We celebrated New Year’s Eve with a bunch of friends powder skiing in a Steamboat Springs Colorado. It was a gorgeous blue bird day & we had an epic time. I’ve been lucky enough to ski nearly 20 days & ran 6 out of every 7 in the early stages of training for a good for age entry to the London Marathon 2020. I’ve been following Matt Fitzgerald’s slow running 80/20 plan.
As I skied through a bunch of narrow aspens it passed through my head that I’d made it to the 14th run of another epic powder-cat day unscathed. 10 metres from the end of the run & the road below things get a bit hazy. I clipped something & my left ski got stuck in between 2 aspen trees & I rotated around ending up both skis still attached with my right ski up & behind me. There was a “pop”sound that I both heard & felt as my knee hung at about 90degrees with a big valgus (outwards time inwards) stress. I wailed like some injured animal knowing in that instance what had happened & that I wasn’t going to be running or doing much of anything for a while.
A bit more guttural wailing & some calls for help. All I could concentrate on was alleviating the pressure on my right knee by literally hugging the offending aspen tree! Help arrived in the form of friends who disentangled me & unclipped my skis while we awaited the snowcat. A unceremonious mini sled ride of about 10m got me back to the cat & in I bum shuffled not wanting to put weight on my knee.
Next stop the ER (no George Clooney wasn’t on shift). My husband Chris sorted my travel insurance details & we were in. No waiting room. I clutched to the notion that maybe I was being melodramatic & overthinking the injury. It only throbbed a bit after all. A brief examination of knee ligament stress tests revealed I had too much laxity and no “end feel” as us physio’s call it & a Anterior cruciate ligament (ACL) rupture was suspected along with a sprain of the medial collateral ligament (MCL).
The anterior cruciate ligament is one of 2 ligaments that cross inside your knee. It attaches diagonally from the femur (thigh) to tibia (shin bone) and maintains the stability of your knee by stopping the tibia sliding forwards on the tibia. It also has a key role in rotational stability (twisting) or the knee.
Without it the knee tends to give signs of instability by giving way on turning or side to side movements. Now sometimes you can get away with a truck load of rehab. Primarily this is aimed at your hamstrings to act as a breaker if you like to stop that sliding forwards of the tibia on the femur. Also it depends on age of the person and what activity they want to do. If I was sedentary and not particularly active this injury may be fine to manage conservatively (without surgery).
My buddy on the ski trip Katie has managed for 20 years sans ACL. She’s a furious skier & ran her first 2 marathons last year. The risk can be that if the knee isn’t stable enough you can’t function at high impact sports particularly those involving twisting. Running is fairly linear (except when your dodging runners in big races!)
It’s also pretty useful to have stability on the inside of your knee or medial collateral ligament. On initial assessment it seemed I’d sprained this. These examinations aren’t always hugely sensitive /specific but as there wasn’t yet any knee swelling as I’d come straight off the snow they were likely accurate. ie a lot of laxity with no end feel gives a pretty reliable likelihood of ACL rupture.
So not more than 45 minutes after arriving in the ER I’d been examined, had an X-ray & was wheeled in for an MRI from a spangly new machine. This would give insight into both the state of ACL & MCL.
The ER doctor confirmed ACL rupture from the MRI but I’m still awaiting radiology report on the MCL. With these kind of injuries the outcome isn’t generally great for early surgery. Most surgeons like to wait until the haemarthrosis (bleeding of the joint) and swelling reduce before surgery which can be 4-6weeks plus. That also gives an opportunity to prehab & see how I fair symptomatically.
Homeward bound I gingerly walked with some lovely ted stockings & mini aspirin to prevent a DVT (deep vein thrombosis), a swelling wrap to reduce inbound joint effusion, a robo style leg brace fixed from 0-30degrees which will enable me to walk without instability, also some ibuprofen/paracetamol for the inflammation & pain respectively.
My main aims over these next few days are to be a top student & ace the “RICE” advice. Rest/ice/compression & elevation to reduce swelling & maximise range of movement. Oh & it might be useful to stop blubbing every 5 minutes!
Welcome to the rehab journey. I’m sure it’ll be a bumpy journey this next 6-9 months. I’ve walked plenty of patients through it on the otherside . Now it’s my turn! I have my eyes on the prize & let’s face it I’m sure I’ll learn a thing or two along the way.
That powder though!