Tore ACL skiing. Don't want surgery. Can I ever ski again?
March 3, 2013 6:42 PM   Subscribe

I'm looking for opinions and stories from people who've torn their ACL but elected not to get surgery. How much physical activity can you still do?

30 years ago, I partially tore my left knee's ACL in a downhill skiing accident, and 3 weeks ago I had another skiing accident in which I tore what was left of that ACL. (An MRI last week confirmed this.) I'm not particularly keen on having surgery if I can avoid it. I'm male, 49 years old, not overweight, in good health, modestly fit, expert but non-competitive skier. I've never been super-athletic, though I do love skiing, and I also enjoy scuba, sometimes running and bicycling, hiking, and hitting the gym for cardio and weights the rest of the time.

My doctor describes the choice between physical therapy and surgery as choosing between being able to do "fitness-level" activities and "sports-level" activities. Skiing falls into the latter category, but for me, it's the only thing that would be in that category—I don't need to do any competitive sports, and it doesn't sound like any of my other physical activities would be a problem without surgery. But I think I would miss skiing...

If I do physical therapy, exercise, and get a brace, can I ever ski again?
posted by StrawberryPie to Health & Fitness (17 answers total)
I haven't had a left ACL since I was about 20, about two decades. I can walk and bike easily and spend a lot of time doing both, but the knee is pretty compromised for all other activities. I do go skiing occasionally and that knee is unstable and develops more pain in the course of the day, both in the joint itself and in surrounding muscles, which are straining to compensate for its looseness. I can't run at all without some pain, and I have to be very careful with activities that put a lot of lateral stress on it, like tennis. Can't do common yoga poses. It's gone out a few times on my at inopportune moments, such as at the top of a stairs. If I had it all to do over again, I'd have gotten the surgery when I was young and not as busy as I am now. One of these days I still hope to get my shit together to have it taken care of.

Meanwhile, my wife tore her ACL in a fall maybe 6 years ago, got it repaired immediately and it is now the stronger of her two knees -- she runs probably 30 miles a week.
posted by M.C. Lo-Carb! at 7:04 PM on March 3, 2013

I know its explicitly not what you are asking for but I cant imagine why anyone would not want the surgery. Its a total slam dunk procedure, quick recovery and you will be back with better, after-market parts.
posted by H. Roark at 7:32 PM on March 3, 2013 [3 favorites]

hi, i'm a manual therapist who is totally averse to most surgical procedures, i even avoid taking tylenol for headaches, ffs. but if surgery is at all an option, i would say go for it. my patients who have had their knees repaired seem to have less knee pain, and can be more active - but also less back pain, fewer hip problems, etc, because the body isn't always compensating for some huge laxity in one of the joints.

having said that, if you elect not to get the surgery, you'll probably be fine until you're not - if/when you fall or do some twisty maneuver, a knee brace is going to help you but not save the day.

good luck!
posted by andreapandrea at 7:39 PM on March 3, 2013

I'm squeamish as fuck, don't even like skiing and thought, "dude, get the surgery so you can ski again with confidence."
posted by notsnot at 7:39 PM on March 3, 2013 [5 favorites]

I would disagree with the "quick recovery" but if skiing is important to you, I would strongly consider surgery. The main thing the ACL does for a non-competitive athlete is slow the progression of arthritis. If you have some already, that may not be as strong a consideration. If not, as a skier you will want to keep it that way.
posted by karlos at 7:39 PM on March 3, 2013

I am about mid-way through recovery of ACL surgery (allographt). Let me tell, the surgery is quick but the recovery is very long. Now if you do opt for surgery, you might be ready to go by the next ski season, so there's that.

When I first met with an orthopedic surgeon for a consult, he told me basically the same thing. If I ever wanted to do active, cutting sports (like skiing or soccer), I would probably have to have surgery. He tore his ACL skiing and just gave up the sport.

So yeah, I echo the others that say if you want to ski again and it's super important to you, get the surgery. Some days I'm annoyed at the whole thing, but then I remember I will get to play soccer again, so it's sort of worth it. Also, there's sort of a club of people who do their ACL.
posted by kendrak at 7:42 PM on March 3, 2013

Here's some information that might be helpful in deciding: research shows that ACL reconstruction is often unnecessary. In particular, you can wait and see, then have the surgery later if needed. From here, a summary of the research on surgery for ACL tears:

[P]atients will function just as well, and have symptoms to a similar degree if they opt to leave it alone and only have a reconstruction later if necessary, and most will avoid a reconstruction.

H. Roark, why would anyone want to have unnecessary surgery?
posted by medusa at 7:46 PM on March 3, 2013 [1 favorite]

I have one repaired and one un-repaired ACL, and I have no regrets about electing to not have the second one repaired. Both were skiing accidents--the first was in 1993 and although the repair (a patellar tendon graft) has held up well, I had complications after the surgery (broke my patella at the graft site a year later). When I tore my other ACL in 1998, I decided not to do the surgery, and that knee has held up fine. It very very occasionally ''goes out'' which can't be good for the soft tissue and joint, and may well set me up for some issues later, but it's been 15 years since then and I am not at all limited in my activities by either knee. I sometimes use a compression type brace when doing twisting types of activities. I ski with a custom brace on both knees; I used to ski quite aggressively even in the years after the torn and unrepaired ACL, though now not so much, but not because of any knee issues--just more cautious in my old age.
posted by gubenuj at 8:11 PM on March 3, 2013 [1 favorite]

P.S. You might want to see the answers to this question: "Torn ACL--OK to go without surgery" on Berkeley Parents Network. You'll notice that I responded almost verbatim there, only it was three years ago. My opinion has not changed since then.
posted by gubenuj at 8:32 PM on March 3, 2013

I tore my ACL a few years ago. Because I didn't get an MRI right away then couldn't schedule the surgery for a while, I spent the better part of a year with it torn. It was completely fine unless I tried to make a hard running cut, i.e. put lateral stress on the knee. Then, the knee would just give out. I suspect that to ski with confidence you are going to need to have it repaired. That said, stability of ACL-less knees varies considerably. It seems like your Dr. has given you the go ahead to try living without it. Try skiing and see how it is.
posted by gimletbiggles at 8:37 PM on March 3, 2013

I tore my acl skiing last may. I did not want the surgery, either, but six months after the injury i could not jump without pain. I did not even try skiing again, so i can't speak to that. I knew if i could not jump, skiing would not be possible. I was in a position to have the surgery really cheaply overseas, so i did it. The recovery sucks, bluntly. I am two months in, and still weak, with an atrophied thigh. They say it's worth it, though !
posted by amodelcitizen at 8:42 PM on March 3, 2013

The thing about ligaments isn't just what you can/can't do, it's the amount of confidence you will have in doing them.

For lifting weights, if you are squatting, deadlifting or doing a variety of plyometric exercises, you need strong knees in order to stabilize your movement, otherwise you may find yourself cheating on posture and causing other injuries. If you hike, you may find it difficult to tackle certain types of terrain as your knees help to ensure you balance weight properly. Running and biking with an ACL injury? I can't imagine that's fun.

I don't know a lot of athletic people who've regretted ACL surgery - yes, there is short-term pain, but the ability to confidently performing the range of things you enjoy now is really worth it.
posted by Rodrigo Lamaitre at 4:06 AM on March 4, 2013

I don't know a lot of athletic people who've regretted ACL surgery

I tore my ACL and got the surgery. It took about a year to recover and was not particularly easy. It subsequently tore again (I'm not even sure how it happened.) So, yes, I regret the surgery because it took so long to fully recover and the results didn't last. I've been skiing once since then so it is clearly possible to do, but I don't know that my luck will last. I do a lot of weight work and find the results sufficient for biking without problems.
posted by Obscure Reference at 6:20 AM on March 4, 2013

I'm in my mid-forties and first tore my ACL in high school. Over the next several years I injured it further and now have no functional ACL in that knee. I seriously considered surgery, talked to four orthopedists, and decided not to do it. I did physical therapy and spend a lot of time in the weight room strengthening the muscles around my knees. Since starting strength training about 10 years ago, I have hiked, jogged, played casual sports, and done Brazilian jiu-jitsu without further injury. I use a custom brace to play raquetball (and I don't push it). I understand serious skiing is a different ballgame. But there are many professional athletes who play without an ACL and do just fine -- it just depends on the structural integrity of your particular knee and how much time you spend taking care of it. Perhaps my most important advice: See at least two orthopedists.
posted by Shoggoth at 8:08 AM on March 4, 2013

My son tore his ACL at 15 and had reconstruction surgery on the advice of the orthopedist and the physical therapist. He returned to high school sports, but found it too painful to snowboard. He also had a "dead spot" on his leg that never came back.

Two years later later he tore it again while wearing his ridiculously expensive and physically limiting custom brace. Rather than see an orthopedist right away (we had an insurance change), he went to a sports medicine specialist and got what we think was good advice. He told my son to go out and live his life, and if he experienced limitations because of his knee then have the surgery. Otherwise, don't. The doctor cited a small study that showed a group of patients that did at least as well with PT only as a group that had ACL reconstruction and PT. Small so inconclusive, but it was enough to convince my son to wait.

Now 20, my son has played intramural sports and returned to both snowboarding and stupid boy tricks. He wears a lightweight brace he got from the doctor. He sometimes experiences soreness and uses ice, but it is no worse than when he had a reconstructed ACL. At this point the surgery isn't even on his radar.

Whatever route you choose, I wish you a speedy recovery.
posted by Breav at 12:28 PM on March 4, 2013 [1 favorite]

I tore my ACL and part of my MCL in a skiing accident nearly 3 years ago. My recovery with regard to range of motion returning was very slow, so my surgeon opted to delay reconstruction surgery until it came back. By the time it was good to go, it was six months later and I didn't want to have to rehab it again. The downside is that I don't have full range of motion in one knee. The upside is that two years of rehabbing it with strength exercises (such as heavy backsquats) means I've never had it even collapse on me. My quads, calves and hamstrings are strong enough to compensate.

I am wary of activities that involve unpredictable movements for my knee. Running, skipping still have impact on my knee but don't stress it; box jumps, lateral jumps and skiing (if I ever did it again) terrify me because I can imagine not falling correctly being a huge risk factor. I would love to ski again (especially since I did it the first time I ever skiied) but knowing how my knee feels when it's close to where it's at it's full range of bending, I think I may have to resign myself to hot cocoa at the ski lodge instead.

It does sound like even with a fully reconstructed ACL, the potential to re-tear it is huge. Sounds like it's damned if you do, damned if you don't. I had an arthroscopy to clear out some damaged tissue and the recovery was immediate. I may have to have semi-regular arthroscopies for the rest of my life ... but I'd take that over the potential for redamage.

Good luck.
posted by chronic sublime at 4:24 AM on March 6, 2013

Everyone: thank you for taking the time to reply! This produced many more replies and much more information than I hoped to get. (Once again I'm reminded how much I love AskMeFi :-).)

Here are some replies to specific comments above:

@medusa: That link to Doctor Skeptic was a fantastic find. Thank you very much for that. I was able to find a follow-up paper (January 2013—link included below) to the 2010 Frobell et al. NEJM article mentioned in that Doctor Skeptic page, and the conclusions from that study still stand after a 5 year assessment. (That is, the study did not find a difference in outcomes for surgery versus non-surgery for their subjects even after 5 years post-accident.)

@notsnot: I think I'm more squeamish than you :-).

@H. Roark: Here are some of the reasons to think twice about having joint surgery:
  1. It's not just a decision about short term results: there are possible long-term consequences of having joint surgery. In medical studies, ACL injuries are well-documented as increasing the probability of developing osteoarthritis in the affected joint. This is generally attributed to collateral damage at the time of injury (e.g., to the meniscus) as well as to changes in how your joint moves. This leads to a question: does surgery reduce the probability of developing OA many years later, or increase it? And the answer appears to be: it does not reduce the probability. Here are just a few articles I've read that discuss this:
    1. Frobell, R. B., Roos, E. M., Roos, H. P., Ranstam, J., & Lohmander, L. S. (2010). A randomized trial of treatment for acute anterior cruciate ligament tears. The New England Journal of Medicine, 363(4), 331-42. doi:10.1056/NEJMoa0907797
    2. Frobell, R. B., Roos, H. P., Roos, E. M., Roemer, F. W., Ranstam, J., & Lohmander, L. S. (2013). Treatment for acute anterior cruciate ligament tear: Five year outcome of randomised trial. BMJ (Clinical Research Ed.), 346, f232.
    3. Streich, N. A., Zimmermann, D., Bode, G., & Schmitt, H. (2011). Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up. International Orthopaedics, 35(4), 607-13. doi:10.1007/s00264-010-1174-6
  2. The surgery itself may be quick, but the process doesn't end there: the recovery will take much longer than the surgery itself. I already suspected that, and a number of people confirmed it in their replies to my question here. In addition, the following past discussions on AskMeFi document the length of recovery and some of the problems that can arise:
    1. Is my knee ever going to get better?
    2. What to expect with ACL reconstruction surgery?
    3. Possibly torn ligament or tendon in knee
    4. What kind of ACL graft did you get?
  3. Just because you have the surgery doesn't mean that it will be successful or that the results will be without problems.

  4. Complications may arise during the surgery itself. It's a low probability, but it's not zero.
@Rodrigo Lamaitre: Those are good points. I've been thinking a lot about them.

@Shoggoth: It's incredible what you can do, and does give me some hope, as we're in the same age range.

Overall: After researching the medical literature, studying over 40 journal articles, reading about people's experiences, talking to my doc, etc., I've decided to try physical therapy first. I'm also researching braces. My goal is to see how my knee recovers, and reevaluate the decision to have surgery in a year.

Decisions to have surgery have to be weighed carefully. It would be different if I weren't able to walk without it, but as it is, right now I'm close to being normal in everyday around-the-house activity. I'm very, very glad to have the opportunity to think through the options and research the pros and cons, rather than make a hasty decision.
posted by StrawberryPie at 8:46 PM on March 8, 2013 [2 favorites]

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