StanP

Hello everyone,

I'm now seeking info and experiences on what bicycling is like with a busted, unrepaired ACL.

On Wed. 28 May 08 I started a thread in this forum--> "MRI best for an injured knee after an accident?". I told you about the car that crashed on Tues. 27 May into my left side and the left side of my dear, very old, classic, sturdy Raleigh touring bicycle. I was taken to the hospital due to bad leg injuries (especially of the left knee).

On Wed. 29 May I saw my VA doc who said I have an MCL (medial collateral ligament) tear. He said the injury was serious enough and with my left knee now unstable due to the car that hit me, he was arranging a meeting for me with an orthopedist.

Today I met the young orthopedist at my local VA. Only X rays of the left knee have been done to date and since 29 May I've been wearing an Ace bandage and an easily removable, nearly full leg length immobilizer on my left leg-- it keeps the leg straight. The orthopedist carefully examined my leg and said "Yes, you have an MCL tear." [I knew that that kind of tear is never surgically repaired: it heals in time.] But he also said I have an ACL tear and, due to my age (nearly 61), it would not be surgically repaired. Since I told him that bicycling is very, VERY important to me, he said I'd be able to ride again after healing-- the ACL wasn't crucial to bicycling. [I think he *might* have said too that I might have to wear one of those pull-on black knee supports-- I don't know.]

I told him I could not now flex my loaded or unloaded left leg because in that formerly so easy flex, I now, post-accident, have great pain in attempting to do that. In him exam, he started to bend my left leg so that the lower part would fold under the upper part but the pain quickly became too great and I stopped him from going further. [I asked him what that great-pain-with-simple-flexing meant. He said something but I can't recall what he said it means.]

When he said that in time I'll be riding my bicycle again, I didn't think of asking him "What do you mean? Riding only 3 mph or able to easily ride at 15 mph?" [Before my recent accident, I generally rode the roughly 15 mph speed as long as there weren't terrible headwinds.]

I'm wondering if he said that the ACL is not repaired due to my age because I go to the VA or is this true also for any non-VA clinic and hospital? What do you know about age and repair of a torn ACL?

I'm wondering if the kind of ACL tear caused by a car crashing into you is different from any other kind of ACL tear and if any difference between them also has a bearing on being able to ride a bicycle again.

He told me today he's ordering an MRI of my left knee in order to understand and know if there's any other damage in my knee from the car hitting me late last month. He said the MRI would be done within a few weeks. [I'll be back in the VA's orthopedics clinic after the MRI is done.]

I didn't ask him how a busted, unrepaired ACL would affect other activities I like: dayhiking, long, fast walks, and perhaps a return to backpacking (carrying a hefty load). Would hiking uphill or downhill or both be difficult and maybe painful with a busted, unrepaired ACL?

What can you tell me about any experiences or knowledge you have in this kind of an ACL injury and how it affects bicycling (and any other kind of physical activity)?


Thanks

Whiteknight

I had an ACL tear in 1975. Bicycle accident at work. Repaired in 1977. Which then went degenerative around 1990.

An MRI is about 80% accurate when it comes to looking at damage within the knee joint. The only 100% sure thing is a scope job on the knee. An MRI on my knee in 1992 missed a torn meniscus which was discovered when they went in to clean up the rear face of the kneecap.

Most orthopedic docs are hesitant to dive into ACL repairs these days unless clearly necessary. They do push the idea of strengthening the muscles above the knee that stabilize the knee. The best way to strengthen these muscles is to pedal a bicycle. Pedaling also helps to lubricate the knee joint and does not produce impact on the joint as would be the case with running or walking.
Ten years ago my orthopedic specialist gave me a choice. A bicycle or a cane. Settled for 3 bicycles.

Dr2006

(Physician: Surgeon turned Radiologist)

Performing a physical exam of the lower leg, which includes the anterior drawer test (check for ACL injury), gives physicians information regarding the stability of the ACL. Physicians can predict the extent of injury by using specific physical exam maneuvers, however an MRI is the "Gold Standard" diagnostic modality for joint ligamentous injury.

Approximately 50% of the time the MCL is injured with the ACL.

There are three Grades to ACL sprain (most ligamentous injuries use this scale):
Grade 1 - Ligament is stretched, but no fibers have been torn (not surgical, knee is stable)
Grade 2 - Ligament is stretched with partially torn fibers (usually not surgical, knee is stable/unstable)
Grade 3 - Ligament is stretched with complete disruption of fibers (surgical, knee is unstable)

Only an MRI can determine the above.

Often times, isolated ACL injury is treated conservatively, but this is usually an option that is reserved for those with contraindications to surgery or a very low impact lifestyle (amongst other reasons for non-surgical management.) I am guessing your orthopedic physician felt that your physical exam was not that of a complete tear and is therefore predicting surgery may not be indicated, however to be certain, an MRI must be performed.

Post your results after your MRI if you have any questions regarding the report.

Get Well!

Dr2006

MRI is approximately 95% sensitive and 100% specific for an ACL injury.

It is approximately 80% sensitive and 95% specific for an associated MCL injury.

TXChick

I don't know if this is helpful or not, but a co-worker tore his ACL back in January while playing basketball. He wore a contraption on his knee for about four months--a metal brace thing that was adjusted every few days to bend his leg at an increasing acute angle. He is 43 and was told this was the best therapy route to make his knee useful again.

My dad, when he was about 45, tore his ACL stepping down off a truck. He had arthroscopic surgery and has been fine ever since.

Neither are cyclists, but my dad has had full range of motion all these years and my co-worker expects to have full range of motion eventually. Even though he no longer wears the brace, he is not 100% yet.

atomship47

i've had 1 'scope and a reconstruction on each knee.

cycling was the single best activity for me pre-surgery, during rehab and after.

oddly enough, i didn't become a "cyclist" until 10 years after my last surgery. my knees feel better now than they have since i was a teenager.

regarding not repairing your acl, it's your knee. i'd never consider just living with a torn acl. it was painful and debilitating to have a torn acl. my knee would "pop out" at unpredictable times and during completely everyday activities.

deraltekluge

I tore my ACL (at age 65) falling off a bicycle. I ended up seeing a sports medicine specialist, and was informed that surgery to try to fix it would be a very big deal, and that I should learn to live with it rather than go through any surgery.

RonH

I'm 63 and just had my knee repaired. Read the following for my story.
https://www.bikeforums.net/showthread.php?t=404201
https://www.bikeforums.net/showthread.php?t=417301

Dahon.Steve

Have you contacted a lawyer? This sounds like a costly accident.

StanP

Steve, I've not yet contacted or interviewed any lawyer. I thought it would be best to do that *after* the left knee MRI which will be done in the next few weeks.

I've already received maybe 8 or 9 pieces of mail from lawyers who tell me they're 'so sorry' about my accident and who want me to hire one of them.

Soon after the accident (27 May) I got the names of two bicycle friendly lawyers in my city. One of them was a bicycle racer in the 1970s and now is a coach to bicycle racers. I'm not a bicycle racer (and was not one in the past) but I figure this guy *might* be the one I'd want to handle this matter for me. He'll certainly know how important it is to be riding a bicycle and how one feels about having been cheated from riding by such an accident as mine was.

The girl who hit me on 27 May is a MINOR. She turns 18 next month. So I'd have to sue her parents. Since the insurance company of the driver and/or owner of the car (her father) has not contacted me, I figure she and her dad have not filed a claim with the company, therefore no phone call to me yet from that company which of course anyway only wants a victim to settle for some lower amount, not sue, and then quickly sign their document saying the victim will never again try to get $ from that company. [The car owner does have car insurance, but I of course don't know what kinds of coverage limitations.] [Maybe the girl and dad hope I just go away and never file a claim-- I don't know.]

Maybe she never told her dad about the accident and will just quietly pay the ticket she got. I don't know what happened to her car in the accident. Since it was a crash into my left side, maybe my body took all the damage and protected the car. I know she wasn't injured.

[Steve, I grew up in Nutley; long, long ago, went to Rutgers in New Brunswick.]

StanP

Dr2006, thanks for the helpful info and for your good wishes that I get better. I hope to do that but will know more of what's ahead for me after the left knee MRI which will come along within the next few weeks.

Seamless

Your attorney will verify, but generally, once a minor attains majority, s/he can be sued in her or his own name even for accidents that occurred while a minor. If 18 is majority age in WI, then you may be able to sue her directly next month.

There may also be grounds and strategic reasons (depending on WI law, which I'm not familiar with) to include the owner of the car as a defendant, so ask your attorney.

Filed a report? (You would make the claim.) Don't delay notifying her insurance company of the accident: the insurer may try to deny coverage for failure to receive prompt notice by the insured. You don't need to provide a recorded statement in order to institute a claim (and don't give a statement without asking your lawyer as to how much detail you should provide, if any, beyond a letter with copy of the accident report).

I have no experience with VA medical benefits; it's possible VA may have a lien on any proceeds you might receive (which is typical in the case of private insurance plans and public benefits). So check with your attorney before settling your claim.

It might be helpful from a civil suit point of view (again, depends on WI law) to have your attorney on board before the traffic violation plea.

I've suggested a few reasons why, if you expect to use an attorney, you should get the attorney involved early on.

StanP

Thanks for the useful and interesting info.

I found one website (https://lawdigest.uslegal.com/minors/...majority/6425/ ) that says this about age of majority in Wisconsin:

In the construction of Wisconsin laws the words and phrases which follow shall be construed as indicated unless such construction would produce a result inconsistent with the manifest intent of the legislature:

- Adult. "Adult" means a person who has attained the age of 18 years, except that for purposes of investigating or prosecuting a person who is alleged to have violated any state or federal criminal law or any civil law or municipal ordinance, "adult" means a person who has attained the age of 17 years.

- Minor. "Minor" means a person who has not attained the age of 18 years, except that for purposes of investigating or prosecuting a person who is alleged to have violated a state or federal criminal law or any civil law or municipal ordinance, "minor" does not include a person who has attained the age of 17 years.

Chap. 990, §990.01(3), (20)

[end of webpage info]

If the above is true (I've contacted my state senator to find out if it is indeed true), then she - still 17 on the date of the accident - would be a major since she was given a ticket by the police. The policewoman in charge of my case told me she (the 17 y. o.) failed to yield and therefore violated a municipal ordinance (I suppose).

I have to find a lawyer very soon it seems.

TRaffic Jammer

If you've been seriously injured you need to get a lawyer on them and their insurance company ASAP.

DCCommuter

If you are really considering litigation you shouldn't discuss your case on an Internet forum.