Second ACL Injury - advice

A snowHead

Hi All,

So I tore my ACL on left leg about 6 years ago. Didn’t opt for reconstructive surgery and was skiing (with a physio brace) the following season.
I didn’t opt for reconstructive surgery and have had minimal issues going about an active life without my left ACL.

Bring on 2024 season and you guessed it, I’ve managed to tear my right ACL and add in a tibia fracture for good measure.

My question is, has anyone successfully returned to skiing with zero ACLs?? What’s the thoughts on it.
Just wondering if I should go through the hassle of having reconstruction on at least one now having none?

I have a 10month old so not having to undergo surgery and just physio will be easiest…..but I also want to successfully return to skiing

A snowHead

No easy answer, it depends on many factors.

- Your age, ACL reconstruction has a better outcome the younger you are
- your fitness level and general conditioning. Surgery can form part of solution to a torn ACL, but physiotherapy targeted at improving strength in your knee will see the biggest improvements and is the best mitigation against future instability and continuing joint health.
- What sort of skiing you do and your performance and endurance expectations
- what activities you do outside of skiing and your expectations to return to those as well

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

Thanks,
I’m 40….my other leg seemed to cope extremely well with physio and strength building.
I farm as well as horse ride and hike with the dogs so I think that gave me the strength when I was able to get back to it.
I’m an intermediate skier. Usually did 2-3 weeks a year.
Hoping maybe just strengthing the other ligaments and taking it slow will bring me back to where I was.

I was just wondering if anyone else had similar happen and how they coped skiing again with no ACLs.

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@SkiClaireSki, unfortunately there is about a 10% risk that if you rupture one ACL you’ll rupture the other side. The literature on ACL injury is massive and there are nuanced questions we don’t have answered for that are backed by research. We know that perhaps as many as 50% can cope without reconstruction but that would almost certainly include some who have to avoid certain sports.
A brace may help if the sports allows.
I don’t think it’s a guarantee that two ACL deficient knees in the same individual will behave the same but if you got a good recovery from initial injury it certainly makes no op care worth considering.

In spite of the literature not being helpful in predicting which ACL injuries to manage non operatively I do think there are a subset where it is decently worth a go. This is because some just aren’t very rotationally unstable but the test for checking how rotationally unstable you are is very subjective and difficult to measure with instruments( and so largely ignored by the academic literature). The literature mostly talks about lachman test.

To clarify when you rupture the ACL you get increased forward movement of the tibia( shin) on the femur it is graded 1-3, 3 being the most. However you will also get, to a varying degree, you will also get excessive rotation of the tibia. This is tested with a pivot shift test and it is almost impossible to measure and it ends up being really a “ feel” of how unstable the knee is.
Lachman test does not predict who needs reconstruction that is clear from the literature.
I believe that a 1-2 lachman and a negative or low grade pivot test predicts who will do well non operatively. That pattern occurs frequently in skiers in my opinion and much less commonly in other sports. Why? Because it is as a result of hyperextension injuries that occur commonly in skiing.

So talk to your ortho. If they say the pivot shift is minor or inly just detectable that will, I believe, increase chances of success with non op treatment.

In many case we will simply trial no op care. That is a pragmatic way that avoid all the above assessments. If you work with a physio for 3-4 months they should be able to test your stability. If however you give way after the first 3 weeks then you need a reconstruction. Btw the result for 40 and above are better than for under 40’s. Hope that helps a bit Jonathan Bell

Anyway, snowHeads is much more fun if you do.

I came on to ask this. I had a fall in Kitzbuhel last week, ( well more of a total cock up) I had an acl tear years ago on my left knee, and at the time didn't have an MRI. I just got bandaged up and sent on my merry way. I went back show jumping, cycling, hill walking and skiing. However I never made the association that I would if I were to fall, always lose the edge on the left ski, . So this time I had an MRI, the doc said that I probably had an unstable knee since that accident, and now my injuries are a ruptured ACL, and a second degree tear on the MCL, and other fiddle bits. ( I don't have the letter on me now) So he suggested surgery, but my Insurance wouldn't pay for it in Kitzbuhel, ( or more correctly Brixam) so gave me my MRI and letter for a hospital here in Ireland. So I went to a sports injury clinic, and the guys there suggest I just go for rehab and build up the muscles again, and that I will be able to ski again next season. I " was " a fairly aggressive skier, steeps and ice didn't bother me too much, I'm wondering was the advise not to have the surgery what I should go with? They said they wanted the MCL to heal before they made a final decision, but at my age 56 then the surgery wouldn't be in my best interest due to recovery and rehab. What say the wise people on here. Jonathan, your information is great, brilliant that your on the conversation. If I go without the surgery, I seem to be fairly stable, would wearing a brace help for future ski trips? I certainly don't want to give up skiing.

Help!!

Second ACL Injury - advice

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