Knee/ACL injury and surgery info

[Guest cbire880]

So I injured my right knee skiing about a year ago. Now its time for me to go to MEPS for OTS and I've got a predicament. The ortho I was seeing sent me for an MRI which returned with a possible ACL rupture. I was told to exercise it and come back to see him if the knee continued to bother me. I haven't had it give out on me since and am running appprox 20 miles a week on an indoor track. Doesn't hurt to run, but I can tell its not as good as my left knee. So I was doing my research in prep for MEPS and came upon the DQ for ACL injuries. I know the reconstructions can be waivered, but has anyone heard of a waiver for a previous knee injury without surgery? I'm running out of time before I have to decide whether or not to get it done(going to graduate school in 3 months). I'd like to avoid surgery if at all possible, especially since I feel I'm 100%, but I'll do it if that's the only way to get qualified. Any help would be appreciated.

[Guest F16PilotMD]

I don't know of any specific individuals who have received a waiver for this on induction to the USAF. I know plenty of pilots who have blown out their knee, and worse, who are still in and still flying.

Make sure you have a no kidding diagnosis of an ACL injury before you state that to the MEPS. From what you wrote, I would say you have a history of knee injury with full functional recovery. An MRI that shows a "possible" anything is NOT a diagnosis.

I don't advocate dishonesty ever...but don't shoot yourself in the foot (knee) either.

Good luck.

[Rocker]

I have a flying status waiver for PCL (similar to ACL) reconstructive surgery, and a titanium IM rod in my right femur. ACL and PCL require the same waiver. I am non-prior service and the waiver was approved (after a few tries) for accessions and upgraded for flying duties.

I recently received a PM from a user here about this subject, and I will paste my response below. His case is very similar to yours. It's pretty much a straight cut and paste, so not all of it applies directly to you:

-------------------------------

I do know alot about this subject unfortunately... What I can tell you first off is to be honest and not hide anything (only concerning actual doctor-diagnosed health issues...not "I think I may have had a kidney stone one time..." type stuff - you DO NOT want to open unnecessary cans of worms). If you can get your doctor to sign off on your knee saying that there is no residual instability and it is strong, then you might have a shot - though that does not sound like your case right now. I'm not sure which avenue you are pursuing a commission though, but more than likely, you'll go through a MEPS (Military Entrance Processing Station) for your initial physical (long before an FC1), and when they find out about your knee trouble, they'll send you on an orthopedic consult. No big deal, just another civilian doctor who will examine your knee and make an official recommendation. One thing with the ACL though, is that when they do the Lachman's test, it will likely be positive. If it's over +1 (basically if instability is anything but very mild), you're going to have problems with AETC and you'll be disqualified. I know this because I was DQed - twice. (I realize that Lachman's is not really a function of the PCL, but it's an issue I was dealing with) The biggest reason for coming clean about this when you're supposed to is because if they find out about it later, you are SCREWED. It could become a fraudulent enlistment case and that is not good. Save yourself worrying and headaches, get reconstructive surgery (or get on a physical therapy plan that will get you back to close to 100% - at the advice of your doctor), get your waiver, and go in the right way. Now, having said all of that, let me just say this: if your injury is just a partial tear (and your doctor is really the one who can tell you about this), you might have a good chance at building up your quadriceps and other leg muscles (but most importantly the quads) and making your knee stable. But I can tell you that if you require a brace for normal athletic activity, you won't make it. Also, on the form that you fill out when you do the physical, with about 100 questions starting out with "Have you ever had or do you now have...." I think there is one question about torn ligaments. They also ask about surgeries, etc... But with just a partial tear, you might be able to get by - just keep in mind that they are serious about knees. I suppose if you can truthfully get your knee into top shape without surgery or the need for a brace you'll be good to go. But if this is a diagnosed condition and it's in your medical records, be honest, do what you have to do for your knee, get your doctor's sign off, and move forward. I know I'm rambling a little but the bottom line is this: get your knee into shape and then apply. A medical disqualification is extremely disheartening. Do everything to avoid that in advance, whether it be surgery or a physical therapy regimen.

Sorry this went so long, but there's alot to it. If you do get wrapped up in the waiver process, you've got to be very persistent and patient. There is no good way around it, but don't just give up. Best of luck and let me know if you have any more questions,

John

[ 03 February 2004, 10:14: Message edited by: John Thompson ]

[Guest cbire880]

Thanks for the advice. What I've heard from several sources is the same. I think I got a reply from you John on airforceots.com too. I haven't used anything more than an ace bandage to support the knee when running, etc. Usually, I don't wrap it at all unless its a little sore at the end of the day and that's pretty rare lately.

I've got an appointment to see another ortho for his advice one way or the other. Get him to do the lachman's test and all. If he'll sign on it as good to go, I'll be in for the 04-05 board, otherwise, its off to surgery and rehab. Thanks again.

[ 03 February 2004, 01:21: Message edited by: cbire880 ]

[Rocker]

Good luck! I can tell you what my contact at HQ AETC/SGPS told me: if you have an uncomplicated recovery, no residual instability in that knee, and symmetrical size and strength (and the doctor indicates all of that in his prog. report), then a waiver IS likely. Keep that in mind and hang in there!

I remember the airforceots.com response now...

[ 03 February 2004, 10:19: Message edited by: John Thompson ]

[Guest cbire880]

John, just a quick question to clarify. You were talking about recovery after surgery right? They won't waiver it if its torn and you don't get surgery its what I've heard.

[Rocker]

Correct: recovery after surgery. I feel very confident in saying that they will not waiver it if it is torn and unoperated. Not to say a waiver is impossible for a stable knee with a torn ligament - good ol' FlightDoc even told me back in the day what I'm telling you here - but strong ligaments (and musculature) are what stabilize knees...so you can see where that gets you. I first attempted a waiver with an unoperated knee with a torn ligament. It was mildly unstable, but there was absolutely no functional deficit (active in running, biking, and full contact sports with no need for a brace, etc...). I also had favorable letters from both my doctor and the MEPS ortho consult doctor indicating this. Regardless, it was a pretty quick but painful DQ from all military service. The second DQ came over a year later, after the recovery, but when the knee was not quite up to standard yet. A few months of hardcore physical training and the right doctor put me on the right path to an eventual waiver. Perhaps it can be done with a currently partially torn ligament (I'd give it an 80/20, in favor of the DQ), but I would say with a completely torn ligament and anything more than mild instability, you will most definitely be disqualified. But again, my guesses are just that. I'm certainly not the AETC.

Again, sorry for being wordy, but there's alot to this. Definitely feel free to post more questions if you have them.

[Guest cbire880]

I went and saw my family doctor today so I could get a referral to a specialist, gotta love HMOs. I'm getting a new MRI done next friday, but from the look of things I'd say there is an 80% chance that its shot and I'll need surgery.

So I'd like to keep the ball rolling as fast as possible with the waiver issue if I have to get cut. Do I need to get DQ'd at MEPS before I can start the waiver process? So should I go down there and get DQ'd if I find out or wait to see them at all until after I recover? I'm not sure how much extra lag there will be if I go there after recovered and they send me home telling me I need a waiver. Thanks for all your help so far.

[Rocker]

Whether or not to go to MEPS with a known disqualifying condition can be a tough decision. You know you will likely be DQ'ed...but what if? Somewhat of a crapshoot, though the odds are most definitely in favor of a DQ (assuming you have a torn ligament or otherwise unstable knee). However, if you take the long road, get your knee squared away now (for your own good as well - afterall, your health is the most important issue), and then proceed to the MEPS, the waiver process will go much more smoothly (I wish I would have done it this way back in 2001). It'll also save you a lot of potential heartache. When you go to MEPS after your recovery, you will be sent on an (or another) orthopedic consult and will be disqualified by MEPS. Your MEPS information will then be forwarded to HQ AETC/SGPS for waiver/certification. The MEPS approval authority is DoDMERB (DoD Medical Exam Review Board - not USAF) and acts as a channel for all of your stuff going to AETC.

Don't sweat a MEPS DQ too much...it's just a necessary process for your package to go up to the SG, and it WILL happen if you have a disqualifying factor. I used to get DQ'ed by MEPS all the time. Then when I finally had my waiver, and had it printed out and with me, it was like a force field against those MEPS people.

But as I've said with all of this...it's a long road and it's going to take tons of persistence and patience. And it is not unlikely that there will be significant paperwork errors and delays along the way. Hang in there and keep your eye on the ball. Also keep the questions coming as you think of them.

[ 04 February 2004, 20:18: Message edited by: John Thompson ]

[Guest Roy Rogers]

In 99' I tore my miniscus with a slight tear of my MCL while playing college football. I had it scoped and they put some sort of disolvable plastic arrows in there to let it heal up properly. However, a few months later my knee still bothered me and I went back in for a second scope. They ended up taking out about 25% of my miniscus, but they left the MCL alone and said it would be fine. My question for anyone is this: is this a disqualifier? I had no pins or metal put in me and they never cut me open either. Just two little scope procedures and now I feel great and it doesn't bother me at all. What do you think? Thanks for the help.

[Guest riceowl63]

My brother is a zoomie and he blew out his left knee bad. Torn ACL, MCL, patellar tendon, mensicus, and PCL. They put it back together and he tried to play ball at the Academy, but he just couldn't push it that hard. Anyways, he's had his flight physical and he was DQed for the knee thing, but they told him it was a really easy waiver to get. If he can get the waiver with all he did, you shouldn't have a problem.

Who do you play football for? I play at Rice. Maybe we'll knock heads this season.

[Guest cbire880]

I injured my ACL skiing a year ago then found out its disqualifying. I don't recall the exact reg, but any internal damage to the knee is DQing. I don't know about repair for the MCL since it will heal itself unlike my ACL. John Thompson helped me out a lot with the waiver questions in a thread I started earlier about knee injuries. I'd suggest you check out his replies for specific regs. I'm two weeks out of ACL reconstruction sugery so we'll see how my waiver goes in a few months.

[backseatdriver]

I've had ACL reconstruction and have two screws in my knee and passed my FC1A without even needing a waiver. I have a buddy who's headed to UPT after he graduates in May who passed his FC1 as well - same surgery and same screws. I also know a guy who flys 15Cs who graduated from my Det and had ACL surgery.

So, Roy Rogers, short answer is no, there's no problem with you having had the knee surgery, especially if you don't have any screws or anything in you. As long as you have full range of motion and full strength in the knee, you should have no problem passing.

[Guest F16PilotMD]

The applicable sections of AFI48-123 are below. Knee ligament repair is DQ for induction to the USAF. Knee "weakness" is DQ for flying. I know many pilots with ACL/PCL etc repairs. I don't know any with waivers on induction. Seems like an easy one to get, however. Must have documentation of complete healing with no limitation, etc.

MEDICAL STANDARDS FOR FLYING DUTY

A7.26.1.6. Disease or injury, or congenital anomaly of any bone or joint, with residual deformity,

instability, pain, rigidity, or limitation of motion if function is impaired to such a degree it interferes

with training, physically active lifestyle, or flying duties.

A7.26.1.8. Instability of a major joint if symptomatic and more than mild, or if subsequent to surgery

there is evidence of instability, weakness, or significant atrophy.

A7.26.3.10. Weak Knee. Dislocation of semilunar cartilages or loose foreign bodies within the

knee joint; residual instability of the knee ligaments; or significant atrophy or weakness of the

thigh musculature in comparison with the normal side; or range of motion less than specified in

A3.27.MEDICAL STANDARDS FOR APPOINTMENT, ENLISTMENT, AND INDUCTION

A3.27.3.3. History of surgical correction of knee ligaments.

[fou]

F16PilotMD - so are you saying after being inducted into the USAF that you wouldn't have to have a waiver for knee surgery for flying status? Say you had no problem before getting in, then got hurt and had surgery that you wouldn't have to get a waiver?

[Guest F16PilotMD]

The specifics of each injury are important but I find nothing to indicate that you need a waiver for a flying class I or II for just an ACL or PCL repair. You may need the waiver to stay in the USAF since it's DQ for induction.

[ 21 March 2004, 10:26: Message edited by: F16PilotMD ]

[Guest pilot -applicant]

I had ACL reconstruction in Nov 2003, and I'm scheduled for MEPS this June. My question is should I be prepared to be told that I have to wait some time period before I can get a waiver? And if so should I have my surgeon give me a full recovery status before I go to MEPS, get DQ’d and ask for a waiver? I’m on track for a full recovery real soon, and I’m just wondering if I should wait until the September deadline so that I don’t have any hang up’s with MEPS?

[Guest F16PilotMD]

You HAVE to be fully recovered before you can apply for a waiver. Your waiver application will have to contain evidence of said recovery.

[Guest ET]

OK, what I thought was a non-issue has raised a couple eye-brows so I was hoping for a few specifics.

I found a couple old posts but want to make sure.

ACL reconstruction with patellar tendon, 5 years ago, checked out recently for Navy and was better / more stable than my other knee with no complications, now applying for Guard, 2 screws which doctor said could be taken out if needed when I had it done.

What has me worried is the 2 screws, they're not doing anything now that it's healed, should I have them taken out or is this not an issue? I'd rather not as it would be a pain in the a$$.

[Guest ET]

Also, looking at the waiver guide under retained hardware, I think I'm OK. I had a friend who got approved with staples and I don't see any difference in having screws, the doc put them in instead of staples because he felt they held better for healing.

[Guest Hoser]

ET,

I am by no means a Flight Doc, but I did have 2 knee surgerys within the past year, one to put my knee back together and one to take the screws out after it healed. I was back up on flying status 6 months later. I was told by my flight doc that it is no problem getting back on flying status with the screws still in. In fact a dude from my old squadron has 2 screws in his writst.

The only reason I had mine taken out was because of where they were. I had broken my tibial plateau and as the swelling went down, the doc told me I would probably start to feel the ends of the screws under my skin, and if I did, he would take the screws out, but he didn't recommend the surgery if the screws weren't bothering me. I think you are ok with the retained hardware, but definetly wait to see what F16PilotMD has to say as well.

Good Luck,

Hoser

[backseatdriver]

I've got two screws in my knee from ACL reconstruction and didn't have any problems with getting on flying status. I've got a buddy who just passed MFS and is on his way to UPT that also has two screws in his knee from ACL surgery. So, in short, it won't be a problem.

[Guest F16PilotMD]

There are three issues.

#1 Getting in the USAF to begin with because of:

A3.27.3.3. History of surgical correction of knee ligaments.

#2 Getting an Initial Flying Class 1 because of:

A7.26.1.11. Any retained orthopedic fixation device, that interferes with function or easily subject to trauma.

#3 All of the above if there is ANY residual symptom or weakness in the injured leg.

Having said all of that, I too know several people who have entered the USAF and gone to UPT with a rebuilt knee and retained hardware. It appears the enlistment waiver is easy to get and after that the IFC 1 waiver is a done deal. But, it's all contingent on favorable documentation from your orthopaedic surgeon in regard to the details of your injury, repair, current status. Also, your flight doc needs to write it up correctly to ensure approval.

[ClearedHot]

It has been nearly two years but on my last mission in Afghanistan I had a small fire on the plane. We did the IFE song and dance followed by an emergency ground egress. When I jumped off the ramp I felt something tear in my knee. It was sore for a while but seemed to improve with time, but never completely healed. Last year at ACSC I was doing a lot of running and it started to get worse again. Now it is to the point where it hurts to go up stairs. Sometimes it is fine, but if I move laterally, I get some fairly severe pain. I completely stopped running in May in an attempt to give it a chance to heal, it hasn't. I finally broke down last month and got a referral to see an orthopedic doc up at Bethesda. He looked at my knee and had them take 5-6 X-rays only to tell me I don't have a torn ACL or MCL (the flight doc thinks I have a torn meniscus). Bottom line, the doc acted like I don’t have a problem, perhaps some early arthritis, but nothing more. He gave me some Naproxen ordered some physical therapy to strengthen the upper muscles on the upper part of my knee and sent me on my way. I have a fairly high tolerance for pain, but this is really starting to cramp my style. Wouldn’t an MRI give a better idea of what is going on? I could really use some words from one (or more) of the docs on here to point me in the right direction.

[backseatdriver]

Well, I'm no doc, but I have torn an ACL, and I know I was told they couldn't know for sure about the ACL without a MRI. I've got a buddy who tore his and the first doctor he went to told him his knee was just sprained a little, and a month later went to another doc and found out he had a torn ACL once they MRIed it. So with my limited knowledge of such things, I would press to get the MRI done.