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Author Topic: Are there actually any ACL Deficient Copers out there??  (Read 19405 times)

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Offline libero6

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Are there actually any ACL Deficient Copers out there??
« on: May 10, 2013, 08:14:43 PM »
Hello Knee Guru community!

I injured my knee playing Ultimate Frisbee... MRI shows a complete ACL tear, along with grade 2 MCL and LCL tears. It's been 6 weeks since the injury and my sports doctor thinks my knee is doing really well and would like to continue conservative treatment. I haven't had any stability issues (though I haven't been testing it really much - most strenuous activity is probably going up and down the stairs), swelling is looking better, and to my doctor's surprise, he is starting to feel some kind of "endpoint" during the Lachmann test recently (despite the MRI indicating a complete tear).

I am in my mid-20's, super sporty, and plan on playing competitively for as long as I can. My main sports are Basketball, Volleyball, Ultimate Frisbee, and soccer.

Almost everything I've read and everyone I've talked to recommends surgery for my lifestyle. The doctor and many others on here said that there are 1/3 of people who can "cope" with no ACLs and return to full activity... but the thing is, I don't think I've come across any of these copers. I can't seem to find a single story where someone was able to continue playing high intensity sports without an acl at 100%.... and those that have seem to have injured themselves later down the road and eventually opted for surgery... now I am just wondering how many of these "copers" actually remain copers for the rest of their lives? Was that taken into account in the 1/3 stat?

I've always been a fan of healing the "natural" way but I am leaning towards surgery as there seems to be better odds that I can resume my lifestyle. I'm not sure how much longer I can watch form the sidelines....

Anyone know any copers? Or have some stories that can shed some inspiration? Any help would be appreciated.

Thanks in advance!
« Last Edit: July 25, 2013, 09:06:25 PM by libero6 »

Offline ob1konoknee

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #1 on: May 13, 2013, 06:23:20 PM »
Hello -

People can function/perform without an ACL, true. I've even heard of professional football payers playing without an ACL - this I think is a rare exception. You can most certainly 'cope' without an ACL. However because of your active lifestyle and participation in high impact sports like ultimate, soccer etc. you run a very high risk of causing greater damage to your knee without an ACL.

Your ACL is a key stabilizer, it prevents your tibia from moving too forward while moving/running and it also prevents rotation of the femur and tibia within the knee joint. Without this key stabilizer your knee is exposed to forces which potentially can cause damage to your knee, most specifically your meniscus, another hugely important knee stabilizer. (You DO NOT want to damage/tear your mensicus!)

There are alternative therapies - Prolotherapy etc. that some claim to have healed complete ACL tears as well as MCL/LCL tears. Basically a solution is injected into the knee joint which 'agitates' the injured ligaments and prompts the bodies own healing process to repair the damage. This works well for the LCL/MCL tears since they are exposed to a blood supply, but the ACL is avascular, meaning no direct blood supply, so healing is difficult and for a complete tear perhaps impossible.

You are still very young, I would not take any chances - I would persue the ACL recontruction to restore natural knee function and stability to as close as you had proir to your injury. This will help safeguard you against further damage to your knee (think meniscus). There are no guarantees but in my opinion this is the wiser course of action. If you were to opt out of any rigorous sports and just ride your bike and do some mellow jogging, than you could get away without an ACL and just 'cope'.

I have had 2 ACL repairs and now I am looking at my third with a meniscus transplant. I played competitive soccer and without my 2 previous surgeries would not be able to play at any level. My grafts were not placed in the ideal positions, plus I had no medial meniscus, which works in tandem to stabilize your knee - this is why I kept retearing my ACL (twisting knee = ACL tear).

Technology and techniques have advanced tremendously, the surgery has a very very high rate of success, find a good surgeon you trust and you will be good as new. Also to keep in mind - now for the rest of your life you will have a compromised knee - you will be 'rehabbing' it for life. Doing leg strengthening/knee stabilizing exercises will be a constant in your sporting regime. Do not neglect this as you need to be vigilant to provide the best protection and promote longevity for your knee.

These are my points of view and others will have different opinions. Best of luck to you.

-ob1

My knee story blog (in progress)
http://imessedupmyknee.com










Offline bizzylizzie

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #2 on: May 21, 2013, 10:11:47 PM »
Hi there, I haven't had an ACL for the past 12 years after I completely tore it. For 10 of those years, fine no major problems. I carried on with sports and it didn't stop me doing anything.
However the past 2 years my knee has got progressively worse and I now have grade3/4 degeneration and cant do most things. A result my OS thinks of having no ACL.
Just one story so don't let it put you off but think carefully about your choices. Good luck.

Offline Snowy

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #3 on: June 03, 2013, 06:15:56 AM »
Hi Jules! So sorry to hear about your ACL. It's a tough decision to make, for sure.

I only know personally of one coper, and although she's doing really well - back to skiing and all her other activities - she's only a couple of years out from her tear, so there's no way of knowing how well things will go in the long term and if the ACL deficiency will lead to other damage. She's certainly working very hard on strengthening all the supporting muscles around the joint to try and protect the knee from future problems.

When I tore my ACL, I fell solidly into the "coper" category. I regained full ROM and strength very quickly, and was able to participate in a 100km bike ride less than a month after the injury and resume skiing six weeks later. I had no ongoing instability in my knee at all after I recovered from the immediate aftermath of the tear. However, I opted for surgery. My physiotherapist, who is an ACL rehab expert, told me that given the level of activity I participate in there's no question that I would eventually see a long-term impact of having no ACL (arthritis from the increased lateral movement in the joint over time, even if it wasn't enough for me to be aware of). He also warned me that the potential impact of a similar fall in the future would increase with no ACL in the joint. My main goal was to return to high level skiing, so in spite of my good recovery I never seriously considered not having surgery.

One interesting thing that you note is that your surgeon says he can feel an endpoint when he tests your ACL. MRIs are not infallible - I know of two people on this board who turned out to have completely torn ACLs when they went under the knife even though the MRI showed no tear, and two who went into surgery thinking their ACL had gone only to find out it was intact (a MUCH happier outcome!) With this in mind, it may be worth seeing how things progress for a little bit as the LCL and MCL heal.

If it does turn out for sure that the ACL is completely or mostly gone, good luck with your decision. I know from having been there that it's not an easy one, especially when the knee feels pretty good without surgery. Rehab is long, and a lot of work. For me, it's been a great choice in terms of the outcome for my knee, but that doesn't mean it's the right choice for everyone. You're asking lots of questions and doing your homework before making a decision, which is definitely the right approach. Best of luck!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline marznc

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #4 on: June 13, 2013, 02:23:12 AM »
As the OP already knows from a ski forum, I'm a successful coper who was mostly worried about continuing to ski at a high level.  For folks considering what to do after losing an ACL, here's my story.

It's been a year since I popped off an ACL doing something stupid while on vacation.  Used crutches to finish off the vacation, but was able to be weight bearing from the very beginning.  Had an MRI done and started PT about 4 weeks after injury.  Never had pain except from the MCL strain if moving laterally, which went away by Week 6.  No instability and little swelling after a couple weeks.  As it turned out, the MRI showed the ACL was gone, Grade 2 MCL strain, and 2cm tear in the red-red zone of the meniscus.  My ortho surgeon said the MCL and meniscus could heal without intervention.

I'm mid-50's, an older relaxed mom because I could retire early, and was in pretty good shape.  Having read about ACL injuries and rehab on ski forums for several years, I didn't want to jump into surgery.  I stopped playing sports (soccer, basketball, tennis) that require cutting/pivoting quite a while ago.  Never did like running for exercise.  My passion is alpine skiing, but not jumping off anything or dealing with extreme steeps.  I also do intermediate rock climbing at an indoor gym for fun and exercise.  My surgeon agreed at the second visit--about 3 months after injury--that there was little reason for ACLr surgery.

So I spent last summer and fall doing PT exercises daily, learned a lot about proprioception (balance), and started working with a personal trainer to continue strengthening muscles around the knee and for general ski conditioning (core strength, balance, leg strength, flexibility).  Took about 4 months to be completely fine for day-to-day mobility, including hiking.  That's when I went back to the climbing gym.  I finished with formal PT shortly after that.  Was on a ski hill by Jan, six months after injury.  By Feb it was clear that I could ski without an ACL the way I like with no issues.  Took some lessons to improve technique.  By the time I went out to the Rockies in late March, I was skiing better than before.  Also able to ski longer without getting tired.

For more info about rehab post-injury and life as a coper who is a ski nut, look here:
http://www.theskidiva.com/forums/index.php?threads/learning-to-be-a-coper-without-an-acl.14847/
http://www.theskidiva.com/forums/index.php?threads/no-acl-no-surgery-no-problem-my-new-normal-as-a-coper.15049/

The knee is complex.  Every situation is different.  For me, being a coper is working out fine.  However, if I'd been 10-15 years younger, I would've considered surgery.  Note that I'm not thinking 10-20 years, but more 30-40 years.  My parents were active well into their early 90s.  Both lived until age 95 and did not slow down physically until after about age 92.  I fully intend to still be skiing when I'm old enough to not pay for a lift ticket.  :)

Offline marznc

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #5 on: June 13, 2013, 02:32:15 AM »
This is an older thread, but includes a 3-year follow up post from a woman who chose to avoid surgery.  She is a successful coper.

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=48352.msg578270#msg578270

Offline libero6

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #6 on: August 08, 2013, 06:41:01 PM »
Hello Gurus!

Just thought I'd do an update on my situation... I finally saw the OS a couple weeks ago. At the time, I was quite sure that I wanted the surgery. I had it booked for Sept 10th, but after letting the decision sink in for a few days.. I called in and cancelled it. Something just didn't feel right, I felt that I didn't really give my knee a chance to see what it could do.. I mean if at any time, it gives way or if it's holding me back from what I'm used to, I'll reschedule the surgery and be at peace with my decision.

The OS mentioned that surgery is really not as impeccable as people think, there are many complications, and he thinks my knee currently is performing better than some who have had the surgery and went though the rehab. He also mentioned that there is no evidence that a reconstruction will prevent the onset of OA. Seeing how well I was doing, both my trainer and the OS actually suggested that I should continue with non-operative rehab for at least another month and see how I feel on the field.

Currently, I'm doing a bunch of on-field exercises (cutting/sprinting), strengthening in the gym, as well as intensive one-legged hopping tests. It appears that my bad knee is no worst than my good one in terms of hopping for distance and stability... and still no instances of giving way, pain, or stiffness. It does feel a bit different - very subtly though.

I may be able to play a full game by the end of the month, and by then, I should have a better idea of whether or not I'd be happy with my ACL deficient knee and whether or not I would want surgery.

Any thoughts? Is this a really dumb move? After all, I do play sports that require quite intensive pivoting (i.e: basketball, ultimate, soccer)

Thanks all!

---------
some background on my injury:
- Injury on April 4th 2013
- MRI confirmed complete tear in ACL, partial tears in MCL and LCL.


Offline marznc

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #7 on: August 09, 2013, 03:05:41 AM »
Good to hear an update.  I know exactly what you mean about the knee, or rather the area around the knee, feeling slightly different even though everything works fine without an ACL.  My guess is that there are muscles near the knee that are working harder so feel just a touch different.  Once I'm completely warmed up doing something, I don't notice anything at all.  Tend to notice more after sitting for a while.  Nothing hurts, but my calf muscles tend to be a bit tight.  It's been 14 months since I popped my ACL.

Very hard to say what's best in terms of whether or not to do ACLr.  Everyone's situation is different.  There are risks either way for those who enjoy cutting/pivoting sports.  Plenty of folks end up having to do a second ACLr, either on the same knee or the other one.  Doing ACL injury prevention exercises is VERY important regardless.

Did you happen to read the story of the young woman in Australia who opted to be a coper?  Her sister went for ACLr.  The coper is doing roller derby!  She also skates and skis.

Best of luck!

Offline virtual_me

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #8 on: August 13, 2013, 10:46:05 AM »
I guess it all depends on the level of activity you want to do.

In the time between my injury (once swelling had gone down) and surgery, I returned to most of my sports (though I don't do things like soccer).  I climbed, hill walked and ran, and didn't experience any major problems.  This was with a torn ACL and meniscus. 

However, when I started increasing my running distance, I started experiencing niggles, which is when I finally got referred to a consultant and discovered I'd torn things.  They said that without the meniscus and ACL, I wouldn't be able to run more than may be 5 or so miles.  That is basically why I opted for surgery.  Plus there might be other sports I want to take up which require an ACL.  Plus I didn't want to risk further damaging things.

I guess if I led a fairly inactive lifestyle then I could have managed happily without it (but then I wouldn't have torn it in the first place!). 

I think if I was you, I would mostly be concerned about the possibility of doing other damage elsewhere through missing this ligament while doing the sports you do, and that would be what I would want to research.

Offline virtual_me

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #9 on: August 13, 2013, 10:49:49 AM »
What would you recommend as ACL injury prevention exercises?

Good to hear an update.  I know exactly what you mean about the knee, or rather the area around the knee, feeling slightly different even though everything works fine without an ACL.  My guess is that there are muscles near the knee that are working harder so feel just a touch different.  Once I'm completely warmed up doing something, I don't notice anything at all.  Tend to notice more after sitting for a while.  Nothing hurts, but my calf muscles tend to be a bit tight.  It's been 14 months since I popped my ACL.

Very hard to say what's best in terms of whether or not to do ACLr.  Everyone's situation is different.  There are risks either way for those who enjoy cutting/pivoting sports.  Plenty of folks end up having to do a second ACLr, either on the same knee or the other one.  Doing ACL injury prevention exercises is VERY important regardless.

Did you happen to read the story of the young woman in Australia who opted to be a coper?  Her sister went for ACLr.  The coper is doing roller derby!  She also skates and skis.

Best of luck!

Offline marznc

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #10 on: August 13, 2013, 02:13:05 PM »
What would you recommend as ACL injury prevention exercises?

Most of the research done about ACL injury prevention is based on exercises that increase hamstring strength AND build muscle memory for the safest way to land from a jump.  So a combination of strength, balance, plyometrics, and agility.  Important to avoid landing a jump knock-kneed and to automatically avoid getting a knee beyond the toes.  Also want hamstring and quad strength to be about equal.  Improving proprioception (balance) is important too.  What surprised me was that improving core strength helps a lot too.

How someone approaches the exercises depends on whether they are a coper or have completed ACLr surgery post-op rehab.  I starting working with a personal trainer even before completing formal PT.  That helped keep me going in order to be ready for ski season.  She watched my form, which made it easier to learn to do exercises properly.  Needless to say, also useful for someone who has two intact ACLs.

A good book that includes good explanations and exercises is "The ACL Solution" by Dr. Robert Marx.

Here is a webpage that will give you some ideas.  If you are still doing formal PT, best to discuss when it's appropriate to do specific exercises.

http://www.hss.edu/conditions_acl-injury-prevention-stay-off-sidelines.asp

A search on "acl injury prevention" will turn up many useful answers.  "PEP" is the acronym for a set of exercises designed to be used by coaches in sports like soccer, basketball, volleyball, etc.

Note that as a coper, I started doing agility exercises about 4 months after injury.  Probably started jumping exercises a couple months later.  For someone who has to recover from ACLr surgery, the timing would be different.  As always, check with your doctor or physical therapist because every knee situation is unique.

Offline virtual_me

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #11 on: August 14, 2013, 12:27:51 AM »
Thanks.  I'm just 8 weeks post-op, so still following a PT programme.  But going forward beyond the rehab programme, it's good to know what to work on to prevent it happening again (and instead I'll probably just hurt something else!!   ;D ).  So I will keep this in mind, and speak to my PT about it.

What would you recommend as ACL injury prevention exercises?

Most of the research done about ACL injury prevention is based on exercises that increase hamstring strength AND build muscle memory for the safest way to land from a jump.  So a combination of strength, balance, plyometrics, and agility.  Important to avoid landing a jump knock-kneed and to automatically avoid getting a knee beyond the toes.  Also want hamstring and quad strength to be about equal.  Improving proprioception (balance) is important too.  What surprised me was that improving core strength helps a lot too.

How someone approaches the exercises depends on whether they are a coper or have completed ACLr surgery post-op rehab.  I starting working with a personal trainer even before completing formal PT.  That helped keep me going in order to be ready for ski season.  She watched my form, which made it easier to learn to do exercises properly.  Needless to say, also useful for someone who has two intact ACLs.

A good book that includes good explanations and exercises is "The ACL Solution" by Dr. Robert Marx.

Here is a webpage that will give you some ideas.  If you are still doing formal PT, best to discuss when it's appropriate to do specific exercises.

http://www.hss.edu/conditions_acl-injury-prevention-stay-off-sidelines.asp

A search on "acl injury prevention" will turn up many useful answers.  "PEP" is the acronym for a set of exercises designed to be used by coaches in sports like soccer, basketball, volleyball, etc.

Note that as a coper, I started doing agility exercises about 4 months after injury.  Probably started jumping exercises a couple months later.  For someone who has to recover from ACLr surgery, the timing would be different.  As always, check with your doctor or physical therapist because every knee situation is unique.

Offline marznc

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #12 on: August 14, 2013, 01:05:12 AM »
In that case, it will be a while before you need to think about the injury prevention exercises.  By the time you can do all of them, some will be already be familiar.  Now is a good time to research exercises related to avoiding knee injuries in general.  You might check online forums for your favorite sports.  Many have sections for knee injury and rehab.  I found plenty for alpine skiing.  Also looked around at rock climbing, tennis, and golf.  I stopped playing tennis quite a while ago for other reasons (I'm over 55), but it was interesting to read how folks with ACL issues returned to tennis.

Best of luck with rehab!

Thanks.  I'm just 8 weeks post-op, so still following a PT programme.  But going forward beyond the rehab programme, it's good to know what to work on to prevent it happening again (and instead I'll probably just hurt something else!!   ;D ).  So I will keep this in mind, and speak to my PT about it.

Offline libero6

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #13 on: August 14, 2013, 09:39:17 AM »
Thanks for the responses everyone! Great discussion.

I guess I started this thread because I was curious if anyone was able to return to intense pivotal sports without an ACL. I've heard a lot about people who were able avoid ACLr by reducing their activity level... I think these people are referred to as adaptors and not true copers. There is a stat floating around about how 1/3 of people with ACL injuries are copers, but I can't seem to find much information about these people (except for marznc's awesome detailed blog on the skidiva website - thanks again for that!)

As for ACL prevention/reduction program, I agree with marznc that strength, balance, plyometrics, and agility are crucial aspects. After my injury, my leg muscles in my injured leg atrophied significantly! Month 1, I was just trying to keep the swelling down, regain my ROM, and do simple balancing exercises. For month 2 and 3, I was in the gym for nearly 3 hours every day working on squats, lunges, jumps, balancing, and core exercises (also many exercises from Dr. Marx's The ACL Solution - great book!). I focused on hamstring exercises as, like many other females, my quads were much stronger than my hamstrings which makes it less ideal during physical activity. For the past month, I started agility and field work, following the PEP program outlined by SMSMF (http://smsmf.org/smsf-programs/pep-program)

... and just today I played in my first full Ultimate game since injury!! I was cutting and sprinting hard without any issues! I wore a Donjoy Defiance III and used the PEP warm-up and cool down routines. Once warmed up, my knee feels as good, if not better than it was pre-injury.

The general perception seems to favor surgery for those involved in a high level of physical activity and it goes to perceive that not getting it done may be detrimental to one in the long run... but after talking to many different healthcare professionals and people who have experienced an ACL injury (surgery or not), I am not sure if surgery is necessarily the best option... I am not concerned about the lengthy rehab or putting in the time and money, if there's a guarantee that the ACLr will give me a better knee, I would do it in a heart beat... but just now... I think I will hold off until I'm absolutely convinced that it is the right option for me.

« Last Edit: August 30, 2013, 09:36:18 PM by libero6 »

Offline marznc

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Re: Are there actually any ACL Deficient Copers out there??
« Reply #14 on: August 14, 2013, 01:27:58 PM »
Thanks for the responses everyone! Great discussion.

I guess I started this thread because I was curious if anyone was able to return to intense pivotal sports without an ACL. I've heard a lot about people who were able to skip ACLr but reduce their activity level... I think these people are referred to as adaptors and not true copers. There is a stat floating around about how 1/3 of people with ACL injuries are copers, but I can't seem to find much information about these people (except for marznc's awesome detailed blog on the skidiva website - thanks again for that!)

. . .

... and just today I played in my first full Ultimate game since injury!! I was cutting and sprinting hard without any issues! I wore a Donjoy Defiance III and used the PEP warm-up and cool down routines. Once warmed up, my knee feels as good, if not better than it was pre-injury.

The general perception seems to favor surgery for those involved in a high level of physical activity and it goes to perceive that not getting it done may be detrimental to one in the long run... but after talking to many different healthcare professionals and people who have experienced an ACL injury (surgery or not), I am not sure if surgery is necessarily the best option... I am not concerned about the lengthy rehab or putting in the time and money, if there's a guarantee that the ACLr will give me a better knee, I would do it in a heart beat... but just now... I think I will hold off until I'm absolutely convinced that it is the right option for me.

Good for you!  As you said, not many true copers set up blogs or write about their experiences online.  So it's easy to get the idea that surgery is the only way to go.  The more I looked, the more stories I found of those who put in the work required to not only do what they liked, but also minimize the risk of further injury.  Conversely, also found plenty of stories of those who had ACLr and ended up messing up the ACL again or popping of the other one.

The feedback from a couple Ski Divas who had ACLr surgery was part of the reason I opted to wait and see how strong I could get with formal PT and almost daily rehab exercises.  I didn't push nearly as hard as you did since skiing doesn't require cutting/pivoting.  The end result was better than I expected.  My ski season was the best ever since I was in better overall shape.  No brace, no worries.

Thanks for creating this thread!