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Author Topic: ACL Avulsion gurus  (Read 2272 times)

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Offline wbryce

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ACL Avulsion gurus
« on: March 02, 2015, 06:17:31 AM »
Hey Folks,

Wonderful website, lots of good information.  Looking for some advice on a ACL avulsion on the tibia side.  It was diagnosed as a type 3b and surgery was successful one week ago.  It happened to my girlfriend while skiing whose overseas with me so from incident to surgery was 6 days.  The MCL also had a tear repaired.

Because we are still overseas in a foreign country information has been hard to come by and picking up the phone to see a doctor also requires insurance approval etc due to the costs involved.  So I'm seeking some information from others who have experienced similar injuries.

The surgery removed parts of the fractured bone and reattached the ACL by sutures in the recess of the bone fracture I believe, Right now my partner has a full G2 brace on that is limited to 15degs extension.  At 2 weeks we've to change this setting to 0 degrees on extension, this is in 1 weeks time.

Right now she's struggling to put any weight on the leg but the 15deg setting contributes to this I believe. Any similar stories? 

Looking for others experiences on the recovery and what initial physio you had to do, and how long it took to see some positive results?

Presently we where told to remove brace 3 times daily, and for me to bend and extend the leg, maximum 90deg.  With main emphasis on getting the knee to full extension.  Right now were not successfully getting the full extension, the knee won't extend fully yet and we can get a good 70 deg bend.  Although my partners always quite tense and tight during these exercises.

How did others get on?
« Last Edit: March 02, 2015, 06:19:30 AM by wbryce »

Offline goonemoremile

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Re: ACL Avulsion gurus
« Reply #1 on: October 08, 2015, 06:11:41 PM »
I know this thread is a bit old at this point, but I still wanted to add to the ACL avulsion discussion as I am currently recovering from surgery and have found information very limited.
I avulsed my ACL from the tibial spine on 9/10/15 from a dirt bike accident. So it was a powerful and violent hyper-extension thanks to my suped up dirt bike. I also partially tore my MCL and had some avulsions there as well.
The bony piece was so big that the only course of action was to suture anchor the ACL avulsion back into place. My surgery was 12 days post accident and the doctors thought that was quick to get me into surgery.
Day 9 post op, I was given permission to put weight on it, but not while walking.
I was given a continuous passive motion machine and I'm only at 45 degrees in extension on that thing as of day 15 post op. My knee and the muscles surrounding it are still really bruised and damaged so stretching them is really hard and painful. I start PT next week.
I did as much research as I could before my surgery and locking a patient in 15 degree extension is terrible for recovery from this injury and surgery.
Weight bearing is easy and I don't have any pain standing on my leg, it just feels really weird. I'm taking it easy as everyday those little muscles get a little stronger and better able to handle a little stability.
I start PT next week and they are going to try to strengthen the quad muscles and gain more range of motion (ROM).
From what I have learned, we are worse off that an ACLr. The knee gets so stiff and week and scar tissue usually impedes ROM which impedes muscle development and strengthening. I'm buckling down for a long long recovery.
I am also taking a lot of bone growth supplements, Blue Ice Fermented Cod Liver Oil (for maximum Vitamin D and A absorbtion) and am eating as little sugar and white flours as possible as they impede bone growth. Also, do not taking any NSAIDs as there are dozens of studies on how they impede healing and weaken ligaments over time.

Offline goonemoremile

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Re: ACL Avulsion gurus
« Reply #2 on: December 09, 2015, 02:33:28 PM »
Here I am 10 weeks later! There is very little information on ACL avulsion injuries and how to properly heal them, so I am writing all the information I wish had been available to me when I had this injury.
If your x-ray shows the possibility of an avulsion or even just boney pieces in the knee joint, press hard for an MRI AND make sure you take a copy of your MRI results with you. They will put them on a disk at your request. Orthopaedics are usually slow as it is rarely life threatening so they wonít push for you. Avulsions are very rare. Doctors are generally surprised when they happened and thus werenít looking for them in the first place.
Choose a surgeon who has done this before. Ask to talk to all of the surgeons in the group. In my experience, the first surgeon I saw had never done one and his schedule was too busy so he had already consulted with another surgeon (Dr Scott Szabo) in the group who had done 3 and all were successful. The other surgeon in the group was on vacation and couldnít see me. I asked around about Dr Szaboís reputation and everything came back positive so I moved forward, but always be picky about your surgeon.
Get into surgery as soon as you can.
Choose avulsion suturing for your surgery. The staples back out too often and the sutures will allow you to walk earlier. Suturing will leave you with two tunnels in your bone and a titanium button. The tunnels will heal almost completely eventually.
Get a femoral nerve block as part of your anesthesia. Mine lasted for 36 hours. It was great!
Make sure you discuss the pain meds you want (Percocet or Vicodin, etc) before surgery. My dr never discussed it with me and when I woke up I said I would rather have Vicodin. The nurse then tore up my Percocet after she called in the Vicodin to the pharmacy. The pharmacy called back and said ďYou canít call in a narcotic, it must be a written script.Ē The nurse was able to give me tramadol which is next to worthless. It was debacle because I was the last surgery and the docs were gone. A massive failure.
Have someone take constant care of you for at least 3 days. You will need it.
Get a hospital table for next to your bed. You will use it for all of your meals and drinks.
Elevate your leg but make your leg as straight as possible. Do not put a mound of pillows under your knee. You will need to get your extension back ASAP so that you can walk. They let me start walking at 4 weeks (just a little bit) but I had been constantly sleeping with a pillow under my knee and the capsule of my knee got really tight. It was so painful to correct AND I didnít get it back until 12 weeks post op.
Have your physical therapist figured out before surgery and schedule your evaluation appointment for the day after your first post op appt with your surgeon (you will get your PT script then).
Start deep tissue massages 2 weeks after surgery. This will break up and prevent further scar tissue. You will get your flexion back MUCH faster. I started this at 6 weeks and it was miraculous on my stalled flexion. My massage therapist is a deep tissue specialist and also a certified physical therapy assistant. The perfect person to work on my injured leg! I went 2-3 times a week for 3 weeks and then only go once a week at 12 weeks post op.
Get into acupuncture ASAP! The right acupuncturist will help with pain management, swelling and stiffness and do an awesome job. I started going at 8 weeks post op because I was so frustrated with my progression. My knee was painful and swollen and very stiff. I couldnít get any better than 4 degrees while doing a straight leg raise so I couldnít walk right. After 6 sessions, I have my extension back, my knee is only a little swollen, my flexion is almost complete with no extra effort and I have very little pain. Itís expensive, but it gets you better faster. There is a teenage girl who is a star athlete that had similar injuries to me. For our entire recovery we were at the exact same pace, same flexion, same extension issues but then I started going to acupuncture and she has barely progressed. My PT was giving me high fives yesterday for how well I am doing! Next time I see her, I am recommending my acupuncturist. She has a bright athletic future ahead of her and needs to get better by spring for track.
With acupuncture, you need to give it at least 8 sessions. Iím glad mine was somewhat miraculous with only 6, but Iím still going because Iím not done yet.
Take it slow. If you feel itís too hard, tell your PT. Tell them you need to have less exercises at each session. I wish I had said that. I would leave PT after 2 hours with my knee so hot you could feel it through my pants. I would then do almost nothing the days I had off. Just some light exercises and stretching so that I could recover from PT. At week 8, my PT finally admitted that I am a textbook case of ďless is more.Ē Take it slow. Rest. The body heals when you are at rest, not when you are exercising. Exercising tells the body ďThis is what I need you to be able to doĒ and rests allows the body to make that happen.
Sit with your leg straight and your heal elevated with a pillow as much as possible. Do this at work, at home and at school. This will help get your extension back. You must be able to extend your leg at 0 to walk properly. I used a wheel chair with a board on the foot holder at work. It made it so much easier to get around at work and kept my leg elevated and working on some light extension.
DO NOT TAKE ANY NSAIDs during recovery. NSAIDs have been show to inhibit healing and cause bone and ligament weakness. Itís old medicine to take anti-inflammatories. Inflammation is the healing cascade. There is a lot of data to back this up. Taking some aspirin after surgery as recommended wonít harm you, but I still didnít do it.
Restrict sugar and white flour for several weeks after surgery. Sugar inhibits bone growth.
Take fermented fish oil to encourage bone growth and health.
Take a bone growth supplement the first month.