{"id":36379,"date":"2020-12-01T15:44:22","date_gmt":"2020-12-01T22:44:22","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=36379"},"modified":"2022-11-16T10:26:11","modified_gmt":"2022-11-16T17:26:11","slug":"osteotomy-useful-for-this-100-mile-runners-acl-injuries","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/osteotomy-useful-for-this-100-mile-runners-acl-injuries\/","title":{"rendered":"Third knee surgery\u2019s a charm for this 100-mile runner"},"content":{"rendered":"
<\/div>
\"Ryan
Ryan Larson completed the Bighorn Mountain Trail 100<\/a> in 2019, a course that crosses through Little Bighorn and Tongue River areas of the Bighorn National Forest in Wyoming. Photo courtesy of Ryan Larson.<\/figcaption><\/figure>\n

When Ryan Larson laces up his running shoes \u2013 preferably a pair of Brooks Pure Grit \u2013and sets out on a trail, he\u2019s met with a few different things along the way.<\/p>\n

Stress relief.<\/p>\n

\"This
Larson and his wife, Natalie, prior to the Leadville Silver Rush 50 Mile in 2014. They started running road races together and then progressed to marathons and ultra-marathons. Photo courtesy of Ryan Larson.<\/figcaption><\/figure>\n

\u201cIt\u2019s a way to get physical activity through more personal enjoyment,\u201d he said. \u201cI love getting into the woods and being in nature, regardless if it\u2019s a quick 30-minute run or a 4-hour training session.\u201d<\/p>\n

Community and comradery.<\/p>\n

\u201cIt\u2019s pretty great how much everyone encourages each other in this sport,\u201d said Larson. \u201cWe\u2019ve found others who enjoy running as much as we do, and they\u2019ve become our community.\u201d<\/p>\n

Patience and perseverance.<\/p>\n

\u201cYou really have to take it mile by mile, especially for the longer 75-100 mile races,\u201d he continued, \u201cas you never know what\u2019s going to be round the next switchback, or when the weather might turn, or if you might not feel great at some point. You figure out ways to work through everything.\u201d<\/p>\n

That last sentiment hits home for Larson, who faced his third ACL repair and an osteotomy<\/a> in February 2020.<\/p>\n

ACL injuries: Right, then left, then right again<\/strong><\/h3>\n

It wasn\u2019t running that led to Larson\u2019s first two ACL injuries though.<\/p>\n

\u201cI went for a layup during seventh-grade basketball. Something went wrong with my right knee,\u201d he said. \u201cThe swelling eventually subsided and I just went on with sports as any kid would.\u201d<\/p>\n

Fast forward to Larson\u2019s sophomore year of high school. He was playing soccer and noticed a lack of stability in his right knee, and it continued to bother him. One straightforward ACL repair later, and he was good as new.<\/p>\n

Flag football during graduate school in 2010 led to the second surgery, this time with his left knee.<\/p>\n

\u201cIt hurt like hell, and I knew immediately what happened,\u201d said Larson. \u201cI went to an urgent care initially, and a month later had left knee ACL surgery.\u201d Statistically speaking, this is not uncommon, with 12% of patients treated with ACL reconstruction on one side experiencing the same injury on the opposite knee.<\/p>\n

Following the operation, Larson acknowledged he may not have rehabilitated and trained as much as he should have to get back to full strength, and that he probably wasn\u2019t as physically active after the injury either.<\/p>\n

Then thanks to a friend, he discovered trail running.<\/p>\n

\"A
Larson competes in the Never Summer 100k<\/a> in 2017, a 61-mile race with 14,250 feet of vertical gain and descent. Photo courtesy of Ryan Larson.<\/figcaption><\/figure>\n

\u201cI did one year of indoor track in high school, but past that, never really ran that much,\u201d he said. \u201cNow, there\u2019s 26-mile marathons, 50-mile races, 100-mile ultramarathons.\u201d<\/p>\n

\"This
Not only did Larson finish the 100-mile Run Rabbit Run race in 2019, he did so in under 30 hours. Photo courtesy of Ryan Larson.<\/figcaption><\/figure>\n

In September 2019, Larson had his best run ever during Run Rabbit Run, the 50- and 100-mile endurance races held in Steamboat Springs each summer. He set a goal of completing the 100-mile race in 27 hours and did so at 26 hours, 55 minutes – the first time he\u2019d met his time goal in an ultra.<\/p>\n

He\u2019d already set his sights on ultramarathons for 2020, when right before Christmas, he was out for run on a road and felt a change in the stability of his left knee.<\/p>\n

\u201cThe first thing I thought of was that feeling from high school \u2013 something wasn\u2019t quite right,\u201d he recalled. \u201cI\u2019d suspected my knee had issues for the last few years. I tried another run a few days later and knew it wasn\u2019t good.\u201d<\/p>\n

Third time\u2019s a charm?<\/strong><\/h3>\n

After a left knee MRI and consultation with Dr. Alex Meininger<\/a>, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center<\/a>, the extent of Larson\u2019s injury was more clear.<\/p>\n

\u201cThe repaired ACL graft had likely weakened over time contributing to additional damage,\u201d said Meininger. \u201cThe giving way episode while running was the straw that broke the camel\u2019s back.\u201d<\/p>\n

That\u2019s why Larson didn\u2019t feel the injury as quick.<\/p>\n

\u201cWe discovered there were really three parts to Ryan\u2019s injury \u2013 the torn ACL, a substantial medial meniscus tear, as well as damage to the cartilage that could predispose to arthritis in the future.\u201d said Meininger.<\/p>\n

Meniscus tears are commonly associated with ACL injuries. The normal meniscus acts like a cushion, protecting the surface of the knee. However, a tear of the meniscus – or surgery to trim out the tear – can reduce the effectiveness of the cushion. In fact, up to 50% of patients who have ACL and meniscus injuries will develop osteoarthritis within 10-20 years.<\/p>\n

Osteotomy for ACL injuries<\/strong><\/h3>\n
\"A
Dr. Alex Meininger explains details of Ryan Larson\u2019s x-rays. While an osteotomy is not common with ACL repairs, it is useful in cases of complex knees like Larson\u2019s. Photo by UCHealth.<\/figcaption><\/figure>\n

\u201cThankfully, we got to Ryan\u2019s knee in time to repair it,\u201d said Meininger. Not only did Larson\u2019s knee require a repeat – or revision – ACL reconstruction, Meininger also recommended changing the alignment of his knee through what is known is an osteotomy.<\/p>\n

\u201cDuring an ACL revision, our first choice is to use the patient\u2019s own tissue, followed by a cadaver graft,\u201d said Meininger. \u201cSince Ryan\u2019s patella tendon had already been used, I used part of his quad tendon and bundled it up as a new ACL.\u201d<\/p>\n

Additionally, Meininger performed an osteotomy, a procedure in which Larson\u2019s bone was cracked and wedged open in order to better align the weight-bearing line with his tibia. By shifting his alignment a mere 5%, Larson\u2019s ACL is now better protected from another failure, and his meniscus and cartilage damage are under less pressure, too.<\/p>\n

\u201cThe combination ought to allow Ryan a stable, painless knee that affords him a return to full activity,\u201d says Meininger.<\/p>\n

Preparation before osteotomy is key to success<\/strong><\/h3>\n

Just like he would with an ultramarathon, Larson began to prepare mentally and physically for his Feb. 19 surgery.<\/p>\n

\u201cPhysically, I didn\u2019t have the same recovery of an acute injury. But mentally, I knew the uphill challenges I\u2019d face post-surgery,\u201d he said. \u201cThere\u2019s always anxiety with surgery. I knew I\u2019d have to be patient and that recovery would be slow. I had to remind myself of that more than once.\u201d<\/p>\n

Pre-surgical physical therapy was new for Larson this time around. He knew firsthand the importance of getting as strong as possible before the procedure and building up his strength.<\/p>\n

\u201cI did exercises that as a runner I usually wouldn\u2019t usually do,\u201d he said, such as lunges and squats.<\/p>\n

The work begins following osteotomy for ACL injuries<\/strong><\/h3>\n
\"A
Physical therapist Alyssa Hornbrook measures the range of motion in Larson\u2019s knee. Photo by UCHealth.<\/figcaption><\/figure>\n

Following a successful procedure, Larson began physical therapy at UCHealth SportsMed Clinic<\/a> with physical therapists Alyssa Hornbrook<\/a> and David Grinnell<\/a>.<\/p>\n

Three weeks post-op, Hornbrook said he was right on track.<\/p>\n

\u201cIt was a gnarly surgery, and it takes a while for the bruising to go away, the swelling to go down and the contours of the knee to appear normal again\u201d she said. \u201cBeing non-weight bearing for six weeks while the tibia is healing takes its toll on muscles, too.\u201d<\/p>\n

\u201cThe biggest difference I recognized right away was not being able to put weight on my leg. After my first two knee surgeries, I was walking right away. Not being able to do so after this surgery was a huge difference,\u201d said Larson. \u201cI felt like my leg was going to be able to do more and more quickly. It\u2019s uncomfortable. Imagine a cramp in your leg \u2013 it\u2019s that kind of tight all the time.\u201d<\/p>\n

Hornbrook could literally see Larson\u2019s leg muscles start to work, thanks to the home exercise plan he followed. And, knowing the importance of keeping his cardiovascular endurance in check during recovery, Larson became a master at the hand cycle at Old Town Hot Springs<\/a> for cardio.<\/p>\n

Then the world changed<\/strong><\/h3>\n

About one month after Larson\u2019s surgery \u2013 almost to the day, the impacts of a worldwide pandemic hit Steamboat Springs. Due to COVID-19, non-urgent, elective surgeries and procedures were postponed at YVMC, and visitors were no longer allowed in the building. Larson\u2019s in-person physical therapy appointments were reduced, putting even more emphasis on his at-home routine.<\/p>\n

\u201cSince PT was critical for my recovery being only six weeks post-op, I was fortunate I could still go to SportsMed once a week. It was my check on what I could do next and how I was progressing,\u201d said Larson. \u201cI found a lot of progress on a stationary bike, and it was so helpful for range of motion and just mentally to get a little bit of an increased heart rate. I wanted to do more and feel less pain, but where I was at is what I expected.\u201d<\/p>\n

Walking crutch- and brace-free was a big milestone for Larson.<\/p>\n

\u201cIt\u2019s amazing the freedom I felt being able to carry things in my hands instead of juggling with crutches,\u201d he said. \u201cWalking around freely was huge, as was being able to get around better at work and at home.\u201d<\/p>\n

Mental progression through recovery was also something Larson recognized throughout his physical recovery.<\/p>\n

\u201cThe exercises during recovery aren\u2019t exciting, and motivation was mentally challenging,\u201d he said. \u201cThe progress with doing more meant I was further from surgery and closer to recovery. Since this is the third surgery, I knew it\u2019d be a slow-go. But every day got me a little closer.\u201d<\/p>\n

And while he felt for his fellow running enthusiasts that nearly all races got cancelled in the spring and summer, the fact that he didn\u2019t miss races helped.<\/p>\n

Back on the trails<\/strong><\/h3>\n

By the six-month mark in August 2020, Larson was running up to 10 miles on trails and felt great.<\/p>\n

\"A
Strength training is a key component of Larson\u2019s rehab, recovery and returns to running. Photo courtesy of Ryan Larson.<\/figcaption><\/figure>\n

\u201cI\u2019m exactly where I hoped to be, maybe a little ahead,\u201d he said. \u201cI started doing limited running at the end of June and now feel about 85%, with hopes to gain about 5% each month. I should be at full endurance soon.\u201d<\/p>\n

\u201cPatient commitment and cooperation in recovery is important, and Ryan has been exemplary,\u201d said Meininger. \u201cHis knee is free of inflammation, the new ACL ligament is solid and his stability is there, and his strength is coming back. The work he put in prior to surgery has served him well.\u201d<\/p>\n

He\u2019s still focused on strength, especially in his calves, to give him the power and control he needs to run ultra races again. Weights in the gym and interval running will help get him there.<\/p>\n

\u201cQuick power off the ground, like a hop or jump, is hard, but I\u2019m getting there,\u201d said Larson. \u201cThirty days ago, I felt ok running uphill, but downhill was painful \u2013 I\u2019d last 4-5 miles at most and it was really slow. Now, uphill feels 95%, and downhill is easier and less painful.\u201d<\/p>\n

Not only can Larson feel the improvement as he continues to rehab, his mile times show it, too.<\/p>\n

\u201cThe times are getting faster and faster, which means I\u2019m another step closer to getting back to where I was before the injury occurred,\u201d he said.\u00a0 \u201cAs I progress in recovery, I feel endurance in running will be the last challenge.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

When Ryan Larson laces up his running shoes \u2013 preferably a pair of Brooks Pure Grit \u2013and sets out on a trail, he\u2019s met with a few different things along the way. Stress relief. \u201cIt\u2019s a way to get physical activity through more personal enjoyment,\u201d he said. \u201cI love getting into the woods and being […]<\/p>\n","protected":false},"author":2146,"featured_media":36380,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[7],"tags":[2863,183,110,9167,2641,2518],"class_list":["post-36379","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories","tag-knee-injury","tag-orthopedics","tag-physical-therapy","tag-specialized-services","tag-uchealth-sportsmed-clinic-steamboat-springs","tag-uchealth-yampa-valley-medical-center"],"acf":[],"yoast_head":"\nOsteotomy useful for this 100-mile-runner's ACL injuries - 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She has spent the last ten years working in marketing and communications in health care, an industry she never considered but one to which she's contributed through her work in media relations, executive messaging and internal communications. She considers it an honor to interact with patients and write about their experiences; it\u2019s what keeps her coming back to work each day. A native of Nebraska, Lindsey received a Bachelor of Arts degree in journalism, with a focus on public relations, from the A.Q. Miller School of Journalism and Mass Communications at Kansas State University \u2013 she bleeds purple. She could see a Broadway musical every week, is a huge animal lover, enjoys a good shopping trip, and likes spending time in the kitchen. 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