jr@vaxine.UUCP (Johanna Rothman) (04/03/85)
This is a summary of all the replies to my article about torn anterior cruciate ligaments (knee) a few weeks ago to the net, and where I am in my rehab program. First of all, thanks to all who responded - I needed the moral support! My knee is much stronger, due to the exercises and bicycling twice a day - I spend at least two hours exercising both knees each day. That includes about 15 minutes of cycling on a stationery bicycle. I'm walking without a limp and without a cane, even outside or in crowded places. Swimming therapy is supposed to be added this week, and I'm getting some nutrition advice for proper eating with all this exercise (but not enough aerobic exercise). A couple of extra pounds doesn't seem to help the strengthening/stability process. It also seems that if anything happens to one's knee, it is best to go IMMEDIATLEY after the injury to a sports medicine orthopedic physician. There have been too many reports of incorrect diagnosis and mistreatment by supposedly competent physicians. This statement can probably be generalized to other types of illness and doctors, but I only know about allergists and orthopods. For those of you who were curious, I fell down while running to catch a frisbee. (I know, frisbee - a contact sport??) It turned out there was some- one taking a picture at the instant I fell, and my leg is at a very odd angle from the knee down. I also have incredibly flat feet, with very loose ankle ligaments. That added to the general instability (under normal circumstances) of the knee. I just got orthopedic supports for my shoes, which if I'd had for the past thirty years MAY have prevented this problem. My prognosis is pretty good. Bicycling outside when I can bike at least 30 minutes indoors, swimming probably immediately, and after I get measured for a Lenox Hill brace, skiing next winter. Thanks again to those who responded, and here are summaries : From moncol!ben (Paraphrased) The March 1985 issue of SKIING had info about ACL injuries which may be helpful. From aecom!werner In 1st year anatomy at Med School, they tell us that theoretically, one can go without the cruciate ligaments provided that the Quadriceps muscles are strong enough. They do no reccommend this, however. Keep up the exercises. From rokhsar@lasspvax (Paraphrase) 5 years ago, tore acl, while playing football, and was misdiagnosed even though reported hearing the characteristic pop. After a year of exercises and resting it went out again while playing football. Different doctors misdiagnosed, and the knee went out while walking and going down stairs. (end paraphrase) Obviously something was wrong, and finally someone interpreted it as a torn ACL. Since so much time had elapsed, there was little hope that the ligament was still there - a completely torn ligament atrophies in a month or so. The surgeon at Cornell wanted to do an intra and extra articular reconstruction, in which tendons are rerouted from their normal attachments to be stapled in place of the torn ligament. This is the standard reconstruction operation, which is accomplished by opening the knee, dislocating the kneecap to expose the bones, and stapling the tendons in place. Luckily, I heard of a surgeon in NYC who is working on a new procedure still under FDA testing rules. Called a "bovine xenograft", a specially treated cow tendon is inserted in place of the ACL. My doctor performs the xenograft procedure arthroscopically , so that trauma to the knee is minimized, and rehabilitation time is shortened. Six weeks are spent in a cast-like immobilizer, and then a special brace is used. My doctor has performed 30 of these operations over the last 3 years with an almost 100% success rate (one patient fell down the stairs,tearing the graft, which was replaced by another one). I did not have the xenograft, since my ACL had torn from the bone and fused to the posterior cruciate. The surgeon was able to reattach it (arthroscopically) and I didn't need a graft. I am now 3 1/2 months post-op and walking without a cane for the last 2 weeks. Rehabilitation is a slow process (I had expected a Rocky-like return to complete health) but in 2 or 3 months I should be running again. Muscle strength deteriorates rapidly in a cast, unless you're constantly doing leg raises and quad setting excercises, which is perhaps the most distressing thing about beginning rehab, and it only comes back through hard work. I figured that in the year before the surgery I was spending about 1/3 of my time recovering from an incident of instability, and if things continue to go as well as they've been going, I don't regret having the operation. Swimming is one of the first things you can do (~2 months post-op), and bicycling, once flexibility has returned, is also an early part of rehab. I've been told that with a brace I could ski next winter, but I'm not sure its worth it for me. According to "Sports Health", a book by Dr. W. Southmayd and M> Hoffman about sports injuries, "Studies show that 90% of patients can get along without the ACL, which means they can return to sports". I have two friends who have torn ACL's and did not have surgery. One uses a Lenox Hill Derotation Brace, and is very active (baseball, basketball) but does not ski anymore. Another tore her knee playing rugby and has not had any problems with instability since. She is more muscular than friend #1, which may account for her not having to use a brace. According to "Sports Health", "50 percent of patients with ACL instability can function using the brace." This means no brace for everyday activities (like walking down stair) but using a brace for sports. A third friend tore his knee skiing, had a reconstruction done, and now ranks in the 20's in American downhill racers. Last month he hyperextended his other knee, tearing the ACL, but his doctor told him that he could probably do recreational skiing without surgery, just with a brace. NOTE - I'm going to Sports Medicine, Brookline, where Southmayd practices. My physician is Frank Bunch. My advice, paraphrasing my surgeon, is that is the instability interferes with normal activities like walking or climbing stairs, get it fixed, because the continual wear and tear that repeated dislocations and hyperextensions cause will cause lots of trouble as you get older. The arthroscopic technique, though new for ligament repairs, is probably one of the greatest advances in orthopedic medicine, and is slowly gaining adherents. The xenograft is new and exciting, since it does not sacrifice the natural functions of the tendons used in order to stabilize the knee. My doctor is Stuart Springer of the Hospital for Joint Diseases-Orthopedic Institute and his office number is (212) 473-2520 if you're interested. Perhaps he could recommend someone in the Boston area. The book "Sports Health" has a good discussion of knee injuries, and I would recommend it as a way of becoming more informed about your knee. (Paraphrase) He's doing well, walking around and getting back to full strength. What seems to be important is getting strength, stability back, and having a doctor you can trust. (End Paraphrase) From tektronix!tekgvs!lynnef (paraphrased) About 3 1/2 years ago hurt knee playing racquetball. Apparently tore a little bit of cartilage (didn't show on the arthroscopy, so they are theorizing), and stretched the anterior cruciate ligament. No surgery, but therapy for a couple months. She wears a Lenox Hill brace for skiing, racquetball, softball, etc. No needed for bicycling or running, but not invovled frequently in either. Knee will become unstable if step down and sideways, like stepping down from a rockpile, or coming down steep stairs while carrying daughter. It "shifts" and hurts when that happens. I really do ski a lot, and I don't even notice the brace except on the chairlift, because it does cut the circulation a bit. Make sure your brace really "stops" your leg from fully extending; mine failed last summer in between 2nd and 3rd base.