There are countless cases of skiers being sidelined for months at a time after tearing their Anterior Cruciate Ligament (ACL). How can you avoid this injury and what should you expect if you do tear it?
Here is an image of the knee with several tendons and ligaments labled. Note that the ACL is in the center of the knee. Due to its location the ACL gets little blood flow and therefore heals much slower than most ligaments and cannot heal on its own.
If you are an avid skier there is always a risk of injuring your ACL no matter how cautious you are. I have torn both of my ACLs on two separate occasions. In both instances I was spinning onto a small rail at relatively low speeds. It is not the force of an impact that will tear your ACL but the twisting or hyper extension of the knee joint. In order to avoid injury there are some key factors to assess before hitting any park or backcountry feature:
1. Snow conditions: if there is new snow on the ground that is wet it can catch and hold your skis much easier than groomed or packed snow. New snow in the park can also lead to rutting of landings and around rails which can be dangerous.
2. The setup: how is the feature setup? Take things like in-run and landing space into consideration. It is important to know that the size of a feature does not necessarily dictate how dangerous it is.
3. Use your judgment, if a feature does not look right don’t hit it, even if there are other people hitting it.
The easiest way to tear your ACL is to crank your binding’s DIN setting above what it should be set at for your weight, strength and ability. Never crank your DINs by more than 2 settings at once. If your bindings are not holding you in as they should increase your DIN by one setting, then take a few runs. If you continue to release when you shouldn’t, repeat the process until you are at your desired DIN setting.
So you didn’t listen to me and you think you tore your ACL.
A torn ACL
How can you tell if you tore it?
Usually if and ACL is completely torn a hard pop can be felt or heard possibly followed by a grinding feeling in the knee. A sharp pain will be felt initially but the pain should subside after a few minutes unless other ligaments or tissue are damaged. The knee will swell when any ligament in it is torn. The knee will feel very awkward and it may give out when weight is put on it which will cause the person to collapse. There is a common misconception that if you tear your ACL you cannot walk, this is simply not true. Usually when the ACL is torn the person can walk around with a limp within minutes of the injury.
Tearing the ACL most often happens when the knee twists too far in either direction. Activities that result in a torn ACL are most commonly skiing, soccer, football (or any sport with cutting and pivoting).
An illustration of how twisting causes ACL injuries.
My experience:
So I have torn both of my ACLs on separate occasions.
On both occasions I was spinning onto a rail, I came off and my skis hit the snow and stopped rotating....... but my body didn't. Leaning back with my weight falling to the right there is only one point that can twist, my knees (because my ankles were held in place by the rigid ski boot and my bindings didn’t release). As I was falling I felt a brief stress on my knee then a "pop" both times. I immediately knew what had happened both times I did it and started shouting b/c I knew I just blew a season of skiing.
What are my options now that I know it’s torn?
There are two options. The first is surgery, if you ever want to ski park again your going to have to choose this one. The second is rehab the knee until the muscles in the knee can compensate for the lack of an ACL. This option often results in further injury to the knee.
What should I know about Surgery and how to prepare for it?
Depending on your Doctor and how your schedule works out you will probably have surgery scheduled 2 - 4 weeks after the incident. Any sooner and your knee would still be swollen and hard to operate on. Any later and you may further injure your knee, most likely your meniscus.
Before surgery you should try to gain back near full flexibility of your knee. You should ice it daily to decrease swelling. It is important to know that before surgery you are trying to get your knee as normal as possible, so engage in low contact activities such as stationary biking and walking.
Surgery can be very overwhelming. Try to relax its really not that bad. You and your doctor will decide whether to get a Patella tendon, Calf muscle or cadaver graft. A graft is the piece of tissue that will be used to replace your torn ACL. Surgery these days is done arthroscopic ally (with cameras, lights, grabbers and cutters inside your knee) so that your entire knee does not have to be opened up.
Recovery is the hard part. Initially you will probably be put on a CPM (constant pneumatic machine) also called a constant motion machine. This machine flexes your knee joint while you sleep or lay in bed. Yes it sucks but it really helps recovery and only lasts for a few weeks. Physical therapy usually starts about a week after surgery. Do what your therapist says and you should be walking without crutches in a few weeks. Rehab hard and get your strength back b/c your injured leg will be affected by atrophy from lack of activity.
Once you are recovered you will never hurt your knees again b/c you will know how much it sucks, unless you are me.
My Experience with Surgery and Recovery:
My surgery and recovery were pretty much normal. When I got my strength test my injured knee was stronger than the healthy one. Proof that rehab really does help.
Here is an image of the knee with several tendons and ligaments labled. Note that the ACL is in the center of the knee. Due to its location the ACL gets little blood flow and therefore heals much slower than most ligaments and cannot heal on its own.
If you are an avid skier there is always a risk of injuring your ACL no matter how cautious you are. I have torn both of my ACLs on two separate occasions. In both instances I was spinning onto a small rail at relatively low speeds. It is not the force of an impact that will tear your ACL but the twisting or hyper extension of the knee joint. In order to avoid injury there are some key factors to assess before hitting any park or backcountry feature:
1. Snow conditions: if there is new snow on the ground that is wet it can catch and hold your skis much easier than groomed or packed snow. New snow in the park can also lead to rutting of landings and around rails which can be dangerous.
2. The setup: how is the feature setup? Take things like in-run and landing space into consideration. It is important to know that the size of a feature does not necessarily dictate how dangerous it is.
3. Use your judgment, if a feature does not look right don’t hit it, even if there are other people hitting it.
The easiest way to tear your ACL is to crank your binding’s DIN setting above what it should be set at for your weight, strength and ability. Never crank your DINs by more than 2 settings at once. If your bindings are not holding you in as they should increase your DIN by one setting, then take a few runs. If you continue to release when you shouldn’t, repeat the process until you are at your desired DIN setting.
So you didn’t listen to me and you think you tore your ACL.
A torn ACL
How can you tell if you tore it?
Usually if and ACL is completely torn a hard pop can be felt or heard possibly followed by a grinding feeling in the knee. A sharp pain will be felt initially but the pain should subside after a few minutes unless other ligaments or tissue are damaged. The knee will swell when any ligament in it is torn. The knee will feel very awkward and it may give out when weight is put on it which will cause the person to collapse. There is a common misconception that if you tear your ACL you cannot walk, this is simply not true. Usually when the ACL is torn the person can walk around with a limp within minutes of the injury.
Tearing the ACL most often happens when the knee twists too far in either direction. Activities that result in a torn ACL are most commonly skiing, soccer, football (or any sport with cutting and pivoting).
An illustration of how twisting causes ACL injuries.
My experience:
So I have torn both of my ACLs on separate occasions.
On both occasions I was spinning onto a rail, I came off and my skis hit the snow and stopped rotating....... but my body didn't. Leaning back with my weight falling to the right there is only one point that can twist, my knees (because my ankles were held in place by the rigid ski boot and my bindings didn’t release). As I was falling I felt a brief stress on my knee then a "pop" both times. I immediately knew what had happened both times I did it and started shouting b/c I knew I just blew a season of skiing.
What are my options now that I know it’s torn?
There are two options. The first is surgery, if you ever want to ski park again your going to have to choose this one. The second is rehab the knee until the muscles in the knee can compensate for the lack of an ACL. This option often results in further injury to the knee.
What should I know about Surgery and how to prepare for it?
Depending on your Doctor and how your schedule works out you will probably have surgery scheduled 2 - 4 weeks after the incident. Any sooner and your knee would still be swollen and hard to operate on. Any later and you may further injure your knee, most likely your meniscus.
Before surgery you should try to gain back near full flexibility of your knee. You should ice it daily to decrease swelling. It is important to know that before surgery you are trying to get your knee as normal as possible, so engage in low contact activities such as stationary biking and walking.
Surgery can be very overwhelming. Try to relax its really not that bad. You and your doctor will decide whether to get a Patella tendon, Calf muscle or cadaver graft. A graft is the piece of tissue that will be used to replace your torn ACL. Surgery these days is done arthroscopic ally (with cameras, lights, grabbers and cutters inside your knee) so that your entire knee does not have to be opened up.
Recovery is the hard part. Initially you will probably be put on a CPM (constant pneumatic machine) also called a constant motion machine. This machine flexes your knee joint while you sleep or lay in bed. Yes it sucks but it really helps recovery and only lasts for a few weeks. Physical therapy usually starts about a week after surgery. Do what your therapist says and you should be walking without crutches in a few weeks. Rehab hard and get your strength back b/c your injured leg will be affected by atrophy from lack of activity.
Once you are recovered you will never hurt your knees again b/c you will know how much it sucks, unless you are me.
My Experience with Surgery and Recovery:
My surgery and recovery were pretty much normal. When I got my strength test my injured knee was stronger than the healthy one. Proof that rehab really does help.
