ACL Solutions - Real-life Stories

As I went down, I felt something go "pop" in my knee...

Evan was thirty-one years old when he injured his knee in a skiing accident. This is the story of his experience with ACL surgery, recovery, and the process of getting back to feeling strong again.

THE INJURY

When I had my first serious knee injury at the age of thirty-one, I suddenly realized how much we all take for granted about the way our bodies work. I live in Ski Country, and when everyone around you is living and breathing skiing, you hear a lot about injuries, but you don't really focus on the ones that keep people from ever skiing again. And when you're young, active and in good shape, you tend to get this feeling that nothing serious will ever really happen to you.

Well, it finally happened to me on a day when I swerved to keep from running into a buddy of mine. It's funny how you focus so much on avoiding a collision that you don't think of anything beyond that one goal, or what the alternative will be. Mine was crashing. As I went down, I felt something go "pop" in my left knee, but I didn't think much of it at the time. When I stood up again and collected my skis, it didn't seem as if anything really serious had happened. I checked myself over and even did a deep knee bend, but everything felt all right, so I put my skis back on and continued down the mountain. At the bottom, my knee felt a little tight, but it didn't seem significant enough to keep me from skiing for the rest of the day. Little did I know I had torn the ACL in my left knee.

About a month later, I was skiing in a field of moguls when my knee just went out from under me with no warning. One minute, everything was fine; the next, it was like someone had flipped a switch and just deactivated my whole leg. Except for the pain. The previous time had hardly hurt at all, but this time the pain was incredible. It was bad enough that when my friend said he was going to go tell the ski patrol that I needed a sled, I didn't try to talk him out of it. But while I waited for the rescue crew, the pain subsided. After a few minutes, I stood up and did a gentle knee bend to check its status. The pain was gone and everything seemed to be back to normal, so I skied the rest of the way down the mountain to tell them they could call off the St. Bernards.

But I also decided that day that I had to see a doctor about my knee. Up to that point, I suppose I had been in denial, telling myself that it was nothing major, and that if there was any damage, it would heal in a few days, just like when I was a kid. This time, however, the pain and the fact that my knee just gave out forced me to admit that something had gone seriously wrong in there, and that I had to get some outside help to set things right.

VISITING THE DOCTOR

The first doctor that I went to see was a non-operative sports medicine doctor. I decided to see him first because a lot of my friends had been to see him for all sorts of injuries, and he was pretty well liked by people that I knew. He was the first doctor to tell me that I had torn my ACL. It didn't really come as much of a surprise, since by then I knew that I had torn something inside my knee, and ACL injuries are pretty common among skiers. I guess that from the moment my leg buckled under me on the moguls, I knew I was eventually going to end up in a doctor's office with him or her giving me some serious news. It's funny, though - when they tell you you've torn your ACL, I guess they expect you to cry or something. They say, "I'm afraid you've torn your ACL," and then they wait for you to react. I just said, "OK, what next?"

The doctor had a good deal of experience with ACL injuries, and we discussed my options. My legs were strong at that time because I had been skiing and cycling a lot, so that meant I was starting off in pretty good shape. But my left leg was already starting to atrophy. When he felt my left leg, we both noticed it had become a little soft in comparison with the right one. Apparently, I had already begun to favor my injured leg without even knowing it.

"I don't know if it was because the doctor told me what I wanted to hear or because I just heard what I wanted to hear, but I decided not to have surgery at that time."

I suppose deep down I already knew I was going to need surgery, but I also really wanted to keep skiing for the rest of the year. In the end, I don't know if it was because the doctor told me what I wanted to hear or because I just heard what I wanted to hear, but I decided not to have surgery at that time. The doctor gave me a knee brace and some good advice about keeping my legs strong, and I was back on the slopes the following week.

THE DECISION

I also started going to the gym every day, doing all kinds of lower body exercises. I was working out all the time, riding a bike, lifting weights, trying to keep my legs strong. In my mind I had already decided that I would probably need to have surgery, but I was putting it off. I told myself I'd have it done at the end of the ski season, in April or May. And then about two weeks later, I was skiing again with the brace on when I felt my knee give out once more. This time was really serious. There had been hardly any swelling during the first two incidents, but this time it swelled up so much that I could no longer even straighten my leg out. Surgery was not going to wait until the ski season was over.

"You don't need to have surgery, but if you don't, you probably have to give up hard skiing."

I decided to talk to a couple of surgeons who had operated on friends of mine. Both of them were really impressive, and I was able to ask them a lot of questions. They both told me the same thing the sports medicine doctor had told me:"You don't need to have surgery, but if you don't, you'll probably have to give up hard skiing." I just couldn't see myself on the Bunny slopes for the rest of my life. Plus, not being able to straighten my knee out seemed to be serious evidence that something needed fixing. I wanted to make things right again.

Even though I knew deep down that I wanted the surgery, I felt I still needed time to think about it. The first surgeon was very relaxed, giving me answers without any pressure. The second kept asking, "When can we schedule an appointment and get you in here to fix your knee?" Even though I was pretty sure I was going to have the surgery, I wanted to feel it was my decision, not that I had been talked into it. In the end, I decided to go with the first surgeon.

PREPARING FOR SURGERY

He explained to me that there was a chance - a very slim chance - that I hadn't torn my ACL, but they wouldn't know for sure until they put the scope in my knee and had a look around. He was pretty certain that it was my ACL, but he said that there was always a chance that it could be something else, or that another part of my knee could have been injured at the same time. Once he said this, I got this feeling that we were going to find something else wrong inside my knee, and I was pretty sure that he was going to find that my meniscus was also damaged. I turned out to be right, but I didn't find out until after the procedure.

After I told him I definitely wanted to go through with the surgery, he told me everything I needed to know about the procedure - the anesthesia, what would happen during surgery, and the rehabilitation that would follow. Because I knew a few people pretty well who had had their ACLs fixed, I felt I had a good idea about what to expect. We scheduled the surgery for about a month later. However, as the time got closer, I decided to postpone the surgery for a month. It wasn't that I was having second thoughts (though the idea of having a general anesthetic scared me to death), but I felt I needed a little more time to adjust to the idea. I wasn't nervous about the surgeon I had chosen, because I was convinced from our conversations and the recommendations of my friends that he was talented and really knew what he was doing. I suppose I just wanted to be really sure this was the best method of care for my injury. I did some more research in the following weeks, and by the time my second date came around, I had decided to go through with it.

"What really made me nervous was the idea of letting go…of going to sleep."

As the date approached, I started to get a little nervous. I suppose everybody goes through this. Some of my nervousness involved the thought of something going wrong during the procedure. After all, even the best carpenters in the world sometimes make mistakes. But I knew I had picked a great surgeon who would do the best job possible, so this wasn't my biggest concern. What really made me nervous was the idea of letting go…of going to sleep. I was scared that I wouldn't wake up again. I knew it was irrational, but it still scared me. I hardly slept at all the night before surgery. In fact, I hardly slept at all for several nights before surgery.

THE PROCEDURE

On the day of my surgery I went to the hospital early in the morning, feeling pretty nervous. I changed into a gown, and they shaved my leg and had me put an "X" on my knee. I guess they wanted to make sure they operated on the correct one. They started an IV and then sent me to wait in the holding area. The anesthesiologist came into to talk to me, but I was so freaked out about having surgery that I don't remember much of the conversation.

It seemed like forever before the nurse came to get me. In this hospital they lead you down a corridor with little windows that look into the various operating rooms. I remember I kept trying to stop and peer into each operating room, but the windows were a little bit above eye level, so I had to jump up in order to see in. The nurse was dragging my IV pole along, and she kept telling me that I had to hurry up. Then they sat me on the bed, gave me a shot of something in the IV, and the next thing I knew I was in the recovery room.

When I woke up from surgery I was asking the nurse questions that didn't make a lot of sense. Questions about some T.V. show or something. I was really groggy, and I'm sure that I wasn't being very coherent. After about an hour, they wheeled me to my room. I had already planned to stay the night in the hospital, because I was living up at a ski resort and it would have been pretty difficult for me to get up the canyon and into my house after the operation.

"A friend of mine had warned me that I would hurt like I had never hurt before…Turns out he knew what he was talking about."

I guess the thing that surprised me most was the level of pain after the procedure. I'm normally pretty good with pain, so I don't know if it was because I was still groggy from the anesthetic or if I was just trying to deny the pain, but I didn't take any pain pills for the rest of the day, despite the fact that my knee was hurting. By nighttime, my knee was killing me. The nurse had to give me a shot of morphine or something around 2:00 a.m., which finally took the edge off, but I still had a pretty sleepless night. I think that I would have been fine if I had just taken a pain pill every few hours, but once I got behind, it took a long time to catch up. A friend of mine had warned me that I would hurt like I had never hurt before, and I remember telling him, "Yeah, sure." Turns out he knew what he was talking about.

The nurse that took care of me during the night in the hospital really had a lot of character. She was a bit older, had been around for a while, and had a great sense of humor. After a couple of hours she pointed out this pee cup I hadn't noticed before, hooked over the edge of the bed. She told me that if I didn't give her a liter or so soon, then I was going to get a catheter. With all the excitement, I hadn't even thought about peeing up till that point. It was hard to go at first, but once I got going, it seemed like I would never stop.

RECOVERY

After that first night, I began to feel better each day. They had told me everything about the surgery and what to expect, and there weren't really any big surprises. I had a big bandage on my knee, and I'm pretty sure that when I came out of surgery I had that special sock on that is supposed to keep the blood moving. I didn't have a tube in my knee, but I know that some people do. When I took my bandage off for the first time, my knee was pretty hideous. I guess it's the iodine or whatever they use to clean your skin, but it looked like it had been stained with blood. My knee was huge with all the fluid in it, and it looked like it didn't belong on my leg. The whole experience of unwrapping my leg after surgery was a little unreal. It just didn't seem to be part of my body anymore, and it certainly didn't seem like it was ever going to work normally again.

When I went back to see my surgeon after the operation, I found out my suspicion about my meniscus had been correct. When my knee gave out on me for the second time, my meniscus took a lot of punishment because the ACL wasn't there to protect it. My doctor told me that he was able to repair it and didn't have to take much of it out. I don't know exactly what he did - I know he sewed up the edges, and I could tell by the video that he cleaned up the edge just a little bit. But he only gave me a fifty-fifty chance of its healing over time.

When I started going to physical therapy, I was going three times a week. My physical therapist was really knowledgeable, and he did a lot of good for me. He used to be a coach for a cycling team, and later on when the weather got warmer he set up my pedals and my alignment so that I wouldn't put any unnecessary stress on my knee. I also think that he was giving my doctor day to day updates on my progress. He had a lot of patients that had been operated on by the surgeon who worked on me, and on a couple of occasions he was at the doctor's office when I went back for my postoperative visits.

"You can't be a couch potato after knee surgery and just expect it all to happen for you."

I think recovery from a procedure like this involves a lot of serious effort and dedication. While the physical therapist is responsible for a large part of the recovery, you really have to work hard and do your part, too. You can see your physical therapist every day, but he's not a witch doctor. If you don't keep working on your strength and range of motion when he's gone, you will never get back to full strength. Of course, the therapist will do things that you can't do yourself - when we were working on motion he would really stretch my knee, trying to touch my heel to my butt, and you're not going to do that on your own. In fact, no one who cares for you is going to do that for you. But it's up to you to keep the motion that your physical therapist helps you achieve. Even now, I have to stay in shape to keep my knee strong. You are responsible for yourself, and even though your surgeon and therapist are there to provide their skills and expertise, you can't be a couch potato after knee surgery and just expect it all to happen for you.

GETTING BACK TO NORMAL

I got skinny after surgery, and it was sort of hard not to get addicted to pain pills. You find yourself starting to depend on them at times - you want to get a good night's sleep, so you take a pill. I think that I was on pain pills for about a month before I cut myself off. I was afraid that I was starting to rely on them, and I knew it would just get harder to give them up the longer I waited. Starting activities again for the first time after my surgery was weird. Just walking down stairs for the first time made me feel really uncomfortable. Running again for the first time was really strange, because I felt like there was no life left in my leg. My right leg would spring forward and my left leg would drag behind, and to tell the truth I felt lame.

But that got better over time. I did a lot of cycling over the summer and then started skiing again the following winter. Skiing again was hard, because I didn't feel as strong as friends of mine had seemed after they had gone through their procedures. It made me a bit discouraged at first, because I really felt timid, and I kept telling myself that I should be feeling stronger because other people had looked stronger when they came back. But I persevered, and slowly was able to work back up to the condition I had been in before this all happened.

Giving up my knee brace turned out to be harder than giving up the pain pills. Even though getting rid of it was an obvious symbol of my recovery, I started to depend on it - maybe more for confidence than anything else - and it took a while before I felt I could give it up for good. For the first couple years, I wore the brace for almost everything. I even wore a brace while fly-fishing. In fact, fly-fishing was one of the most unnerving things to do after surgery. Walking on slippery rocks in a stream was hard, because you twist every time you step, and when you don't trust your knee, you're afraid every step means you're about to go for a swim. I managed to give up the brace when fishing after the first year or so, but I still felt I needed it for more serious activities like skiing.

"After you have been using it for a while, your brace becomes a bit of a crutch."

I guess after you have been using it for a while, your brace just becomes a bit of a crutch. Its hard to give it up, even though everyone tells you that you don't need it and you know it really won't prevent you from injuring your leg again. Of course, you definitely need it right after surgery. They told me there is a time after surgery when your new ACL is like a wet paper towel. But it doesn't start to heal and get stronger right away, as you might think. In fact, it actually gets gradually weaker for a while. I think they told me that it would be at its weakest point three months after surgery before it started to get stronger again. I especially wanted to wear the brace during that period of time, because I had this image in my mind of my knee as a wet paper towel, and it was hard to shake.

So it took me three years before I finally had the confidence to ski without the brace on. In the end, I felt the brace was just a reminder that my left leg was weaker, and I needed to move beyond it and just start skiing normally again. It had kept me from skiing in certain ways, since I couldn't angle my legs in a turn the way I wanted to, and I knew that I had to let go of it in order to really feel like I had made it back.

LOOKING BACK

After surgery I felt unstable at first. There had been so much atrophy of the muscles in my leg that just to balance on one leg was nearly impossible. But once I recovered, my knee has never felt unstable again the way that it did before the operation. My legs are strong again, and I'm back to doing everything that I want to do. Sometimes I notice my scars in the summer time if my legs get tan and I've been riding a lot, but they are so small that you really have to look for them.

As for my meniscus, it seems to have healed pretty well. I have a little bit of popping in there from time to time, which I notice when I roll over in bed or bend it in a certain way. But so far so good. My doctor tells me there's always the chance of injuring my meniscus again, even this far after surgery, and that it will never be as good as it was before I injured it, but I'm glad to know that its still in there.

"Once you've damaged your ACL, if you don't have the surgery done, then I think you end up with even bigger long-term problems."

Having the surgery was definitely the right decision for me. Once you've damaged your ACL, if you don't have the surgery done, then I think that you end up with even bigger long-term problems. Especially if you lead an active life, where you're putting stress on your knee from day to day. This became really clear to me during rehabilitation. Some people that I did rehab with had torn their ACLs in their twenties and never had them repaired, so now they are in their mid forties and looking at these ugly reconstructive knee surgeries and transplants because they've worm out their meniscuses. I know that there's a possibility this can happen even after ACL surgery, but the way I understand it is that having a healthy ACL reduces the wear and tear on your meniscus and helps you avoid having to go through this procedure. That sounds like a good idea to me, because some of the stories I heard in rehab about meniscal transplants made them sound much worse than the ACL procedure. One guy who had a meniscal transplant had a really low tolerance for pain, and I don't think that he got even ninety degrees of motion after surgery. Several months after the procedure, they had to take him back to the operating room to restore the range of motion in his knee while he was sleeping. There was so much scar tissue built around his knee that it set his progress way back, and I think it kind of broke his spirit. I'm not saying that all meniscal transplants turn out badly, but it sounds like I got off easy in comparison with my ACL surgery.

Would I have ACL surgery again?

Well, going out and tearing my ACL again isn't really on my To Do list, but if it happened tomorrow, I'd have the surgery again in a heartbeat. If it happened when I was fifty, I'd have to think about it, but I'd cross that bridge when I came to it. I want to have an active life, even when I'm older, but I know there are more things to consider about surgery when you're fifty than when you're thirty. Ultimately, it wasn't a hard decision for me, because I had seen how unstable my knee had become without an ACL. Those occasions of instability before I got my knee fixed were perhaps the worst part of the whole thing. I still remember skiing through the trees, and all of a sudden I didn't have a leg underneath me. When you're as active as I am, you kind of come to rely on your body's responding to your every thought, and when a part suddenly goes out of commission with no warning, it really shakes your confidence. I knew if I didn't have it fixed, I was never going to be able to ski with that kind of confidence again. It's like having a leaky brake line - if you don't get it fixed, every time you drive there's this nagging voice in the back of your head asking, "When is it going to go?"