Skiing Accident - torn ACL and MCL - please advise and share your experience

[Venus_Sky]

Hi All,

This is my first ever post and I am hoping to get an advice and support from people with similar unfortunate experience as well as medical advice from professionals who are happy to share their knowledge in treatment and healing of torn ACL and MCL ligaments.

I would be grateful for any comments or advice on the following:

1) How to cope with ACL and MCL injury:
- when is it better to start partial and full weight bearing on injured foot?
- will moving around on crutches help or prevent faster healing? Staying active VS more rest?
- how to manage coldness/numbness/change of colour of lower part of injured leg?
- are there any medicines/creams/vitamins which will support healing of torn ligaments?
- how often shall I visit my physiotherapist? Initially I have been recommended twice a week visits then to be reduced to once a week.
- how long shall I wait for 2nd MRI scan to check the progress of MCL healing and any change to torn ACL?

2) What are estimated recovery periods for MCL and ACL injury?
- when I will be able to walk on both legs with crutches (currently I am non-weight bearing)
- when can I expect to walk without crutches?

3) ACL Surgery - is it necessary or can I live a normal active life without it? Have you heard of healing miracles without surgical intrusions or do you know of any alternative treatment methods?

4) Driving an automatic car with a left leg in full brace and with crutches:
- can I drive once the pain settles and I am able to easily bend the knee?
- what are UK regulations and restrictions from car insurers and DVLA on this matter?

5) How to deal with a primary school pick-ups, drop-offs and afterschool activities for a mum with such injuries?
- grandparents and relatives are not around to help
- husband is working long hours
- school friends are currently helping but it is too much to ask for the next 12 weeks or until I'm able to walk/drive

6) When can I plan to return to work?
- working from home? It has been 13 days since the injury and I currently find it impossible to sit uninterrupted with a computer due to pain, regular exercises and leg positioning. I was recently issued with a Not Fit To Work certificate by my GP for the next 4 weeks with promise to extend. Is there a hope to be able to start working 5-hours-day from home earlier than 4 weeks from now?
- returning to the office (traveling by tube involving line changes and then walking 15 mins)?

Here is my story:
13 days ago I had a skiing injury in picturesque Alps during a group skiing lesson - it was my first day in an intermediate level group, surprisingly there was no initial skills assessment and the instructor opted for a high slope on a high speed, hardly waiting for a greater part of his class to catch up. During my 2nd fall ski binding didn't unlock...
I heard loud cracks with sharp pain and unsteadiness on attempting weight bearing. I had further click and agonising pain while trying to get back on skis as per instructor's request (he knew of my pain but asked to try skiing down the slope again!!!) and I was eventually taken to base with ski-do and then ambulance.
I was assessed in resort ER but not X-rayed as I was in early stages of pregnancy. The knee appeared very loose, full tear of ACL and MCL was suspected and I was given a full leg brace and crutches. The miscarriage in two days after a skiing accident made me even weaker physically and emotionally.
On my return to London I have seen a recommended specialist and had MRI & X-rays scans which confirmed a full tear of ACL & MCL with bone bruising. I was referred for urgent and regular physical therapy with restoration of knee/lower limb control and motion before any further treatment can be determined.

I have just had my 2nd physio appointment and am doing regular exercises as instructed. Ahead are longest ever 4 weeks before I can see my doctor again to assess the progress of physical therapy and another 2-3 months before repeated MRI scan to check resolution of bone bruising and better ACL ribbon contour. Currently I am on seek leave from work and am hoping to be able to start working from home before getting fit enough to return to the office. All depending on the length and course of treatment. On the top of it, I am a lucky mother of energetic 8-year old boy who needs to be taken to school and numerous after school activities.

I cannot wait to take off my newly acquired robocop gear (AKA brace:) and go back to a normal happy life! Please get in touch if you know any answers to the above, have a similar story or can support with advice. Many thanks for reading

[vickster]

There aren't any medics who frequent the site. U.K. Doctors and Specialists won't give medical advice outside appointments

Check out the ligament forums and diaries for some more experiences. Search on ACL

Have you discussed all your questions with a knee surgeon? They would be best placed to tell you your options. Physio should help with the practicalities, weight bearing etc. Get referred to a knee surgeon with expertise in ligaments. Where in the uk are you?

There are good ligament primers in the learning hub (link top right). My understanding is a torn MCL will heal (but could take months). However a fully torn ACL will not heal due to lack of blood supply and needs to be surgically reconstructed. Most commonly with part of hamstring from other leg. If not too unstable, you could cope with no ACL but generally this is more for older less active patients. The lack of an ACL can lead to damage to other structures and the bone surfaces (ie arthritis)

Http://www.kneeguru.co.uk/KNEEnotes/pri ... ent-primer

http://www.kneeguru.co.uk/KNEEnotes/pri ... ent-primer

Ref driving. Do NOT until your specialist has cleared you, regardless of car type. If you have an accident, even if not your fault, your insurance could very well be void. They'll argue you weren't in full control

Good luck

[Venus_Sky]

Thank you Vickster, your time and helpful advice is much appreciated. I am based in London and have already visited a knee specialist who carried out all diagnostics tests and put together a treatment plan. The plan is to work on MCL to heal and have a repeated scan in 1-2 months to determine if ACL condition has changed.

Currently, I am trying to gather more experience-based information for better understanding of possible outcomes and how to deal with current and upcoming difficulties.

Good point about driving. Would a clearance to drive letter from a specialist be enough or is a written consent from insurance company also required? Does DVLA need to be notified of medical changes?

Many thanks in advance

[vickster]

Ask the specialist what needs to happen for you to be able to drive again. Previously when I've had surgery (knees, elbow, shoulder), the surgeon has just told me when I can drive again, but I've not been in a brace

[jg5118]

Regarding the driving

You don't need to notify the DVLA as it's not a "notifiable condition" however, it may be worth ringing your insurance company - but as you say, left leg, automatic car, it's not going to affect your driving. Normally, the ruling is that provided you can safely perform an emergency stop, it's safe to drive.

Make sure you don't take too many painkillers because you can get charged with Drug Driving if you are involved in an accident and tests show that the level of painkiller was too high - mainly morphine, diazepam etc. but careful with codeine based medication too

Are you on NHS or have you gone privately? Why not give the consultants PA a ring and get him to ring you to advise on driving

Do you have the flexibility to work from home? You don't want to go stir crazy - says the girl who was back at work a week after ankle surgery - but I only have a 100 yard walk to the office. If you do go back doing short days, I presume this is to travel outside rush hour - remember, even a five hour day will be exhausting by the time you add travel on top, and you know how rude we Londoners are when we are commuting...

Hope that helps

Judith

[vickster]

I would definitely check with the specialist before even considering driving. A large bulky brace could potentially have an effect on ability to drive comfortably, get in and out of car etc.

Tramadol and the neuromodulator drugs (e.g gabapentin) also to be wary of once start to drive

[Audice]

I'm offering strictly personal experience here, Venus Sky. Back in 2005 my horse & I parted company & although I didn't have a hard landing, my knee was in a position causing me to hear two pops. Swelling & pain were immediate but I still got back on my horse to finish what I'd started.

The next day I saw my internist who said an MRI was in order but I held off on the decision for a few days. The MRI done, I then had to wait two weeks for an appointment with an orthopedic surgeon. So by the time I walked into his office, I had only a very swollen knee but minimal pain & barely any limp. I'd not been offered either brace, crutches or cane so made the best of things w/o.

The specialist told me that although there might be a few strands of the ACL still intact, the ligament was ruptured & the MCL was partially torn. With that he said that nobody my age ever went through ACLr.

He suggested I have a custom brace made & gave me a script for it, handed me a neoprene brace to wear & suggested that whatever I was doing to continue doing it & he'd see me in a month.

I decided to begin a regimen of walking, first on the flat & soon on hills & in a months time I had the Townsend brace to wear & was back to riding my horse. I'd remove the brace before I rode. The orthopod suggested, when he checked the strength of my quads that whatever I was doing to continue doing it & told me no PT was needed.

That first year I did wear the brace quite often but I'm now 12 years past the injury & it's been years since I've worn it. Age & spine issues prevent me from riding or even walking but still the knee is strong & solid.

Althougn at the time I was told surgery wouldn't be an option because of my age, I was annoyed. At 67 I was probably more physically active than my doctor. But I can honestly say I've had few issues with the knee in all of these years. I'm pleased with the outcome & don't regret having closer supervision & more options post injury.

Wishing you well.

[Venus_Sky]

Hi Audice,

Thank you so much for your reply and for sharing your experience.

Wishing you all the best as well.