Torn ACL - how does it affect your ride?

[mattj]

I tore my ACL on Boxing day 2004. Then resprained my knee in mid-February. About two weeks after the respraining, I was good to bike. I have been biking problem free for a long time now. I even tried skiing once more later in the season, I felt instability in the knee so I decided to call it quits for the season. Yesterday I resprained my knee while biking. Doing a jump thing and I came down on my leg and on my wheels, the force of landing on the straight leg and the lack of ACL to stabilize the knee allowed it to resprain.

Now, I'm ok with this. This is what I consider an "acceptable" consequence of my decision to not have the surgery. What I'd like to know if there are other riders who ride hard with knee problems. I'm not talking about road or xc or recreatioal rides. I'm talking hard freeriding here. Does anyone here ride hard with a bad knee? Has anyone had their bad knee fixed based on the fact that it didn't work properly for biking?

I'd also like to hear from anyone who's in my position: riding hard with no ACL, how often do you resprain your knee?

I figure it's like with concussions: every one makes you a little stupider. Well, every knee respraining is one year closer to arthitis which is the point of no return for an eventual knee replacement. I'd like to finish my life with my OEM knees, as I'm not too fond of the aftermarket products available. I might consider the surgery if this is something I should be expecting frequently....

Any thoughts?


-m

[DaveM]

I'm riding with a torn ACL right now, waiting for surgery. Get the surgery, without it you will always be limited.

I use a Generation 2 brace http://www.g2orthotics.com/Products/Details/?target=02%2DEXTR It allows me to do anything I did before the injury with basically no fear of re-injury. I bike, hike, jump, run (well I don't run very much, but I didn't before). My Roach Rally's fit over top and after the first couple of days of wearing it, I don't even know it's there. You can buy them direct from the factory in Richmond, mine was just over $1000.00, and is covered under my health plan at work with a doctor's perscription.

[a-d-s]

Matt...I didn't ride until I got mine fixed. I was told there was a pretty good chance of tearing other stuff (MCL, meniscus etc) without the ACL which I wanted no part of. I know Jay Hoots rides without one, he said he was fed up with surgeries.

- A

[DaveM]

My doctor told me as long there's no pain, do whatever I want. The brace doesn't allow any movement outside of normal range. I'd hate to not ride until surgery, I was told by my surgeon the wait list is 6 months - 2 years. You'd think they could narrow it down a bit closer than that.

[Duncan]

I've been riding without an ACL or MCL in my right knee for about 2 years. My ACL got ripped off my tibia so hard it took some bone with it. I ride with a custom-fitted GenerationII Extreme knee brace (work paid for it). It has limited me a lot. I don't ride anything more that a couple of feet off the ground, I can feel my knee buckle when my foot hits the ground. I never plant or pivot about my right foot. Actual pedalling is fine (I road ride 200+ km in a typical summer week).

The good news is that I'm getting them reconstructed in a month (second surgery in 3 years). I decided to get it done because I'm pretty sure if I left it as it is, I'm going to do myself some more serious injury. Also I'll be dammed if I ever let my kids outride or outrun me. Apparently my meniscus and cartillage is all intact, so things are looking up.

About waiting lists, it may vary from place to place, but after you get a referral to an orthopedic specialist on the North Shore (Paul Sabiston - that alone can take months), you can probably schedule something within the year at Lions Gate. I planned my referral so that I could get opened up in July of this year. There will be a few months of rehab, and then I'm gonna train my ass off for a triathlon in 2007. D.

[The Janitor]

I freeride hard (xc/road too) and I tore mine Feb 03. Surgery came Dec 03. During the waiting time I did road rides and pretty much stayed off my big bike. With only 3 out of 4 ligaments holding my knee together I was totally worried about tearing more than just the ACL in a bad crash. The recovery from surgery was a bit longer than I expected but now I find that it was completely worthwhile. Without the ACL to properly locate the knee at extension there is also the risk of cartilage damage which can't be repaired and has serious implications later in life. Get the surgery. It's gotten much better in the last 10 years so don't believe everything you hear about botched jobs. I think mostly people have trouble because they don't rehab well after having the work.
For the recovery a road bike is pretty valuable. Spinning instead of hucking is best. Range of motion first and strength second. I put road bike on a trainer for the first month and then ventured out.

They usually use a piece of the hamstring to replace the ACL so don't worry about keeping everything OEM. The only aftermarket parts you get are the staples that attach it to the tibia and the titanium button used on the fibula. My procedure was called an endo-button. Funny, that's what I was doing when I tore my ACL.

[Duncan]

It's gotten much better in the last 10 years so don't believe everything you hear about botched jobs.

I've never heard of a botched knee reconstruction. Quit scaring me. :dead: D.

[The Janitor]

Paul did my knee. Don't worry...be happy.

[Duncan]

Paul did my knee. Don't worry...be happy.

Paul is a good guy. Straight up, plain English explanations, no bs and zero trace of ego. D.

[a-d-s]

I got a young surgeon (Dr. Jando), therefor minimal wait list and he worked in Sabiston's office. So far so good everything is on track 5 months out. Mattj, PM me if you want any more info.

[skifreak]

My ACL got ripped off my tibia so hard it took some bone with it.

Did the same thing back in 1995 - but I was lucky enough that the bone fragment was large (full avulsion fracture of the inter condylar eminence) so they did surgery the next day...

None the less - leaving it is not good - get it taken care of asap and you'll be happier in the long run.

if I'm correct, Steve Romaniak had surgery I think in later 2003? and if you saw the difference in him in season 2 Drop-In to Season 3 Drop-in there is a good improvement from one year to the other...

[samsquampsh]

^^same thing happened to me in grade 8. I think its called a tibial spine fracture or something, I got surgery within a week. It took me around 6 months to start biking again.

[Dude Man]

Ok here is my deal . Back in 97 I tore my right acl and had a re-construction surgery in late 97. All was good for 4 years and my physio told me I didnt need to wear my GII brace anymore that summer playing soccer I re-tore the new ligament that was put in my knee. So I got it fixed again in 2002 and it has been good since. Now the story gets good. I was riding last friday at Whistler and took the high side on the first step up on Dirt Merchant {done it thousand of times}and landed rear wheel in the middle of the high and low side landing area can you say BUCKED off and landed left heel first causing me to hyper-extend my left knee and tearing my acl. Now i have a cracked heel {fun} and a torn acl. Good news though I get to see the Specialist on the 29th.

I would say get it fixed then go crazy , I just wouldnt want to risk tearing the rest of your knee up. Now when you see me i will be the guy with two braces on.


FOR SALE --Whistler pass --- To a guy with long hair. LOL!! 5 days in and the season is a wash.

[Jay T.]

my knees are fucked, i fractured my knee cap four years ago, acl is messe din both, and i am actually cosidering ending my biking adventures because of this, it may be accpetable p[ain for me rite now, but hell i am 17, i have a good 50 years left and all i can say is i am going not going to ger better before i get worse.

[Col. Craig]

i wrecked my ACL in march last year, it sucked. i was on crutches for 6 weeks. after i rode mildly but if i crashed it would pop out, even with a brace on. it was especially bad bailing on skinnies. since i was only 16, the doc said to wait and see how things turn out before jumping to surgery. its a year later and pretty much after 8 months after the accident, nothing sketchy has happened. my advice would be if your young just stick it out and hopefully you can heal yourself.

[CreamyCanuck]

Join the club. I torn my right ACL back when I was 16, that's 14 years ago...time sure does fly. I have been using an GenII brace (4 models over the years) to play any sport that requires me to pivot on my right foot. I don't use it to bike and so far so good. The ACL repair has left me with almost daily slight pain under my knee cap and when the weather changes it can really start to act up. I have been runing for the last 12 months trying to change up my cardio and now all of a sudden both my knees are feeling pain. So no more running and back to the doctor I go. I had both knees x-rayed today and will wait to see a specialist. Honestly, when you screw your knee once it will be with you for the rest of your life so learn to deal with it. When your ACL is torn don't do anything that risks ruining the remaining parts of the knee just wait and get it fixed or at least wear a GenII brace while free-riding.

In my experience I expect my knees to give me problems for the rest of my life but that isn't going to stop me from riding hard.

[Duncan]

I would say get it fixed then go crazy , I just wouldnt want to risk tearing the rest of your knee up. Now when you see me i will be the guy with two braces on.


I've met several people now who have had both knees reconstructed. Maybe its lifestyle, or maybe its genetic, or maybe its a combo of both. Good luck with your next surgery. I'm pushing 40 and probably going to tone down the riding even after I get mine fixed. I've had my fun, but with a mortgage, car payments, wife, 2 kids, needing 3-6 weeks of medical leave from work this time around, etc its just not worth the hassle anymore. (But I must confess I recently discovered with my kid what a hoot dirt jumping is). D.

[mattj]

Thnks for all the input. From the time I started this thread to now I've done a lot of thinking and read/heard many opinions and experiences and I have to say it sounds like getting it repaired is thr tight choice. The lucky thing for me is that I've had the MRI and the consultation. One phone call and I'm getting booked. Should be able to get repaired this winter sometimes, ready t ride again next season. Definitely not going to hit the slopes at all this winter. Too much risk of re-injury. Watch it be the most epic snow year ever...

Oh and Howeller, I'm 26 so age is against me in the"WAIT AND SEE" department... I guess I'll take the plunge and get the surgery. The brace is a definite for skiing, but I'm hoping not to have to bike in one...

Sorry about the poor typing - it's one handed - the other hand is busy holding the ice on the knee...


-m

[a-d-s]

Good luck man! I think you are making the right decision, you've got alot of riding/skiing ahead of you. If you need any rehad or post-op advice let me know.

- A

[Dude Man]

Sorry about the poor typing - it's one handed - the other hand is busy holding the ice on the knee...


-m


Go get yourself a wide ass tensor bandage and wrap that ice pack up around your knee , the compression of the ice works far better and you can even walk around.

[skifreak]

Go get yourself a wide ass tensor bandage and wrap that ice pack up around your knee , the compression of the ice works far better and you can even walk around.

The other that works great if you're gonna be dealing with surgery and can't make it too and from the freezer every 20 minutes for fresh ice...

http://www.aircast.com/products/product.htm?pid=23&pgid=53AF5B11-7E54-45F7-AEC9-81D5BD77A9D6&rnd=172329070

[gizmo]

I tore my ACL up in Whistler a year and a half ago. I had surgery 2 months ago and it's almost good as new. Still haven't ridden downhill yet, I'm going to wait and make sure it heals well ( I'm 39 and the body doesn't heal as fast any more ) I'm thinking of getting the Gen2 knee brace just to be on the safe side since there is always the thought of screwing up my knee again if I have to bail.

[BenWA]

I haven't read thru the responses in this thread, but i blew my ACL first day of the season skiing at Baker in 2003 (I was your age, 26). I had surgery about a month after i blew it, and did some fairly hard riding the last week or two before surgery. I didnt feel comfortable at all riding without an ACL, so i was glad to have the reconstruction. Post surgery, i was riding a road bike in about 6 weeks, then did a road race 3 months post op, then starting riding my street/jump bike 4 months post op, then was feeling pretty close to my good old self at 6 months post op. I felt fragile for a long time following surgery, scared to tear it again...but the fact is my new one is 30% stronger than my original one (quad-stranded hamstring graft). I had a lot of stiffness, soreness, lack of full range of motion, etc. for nearly a year after surgery...but now, 2.5 years later, I'm 99% and glad I spent the time having it fixed.

I didn;t ski last year ('03/'04), but i went out this past season at Baker for two days and felt totally solid. I was really nervous to ski again, but after a few runs I was huckin 15-20'ers and arcing high speed pow/crud turns, and felt almost back where i had left off. This was all on my first day back skiing in 2 years. My buddies were all impressed that i had made such a lightning quick psychological comeback.

Oh yeah, I don't have a real brace, never did. My OS's theory is that using a brace doesnt allow your supporting muscles to regain strength and proprioception when needed most.

On another note, I had a buddy who blew his knee and didnt have surgery. He rode pretty hard on it for a number of years, but eventually decided to have a reconstruction about 4 or 5 years after the injury. He was glad he did it.

You'll be glad you did the surgery, it's 4 months of pain and not riding, but the time goes by quick and its nice to have people waiting on you while you recover.

p.s., do a google for bob's acl page. It's a good support group type forum that you can ask pretty much any ACL question on. I found it helpful/comforting.

p.p.s, you're going to become a roadie whether you like it or not. If you dont own a road bike, get one. It's the best possible rehab for a knee injury.

Good luck man,
Ben Cashmoney

[mattj]

Thanks a ton for the response Ben! Makes me feel very comfortable about what's coming for me in 2006. Thanks to everyone for your supportive responses. It's made me feel a lot better about the surgery.

Anyone have a story as to why NOT to get surgery? Are there any pros really for not getting your knee fixed?


-m

[Nat Bailey]

I'm glad you're going for the surgery; I did my right ACL in '88 and my left one in '94. Had the surgeries done by the pros at UBC (Regan). The differences in how the surgeries evolved in just that 6 year span was amazing. BTW, I'm F, 19, blonde, toned - wait, that's my other net persona. Actually, I'm 46, bald, and sit too close to a tv for a living.

Anyway - the first operation had me in a plaster cast from hip to toe for 2 months - it was so heavy, I had to wear a freaking shoulder strap. It was done pre-scope, so they cut and invade. If I'd hurt myself any earlier in my life, I guess I'd just have a "trick knee," a malaise that seems to have gone the way of "consumption" "vapours" or "the grip." At least they didn't bleed me.

After the plaster, I ended up in a fiberglass thigh/calf cyclinder hinged at the knee with Allen keys I was allowed to back off a quarter-turn a day, slowly reclaiming range of motion. From there, straight to a GenII. Did my rehab at The Pizza Hut (the field house at UBC), and got on the bike ASAP. Managed an epic with PatrolSkid and the boys at Manning that fall, then off to ski in Japan for the season. From crash to skiing, was about 10 months.

That was the last year I wore the brace skiing; I was worried about not developing muscles and compensating. I'd make that call again if I had to.

I got my wish: I did my left knee in '94. UBC, top of the line. Was in a ward with John Caitlif, the Whitecap. All done with 'scopes, no big cuts. No cast, just a Tensor and crutches. Hobbled out next day, started bearing weight on the heel in two weeks. Healed WAY faster, and the physio was much more aggressive. Skied that fall, no brace. Fast forward 10 years, and I'm twice the man in half the shape LOL. Anyway, got 30 days in at Cypress and Mammoth this year, no probs as long as I RICE. Here's the downside: light pow, ice, hardpack and corduroy are pretty much it for me. If it's crusty or concrete pow, there's no way. It's the resistance against steering, plus the weight on top of the skis in deeper wet stuff that causes me a lot of grief. Part of that is hip and core muscles not getting the love they need :) The other thing is potholes, or on low-viz days, coming out of Moon's on Cypress, and transitioning across a low-snopack drainage ditch onto Collins. That's bad news.

I can even still skate, as coming off on to straight surfaces running ain't so bad. Freeride is tough though, coming off logs and stuff and landing on uneven surfaces is bad news for me. That's why I'm trying to sell the Bullit, staying with the Torrent, and will probably be one of those fat old guys spinning out to Horseshoe Bay along Marine Dr. on road bikes soon enough. That'll only be a concern for the guys who ace'd their MCATs though, once they buy swanky homes in Worst Van.

Anyway, you'll be fine. The surgery is the right way to go. I know it seems like a long road ahead now, but from my perspective 10-15 years on, it was a blip, and the benefits way outweight the initial downtime.

Good luck.

- Nat

[a-d-s]

Anyone have a story as to why NOT to get surgery? Are there any pros really for not getting your knee fixed?
-m

My surgeon basically said if you are active and plan to be, do it. So I guess it's not worth it for someone who isn't going to be doing any sports.

[BenWA]

My surgeon basically said if you are active and plan to be, do it. So I guess it's not worth it for someone who isn't going to be doing any sports.


That's exactly right, that is the only good reason not to have the surgery...if you dont plan on doing anything fun for the rest of your life.

Matt, I don't know if you know what kind of graft you're doing, but if you have the choice, I'd suggest doing the quad stranded hamstring graft that uses the gracilis and semitendinosus (sp?) tendons from the hamstring simply because it's the strongest graft on the market. It has it's drawbacks...namely, you have to do a lot of extra work to get your hamstring strength back (which is pretty uncomfortable work, I must advise) and frankly I'm still working on getting my hamstring back to 100% 2 years later (although it's been at about 98% for a while now). Also, you have to work harder on regaining your ROM (range of motion) back with the hamstring graft. The other main type of graft of course is the patellar tendon from your knee. This surgury usually gets you fully recovered quicker and easier...no hamstring to worry about rebuilding, and not so much of a ROM regain issue.

BUT here's the thing: the hamstring graft is significantly stronger than the patellar, and i have to say that the psychological comfort of knowing that I have the strongest graft possible has really been worth its weight in gold for my confidence, and that alone has made the extra pain of my hamstring rehab worth it. There are actually a couple of research studies online somewhere that give the actual strengths to failure of all the graft types, compared to the original ACL (i'll see if I can find them). That all said, the patellar graft is still good, and i know a lot of people who have had that and have been completely happy.

But I'm glad I had the hamstring graft, my new knee is stronger than my original one...and that wont necessarily be the case with a patellar graft. Avoid a cadaver graft (allograft) at all costs if you can, they are rarely comparable in strength to your original ACL and are significantly weaker than both patellar and ham grafts from your own body. This is all stuff you should discuss at length with your doc.

My other bit of advice is be RELIGIOUS with your rehab. You success is directly related to how hard you work with your rehab early on. I worked my ayss off with rehab and still didn't do as much as I should have. In the beginning it's all about getting your ROM back, and it's very important to get it back quick. Best of luck my man and if you have any questions, let me know.