Surviving your first ACL surgery
All the cool kids have done it, I guess I was feeling a bit left out. So as I neared the end of my 28th winter on skis, I went ahead and blew my ACL.
While coaching at the Junior Freeride World Championships, I tried to put a turn in where the snow was far more sun affected than I expected, my heavy backpack tipped me sideways down the hill. As I tomahawked, my skis stuck into the heavy snow but my body kept going, causing my knee to twist and hyperextend: full ACL tear, partial MCL tear, small meniscus tear. In Austria, that warrants a heli ride!
Because I was skiing on the side of the junior competition venue they extracted me like this (this is some of the event staff, not me, but same process)
After taking a moment to process my disappointment, I reached out to friends for advice on what to do next and received an overwhelming response. It was an inspiring reminder that so many of the skiers I look up to have been sidelined by this injury and come back so strong that it's impossible to tell they were ever hurt. So if you're one of the lucky skiers who has never blown your ACL, hopefully, you never will, but if you ever do, here's a compilation of the best advice I received, and a few things I figured out the hard way:
- Do your prehab. Any and all exercise you're allowed to do before surgery will decrease your rate of atrophy and therefore reduce the amount of rebuilding you will have to do after surgery. Range of motion exercises are also key because many surgeons won't operate until you achieve 120 degrees of flexion.
- Do your research. A few surgeons perform primary ACL repair for avulsions; they can reattach your ligament if it ripped off the bone rather than tearing in the middle. This cuts rehab time in half, find out if you're a candidate! There are also clinical trials being conducted of new methods involving using your own stem cells or blood to heal the ACL instead of replacing it with a graft. The old method of stitching the ACL back together did not produce good results, but these new approaches look promising. Healing the original ACL preserves the proprioceptors, maintains the original angle of the ligament (grafts are not placed at quite the same angle), eliminates recovery from an autograft, and reduces rehab time. Hopefully, these procedures will be available soon!
- Get a second opinion. The first surgeon I saw wanted to wait 2 more weeks to operate because I wasn't quite at 120 degrees of flexion, and said it would be 8 to 9 months before I could be back on snow. I left the office in tears. The next day I saw another surgeon, who got me in for surgery 3 days later (he realized it was pain that was limiting my flexion, I was at 135 degrees under anesthesia), and says I'll be back on snow in 4 to 5 months.
- Take your pain meds. The nurse warned me that days 2 and 3 after surgery are usually the worst, but I was feeling so great on day 1 that I skipped 2 of my 14 pills that day. By the time I went to bed I was in excruciating pain, which continued through the next 2 days, even when I tried taking an extra pill (which made me so high I couldn't stand up). Don't try to be tough, it isn't fun.
- Take probiotics. I received IV antibiotics as a precaution after surgery. I thought that since they were IV they wouldn't affect my gut bacteria (false, should have googled it). Around day 5 I started to feel sick. Even though I wasn't eating much I was incredibly bloated and nauseated. It took me a few days and sleepless nights to figure out that probiotics might be the solution. Sure enough, a few hours after downing a pint of yogurt and a kombucha I started to feel normal again.
- Rent an ice/compression machine. I was put on one immediately after surgery and as a result had very little swelling. I went without it for about 8 hours the other day while going to doctors appointments and running errands and my knee swelled up quite a bit. So use it as much as possible.
- Rent a CPM (continuous passive motion) machine. Before surgery I would work on my range of motion all day, and the next morning I would wake up and my knee would be stiff again. Not so when I sleep with my leg in the CPM machine.
- Do your physical therapy. To get strong enough to ski again. Duh.
- Be patient. From what I'm told, doing too much too soon will end up setting you back. This is the hardest piece of advice to take right now!
- Practice gratitude. The psychological side of rehab is huge. Take a moment to reflect on all the things you have to be grateful for! Like hilarious new modes of transportation…