Physical rehab v ACLr- options & outcomes for older people

[Forwood]

I'm a 58 yr old male with a complete rupture skiing 3 months ago.  The strong message being given is that surgery isn't a realistic option.  

The surgeons seem to be saying the older you are, the stiffer the knee so the less need for surgery to improve stability ... and also that age means surgery is less likely to be successful in terms of improving outcomes!

Although heartened by studies suggesting little difference in outcomes between physical rehab and ACLr, and that some people seem to be good 'copers' without acls, I wonder about the age issue:
- is it really too late to have ACLr?
- do skiers really need a reconstruction?
- will my knee ever feel 'normal' again?
- what's the outlook for arthritis, further damage etc?
- will I always need to keep the knee in shape with strength exercises?

My knee is relatively stable and has been ever since the accident. But it is signficantly weaker and has been very stiff - less so now.  I can walk almost normally, jump, take stairs 2 at a time, also run a bit without much of a problem (am taking Chondroitin and Glucosamine as I've read this may help recovery).  I've booked my first skiing holiday for 2 months time - a fairly gentle 3 day skills course so will have an idea then about how it affects the skiing.  At the moment it feels risky because although much better, my knee tires easily and 3 days a week physio is still pushing the boundaries of pain / weakness.

The key question for me is the scope for improvement without ACLr and whether continuous strengthening exercises will be needed to prevent deterioration.  Would love to hear from older people who have gone down either route on how it's been for them - or just generally, is it even worth asking the question, and outcomes all come down to individual differences?

[Kaputt_Knee]

As an older ACLr myself, I think you need to shop around until you see someone who disregards your age and looks at the long term quality of life aspect.

Whilst you are currently not having any issues with stability and have good muscle control and definition, you are not urgently needing treatment. However, the long term prognosis is that there will be deterioration due to the missing control element within your knee. The ACL has a function that can only be partly compensated for with muscle power from the exterior of the joint. Should you lose that for any reason, then you are looking at a downward spiral of deterioration that is really a vicious circle.

Here in Germany, I live in the Alps and am also a passionate skier, age is never taken into consideration. The highest priority is the functionality of the joint and prophylactic measures to prevent the need for a total knee replacement. In my last rehab centre there were 80 year olds rehabbing with me who had also undergone ACL reconstruction. My surgeon says that he finds that older patients not only rehab more intensively, they do not assume that they are able to go beyond the protocol set. Younger patients often disregard caution at the stage where everything appears to be back to normal, but in reality the graft is very vulnerable. Hence the higher number of failures amongst younger patients.

Try and find a sport specialist who sees beyond the date of birth, and get as many opinions as you can. From the time you posted I am assuming that you live in the USA, and the fact that you were skiing in June implies you are probably on the west side somewhere. Why not look at visiting some of the specialists in the mountain areas who deal with these injuries more or less on a daily basis? They would also be in a position to advise you as to whether a functional brace would be advisable and which one(s) are particularly worth your while looking at.

By the way, my last reconstruction took place shortly before my 58th birthday!     I was back skiing within 5.5 months and am representing myself for my ski instructor's license in November. My coach says I have no worries about renewing it and was the person who persuaded me to re-present! As a national examiner for the Austrian system I assume he knows what he is talking about.

Good luck and good skiing!

 

[Audice]

As I read your post I thought, "At last there's someone who's as old as I am who's being told by an OS that ACLr isn't a realistic option." Then I read that you're 58. <g>

I came off my horse when I was 67 & caused a whole lot of knee damage. My OS made no bones about saying, when I told him I would have no surgery until the riding season was over, that if I were to have reconstruction of the ACL I would be the only person in history of that age to have it done. Since I joined the forum I've heard differently from various people.

So I went no further & lived with that pronouncement. I'm one of the fortunate horse people who can ride a horse comfortably w/o an ACL but as I've said so often on this forum, when one has no repairs, one's life tends to revolve around the knee. Just too much time spent deciding whether the next step is going to be the one that'll have the knee crumbling.

I'm very fortunate in that to this day my work at the farm & with the horses has preserved the integrity of my leg muscles & about the only time I use my custom brace is when I'm walking my two big dogs - one of them having a penchant for smacking into the leg with the missing ACL & very unceremoniously I will go down.

I have a veterinarian friend who's been w/o an ACL for many years but she's skiis, she does wear a custom brace which seems to work well for her. But I agree with Kaputt_Knee who says that you miht do well to shop around for an OS who will make the repairs for you so that your life, like mine, won't center around your knee & what you're going to do on any particular day. Wishing you well...a 72 year old

[mollyc]

Hi there: I was told the same thing, and I ruptured my ACL at 41!  I then went out and researched it and found a series of studies that suggest that there are no differences in ACLr outcomes with those over 50 than those under 50, as long as rehab protocols were followed. (I just looked around my hard drive to see if I could find links to those studies and haven't found them.)

My surgeon also told me I could ski without reconstruction as long as I was not an aggressive skier (which I'm not). Ultimately, I decided that since I was healthy now, I wanted to do the surgery now rather than risk having further knee damage down the road and perhaps I wouldn't be in as good physical shape to do the surgery and rehab at that point.

I was probably a border-line case for reconstruction, given my activity level and the fact that my knee was pretty stable sans ACL.  Would everything been OK had I not done the reconstruction? I don't know.  You can't know.  You just have to evaluate the risks in both directions and make a call about which set of risks you're willing to take. Good luck with your decision making. Molly

[Forwood]

Thanks for all the advice. There is another factor which I didn't mention - that I had a knee twist when I was about 12 which ended up in plaster.  I don't recall the rehab being difficult but it is possible that I ruptured the acl then.  3 weeks after this latest accident, one of the surgeons noted that the MRI showed no sign of an acl or recent injury.  Certainly the level of trauma feels like something has fundamentally changed (plus I damaged the mcl quite badly this time) but if I did rupture it a long time ago then presumably I have muscles which should recover substantially over the next few months. I'd like to see how it goes this season.  If there's really no progress in feeling secure, I'll try and go for it around May June next year.

What I'd really like to know is how many 50+ don't have reconstructions, lead active lives and 10 years on don't have problems. However, I guess there won't be many on these boards in that category.  Unless of course Audice's experience is typical.

Incidentally Kaputt_Knee, I'm in the UK - just tend to roam the net late at night!

[Kaputt_Knee]

Regardless of when the rupture occurred, do you want to spend the rest of your active life thinking about your knee?

OK, say it occurred when you were 12, you remained very active and have good muscle tone, strength and definition. you are now entering a phase in your life where these things, sadly, start to deteriorate. It is a lot harder to build and maintain muscle strength and integrity as you get older. The injuries occur more frequently, take longer to heal, etc. This is when you can get the onset of osteoarthritis and rapid degeneration of the joint surfaces. You are losing muscle bulk, tone and strength while you rehab the MCL tear. Getting it back will be difficult, especially if you are ACL-deficient.

You will have a problem in the UK as this is seen in many Health Authorities as elective surgery these days and they are cutting back on that in terms of prioritisation.

I had my last recon as I said shortly before my 58th birthday and was back to full activity level within 8 months. I do not have to stop before any activity and think about my knee. I know what I want to do, can do and trust my knees completely.

Age is irrelevant when it comes to knee surgery, it is your quality of life that counts. That's a way healthier point of view and one supported in my neck of the woods by all the health agencies.

Sue 

[Audice]

I wish I had known 5 years ago that had I pushed for reconstruction, I might have found someone who would do the surgery. My lifestyle hasn't changed all that much but I surely have a less secure feeling - almost as though my balance were off. Is that age or my knee? I honestly don't know...Ellie

[Forwood]

Regardless of when the rupture occurred, do you want to spend the rest of your active life thinking about your knee?

Of course not Sue.  I am hugely impressed by your experience with surgery though if you could have avoided that, wouldn't it have been better?  And isn't the fact that you went through so many procedures indicative that surgery is not a straightforward option, and carries a risk of complications, even failure?

I'm wise enough to be able to take advice but also to recognise that people have different experience / outcomes and in some cases vested interest.  I just had a very curt response from a US surgeon one member kindly suggested I contact who said 'skiing without an acl is an accident waiting to happen'.  Mind, even with an acl, skiing is accident waiting to happen - and in about 6 weeks since starting 2 years ago I must have fallen well over a 100 times!  (I am getting better at it - honest!)

I think the course I have suggested makes sense.  I will give myself another 6-9 months to see what happens, including skiing again.  If I am still bothered after my january trip, I will progress the surgery option. I'm hopeful of getting this done on the nhs as I currently work for them and used to chair my local NHS trust. In any event, the holidays are booked now so I have little option.

I will keep checking in here in the meantime

[Kaputt_Knee]

My first accident resulted in all my ligaments being either snapped or badly sprained - I had no choice and it was done via open knee surgery. The joys of being a ski instructor! The operation took place within 24 hours of the person hitting me. I spent the summer in a wheelchair and was back skiing by the end of the next season.

The second knee went in a similar way, again there was nothing I could do about it. Except get it sorted as quickly as possible. Unfortunately this time I was working with the industrial injuries board in Germany. A bureaucratic nightmare but an exceptional safety net if your accident results in not being able to return to your job.

I never stopped to think should I or shouldn't I. The longer you mull over things the worse it gets to be honest. Sure I could have avoided surgery but I asked a simple question and got an answer from an extremely smart and experienced surgeon: Will I be OK without surgery - answer: Yes but I'll see you in 5 years at the most for a new knee. When he was finally allowed to operate on me (the IIB surgeon was crap but I had to go that way first) he had me back skiing within 6 months (5.5 to be exact!)

I've worked professionally in sports all my life to me. If the doctors are happy with it, so am I. And I got back on with my work and my playing in the great outdoors.

Your problem is that you didn't know that your knee was suspect all that time - now you do. Believe me it will change your perspective.

Good luck and please prove me wrong 

[Audice]

Sue said, "Your problem is that you didn't know that your knee was suspect all that time - now you do. Believe me it will change your perspective."

You're so right, Sue. The first time I saw my OS some two weeks after the injury he informed me that all the damage had been done recently. I couldn't convince him that I'd had off & on problems with the knee since I was a kid. But nobody til that time had put a label on the extent of damage. That's all it took to totally change my perspective. My right knee became the focal point of my existence & it's likely to be so for the rest of my life.

[Forwood]

Knees and hips - I broke a car headlamp with my right knee when I was about 9, had Osgood Schlatters there diagnosed when 14 and Osteoarthritis in the right hip about 15 years ago (skiing's great for that btw).  Now I've got a left knee problem  - nature's way of evening things up I guess!  Not going to let it become too consuming.  I still think on balance I did the acl just recently but it's possible earlier.  I'd never have thought it unstable for the past 45 years to the point I gave it a huge thwack falling on an off piste road.  Bloody ski just didn't come off!  

Anyway,  Sue - you're right on the button.  I can't yet respond to private posts yet so will do so here. I am doing Rob & Scott's 3 dayer!  I say gentle because there's only 2.5 hours of tuition.  If they really do push us my wife's in for a shock! with my sister and brother in law also going, there'll be enough of us to slow things down if necessary.  I'm the better of the four of us and reasonably confident I'll be ok by then.  Thanks for the advice re the brace. I've got a metal hinged one - a MUELLER HG80 - cheap and it does slip a lot. Not sure I can lay out 500 eu fot eh Townsend but will see if I can persuade someone to prescribe it!.  Yes you were right about the motor cycling doc. Urged to communicate with 'he's a great guy', I got a 3 line answer.  What a prat!

Good luck with your retrun to instructing. What's your SH monike btw?

[Kaputt_Knee]

For the sH moniker, do a wild card search using my first name Forwood! Not many of us there  Or PM me from there using this ID to assist you to find me.  Or sort by location - not many of us living in the Austrian Alps 

On the Inside-Outside site I'm in one or 2 or the pictures and most of the rest from the Sölden trip are mine. I let them use them copyright free (but they were supposed to acknowledge that somewhere - not found it yet!). Look for a short round type in red jacket, black trousers and of course ........... a helmet 

We'll see what happens with the instructors reassessment. I'm just happy to be back at a stage where a National Trainer reckons I'll pass with flying colours, considering an eminent ortho in the SW of the UK said I would never walk again without a limp and a stick! Think the proverbial 2 fingers to that idea. On the actual day, who knows, I'll give it my best shot and if I miss, at least I tried.

You need another few posts to reach PM status (a total of 20) - easily racked up playing in the Games Room . think Apres Ski section but for Grannies! Answer a few of the silly quizzes and you soon have the requisite number.

Sue 

[Wimp Out]

Hi there.  New in and fascinated to find this forum. I am just over 50, female, and disintegrated my ACL in 1982, about 28 years ago.  Have kept it safe with quads exercises and reducing sporting activity.  Over the years I have done some jogging/half marathon on even surfaces and lots of offshore sailing.  Now I have less sedentary work to do and have time for more sport and fun activities but find myself panicking about the knee all the time.

I have started tramping long and high and also done my first ever 5 days skiing with a hinged brace.  Walking downhill in the wet and over rocks is double the time to go uphill.  The skid and stop is painful when it happens.  Couldn't face a blue piste when I started thinking about the torque on the knee.  The green was fine but tame.

Sympathise too with those talking of loss of balance but this is related, in my case, I am sure to loss of confidence I think and possibly variofocal lenses - hard to say.  I was, pre-accident, great on balance - iceskating, roller skating, sailing - but know I know I favour the leg and it is affecting everything.  This can only get worse with age and without the fun and exercise, I know I will age all the faster!

Anyway, thanks for all your contributions because I AM going to get a replacement now.  I want to ski and tramp and should I live to 100  ( ) I have still got half my life left.  I am also going to make sure I set aside enough for physio.

Here, here to those who say that age is irrelevant.

Any advice for me in the South West of England? Thanks.
Wimp Out.

[tez27]

Hi there Wimp Out and welcome, congratulations on your decision to have a aclr, I am 49 and ruptured mine 2 years ago and had the surgery 4 weeks ago today, when my rupture was diagnosed after a scope in Jan of this year, my surgeon told me that at my age and the fact that I was not into any extreme sports I could do without the surgery and just to stregnthen the muscles and I would be fine, for a few months I tried I was going to physio regularly but the knee felt more and more unstable, so went back was reffered to another surgeon and had the op. as I said I am 4 weeks post op anf the stability in my knee has improved greatly I still have a lot of pain and swelling partly due to doing to much, but I have great hopes for thr future.
From all that I have heard and especially with the NHS this surgery in raerly done on people of our age even in the hospital when I had my pre op assesment the ward Doctor when I asked how lone would I be kept in hospital for informed me that "most patients having this surgery are 20 year old footballers and theyre kept in over night whereas you being older than the normal may be in for a few days" needless to say I was out of hospital the day after my op as no 20  year old footballer is going to beat me 
As you say you still have half your life to live so why live it with a knee that lets you down and that you cant trust to carry you through all you want to do.
Any date yet for your surgery? and please keep us informed about how your doing.
Take care Tez



2m       

[Wimp Out]

Hi Tez and thanks for the response.
Will keep you informed - likewise!

Have investigated the London end for interest.  All-in procedural costs at 7000.  Devon end seems to be 5000.

Will let you all know consultant response to a 54 yr old with 28 yr old distintegration of ACL in due course.

By the way, 28 years ago consultant said same thing.  You are not an olympian athlete so I did not repair it (with a bovine ligament) - just keep the quads going and you'll be fine....  Glad I waited for better developed options, though.

Wimp Out

[mollyc]

Tez: Nothing like the motivating force of low expectations! My OS told me that people in their 40s didn't recover well from ACLr because they couldn't keep up with the PT regime (mainly due to family and work obligations).  Made me angry!  I was so determined to prove him wrong that I probably worked 2x as hard.  It was sweet when he confessed surprise at my smooth recovery. Molly

[Forwood]

(edit: This'll seem a bit odd as it was a response to a post from a US surgeon, subsequently deleted!)

Perhaps if I posted the 'come on' your 'grateful patient' sent me, the questions I asked you and the dismissive reply you sent me, others might come to a similar conclusion.

[Kaputt_Knee]

Now that's what I call a response to a sock puppet Forwood! Nice one!!! 

Wish we had the laughing smiley here 

 

[Forwood]

Just got back from 3 days skiing in Tignes.  Perfect weather and a 3 inch dump the night before the last day was the icing on the cake.  However it was not without problems, partly because the lack of chair lifts meant I only got a sit down over lunch! 

I took along a standard Mueller Hg 80 Triaxial Hinged Knee Brace which is a little restrictive, so I took it off after lunch the first day.  Big mistake!  Immediately felt the leg slipping off to the side, ie very little lateral (side to side) control.  It was quite frightening so I put the brace back on (not easy when you're on the slopes and need to take your boot off completely!).  After that I was OK.

I found the lack of lateral strength surprising because by now, the knee exercises / weights used suggest my knee is stronger than before the injury.  Just goes to show that exercises mostly reinforce that activity rather than others. My physio is trying to think of exercises which will target this so if anyone has ideas I'd welcome hearing them.

End of day 3 and i couldn't do any more. The knee had stiffened up a lot and generally felt weaker  Has taken about 3 days to return to 'normal'. Am wondering whether that is because it was still a bit early to return to skiing and also that the brace was a bit too supportive.  Am definitely going to try one of the specific acl braces such as the Townsend Sue recommends

[Kaputt_Knee]

I was looking at the pictures (through gritted teeth and snarling according to my office partner!) - looked absolutely great. I'm full of envy, but only until Monday when I go skiing on either the Kitzsteinhorn or Hintertux.  Then it is really kicking off with a weekend in Sölden for the first  World Cup Races and skiing on the Tiefenbach and Rettenbach glaciers (bigger area and more options than Tignes). Then kooky and I will be posting photos to make you green 

I cannot recommend the Townsend highly enough and the service from them was unbelievable. I contacted Mike Huston, the VP for Sales and he sorted out a rep who contacted me to pinpoint my location then organize an appointment with a local fitter. They are not generally on sale here in Germany but they really put the boat out for me to get it organized. I believe my surgeon is now prescribing them as well as he was really impressed with the performance.

Back to the gym I think for you to build up the strength around your knee and then decide what you want to do about the damage. With a good surgeon and pre-/post-op rehab with a good physio you could be back on the skis within 6 months. And back in full action within a year.

Keep us posted on what happens next won't you! Don't let Scott and Rob bully you at Hemel though, you have an honerable excuse to concentrate on the Après for the time being 

Sue

[mouk786]

Someone at work is about 55 I think and has done his ACL in

On the UK NHS they are reluctant to do it unless he REALLY says he wants a sporty lifestyle

Obviosuly it varies with surgeons but my impression was that on the NHS you would have no chance of having it done at 58 on the NHS. There may be more leeway in private hospitals though

My understanding is that skiing in one of the main ACL killers along with football so my inital thought would be to have the op if you want to carry on with it

unfortunatley i dont have any info on recovery outcomes for 'older' people.

[LARSknee]

Hi everyone

I am 51 and had my ACL repaired with LARS on 4th Aug this year,and have had an amazing recovery,age is just a number,I am fitter and healthier than lots of people half my age.

If anyone wants surgery to continue with their healthy lifestlye i say GO FOR IT :>)

Cheers
Shelli

[Audice]

If I had known 5 years ago what I know today about the knee I would have gone in search of another OS who might have been willing to attempt ACLr on a then 67 years old.

At the time I was riding horses daily & was as active as any of the much younger people at the farm & do believe I could have held my own with PT. As it was my OS felt my leg muscles were strong enough that he said PT wasn't necessary but to just continue doing what I was doing. So I did. A month after my injury I was back to riding my horse daily & now 5 years later my leg is still quite strong but life does revolve around each step I take...Ellie

[tez27]

Well my ACL is 12 weeks old yesterday and I had my 3 month post op appointment today and got the all clear from the O.S he was really pleased with my progress and dosen't want to see me again unless I have a problem.... not bad for a 49 year old unfit hairdresser who is not much into any kind of sport, but just wanted a stable knee that I could trust not to let me down.
What he did say to me was that I already had some wear and tear of the cartiledge that has been made worse by the movement that the lack of an ACL caused which would possible have resulted in me having to have a TKR in the future if that movement had continued to happen, so having it done even at my advanced years I have saved the NHS a fortune by not having to have what would be a more expensive proceedure in the future.
So my advice to anyone who has been told they are too old for a ACLR then get a second or a third opiniun untill someone will do the surgery for you.
Take care Tez

[LARSknee]

Just another post from a 51yr old 3 months post LARS ACL,confirming you dont have to be 20yrs old to have an successfully rehab from this surgery.

I had my 3 month surgeon review this week and he couldnt have been happier with my progress,i have full flexion and extension,knee is strong and stable,no tenderness swelling or pain,have been cycling pain free on my road bike even standing out of the saddle riding up hills since about week 6,returned to tennis today and played 4 sets and knee felt completely normal.

I am very glad i chose to get my ACL reconstructed,and have been able to resume my normal sporting activities.

Age is just a number so if anyone is considering surgery i can say from my own personal experience it is well worth it.

[Forwood]

Finally got to see the 'best man' locally, NHS consultant Tom McAuliffe, after a referral from my Physio. Upshot is he will do me a recon (Hallelujah!), though is not exactly enthusiastic and says it will take a year to get through rehab - not the experience of most on here.  Reckons he'd give up skiing if it happened to him!

His findings arrived Christmas Eve - a small effusion, a full range of movement, slightly positive Lachman's and "I think probably a pivot shift although it is not gross" (whatever that means).  "MRI confirms a tear of the anterior cruciate but he also has a lateral meniscal tear". He's the 4th doctor to look at the MRI but the first to come up with the meniscal tear.  Makes you wonder about the precision of diagnoses...

Am still unsure whether I want to go through the hassle of a recon when right now it feels pretty good.  After 6 months physio, my knees are stronger than they've ever been.  But I still feel the absence of an ACL and worried that if I don't have one, I will suffer later.  It would be good to have certainty about the right course of action but perhaps like many big decisions, it will have to be 'on balance'.

After a little push for a referral, the Orthotist gave me a Townsend Rebel Pro brace - which arrived last Thursday (why do people pay for these if the NHS will prescribe them?).  Tried it on for the day and was a little disappointed on the comfort and stability after the many positive comments.  It was ok  - felt a bit more support below the knee but I wondered how much it would prevent damage in another bad fall.  I felt I could twist the knee quite a lot.  Also wondering if I could ski as well without it.  I did 3 hours in a fridge without one about a month ago and it felt ok, but maybe a whole week on the slopes is another matter. 

Am going out to Les Gets on 2nd Jan and this is going to be the test.  I shall try with  / without and see what happens.

[Forwood]

Back from skiing, which was problematic. Second day I slipped on pavement ice with the leg extending forward. 'Though wearing the brace I pulled my hamstrings (as I was told later).  It wasn't too painful but I later noticed a hard lump top of the calf on the inside crook of the knee. Am annoyed the brace didn't prevent this injury and initially put the lump down to the brace as this is where one of the key supports is. 

I continued skiing but the muscles got to complain more and more, stiffening up and limiting flexion, but pain manageable with pills.  By the end of the 6th day, where I'd done a lot of moguls (not my choice - was being 'guided'!), the knee was really sore and stiff.  Almost decided not to ski last day but was good enough in the morning to manage ok.

A week later and the stiffness is wearing off.  Am getting a lot of clicking around the lateral mid knee, particualrly on stairs and for the first few hundred metres walking. I can actually feel it and stop it by pushing it in! I didn't have this before.  My PT says it may die down in a week or two and to keep icing and exercising it.  Am worried it may be related to the lateral meniscal tear.

Anyway, this has pretty much decided me to go for the reconstruction. If the muscles are going to complain so much after 6 months of rehab when they're stronger than they've ever been, it's clear that they're never going to be strong enough to do the job without a ligament.  Just want to get one more week in this ski season before doing it!

[Forwood]

Thought I'd update.  First the good news: had the reconstruction using a 4 string gracilis and semi-tendinosis graft and a small bucket handle repair to lateral meniscus 6 days ago.  Odd thing, after 2 MRIs and several opinions saying ACL was gone, it was found intact but lax!  Guess MRI analysis is no substitute for a surgical look see. 

Am remarkably pain free - was worried the hamstring graft would hurt but apart from bruising at rear of knee, that is all (had thought that this was harvested from behind the knee but no - it's from a key hole incision on the medial side). With 5 small holes and a very neat 10 staple scar line I feel I have had a very good job done.  Early exercises are proving OK and I look forward to staples coming out next week.

The bad news is that in March I broke my shoulder in 3 places (skiing fall). Needed 3 screws around the ball and socket, the latter being very tricky surgically, not helped because they found my bones were very soft.  Have progressed to active Rehab now but still in pain, with worry this will turn into long term arthritis. I don't recommend this type of fracture - comparatively acl recon feels like a walk in the park!

Oddly, a test for osteoporosis shows my upper body has some softness but leg bones are OK. Guess I need to go topless more often! 

Despite very bad luck with skiing falls, I do intend to get back to it asap. Will just have to reduce the risk taking.  Don't think the family or my employer will tolerate another bad fall!

[Kaputt_Knee]

Sorry to hear about the shoulder but glad that the knee looks like it is going to be great once the rehab is finished. How did you do the shoulder? This past season was lethal for shoulder injuries - rock hard artificial snow pistes and too many people competing to too little space a lot of the time, especially in the popular French resorts.

I had the same graft as you - that bucket-handle tear sounds as if it could have been really nasty if you had left it much longer. MRI interpretation is only as good as a) the image, b) the equipment it is being viewed on and c) the particular skill of the radiologist. ere in Germany (as far as I know and certainly in line with my personal experience) the definitive diagnosis is only given by a qualified doctor with special training in this type of imaging. My surgeon is also sceptical and says nothing beats a look see though.

I'm going back to him on the 7th of next month for an evaluation about a possible meniscus tear - I just hope it isnot a big one!

[Forwood]

Hi Sue - was zig-zagging down a narrowish red in a guided group going to Tignes La Breviere when suddenly picked up too much speed for the turn (still don't know how!).  Went over one mogul at the side and hit the next with forehead and shoulder.  Am told it was rock hard!.  At time, didn't think I'd done more than had a bad fall. (ironically, there was an ortho registrar in the group who examined and reckoned I was ok!).  Even went skiing next day!  Was quite shocked when they told me I'd broken chip off greater tuberosity (ball) and had a crack in the glenoid (socket).  While waiting for op, I made it worse dodging a pedestrian, fracturing the crack into 2 bits;  that made the op considerably more difficult.  The worst of it was having to keep it in an extended sling for 6 weeks, fearful that any bad move would undo the surgeon's work.  Eight weeks later the wound became infected leading to 3 weeks on penicillin.  Now it is just sore!  My PT says this type of injury is one of the worst and at the moment I'm not arguing.

Don't think my bucket handle can have been too serious.  In the months running up to the aclr I had no trouble with it. Am aware these things can be troublesome and hope yours is not too bad.  How was your season?