Recovery

Or Rediscovery

The biting wind whipped at my face as two figures emerged from the swirling mist on the final ridge of Gannett Peak. My breath hitched, a mix of awe and a strange kinship settling over me. They moved with the familiar grace of climbers, harnesses and gear clinking softly, but I noticed the absence of a rope. A quick nod, a shared glance of understanding, and then their voices cut through the wind. "Started from high camp last night at 8:15 PM," one of them rasped, a weariness in his tone that spoke volumes. "First to break trail, first to summit." They offered a customary mountain blessing – "Good luck, be safe" – and disappeared, leaving me alone with the vast, unforgiving expanse.

Below, I’d seen few parties turning back, defeated by the brewing weather. Even a seasoned guide had cautioned about an 11 AM turnaround. But I was here, less than 15 minutes from the summit. Soon, I was the third to stand atop Gannett that day, and the first to have ascended via the Bonney Pass route.

The Titcomb Lakes, usually a bustling hub of humanity, lay eerily silent and deserted when I camped there yesterday. A wave of disbelief washed over me, a surge of raw, unadulterated emotion. Just nine months. Nine months after a doctor had delivered a cold, clinical prognosis that shattered my world, I was here. On the "Apex" list, one of the most difficult county highpoints in the contiguous USA.

Fifty-five miles of grueling backpacking and mountaineering through the relentless pristine Wind River Range, and now, I was resting in the famous Jackson town square, penning these very words. Life, I realized, was an absolute miracle.

The memory of that sterile doctor’s office still stings. "Your left knee is at its worst condition," the doctor had declared, his words devoid of any empathy. I felt more sadness for his lack of compassion than for my torn ACL. His assistant, equally dispassionate, had briskly informed me that surgery was scheduled for next week, their books "pretty booked." She rattled off the options: my own ligament or a cadaver's. "Young people usually opt for their own," she’d said, "but this particular surgeon only does cadaver." Deeply unsatisfied, a knot of dread tightening in my stomach, I had driven home.

Crutches became my constant companions, my world shrinking to the confines of my apartment. Movement was a luxury I no longer possessed. So, I did the only thing I could do: I thought, and I researched. I delved into the rabbit hole of ACL injuries, starting with Reddit posts, particularly those from soccer players. What is an ACL? How does it function? The more I read, the more fascinated I became.

My research revealed that ACL injuries were extensively studied during World War I on soldiers. The prevailing wisdom then was that the ACL area lacked blood vessels, making self-healing impossible, thus surgery was mandatory. Today, the U.S. alone sees some 250,000 ACL injury cases annually, with an average surgery cost of around $35,000. But I wasn't entirely convinced. I'd seen friends and family endure ACL surgeries that weren't total successes.

Then, I stumbled upon it – a research paper by a father-and-son orthopedic duo in Australia. Two years prior, their groundbreaking research had challenged conventional wisdom, revealing sufficient blood flow around the ACL to allow for natural recovery. Based on their findings, they developed a procedure called Cross-Brace Protocol.

In essence, Cross-Brace Protocol (CBP) enables the body to heal the ACL on its own. It simply requires time and optimal conditions. When the knee joint is at a 90-degree angle, it’s the shortest distance between the torn ends of the ACL. The therapy had to begin within 7 to 20 days of the injury. For four crucial weeks, 24/7, I would have to keep my injured knee at a 90-degree angle using a special brace with angle readings. Eating, sleeping, everything – it was all done with that knee locked in place. This initial period was where the most significant healing occurred. For the subsequent two months, I would gradually lower the angle by 15 degrees every two weeks, aiming for a fully straight leg by the end. Their study, with 300 participants, boasted a remarkably high success rate, with almost all participants experiencing full or partial healing. It was a remarkable study, a beacon of hope in my despair.

I started the Cross-Brace Therapy (CBP) on the 20th day. I still don't know why I waited so long, probably due to my travels to Knoxville. That first day was brutal. Sleeping with my knee locked at 90 degrees was incredibly difficult, especially since I already struggled to sleep with the injury. I had to reduce my shower frequency to twice a week. The research suggested regular consultations with nurses or doctors proficient in the therapy, but I had no one. I constantly reread the paper and instructions, desperate to ensure I was doing it right, acutely aware of the high risks of blood clots and nerve damage.

Yet, with the injury came a strange gift: time. After work, my usual outlets of hiking, climbing, and riding were gone. As a child, I'd always dreamed of acting, and now, it seemed like the perfect opportunity to explore that hobby. I found a local acting school in SLC. The main course was a year-long commitment, so I signed up for a six-month course, unsure if I’d even enjoy it. From day one, I loved the acting classes.

With my newfound passion for acting and dedicated shoulder workouts at home, I was thriving despite the injury. The first major milestone arrived when I finally readjusted the brace from 90 degrees to 75 degrees after four weeks. My knee could bend a little! The sheer joy I felt was overwhelming. The next eight weeks flew by. Honestly, part of me was so utterly convinced this therapy would work, that my ACL would heal. But another part, a nagging, fearful voice, whispered doubts, fearing I’d wasted three months only to face surgery and recovery all over again.

After three months, I underwent another MRI. I found a truly wonderful orthopedic doctor, an outdoors enthusiast like myself. She was one of the sweetest doctors I'd ever met, and she was familiar with CBP. As she looked at my latest MRI report, she smiled. "Your ACL has partially healed," she said, and for me, it was a magical moment. There was still a meniscus tear to heal, she explained, adding that for some patients, a partially healed ACL lasts a lifetime, for others only weeks or years. She strongly recommended physical therapy to strengthen my other leg muscles, providing comprehensive support for my ACL.

I returned to the same physical therapist I'd seen between my injury and starting the CBP. My left leg muscles had atrophied significantly compared to my right; for three months, they had been virtually useless. For the first few weeks, the focus was entirely on knee mobility and range of motion. Eventually, I was cleared to ride a stationary bike. The feeling of pedaling, of sweating after such a long period of inactivity, was incredibly liberating. One crucial lesson I learned from therapy: if the pain was above a 3 out of 10, stop immediately; otherwise, keep going. Within days, I transitioned from a stationary bike to a real one, riding four miles daily. My right leg still bore the brunt of the effort, but I was out there, riding.

Slowly, I began taking walks around my neighborhood. Physical therapy continued. My bike rides grew longer. Soon, I was riding to the office, a total of eight miles each way. With my progress, the therapist introduced a running program. I started with walking for a few minutes, then jogging for a minute, repeating the cycle. On the second day, my knee began to hurt. My therapist had changed, and I wouldn't see the new one for two weeks. I was in limbo, unsure if this was part of the healing process or a permanent setback.

My new therapist was kind and resourceful. When I mentioned the pain while running, she guided me through a series of exercises, pinpointing the problem: my left knee still couldn’t bend backward to its full capacity. That was the root cause of my pain. She gave me exercises to address it, and it took another month before I could restart my running program.

"Eight minutes walk, one minute jog." That’s how the running program began again. Week after week, I followed the regime, making incremental progress. I could now go on short hikes. Each tiny step forward felt monumental. Being an outdoors person, every small improvement allowed me to reconnect with nature in different ways. Biking to work helped immensely in rebuilding my leg muscle mass.

Throughout this arduous recovery, I set myself a singular, monumental goal – a litmus test to truly gauge if I was back to my normal self, if my ACL was completely healed. I wanted to summit Gannett Peak, the highest point in Wyoming. Any attempt on Gannett demands a wide array of mountaineering skills. It's considered one of the most difficult state highpoints, rivaled or exceeded only by Denali, Mount Rainier, and Granite Peak, depending on conditions and experience. You have to backpack 17 miles just to reach the base of the pass, and even then, the peak remains hidden. It is a truly remote mountain. If I could embrace this grand objective, I would truly be back.

Appendix

The Cross Brace Protocol (CBP) , developed by Australian orthopaedic surgeons Dr. Mervyn Cross and his son Dr. Tom Cross, fundamentally challenges the long-held belief that ruptured ACLs cannot heal naturally. The protocol involves precise knee immobilization at 90 degrees of flexion during an initial critical period, followed by a meticulously graduated rehabilitation program. This approach aims to facilitate natural healing by ensuring the torn ligament ends are closely approximated.

Initial clinical data, particularly from a case series published by Filbay et al. in 2023, demonstrates highly promising outcomes. This research indicates that 90% of participants showed MRI evidence of ACL healing at 3 months, and 79% successfully returned to their pre-injury sport within 12 months. ¹ As of October 2023, the protocol's success continues, with 94% of the first 301 participants achieving ACL healing from a growing cohort of over 487 patients. ² The CBP offers a compelling alternative to surgery, providing potential benefits such as reduced recovery time, a stronger native knee, and the avoidance of surgical risks and considerable costs.

Citations

https://www.ncbi.nlm.nih.gov/books/NBK499848/
https://www.jeremyburnhammd.com/what-does-acl-replacement-surgery-cost/
https://www.fitasaphysio.com/acl-cross-bracing-protocol.html
https://www.mediaustralia.com.au/products/therapy-concepts/cross-brace-protocol/
https://www.researchgate.net/publication/371590033_Healing_of_acute_anterior_cruciate_ligament_rupture_on_MRI_and_outcomes_following_non-surgical_management_with_the_Cross_Bracing_Protocol