Advice wanted on knee ligaments...

sylvanus

I was knocked over whilst on family ski hols last week. Someone ran in to the back of me whilst we were queuing for a lift and my knee twisted as I fell and the skiis shot out from under me. Lots of pain and swelling soon after and the person responsible didn't even stop!

Went to the sports doctor yesterday since I was fairly sure I'd pulled / torn the medial ligament on the inside of the knee which he confirmed. Very charming and professional chap. He also suspects I have a "lax" Anterior Cruciate Ligament which sounds far more ominous and might/ would require an op if confirmed. I have an MRI later today. So two questions for any of you that are in the know or have had similar complaints:

1) If the injury is just to the Medial Ligament, which I believe heals fine on its own, then how long must I stay off the bike? I was just starting to ramp up training for the year and this look to have blown it! I'm hoping I can start some gentle spins on the turbo quite soon?

2) If the ACL is damaged too then I presume its months rather than weeks? Has anyone else carried on biking / gentle spins with a damaged ACL? I assume at the very least I can carry on upper body gym work but would it make sense to carry on exercising the "good" leg on a turbo or will that just lead to greater imbalances?

Sorry for all the questions but I'm yearning to get out on a bike and feeling a bit sorry for myself!

remy martin

Hi Slyvanus,

Sorry to hear about you injury(ies).

I partially tore my ACL in 2005 and didn't have my operation until about March 2006. In the meantime I was encouraged by the physiotherapist I saw to continue cycling. However, he advised me to keep off the London roads largely because he felt the constant stresses on the knee of communting through traffic, having to remove my foot of the pedals and then reattaching it wouldn't be a good thing.

I kind of ignored the 'stay off the road advice' but I did attach flat mountain bike pedals to the road bike to avoid any further twisting of the knee (yes, I know sounds like heresy, you should have seen the looks I used to get from people).

Basically, I also stopped the sport that contributed to the injury, went to the gym, did lots of seated rowing, cycling, used the cross trainer etc until the operation.

On the day of the operation, I was told that the ACL did tear further over the course of the year that I had waited for the op. I don't know what technique the surgeon you'll eventually have will use either to fashion a new ACL for you but that will also make a difference to your recovery time. (Mine used my hamstring as the new ACL). There are various benefits to the techniques they use but usually it comes down to the surgeons preferential method.

After the operation, I was on crutches for about 5 and a half weeks, did all the exercises I was told to do and then some. Fortunately, once I was able to place some weight on my operated knee, the first exercise recommended was stationary cycling and then the real deal within about 2 -3 months.

I left the mountain bike pedals on for further 6 months and then moved on to SPD's. Obviously, you will lose a lot of muscle mass on your legs after the operation (I lost about half of my quad and the remaining bit felt a little like jelly for a while) so ,the more work you do to maintian some degree of strength in your quads before the op the easier you'll find it after the op.

2 years or so down the track now and I still enjoy riding. If you maintian riding, you will regain that lost muscle within 6-12 months depending on how much you ride and possibly quicker if you couple that with weight training.

Best fof luck anyway. I hope the MRI gives a definite picture as to the problem.

dennisn

Wait for the results of your MRI. Then talk to your DOCTOR about options. Don't
look to forums for medical advice in the hopes that someone will tell you that everything
is ok and go ahead and ride, no problem. Listen to the guy on crutches and above all
listen to the DOCTOR. Please.

Dennis Noward

cee

i partially tore my mcl and split the meniscus.

i could not have got on the bike if i had wanted to for at least 8 weeks, but then I was in a leg brace for 6 of those :roll:

sylvanus

Don't look to forums for medical advice in the hopes that someone will tell you that everything is ok

Absolutely, Understood & agreed. I probably phrased my questions poorly and was looking more for empathy, comparisons and encouraging stories, and not to second-guess the doctor!

Anyway many thanks to Remy Martin for the excellent advice and encouragement. It sounds as though I should have the ACL fixed straightway which seems also to be the advice of the doctor although the results / analysis of the MRI won't b ready for a couple of days.

Oddly enough as I limped to the MRI today the knee seemed a bit better although from the sound of it an ACL injury can be almost pain free. Disappointing though it is to be off the bike I'm determined to make the most of the time and use it well. My greatest fear is that biking is the way I keep vaguely thin and I can see myself swelling to R101-proportions over the next few months! :?

Looks like lots of gymwork at best but I promise I'll check everything with the doctor....!

remy martin

Your welcome Sylvanus. My earlier post was purely what my experience was like. Naturally, yours will differ so as has been suggested, your GP, well actually your physiotherapist and surgeon are naturally the ones you should be listening to.

I shared my experience largely because much like I did at the time, I suspect you’re feeling that things aren’t looking too good at the moment.

All I can say about that is that it does get better in time. I remember being annoyed at the fact that within a few days of the tear, I felt much better and ‘thought’ that I could go back to the sport I was involved in. I felt the ACL pop and then was pain free within a few days. There also wasn’t much pain after the surgery, more tightness in the knee joint as my hamstring was extremely tight and there was a lot of swelling that had to go down.

However, like you’ve stated, I was adamant that I would make the best use of the rest of my body to exercise prior to the operation. You’ve actually echoed some of my fears around weight gain too. In my case, I found that I actually consumed less food during the time I was immobile largely because I wasn’t as hungry. I did put on a little extra weight but that might be to do with the fact that I love my chocolate more than anything else! Anyway, it became such an event to move about that I only moved when I had to exercise the bad knee which was quite often during the course of the day. The weight came off soon after I was back on my feet and as long as you eat a balanced diet, I wouldn’t be too worried about swelling up.

Anyway, keep us posted on how it all goes.

SteveR_100Milers

Be thankful its not a PCL thats torn, which is what has happened to a friend of mine. Its 9 months recovery, of which 4 months in plaster. Fingers crossed for a speedy recovery.

Mike Willcox

Football, Tennis, Squash and Rugby suddenly brought to a halt with one tackle in football training. My medial ligament was ruptured(actually the bone was snapped where the medial ligament was attached). Cruciate ligaments were in shreds and after 2 operationa and aborted come backs finally called it a day when the cartilage went as well.

All this took about 2 years with 9 months off work in plaster and physio. A speicalist told me that it was one of the most unstable knees he had ever seen.

My Father in Law was on the committee of the North Road CC and encouraged me to ride a bike aged 25.

My knee is decidedly dodgy due to stupidly playing a game of football with other dads having a knock about while watching their sons play. Also years of playing squash (with a special knee support) has not helped much either. Right now my right leg is weaker than my left but what the hell it's not going to stop me riding and racing. It's all down to how much you want to do it.

Mettan

sylvanus wrote:

2) If the ACL is damaged too then I presume its months rather than weeks? Has anyone else carried on biking / gentle spins with a damaged ACL? I assume at the very least I can carry on upper body gym work but would it make sense to carry on exercising the "good" leg on a turbo or will that just lead to greater imbalances?

I've currently got a partially torn ACL (I'm going to be seeing a specialist in the coming months to try and get a full reconstruction). You'll have to wait to see whether it's a full or partial tear - if it's a full one they'll probably do the reconstruction within a month or two (they tend to let the inital injury calm down first) - if it's partial then they might reccomend a conservative approach (which unfortunately, is essentially what happened in my case).

Personally I wouldn't risk going on the bike at present, until you get an accurate diagnosis - if you have incurred a substantial tear, and you want to stay very active in sport, personally I'd try and get a reconstruction done (after diagnosis, discuss with your doctor at length though first)

Wish you all the best with it though - good luck.

Mettan

remy martin wrote:

2 years or so down the track now and I still enjoy riding. If you maintian riding, you will regain that lost muscle within 6-12 months depending on how much you ride and possibly quicker if you couple that with weight training.

Hi Remy - if you don't mind me asking - how "stable" is your knee when riding? I don't mean in terms of it "giving way", more, does the joint feel noticeably more "lax" "stretched" as a ride progresses? Does it feel more "lax" after you've finished a ride? Do you get much pain when riding (from a stretched graft allowing the bones excess movement) - if so, does the pain build up throghout the ride?

The reason I ask, is that I'm in a similar situation to how you were and am wondering, how solid is the reconstructed knee on a bike, and can it take substantial mileage without incuring a progressive build-up of joint pain throughout a ride.

sylvanus

if you have incurred a substantial tear, and you want to stay very active in sport, personally I'd try and get a reconstruction done

Thanks for the advice - I'd agree but haven't yet had a chance to discuss the MRI with the doctor although I'm lucky that he's a keen sportsman and specialist Sports Doctor so his immediate assumption was that I would go for reconstruction if the ACL is torn or broken.

Part of me is still hoping that the MRI will come back showing the ACL all clear - the other more realist part knows I'd better accept all that swelling came from somewhere!

remy martin

Hi Meetan,

I don’t feel any lax in the joint when riding now. When I was able to get back on the bike after the operation, my riding was very much based on gradually building up the strength in the knee joint and muscles, i.e I started riding about 45 miles weekly coupled with a 6 hours in the gym of low resistance weight training. It was about 11 months before I increased the riding distance to about 100 miles week along with the 6 hours in the gym.

Then about 8 months ago I added a further weekend ride of about 80 miles and have continued without any ‘lax’ nor pain in the joint either during the ride or after.

The surgeon who operated on my knee was fantastic. My recovery was text book in terms of timing and the leg has gone from strength to strength.

The only thing I would add is that there are a number of variables to consider:
•Your age / fitness level will obviously will affect the pace of recovery for your knee during / after a ride
•Strength and flexibility of your quads and calves. The martial art I was doing was primarily a kicking activity so I have always had relatively strong legs / flexibility, particularly on the operated knee.
•How much you listened to your physio / surgeon post operation in completing the recommended exercises.

So, to answer your question about how solid the knee is, I would say that it feels no different to the un-operated knee and certainly strong enough for lengthy rides of 5 hours. However, if you are riding an 80 mile hill….perhaps you might feel a some pain…

Ultimately if you listen to the relevant medical experts and crucially listen to your body I can't imagine that the longer bike rides will do you any harm.

sylvanus

Doctor called earlier today with the results of the MRI. The ACL is "showing some disruption" which I guess is medical speak for "torn" so it looks as though I'll be going under the knife shortly - damn!! :?

Still I suppose its a chance to perfect my stoical outlook on life and reflect on how much luckier I am than many others....perhaps take up knitting...

Next appointment with the doc on Tues to discuss details and alternatives...

Mettan

remy martin wrote:

Hi Meetan,

I don’t feel any lax in the joint when riding now. When I was able to get back on the bike after the operation, my riding was very much based on gradually building up the strength in the knee joint and muscles, i.e I started riding about 45 miles weekly coupled with a 6 hours in the gym of low resistance weight training. It was about 11 months before I increased the riding distance to about 100 miles week along with the 6 hours in the gym.

Then about 8 months ago I added a further weekend ride of about 80 miles and have continued without any ‘lax’ nor pain in the joint either during the ride or after.

The surgeon who operated on my knee was fantastic. My recovery was text book in terms of timing and the leg has gone from strength to strength.

The only thing I would add is that there are a number of variables to consider:
•Your age / fitness level will obviously will affect the pace of recovery for your knee during / after a ride
•Strength and flexibility of your quads and calves. The martial art I was doing was primarily a kicking activity so I have always had relatively strong legs / flexibility, particularly on the operated knee.
•How much you listened to your physio / surgeon post operation in completing the recommended exercises.

So, to answer your question about how solid the knee is, I would say that it feels no different to the un-operated knee and certainly strong enough for lengthy rides of 5 hours. However, if you are riding an 80 mile hill….perhaps you might feel a some pain…

Ultimately if you listen to the relevant medical experts and crucially listen to your body I can't imagine that the longer bike rides will do you any harm.

Thanks Remy - that's very encouraging - (I've been a bit concerned that the repetive loading on the knee could cause the graft to stretch over time - by the sounds of it, that's not really a problem). It'd good to here a positive story, though - I'm looking forward to getting mine done ASAP.

sylvanus

The surgeon who operated on my knee was fantastic. My recovery was text book in terms of timing and the leg has gone from strength to strength.

Hi Remy

Could you send me a pm with the name of your surgeon? I think I might give him / her a call next week! Thanks too for all the advice and reassurance, its much appreciated by we knackered old donkeys that hope to become racehorses again.....

bahzob

Good luck and hope for a good recovery. Got knackered knees as well due to a bad football tackle 20+ years back but touch wood still feel more of a racehorse than a donkey.