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congenital ACL aplasia

 
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PostPosted: Wed Feb 09, 2005 9:34 pm GMT +0000    Post subject: congenital ACL aplasia Reply with quote

Dr. Nolan,
In 1992, I injured my right knee skiing. Although the injury was a minor tear of the meniscal cartilage caused by hyperextension, I was diagnosed by a U.S. Ski Team orthopedic surgeon with ACL aplasia in both knees. He seemed, for lack of a better term, awestruck. He had read case studies of my condition but had never seen anyone with it. He said that he was amazed since the patients in the case studies had usually undergone replacement surgery by adolescence. He said he had never read of a patient in their 20s who could maintain my level of physical activity (skiing 100+ days/year). He did tell me that the MRI showed that my PCLs and MCLs were larger than normal to compensate. I have been able to move my lower legs out of the knee joints since childhood (hence the hyperextension injury) but never knew why. The doctor at the ski area clinic (not the O.S.) said that my knees exhibited symptoms of "classic ACL tearing." My meniscus healed without surgery and I have not reinjured it or anything else in either knee since then.

Finally, on to my question. Very Happy I am now 38 and I have taken up mountain biking in the last 6 months. I am riding (weather permitting Smile ) 75-100 miles per week. I have begun to notice mild discomfort in my knees after riding. Should I be taking any preventative measures to avoid injury to or degeneration of my knees? I would like to continue biking and other athletic endeavors for many years to come.

Thanks,
S. Racer
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PostPosted: Thu Feb 10, 2005 8:47 am GMT +0000    Post subject: Reply with quote

Speed Racer (Yes, I recognized your avitar!)

Since you have a lack of the ACL you will be more prone to hyperextension injuries. As you ask what preventative measures you should pursue to prevent serious injuries and degeneration of your knee and still be able to bike and pursue other athletic endevors, consider these preventative/preservative measures.

1. Ditch your clipless pedals. Yes, get rid of them, period. Go back to good old fasion platform pedals that will never trap your foot at an inopportune time and cause a potentially serious torsional (twisting) or hyperextension injury to your knee. There is a reason why most down hillers and dual slalom and moutain cross riders go with platform pedals only. Getting trapped in clipless pedals can mean a lost race or serious injury.

2. Talk to your orthopedic doctor about custom hinged knee braces to prevent hyperextension of your knees during sports activities.

3. Consider supplimentation with glucosamine and chondroitin to help keep your knee cartiledge healthy. You should not take these if you are on blood thinners, have diabetes or are allergic to shell fish.

4. Keep riding your bike. But, use lower gears and a higher RPM pedalling technique. Shoot for 90-100 RPM. Going higher RPMs without clipless pedals is more difficult and since it is not in your best interest to go clipless, shoot for the 90-100 range.

5. Look seriously at a recumbent trike for road riding. There is almost no risk of falling over, thus this is one bike you can use clipless pedals on. There are some nice models that are comparably priced to a good road bike (Catrike http://www.catrike.com & Whizwheelz http://www.wizwheelz.com ) and are quite fast. I have ridden a Catrike Speed and there is definitely one of these in my future stable of pedal powered machines.

I hope this information helps.

Thanks,
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PostPosted: Thu Feb 10, 2005 9:14 am GMT +0000    Post subject: Reply with quote

Dr. Nolan,
Thanks for the info. Any idea if custom hinged knee braces would be covered (fully or partially) by my HMO? I know they don't give those things away. Smile Giving up my clipless pedals will be harder than giving up the cigarettes but since you also thought my metatarsal pain was caused by the clipless pedals, I guess I'll kill two birds with one stone. I assume I'll still want a rigid sole biking shoe?
Thanks,
Speed

P.S. Have you seen other cases of ACL aplasia?
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The Bike Doc
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Joined: 08 May 2003
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Location: Corpus Christi and Warda, Texas

PostPosted: Thu Feb 10, 2005 11:07 am GMT +0000    Post subject: Reply with quote

Speed:

I have not seen other cases of ACL aplasia, but the non-surgical management would be much the same as for a torn ACL that an individual does not want surgical management interventions. Talk to your orthopedic doctor about getting a letter of medical necessity to your HMO (which, BTW, stands for Health Maintenance Organizations). Hopefully, they can be convinced it is better (and cheaper) to maintain your good health by your maintaining physical activity with non-surgical treatment and cover the hinged braces than for you to become a chain smoking, healthless couch potato. Definely do get firm soled shoes for riding. They are just as important with platform pedals as with clipless.

Thanks,
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