Sunday, August 16, 2015

A Climber-Centric View of ACL Surgery (and other first world problems) Part 1

Skiing the Japanese Couloir on Mount Barrill in a storm, Ruth Gorge, AK

Well it finally happened.  I have been skiing since I was two years old- in high school I could ski better than I could walk.  I have skied serious lines in the mountains of Montana, Wyoming,  and the Ruth Gorge/Kahiltna Glacier in Alaska.  I finally hurt myself after a 30 year run of no ski injuries and I did it on the school ski trip, in the terrain park, while wearing a one piece Carhart suit.  Stay gaper my friends.

I blew my ACL out (completely) in my left knee.  The past 10 years I have been more of a climber than a skier, I ski for fun, I climb to sustain my sanity in a strange world- so I view this injury as a hindrance to climbing, not skiing (I could never ski again and be fine with it as long as I could climb).  While searching the great cyber world for information pertaining to climbing and ACL replacement I had to wade through a lot of junk indicative of the internet tubes.  The best resource I found was Steph Davis's blog about her ACRr.

Not every climber is the same caliber as Steph so I will relay my injury as yet another anecdotal story that may help others get information, comfort, or psych about this injury.

Here is my story:

March 31, 2015.  Last run of the day I decide to go through the terrain park in my onesie Carhart suit. As a high school kid I was a park rat and I still know my way around the park.  This time was different though.  I went off a small kicker, nothing cool - straight air - and landed hard in super slushy snow.  My left ski must have stuck in the heavy snow for a second longer and I felt a grinding in my left knee as it hyper-extended.  No popping sound, no ejection from the ski, no wreck, nothing special really.  Right away I knew I was hurt though.  I stood up and my knee hurt in a way it has never hurt before.  I leaned on my poles for a minute then skied down.  My knee buckled 2 or 3 times on the way down and that hurt really bad.  I went into the patrol shack at the base area and Anne looked at my knee then sent me to the E.R.  The doctor there pulled on my knee and twisted it feeling for instability or looseness.  He found nothing and sent me home with a brace and crutches, it swelled up a day later.  I was on crutches for 2 weeks and started trail running and top rope climbing as soon as I could. I took it really easy though.  

My knee the day after the injury

I knew something was up with my knee after a month of it still not quite being normal (hard to explain the feeling - cramping of small muscles deep in your knee you never knew you had, afraid to walk hard on it on uneven terrain due to fear of hyper-extension).  It also hurt between the tibial plateau and femur when I bent down, so I couldn't (and still can't) crouch down all the way or sit cross legged. The next doctor I went to pulled on my knee once and chuckled then stated "Your ACL is out".  I got an MRI and the results showed a complete tear and a medial meniscus tear.  sweet.  The meniscus tear is what hurts when I try and bend my knee to sharply.  The ACL doesn't hurt at all, just feels different, it is very stable (I could go skiing on it no problem), yet not 100% and I have been coping.  

MRI of my knee.  The ACL should be dark black (like the PCL near the back of my tibia).  This picture shows a grey, stringy thing between my tibia and femur - that is the remains of my ACL.

Okay, what now?  

The first question I had was "Is surgery necessary for me?"  I have no instability, I can still lead 5.12 trad, I feel totally comfortable on boulder fields, I have surfed, I trail run, I boulder and fall on my knee all the time.  For some people they can't put any weight on their knee following an ACL tear, I don't fall into this category thus this question is harder for me to answer.


I have turned down trips to the Wind River Mountains, The Enchantments, and other amazing places this summer because I can't carry heavy loads on uneven terrain.  This combo makes my knee feel like it could hyper-extend suddenly and then I would really be screwed, especially if I were back in the mountains.  With out fixing my knee I can live a pretty good life (as I have these past 5 months) and I basically do what I always did before the accident, the only exception is I have to never go in the mountains for the rest of my life.  No more trips to Alaska, Nepal, South America, or even the mountains in Montana.  That is the single most important deciding factor for me to get my knee fixed.  If you are questioning if you should get surgery sincerely ask yourself if you are ready to give up whatever you have to give up, there are limitations - address them logically.

The doctor stated that the risk of osteoarthritis increases without getting surgery as there is low level instability that over the years will reduce your meniscus to nothing.  I don't know if I buy this yet as other studies contradict this statement and the cohort sizes are seriously (alarmingly) small for any ACLr studies I have read - I almost trust anecdotal evidence more at the moment (remember I teach science).  Regardless, listen to your body and be honest in the quality of life you will have if you get surgery vs. no surgery.

The second question I had was what type of graft to get.  There are 3 main types, cadaver, hamstring, and patellar grafts.  


I don't know yet.  I am getting surgery this December so I have some time to think about it.  I do know that I don't want a patellar graft.  I have talked to to many people I admire who now have extreme tendinitis from their ACL repaired with their patellar ligaments, they can't ride bikes, jog, etc..  Basically their quality of life is diminished from that graft.  My doctor agrees.  So it's cadaver (which has a higher % of failure, tissue rejection, and is creepy, but heals faster, and doesn't compromise other parts of your body) or hamstring (where they steal part of your hamstring to replace your ACL, longer recovery, reduced strength in leg for life, constant cramping, stronger graft).  Both have limitations but I must choose one.  Keep you posted on which one I choose and why**.

**The next part of this story may be a year from now.  This isn't twitter, I'm not going to have a minute-to-minute play of how everything feels.  I am going to try and provide good, reflective, and sound advise on how my experience with ACLr went via the methods I choose with a climber-centric mindset.

Cheers, Loren


  1. I'm expecting gory surgery pictures - and a full recovery.

  2. I'm expecting gory surgery pictures - and a full recovery.