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Author Topic: Multiple ligament reconstruction - outcomes/encouragement???  (Read 8907 times)

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Offline scouty_lugs

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Multiple ligament reconstruction - outcomes/encouragement???
« on: April 21, 2011, 01:50:15 PM »
Hi all,

I'm new to the board...only 3 weeks post op right now, hurting and worried about the future  :(

So - here's my story. 3 weeks ago I was playing soccer and out of the blue I destroy my knee. No tackle, no collision, just me having a gumby run and my lower leg goes 90 degrees the wrong way. It was a pre-season match, I've been training hard 4-5 days a week for 3 months leading up to the season (so very fit) and now bam - I'm out of it and being told I may never run again.

Somehow I've managed to completely tear all the ligaments and tendons in my knee with the exception of the MCL....so completely ruptured the ACL, PCL, LCL, Posterolateral corner and tore most of the hamstring tendons away in my fall.... only thing holding the tib to the femur was the MCL which had a tear, but stayed in tact. My surgeon said they usually only see this degree of damage from motorbike or car accidents - they'd see maybe one of these a year that was'nt an impact/accident injury.... sigh!!

Anyway, a week later I had total reconstruction for all of the above (allograft for both ACL and PCL which was lucky) and the surgeon seems happy with the surgery....which is good - however, he's hoping for an outcome where I can walk again without a limp or pain.... no more. This has got me worried.

Pre accident I was very active. In any given month I would usually: play and train for soccer (4 times a week), play tennis (twice a week), kickbox (2-3 times a week), surf (in summer 2-3 times a week), wakeboard and waterski (1-2 times a month in summer), spearfish and scuba dive (maybe once a month in summer), run with my son (2-3 times a week).... the idea of losing all this is devastating to me.

So here's my question - has anyone out there had all their ligaments torn at once and come back to any level of reasonable activity? What am I destined for here? I know outcomes are variable, but has anyone come back from this level of injury and run again or played any sports?

I'm currently in a crud-load of pain, cant sleep nights from nerve pain issues into my foot which is exacerbated by the physio and wondering whether there is a light at the end of the tunnel here?

Any comments or encouragement is welcome...but I'd really like to hear from anyone who has had similar multiple ligament ruptures, particularly if you've done the posterolateral corner as well....

Thx guys...

Offline Kaputt_Knee

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #1 on: April 21, 2011, 03:38:30 PM »
Yep been there done that.  :o

My surgeons have written me off twice - in the late 80s/early 90s when I was taken out by a beginner in my ski lesson and again in 2007 after 5 operations to repair my other leg (I slipped on black ice on my way to teach skiing then skied for 3 days with a fooked ACL doing more damage as a consequence).

I was back skiing gingerly, but still skiing, one year after my first accident. My NHS surgeon at the time said that I would never walk again without a stick and would have a stiff leg/limp until I was ready for a new knee (not what you want to hear as a Head of PE and an out and out sports nut!) Luckily for me my initial surgeon in Austria was much more optimistic and positive. He told me not to bother re-validating for my instructor exam for the following season as he felt a season just skiing for myself would be much better preparation to returning to instructing the season after that. My accident was in March and he anticipated me being back on skis by the end of the September if I followed the rehab plan they gave me.

With my left knee, I had the initial accident in March 2006 and by mid 2007 had had 5 operations trying to sort out problems the first op caused. In 2008 I found another surgeon who looked beyond my age and concentrated on why I was unable to straighten my knee and was in increasing pain. He went in in August 2008 and completely revised my original ACL reconstruction, reconstructed the avulsed LCL and repaired the PLC by re-breaking my fibula head and resetting it correctly. The fracture to the fibula head and the avulsed LCL were missed in my original operation and the first reconstruction was such a bodged job the surgeon wanted to to pursue a malpractice claim against my original surgeon and the surgeons who had subsequently operated trying to sort out the bodged work. I followed an very intensive rehab programme and was back skiing by the end of January/beginning of February 2009.

It is your outlook and determination that counts. I believe the doctors are naturally pessimistic so that patients do not get their hopes up too high or too soon. It is a long dragging process that requires you to persevere and push for treatment. It is cheaper if they say "Ohhhh, I think you've had it mate", then the onus is on you to prove otherwise. It is as much a mental and emotional battle as it is a physical one. You will have incredible highs and lows as you push through the programme and there will be times where you want to give up and accept their pessimistic statements. Ride it out and keep battling for what you want to achieve.

Good luck

Sue

PS - in 2010 I had 50+ days on skis including instructing, this year I have had fewer days (only about 30) because I was in South Africa paragliding!

Nil Desperandum Illegitimi Carborundum (Wiki that to get the translation if you don't know it!  ;D )
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline shellygirl55

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #2 on: April 22, 2011, 02:50:18 AM »
yes... been there done that as well..tore all four ligaments and the cartalige all in one fell swoop...

problem is, i don't have much incouraging to say as my surgery was just last week... i had allografts as well, but they coudn't do anything for my acl ( you can read the details in my post op diary

i am here for you though, and hoping others have wonderful encouragement for the both of us
6/5/99 complete knee dislocation
8/99 acl, mcl reconstruction
9/2010 steroid injection
9/11/10 knee locked in place
10/10 arthosocipic 10 cm forign body & miniscus removal
10/10 diagnosis of torn pcl, mcl, lcl failed acl graft
4/12/11 pcl, mcl, lcl with allograft

Offline scouty_lugs

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #3 on: April 27, 2011, 09:04:05 AM »
Hey Kaputt...thanks for your reply. Haven't been online much lately so only just catching up.

Sounds like you've been through the system huh? Can't believe the frustration you must've felt at the setbacks and reconstructions on what should have been fixed properly first time round.

Its great to hear you're back skiing...very encouraging given the extent of injury and helping me have a comparison to hope for. How has the PCL repair been? My surgeon has said that is the one that is much much harder to get a good result from....ACLs they do a lot, PCLs much rarer and harder to fix well....

Also - did you have much nerve pain in your foot from your injury? The nerve pain I'm getting is driving me nuts and I'm hoping will improve sometime, but I know that's slow and I'm probably looking at months of this....not a good thought for me as the pain keeps me up nights and is just relentless. Its far far worse than the pain in the actual knee....if it was the knee alone, I'd be OK with the pain..no problem.

Also - was it difficult to 'trust' your knee again when returning to skiing? That's something I think I may have trouble with, particularly with running/soccer etc.

Anyway, again - thanks for the reply and good to see the Illegitimi haven't kept you down ;)

Offline scouty_lugs

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #4 on: April 27, 2011, 09:12:42 AM »
Shelly....thanks for responding...and I feel your pain.

How's the post op going for you? Started Physio yet?

My biggest issue is the nerve damage and pain down into my foot and toes. Its driving me nuts. Its brutal and relentless and its far worse than the pain in my actual knee....my knee itself has settled down well and isn't hurting me much at all now, except during physio of course. But the nerve pain is always there and then comes in waves of burning that is...well.... certainly distracting.

How's it with you? How'd you do the knee all at once? ....sounds like this has been around for a while huh?

Hope you're feeling better....

Offline shellygirl55

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #5 on: April 27, 2011, 04:00:41 PM »
hi!!
post op hasn't been much fun at all... actually today is the first day in 2 weeks that when getting up this am i didn't want to cry from the pain :)

my os for some reason dosn't want me to start physi till 6 weeks post op?? weird huh?? they have me locked straight however, and want me to build up as much scar tissue as possible to try and hold the grafts in place. i always thought you don't want scar tissue in the knee, but when i asked him about it he said for me scar tissue is good?? so strange!!

tell me about the nerve pain... why do you have it? is it normal for this surgery, or did it just happen to you?? i have been wondering about nerve pain on the inside of my knee... totally a differant kind of pain, and it is kind of like you discribed... waves of burning, i don't even know if there are nerves there, but a couple people on this board tell me that is what it sounds like...

are you locked straight or are you working on rom yet? it's so nice to talk to someone who understands this stuff!!
6/5/99 complete knee dislocation
8/99 acl, mcl reconstruction
9/2010 steroid injection
9/11/10 knee locked in place
10/10 arthosocipic 10 cm forign body & miniscus removal
10/10 diagnosis of torn pcl, mcl, lcl failed acl graft
4/12/11 pcl, mcl, lcl with allograft

Offline scouty_lugs

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #6 on: May 01, 2011, 08:56:20 AM »
Hi Shellygirl...

So sorry to hear you're in that much pain. You've got to go get some relief for it!

Waves of burning sounds like nerve pain to me... you should ask your surgeon about it, particularly re the location and what nerve damage there may be?

From what I've been told, when they opened me up in surgery, they exposed the nerve and could see that I'd damaged it pretty badly, so the nerve pain isn't unexpected, just very very unwelcome!!

If you've got nerve pain due to trauma to the nerve, you'll want to confirm it so you can take specific pain killers for that type of pain. While I'm on normal painkillers for the knee (Paracetamol, Ibuprofen, Codeine)....none of these did ANYTHING to help with the nerve pain...and the nerve pain is just relentless. However, I've since started some drugs that specifically target nerve pain (Neurontin - helped a little, and Endep - seems to be helping much more).

It hasn't completely gotten rid of the nerve pain, but I can still play with the doses yet, and it definitely has helped target the nerve stuff...which, as I say, wasn't being even touched by the normal painkillers.

Re your knee being locked - I've been told its far harder to get extension than flexion, so they like to lock the knee for a while depending on the op. Right now, I'm locked straight....but during my physio I do unlock and they're bending and trying (unsuccessfully) to get me to 90 degrees. Next week my ROM is meant to be up to 110 degrees (given I'm not yet at 90, this was worrying me - but I'm told this is a maximum, not yet an expected??)... anyway, I'm still pushing to get to 90 in my physio sessions but its very painful - I'm told the flexion improves a lot more once I'm allowed to weight bear and walk etc

My surgeon tole me pre-op that I was going to be locked straight for 6 weeks and then put back under general while they 'freed up' my knee, but that hasn't happened post op, so I'm guessing that this is something they must do sometimes but no always, depending on the outcomes of the operation??

I hope to hell they haven't given me ROM too early requiring more ops later....I really don't want to have to go through those post op days again.

Anyway, hang in there Shelly.... go get some info on that nerve pain and if it is neuropathic, then get some drugs that target nerve pain specifically like endep or similar.


Offline claire31

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #7 on: May 11, 2011, 09:30:56 PM »
Hopefully this will be a bit of encouragement:

A friend of mine broke her ACL, PCL, LCL, Platella Tendon (think it's called that) and damaged some cartilidge at the same time in a trampolining accident, the doctors at the hospital said they hadn't seen a person do so much damage to thier knee and warned her that she would not be able to go back to sport which was devastating to her as she is a really sporty person.....anyway to cut a long story short, after 3 operations, she has made a full recovery and showed those doctors that it is possible to return to sport (she plays rugby regularly, skis, trampolines, runs and more)

I think that the doctors air on the side of caution to prepare paitents for what could happen, but with a load of determination, it is possible to return to sport. The only thing my friend can't do is kneel, but hey, who needs kneeling when you can run!

I know it's the hardest thing in the world, but keep positive and it'll come good.

Good luck with it all   :)

Offline HovaK

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #8 on: May 11, 2011, 10:51:23 PM »
Sorry to hear about your situtation.  I dont know if you know who NBA player Shuan Livingston is, but he suffered a similar injury while playing fot the Clippers.  Coming down from a layup attempt, he landed and completely destoryed his knee.  One of the worst injuries Ive seen, you can see the injury on youtube, but Ill warn you that its tough to watch.

He tore his ACL, MCL, PCL, lateral meniscus, dislocated his pattela and his tibia-femoral joint.  Like I said, he completely destoryed his knee.  He was told everything from possible amputation (possible nerve damage), to never being able to walk again.  But they definitively told him he would never play in the NBA again. 

He suffered the injury in 2007.  He missed the rest of that season, and the following season.  He ended up making a recovery and was back in the NBA on the Miami Heat in the 08-09 season.  Living in LA, I saw him play a lot when he was a Clipper, and Ill tell you hes obviously not the same player he was before the injury.  In the 08-09 season, he was still a bit slow but improving.

This season he actually played well, and is playing for the Bobcats.
It took him about 3 years to get back to a really competitive NBA level, but he was playing basketball 1 year after the injury!!!

Hope this encourages you a bit!

Offline scouty_lugs

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #9 on: June 15, 2011, 12:01:25 PM »
Hey Hova and Claire... thanks for the words of encouragement... its appreciated.

I'm at about 11 weeks now and finally off my crutches and out of my brace a lot of the time. I'm just slogging my way through Physio 3 times a week and exercises at home. Doing everything I can to maximise my chances.

I went to see my surgeon last week and he was really positive about my progress. Said there was no movement in my knee and it was very strong, which is great. However, I forgot to show him an issue that bothers me which is when I get close to full extension, my leg sort of buckles and clicks over into a locked position...it feels like the bones in my knee are snapping into extension and the knee separates a bit at the posterolateral corner....anyway, kicking myself (pardon the pun) I didn't show him and ask about it. Its worrying me that there's an underlying physical problem with the reconstruction that will stop me from getting back to running/sports. Am hoping its just a matter of building my muscles back up to support all the structures and it may not happen then....

Anyway, again, thanks for your encouragement.... 

Offline Johnnyp060

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #10 on: September 14, 2012, 06:02:53 PM »
I know I'm a little late to this thread but is wondering how everyone did with their recovery. I am 4 months out from an ACL, PCL and MCL rebuild which was a result of a dirtbike crash back in March. I'm recovery fairly well, it's a long, slow process. My flexibility came back very quick but the strength is taking a little longer. I am at 125 ROM, 15 minutes on the stationery bike, 70 lbs on the leg press for 3 sets of 15 and 5 minutes on the treadmill (still have to support myself on the rails) and I've mostly been walking with one crutch. Not too bad for 4 months out and the amount of damage that was done to my knee.
Let me know how you all recovered. I'm always up for a good, motivational story. Thanks, John
3/4/12 Dirtbike crash, tore ACL, PCL and MCL
5/14/12 Surgery done to replace ACL, PCL and MCL with cadaver tendons
12/4/13 ACL and MCL replaced again, kneecap released and anchored and external fixator installed

Offline gigi307

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #11 on: February 24, 2013, 06:30:45 PM »
I too am wondering how all of you are doing now.  I am 4 months post-op (you can read about what happened to me in my diary if you're interested).  The primary issue I'm having is my ROM is only at about 50 degrees.  I do PT exercises at home and see my physical therapist once a week, but I don't know what else to do to improve my ROM.  Just wondering what progress all of you have made.

Offline scouty_lugs

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #12 on: May 26, 2016, 04:03:43 AM »
Hey Kaput... It's been a long time, but wanted to reach out regarding advice for skiing.

Per my original post some years back.... I've had major trauma to my left knee (all ligaments were ruptured at once and posterolateral corner damage) and an ACL reconstruction on my right knee. Have spent a long time with rehab and eventually got back to Sports (soccer wearing a DonJoy brace) which is actually how I did the right knee, but different story 😜

Anyway, with a lot of work and ignoring prognosis, I've defied outcomes and regularly coach soccer, surf, play tennis etc etc - though I'm always careful now and wear the brace in any contact or high twisting sports.

So my question... I would LOVE to ski again with my 14 y/o son, but worried about skiing with my knees. I see you're an avid skier. Was wondering if you have advice re braces, bindings, skis vs snowboard etc etc.

Any thoughts would be great. Thx.

Offline BarefootPilgrim

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Re: Multiple ligament reconstruction - outcomes/encouragement???
« Reply #13 on: August 02, 2016, 09:27:32 AM »
Hey Scouty,

great to read your update after your original post... incredible determination on your part, gives me a tiny bit more hope for my own prospects.

Hope you're well and that you can get some advice on hitting the slopes again.