Anyone have ACL issues?

[hikrgrl]

I'm wondering if there is anyone on here who has experience with trashing their knees...more specifically, is there anyone here who has had an ACL reconstruction, blown that one, and gone for a second one (a revision)? I'm especially interested in graft materials...

A little backstory: I tore my ACL while hiking in 2006. Had surgery, using my own hamstring tendon. I was diligent about doing my physical therapy at home. I went on to thru hike the AT three years later, and then did the PCT. This past summer, my plan had been to knock out the Long Trail, but I got knocked out instead - I slipped on a rock in mid-July. I was first diagnosed with a torn meniscus, but the MRI later revealed I'd partially torn my ACL...and the NP who saw me said a partially torn ACL is like being partially pregnant...so, I'd need to get that fixed, too.

The surgeon was concerned about losing strength permanently in my leg if the meniscus and ACL were repaired at the same time, so we opted for two surgeries, starting with the meniscus, and cleaning out the remains of the previous ACL - that involved putting in some bone grafts, which need a full six months to heal. That means that the earliest I can have the ACL revision is March, but because of my job, I will not be able to schedule the surgery until June. I can't even begin to hike again until six months post-op...it will be NEXT December, at the earliest, that my toes will touch dirt. I'm starting to feel like I will never hike again...that my long-distance backpacking days are over. Well-meaning friends have told me that I'll be back on trail again...but none of them have had multiple knee surgeries, and been grounded for 18 months.

Is there anyone here who has overcome two torn ACLs, and returned to multi-day backpacking trips? I'm curious about graft materials, as well...allograft? Autograft? (although I'm not sure my body has anything that is usable). I've discussed much of this with my doctor, and he is very aware that ultimately, I want to be able to hike again...but I would like to hear some first hand accounts, if there are any, of people successfully returning to the trail.

 

[BISCUT]

The right doctor is everything. Since you have some time, see a few. I don't know where you are located, but in 2001 I had a repair done by Dr. Greg Cavalerie and Dr. Madallo out of the Westchester NY area. I had gone to 2 other doctors prior and thank God I didn't let them operate. I was lucky as workers comp covered my repair (I was injured line duty). Cavaliere was the only dr to take into consideration the future pounding of coming down trails like Tucks and such. He went in and instead of the easy route of scraping the meniscus, he took the time to grab the little that was there when he opened me up, and re-tied. He did a damn good job on me. Took a good year for full strength, but I have been able to use some very heavy weights int he gym with no issue of the knee.

Yours sounds a lot worse than mine, so care in choosing your dr. Good luck! Quick recovery to you as well!

 

[Becca M]

Gosh - such a heartbreaking story!!!!! I'm sure all of us avid hikers can feel for you!!!! Many of us have had what seemed like season/etc-ending injuries as you, though, many not as severe. However, keep in mind that there are many hikers out there (on this board even) who have had total knee replacements and were able to get back on the trail with a lot of work and time, but, they did it!!!!

Hang in there... patience is your friend!!!!

 

[Sabra]

Stem cell technology is making large and fast progress and is able to help injuries of this kind. I would recommend that you check it out and see if this might be a treatment option for you.

My experience with this treatment is through a family member who had multiple knee injuries and surgeries including complete knee reconstruction that happened throughout his Judo and wrestling professional training. He is going through stem cell treatment these days, so it is too early to report the results, but you can read about it on the web, including many testimonials. The benefits of this treatment include much faster recovery than the invasive conventional treatments and long term improvement of the overall joint health.

Unfortunately, stem cell treatment is not yet covered by most insurance policies, but depending on your financial situation, it may be affordable to you.

You can start reading here - http://www.regenexx.com/

 

[David Metsky]

I'd be leery of the stem cell approach at this time, especially since Regenexx ran afoul of the FDA and had to move their operation to the Cayman Islands because they weren't following proper procedures.

http://www.cadc.uscourts.gov/internet/opinions.nsf/947528CDDA0B9A5A85257C7500533DF4/$file/12-5254-1478137.pdf

As always, anonymous folks (including me) on the internet are not the best place to get medical advice. Advice is great but please consult your doctors before taking any action.

 

[hikerbrian]

My wife blew out her ACL skiing in high school. Had it repaired with a chunk of tendon from somewhere on her body, I forget where. Was exceptionally diligent in her PT, but always had some issues and went in a couple of times over the proceeding decade to have bits and pieces cleaned up. At ~10 yrs post surgery, she had some arthroscopic work done and it was clear that her ACL had loosened substantially. It looked like a piece of rope with slack in it. But she wasn't having any mobility problems. Until we found ourselves truly in the middle of nowhere Alaska, climbing over and through the worst blow downs I've ever seen (due to spruce bark beetle infestation) with a nice bed of devil's club underneath us. She slipped, screamed, and that was the last of that ACL. Yes we did manage to extract ourselves - I took almost the entire contents of both of our packs (this was a hero load, if I do say so myself) to lighten her load, and she was able to hobble back to civilization over the next two days. MRI showed no trace of remaining ACL.

Surgery #2 was 6 months later, this time they used cadaver ligament, and the surgeon told her after completing the procedure that everything "looked pretty good - you won't run any marathons or anything, but you should have a fairly complete recovery." So 6 months later she felt pretty good. Another 6 months later she ran her first marathon. 1 year after that, her second marathon. Popped out 2 kiddos over the next 3 years, and then ran her third marathon 2 years after that (that's 2 years ago now). She runs, hikes, does everything and more than she did after her first surgery. In fact, I'd say she has far fewer problems now than she ever did before her second surgery.

My feeling is the surgery has gotten MUCH better over the past 20 years. For example, she has a massive scar on the front and side of her knee from the first surgery, but almost no trace of a scar from the second. I think the procedure is so common now and there are so many outcomes to look at that the whole procedure is much better understood.

So don't despair. It'll take time, but you may find you're better off. At the very least, know that many others have gone through two or three ACL's - sometimes that's how many it takes to find the right one. Good luck, stay positive, visualize, dream. You'll get there.

 

[Sabra]

I'd be leery of the stem cell approach at this time, especially since Regenexx ran afoul of the FDA and had to move their operation to the Cayman Islands because they weren't following proper procedures.

http://www.cadc.uscourts.gov/internet/opinions.nsf/947528CDDA0B9A5A85257C7500533DF4/$file/12-5254-1478137.pdf

As always, anonymous folks (including me) on the internet are not the best place to get medical advice. Advice is great but please consult your doctors before taking any action.

To clarify - I recommended to Hikrgrl to check out Stem cell treatment as an option. I didn't recommend to do it! I agree that this is something that Hikrgrl should decide after consulting with professionals.

Just to be accurate, the FDA case to which you are referring is related to the Regenexx-C procedure (Cultural Regenexx). This is different from most other Stem Cell treatments that are being practiced in many clinics in the US and are FDA approved.

 

[hikerbrian]

Are there any FDA-approved stem cell treatments? This page from the FDA's website claims there are not (and I suppose they'd know). From it:

Stem cells, like other medical products that are intended to treat, cure or prevent disease, generally require FDA approval before they can be marketed. At this time, there are no licensed stem cell treatments.

Also worth reading the linked article at the bottom of the page, FDA warns about stem cell claims.

 

[Stan]

Not related to ACLs as much as osteoarthritis but on the topic of stem cells, here's another report with an encouraging outlook ... that 3D technology sounds fascinating, too. I've no doubt that this stuff will be a reality ... probably for those who don't yet have a hint that their joints may need such medicine. http://alumni.stanford.edu/get/page/magazine/article/?article_id=75847

 

[kaseri]

I'm a bit late to this discussion but I have had multiple knee surgeries (torn ACL & medial meniscus). I tore my ACL while descending Mt. Liberty in Feb of 2010. Had surgery to repair it in April 2010 and climbed Mt. Garfield in December of 2010. I had an autograft taken from the same knee (Patella tendon). I was extremely diligent in my physical therapy and recovery. My knee did not feel completely normal for about a year but I was able to climb and hike as much as I wanted. Almost 2 years to the day I tore the medial meniscus in my other knee while descending a winter climb of the Twins. I had it repaired and that recovery took a lot longer for me. A year later I was back on the trail. Since then I've developed degenerative cartilage loss of the medial femoral condyle in both knees. I have full thickness voids which are about 7mm in diameter in both knees. It hurts to stand up, sit down, climb stairs. Anything that involves the Patella sliding over the void hurts. I attempted two climbs last winter, Garfield and the Osceolas. I had to turn around both times because my knees hurt so much. My Orthopedic Surgeon says my situation "sucks" (his exact words) My knees hurt bad enough that I'm unable to climb but they are not even close to needing knee replacements.

My plan for 2015 is to get my knee issues resolved to a point that I can get back out on the trail without too much associated pain. I don't mind if they are hurting but right now I can't do any climbing at all outside of things like the Blue Hills. The silver lining is that my oldest son loves hiking and I've been able to get out with him on what VFTT members would consider very easy hikes and spend time with him in nature. Hopefully he doesn't inherit my knees.

 

[Fisher Cat]

My ACL had been weakened by previous injury (partial tear, no surgery), and then completely tore years later. After having 'a go of it' without surgery, I submitted and had it done. The surgeon told me to get it done before I was 30 to help the healing process. My surgeon was the former personal surgeon for Tony Dorsett. They used patellar tendon to replace the ACL and I have had no problems whatsoever, and that was in 1999. So I'm sure there are newer methods, but dang it, what a great job he did. I have resumed normal activity 100% which includes skiing, snowshoeing, trail running, weights, trail work with huge amounts of tools being carried, etc. Glad I had it done!