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ACL (no operation) - My rehab back to skiing without the op

 Poster: A snowHead
Poster: A snowHead
For those of you who may not want to go down the long road of an ACL repair here's my story from popping my ACL to getting back to full skiing and a higher level of fitness and agility.

Pop goes the ACL

Skiing and a slow fall backwards. I was lucky. I didn’t twist, it wasn’t fast, and I didn’t rip or tear anything else. It didn’t really hurt, just the dislocating pop of the knee and a feeling that something fairly bad might have happened.

Of course, I didn’t really know what an ACL was, or what happens when it snaps so, no worries I thought, and shaking off the dull ache I skied to the T-bar for one more slow run before heading down on the chair to sort out my ‘sprained knee’.

And so the journey begins.

Day 0:

At the bottom of the chair I walked a few hundred metres and a stairway back to the car. Slow but not limping. Racked the skis on the roof, rounded up the tribe and set off on the four-hour drive home. The knee looked puffy and was stiff after the long journey but nothing a good night’s sleep wouldn’t sort out.

Day 1:

The knee was a bit stiff and a bit swollen around the quad with a stiffness at the back. I could walk and use the stairs and there was some aching and occasional jangling nerve pain.

I couldn’t put my sock on. Bending my knee fully just wasn’t happening. Being a man I immediately called work to take a day off. So RICE time (Rest Ice Elevation Compression) and a boxset to watch on Netflix.

A physio appointment in the afternoon wasn’t great. His opinion was probably a torn ACL but he wasn’t sure because of the swelling. I think he was being kind and breaking the news to me slowly. I left with an appointment for an MRI and a sudden desire to consult Dr Google and find out what this ACL actually did. Or in my case probably now didn’t.

Day 2:

More RICE. More boxsets. More YouTube ACL videos. I was getting a bit concerned. I need to be fit for my job and didn’t fancy a few months of desk duty.

Day 3:

Back to work with sick note for a few days of desk-based work. I have a tight compression bandage on my knee reminding me all is not right. Still a bit puffy round the patella and quad. I can walk without a limp but having taken two days off work I feel the need to move slowly so they don’t think I was wagging a couple of days off. I’m not up to running or jumping; and putting my boots on is a bit of an issue but other than that I seem to be recovering well. Maybe the Physio was wrong and it is just a sprain.

Day 4:

Walking round the office is no problem. Not quite up to getting out and about on the road and carrying gear. I’m concentrating on a proper walking gait; heel to toe, no limping. All is going well. I have a physio appointment after work for a leg massage. He’s 80% certain it’s a blown ACL. I’m 80% certain he’s wrong, but I know he’s the expert and now I’m getting worried. We’ll wait for the MRI. I don’t feel any major instability in the knee. My bit of arthritis in the patella is playing up from the swelling and the inside of my knee is a bit tight, but I can squat, walk, use stairs and the swelling is almost gone. Still can’t put my sock on.

Day 5, 6 and 7:

No change. The swelling has gone. Doing a few of the gentle exercises from the physio; clenching the quad, bending the leg fully to the glute.

Week 2:

The week starts with the MRI. The results are in and the physio gives me the good news, “Yea, yea, nah, it’s gone,” (Aussies have a way with words). It’s a grade three tear of the ACL. A complete rupture. But he goes on to say I can manage without an operation if all I want to do is bike and gym but skiing is probably out. “Can I snowboard instead?” I ask. He thinks not.

The operation to replace an ACL sounds like a long and painful rehab road. There are however a few articles and blogs by people who have managed without an ACL and continued skiing. Some even showing better results than those who have had the op.

I go down the gym. The physio says I need two weeks of strength work to build the muscle and clear out the after effects of the swelling. 30 minutes gym work goes well. Lots of alternate leg squats, extensions and weight work. All my usual gym work but without the running and jumping. Definitely a bit tender after 30 minutes but no dramas. I take the next day off from the gym and feel the improvement. Almost no discomfort until the end of the day.

One more gym day to end the week. I’ve booked in with a sports science personal trainer to sort out a plan to get my leg work more focussed. I come away loaded with a heavy programme. Leg pressing 70KG, more extensions, glutes, calves and hamstrings; all high weight and low reps. My bad knee is performing better than my good knee and there’s no real discomfort – pain level 1 out of 10.

The Personal Trainer blew her ACL nine months ago and has just completed six months post-op rehab so we have a long chat about tendon grafts and hospitals.

Week 3:

14 days ago I blew my ACL. I’m back in the gym and I have a plan. I’m going to build up my leg muscle, improve my agility and lose 10kg (22 lbs). I’ll add in four months at the local F45 (boot camp) gym and then book a few days skiing in Japan. If I can’t ski when I get to Japan I’ll opt for the op.

I feel better. I’ve taken all of our skis out to the garage for an end-of-season wax. I look at the race bindings on my skis and wind back the DIN setting. I think I might have to trade down on these.

I have a plan. I’m 90% back to my general fitness of two weeks ago. I have no pain, just a little discomfort when I push it in the gym, and there’s no swelling. Maybe I’ll be fitter and healthier as a result of all this.

Weeks 4 and 5:

Two more weeks of gym work with four to five days a week at the gym to strengthen my legs. All’s going well and I can feel the strength building. I realise I was getting a bit unfit before the accident.

Week 6:

This is the last week of the Aussie ski season. Six weeks after the accident. I decide to head up to Mt Buller for a ski day. I’m anxious about not being able to ski.

I head up the main chair. There’s a fair bit of snow remaining for this time of year but it’s heavy and slushy. I ski. I can ski, I ski like a beginner. I am so nervous of my knee collapsing at any moment. It’s about an hour of slow turns before my confidence returns and I begin to push through the slush and carve some real turns. The morning goes well. I build up the speed. It’s a blue-sky day and I begin to enjoy myself. The knee hasn’t collapsed and there’s no discomfort. Time for lunch.

After lunch my skiing gets faster and more confident. I start to smash a few of the bigger slush bumps on the black runs and things start to get fun.

Sitting on the chair in the sun knowing I can ski is an awesome feeling. I knock off early so I don’t overdo it. The only time my knee was giving way a little was in the bumps. When I got the bumps right it was all good but when I was thrown out and had to fight for a new line or pop out to the side of the run then the knee would feel weak; mainly when I was out of position and leaning back too much.

Week 7:

I join the F45 Gym and start some hard boot-camp gym work. Sprints, squats, twists. Lots of functional and dynamic leg work. I’m taking it easy on the twisting and jumping and all goes well.

Week 8:

I sign up for the F45 Challenge. Eight weeks to lose 10 KG (22 lbs). I’m scanned and weighed and plan my diet and gym sessions.

This is the week I get my hospital consultant's letter saying I will probably get a consultation in 11 months for the ACL op. I could go private if I paid but I’m thinking $10,000 could pay for a sweet little ski trip to Colorado next winter. I’m still not sure I need to go through with an op.

Weeks 9 to 16:

Eight weeks later I finish the F45 Challenge. 120 people joined and I came second in the male category. Six intense gym sessions a week. 13KG (29 lbs) of fat lost, 4KG (9 lbs) muscle gained. Two sizes less on the waist. I’m fitter and leaner than before the accident. The knee is strong. It’s stable and hasn’t given way. Dynamically I can do a lot more than before the accident.

After 4 Months:

I booked in for a final physio. Top marks. His advice was that if I can do everything I want to do then don’t get the op. Post-op is a long hard road, and research shows having no ACL doesn’t increase the arthritis risk.

To sign off

So, I’ll keep the op consultation in 11 months but at this stage I don’t have any pain and my knee is functioning a lot better than before the accident. I will need to maintain my knee strength, so for me this will be motivation for some life-long fitness. Getting back in the gym regularly has been a real silver lining to the accident and a wake-up call about my slowly declining fitness.

See you all in Colorado in 2020. Bring skis.

If you want to see what the F45 gym is all about follow the link and click on the video
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
My ACL ruptured completely after 20yrs of having a lax knee with a partial tear. After waiting 4months to see an orthopod hNHS), he arthroscoped it and stressed it under anaesthetic, polished the condyles an snipped off a bit of torn meniscus.
He reported that the stump of the ACL had fused onto the PCL, resulting in a more stable knee than if he had performed a reconstruction, which he promised he would if I needed one.
Back to skiing with a properly fitted metal knee brace and DIN setting to 4 as I’d rather the binding released than my knee!
A self-healing knee is great.
I have a specific exercise routine in the gym, which I do for 3 months prior to skiing, that strengthens all of the leg muscle groups and the core, with lots of flexibility at the end.
I’m 66 and off to Val Thorens in 10 days!
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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?
@oz, snowHead snowHead
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"He reported that the stump of the ACL had fused onto the PCL, resulting in a more stable knee than if he had performed a reconstruction, which he promised he would if I needed one" - whhhaaat? What in the world does that mean? Had never heard that before
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
@ItaloSkier, Mine did too, though it's probably (definitely?) not as good as having an op. But at my age (63), it's hardly worth it. My knee surgeon, a keen and apparently good skier (and golfer) reckons no one should have their bindings set beyond 5 on piste, and advised me to have 4. Mind you he can't weigh more than 160 lbs himself. As the name suggests the ACL and the PCL cross over each other. Where they touch they can fuse, or something like that. No doubt someone with more knowledge (not difficult) will expand.
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@oz, 13KG (29 lbs) of fat lost. just wow. that, in itself, is hugely impressive. you must be chuffed. enjoy Colorado!
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
ItaloSkier wrote:
"He reported that the stump of the ACL had fused onto the PCL, resulting in a more stable knee than if he had performed a reconstruction, which he promised he would if I needed one" - whhhaaat? What in the world does that mean? Had never heard that before

Pretty much what my doc and physios guess might have happened to me, too (though no further investigations, so no proof); certainly have heard about it happening for some (ACL reattaches itself where torn to the PCL or any other structure or tissue nearby; if lucky, it stays and doesn't cause problems).

I certainly also got the surgical consultant saying at about 6 weeks that he could not give me any better a stability in either knee (I took out both ACLs completely, apparently) than however they had sorted themselves out, whatever they had decided to do. (Long may that last.)
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
Update Feb 2020 (18 months after)

I've just returned from a week in La Rosiere. It's good to report the knee was great with no problems. I was regularly skiing some long sustained runs with a fair amount of bumps and the occasional icy patch. I threw in a little powder on the side piste now and again and the knee never caused a problem.

My fitness is still looking good. I've improved my diet and I'm still getting to the gym at least 3 times a week for the boot camp.

The surgeon's appointment came through after12 months and it was a good feeling to cancel it.

So for me it has turned out well. I'm increasing the exercise and I have a plan.... 2022 Haute Route Alps. 7 days cycling with 20,000 metres of elevation. And maybe a quick lads ski trip to Japan next year if the OH gives it the green light Smile Always got to have a plans!

I know some people may have different experiences with injuries may not all have the same outcome but I hope my post helps to show that if you pop your ACL you can give rehab a shot and it is possible to get a good result.

And if anyone wants to join me on the Haute Route cycling....
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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.
ItaloSkier wrote:
"He reported that the stump of the ACL had fused onto the PCL, resulting in a more stable knee than if he had performed a reconstruction, which he promised he would if I needed one" - whhhaaat? What in the world does that mean? Had never heard that before

When the ACL is injured its worth considering that not all patterns of rupture are the same. The majority rupture in the proximal (Nearest the hip) half.
About 15% come directly off the bone and the ligament is not too badly shredded. In many cases there are a few strands holding the ligament to the bone it came off( the femur).
This pattern typically occurs, in my experience, during hyper extension injuries of the knee. These are the ones that are worth considering for repair. This pattern of injury is a bit more common in skiers than other sports.

More frequently the ligament comes away completely and the ends of the ruptured ligament end up quite frayed. The ACL is very close to the PCL , which it crosses, hence the name.
As these frayed ends try to heal they shrink back a bit which means the proximal end of the ACL is mm’s from the PCL and the ACL then fuses to the PCL. This can mean the knee is a bit less unstable on examination but the stability will be a long way off that of the uninjured, or successfully reconstructed, ligament .

The degree of instability in the knee following ACL injury is quite variable hence why some can manage without surgery. Typically those that manage without surgery will not be that unstable on a test called the Pivot shift. The more frequently cited and talked about test- the Lachman test- is a surprisingly poor predictor of who will cope without a functioning ACL. Confusion exists, in part , because of this difference as the Lachman is an easy test to perform and easy to measure so gets talked about in scientific appears a great deal. The pivot shift is a much more difficult test to perform and very difficult to measure so isn’t often “overlooked “ in the scientific literature.

When an ACL sticks down to the PCL it will improve the Lachman but less so the Pivot shift. However, some will still cope without surgery, in spite of this.

Jonathan Bell
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 Ski the Net with snowHeads
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I completely ruptured my ACL some 20 years ago. I had an arthroscopy, and the surgeon reported that I had a strong knee joint and would probably be OK without having it repaired.

I have given up running because it is a high-impact activity, but 20 years later I am skiing (with a knee brace), cycling and rock climbing with no significant pain.
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