Five years after rupturing an ACL, still a successful coper

Hearing from other people in the midst of knee rehab recently made me think back to my knee rehab process.  My knee injury resulted in a complete ACL rupture (not a skiing accident).  Using KOOS (max 100, Knee Injury and Osteoarthritis Outcome Score) was useful for tracking the healing process.  After five years I have a different appreciation for milestones during the first year.  During rehab it was not clear how long the process would take and whether or not I would have to change my approach to skiing.  I decided to take the treatment approach based on physical therapy and improving fitness only, as opposed to scheduling ACL reconstruction surgery.

• Month 1: crutches (injury was during 2-week international trip) and rest - June 2012
• Month 2: formal PT, mostly no impact exercises while giving MCL strain time to heal completely, MRI confirmation that ACL completely ruptured
• Month 3: started weekly personal training, fully functional for daily living, KOOS 86-88 (Mild or Moderate for Running, Jumping, Twisting/pivoting because avoiding those actions), second and final appointment with orthopedic surgeon

• Month 4: continue personal training, back to indoor rock climbing, avoiding jumping and running (never liked running for exercise)
• Month 5: final PT session included agility exercises, KOOS around 90
• Month 6: ready for easy skiing, KOOS at 94 (Moderate for Twisting/Pivoting) 

• Month 7: skiing at speed on small hill (Massanutten) - Jan 2013
• Month 8: started lessons with a very experienced instructor (three Silver Clinics at Massanutten with Walter, PSIA Level 3), decided not to bother getting a brace
• Month 9: 3-hour private lesson at Bridger (Ric Blevins, PSIA Level 3, worked with Ric the season before), skiing at Bridger and Big Sky included a few bump runs steeper than the year before

• Month 10: skiing harder ungroomed terrain at Alta than the previous year, KOOS about 96 - Apr 2013

I had a relatively easy time making an educated decision about which treatment made sense for my ACL injury. I had an MRI and was evaluated by a orthopedic specialist about a month after injury. The collateral damage was a minor MCL strain and a small hole in the part of the meniscus that could heal fully without medical intervention. By the first time I met with the surgeon I had researched the most common treatment options was ready to discuss the options. Even though I was over 50, my orthopedic surgeon was willing to do surgery if I was interested.  At three months my surgeon supported my decision to stay a coper.  I was very careful the first six months and gave my body almost a year before considering the healing process complete. I made use of Chinese medicine (acupuncture, herbal Yunnan BaiYao) from the start.

What I’ve learned since rupturing an ACL is that there are a lot of factors to consider when deciding on treatment. Initially I thought that the level of collateral damage (meniscus, bone fracture, other ligament damage) were the most important. After reading about ACL treatment options, recent research results, and learning more about copers who ski, including skiing with several older advanced skiers who are ACL-deficient, I think the following is only the start of a list of other significant factors.

• Health care system of the patient’s country
• Age of patient
• Personality of patient related to fear of further injury
• Personality of patient related to ongoing fitness exercises
• Type of physical activities and sports the patient enjoyed at the time of injury

The medical approaches for how to treat ACL-deficient patients continue to evolve.  The knee is complicated.  Everyone's situation is different. Regardless of what can be learned online about copers and ACLr surgery patients, it's ultimately a very personal decision that should be made in consultation with experienced medical professionals.