Knee/ACL injury and surgery info

[Guest F16PilotMD]

I'm not an Orthopod, but...

I would either get back to him or get to another one. You are too young for arthritis unless you have a previous, severe injury. Your knee should get better with rest for simple strains, etc. If not, I would think an orthopod would/could diagnose most things with physcal exam. If not, I would think MRI makes sense.

My gut tells me you got the "wrong" doc.

[Guest Tomguy33]

Hey all, i just flew by the recruiter just for some more info. but head guy was out and he took down some info about me. but then he asked if i had ever broken a bone or anything? i told him about my knee injury. ( tore my acl in high school football ) and next question was do i have any pins or screws in my knee. well i do, two titainium screws in my knee and that seemed to put up a red flag in his eyes. he made it sound like i can't fly with those. i hope i still can, i'm already bummed because there now is another possible halt on my flying besides vision. and i have good eye sight just don't know the numbers yet. please don't tell me that i can't fly because of my damn knee.

[backseatdriver]

I'm a nav and have two screws in my knee from an ACL reconstruction. A buddy of mine is a pilot with the same thing. As long as you have full use/range of motion, it's not a problem to pass your flight physical.

[ 11. January 2006, 17:47: Message edited by: backseatdriver ]

[Guest Mary G]

May be able to waiver the hardware if necessary. I have a buddy that had ACL surgery twice (the 2nd time while he was in pilot training), though I'm not sure if he had any hardware, so it's possible.

Definitely don't just listen to the first recruiter - keep trying and doing the research. Good luck.

[Guest Hoser]

I had a fairly serious knee injury back in mid 03. I had tibial plateau fracture with compression. Think of breaking the tibia (larger of the 2 bones in the lower leg) along the bone (ie splitting) instead of across like a normal break. After the screws put that jem back together, it didn't really want to join with my knee cap again, so I had to have bone graft. Since the break.graft was at the point of weigh bearing, I was in a metal brace for the first 3 weeks and had to keep all weight off of it. Then the 3 months of physical therapy started.

Once I had normal range of motion in the leg again (0 to 135 degrees IIRC), then I went back to the flight doc, and was put back on flying status. He said the AF wouldn't have a problem with the screws being in, but around that time, as the knee swelling was still going down, I was starting to feel (and see) the ends of the screws as they were pushing up against my skin. The Orthopedic surgeon said that might happen, so I had the screws taken out. Another month of DNIF followed, and then full up again.

Hoser

[Guest jriggoMOANG]

I had the same question a year ago about hardware in my elbow. I "SEARCHED" the forum and other places on the internet and found this answer on the brooks.af.mil waiver site.

I. Overview. Fractures requiring open reduction and internal fixation (ORIF) are fairly common among our active aircrew member population. Less common are degenerative joint diseases requiring prosthetic joint implants due to the relatively young population served. Retained hardware, except in the case of joint replacement consists primarily of screws, plates and wires. These components are placed to stabilize the fracture and allow for adequate healing. Once the bone has healed, in most cases the materials may be removed without detriment to the patient, whereas prosthetic joint replacement devices are life long. Occasionally the orthopedic specialist will defer removal of ORIF hardware due to the complexity of the procedure and the risk of surgery outweighing the benefit of removing an unoffending foreign body. If the retained fixation device is intact, not subject to trauma, and does not cause the patient pain or a reduction in function, it can usually remain and the patient may be considered for waiver. Fixation devices in the spine are not waiverable.

II. Aeromedical Concerns. The chief aeromedical concerns of aircrew members with retained hardware are the actual underlying orthopedic diagnoses. If the ORIF hardware has to remain in place due to a bony defect then the condition can not be waived whereas a prosthetic joint may be waived. Other concerns are discomfort due to the hardware, risk of re-fracture, adequacy of function, soft tissue inflammation, increased risk of infection leading to osteomyelitis, stress shielding and fatigue failure of the devices which all may lead to flight safety issues and failure to complete mission requirements. Finally in the case of prosthetic joint replacements is the concern that they generally wear out in 10 to 15 years.

III. Information Required for Waiver Submission. A request for waiver for a retained fixation device or prosthetic joint should be accompanied by appropriate x-rays, orthopedic consultations, operative reports, physical therapy reports regarding muscle strength and functionality and a written opinion from an orthopedist that the hardware should not be removed and that it is unlikely to cause problems during the patient’s lifetime.

IV. Waiver Considerations. Patient is grounded until evidence of bone healing and return of full function can be documented. Waiver is not required on recovery from fractures where full function has been restored without retained fixation devices or when fixation devices have been removed. Waiver should be applied for when function is compromised or where fixation devices are retained. Waiver is generally not granted for long bone intramedullary rods, femoral and tibial plates, hip screws or pins, spinal fixation devices or where location could lead to trauma. In the realm of joint prosthetics, a Class IIB (non-ejection seat) waiver may be considered for hip or shoulder replacement and unrestricted waivers may be applied for in other joint replacements. The Air Force experience is fairly low with both retained ORIF hardware and joint prosthetics, but of those applying, over 80% have obtained a waiver in the past.

If you read thru all of that, even though it is in reference to Open reduction internal fixation of a break, it does reference retained hardware.

"If the retained fixation device is intact, not subject to trauma, and does not cause the patient pain or a reduction in function, it can usually remain and the patient may be considered for waiver."

If you want to go for the waiver, I was told that you need to have all the documentation from your injury and from your surgeon that outlines EXACTLY what, why, when, etc. Also...VERY IMPORTANT...a letter from the orthopaedic surgeon CLEARLY stating how well you've healed and that you are under no restrictions and that you are at NO risk for joint instability, etc, etc.

That was from F16PilotMD on this board. Hope that clears things up

[Guest F16PilotMD]

Your knee should not be a problem but every case is different. The above post is from the Waiver guide and gives good advice. You are correct, get all the details you can find. That will be the key to success. Stories about other folks are nice but, again, each case is different.

BTW, don't listen to recruiters...about anything.

[Guest rajunkajun21]

I had arthroscopic knee surgery on one knee about two years ago. I have no ligament or cartiledge damage. They had to basically clean it out and shave my patella. I chipped a piece off when I was younger playing sports. I have full use/motion now. What are the chances I will be turned away from a pilot slot because of this.

[Guest Hoser]

Rajun,

I had 2 knee surgeries (both of them after I had my wings). I had tibial plateau fracture with compression. Bone graft, hardware, etc.

After 5 months of physical therapy and regaining full range of motion, I had no problem getting back on flying status.

You should be fine.

Hoser

[Guest Cattelan]

I need some advice, I have had minor knee aches for several years on and off. Nothing too bad. However, I just was accepted by a guard unit for a pilot slot and my knees seem to be hurting more now.

I have never been limited by my knees when it comes to running/biking. However lately they seem to hurt a little when I run. My right knee also will "pop" when I bend over once in a while, however it doesn't hurt when that happends. My question is, should I just bear any pain I may have now until I get out of UPT, or should I have it looked at in case something needs to be fixed. I'm afraid to do so and fail my First class medical, And just in case they need to fix something, will this disqualify me for my FY08 slot?

Any advice or past expierence would be much appreciated.

[Guest P27:17]

FB,

IMHO, if it is "minor" now but getting worse it seems logical that the more you use it the worse it will become. You have over a year before going to UPT...why not see what's going on now and get it fixed (if necessary) before it becomes a major issue just before or while at UPT? If it something that requires surgery, the sooner it's done...the sooner you'll heal. It may push your physical date back a little but if it heals well you'll be good to go for the physical and UPT.

[Guest Hoser]

Flying Burrito,

I wouldn't sweat going to have it looked at. I have one REALLY bad knee (tibial plateau fracture with compression) which required 2 surgeries, 2 screws, a bone graft and 5 months of physical therapy. Granted I already had my wings when it happened, but the flight doc said that even with hardware in the knee, as long as I had the 'normal' range of motion (IIRC, 0 to 130 degrees) that I would have no problem getting back on flying status.

I know a few people that have had ACL surgeries, etc and they are all still flying.

Good luck,

Cap-10

[Guest doctidy]

Does it hurt right at the knee cap?

Have you increased your running / biking?

[Guest Cattelan]

No, it hurts in the joint. I have not increased my running or biking, lately I have decreased to try and heal. My thought lately is that I don't have the proper shoes to combat my flat feet, I have orthotics, but I'm thinking my shoes allow for too much movement when I run.

The only concern I have though is my knee will "pop" or feel like it moves in the joint. Like I said, it doesn't hurt when it pops, but feels sore most of the time otherwise.

[Guest doctidy]

I think you will find this is just some minor problem which requires some PT or orthotics, etc. I don't see anything you are telling me that this will in any way jeapordize your slot.

[Guest RockNRoll]

Is arthroscopic knee surgery disqualifying? I haven't had it done but know that it would be the wost-case scenario for me knees that just started bugging me a bit.

I already have my FC1 but don't start UPT until the summer.

Any help would be apprecciated.

Thank you!!!

[JoeNJ]

You'll probably find what you need with a quick search, i'm pretty sure knee surgeries have been discussed before.

[Guest cbire880]

No, knee surgery is not disqualifying provided the recovery is uncomplicated and asymptomatic. It could delay your entry to UPT if you don't coordinate it properly. Do not take arthroscopy lightly though. Don't have surgery unless you absolutely have to, its not worth the risk.

[Guest RockNRoll]

No, knee surgery is not disqualifying provided the recovery is uncomplicated and asymptomatic. It could delay your entry to UPT if you don't coordinate it properly. Do not take arthroscopy lightly though. Don't have surgery unless you absolutely have to, its not worth the risk.

I did do a search. There were quite a few topics but none of them quite corresponded to my specific situation.

[Guest cbire880]

Well considering arthroscopic knee surgery is a broad range of procedures which only share a common set of instruments, you are going to have to be more specific about your case if it is so unique. I have posted quite a bit about my ACL reconstruction which has been cleared without a waiver for an initial navigator physical. I would venture to say that unless you are looking at a total knee reconstruction via arthroscopy (which has been done, pretty cool actually), any knee work will be less severe than rebuilding ligaments.

[Guest Hoser]

Without knowing the particulars of your case, and I'm not a Flight Doc, but I personally know two people in my old squadron that had arthro done on their knee, and I had two full up knee surgeries for a tibial plateau fracture with compression.

Granted, we were already rated aircrew when we had our procedures done, but barring any serious complications, I think you'll be OK.

Cap-10

[Guest P27:17]

If what ever is causing your knee to hurt is "cured" by the arthroscopic surgery (if truly needed) you should be good to go in relatively short amount of time. Talk to your Doc...if it is needed, the sooner the better.

[JoeNJ]

Thread revival. I've been reading lots of positive information regarding ACL Reconstruction and waivers. I also have had ACL Reconstruction on my left knee, and another surgery on the left knee for meniscus repair, with full recovery. Unfortunately, I recently injured my RIGHT knee and need ACL Reconsruction as well as repair of a slight meniscus tear. Pending a full recovery after this third surgery, do you think the outlook would be good for a non-prior like me to obtain the waivers I needed to fly? I would imagine multiple knee surgeries doesnt look very good in the eyes of the Air Force.

Edited July 17, 2007 by JoeNJ

[Guest P27:17]

Thread revival. I've been reading lots of positive information regarding ACL Reconstruction and waivers. I also have had ACL Reconstruction on my left knee, and another surgery on the left knee for meniscus repair, with full recovery. Unfortunately, I recently injured my RIGHT knee and need ACL Reconsruction as well as repair of a slight meniscus tear. Pending a full recovery after this third surgery, do you think the outlook would be good for a non-prior like me to obtain the waivers I needed to fly? I would imagine multiple knee surgeries doesnt look very good in the eyes of the Air Force.

The only limitation you will have is how long between your surgery and your FC I...will it be enough for complete healing? If so, you might not even need a waiver. Everything hinges on the success of the surgery and the long term prognosis.

Good luck

[Guest ready2fly]

Hello,

I'm a new stud about is going to be starting in a few weeks.

Recently (I've played sports, ran cross-counrty, etc) I just started having some knee problems. I had moderate pain in the insides of both of my knees that kept me from running. I took time off from running and it became controllable even tho the pain came back slightly and occasionally and the location of the pain often varied. I was able to run so long as I didn't over-do it and took care of my knees (icing, IBProfeun [sp], etc).

I saw some docs and they couldn't find any problems (X-Ray, MRI, etc)..

How they are now: There is now obvious fluid build-up on the outside portion of the knees and a little on the inside portion sometimes. Running does not seem to hurt so long as I take the proper steps before and after. However, sometimes it seems to slightly increase the fluid temporarily. Wearing "very good" running shoes or other shoes does not bother my knees really AT ALL (running, walking, sports). However, even walking in my flight boots bothers them (I'm trying to find good inserts!). I also will have to stop taking the IBProfeun before I run in the future since I will be on flight status.

Should I see the flight doc? Or only if it starts to interfere with my duties (which it isn't right now..so long as I find good inserts for my boots). Would that make me go DNIF or would he most likely just assist with the flight boot issue? Just wondering what to expect if it ends up that I should go pay him a visit.

Thank you so much!

Edited July 24, 2007 by Toro