Ski season is here and I'm sure most of you are beyond pumped, especially here in the Vail Valley after some fantastic early season pow for the 2015-2016 ski season.  After hosting last year's 2015 World Championships, Beaver Creek, Vail Valley, and Summit County are ready to rock.  Not to mention all this talk of "El Nino"... more snow anyone? I say let's do this.

Of course, now's the part where I pivot to talk about what you expect me to talk about-- knee injuries.  I know some of you are recovering from skiing's most notorious injury, the big, bad, ACL Tear.  

So let's dive into some questions that I've fielded at the start of ski season that I think will help you recover faster and better if you are bouncing back from an ACL injury or just want to know if you should consider surgery going into this sure-to-be-glorious ski season.

Hey Dr. Sterett, What Does the ACL Do? #Vail #ACLsurgery

To keep it brief, the ACL provides our joint with stability, whether you are skiing, playing soccer or hoops, or even just walking around.

As I've stated before, this stability is more than just a "trust" factor when it comes to the knee. Our ACL serves to protect our "cushion cartilage" (aka the meniscus) from damage that can be caused by twisting and shear.  

Once the ACL is torn, it leaves the meniscus open to possible damage.  If the meniscus is damages, we end up with arthritic joints...which is why so many people opt to have the ACL fixed after it is torn.

Do More People Get Their ACL Fixed #Vail/ Colorado Than Other Places?

Well, we tend to live a pretty "outdoorsy" lifestyle in many parts of Colorado, and I can speak specifically for the Vail Valley and say I know quite a few older folks who ski at least every other day during the season.  

Great snow equals more skiing which equals more injuries. As I mentioned previously, your EPIC pass doesn't care how old you are, and many people are pushing to get their million feet of vertical before the end of the season.

The decision to fix the ACL in a patient has become more a function of their desired activity than anything to do with age. How many other places do you know that have as many 70 year olds trying to ski 70 days in a year? And we get a ton of people who come here to indulge in our outdoor fun, not to mention those who travel here specifically to get surgery. 

Okay Dr. Sterett, talk to me about #ACL Replacement

You'll usually either have your ACL replaced with an autograft (your own tissue) or an allograft (cadaver graft.).  You can expect a fair amount of pain, but as you work on your range of motion the swelling will decrease, in turn eliminating the risk of scar tissue forming.

When can I return to sports after an ACL Injury?#VAil #ACL #surgeon

The most common question I get is "When am I allowed to get back to unrestricted sports?” The answer is not an easy one. For me, return to sports has always been a combination of: 

1. Biology

2. Rehab

First the biology of #ACL surgery recovery

The ACL must get weaker before it gets stronger. This is called "remodeling", which means that whatever we replace the ACL with must grow new blood vessels, in turn taking away the old graft fibers and leaving a temporarily weakened scaffold.

Next Up: New ACL Cells

Now new "ACL Cells" are deposited upon the scaffold, which make for a stronger, better ACL graft.  This takes less than 9 months to happen, but the scaffold phase is the time when the new graft is at the weakest point.  8-12 months after surgery, the new ACL many be less than half of it's original strength. However, our modern techniques and 

Next up: Rehab the ACL to full strength

Having access to great therapists is a luxury we are blessed with. Getting back to full strength can be achieved about three months after surgery.

However, we don't like to rush people back onto the slopes that quickly- there is a reason ACL injuries are often referred to as "season-ending" for pro athletes.

That's because the return of strength to the knee is not the sole factor for returning to the sport of your choice. Usually we don't rush back and let the graft re-model at it's own speed.

Getting back on the mountain- the functional sport test

I wrote the following in an earlier post, which sums it up:

"We have modified our functional SPORT test over the years. This functional testing is now utilized by the US Ski Team to determine when their athletes are able to start a "return to snow progression" safely. If there are any problems with the knee accepting a load, I want to know about it in the controlled environment of a therapistʼs office, rather than on the hill."

The Functional SPORT Test #ACLRehab #ACLRecovery

Here's the functional SPORT Test:

1. Forward Running with Cord resistance - 1 minute

2. Backward Running with Cord resistance - 1 minute

3. Side to Side Agility with Cord Resistance- 1 minute

4. Single leg knee dips with Cord - 3 minutes

Recreational Sports can typically start at 4-6 months after surgery, while competitive sports average 6-9 months.

WILLIAM (BILL) STERETT, M.D. IS AN ORTHOPAEDIC SURGEON RESIDING IN VAIL, COLORADO.

DR. STERETT IS THE HEAD TEAM PHYSICIAN FOR THE US WOMEN’S ALPINE SKI TEAM AND THE MEDICAL DIRECTOR FOR THE VAIL VALLEY SURGERY CENTERS.