Wrecked knee - help!
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Discussion

Harry Flashman

Original Poster:

21,784 posts

271 months

Thursday 4th May 2017
quotequote all
I have destroyed my knee, skiing.

So, consultant this morning. I have a ruptured MCL and snapped ACL, as well as meniscus damage.

As the MCL has started to heal in a stretched position, they have to wait for it to heal, and then operate to put a new tendon in there to give it some tension, and repair the meniscus at the same time.

I then have to wait for it to heal before they do the ACL, and I can start rehab.

Certainly not skiing next year, and he has doubts I will ever ski the way I used to again (heavy off-piste, park).

Gutted isn’t the word. And has anyone else had such a complicated knee injury? If so, what advice can you offer?

To think that when this happened (doing a rail in the Avoriaz Park) I strapped it up and skied down to the Ardent gondola on one leg, got a transfer to Geneva and then went home (I had a friend’s father’s funeral the next day). I should have been carted off by the medics and gone straight into hospital for immediate surgery. The fact that it is partially healed has caused more complications. What an idiot.

Feeling a bit low - this on the back of a tough year generally. Can anyone offer any advice or even just some hope?

Lotus Notes

1,331 posts

220 months

Thursday 4th May 2017
quotequote all
I'm a skier, but have avoided ACL injury over the years..Many friends have torn or snapped theirs..

From their experience - Absolute minimum of six months before skiing (on piste).

If it's been repaired by a graft from the hamstring, don't try and advance your rehab. too early. The graft will fail as the hamstring needs to 'take on' the role of the ligament.

Physio, physio, physio.

I have friends who have come back from this injury and skied serious stuff nine months later.

Good luck.

joshleb

1,550 posts

173 months

Thursday 4th May 2017
quotequote all
Knees are a nightmare, no getting round that.

I did mine in the alps, but dh biking 7 years ago now, July 2010.

I snapped ACL, stretched MCL, trauma to femur and a right mess of the meniscus.

I had an arthroscopy a couple weeks later, leg was too swollen for the MRI to see the results, and in the arthroscopy they trimmed all the meniscus up, barely have any left now..

I then had 6 weeks on the sofa unable to put any weight on my leg without it collapsing, but going to physio every couple of days. Ultimately able to walk on it and I spent the next few months still going to physio and the gym strengthening it before I had an ACL reconstruction in May 2011.

Another year rehabbing and not pushing my leg too much with anything, and now it is all good again.

I play rugby and back skiing and DH biking, for anything where I'm pushing the limits I wear a Donjoy Armor knee brace. I bought it before I had my surgery and used to wear it when on a road bike, amazing how loose my leg felt after I took the brace off before I had the surgery.

One more thing, how old are you?

Good luck, long process but hopefully all goes well.


Harry Flashman

Original Poster:

21,784 posts

271 months

Thursday 4th May 2017
quotequote all
Thanks. Josh - I'm 40, and my injury sounds similar to yours. 2 years out: ouch! But to hear that you are back to sports is encouraging.

Mr E

23,039 posts

288 months

Thursday 4th May 2017
quotequote all
A friend of mine blew her knee to bits falls by falling about 4 feet off a bouldering wall.
Multiple operations, lots of physio. Still not right although she has started running again a couple of years later.

I'll ask her exactly what she damaged.

WinstonWolf

72,863 posts

268 months

Thursday 4th May 2017
quotequote all
I had a far more complex injury, I've found cycling really helps to build stability.

I had 4" missing from the end of my femur thanks to a comminuted supracondylar fracture femur, missing ligaments and cartilage and the quad is part bone, part muscle. I've still got 2" missing but on a good day I can cycle 100 miles. Crap x-rays but you get the idea.





I'd concentrate on maintaining your range of movement and locking the knee in the early stages, if you lose either of these functions recovery will be much harder.

The two most important exercises (when you're allowed) is sliding the knee back on forth on a teatray and doing straight leg raises.

Good luck, exercise is key smile

Wobbegong

15,078 posts

198 months

Thursday 4th May 2017
quotequote all
I think the surgeon left an IKEA screw pack in your knee hehe


AlfaPapa

281 posts

189 months

Thursday 4th May 2017
quotequote all
Mr E said:
A friend of mine blew her knee to bits falls by falling about 4 feet off a bouldering wall.
Multiple operations, lots of physio. Still not right although she has started running again a couple of years later.

I'll ask her exactly what she damaged.
Hiya!
4 feet... it was actually 5m but it wasn't the distance that did the damage, it was landing in a spin that ripped my knee apart.

I completely ruptured my MCL, PCL, ACL and POL, damaged the meniscus and broke my tibia.
That was almost three years ago.

When I was told how much damage I had done and that I would be lucky to walk again unaided, and I definitely wouldn't be skiing, running or climbing I was beyond devastated. Truthfully, I am not fully recovered mentally now and still have nightmares about the accident.

From that initial diagnosis, I was admitted and had surgery a week later. The knee was still very swollen and hot, but it was just initial surgery to reattach the MCL and POL (with a couple of handy screws).
I enjoyed several weeks in a large, and heavy full length cast, and then moved into a fixed brace.
Twice weekly physiotherapy got my knee to bending 90 degrees in four months. I obsessed over the ROM and used a special bike in the physio gym which had adjustable pedals. It was agony.

By November 2014, I was ready for the second surgery and had a hamstring graft (from my good leg) for an ACL reconstruction and an allograft from a dead man's achilles for the PCL.

Since then, it has been constant physio and strength work.

Whilst I can't run particularly beautifully (i probably never did) I am running, I am back climbing and four weeks ago I *almost completed my Mountain Leader training until a particularly large and loose boulder made me slip on my bad leg, twisting my knee and resulting in a free helicopter ride.

If you are determined and willing to work through the pain, which I have no doubt you will, there is no reason you won't recover and find a new normal. It's really tough accepting your limits (I've literally just had to buy an auto to use for work because sitting on a heavy clutch in traffic is downright stupid).

Multi-ligament knee injuries are quite rare, but there is an excellent group of people with lots of different stories on Facebook - The 0.02% My Multi-ligament Injury. With lots of top tips, including how to go to the toilet and shower...

More than happy to chat as well. It's utterly ste. Really ste. Especially when you're used to being fit and active.


I have since discovered there's actually several more bolts and screws in - this x-ray is just from the first surgery and doesn't include the two large bolts through my tibia.

Mr E

23,039 posts

288 months

Thursday 4th May 2017
quotequote all
Thanks chuck.
Can I link the "21 year old helicoptered off mountain" news story now?

technodup

7,661 posts

159 months

Thursday 4th May 2017
quotequote all
Currently waiting for an MRI on both of mine, suspected torn/damaged meniscus. Given some days I can barely walk and just yesterday I nearly crash landed in the bathroom it's good to hear people get back to normal.

AlfaPapa

281 posts

189 months

Friday 5th May 2017
quotequote all
Mr E said:
Thanks chuck.
Can I link the "21 year old helicoptered off mountain" news story now?
Of course you can!
Still kicking myself (well, not literally, I've a non-functioning knee dontcha know) I didn't get any photos.

Mr E

23,039 posts

288 months

Friday 5th May 2017
quotequote all
Still, free ride in a helicopter is not to be sniffed at.

Harry Flashman

Original Poster:

21,784 posts

271 months

Monday 8th May 2017
quotequote all
AlfaPapa said:
Mr E said:
A friend of mine blew her knee to bits falls by falling about 4 feet off a bouldering wall.
Multiple operations, lots of physio. Still not right although she has started running again a couple of years later.

I'll ask her exactly what she damaged.
Hiya!
4 feet... it was actually 5m but it wasn't the distance that did the damage, it was landing in a spin that ripped my knee apart.

I completely ruptured my MCL, PCL, ACL and POL, damaged the meniscus and broke my tibia.
That was almost three years ago.

When I was told how much damage I had done and that I would be lucky to walk again unaided, and I definitely wouldn't be skiing, running or climbing I was beyond devastated. Truthfully, I am not fully recovered mentally now and still have nightmares about the accident.

From that initial diagnosis, I was admitted and had surgery a week later. The knee was still very swollen and hot, but it was just initial surgery to reattach the MCL and POL (with a couple of handy screws).
I enjoyed several weeks in a large, and heavy full length cast, and then moved into a fixed brace.
Twice weekly physiotherapy got my knee to bending 90 degrees in four months. I obsessed over the ROM and used a special bike in the physio gym which had adjustable pedals. It was agony.

By November 2014, I was ready for the second surgery and had a hamstring graft (from my good leg) for an ACL reconstruction and an allograft from a dead man's achilles for the PCL.

Since then, it has been constant physio and strength work.

Whilst I can't run particularly beautifully (i probably never did) I am running, I am back climbing and four weeks ago I *almost completed my Mountain Leader training until a particularly large and loose boulder made me slip on my bad leg, twisting my knee and resulting in a free helicopter ride.

If you are determined and willing to work through the pain, which I have no doubt you will, there is no reason you won't recover and find a new normal. It's really tough accepting your limits (I've literally just had to buy an auto to use for work because sitting on a heavy clutch in traffic is downright stupid).

Multi-ligament knee injuries are quite rare, but there is an excellent group of people with lots of different stories on Facebook - The 0.02% My Multi-ligament Injury. With lots of top tips, including how to go to the toilet and shower...

More than happy to chat as well. It's utterly ste. Really ste. Especially when you're used to being fit and active.


I have since discovered there's actually several more bolts and screws in - this x-ray is just from the first surgery and doesn't include the two large bolts through my tibia.
Thanks you - I have sent you a PM. I am particularly scared of not being able to ski again, as it is a big part of my life. I am willing to do whatever I can to get back on the mountain and generally be healthy! I am worried about both operations and the rehab: I would really like to know more about what that all entails. The online forums for this sort of thing are terrifying - I would just like to chat to a couple of people who have been through multi-ligament injuries and get the low-down!

I too feel that my days of manual cars (I live in London, so clutch is a constant) may be opver, sadly.

Harry Flashman

Original Poster:

21,784 posts

271 months

Monday 8th May 2017
quotequote all
For anyone giving advice, here's a timescale of the injury and latest advice from surgeon.

Here is the text of what the consultant surgeon (who is not currently Mr Bell, but seems pretty capable and has dealt with colleagues) has said.


Sunday 9th April - accident happens. I put neoprene brace I was using on other knee (old sprain injury) onto the knee, compressing it, and ski down to the gondola on one leg, avoiding further damaging the injured knee. I fly home - but putting weight on the knee as I have no crutches. Plenty of inflammation, but little serious pain. So probably did some more damage here.

Wednesday 12th April - see my GP, get X-Ray. No fracture shown but a soft tissue "fusion"

Thursday 13th April - I see a knee specialist, who sends me for MRI that day.

Friday 14th April - I swap the neoprene brace I have been wearing for a rigid metal one, allowing me to set degrees of movement.

Wednesday 19th April - specialist diagnoses me with snapped ACL and severely disrupted MCL. Refers me to consultant knee surgeon. I state that I need to be in the USA for work from Sunday, he says fine if no pain, bit wear rigid brace with no more than 30 degrees movement.

Thursday 4th May - I see consultant knee surgeon, who diagnoses as above but also the meniscus issue. He says that this is "a bad one" and "career ending if you were a professional skiier", which rather freaks me out.

I spent about 5 days in a neoprene brace before buying this proper, rigid metal thing I now wear, so probably did some further damage to the MCL here.

Because Ihave felt little pain, I thought things not too serious. That will teach me.

I also waited to deal with work commitments before getting on and seeing the surgeon - another big mistake.

From now on in, I want to do things correctly. This is the surgeon's e-mail from yesterday:

[quote] Going through the imaging further - I'm concerned there is a peripheral split in the meniscus cartilage . These are notoriously 'missed' on MRI but the injury mechanism and the appearances - make it very difficult to exclude with confidence . The instability we identified stressing the inner medial ligament is concerning - especially the laxity in the extended / straight position of the limb - suggesting the ligament is significantly damaged .

The elapsed time since the injury is my main concern

As we discussed - we could let everything settle and then reconstruct the ligament as a delayed procedure . This would mean two separate spaced surgeries - give that we would deal with the ACL at a second stage .

I'm fairly sure there is going to be a significant problem if the medial ligament and meniscus are not addressed - and on balance and having deliberated - it may be easier if we do in fact do something 'sooner' rather than later despite the weeks that have already elapsed . Examining the knee now with a camera - would clarify the issue with the meniscus - very accurately ( more so than with MRI).

If we repair as much as possible now ( and even augment the ligament as necessary at this stage ) - it will mean a more rapid recovery overall . We would need to immobilise the leg in a brace for a 2-3 weeks - but on balance I think we may achieve a more stable knee longerterm if we at least try to repair things now . You would then be recovering from the surgery in the same time period as recovering from the actual recent injury - if that makes sense.
[/quote]



Edited by Harry Flashman on Monday 8th May 16:49

FiF

48,711 posts

280 months

Monday 8th May 2017
quotequote all
Knees are a bugger.

Almost a year ago suffered a tibial plateau fracture. After the plaster and locked knee brace it's been physio, physio and physio.

Despite all the exercises, including single leg crunches, still have trouble with eccentric muscle contraction, so going downstairs and steep slopes is a problem.

Warned to expect arthritis and knee joint replacement in years to come, which is a bit of a bugger as local care commissioning rules have just altered to make knee and hip joint surgery very restricted to save money.

The_Doc

6,255 posts

249 months

Monday 8th May 2017
quotequote all
Harry Flashman said:
For anyone giving advice, here's a timescale of the injury and latest advice from surgeon.

Here is the text of what the consultant surgeon (who is not currently Mr Bell, but seems pretty capable and has dealt with colleagues) has said.


Sunday 9th April - accident happens. I put neoprene brace I was using on other knee (old sprain injury) onto the knee, compressing it, and ski down to the gondola on one leg, avoiding further damaging the injured knee. I fly home - but putting weight on the knee as I have no crutches. Plenty of inflammation, but little serious pain. So probably did some more damage here.

Wednesday 12th April - see my GP, get X-Ray. No fracture shown but a soft tissue "fusion"

Thursday 13th April - I see a knee specialist, who sends me for MRI that day.

Friday 14th April - I swap the neoprene brace I have been wearing for a rigid metal one, allowing me to set degrees of movement.

Wednesday 19th April - specialist diagnoses me with snapped ACL and severely disrupted MCL. Refers me to consultant knee surgeon. I state that I need to be in the USA for work from Sunday, he says fine if no pain, bit wear rigid brace with no more than 30 degrees movement.

Thursday 4th May - I see consultant knee surgeon, who diagnoses as above but also the meniscus issue. He says that this is "a bad one" and "career ending if you were a professional skiier", which rather freaks me out.

I spent about 5 days in a neoprene brace before buying this proper, rigid metal thing I now wear, so probably did some further damage to the MCL here.

Because Ihave felt little pain, I thought things not too serious. That will teach me.

I also waited to deal with work commitments before getting on and seeing the surgeon - another big mistake.

From now on in, I want to do things correctly. This is the surgeon's e-mail from yesterday:

[quote] [i] Going through the imaging further - I'm concerned there is a peripheral split in the meniscus cartilage . These are notoriously 'missed' on MRI but the injury mechanism and the appearances - make it very difficult to exclude with confidence . The instability we identified stressing the inner medial ligament is concerning - especially the laxity in the extended / straight position of the limb - suggesting the ligament is significantly damaged .

The elapsed time since the injury is my main concern

As we discussed - we could let everything settle and then reconstruct the ligament as a delayed procedure . This would mean two separate spaced surgeries - give that we would deal with the ACL at a second stage .

I'm fairly sure there is going to be a significant problem if the medial ligament and meniscus are not addressed - and on balance and having deliberated - it may be easier if we do in fact do something 'sooner' rather than later despite the weeks that have already elapsed . Examining the knee now with a camera - would clarify the issue with the meniscus - very accurately ( more so than with MRI).

If we repair as much as possible now ( and even augment the ligament as necessary at this stage ) - it will mean a more rapid recovery overall . We would need to immobilise the leg in a brace for a 2-3 weeks - but on balance I think we may achieve a more stable knee longerterm if we at least try to repair things now . You would then be recovering from the surgery in the same time period as recovering from the actual recent injury - if that makes sense.[/i]
Sensible

I like the cut of his jib smile


NorthDave

2,538 posts

261 months

Monday 8th May 2017
quotequote all
Sorry to hear that Harry. Nothing much to add other than once you have found a good surgeon then go with their recommendations and then physio the hell out of it.

In relation to skiing - all skiing is good skiing! I've always thought I would be happy doing blues if that is all I could do. At least you are in the mountains enjoying yourself. One of the ski instructors in Avoriaz has one leg - so every cloud and all that!

AlfaPapa

281 posts

189 months

Monday 8th May 2017
quotequote all
Harry Flashman said:
Thanks you - I have sent you a PM. I am particularly scared of not being able to ski again, as it is a big part of my life. I am willing to do whatever I can to get back on the mountain and generally be healthy! I am worried about both operations and the rehab: I would really like to know more about what that all entails. The online forums for this sort of thing are terrifying - I would just like to chat to a couple of people who have been through multi-ligament injuries and get the low-down!

I too feel that my days of manual cars (I live in London, so clutch is a constant) may be opver, sadly.
I am essentially incompetent and have an old email address used for Pistonheads and can't seem to change it so haven't picked up your PM, I've messaged you with my current email address.


Your consultant sounds sensible. The sooner you have surgery and they are able to see what's going on in there, the sooner you can start on your road to recovery. You'll try and put work first (I know I did, I wrote a bid in my hospital bed whilst enjoying the effects of tramadol and morphine... we won the bid btw) but, actually, your knee is far, far more important. It's time for a change in pace and a change in focus. Put yourself and your recovery first. You will need to make physiotherapy a priority.

I genuinely think, if skiing is your focus, you will be able to ski. Not next year, and probably not the year after, but you will. It'll hurt, and you'll find it hard, but you'll do it. Accepting that your knee will never be the same, but it will function and you will be able to enjoy things you used to enjoy.


After my little helicopter ride, I saw my consultant this morning who has checked scans and examined my knee and declared it is 'still intact' predominantly thanks to the amount of physio I've done and the muscle that now supports my knee. This means my "very fragile joint" is not so fragile after all (it was quite a brutal fall). I'll be back out in the Lakes this weekend collecting Wainwrights and logging mountain days, taking painkillers and expecting to elevate and ice my knee at the end of each day but having a flipping amazing time and being grateful for every step.

Harry Flashman

Original Poster:

21,784 posts

271 months

Wednesday 10th May 2017
quotequote all
Thanks for the help all - on and off-thread. I am seeing a clinic who specialise in ski rehab, in Wibledon, on Monday morning. I shall report back.

In the meantime, the reluctant decision was made to sell my Aston, as I won't be using it for the foreseeable future - can't operate a manual, won't be able to for a while. Sad times. frown



phatmanace

679 posts

238 months

Wednesday 17th May 2017
quotequote all
I had my ACL reconstructed about 2 years ago + meniscus trim. if followed a footballing injury that was misdiagnosed - so I was walking around with a busted ACL for 2 years.

We used to go skiing every year, but stopped for a while after we had kids. When we went again - that's when I discovered the hard way that I'd bust my ACL two years previously.

I put it off for a while (didn't like the idea about the general anaesthetic) - and in the end had a hamstring repair.

My observations/reflections

  • immediately after the operation, see if you can get a game ready machine - I was off crutches in a week and also see if you can get a donjoy brace if you want to do sport afterwards.
  • You'll need *lots* of physio - I think most people focus on the surgeon, but having a good physio is critical - I went for loads of 1:1 physio, now I still attend a weekly 'rehab' class (yeah, looks funny when the direct debit goes out of my account to 'rehab') - its like a circuits class, but run by physios and they focus on exercises to strengthen the muscles around your joints.
  • if you do get a brace - they are a blessing and a curse for normal use - you'll feed quite vulnerable in public to start with in case someone knocks you, and the brace can really help. However, when you wear the brace, your muscles around the joint will waste really quickly. I had to be weaned off mine by physio.
  • if I had my time again - I would have had a allograft (dead person's tissue) - as I had an autograft (my own hamstring) - I've had to rehab two things (knee + hamstring) - even at this stage, my hamstring on the other side is noticeably weaker. I couldn't get comfortable with the whole dead person thing, so bottled it at the last minute - in retrospect, would probably have been a better solution.
  • Although 100x better than before I had the operation, my knee is definitely not the same any more - I probably won't trust it to skiing (even with a don joy brace) - but it's fine for cycling and everything else I want to do. direction changing sports (football, tennis) etc would be possible, but I choose not to play them any more, mostly as I don't want the risk of buggering it up again. Much of this is probably personal confidence, I took the view that it wasn't work the risk for a weeks skiing.

Any questions, do PM me.

--Ace