Cancel dive trip due to torn ACL???

[adrisen]

I have torn the ligaments in my knee, and dive on an on going basis. Not that you can't have problems. I have had to strengthen the muscles in my legs surrounding my knee. I have also had to modify my kicking to my own style that works. when I was on a liveaboard I was able to gear up on the boat but I could not get back up the on the boat so I had to remove my gear in the water and it was hauled up. I sometimes dive with my knee bandaged and it helps. I also cut my diving in half. half the group did close to 15 fives I think I did around 7-9 for the week on the boat, I took it easy.

I would see a specialist ASAP though and if you do go have a great time.

 

[El Cid]

I had symptoms similar to patellar tendinitis a few weeks back from softball and jogging but dove anyway. I ended up thumbing one dive early not from the pain but from a wierd pressure during my kicks. I was capable of diving and climbing the ladder, walking etc. If I were in your shoes I would try to work out a rain check with the operator. Promise to take the trip when you heal. I'm sure they don't want to have a dive emergency on their boat so they may be willing to work with you.

Its always best to be on the safe side since you could cost yourself months of diving later down the line. On the other hand my incident was with a local dive op so I can still go out and play later. A liveaboard might be different. Definitely see what a family practitioner or specialist says but don't expect to be healed in 20 days. Even though your buddy is experienced, problems can always arise where you may need to tow him in or get over to him in a hurry when he's entangled. Be honest with yourself and your buddy.

 

[TSandM]

Also depending on the MRI and type of tear there is definite seepage of fluids into the area absolutely ripe for a embolism.

Having some edema or effusion in the knee does not increase your chances for an embolism. You have any number of normal fluid spaces in the body.

As previously stated, ligamentous injuries can vary tremendously in their severity. It is quite possible that a mild strain might be essentially well in three weeks. A severe strain will most likely not be, and might be converted to a complete tear by the stresses involved in handling gear on a boat, where sudden twisting loads might be quite reasonably expected.

ACL injuries don't even all require repair. It depends on the demands a person is putting on the knee. Sedentary people may not find a torn ACL to be that limiting, whereas athletes will not be able to function that way. I think if one dives regularly, one would want a healed or repaired ACL to do so. For this reason, avoiding converting a strain to a tear would be highly desirable.

Again, discuss this with your orthopedist. He is in the best position to know how bad your injury was, and how much your knee is likely to be able to take. Be sure you tell him about how you kick (eg. flutter vs. frog) and about carrying gear on the boat, and climbing ladders, etc.

 

[dpbishop]

My GF tore her ACL about 10 years ago. After 4 months of saying " we will just watch it because we think it will get better" the docs finally scheduled surgery. The HMO wouldn't authorize a full repair ("not for a women your age" they said. "maybe if you were a young basketball player") so they just cleaned up the torn cartilage. 6 years later she hyperextended her PCL going down the steps at La Jolla Cove in Full Dive gear. The doc (new insurance co.) said it was due to the lack of an ACL; so this time the repaired the original ACL like they should have done first. I wouldn't risk further injury, and I would make damn sure that they do a full repair. If they say you don't need it say "I would like to file a grievance".

 

[BarryNL]

Because ACL injuries can vary from tearing a few fibers to completely diving the ligament, the best person to answer this question for you is the orthopedist who is following your injury. But I think even if you are cleared to go, it might be reasonable to modify some of your procedures. What comes immediately to mind is the stress on the knee involved with trying to maneuver oneself on deck while wearing scuba gear, as the boat is pitching. I think at the very least, you might want to gear up in the water.

As I've posted elsewhere, I have a completely divided left ACL and no problems with diving (and I'm a frog-kicker). Basically, the ACL is there to prevent over rotation of the knee; diving, especially with a flutter kick, really doesn't put any rotational stress on the knee. I've run a marathon with this busted ACL so I can definitely say that back and forth movement is not an issue. Even with the frog kick you are supporting the joint with the muscles during the power stroke so it is not a problem.

As you point out, the real problems come from things like rocking boats which can cause unexpected rotational stresses on the joint, as well as slippery surfaces and simple carelessness walking with heavy gear on. But that's life in general with an ACL injury.

 

[BarryNL]

I would make damn sure that they do a full repair. If they say you don't need it say "I would like to file a grievance".

I wouldn't be so sure that's the right way to go. Don't forget, there's a significant risk (maybe 1 - 2%) of serious complications from surgery. Then there is the very difficult rehabilitation period and the chance that the joint may end up worse than in the beginning. I was offered a full repair but given the risk/reward I felt the procedure offered I decided I'd rather live with it.

An ACL repair is not trivial and you really need to carefully think about the risks and benefits before deciding to go ahead.

 

[Diver Dennis]

1 - 2% is significant???

 

[Noboundaries]

I wouldn't be so sure that's the right way to go. Don't forget, there's a significant risk (maybe 1 - 2%) of serious complications from surgery. Then there is the very difficult rehabilitation period and the chance that the joint may end up worse than in the beginning. I was offered a full repair but given the risk/reward I felt the procedure offered I decided I'd rather live with it.

An ACL repair is not trivial and you really need to carefully think about the risks and benefits before deciding to go ahead.

Hmmm, 1-2% risk. I'll live with that.

I had a full repair following a karate injury back in August 2004. In fact, I didn't know it at the time but I had a full blown ACL when I got certified in September 2004. The docs were still in the "lets wait and see stage" at the time of the cert class. We even continued with Karate until my surgery in December 2004. Other than the knee collapsing backwards every once in a while, it wasn't a problem. I adapted.

We didn't dive after the certification for two and a half years, but that's because we HATED our certification dives, not because of the injury. I had the knee repaired in December, was back at work in three weeks, and rejoined our Karate class in about six months. Every once in a while I'll get a twinge, but that knee generally isn't much of a problem.

Knee rehab? It's just about exercises and pain management. Do as you're instructed and you'll be fine.

I'll be able to tell you about hip replacement surgery in a couple of months (old motorcycle accident injury). I've had so many surgeries due to active lifestyle injuries I just tell the surgeons to use zippers instead of stables because I'll be back.

 

[Texasdivechick]

Update:
There have been significant improvements since my original post. I have made the decision not to cancel the trip, a decision that was not made lightly, I might add. The doctor and captain of the liveaboard has cleared me for diving (YAY!!!) and I have been working with a physical therapist to improve the strength in my knee. The surgeon informed me that since it was only the ACL that was damaged that I should recover very quickly and be able to do most of the activities I engaged in before the accident, though had I damaged the miniscus, MCL, or PCL in addition to the ACL, I would not be allowed to dive. I'm now walking without crutches while wearing a specialized brace, climbing stairs, and doing my therapy religiously. The PT told me that I'm doing very well so soon after the injury and that I should have no problems in the water. We discussed the mechanics of different kick styles and I was told that my usual frog kick is actually the best method in terms of preventing strain/ pain (something to do with avoiding hyperextending the knee when using a straight-leg kick). I was issued a really cool neoprene water brace that will help keep my knee stable but still allow me to walk and bend my knees. My dive buddies and I are going to spend some time in our local pool to work out any kinks as far as donning/ removing gear before we leave for our trip and climbing wet, slippery ladders (my dive buddies ROCK!!). The main issue with an ACL injury is to guard against instability, such as when walking on a wet deck with heavy gear. With this in mind, I also have a plan of action involving my primary dive buddy and 4 of my close friends who are on the trip with me in regards to helping me with my gear on the boat and everyone has agreed to lend a helping hand. As far as variables go, I plan to dive very conservatively and not push myself to do every dive offered. If the current is swift, seas even moderately choppy, or reef is deeper than about 50 fsw, I am satisfied to stay on the boat (without pouting!).
I will be making my 100th dive in the Dry Tortugas, so it will be a memorable trip in many ways!

 

[Texasdivechick]

I wouldn't be so sure that's the right way to go. Don't forget, there's a significant risk (maybe 1 - 2%) of serious complications from surgery. Then there is the very difficult rehabilitation period and the chance that the joint may end up worse than in the beginning. I was offered a full repair but given the risk/reward I felt the procedure offered I decided I'd rather live with it.

An ACL repair is not trivial and you really need to carefully think about the risks and benefits before deciding to go ahead.

Not everyone chooses to have knee surgery for a damaged ACL: it totally depends on the individual's lifestyle and personal goals. My surgeon and I have decided to go ahead with the surgery after the trip, though he told me I could wait up to six months without suffering long-term damage. He wants me to be aggressive in my physical therapy in order to make my knee and surrounding muscles strong before the surgery. I chose to have a donor ACL ligament rather than using my own hamstring, a choice that cuts the recovery time in about half but doubles the ick factor. I'm very fortunate that I live close to a major sports rehab center and hospital so I know that they do these types of operations all the time. It is a 1 hour outpatient procedure using only a local anesthetic and they want me up walking by that evening. I know it will be painful, but I've been told I will be issued a cryo-cuff or gameready machine that will ease the pain and a CPM (continuous passive motion) machine that will keep my knee from getting stiff. Doesn't this sound like fun?!? Perhaps I should plan another dive trip for the fall sometime, just so I'll have some incentive to heal quickly! If I do, I'm definitely taking out dive insurance, just in case!