1 Year ACL Anniversary
For a long time, I’ve been saying to myself, “I should do a blog on my ACL injury.” And in true procrastinator form, I have put this off for exactly one year. But they always say better late than never, right? So here goes a Jeopardy-themed recap on the last 365 days of my ACL deficiency. Take it away, Alex!
You: “ACL for $200, Alex”
Alex: “Soccer and it is a great sport and a stupid sport all at the same time.”
You: “What is the sport that Chris hurt her ACL?”
Correct! You get to collect $200 and pass go! No? Wrong game?
All it took was one shitty touch from me to create a 50-50 situation and one mis-step. Non-contact, plant, pivot, boom. They say it takes only 40 milliseconds for ACL to rupture (Koga et al., 2010) but it felt like the most slow motion thing. It felt EXACTLY like how my patients have described it – like your tibia briefly detached from your body. Heaps of fun really!
You: “ACL for $400, Alex”
Alex: “High grade MCL, lateral meniscus tear, and classic impaction injury to lateral femoral and tibial condyles.”
You: “What are Chris’s concomitant injuries?”
Winner winner, chicken dinner! Look at your money board thingy grow to $600!
Now please note, I don’t often encourage people to get MRIs for their knee injuries because clinical assessment is (or should be) quite accurate (Swain et al., 2014) but I wanted it on record in case I ever write this up into a case report. Turns out, blogs are way more fun than scientific writing. Anyway, one incidental finding was that I likely had an avulsion injury to my MCL when I initially hurt it over 15 years ago also playing soccer (ugh). All those years I wasted not telling everyone I met that I had a Pelligrini-Stieda lesion!
You: “ACL for $600, Alex”
Alex: “It only happens when Chris is being a complete dumbass”
You: *thinking for a long time because there are lots of occasions that can result from my dumbassery*
You: “What is instability?”
Ding ding ding! You are well in the lead with $1200 but I don’t know if anyone else is playing…
Apart from the first couple hours of major wobbliness, I’ve only experienced one true instability. So here's a story within a story – think Inception but the blog version and about knee injuries not Marion Collitard. In late October 2018 (roughly 6-8 weeks post-injury), I decided it was a good idea to progress from a stationary lunge with 2x10lb dumbbells to a reverse lunge with a 15kg barbell. Spoiler alert: it was not. This little mishap led to the creation of a tiny friend that lived with me from November to May. Let’s call him Caillou because he was one annoying MFer. Caillou was a pseudo cyclops lesion that resulted from my ACL stump deciding to make its home in my intercondylar notch. Well, Caillou reminded me of his irritating presence at least 5x/day, always catching when I went into full extension, always causing a persistent small effusion.
You: “ACL for $1000, Alex”
Honestly, why do people do this in Jeopardy? Why not just go in order? The OCD in me writhes.
Alex: “Despite being the most common question Chris gets asked, the answer has always been the same.”
You: “What is ‘how did you get to be so good looking and hilarious?’?”
Alex: “Yes! However, there is another correct response for another $1000!”
You: “What is ‘are you going for surgery?’?”
You charming son of a bitch. Well done, you! You just leveled up a thousand points in my heart and that has more value than anything money could buy.
First off, I credit my family for my looks (quite sure that shit is genetic, folks) and my friends for my humour. Secondly, no, I am not going for ACL reconstruction. I’ve always told my patients that I would trial conservative treatment before opting for surgery so I’m living up to my words! With a modification in activities (Filbay et al., 2016), I’m quite sure I can be happy and active. Plus, I also love that Frobell RCT and my inner nerd is pretending I was randomized into the conservative group with optional, delayed ACLR (Frobell et al., 2010).
Why not use myself as a human experiment? The ultimate n=1! I’m seeing how far I can push this knee. I ain’t no scrub though If I can’t get back into hockey and snowboarding this winter, I will reconsider the knee probin’, bone drillin’, graft threadin’ alternative.
You: “ACL for $800, Alex”
Alex: “It marked the end of Chris and Caillou’s tumultuous relationship.”
You: “What is an arthroscopy at approximately 15:30 on May 16, 2018?”
Yes… How did you know the exact date and time, you creep? Here I must thank my wonderful friends for taking care of me as I was coming off general anesthetic. I was a blast (nope, never, not even close). After Caillou was literally excised out of my life, I was finally able to start progressing my rehab!
Today, I can lift, run, sprint, and jump. I am lifting heavier than I ever have. I am running as much as I did before – which is never, for the record, because running is the worst, so boring. I am sprinting but probably slower than when I was mid-20s – not my fault though, blame inherently shitty tendon turnover. I am jumping like a ninja again and my vert is back to where it was before injury.
Alex: “The Final Jeopardy theme tonight is: Disney Movies.”
You: “This is the best game of Jeopardy ever!”
Alex: “Here is the clue: This 1998 Disney song spurred on Christina Aguilera’s success.”
You: “WHAT IS ‘REFLECTION’?!”
Congrats on winning this bizzaro version of Jeopardy, you sly fox! Your prize is a long-winded monologue by yours truly! A reflection if you will…
SELF-REFLECTION #1: THIS IS A LONG PROCESS
When clinicians tell patients it’s going to be a long, arduous process, they aren’t lying. There were many days when I wished this ACL injury never happened, when I just wanted to lay in bed instead of going to the gym at 8am (which is hella early for me), when I should have annihilated my nephews at dodgeball but barely beat them because I was tentative of my knee. It takes a lot of will power.
My best advice for this journey is set small goals. A body weight squat might seem like a ridiculously easy thing to want to do but when you can do it for the first time, it’s amazing. Running 5 minutes can seem like an eternity and it is. Running sucks but I can at least do it if I really had to (aka someone held a gun to my head). The warm fuzzies really got me when I got back to my pre-injury weight for my front squats. Now I could crush past Chris with my still-somewhat-atrophied right quad and minimal effort. Small goals are huge helps.
Also, the silver lining is that this injury forces me to rehab and be active. Otherwise I likely would have become an overweight blob from sitting on my ass all day #PhDLife.
SELF-REFLECTION #2: MY #PHDLIFE
I don’t believe everything happens for a reason but this injury has really changed my research path. I went from “I want to research everything there is to know about ACL injuries!” (stupid past Chris) to “I want to know about health-related quality of life after an ACL injury.” No, I don’t plan on returning to soccer, my glory days are well behind me. But that doesn’t mean I’m going to be a sad sop for the rest of my life. So if I can give up sport and still be happy… Can others?
More importantly, can young kids (where sport is their entire life) do it? This ACL injury at 21 would have had a drastically different impact on my life compared to this injury at 31. Would I have played varsity? Would I have met all my sister pandas (the precious nickname we gave ourselves) and lived with a house with 3 of them? I probably wouldn’t have be as witty as I am now… *shudders*.
Anyway, I really just wanted to plug my research in HEALTH-RELATED QUALITY OF LIFE IN YOUTH FOLLOWING A SPORT-RELATED KNEE INJURY. Moving on.
SELF-REFLECTION #3: EMPATHY IS KING
On some weird level, I think my patients trust me a bit more now that I can say “Yeah, I know what you mean” and actually know what they mean! It’s oddly cathartic for me when I can express ACL-isms and others get it. I hope my patients feel the same way when they’re telling me about their injury experiences.
Also, I have never been treated so nicely as the time I worked an ACL clinic 2 weeks after my injury. I hobbled into rooms with my massive ROM locked brace and crutches and was instantly greeted with warm, sympathetic welcomes. I’ve genuinely considered popping on the brace again just to feel that instant compassion again.
SELF-REFLECTION #4: MY FAMILY AND FRIENDS ARE THE BEST
It’s very likely the only person who will read this is my mom. I’ve sworn a few too many times so I need to redeem myself here a bit. Mom, you are the best mom everrrr :)
On the off chance you are not the adorable Momma Le, you should know that my support network kicks ass. My mom drove me around for the first few weeks after my injury. When she left to go back home, my roommates stepped up and helped this gimp out. My colleagues (still) put up with incessant questions about my technique for this squat or that deadlift. My BJSM buddies let me share my story. My orthopedic pals set up or performed surgery on me. My orthotist friends are helping me get a brace. And in general, all my family and friends have been incredibly supportive and still love me despite the fact I am so much better looking and way more funny than them. It’s the definition of a miracle.
/monologue
This thing has gone on for way too long. I hope you’ve learned something from this post. If you want more, follow my journey on Twitter! At the very least, please take away that I’m an ordinary human being with Zoolander-level looks and clever wit but happen to be operating 50% of the ACLs most people are born with.
But you are even more awesome than me for making it through this lengthy, drawn out, lingering, never-ending post. You reading has made me the happiest, ordinary human ever.
- Chris [@yegphysio]
References:
Filbay SR, Crossley KM, & Ackerman IN. Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: A qualitative study. Journal of Physiotherapy. 2016;62(2):103-110.
Frobell RB, Roos EW, Roos HP, Ranstam J, & Lohmander LS. A Randomized trial of treatment for acute anterior cruciate ligament tears. The New England Journal of Medicine. 2010;363:331-342.
Koga H, Nakamae A, Shima Y, Iwasa J, Myklebust G, Engebretsen L, et al. Mechanisms for noncontact anterior cruciate ligament injuries: Knee joint mechanics in 10 injury situations from female team handball and basketball. American Journal of Sports Medicine. 2010;38(11):2218-2225.
Swain MS, Henschke N, Kamper SJ, Downie AS, Koes BW, & Maher CG. Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review. Chiropractic & Manual Therapies. 2014;22:25.