There is an estimated 100,000 ACL surgeries performed yearly in the US alone. Everyone goes through a different journey and the spectrum of healing is quite varied. Why write about my story?
A few reasons come to mind:
This blog started one weekend in October 2017 when I was stuck on the couch with severe anterior knee pain and was feeling rather hopeless. My original surgeon/physician assistant/physical therapist team had never dealt with someone with such extended pain. In the blog, I will talk about my exercise routines, my struggles, my outlook, how I manage to keep a somewhat positive outlook, my research, general thoughts on this whole process, and some positive things that are a result of having been injured. This is really meant for my journey, but if helps you in any way then that's a bonus!
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I tore my ACL on January 29, 2017 in the afternoon. I was backcountry skiing in my local mountains. It was my 30th day of backcountry skiing in a short 58 day season. I was having my best skiing season ever at the age of 40. I had just raced in a ski mountaineering race the day before, so I was already a little tired. I wanted to go on my own at an easy pace, but was convinced to join my husband and friends on a tour. They were doing a big day, but I would just sit out every other run to rest. These are fast people, but I went at my own pace.
It was a great powder day, but I cut myself short and called it day when I felt I had enough vert. I had just left my husband and two friends and headed to the car which was ~3 miles away at the trail head where we had two cars waiting. It was a rather large avalanche path and I was just about to exit the chute. Near the exit of the chute it pinched off and flattened a bit; I lost some momentum and was going fairly slow. I looked behind me (not sure at what - my tracks, to look for animals, where there any roller balls coming at me?) and lost my balance. This lead to the most awkward somersault with one boot/ski lodged into the snow. I heard the pop. Normally a fall like that would have released my bindings, but with a buried boot and ski the release happened in my knee. "It's just a rock, just a rock, just a rock!" I immediately chanted in my head to calm myself down. I heard the pop and I tried to convince myself I just hit a rock instead, but I wasn't convincing enough because I soon realized that there was 10+ feet of snow on the ground. It couldn't be a rock. Now, I'm now thinking, "Oh shit! I have to get myself out of the bottom of the avalanche chute!" I had to dig out my ski and boot which was quite lodged beneath the snow. It took three digs and pulls to free it. I managed to stand up somehow and instantly felt like I was going to throw up. The nauseated feeling was the first sign that something was very wrong. I had to get out of my location. Somehow I could ski to the right since all the pressure was on my good (left) knee. However, as soon as I tried to go left, I immediately collapsed (it buckled inward on itself) as if nothing was holding up my leg. That was the other sign that something was very wrong! It wasn't excruciating pain, but it didn't feel good and mostly scared me so I screamed out with each fall. I had to cross a little dip in a snow covered creek, went through some brush, basically bushwhacking for a bit. My knee collapsed four times, each time I had to get back to my feet which was such a struggle in deep snow. I finally made it out of the chute and on to what is the summer trail at the bottom of the deep canyon. Here out of the chute, I felt relatively safe and I pulled out my phone to text my husband. They were on the ridge above me (too far to yell), and they were also looking for my text that said I made it to the car. MESSAGE NOT SENT Shoot! It is a deep canyon I didn't think it would work honestly. I told myself I had to keep moving. It's cold, no sunlight is hitting this canyon, so moving is best. Plus they will come upon me in a few hours when they exit for the day. I put my skins back on my skis so that I wouldn't have to plow to a stop and it could slow me down. I kept contouring to the right as much as I could, but I was also aware that this plan would not actually get me to the car! Canyons, cliffs and trees would soon become obstacles, but it was working for the moment. Meanwhile I kept trying to resend that text. Finally after 10 or so tries, it went through! My husband replied right away and skied down in 9 minutes. Then our friends followed his tracks. As a group of four, we discussed the options and agreed that search and rescue would take too long (and how would we contact them too?). They would have to take me out by skis, but that is what we were going to do anyway. It was in a designated wilderness area, so it's illegal to drive a snowmobile in. Another option was for someone to ski down to the small ski resort where we parked the cars and grab one of their rescue toboggans but that would take time and what if it's locked up. In the end, we did our own self rescue. At first we tried building a sled out of my skis. Our friend had a cool avalanche shovel (not sure of brand) that when taken apart can rig the injured person's skis into a fixed sled you sit on top of. Then someone pulls you. I sat backwards on my pack, on the skis, and held on to a strap. It was a major core workout trying to stay on the "sled," not to mention being pulled through 2 feet of new snow! However, he didn't bring all the parts for this tool, so the sled kept falling apart. We made 0.25 miles. What a great tool however! Next method got us to the car. I put my skis back on without skins. The guys put their skins on (skins are sticky full length synthetic or mohair strips that allow you to go uphill and slows you down on the downhill). My husband and friend were on either side of me, and I shoved my hands behind their backpacks and held on to their waists. They each had a pole and they grabbed my harness with the inside hand (I happened to start the day in a lightweight racing harness). This is how they pushed/pulled me out while I skied on one leg for 2.5 miles. The other friend would break trail and shake all the snow of the snow-laden trees that were blocking our path. It took about 3.5 exhausting hours. Rarely we ski with more than the two of us, so it was incredible that this happened with two other people. I'm not sure we could have gotten out if it were just me and my husband. Overall I was very calm, alert and not in any pain as long as I didn't use my leg. I could touch the ground with the ski/ski boot just to balance, but nothing else. Occasionally my leg got caught on a branch and I would yell out to stop. Once we made it home, I decided to just sleep on it (the ER couldn't have done much for me) and call the orthopedic surgeon the next day. I got a same day appointment Monday morning. MRI was taken 3 days later. By that afternoon I could read my report online before anyone called me. It was a very sad day. I was at work, and I hobbled to the bathroom to bawl my eyes out. This would mean I would have to have surgery. By the end of that week, I booked a surgery date with the hospital before the surgeon even talked to me to give me my MRI results. I just wanted to get the show on the road! Next available surgery date was in 16 days on Valentine's Day. I had no idea about prehab, but luckily my surgeon said due to my decent range of motion and the lack of major swelling, and decent quads (which are now a distant memory), I didn't need prehab. I am glad we got things moving and he didn't delay surgery. Surgery was a success meaning the patellar tendon graft harvesting, bone plug carving, and bone tunnel drilling all went as expected with no complications. That does not mean you are good as new! A VERY long recovery awaits. Even in normal average recoveries, this can take up to a year. I chose the bone-patellar tendon-bone (BPTB) autograft. I think they were surprised at my choice when I told them on surgery day. For patients 40 years and over, the general thought is to use allograft, but I am an active outdoor person and I wanted the best graft for me for years to come. BPTB is the strongest graft due to the bone plugs and the gold standard. It's also the most painful and longest to heal from. My surgeon did say my graft was up to me and didn't way me either way. I knew it was the longest to heal from, but not epic slow as I have been. Photos: My last ski run (L), epic 3.5 hour rescue (M), home from surgery (R) Post surgery rehabilitation probably went as expected until week 12. I had 2 Biodex testings and my latest one showed I wasn't really growing quad muscle as they thought I should be despite the hard work I was putting in. I did have some major pain at the harvest site the entire time especially with lunges, but I managed to get through my workouts pushing through the pain as instructed. Turns out I was subconsciously compensating and using a lot of my glutes and poor form. At week 13, physical therapy really ramped up my program with both gym time and pool time. After about a week of that, I was left in a lot of pain, crippled, back to using crutches. This is when my atypical recovery started. I've had multiple flare ups that left me on a crutch or on the couch for days.
We tried iontophoresis patches with dexamethosone, a month of Celebrex (I'm allergic to all other NSAIDs), low level laser therapy, Active Release Technique massage, taping, light activity, lots more. The assumption was that my pain was patellar tendonitis related to my harvest site. Later it was discovered that this was not correct according to a leading tendon research expert who is helping me. I was so tender and inflamed that we even tried two months of full rest (around month 4-5) to give it a chance to settle down. I lost even more muscle which felt like a huge set back. Walking became really exhausting and painful. If I push it or advance, I immediate have ruined my day with swelling, pain, probably on the couch for a few days, so it does not pay to push through or work hard. Later after lots of research, I may have started patellofemoral joint pain syndrome from that week of too much, too soon. |
AuthorA 42 year old active female who tore her ACL in January 2017 (at the age of 40). Reconstructive surgery in February 2017 with bone-patellar tendon-bone autograft. ArchivesCategories |