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Friday
Apr132018

Blown - Life after my ACL rupture - 1

The following is the first in several posts I plan to write about my new adventure involving the injury to and subsequent reconstruction of the Anterior Cruciate Ligament of my left knee. Before starting to write, I was conflicted about even doing this. I could just suffer in silence and get on with the business at hand. But with an extra 15 to 20 hours a week on my hands and a real need to quell some demons in my head, I decided that writing about the experience would be good medicine. I also believe that documenting this medical adventure may provide insight to other members of our tribe that might face the same road someday. This injury leads to a series of important decisions that many skiers are completely ill-prepared to make. I hope these pages provide a resource for making well-informed decisions about treatment and ultimately, return to the sport we love.

Sam on top before the weather got interestingPOP

I’ve made a lot of ski turns in my life. Some of them pretty, some not. Some easy, some difficult. Powder snow or frozen chalk board. Usually taken for granted, every turn is a mini adventure into possibility. Blissful, fear-inducing or down right dangerous. Steep skiing provides all of these sensations. Most of these moments pass with a smile or a sense of relief, or both, to be repeated every time we venture out. But for many of us, one single turn can be different from the rest. And that turn can alter the course of one’s life in ways you dread. For some, that alteration comes in the form of broken bones. For others like me, torn tissue. Both kinds lead to unwanted challenges and the temporary abandonment of skiing and traveling in the mountains for the foreseeable future. 

Ben enjoying lighter moments when all was right in our Alpine worldSamOn April 3rd while skiing steep couloirs with two friends in the Western Chugach of South Central Alaska, one of my biggest fears came to pass. An off-balanced turn in a 45° couloir filled with some funky snow led to an awkward hip check and the oft-mentioned “pop” in my left knee. I tore my Anterior Cruciate Ligament (ACL). I was sure of it. It hurt for a moment but the absolute avalanche of thoughts that tumbled through my mind in the next 60 seconds erased any fleeting sense of pain. 

First, the realization of suffering the most cliché of all skiing injuries and all it entails. Honestly, it’s surprising to many that I’ve made it this long skiing as much as I do without sustaining an ACL tear. I don’t think there is a day I’ve gone out where it didn’t cross my mind. At the top of every run, the ceremonial locking or unlocking of my tech toe pieces brings the event to mind if only for a moment. Having worked in orthopedic surgery for the past 24 years, I’ve treated many patients through all phases of the injury. 

Second, was the absolute destruction of my vacation plans with Karol, a ski adventure to Italy and Switzerland to start in about two weeks. The ripples and waves of the injury were spreading outward quickly.

And in the next moment, as I declared my fate with much obscenity to my partners watching just a few steps away, I became acutely aware of the impact the injury would have on their lives for the next few hours. This became my primary focus as I pondered the logistics of traversing the five and half miles of moderate terrain to the car with an uncertain weight bearing tolerance. As I looked up at Sam and Ben, I tried to read their facial expressions. The falling snow and fogging glasses made my effort fruitless. 

AssessmentSam sprung to action, rushing over to me, freeing my injured leg from my binding and helping me get a sense of things. He had an alumafoam (SAM) splint and pulled it out. I quickly pulled up my pant leg and tried to assess the situation, trying to find tenderness and elicit pain and make some sort of diagnosis beyond what I already knew. I tolerated standing on it so I clicked back into my ski. With the falling snow, a sense of urgency nearly overwhelmed me. I wanted to get on with it. I absolutely loathed the idea of burdening my friends with the task of getting me out. Standing on my left leg was reasonable but twisting motions sent sharp pains from the back of my knee. I was going to depend largely on my right leg for the task. 

Sam taking my loadSam took my pack and I quickly side-slipped down the apron to my partners. We lashed the splint to my leg with my climbing skins and some Voilé straps. Ben and Sam talked amongst themselves and I started moving. The terrain is gradual for the 5 miles down the valley and can be done without re-skinning. I used Ben’s longer poles to make flat sections more efficient. I had a couple of painful moments when I forced a right turn or two and I even crashed once in some breakable crust. But for the most part, the execution of the extraction was much easier than the anticipation of it. Along the way I got a cell signal and my phone came to life. I texted Karol what had happened then I called her to tell her. That was probably the most difficult part of the whole thing. I felt like I’d completely let her down with the upcoming vacation. 

Ready to rumbleI made good time and was mostly out of the zone in about 90 minutes. I borrowed Sam’s skins for a section of steep road in hopes that they’d keep going slow enough to avoid disaster. Both Sam and Ben went for the car and left me to my own devices and the non-stop rush of thoughts pouring through my brain. Then the car arrived and it was over. Just like that.    

Scan

As soon as I had cell service again I called my boss and told him the news. I also called the office to see about getting an MRI that evening. They obliged. Karol met me at the office and wondered out loud of I could be wrong about my presumptive diagnosis. I wish. The scan was done in less than 30 minutes and confirmed the ACL tear and brewing swelling. No fracture. My old medial meniscus stuff was there from two years ago. I hobbled to the car and drove home. 

The swelling was significant over night and my range of motion was pretty shitty in the morning. I convinced one of the PAs at work to drain it for me since I had to work for a few hours in the operating room. He pulled off 60cc of blood. It felt better immediately but the blood reaccumulated later in the day after standing in the operating room and I was back where I started. Crutches made things easier. 

I now had some important decisions to make regarding what to do next. I was certain I wanted to have my knee fixed but when, who and what needed to be answered. The next post will dive into this mess of opinion and hopefully make some sense out of what I ultimately decided to do. Stay tuned. 

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Reader Comments (8)

Brian, wish you the fastest recovery!
Thank you for the descriptions (and also upcoming ones), as you've already written, one never knows and being informed might at least help mentally those who are not health professionals.

On the other note, I had to reread that you wanted to visit Switzerland with Karol: the world is small and I share the same name with your Karol, live in Switzerland, but I am for sure not her. Where I was born (SK), the name is male. Names are sometimes quite ambiguous.

Best wishes,
the other Karol

April 14, 2018 | Unregistered CommenterKarol

Karol,

Curious. In the States, I've seen men named Karol spell it "Carroll". Who knew? Otherwise, women in America spell it both ways. Interestingly, my Karol's father is a German immigrant.

April 14, 2018 | Registered CommenterBrian

Will pray for your recovery!

I have not had this injury so I greatly appreciate your post.

April 14, 2018 | Unregistered CommenterMitch

Thanks Mitch.

April 14, 2018 | Registered CommenterBrian

Brian, such a bummer to hear about the knee. ACL tears may be the most "clich├ęd" ski injury but that doesn't make them suck any less. And, shit, they happen to the experts too (as you and Mr. Dorais have proved). I tend to think that beyond the initial physical pain, the hardest thing about an injury is not the healing or initial recovery phase -- that is easily done with sufficient motivation -- but the re-adjustment of athletic/mountain expectations that sets in after a long layoff. I broke my leg this past fall (slipped on ice while trail running) and the imbalances that have developed, along with the enormous fitness hole, have been tough to deal with as I get back on skis. Suddenly a little 3-4k' day feels like 10k'. But these things are fixable. I've been motivated by Tom Goth's seemingly superhuman ACL recovery -- eight months from knee surgery to Pierre Menta!? -- to quit feeling sorry for myself.

Would be interested to hearing in subsequent posts about whether your thoughts on brake release have changed. There's always a healthy debate at the top of a steep run as to whether one should "lock out," but I don't use brakes and dislike carrying leashes so I almost always lock. Also, whether the previous meniscal issues might have contributed to the current trauma. Maybe this is naive but I've watched friends' knees fall apart bit by bit over time until they take aggressive surgical/therapeutic action.

April 20, 2018 | Unregistered CommenterScott

Honestly, this is the main reason I took so long to get into skiing. Otherwise I probably would've started in 2011 instead of 2015. It just seemed like nearly everyone I knew who skied had fucked their ACL at some point and compromising my running was still too important to me in those years. Now my running is nearly always compromised anyhow.

I've strained my MCL's in breakable crust in both 2015 and 2016, both times in the week leading up to the Grand Traverse, meaning I've never even gotten to start that damn race. Very interested to hear why you think yours popped in this particular instance (probably an impossible question) and how you're going to deal with the reconstruction and rehab. Stay strong, dude!

April 20, 2018 | Unregistered CommenterTony K

Hey Scott,

Thanks for reading and commenting.

It's funny, I listened to a lecture to some mountain guides recently or possibly avy pros that discussed the dangers of skiing with locked toes. As a result, I've done most of my skiing this season with my toes unlocked. I nearly lost a ski once but it stopped in some soft snow. Other than that, no issues.

At the top of the couloir on this fateful day I consciously decided that the run was steep enough and the consequences of losing a ski grave enough that I locked out the toe. Of course, it's hard to know if that is what led to my knee injury but there's a good chance that it did.

As a result, I'll continue to ski with them unlocked. I will add a leash in specific conditions where ski loss would be a real problem. It's an easy compromise. I'll see if B and D Ski Gear can fashion something sexy for the task.

April 22, 2018 | Registered CommenterBrian

I hear you, Tony. The risk is real and there hasn't been a ski day in my life where blowing my knee hasn't crossed my mind, particularly in funky conditions. On the other hand, I've been skiing a long time and avoided the injury until now. In addition, earning your turns simply exposes you less to the possibility since you're simply making fewer turns overall.

I've thought about the event. Hell, I even have it on film from my GoPro. It's hard to watch. Maybe a little PTSD. Really doesn't look like much but suddenly my ski tips are up and I hip check awkwardly and my skis get under me in a strange way and, boom, just like that things change forever. Sobering as fuck. Maybe if my toe piece was unlocked I would've come out. Tech binding release is a little unpredictable but I would have had a better chance with them in downhill mode. For reasons I stated above, I chose to lock them.

In the future, I think I will continue to unlock the toes as I did for most of the season but add some sort of leash in sketchy situations where losing a ski down the terrain would be bad. This doesn't deal with the real risk of popping a ski on fall-you-die terrain but that's pretty rare. But, then again, so is blowing your knee. Fuck, skiing is just dangerous sometimes.

The surgery and rehab is long road, man, and I'm just at the start. I can deal but, damn, things are a little grim right now. In the next day or two I'll do the next post on my impression of things thus far.

Cheers, brother.

April 25, 2018 | Registered CommenterBrian

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