recover from the operation within 2-3 weeks. If there is then you don't want to lose time before you start physio.
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Wow - thanks for sharing your experience Phillip. What I'd really like to know is how on earth did u ski on your knees for the next 8 days after your bad fall??
I didnt even have a decent wipeout. Just fell funny. It was snowing so heavily and was a complete whiteout. When I stood up and tried to ski, my right knee just buckled.
I have just come back from St Mary's where I managed to see the ortho s.h.o. via doctor mate of mine...I'm seeing a knee specialist at the fracture clinic this Wed who will prob refer me for an MRI!
S
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You know it makes sense.
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| Spacegirl wrote: |
| What I'd really like to know is how on earth did u ski on your knees for the next 8 days after your bad fall?? |
Surprisingly easily. In fact I managed to ski the rest of the season (very cautiously - and foolishly) on the knee. I reckoned that if I'd done 8 days straight then the odd weekend for the rest of the season.
It was on 1st May, when I could only make two turns down a run, that I decided enough was enough.
Knees are funny old things. I'd been running consistently for the six months prior to the accident and was really quite fit. That fitness hid the worst of the injury. It was only when the quad had deteriorated that the full extent of the injury became apparent. Just over a year after the injury I am still reminded on the odd turn that things still aren't quite back to how they were.
On a positive note, when I fell I was part of the way through summersaulting and I'd taken air and had foolishly looked at my feet. I landed completely prone - on my head and my left ski boot - which then twisted past 90 degrees.
Another 15-20 degrees of rotation then I'd have landed on my neck.
So you'll hear no complaints from me about my knee - I walked away and I'm happy with that.
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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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BTW - I'm glad that you're getting stuff sorted.
A few years ago a friend of mine skied into a clump of heavy snow at fairly low speed and broke their leg...
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Poster: A snowHead
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Summersaulting?? Mentalist!
Unforntunately, am too much of a girl for those sort of tricks. wish I could tho.
yes, am v glad to be sorting myself out, tho someone did tell me it would have been better if i had broken my leg as this heals faster than ligament injuries?? wha...??
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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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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You need to Login to know who's really who.
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thecrow, the tendency now is not to take the graft from the middle third of the patellar tendon but to use a bit of hamstring tendon. Although this tends to be a bit more painful at the time, you don't get the problem that you have had.
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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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If you do go for replacement, try and find someone who does it arthroscopically...
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You'll need to Register first of course.
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Nick L,
The gold standard graft has alway been considered to be the Patella option as there is a bone plug at each end which helps with the healing process. The hamstring graft is created by shaving the hamstring, and then platting the strangs to make the new Ligament. These are then held in the tunnels with screws. These graphs are designed to act as the structure to which the new ligament grows, so during the first 3 months post op they die and then gradually start to grow. Its at this point (3 months) that the graft is at its weakest, and that is why the first 3 months of rehab concentrates on regaining range of motion and building the quads and hamstrings back up.
I have had both recon methods on the same knee, after blowing the first recon playing football. If you have a while before surgery I would advise spending as much time as you can building up the has and quads, as they will waste quickly post op.
Work hard with the rehab, it my be thogh at times but you won't regret it six months later.
All the best Spacegirl,
Bod.
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Spacegirl, I had an avulsion fracture of the Tibial spine the ACL comes away from where its attaches to the Tibia. I did it exactly a year ago I had surgery in the 1st week of February and was walking again without crutches about 10 weeks after surgery. I was only discharged from the hospital in January. It is vital you get a scan of the joint to access the damage a non surgical conservative approach may well work but a rebuild may be your only option the scan with give you a better idea. I was lucky the ACL wasn't damaged just the point of attachment to the bone for me the key was and still is lots of physio. I have skied since I went to Castleford in November and plan to ski in April. Do not rush the recovery allow it to heal and do lots of exercise to support the joint afterwards.
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Spacegirl, It is possible to ski with a complete ACL rupture various WC racers have (can't remember her name but a contender for the world cup ruptured an ACL a few weeks before the competion and skied without an ACL), but they have massive leg muscles to compensate for the instability.
I ruptured my ACL playing football (took 12 months to diagnose) and the consultant surgeon adviced me not to have the operation (could be an NHS thing) saying my leg strength would compensate for the instability. However, I insisted on the operation, as I was in lots of pain and the leg kept buckling even though I had strong leg muscles. I now have no problems with my knee and I could ski 5 months after the operation.
I had the hamstring tendon version and have no scars (2 pencil thin 1cm lines on the knee & 1 pencil thin 4cm line on the shin, but they disapeared very quickly).
If you can get the operation quickly, go for it you'll miss this season but be fully fit and confident in the knee for next season.
I hope you get well soon.
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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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BOD, I think that you might be correct to state the patellar tendon graft "has always been" the gold standard but I think that the current more popular op is the hamstring graft (because it produces less problems with numbness and tenderness at the front of the knee (especially on kneeling).
Regardless really, Spacegirl's priority has to be a proper diagnosis! i.e. an MRI or an arthroscopy.
Spacegirl, keep us in touch with your progess.
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Don't know what the medics are like down your way, but up here they are soooooo reluctant to send anyone to specialists or for MRI scans, unless you push, push, push. I done mine playing rugby and it took three years of pressurising before they would refer me!! Several docs examined me and said it was muscular and well, you kinda believe them. But when it continually buckles, you just have to keep shouting louder.
Knee specialist could see immediately that there was a problem even tho he performed same tests as GP, bottom line is, he is a specialist and the GP aint, so you have to see the right people. When MRI result came back the ACL was snapped completely and didn't even exist anymore!
This along with another disastrous diagnosis (Docs missed an ectopic pregnancy with my wife, even though we went to Hospital for the pain at 6 weeks, they sent her home with some paracetamol!!!!!!) has made me completely disillusioned with the NHS and GP's in general (I don't like to criticise, but they aren't specialists and if in doubt, refer!). 
Right got all that off my chest.
Bottom line, see a specialist and get a scan, otherwise you'll never know for sure and may do further damage.
I finally got an ACL replacement in 2003, 4 years after the initial injury and am skiing for first time since in March. Hope repair worked, it is a worry.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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lyndalelodge, re GPs and diagnosis - it depends on the GP. If there a number of GPs in the practice, there may well be one who has an interest in sports medicine - ask the receptionists they may know - but usually they don't have access to NHS MRI scanning, so Spacegirl needs onward referral. You still need the GP to write the referral under the current system and nearly all orthopaedic consultants would not accept a self-referral even if the patient is willing to pay.
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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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If you can't get an instant referal, it might be worth paying (~100 pounds) to see an orthopedic consultant. I had to wait for 12 months (physio work) to see an orthopedic surgeon and after the MRI which showed that I had no ACL. I had to insist on the ACL operation (consultant said I could live without it). I don't blame the physio for not picking up on the injury as my muscle strength hid the injury, or the GP who was great at getting me a quick referal and ACL operation (I was having to take pethidine for the pain so she knew it was serious).
If I had to go through it again I would be stuborn and complain (for some reason the more noise you make the quicker you are dealt with. It doesn't seem right but as the story goes "The more noise you make the quicker you problem gets attention").
I would insist on getting it fixed via the operation and go through physio, and if you work hard, next season you will be fine to ski. As they say in the US "be a pain in the ass".
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I blew my ACL at New Year 2005. Saw specialist at the end of Jan 2005 after being sent for an MRI. Fortunately this was all done privately and I elected to see a specialist of my choice who opted for the patella tendon graft. This was done for strength of the graft as I would be continuing with skiing as a career. The specialist advised that the minor problems from this graft were not as big an issue as my 'new' ACL becoming damaged through a lot of use/abuse.
Had the op. was walking with only one crutch after a couple of weeks and, with pretty intensive work on rehab, I was skiing (albeit tentatively) 6 months later. within a year, my muscles were back to their preop strength and I was skiing with no problems at all.
If you have a PTG, do be prepared for some tenderness around the graft site when you first start skiing again. This is pretty minor and not usually anything to worry about.
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You know it makes sense.
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Mrs lbt snapped her ACL late last seaseon - very slow fall and no release. She had surgery in may and was at ESA last week - but wished she'd done more strength rehab(!)
As per lyndalelodge I would be very sceptical about a GP diagnosis - you need to see a specialist (including Nick L's sports GP). Denise's initial diagnosis was at the clinic in the resort and we walked in to our GP and said "the ski resort doctor said she's probably snapped her ACL" - our GP then basically said "whatever she says" (fully acknowledging that he doesn't see that many skiing injuries  )
He sent us to a specialist and luckily work provides private medical cover so we were seen quickly.
FYI : a private MRI in Swindon cost about £70 iirc (I saw the bill and was surprised at the low cost.)
It's a "walk in" clinic and they saw my wife the morning after she saw the specialist - local hospital had a 2 week wait. We went in and came out an hour later (<15 mins of scanning) carrying the MRI images.
You do need someone who can read MRIs; in our case the technician sent his opinion to the specialist who agreed. I have no idea how it may work as a completely private transaction but if anyone would like more details just ask and you can get in touch yourself.
Her knee surgeon specialist said we could have either the patella tendon approach or the hamstring approach. Since we dance and ski he said the patella approach was the strongest repair but did result in kneeling pain issues unless it was de-sensitised soon after surgery. Of course he may just have been guiding us to his preferred option.
As I mentioned Denise is recovering well; the scar is still red and healing in places but where it's healed it is almost invisible. She has a little numbness too but the nerves seem to be regrowing. She did have some pain around the knee and "only" skiied 11 of the 12 skiing days we had (well, to be fair, she had a few half-days and generally took it carefully).
Overall she'd have the surgery again (but she'll also try and get more muscles too!)
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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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lbt,
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| wrote: FYI : a private MRI in Swindon cost about £70 iirc (I saw the bill and was surprised at the low cost.) |
What's the clinics name?
That's a real bargain, from the BUPA site: The guide price range for an MRI scan is from £600* (single body part scan) Others are around the £350 mark.
I'm real interested as I am waiting on a NHS scan myself and that'll be many many, weeks away.
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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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Of course these are PPP costs - they may be a *lot* different privately without PPP's bulk buying power 
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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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I have a complete ACL tear diagnosed last summer but may have occurred some time before but I have opted so far not to have a reconstruction. After plenty of gym work I managed 23 days back to back skiing and snowbording over Xmas (admittedly not on hard Euro pack) and could even walk each evening!
If I tear more cartilage or my condition becomes more chronic I may have a reconstruction but at the moment a conservative approach is working for me.
I'd also add a note of caution re internet research on the subject. A lot of content comes from the US where my surgeon had spent time and said that reconstruction was almost the de facto treatment as soon as the patient came off the ski slopes so content is skewed towards ops rather than rehabbing without.
It's also worth noting the length of time rehab takes e.g. Michael Owen is a performance athelete in prime physical condition with presumably the best resources in the world available to him and he'll still be out for almost a whole season.
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You need to Login to know who's really who.
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Spacegirl, Sorry to hear of your accident!
I tore my ACL, medial & collateral ligaments, medial & lateral meniscuses & posterior capsule last year. None were complete tears - the orthopaedic surgeon saw the MRI & declared that it looked like an explosion had happened - which was how it felt.
I suspect I'm a lot older than you (51), & the advice I was given by the specialist, was that he would be reluctant to operate on me at my great age. So, I had loads of physio & followed it up with lots of exercise rehabilitating it at the gym, & a Donjoy Armour knee brace. I've had no problems with it & have just returned from 2 weeks skiing in Plan Peisey & the knee was absolutely fine.
I think the advice given by Nick L, looks good, but make sure you find yourself a good orthopaedic surgeon who specialises in ACL repair & knees & listen to what he advises.
Good luck 
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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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BMF_Skier, OK - I could have been completely wrong on the price - do check I was surprised at how low it was but of course I may have misunderstood the bill I saw.
(just checked Mrs lbt thinks it was about £70 too)
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Best I can find is local hospital, 3 week wait and £250. Other start at £350 and go upwards...... I'll phone them and get a quote.
Thanks for the info.
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You'll need to Register first of course.
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I was sent for MRI imediately but I went straight to casualty on advice of my GP so I because I had a bone fragment on the end of the ACL showing up on X-ray. The MRI scanner was off line so they were going to send me to Leeds but decided in the end to open the knee because they were pretty sure the ACL have detached from the tibia they then did an arthroscope at the same time as the repair to check for further damage.
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bloxy
bloxy
Guest
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About 14 years ago I partially ruptured my ACL attempting a Heli on a a dry slope.
I was pretty sure what I had done as soon as it happened but as I had two ski trips booked in the next few months and as I was in the process of taking out private medical insurance and did not want the injury to be recorded as a pre-existing condition and be excluded I did not seek medical attention. Instead I bought a heavy support and did lots of exercises to strengthen quads and hamstrings . I planned to get it fixed privately after the skiing. At that time MRIs were almost unheard of and ACL reconstruction was still experimental with things like Gortex being tried to replace the ligament.
I managed to get through the first weeks skiing with lots of Ibuprofen. A few weeks later during during my second 2 week trip I had a fall off piste near Renard in thee PDS couldn't control the leg and ended up with a major fracture of the tibial plateau when my knee folded lateraly, a trip in the blood wagon and two helicopter lifts needed. Knee smashed into lots of pieces and needed major surgery in Thonon to rebuild it with screws and a plate. They also identified the pre existing partial rupture of the ACL and tidied it up, but did not do a reconstruction (it was still not that common then). Doubted if I would ski again.
Had a year off skiing and all the hardware removed, worked hard on the weights and took up mountain biking to build up the strength again (the bike led to lots more injuries!).
Now I ski harder, steeper and better than ever, my knee swells up and hurts like hell though! If I get fatigued and cant' control the path of movement of my knee with the musculature then it can cause problems and the arthritis is starting to getting worse.
Moral? Don''t try and ski on it, get it properly assessed and fixed. Surgical techniques are now excellent and almost routine. If you don't opt for surgery make sure you build lots of balanced strength in the leg muscles to control the joint and get a proper custom built rigid knee brace (not a neoprene hinged support) that will control the joint and dissipate forces.
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FAQ
