ACL tear and surgery

Dumb question: are ACL tears an issue mainly for alpine skiers? Does the tele free heel minimize or eliminate the chance of this injury?

Yes, those sissy tele dudes rarely tear their ACL

I remember reading many years ago that the rate of ACL injuries among skiers skyrocketed when the industry moved from straight to shapes skis. The same sidecut that made the ski so easy to turn increased the incidence of "phantom foot" injuries, where one ski tracks away from the skier's direction of motion, torquing the knee. It's the downside of having skis that are capable of literally turning themselves. Does that comport with you guys' experiences? I've had this "phantom foot" theory in the back of my head for probably 15 years, especially when I'm skiing crud or mank, but I don't know if my understanding of it was ever correct.

I'm young, but I've yet to have a major injury related to skiing. The worst skiing related injury I've had was when I threw a 360 and landed way too tail heavy, and because bindings don't pop pout through the toe, it put a ton of strain on my leg, and messed something up. Nothing was broken.

My first set of skis was a pair of old K2 straight skis. All I can say is I did a lot more side slipping on those then I did with my shaped skis. Shaped skis make it much easier to hold an edge. I've had a bunch of different skis over the years, but now I'm using a pair of 184 long Fischer Watteas with a 126-84-112 sidecut.  I love them because that is a very wide turning radius considering the length. Compared to a lot of shaped skis I see nowadays, these appear relatively straight. Not only do they allow you to go fast but when you turn them on edge, they don't whip you around super quick. They take their time to turn which is nice, because it won't catch you off guard.

Brownski wrote

I remember reading many years ago that the rate of ACL injuries among skiers skyrocketed when the industry moved from straight to shapes skis. The same sidecut that made the ski so easy to turn increased the incidence of "phantom foot" injuries, where one ski tracks away from the skier's direction of motion, torquing the knee. It's the downside of having skis that are capable of literally turning themselves. Does that comport with you guys' experiences? I've had this "phantom foot" theory in the back of my head for probably 15 years, especially when I'm skiing crud or mank, but I don't know if my understanding of it was ever correct.

Don't know about the stats comparing before/after ski design changed but here is recommendations for avoiding ACL injuries due to "phantom foot."

https://vermontskisafety.com/research/tips/

"One common ACL injury scenario has been termed the Phantom Foot because it involves the tail of the ski, a lever which points in a direction opposite that of the human foot. Phantom Foot injuries can occur when the tail of the downhill ski, in combination with the stiff back of the ski boot, acts as a lever to apply a unique combination of twisting and bending loads to the knee."

The other common type of action that leads to ACL injury is called "boot induced."

"The knee injury scenario that is probably the simplest to avoid altogether has been termed the Boot Induced ACL. The injury is sustained during hard landings by off-balance skiers. Typically, the skier begins a jump off-balance to the rear, and rotates the downhill arm up and rearward in an attempt to regain balance before landing. This motion is instinctively coordinated with the extension of the skier’s uphill leg."

Get the surgery .... give yourself a minimum of 8 months of intense PT/rehab. I had a great surgeon, but, it's really the PT who saved my life. The surgery is commonplace. A good physical therapist will become a lifelong friend. I was going 3-4 days a week initially. You get out what you put in.  Go back too early and your chance of reinjury is very high.

I had mine done when I was 50. I'm 53 now, play pick up basketball 2-3 times a week, ski and sail .... get it done right and do the PT.

I feel somewhat vindicated by the article you found Marz, though I don't think I explained that well. It seems like balance is always the answer in skiing. I believe Z has made the same case here (regarding balance being the key to adults improving and avoiding injury I mean) in the past. I find everybody's take on treatment and recovery to be useful and informative but I think I'd like to see some purposeful thread drift here as well- to cover how the injuries occurred and how they ski differently post-injury to avoid additional damage

Brownski wrote

I feel somewhat vindicated by the article you found Marz, though I don't think I explained that well. It seems like balance is always the answer in skiing. I believe Z has made the same case here (regarding balance being the key to adults improving and avoiding injury I mean) in the past. I find everybody's take on treatment and recovery to be useful and informative but I think I'd like to see some purposeful thread drift here as well- to cover how the injuries occurred and how they ski differently post-injury to avoid additional damage

My approach was very simple to avoid any knee injuries while skiing: 1) get into better shape, 2) improve technique by investing in high level lessons and spending time practicing to ingrain new habits.  Note that I'm somewhat adventurous when skiing with ski buddies but not that aggressive.  Meaning I'm not interested in high speed zipper line bump skiing or narrow chutes.  Powder in an open bowl or in trees was more my idea of ideal conditions when I started taking lessons.  Thinking that bumps are fun was an unexpected side effect of becoming a better skier.

After popping off an ACL (not skiing) and completing PT (Weeks 3-10 after injury) I started doing year round ski conditioning that included weekly sessions with a personal trainer.  I work with my trainer for a few months after the ski season is over (late April thru June or July) and during pre-season (Sept thru mid-Dec).  I work out on my own at home or at the local fitness center but rarely more than 3 times a week.

What I mean by "high level lessons" is lessons with PSIA L3 instructors or L2 with 10+ years of experience.  I was over 50 and a low advanced skier when I started upping my game.  Had I known what I learned after the first two seasons of lessons, I would've invested in my own skiing when it was clear my daughter was hooked.

I convinced my main ski buddy to join me for semi-private lessons at destination resorts.  He hadn't had a lesson since he was an advanced skier skiing bumps on Bell Mountain at Aspen in high school.  Took a few seasons, but since he has a wonky knee (messed up meniscus in high school) I guess he thought it was worth seeing what could change.  He skis smoother and more hours during a ski day at age 65 than he did at 60, and he was quite a good skier when I started skiing with him at North Country School alumni gatherings at Alta Lodge ten years ago.  He grew up in NYC skiing in the northeast with family before going to NCS in the 1960s.  I learned to ski at NCS and skied very little after that.  NCS students ski at Whiteface, as well as the school's hill (rope tow).  He did a Taos Ski Week last season and will do another this season.  I don't think he would be skiing Taos double-blacks quite as much without the lessons we did together.  I think it's ironic that my favorite instructor at Alta is from North Carolina.  He lives about 30 min from me during the off-season.  Recommendation came from my boot fitter who owns a NC ski shop.

End result of what I did the 2-3 years after knee rehab is that I was skiing faster on groomers and exploring more complex terrain than before losing the ACL.  Quite a silver lining in my case.

I've had my share of orthopedic issues, but no ACL tears.  All I can say is, don't be afraid to get a second opinion before choosing a surgeon.  If you haven't already done so, try to read up on the options.  Two different surgeons looked at the same MRI of my knee and recommended drastically different procedures.

Best wishes for a complete recovery.

My injury was due to a binding pre release that occurred while truckin along at a good clip. Ski boot hit the snow, and, well, resulted in a effed up knee.

As for skiing after my injury it seems like it's always in the back of my head me knee could buckle at any given time. Even tho it's braced up, that doubt is still in there. Because of the, shall I say, not so perfect conditions we have here in CNY, unless it's "soft day" it's not even worth the pain to go out and ski.

Thus the new sled

I considered a brace.  But decided on a wait-and-see approach.  One reason I decided to pass was a lesson I had at Massanutten with a L2 instructor.  Turned out that he was missing an ACL too.  Had a brace for a couple months and then quit using it.  His day job . . . was in physical therapy.

My surgeon noted that a brace would only really protect from hyperextension.  He left the decision whether or not to get one up to me.  He was perfectly comfortable with my decision to work at being a coper instead of doing surgery.  My knee was very stable.

For me, a custom brace would not have been covered by insurance because I have a high deductible.  Didn't make sense to spend money on something that was likely to end up in the closet.  I spent the money on private or semi-private lessons instead.

So its confirmed.  Full ACL tear.  I was somewhat surprised since I recovered so quickly with physio.  Its been two weeks since and I am walking without crutches.  I am now waiting for the appointment with the surgeon.  I am still hoping that I might be able to ski for March break with a brace of something.  I would hate to sit in hotel in Le Massif and have all my friends and family go skiing while I sit there.  

Claude

BigK75 wrote

So its confirmed.  Full ACL tear.  I was somewhat surprised since I recovered so quickly with physio.  Its been two weeks since and I am walking without crutches.  I am now waiting for the appointment with the surgeon.  I am still hoping that I might be able to ski for March break with a brace of something.  I would hate to sit in hotel in Le Massif and have all my friends and family go skiing while I sit there.  

Claude

Sorry the ACL is gone.  As long as you are willing to stay on groomers and take it easy, if your knee is stable then possible to ski by March.  I was fully functional for daily living by Month 3.  Did a little indoor rock climbing in Month 4.  Ski season didn't start until Month 6.  I was fully weight bearing on Day 1 but couldn't start formal PT until about four weeks after injury.

http://over50skifitness.blogspot.com/2017/10/five-years-after-rupturing-acl-still.html

I suggest you get a baseline Knee Injury and Osteoarthritis Outcome Score (KOOS) so that you can track progress in the next year or two.  Don't do it too often though.  Once a month is about right while doing PT.  After reaching about 90, then every 2-3 months is better.  I reached 94 by Month 6 as a coper.  I wasn't doing any pivoting/cutting but put down Moderate to get a conservative KOOS.  One item doesn't change the overall score that much.

http://www.orthopaedicscore.com/scorepages/knee_injury_osteopaedic_outcome_score.html

I'm only passing on my personal experience.  Not a medical professional but I am a statistician who worked in the pharmaceutical industry working on clinical trials so know how to research a medical topic.  Every knee injury is unique.  Working with medical professionals who have experience with treating ACL ruptures and any related damage inside the knee is best.

Get the brace and have at it.  You wont even notice you have the tear.  

tjf1967 wrote

Get the brace and have at it.  You wont even notice you have the tear.

Wow that would be awesome.  I am at the point where I can road cycle on my trainer for about 30-45 minutes a day at my usual speed and I can walk with a limp and easily climb stairs.  I do my physio religiously.  If I could ski for March Break that would be amazing :)

Claude

BigK75 wrote

Wow that would be awesome.  I am at the point where I can road cycle on my trainer for about 30-45 minutes a day at my usual speed and I can walk with a limp and easily climb stairs.  I do my physio religiously.  If I could ski for March Break that would be amazing :)

Claude

For what it's worth, my PT much preferred that I use a cane until I could walk without a limp.  Hard to break the habit of limping even after more than enough healing so that it's not necessary.  Took a week or two to break the habit after I started formal PT.

Someone I know just had  his fully torn ACL repaired using a very new procedure. It was much less downtime than a reconstruction. I'm not sure if all tears can use this new procedure but maybe worth asking about. He went to HSS is NYC and is a skier.

tom

Thought I would send an update.  Saw the surgeon and he doesn't think I need the surgery just yet.  He said that all the biking has kept the knee incredibly stable and he really couldn't feel the difference between the two of them.  I am now praying my braces is ready for March 10th so I can go ski Le Massif.  He wants me to come back in May and tell him how it went and whether I want the surgery or not.  I am definitely not going to take any surgery that will put me out of skiing next year.  I will ski next  year with my brace and if I need the surgery I will get it at the end of next March.  In the meantime I am rehabing like its my job (to quote SJ).  I am going three times a week and I am up to 170lbs leg press and 40lbs hamstring curls (one leg at a time).  I also riding 125km on the bike each week.  So far its coming along great although I still have a bit of a limp.    

Claude

Glad things are going ok, hope the brace arrives in time!

BigK75 wrote

Thought I would send an update.  Saw the surgeon and he doesn't think I need the surgery just yet.  He said that all the biking has kept the knee incredibly stable and he really couldn't feel the difference between the two of them.  I am now praying my braces is ready for March 10th so I can go ski Le Massif.  He wants me to come back in May and tell him how it went and whether I want the surgery or not.  I am definitely not going to take any surgery that will put me out of skiing next year.  I will ski next  year with my brace and if I need the surgery I will get it at the end of next March.  In the meantime I am rehabing like its my job (to quote SJ).  I am going three times a week and I am up to 170lbs leg press and 40lbs hamstring curls (one leg at a time).  I also riding 125km on the bike each week.  So far its coming along great although I still have a bit of a limp.    

Claude

Good for you! I went five years before getting ACL surgery. First season, I wore the brace for just about any outdoor activity. After that it was only for downhill skiing. You still need to be careful, I tweaked my knee with the brace on, which tipped the scales over to finally getting it fixed.

What brace are you getting? I had a Donjoy Defiant with a nice metalflake paint job. Still have it actually, since it is a custom product.