ACL reconstruction surgery is one of the most common operations performed worldwide, especially amongst sports athletes and dancers. The anterior cruciate ligament (ACL) is one of two central ligaments in the knee connecting the femur and tibia. It prevents the knee from buckling and stabilizes the knee joint in running, jumping, and pivoting. So, what if you're a dancer, and you tear your ACL? What do you do next?
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*Disclaimer: This article is not meant to substitute professional medical advice. It is based on my own experiences as a 22-year-old dancer who's had ACL reconstruction and meniscal repair surgery. If you have questions or concerns about your condition, please see a licensed practitioner in your area.
A little backstory: I didn't know that I had torn my ACL when it happened. I was at an audition for a music video just two weeks after I'd finished up two weeks of performing in two Toronto Fringe Festival 2019 shows. Wow.
The audition consisted of "hip hop/contemporary," according to their casting notice. It was being led by one of Toronto's most established professional dancers.
Then it came time to split into groups and do the actual audition after we'd been sweating up buckets learning the choreography. I can't remember now if we were on the first try or second, but I was midair from a small "farmer" jump when I landed on my left foot and immediately felt something buckle in my knee. I knew something was terribly wrong, but unfortunately I couldn't stop the rebound and jumped midair again. This time, I landed and promptly hit the floor. Another even more definite buckle had happened in my knee, and in that split second of something akin to pain -- though it was more like shock -- before it numbed, I knew a horrible something had happened, and I wouldn't be getting up by myself anytime soon.
So, I sat there.
I sat quietly on the floor as my group cartwheeled and flipped aerials around me during the improvisation section until someone finally stopped the music. My friend and another auditionee ran up to me.
Fortunately, the latter also happened to be a licensed physiotherapist. He provided first-aid, then my friend and him brought me aside -- to a round of applause! -- so the audition could continue, and he proceeded to give my knee a massage (oh, yeah, that was definitely nice). He told me I was alright and that I had all my ligaments intact. I'd probably just sprained something. There was a lot of swelling (edema) that would go down with time.
Unfortunately, kind as he was, his diagnosis turned out to be wrong... Which leads me to the first thing you should do when you injure yourself:
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GO TO THE HOSPITAL!!!
This may sound obvious, but you would not believe the number of people who don't go to a hospital for a check-up, including me.
In my case, the moment the tear happened was pretty painless. It was mostly shock and a feeling of dread, but otherwise I was fine. This, combined with the physiotherapist's assurance that it was just some swelling and sprains, compelled me to call an Uber and go on home. The inside of my knee felt slick and slippery, and if I tried to put any weight at all on it standing up, I could feel my bones sliding around awkwardly. I had to ask a couple people to help me hobble outside.
This should've been my big clue that all was not well, if anything. Instead, once I arrived home, my mom and I went to a nearby walk-in clinic for a simple once-over.
Bad idea. They scheduled me for an X-ray and ultrasound a couple days later. The results yielded nothing wrong except the swelling, of which the clinic doctor said would subside in two weeks' time, and I would be right as rain.
Of course, as it turned out, I was not alright. Instead, when you're injured and go to the hospital...
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GET AN MRI
Magnetic resonance imaging (MRI) is so great because it's not only completely safe (unlike an X-ray, which still yields radiation), it also gives a more accurate and full picture, literally, of what's going on inside you. Also, it's covered by OHIP, for those of you living in Canada.
The MRI machine is a large circular tube that you slide into supine. When it's running, it'll make loud clacky sounds, so often the operators will give you earplugs and headphones to wear, unless the MRI is for your head.
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The MRI machine is super expensive to run for the hospital, so don't be late to your appointment, and try not to cancel. If you do have to cancel, make sure you inform the hospital. Most hospitals have a waiting list, so they'll call the next person available to take your spot, and who knows when you'll be able to get an MRI again.
I don't know if you can immediately get an MRI from Emergency, but for reference, it took me 6 months to get mine. That's without cancelling or being tardy. Let me explain.
I started my last year of post-secondary about a month after the accident. It didn't take me long, being in a dance program, to realize that something was still very wrong with my knee. I therefore made an appointment with an on-campus physiotherapist and one for a sports medicine doctor off-campus the next day.
Again, the physiotherapist told me my ligaments were fine; it was merely a case of severe muscle loss. I would have to go to the gym and attend physio regularly to regain that strength. The next day, within 10 minutes of seeing the sports med doctor, he said, "You have a complete ACL tear, and you need surgery." He then said the rehabilitation process would take 9 months.
Well, after hearing that, I proceeded to buy a cup of my favourite bubble tea on the way back to wallow in my misery. The sky was fittingly grey and dreary.
But that's it! That's all the time you get for self-pity, ok? There are things to be done! Gears to get turning!
What the doctor did in the room was perform the Lachman test and some others to observe the extent of the damage by eye. Oftentimes they'll have interns or students watching alongside and trying it out on you too, but you can say no to this if you're not comfortable.
The MRI is really just to confirm the doctor's suspicions. The doctor submitted a request to Mount Sinai Hospital for an MRI (by the way, Mount Sinai is very good, according to my second physiotherapist). That took about a month to arrange. Then the official letter of appointment came, and it turns out I was scheduled for half a year later.
Now, this may or may not have been a oversight on the part of the medical system. Many of my various physiotherapists have found it odd I had to wait this long, and they suggested perhaps something was miscommunicated. Anyhow, that was my lot of the draw.
My physiotherapist gave me a tip: call the hospital and tell them to put you on the waitlist. It might give you faster results. Even if you have to go at 3 AM in the morning, you go get that MRI. It's the quickest and safest way to get reliable results.
What was strange was Mount Sinai claimed to not have a waiting list, which goes directly against the fact that the MRI machine is super expensive to run, as I mentioned above. I couldn't tell you what was really going on. At the end of the day, I had to wait out my 6 months.
There is a way to try to get an earlier MRI, which I'll explain after this third course of action:
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REST REST REST
You should be resting as much as possible if you tear your ACL. For one, you literally won't be able to walk for the first few days. For another, you have to help the swelling go down.
Edema is good when an injury first sustains itself because it protects the area by encasing it in fluid. Edema is not good if it persists and won't subside.
I lied in bed for about three days before I could start to put weight on my injured knee without toppling over. If you need to go the bathroom in that time, ask someone for help.
After two weeks, I could hobble around by myself, though the swelling hadn't completely gone yet. My knee was fixed in a bent position due to it (i.e. I couldn't extend or flex it fully). My walking was slow-going but fairly sustainable.
After a month, I could extend it well enough again but flexing all the way was out of the question. Admittedly, I did go on a trip with my friends around this time, but I learned the hard way that my knee was still weak. Walking longer distances was fine, but when the waves crashed against me on the surf of the beach? Yikes. I guess the lesson is you shouldn't stand at a point in the tides where the waves crash directly against the joint of your knee.
Now it's time to look into getting an earlier MRI.
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TRY A DIFFERENT HOSPITAL
Maybe you know a doctor somewhere else. Maybe you do it the old-fashioned way and book a random appointment. Maybe you get your family doctor to book it for you. Whatever you do, it's ok to try a different hospital.
In my case, I went to a clinic called the Al & Malka Green Artists' Health Centre that I'd heard of from my studies at school. They were located in the West Wing of the Toronto Western Hospital back then, but they've since moved across the street. The Artists' Health Centre (AHC) deals with artists and performers: dancers, actors, singers, etc. They provide physiotherapy and mental workshops, among other things.
All you have to do is call reception, give your health card information, and make an appointment. The practitioners who met with me were very kind and understanding about the situation. It's also where I met my second physiotherapist -- who coincidentally worked on my campus as well -- after my first one moved to sunny California.
Unfortunately, I lost myself in school studies and didn't end up making an appointment with them specifically for MRI options until a month before my scheduled MRI was to take place. At that point, they didn't think anything they scheduled would happen before my original appointment anyway, and I agreed, so I decided to wait out the last month.
Here's the thing: many people are apprehensive of switching hospitals or doctors or "shopping around," as some may see it. However, there's really no problem. I even asked my physiotherapist's opinion if it was inappropriate to change doctors, and she said it's absolutely fine. Remember you are the patient. You have the right to check out different options, get a second or third or fourth opinion, and ultimately decide which place or person is best for you. Also know that this is actually pretty commonplace for doctors. They have patients hopping to another person or system all the time. Besides, the doctors' hectic schedules wouldn't let them care, anyway.
Sometimes it's an issue of time. Others, it's just a matter of personal taste. All in all, you don't have to feel bad for trying a different hospital.
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DO YOUR PHYSIOTHERAPY
Whether you managed to get an early MRI or not, it's so important at this stage to go to regular physiotherapy sessions and make sure you diligently devote yourself to your exercises.
So much of recovery is delayed or obstructed because people don't take the time to do their exercises, or they think it's a waste of time, or they don't do them properly! Your physiotherapist will help you through all of this, so make sure you get a good one.
If you're a student, you can check if your campus has a centre for physiotherapy (most do). Some campuses provide student insurance you might've opted into at the beginning of the year that you can use for this. You could also do some research in your neighbourhood and find a person you trust. It doesn't matter where you go. All that matters is that your physiotherapist knows what they're doing. If you're a dancer, try to find someone experienced with dancers specifically.
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The fact of the matter is dancers train and focus on different muscles and tendons than traditional ball players. The best thing you can do for yourself to get back in the game is to find a physiotherapist who knows your profession and understands the intricacies.
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KNOW YOUR MAX
I'm not going to use the word "limits" here because it's not about your limits; it's about your maximum: what you can and can't do based on your condition that ensures your personal safety.
You know now you have a torn ACL. That's going to affect some functions. If you're anything like me and in a professional dance program, that's going to mean facing a lot of side-eye and beratement from your peers and teachers as well (long story short: I spent my entire last year of school trying to get my instructors to understand there are just some things I can't do right now, and it was exhausting).
If your peers and teachers can't understand this, even with multiple doctor's notes and results, that's on them. You don't have to shout out to everybody the cause of your bereavement. You don't have to tell anyone who doesn't have a direct correlation to it. The only people you should tell are your instructors or managers or people who actually have an obligation to know what's going on.
Even then, your woes might fall on deaf ears. This is where you have to really stick up for yourself. You only have one body for your entire lifetime. Is it really worth risking more injury to your already injured self just because someone wanted you to do a higher arabesque or stop "affecting" your classmates? No! (I'm sorry, but if the fate of the world's dancers lies in one person's ability to jump like everyone else, then we've got a problem.)
Look, you're dealing with a torn ACL. Sure, some magical people can still do everything with a torn one. Even I curbed somewhere along the "odd" side and managed some light jumps and pivots, but for the most part, it's not a pretty condition. Other people can still function just fine. Your quiet presence shouldn't be disrupting their process.
If you physically can't do something, you could try to negotiate or just make it clear you won't be doing it. Are you pressured to do it anyway? Here's a handy thought: if it ever comes to a judge, you're the one in the right.
That should settle some nerves.
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GET SURGERY
Depending on the results of your MRI, you may not even need surgery. There's a lot of new research nowadays that shows how a person can function even without ACL reconstruction surgery. However, if you're a young, high-performing athlete (which dancers count as), the general consensus is that it's not an option. You need surgery.
With a partial ACL tear, it's possible to forego the surgery and focus on lifelong physiotherapy. With a complete tear, it's best to just get it. You risk early onset arthritis if you don't. Hey, take it from me! Being "young and healthy" is your biggest advantage, as my multiple doctors and physiotherapists all told me. Of course, this comes with the assumption that you've been taking care of your body. If you haven't, it's time to start now. No drinking, no smoking, no anything that could damage your health (yes, it's best to put caffeine down too).
The physiotherapy you do in preparation for surgery is known as "pre-hab." The stronger you get in pre-hab, the better and faster you'll recover in rehab.
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ACL reconstruction surgery is now minimally invasive. That means they can do the whole operation with just a few incisions. (There is research on a newer procedure called BEAR, but it's not sufficient enough to be undertaken widespread yet.)
The next question you have to answer is whether you want to use a hamstring graft or patellar tendon graft. Basically this means they'll snip off a bit of your hamstrings or patellar tendon to create the new ACL, which replaces your original one. This new ACL is constructed to be much stronger, so you're at less risk of tearing it again.
Some doctors have a preferred graft, and some will decide for you. I had my doctors recommend different grafting points for me based on the fact that I'm a dancer, so this is going to be a bit confusing for you. What you have to do is research on your own and understand the implications and risks of using either. Google is your friend. If you know someone who's undergone the surgery before, talk to them! They'll shed a lot of inside information you won't find commonly on the Web.
I ended up going with a hamstring graft, and so far nothing's felt bad. Make sure that whatever you choose, your doctor is both ok with it and experienced enough to perform it. The first surgeon I consulted only did patellar tendon grafts, so if you're leaning otherwise, find a doctor you can trust who will perform that operation for you with expertise.
That you're comfortable with your decision will ease the process tremendously.
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KNOW THAT YOU'LL BE ALRIGHT
None of the decisions you'll have to make is more important than how you choose to face this challenge. Maintaining a positive attitude is crucial to your recovery, and, honestly, there are so many things to be grateful for.
Surgery is not setting you up for failure. It's specifically intended to improve your quality of life. Your doctors, surgeons, and medical practitioners have undergone years of training and education to get where they are. Most of them, if not all of them, want to help you. They've seen any manner of distress or emergency already. You're in steady hands.
The hospital is there to provide you support both pre- and post-op. Your family and friends are there to support you once you get out of the hospital. Your physiotherapist has a duty to help you get back in the game. Your doctor will do regular check-ups to make sure everything's going smoothly.
You're standing on a lot of shoulders.
And by helping them help you, you're helping your own future and career. Once you cross this threshold, you're going to come out physically and mentally stronger. So don't fret, my friend. You're going to be ok. :)
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