Return-Path: Received: from galadriel.gandalf.cs.cmu.edu by K.GP.CS.CMU.EDU id aa05230; 4 May 90 15:44:30 EDT Received: by GALADRIEL.GANDALF.CS.CMU.EDU id aa01499; 4 May 90 15:42:40 EDT Received: from galadriel.gandalf.cs.cmu.edu by GALADRIEL.GANDALF.CS.CMU.EDU id aa01495; 4 May 90 15:41:51 EDT To: bovik@GALADRIEL.GANDALF.CS.CMU.EDU Subject: Advice on knee injury Date: Fri, 04 May 90 15:40:43 EDT Message-ID: <1493.641850043@GALADRIEL.GANDALF.CS.CMU.EDU> From: Barbara.Staudt.Lerner@GALADRIEL.GANDALF.CS.CMU.EDU Here are messages I received about how people dealt with a torn anterior cruciate ligament, in particular whether or not surgery is required. --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 13:19:45 EDT From: David.Kosbie@KOZ.GARNET.CS.CMU.EDU I have had 4 fairly major injuries to my left knee, 3 of which required operations. In the last one, about 3 years ago, I tore all the cartilage, tendons, some muscle, and got a fissure under the kneecap. I also tore my ACL in that injury. That was the worst part. ACL's are no fun. I had it reconstructed. I had it done in San Diego about 3 years ago. They took out part of my "IT band" (a tendon), and installed it as an artificial ACL. There are other methods. The technology is constantly improving, and I would expect modern methods to be far better than the archaic means I could consider. The operation is no fun at all. I have had >10 operations, and this was by far the least pleasant. But, then again, it's improving all the time. Anyhow, it is a painful operation, and a long, painful recovery. You *must* do physical therapy, and you *must* really put protracted effort into it. It's a pretty good test of your mettle. But in the end, after months and months of PT, you get a working knee in return for your suffering. I chose a CTI brace. Again, there are others, and the technology here is probably also much improved. The brace is not that comfortable, but -- like contacts, for example -- you soon get used to it. I wear the brace for any sports where I might stress the ACL, whether by sudden starts/stops, quick turns, or impact. Thus, I don't wear it if I just go jogging, but I do wear it for basketball, skiing, football, etc. Softball is a tough one -- I wear it, since there is an *outside* chance that maybe I'll dive or something and just happen to catch my leg fully extended... I am no less aggressive in sports now -- the brace is made of graphite and titanium (so are F14 fighters!), and if I got run over by a dumptruck, at least my knee will survive! However, I am not nearly as fast as I used to be. Also, after a few hours of intense physical activity, my knee will burn very badly. Ahhh, the price to pay. Well, is the operation right for you? Hard to say. For me, it was easy. Sports have always been a prime focus of my life. I was playing intercollegiate rugby when the big injury occurred. I could not be happy without being able to play sports, and would make virtually any sacrifice to continue doing so. However, this is not everyone's view of the matter. If you don't care about your loss of physical ability (speed, agility, etc.), and you don't mind that certain sports are just a write-off for now on (like skiing), then why go through the bother?!? It's a personal decision. However, it is also one that probably need not be made immediately. You can probably wait as long as you wish before getting it reconstructed (although the surgeon, with some monetary concerns there, might not agree -- get *several* opinions..). In my case, I wanted to wait a short while and finish out school (it was in my senior year of college), so I had an arthroscope done to clean it up a bit (they removed the ligament, fixed up some cartilage, etc...) and had the reconstruction done later, when I could be at home. You really will want someone to take care of you for a few weeks following the operation. Hope this helps! Best of luck! --dave --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 14:14:55 EDT From: Daniel Klein - 412/268-7791 I injured my knee 5 weeks ago playing ultimate frisbee - tortional disruption of the knee with a torn anterior crucate ligamant - and am heavy into rehab right now. I have been told that by strengthening the quadricept and hamstring muscles, you can avoid surgery if you are careful not to do tortional activities (i.e., basketball, racquetball, ultimate frisbee, soccer, etc.). You can also wear a reinforcing knee brace, which *may* help avoid further injury. This is my current plan of action. I am shooting for 100% recovery, and have been told that this is realistic. Right now I am back to walking a couple of miles, doing lots (100's) of leg curls, and taking steps two at a time (although a little more slowly than normal). When I go back to playing ultimate, my only concession will be not to play against novices (kids don't have a good proprioceptic sense, and I was injured by someone else who wasn't aware of where I was relative to him). As it was explained to me, there are two types of people - ligament dominant and muscle dominant. The former relies on the static structure of the knee for stability, while the latter relies on dynamic structure. If you are muscle dominant, then you are unlikely to reinjure yourself (I was injured because I was clipped while making a sharp running turn). If you are ligament dominant, then no amount of strengthening will help you. Personally I am betting on being muscle dominant (I have big, heavily muscled, strong legs). Your best bet is to go through rehab (and be SERIOUS about it), and see how much you recover. If you feel safe, then you probably are safe. If you feel unsafe, then go for the strengthening surgery. If you do not have any meniscus damage, then you don't *need* the surgery to forestall meniscal necrosis, so you may as well adopt a wait-and-see attitude. If you do go for surgery, there are 2 places you can get a ligament to replace your ACL. The first is from a cadaver, which is easier surgery (I believe it can be done completely arthroscopically) but runs the risk of transplant rejection (low, considering the vascularization of tendons) or of infectious disease transmission (also low, but nonetheless a worry in this time of AIDS). The second place to get a ligament is from yourself. The split one of the patellar ligaments/tendons (I forget which), and use a piece of it as your new ACL. More surgery (you get 2 or 3 incisions), but almost zero rejection risk and no infectious disease risk. I have been going to the sports medicine clinic - good people. Although Freddie Fu is highly recommended, I would avoid him. I had elbow surgery by him, and although I have no complaints about it, he works too damned fast and doesn't give you a good "bedside chat" explaining your options. Find yourself a doctor who will take the time to explain everything to you. Or you can write me, and I'll tell you what more I know. -Dan --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 14:36:19 EDT From: David.Kosbie@B.GP.CS.CMU.EDU Well, if the doctor is going to be honest, you really can't snow-ski, water-ski, play tackle football, etc. This may vary from person to person, but basically without the ACL you have no lateral 'stop' in your knee, and when you do one of the sports I listed, you expose yourself to a very high risk of a severe injury (because you'll get a sudden, severe lateral impact, there won't be a ligament there to stop your knee, and your knee will just keep going around the side, tearing everything apart). I know. I had some time between the arthroscopy and the reconstruction, and during that time I felt like I could do anything, except when I did it my knee would constantly give out on me. Anyhow, this is too serious an injury to listen to just one doctor -- get other opinions. And get them from doctors who only do knee reconstructions (the surgeon who did my knee only did this particular kind of ACL!). --dave --------------------------------------------------------------------------- From: John Lee Date: Tue, 24 Apr 90 14:59:36 EDT Hi, I tore my acl about 3 three years ago while I was an undergraduate. At the time, the doctors weren't able to diagnose the injury correctly. The end effect was that for the next two years or so, I was in and out of therapy as I re-injured my knee every time that I would play any intense sport. Besides numerous doctors visits, therapy sessions and weeks spent in immobolizers and crutches, I also had an NMR scan done on the knee. This, too, proved inconclusive. Finally, I went to see a doctor down at Pitt, Dr. Freddy Fu (yes that's his real name). He is one of the best in the country, and he immediately diagnosed my knee correctly. After two years of half-assed sporting, the decision was clear. They first probed the knee, and found that my ACL was completely gone (I don't think that they found it). Plus there was torn cartilage. I was offered the option before hand of either reconstructing the knee from one of my other ligaments, or from a donor ligament. I stated a preference for a donor ligament, since healing times are usually quicker. That is what I got. Therapy lasted about 8 months for me, and was intense at times - but I was walking in a few months, and running after 6. Before my original injury, I was quite active - I played varsity basketball in high school, and ran cross country. After the injury, but before the operation, I couldn't do much of anything. Since then, I've been much more active, though not as much as during high school (grad life may have something to do with that). I wear a brace anytime I do anything really competitive - but the knee feels great. I've no complaints - I just wish that I had gotten the surgery 2 years earlier - it would have saved _me_ a couple years of frustration. Hope this helps. John. --------------------------------------------------------------------------- From: Gail.Newton@VEGA.FAC.CS.CMU.EDU Date: Tue, 24 Apr 90 16:03:06 EDT Barbara, I recently suffered a torn ACL and my doctor (Bushkoff) advised that I wait for the surgery. It's only been 4 weeks since my arthroscopic surgery, so I am still on crutches trying to strengthen my muscles. I'd appreciate seeing the feedback that you get from your post. Thanks! Good luck! -Gail --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 16:20:45 -0400 From: Kiumarse Zamanian I recently posted my latest survey about knee surgeries to Bovik and CS general (around mid Feb.). I myself had an orthroscopic surgery in February by Dr. Freddie Fu. My problem was not as serious as yours, since I only had a strained ligament and he just split one of ligament to release the tension built up (what they call a lateral release). But I could have avoided this if I had taken care of my knee better after the original injury. I am very happy with the results and hope to be playing tennis in a couple of weeks and ski in Colorado this X-mass. Fu is a very good surgeon but a bit too busy to have time for special attention to his patients. I personally think that you should take care of your knee and don't postpone it, since you may have (as I do somewhat) further problems like arthritis in coming years. Kiumarse. --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 16:29:04 EDT From: Kevin.Lynch@A.GP.CS.CMU.EDU I have two torn ACL's, one in each knee, both collegiate football injuries (one in fall '87, one fall '88). I had the first one 'scoped to remove ligament fragments, and I had nothing done (except lots of rehab!) for the second one. In neither case did I have any other complications, like MCL or cartilage damage, and apparently muscle mass helped some in keeping both knees stable. I was able to return to finish the seasons in both cases (though not at 100% effectiveness) wearing a Donjoy type brace. Anyway, since then I have continued to do heavy leg lifts with no problems. I've also played volleyball, tennis, IM football, baseball, and any other sport I've wanted to with no brace and no problem. Of course, none of these sports have been played with the intensity (and contact) that I played football, and I did have some problem then. On the other hand, that was at least partially due to the fact that I was playing again about 4-5 weeks after the injury in both cases. So the main story is that I haven't had any real problems with the sports I've participated in since my collegiate days, despite some initial hesitancy. My knees will still occasionally remind me that they're not 100% by moving slightly, especially when I make sharp cuts. But these episodes are usually just a brief flash of uncomfortableness which disappear right away. I have heard good things about reconstructive surgery, but those good things don't happen until about a year afterward, and I never felt that my mostly slight problems warranted it. On the other hand, the doctors said I had pretty stable knees without the ligament. But he also told me that about 80% of collegiate athletes can perform at 100% without an ACL (though I can't verify this stat.) Well, didn't mean to be so long-winded. Good luck with your decision. And whichever you choose, REHABILITATE! Long and often. Getting the knee strong with leg extensions and hamstring curls will raise your confidence in the knee and add to its stability. Kevin Lynch --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 16:48:16 EDT From: Gail.Newton@VEGA.FAC.CS.CMU.EDU Barb, My doctor suggested that I could ski and do other such activities with a brace. I have an appointment next week with him to further determine my options. I'll let you know what I find out. Much thanks for the info!! -Gail ps. isn't this a great time!!! (sigh) --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 17:06:05 EDT From: Thomas.Warfel@N.SP.CS.CMU.EDU If you are a serious professional athelete or dancer and need _maximum_ performance, then you should probably consider surgery. If you're in the other 95% of the population, rehabilitation exercises (taken seriously and done as prescribed) can have you walking sooner with minimal discomfort. Surgery is invasive, painful, requires a commitment to therapy for about a _year_, and has the possibility of leaving you worse-off than you were before. True, not having surgery increases the likelihood of eventually developing osteoarthritis, but there's little reason you couldn't have that treated if and when it would develop. I screwed up my left knee in a trampoline accident (caught the left foot in the springs while bouncing) and chose not to have surgery. Since then I have successfully skiied, swam, and played soccer. Unless you have major pain, I would recommend trying physical therapy first, and only consider surgery if you aren't functional in a few months. -Tom --------------------------------------------------------------------------- Return-Path: Received: from n.sp.cs.cmu.edu by GANDALF.CS.CMU.EDU id aa22049; 24 Apr 90 19:12:56 EDT Date: Tue, 24 Apr 90 19:05:04 EDT From: Thomas.Warfel@N.SP.CS.CMU.EDU To: bjs@CS.CMU.EDU Subject: Re: anterior cruciate I used a brace for running/skiing for a few years, but have not used it for the past five years. I'm not sure it really does all that much after the first 8 months or so, anyway, unless you anticipate some sort of lateral impact to the joint. Also, I only go skiing 1 or 2 times a year. Have you talked about your concerns with an orthopedist? -tom --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 20:45:15 -0400 (EDT) From: Kevin William Ryan First, let me say "ouch". In '82 I strained a cruciate ligament myself. Didn't tear it, but it was strained. I underwent an arthroscopy to see whether or not there was cartilage damage - which there was not. I had popped my kneecap out of place (somewhat over to the side) and strained the ligament putting it back in. There wasn't anything to be done about a strained ligament, so they sewed up the little holes and sent me home. Took a while to heal up properly - it turned out that one of the critical things was getting proper arch supports to remedy my flat feet (a contributing factor in my bad knees in the first place). I was marginal for a couple of months, but in pretty good shape after that. I still have difficulty with it on occasion, usually when I have done silly things (like raquetball) or haven't had enough sleep for a week or two. Overuse wears me down, and I limp a little. I went to see Freddy Fu, at the Falk Clinic. No, I'm not making that name up. He has a good reputation - he does knees for the Pitt football team and the Pittsburgh ballet. Inscrutable little annoying oriental man, but he does seem to know his knees. A one-sided injury, I'm told, is more difficult to heal than a two sided injury - there is an imbalance between the healthy and injured ligaments. If you are having reconstructive surgury, I believe that the recovery time before you can take off the brace is ~6 weeks. However, it's well worth it. Knees get a lot of stress, and if you don't let it heal properly, it will be a limit the rest of your life. However (to inject some cheer) if you get it done properly and take good care of it you shouldn't be held back by it. I was advised to avoid basketball and racquetball; the twisting motions are hard on the knees, and to keep my quadriceps in _good_ shape; which supports the knee. Seems to work for me. Note that I fenced for a couple of years since then, and am now learning belly dancing. Good luck with it. Hope this was helpful. kwr "Jest so ya know..." --------------------------------------------------------------------------- Date: Tue, 24 Apr 90 20:58:49 -0400 (EDT) From: Kevin William Ryan After rereading your post: - I strained one of my cruciate ligaments. Didn't tear it. My kneecap slipped out of place (I have loose kneecaps) and I strained a ligament putting it back in. Very loud, very painful. It happens every once in a while these days - I've learned to put it back (relatively) painlessly. That is, I don't scream, much. - I did not have reconstruction done; it's not indicated for strains. I did find that arch supports for my flat feet were _critical_ in my recovery, as said feet put large stress on the joint. - I gave up racquetball, as the knee stress is considerable. I've only played it once since '82: however I did not have difficulty that one time. I would not recommend racquetball, basketball, or other sports that inflict strong twisting on the knee. - I do crosscountry ski, I fenced for a few years, and am presently learning belly dancing. Mostly linear motion in these sports, not twisting. - Whatever you do, KEEP YOUR LEGS IN SHAPE!! Good leg muscles keep the knee supported. Whenever I start to get my legs out of shape my knee begins to ache. I cannot overemphasize this. Don't shred your ligament trying to do this, but follow the recommended physical therapy religiously. - I occassionally have difficulty with my leg. Typically this is after heavy unprepared exertion or going long periods without enough sleep to rest my knee up. Aches, popping, etc.. - Note that a single torn ligament will have unbalanced forces from the healthy ligament. - I do know wear a brace. I found for me the braces put uncomfortable pressure on the joint, especially the kneecap. Note, however, that I never tried the full brace (~30" long), and that I have bad kneecaps. - The local knee man is Freddy Fu of Falk Clinic (no joke). Make certain that you get a second opinion, though. He leans towards operating. kwr "Jest so ya know..." --------------------------------------------------------------------------- Date: Wed, 25 Apr 90 10:49:56 -0400 (EDT) From: Michael Horowitz Barbara, I partially tore the ligament along the inside of one knee about 14 years ago. I did not have surgery, primarily because it was a partial tear. I play everything as before, but wear a sleeve brace on top of an ACE bandage. If I don't, I sometimes come down wrong on the leg and reinjure it. My opinion on full tears is that if one is serious about playing and if one thinks she has the gumption to go through the physical therapy (which is probably necessary in any case), one probably ought to have the surgery. Torn ligaments just don't heal and, unless it's a simple case like mine, you can't return to previous form without it. -Mike --------------------------------------------------------------------------- Date: Thu, 26 Apr 1990 13:27-EDT From: Douglas.Reece@IUS1.CS.CMU.EDU Barb: I remember similar requests for information not long ago; I assume you got responses from a number of people (like Jeff Singh) about their experiences, and about Freddy Foo. After a less severe injury a couple of years ago, I started attending sports medicine seminars and I bought a book called Sports Health -- which should really be called Sports Injuries, because that's what it's about. It's written by a doctor who specializes in sports medicine, and it covers physiology, injury, and treatment fairly well. If you'd like to borrow it to see if it gives you any more insight, you're welcome to. I have it here at school. Doug --------------------------------------------------------------------------- Date: Mon, 30 Apr 90 15:12:54 EDT From: David.Black@G.GP.CS.CMU.EDU Hope this isn't too late. This comes from the experience of my mother and a friend of hers, both of whom had ACL injuries, one had the surgery and one did not. >Specifically, how serious was your injury? Serious tears in both cases. Be aware that an unreconstructed ligament may degenerate away over time. >Did you have reconstructive surgery? One yes and one no. >Are you as active now as you were before the injury? With surgery: YES. Without surgery: NO. >Are you less aggressive in sports? With surgery: A little, perhaps -- small worry about doing it again. Without: Definitely much less aggressive. >Have you given up any sports due to the injury? With surgery: NO. Without surgery: YES, skiing (and possibly others). >What activities do you wear a brace for? Not sure, I believe none in both cases. A brace may not be an adequate substitute for the ligament in some situations. The two things to think about is what's involved in the surgery and what the consequences are. If you have any doubts about it, find a good orthopedist now and talk about it because the consequences of not having the surgery are essentially irreversible. What's involved in the surgery: Basically the surgeon goes into your knee to put the ligament back together. Unfortunately, there's a fair amount of tissue that is cut in the process, and the ligament takes time to heal. When the ligament is mostly healed, the knee has gotten very used to staying in one position. (In technical terms, the knee develops adhesions.) Convincing it to move again takes a good Physical Therapist, time measured in months, and is a painful process. The results are a knee as good as new. Consequences of not having the surgery: The ligament is a critical to the mechanical stability of the knee joint. The person who did not have the surgery now regrets that decision in part. Her description of the results is that she "can't trust" that knee any more. Skiing, or any aggressive physical sport is really not possible because the knee could wobble at an unexpected moment. I believe the ligament degenerates if not repaired, but ask a good doctor to be sure. My (2nd-hand) summary of this. Have the surgery done, unless you're absolutely sure you'll be content with a relatively sedentary lifestyle. If there's some doubt about doing it, get it done because the consequences of not doing it are forever. Talk this over with professionals who have seen the consequences of both choices in their other patients (an orthopedist with experience in sports medicine would be a good choice if you can find one). --Dave