Ski season is here, and all that twisting, turning and occasional falling on the slopes means that we’re booked full of knee injuries here at WLP. These range from minor sprains to serious fractures and ligament tears, such as a dreaded torn ACL which will put your knee out of action for months.
If the worst does happen on your ski trip, you might feel tempted to get surgery as soon as possible to reconstruct your torn ligament. The pain from such an injury is intense, and some local doctors will often recommend immediate surgery to avoid your knee going through the “second trauma” of surgery months down the line.
But no matter how bad your pain is or how much pressure the doctors put on you, I would strongly advise against having surgery immediately after injury. Doing so significantly increases the difficulty of your post-surgery rehabilitation and goes against standard practice here in the UK.
The importance of prehabilitation
ACL reconstruction and other similar knee surgeries take an enormous toll on the body. Not only is there the local trauma from the surgery itself, the knee joint needs to be carefully managed to restore full movement and strength, while the muscles and ligaments surrounding it need to be exercised to prevent atrophy (wasting of the muscles).
Typically, after an ACL reconstruction you’re looking at two to three months before you’re comfortable walking and going up and down stairs. It will be at least nine months until you’re back at pre-surgery performance level. Knee surgery rehabilitation is difficult in even the best case scenarios, but it’s even worse if you rush into surgery without preparing your body first.
To prepare your body for the challenges of surgery and the following rehabilitation, we recommend at least six weeks of “prehab”, where we condition your leg muscles, reduce the swelling in your knee and restore as much movement as possible. Only when we’re confident that your knee is ready to undergo surgery do we let you go on the operating table.
Operating on the knee when it’s still painful, swollen and stiff and while the surrounding leg muscles are unconditioned not only makes for a difficult surgery but also simply means it’s going to be much longer before you’re walking normally again.
Some people get by without surgery
A small minority of people can function normally or even at high performance levels (such as a current West Ham United footballer) without their ACL ever being reconstructed. After the six or so weeks of prehab, they’re back up their feet just fine, with no significant impact on their range of movement, balance or long term health of their knee.
The chances of you being one of these lucky people is slim, but you’ll never know if you rush into surgery immediately. If there’s a chance that you can avoid having to go through surgery and the months of rehabilitation that follow, it’s worth waiting to see how your body recovers.
You’ll get home sooner and receive more consistent care
Beyond a more successful rehabilitation, having surgery back here instead of abroad means that you can return home sooner. You might need a wheelchair in the airport, but it beats being stuck in a hospital abroad.
You’ll also receive more consistent care and avoid communication barriers between the clinicians and consultants working with you. A clear and reliable flow of information is essential to give you the best outcome for your operation and rehabilitation, which we can’t guarantee if we have to work with doctors in other countries.
When should you get knee surgery abroad
If you injure your knee when you’re skiing, the usual response is to speed you off to a hospital for an X-ray to assess bone damage and an MRI to assess ligament damage. If the latter’s discovered, politely decline their recommendations for surgery, but if it’s the former, go ahead.
A broken bone needs to be repaired as soon as possible to make sure that it heals correctly, but ligament damage isn’t going to get worse if you leave it alone for a while, so there’s no harm in waiting until you’re better prepared to undergo surgery.
Most knee injuries won’t actually be the worst case scenario. Muscle or ligament strains are divided into three grades, with grades 1 and 2 not requiring invasive treatment and weeks rather than months of rehabilitation.
If you hurt your knee in an upcoming skiing holiday, you can always get in touch with the clinic at firstname.lastname@example.org , so that we can recommend the best course of action and make preparations for your return, including assessment from world-class knee consultants.
But most importantly, just remember: wait until you return home before you undergo knee surgery.
Musculoskeletal and Sports Physiotherapist, Research Lead at West London Physiotherapy
For any other questions regarding this topic please do not hesitate to contact West London Physio on 0207 937 1628 or email David at david.wynne@westlondonphysio.