Skiing without ACL brace five years after surgery?

DrZoidberg

Active member
I'm curious as to what other NSers have done here. On the one hand I obviously don't want to tear it again, but i certainly wouldn't mind ditching the brace. Skiing is the only time I wear it. I skateboard, surf, play soccer and everything else without it. The only time I've ever felt some pain in that knee is when pushing really hard into a turn while surfing, but in a more layback, awkward position. It's my back foot. Never had any issues skateboarding or with soccer or anything else.

Perhaps I just need a better fitting brace? I have this and I wear that thin stretchy lycra thing under.

fusion-lateral-oa-knee-brace-2.jpg


It slides down sometimes and it can be uncomfortable sitting on the lift. I'm short, so I have short legs and it kinda takes up my entire leg. If it were any longer it'd interfere with my boots. It usually touches the tongue as is, and I had to put tape there to prevent it from ripping it further. Plus I feel like it's not actually keeping the lower part of my leg from twisting independently of the top as it should, or it wouldn't in the case of a hard fall.

**This thread was edited on Jan 29th 2016 at 9:39:04pm
 
Annnnnd the thread title should read skiing without the brace, as I've been skiing with it for the last five years or whatever.
 
13617667:DrZoidberg said:
Annnnnd the thread title should read skiing without the brace, as I've been skiing with it for the last five years or whatever.

i got you
 
Ditch it! It's doing more harm then good.

Your knee needs full range without a brace getting in the way, ditching it will make it stronger and will help it recover for the long term.

Mentally the brace may give you some extra confidence and may help you recover faster on days where you really push it, but that's a short term benefit, long term you will lack extension, range and strength to ensure the new ACL gets as strong as it can be.

I'm on close to 20yrs on my ACL replacement (patella) and the only thing that bothers me is the occasional feeling of broken cartilage floating around in the wrong spot. I used the brace for a few years after my surgery, but it was after I ditched it that I felt stronger.
 
I wanna say try to strengthen your knee again first, and then take off the brace. However I also wanna say for you to get a medical professional to make the diagnosis.
 
13617760:SteezMcGee said:
I wanna say try to strengthen your knee again first, and then take off the brace. However I also wanna say for you to get a medical professional to make the diagnosis.

Well it's gonna be six years post surgery in april so I think whatever strengthening that was going to occur has by this point in time.

13617779:californiagrown said:
idk why its taken you so long to ditch it? its a 100% mental thing now.

Maybe. I never worry too much about the knee, I don't think, but to be honest I don't even remember because I haven't skied in like a year. Season's sucked until last week's blizzard and I work otherwise. I think it's mainly just a fear of cannon rails now. Fuck those guys.
 
As a follow up, I went skiing today without the brace and am currently not making an MRI appointment. One thing that's nice is that I can sit on my bindings again for speed. Seeing as my brother used all our wax and it was like 50 something degrees, it was getting real slow. With the brace on I was unable to do that comfortably since it limits the amount your knee can bend.

I did take a couple wacky falls trying to nose butter 540 this chunky quarter pipe thing, where I nearly did a split since the skis took my legs opposite directions upon landing. Then I had the tail of my left ski pointing the same direction as the nose of the other. No pain on the knee and no issues. I even hit a canon rail, although the rail was so short that I was off it by the time I got my skis sideways. I think it was made for snowboarders to 50 50 and that's it. I tore it on a canon rail so I'm a bit weary of those.
 
I have that brace but it doesn't bug me. I forget im wearing it aside from ball tucking. im on the taller side though

if you ride without it you'll be a little more likely to hurt yourself but if it's bugging you real bad just don't use it or get a better fitting custom
 
MRI is always going to be abnormal since you had surgery. If you re-tear your ACL you will know all about it because your knee will balloon up and it is really going to hurt beyond any minor tweak.

I never skied with my brace post op, it was just a waste of money in my opinion and I regret even spending the money on it.

I just worked a lot on quad and hamstring strength in the time between my surgery and the next season of skiing.

That is whats going to save your knees, the stronger your legs are the less your ligaments are going to be compensating for twisting etc. now I barely notice my knee and both my knees are equally sore after a hard day. Brace definitely restricts movement. Its a gamble though, you could always get hurt again with or without the brace. it comes with the territory
 
Maybe lower the din a little on the bad knee side for awhile until your feeling more confident/stable. I would rather take a slam cause my ski ejected over twisting up my knee any day.
 
8 years post op. only wore the brace my first season back. couldn't tell a difference in stability brace/no brace so I just stopped wearing it.
 
I just ditched mine for one of those $50 supported braces you see in many shops. Much better than the big bulky thing I got through insurance. Go for one of those, it's much more comfortable and still very supportive.
 
blew out my ACL had surgery and was skiing 9months later with no brace and no problems. Its a metal thing, take it off and you will get use to not having it.
 
I rode last season with it as I had tore it the summer before then, rode the first few days this season with and have now ditched it. Feels good,
 
I wore mine for a season, tweaked it the next year without a brace so I wore it for a couple years after then transitioned to a smaller brace for a couple years and now I haven't used anything for two seasons. The faster you ditch your brace the better IMO after your muscles have rehabbed you're good to go.
 
I don't know what your surgeon and PT told you but for me they both said I didn't have to wear the brace at all. I also had my meniscus heal itself before I had surgery though and I had a hamstring graft so I don't know if that changes anything
 
13617779:californiagrown said:
idk why its taken you so long to ditch it? its a 100% mental thing now.

I wear mine because it could prevent a hyper-extension. I don't need it anymore, but it could help me in a worst case scenario. It is more than a mental thing, it could actually help me and does not hurt me. I train a lot and I don't need it for support, but like I said it could help me in a bad crash. I don't wear it running or surfing anymore, as those sports are far less likely to be a problem. My PT told me that i would eventually not need it for anything, but that it could help in the worst case scenario so I wear it because of that. My Dr. told me the same thing. I am a decade out of surgery. I don't need it, but I might as well get the extra protection.

It sounds like the problem might be that the brace does not fit well.
 
13619933:dan4060 said:
I wear mine because it could prevent a hyper-extension. I don't need it anymore, but it could help me in a worst case scenario. It is more than a mental thing, it could actually help me and does not hurt me. I train a lot and I don't need it for support, but like I said it could help me in a bad crash. I don't wear it running or surfing anymore, as those sports are far less likely to be a problem. My PT told me that i would eventually not need it for anything, but that it could help in the worst case scenario so I wear it because of that. My Dr. told me the same thing. I am a decade out of surgery. I don't need it, but I might as well get the extra protection.

It sounds like the problem might be that the brace does not fit well.

Sure. It's like any other brace or body armor at that point. It's there in case something goes really, really wrong, but it does hinder natural movement. And that hindrance cam be anywhere from unnoticable, to annoying, to disabling.
 
13620050:californiagrown said:
Sure. It's like any other brace or body armor at that point. It's there in case something goes really, really wrong, but it does hinder natural movement. And that hindrance cam be anywhere from unnoticable, to annoying, to disabling.

In my case I don't notice it, but it sounds like the OP has a problem. Like I said before, I think it might have to do with the brace not fitting properly which really sucks. If the brace is not fitting properly it might not be helping at all, since it might not help in an accident. My brace was mostly paid by insurance, I think I paid 250 and it cost 1,000, so it was definitely worth it for me. OP, was your brace made specifically to your leg? Or did you buy it off the rack. If you bought it off the rack that might be the problem. This far out of surgery the insurance won't pay for another brace, so you might just be better off without it.
 
The braces don't do anything other than act as a mental reminder (in the treatment of ACL tears). If your tibia moves far enough in relation to your femur that your brace is what stops it, your ACL is long gone. There is no convincing evidence that they help even in the immediate post-operative period (http://www.ncbi.nlm.nih.gov/pubmed/24169301 ), and they definitely aren't required 5 years later.

My physio's advice back when I tore mine was to get a neoprene sleeve to wear as a mental reminder (and maybe some extra warmth) for the first couple days, then ditch it.

If your knee feels unstable this far out, it's either a.) all in your head or b.) it's actually unstable, in which case you need to hit the gym and get those hamstrings firing again - which a brace is only going to inhibit.
 
Yeah I really had no idea as to how long people wore these. I was under the impression people just wore them for skiing forever, although I never really bothered to look into it. I did fine without it so I'm pretty sure I'll ditch it permanently.
 
13620319:reBlocke said:
The braces don't do anything other than act as a mental reminder (in the treatment of ACL tears). If your tibia moves far enough in relation to your femur that your brace is what stops it, your ACL is long gone. There is no convincing evidence that they help even in the immediate post-operative period (http://www.ncbi.nlm.nih.gov/pubmed/24169301 ), and they definitely aren't required 5 years later.

My physio's advice back when I tore mine was to get a neoprene sleeve to wear as a mental reminder (and maybe some extra warmth) for the first couple days, then ditch it.

If your knee feels unstable this far out, it's either a.) all in your head or b.) it's actually unstable, in which case you need to hit the gym and get those hamstrings firing again - which a brace is only going to inhibit.

He said he didn't wear the brace all the time, just for skiing. Your link was interesting, but it does not address reinjury, which is why I still wear mine.. My Dr. and therapist recommended me wearing the brace because it could prevent a hyper-extension. I only wear it for skiing, not anything else, so it has not inhibited anything. I will take their advice and continue wearing it when I ski. I only ski 30-35 days a year, so most of my muscle is built in the gym and running hills. I don't wear a brace for that, because the risk of hyper-extension is not very high.
 
13620399:dan4060 said:
He said he didn't wear the brace all the time, just for skiing. Your link was interesting, but it does not address reinjury, which is why I still wear mine.. My Dr. and therapist recommended me wearing the brace because it could prevent a hyper-extension. I only wear it for skiing, not anything else, so it has not inhibited anything. I will take their advice and continue wearing it when I ski. I only ski 30-35 days a year, so most of my muscle is built in the gym and running hills. I don't wear a brace for that, because the risk of hyper-extension is not very high.

Hyperextension is not how you would re-injure your ACL skiing - it would be twisting of the tibia in relation to the femur head. Braces theoretically could help stabilize this, but that effect is not seen in the real world (see discussion below).

To be fair, there is still some disagreement among PT/Orthopods. So here's the deal:

That review does include safety (=reinjury) as an endpoint. Here's another review that more explicitly states the point. (http://sph.sagepub.com/content/7/3/239.long )

"Eleven studies in the initial review evaluated this question, and no study demonstrated a clinically significant or relevant improvement in safety, range of motion including extension, or other outcome measures [note: this includes re-injury]. Given these studies and the expense of postoperative bracing, we do not include bracing following ACL reconstruction as part of our protocol. This was reinforced by an additional 6 studies published since 2005. None of these demonstrated an advantage from bracing."

And a skier specific discussion can be found here -http://www.jospt.org/doi/full/10.2519/jospt.2012.4024

"There appears to be overwhelming evidence in the current literature that does not support the use of functional knee braces when returning to sport.5,7,19,29,31,37 The current position of the US ski team is that the use of functional knee braces is physician dependent. We recommend using a brace for 1 year, after which the decision to continue bracing during skiing is left to the athlete. Although a systematic review of 12 randomized controlled trials performed in 2007 by Wright and Fetzer45 found no evidence that pain, range of motion, graft stability, and protection from subsequent injuries were affected by the use of braces, we refer to 2 specific ski studies for supporting evidence. Kocher et al24 found that nonbraced skiers were 6.4 times more likely to sustain a knee injury, such as a meniscal tear, chondral injury, or medial collateral ligament tear, than unbraced ACL-deficient knees. Sterett et al41 found that subsequent injuries on ACL-reconstructed knees in professional skiers were 2.74 times more likely to occur on unbraced knees."

Those last two studies are NOT randomized - meaning they just looked at who wears a brace vs who doesn't. Is someone who wears a brace more likely to ski more conservatively and/or rehab more cautiously than someone who doesn't? Definitely. So there is no way to isolate the effect of bracing from the effect of being the type of person that wears a brace. This is why non-randomized studies are not acceptable evidence for determining which treatment to use - they are only for generating hypotheses that should be later tested in an randomized trial. Trials have been run on braces and they indicated no benefit, but they have not specifically been done on skiers (primarily because randomized control trials are extremely expensive and nobody is going to make any money off of telling people to not brace their knees)

TLDR: you can either trust two inadequate studies specific to skiers supporting bracing, or a multitude of adequate studies across a variety of sports that do not support it.

Your doctor and physio recommend the brace because it is the "standard of care", meaning it is what other physicians commonly do and it is probably what they were taught when they went through school/residency - NOT because there is good evidence for it. This protects them from a lawsuit if you were to re-injure your knee and try to sue them for whatever reason. Not to shit on doctors - I'll be one in May (hence my interest in this type of thing)- but this is one example of where the data does not support common practice.
 
13620738:reBlocke said:
Hyperextension is not how you would re-injure your ACL skiing - it would be twisting of the tibia in relation to the femur head. Braces theoretically could help stabilize this, but that effect is not seen in the real world (see discussion below).

To be fair, there is still some disagreement among PT/Orthopods. So here's the deal:

That review does include safety (=reinjury) as an endpoint. Here's another review that more explicitly states the point. (http://sph.sagepub.com/content/7/3/239.long )

"Eleven studies in the initial review evaluated this question, and no study demonstrated a clinically significant or relevant improvement in safety, range of motion including extension, or other outcome measures [note: this includes re-injury]. Given these studies and the expense of postoperative bracing, we do not include bracing following ACL reconstruction as part of our protocol. This was reinforced by an additional 6 studies published since 2005. None of these demonstrated an advantage from bracing."

And a skier specific discussion can be found here -http://www.jospt.org/doi/full/10.2519/jospt.2012.4024

"There appears to be overwhelming evidence in the current literature that does not support the use of functional knee braces when returning to sport.5,7,19,29,31,37 The current position of the US ski team is that the use of functional knee braces is physician dependent. We recommend using a brace for 1 year, after which the decision to continue bracing during skiing is left to the athlete. Although a systematic review of 12 randomized controlled trials performed in 2007 by Wright and Fetzer45 found no evidence that pain, range of motion, graft stability, and protection from subsequent injuries were affected by the use of braces, we refer to 2 specific ski studies for supporting evidence. Kocher et al24 found that nonbraced skiers were 6.4 times more likely to sustain a knee injury, such as a meniscal tear, chondral injury, or medial collateral ligament tear, than unbraced ACL-deficient knees. Sterett et al41 found that subsequent injuries on ACL-reconstructed knees in professional skiers were 2.74 times more likely to occur on unbraced knees."

Those last two studies are NOT randomized - meaning they just looked at who wears a brace vs who doesn't. Is someone who wears a brace more likely to ski more conservatively and/or rehab more cautiously than someone who doesn't? Definitely. So there is no way to isolate the effect of bracing from the effect of being the type of person that wears a brace. This is why non-randomized studies are not acceptable evidence for determining which treatment to use - they are only for generating hypotheses that should be later tested in an randomized trial. Trials have been run on braces and they indicated no benefit, but they have not specifically been done on skiers (primarily because randomized control trials are extremely expensive and nobody is going to make any money off of telling people to not brace their knees)

TLDR: you can either trust two inadequate studies specific to skiers supporting bracing, or a multitude of adequate studies across a variety of sports that do not support it.

Your doctor and physio recommend the brace because it is the "standard of care", meaning it is what other physicians commonly do and it is probably what they were taught when they went through school/residency - NOT because there is good evidence for it. This protects them from a lawsuit if you were to re-injure your knee and try to sue them for whatever reason. Not to shit on doctors - I'll be one in May (hence my interest in this type of thing)- but this is one example of where the data does not support common practice.

Willis mcgehee and Marcus latimore would like to disagree with your assessment that hyperextension is not how the guy would reinjure his ACL haha.
 
reBlocke,

Thanks for posting. I will check these out when I have time. I don't however agree that skiers who wear braces are necessarily more cautious after the first year. I can see the logic, but I would not want to definitively state it without a study. I would agree that braced skiers are more likely to ski cautiously during the first year, I just don't know if they would afterwords. I would agree that they would be more likely to rehab cautiously, I just don't know about the skiing part. Like I said, I would be curious to see a study about this so that I could evaluate the methodology and the results.

Did the studies you are posting consult statisticians? If not they should have. I'm not saying they have reached false conclusions, and like I said I have not looked at them yet. I have seen numerous studies reach spurious conclusions because the people who are in charge don't know how to properly evaluate statistics. In many cases it takes a professional to do that. Economists tend to be very good at it, so do physicists. Biologists tend to be okay, although there are some biologists who have made contributions to statistics. People in fields like sociology tend to be horrible. When I read a sociology study I take everything with a grain of salt. Lots of them took one stats class and think they know enough to evaluate their findings, they usually don't. Scientists take more math and thus are usually able to wrap their brains around results more effectively than those in the social sciences. But the bottom line is that those outside statistics should always consult a professional. They should do so before and after the study. Unfortunately many of them don't.

I am a fellow of the society of actuaries with an M.S. in statistics, so I actually know what randomized means, and yes, I don't see how you could run a randomized experiment on something like this. Unfortunately I would think that studies like this would be observational, although I would have to look over yours to see for sure. Like I said, I don't see how you could do an experiment on something like this, as you can't tell some people to wear one and some people not to, then perform tests. It is like smoking, with most studies you simply have to observe, you can't tell people to smoke, which would be your treatment, you can only observe the effects of something on smokers vs. nonsmokers. You can't really assign treatments to people in this case, they will just wear a brace or not. That's unfortunate, but I don't see any way around that. I wear the brace not just for my ACL, but for anything else that has to do with my knee. Like I said, it could prevent a hyper-extension, which is reason enough to wear it regardless of whether it helps the ACL or not. When my doctor told me to wear it he did say that it could prevent other injuries, so that is a large part of why I am doing it.

The one thing I don't like is the cost statement. I'm going to do something regardless of the cost, within reason. $1,000 is not a big price to pay for something that might well increase my safety, so I don't think that should be included in the decision making. My insurance paid for most of it, but I would have gotten it anyway.

Anyway, thanks for posting. I will check it out when I get a chance.
 
13620931:dan4060 said:
reBlocke,

Thanks for posting. I will check these out when I have time. I don't however agree that skiers who wear braces are necessarily more cautious after the first year. I can see the logic, but I would not want to definitively state it without a study. I would agree that braced skiers are more likely to ski cautiously during the first year, I just don't know if they would afterwords. I would agree that they would be more likely to rehab cautiously, I just don't know about the skiing part. Like I said, I would be curious to see a study about this so that I could evaluate the methodology and the results.

Did the studies you are posting consult statisticians? If not they should have. I'm not saying they have reached false conclusions, and like I said I have not looked at them yet. I have seen numerous studies reach spurious conclusions because the people who are in charge don't know how to properly evaluate statistics. In many cases it takes a professional to do that. Economists tend to be very good at it, so do physicists. Biologists tend to be okay, although there are some biologists who have made contributions to statistics. People in fields like sociology tend to be horrible. When I read a sociology study I take everything with a grain of salt. Lots of them took one stats class and think they know enough to evaluate their findings, they usually don't. Scientists take more math and thus are usually able to wrap their brains around results more effectively than those in the social sciences. But the bottom line is that those outside statistics should always consult a professional. They should do so before and after the study. Unfortunately many of them don't.

I am a fellow of the society of actuaries with an M.S. in statistics, so I actually know what randomized means, and yes, I don't see how you could run a randomized experiment on something like this. Unfortunately I would think that studies like this would be observational, although I would have to look over yours to see for sure. Like I said, I don't see how you could do an experiment on something like this, as you can't tell some people to wear one and some people not to, then perform tests. It is like smoking, with most studies you simply have to observe, you can't tell people to smoke, which would be your treatment, you can only observe the effects of something on smokers vs. nonsmokers. You can't really assign treatments to people in this case, they will just wear a brace or not. That's unfortunate, but I don't see any way around that. I wear the brace not just for my ACL, but for anything else that has to do with my knee. Like I said, it could prevent a hyper-extension, which is reason enough to wear it regardless of whether it helps the ACL or not. When my doctor told me to wear it he did say that it could prevent other injuries, so that is a large part of why I am doing it.

The one thing I don't like is the cost statement. I'm going to do something regardless of the cost, within reason. $1,000 is not a big price to pay for something that might well increase my safety, so I don't think that should be included in the decision making. My insurance paid for most of it, but I would have gotten it anyway.

Anyway, thanks for posting. I will check it out when I get a chance.

In that case why do you not have 2 knee braces, a leatt neck brace, a pressure suit and couple shoulder braces? Haha.

Obviously I'm exaggerating, but I'm sure you get what I mean. Everyone has to decide if the possible protection is worth the loss of mobility, cost, and general PITA that various protection devices require.
 
Can't you just ask your surgeon? I basically just do whatever my surgeon tells me. I've had two ACL reconstructions since 2012 and am getting a meniscal repair in the summer; I ski with a brace at all times because I was advised to.
 
13620948:californiagrown said:
In that case why do you not have 2 knee braces, a leatt neck brace, a pressure suit and couple shoulder braces? Haha.

Obviously I'm exaggerating, but I'm sure you get what I mean. Everyone has to decide if the possible protection is worth the loss of mobility, cost, and general PITA that various protection devices require.

I know. We all have to draw a line somewhere. I guess since I have my brace and it fits well I don't see what the point is to NOT wearing it. Truth be told if I had a brace for the other knee I would wear that as well.
 
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