Flying Home After I Tore My ACL

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Below, I share my story of how I tore my ACL while I was on vacation in the British Virgin Islands. Of course, nobody wants to rupture their Anterior Cruciate Ligament. But I can promise you that you really don’t want to pop it while you’re away – because you have to figure out how to fly home. I’m not a doctor but I saw two doctors and spoke with my insurance company and airline to get the all-clear to take my long-haul flight back home. These are my tips and my experience.

Can you fly with a torn ACL?

The short answer is yes, you can fly with a torn ACL. But there are some things you should check before you fly.

Get checked by a doctor first

If your knee injury is fresh, as mine was, you want to make sure you have no additional issues. A ruptured ACL in itself won’t cause a problem – the ligament is simply snapped. However, I was sent for a Doppler Ultrasound in Puerto Rico to make sure the blood flow in my leg arteries and veins was good. This was to ensure I wasn’t at increased risk of DVT. I should mention my leg was in a bad way after I injured it – immobile, swollen, and with some worrying bruising (which is what prompted the doppler).

After the initial rupture, I flew many times before the repair surgery. I also fly regularly post-surgery. Not since that initial check, in Puerto Rico have I been advised to get tested for DVT risk before flying. If you’re not sure, speak to your knee doctor.

Check with your insurance company

Once you’ve injured your knee, it becomes a pre-existing condition. So, if you want to be covered for it on your travel insurance, you will probably have to get approval from your insurance company. Mine kindly added it for no fee (thanks HSBC). If in doubt, give them a call. It’s a common condition and it’s best to be covered if you can.

Get a fit-to-fly letter if necessary

Again, because I was flying with a new injury, my insurance company and the airline wanted a fit-to-fly letter. My doctor issued this with no problem. I’ve not needed one since that first flight home when I was clearly borderline unfit to fly.

Consider an upgrade for comfort

Fortunately, my travel insurance covered me for an upgrade to business class where I had a flat bed and the ability to extend and elevate my leg. This was necessary as my post-injury range of motion was almost zero. Unable to bend my leg, I couldn’t have sat in an economy-class seat. But even if you can, consider the length of the flight. Reduced mobility can lead to a lot of pain in a cramped space.

Related: Long Haul Flight Essentials For A Relaxing Flight | 40 Travel Safety Tips for a Stress-Free Trip

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Rupturing my ACL

The moment my cruciate ligament ruptured in my knee has left a visceral imprint in my mind. It wasn’t so much the popping sound, although I can conjure up the exact noise at a moment’s notice. Nor was it the pain, which wasn’t as bad as you might imagine because, apparently, the more severe the knee injury, the less pain you feel. It was the feeling of free movement I remember the most – the sensation of my knee no longer being held in place the way it had been before, and the deep queasy urge to vomit that came with that realisation.

When the ligament ruptured, I fell to the floor, as one would. But within seconds I was back on my feet. Years of gymnastics as a teenager taught me about sprains. Although my teenage preference had been for busting my ankles, not my knees, I was more than familiar with the buckling, the swelling, the aches, and, yes, my impatient need to test things out, even if it is with a limp.

British Virgin Islands sunset at sea
If you’re going to injure yourself, at least do it when you have the beautiful views of the British Virgin Islands to distract you from the pain.

So, with a brave face and a fake smile, I pulled myself up, brushed the doughnut dusting of sand off my right side, and took a few tentative steps. And then I took a few more and a few more still until I was convinced I could walk. Yes, my knee felt tender and I knew I’d done something to it, but how badly could you injure yourself taking a sudden sharp turn on sand?

Very badly, apparently.

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Injured in the Caribbean

After half an hour of RICE (rest, ice, compression, and elevation – the system all good first-aiders will tell you about), my bladder called and I hobbled to the loos. Being on a small island in the British Virgin Islands, the toilet block was pretty basic – a jazzed-up portacabin at the top of some steps. Impressed with myself I made it to the top just fine. The way back down was a different matter.

My knee collapsed at the very top and I tumbled to the bottom, leaving behind a six-inch swatch of my shin on every concrete step I met along the way.

When I fell the first time, when the ligament ruptured and the connections came loose, I still had hope. It could just be a sprain. I’d recover in no time.

It was the second fall that told me the truth: your knee doesn’t just collapse underneath you for no good reason. It doesn’t have the humour to go rag doll and laugh at the consequences. It’s formed of ligament and cartilage and muscle and more. And suddenly those parts were no longer playing together.

That was when I knew I’d screwed something up. Big time.

Of course, these things rarely happen with convenience and I was several days’ sail from the nearest hospital at the time.

Related: 33 Travel Stories – The Good, The Bad & The Funny

British Virgin Islands Crew and passengers on boat
The best crew I could have asked for.

I spent the remainder of my trip in the British Virgin Islands staring at the sky, my leg elevated, ice pack on, and a stack of ibuprofen doing good work to keep the pain at bay.

It might sound like a terrible way to spend an amazing trip, but it was probably the best circumstances to be in – the catamaran was small enough that I could hop from place to place. The scenery changed every few minutes and fate had placed me on a boat with the kindest, most generous, and helpful people to be found – had I been tasked to scour the planet for shipmates to assist me with my knee troubles, I doubt I’d have picked a better crew.

And then the trip ended and it was time to face reality.

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What exactly have I done to my knee?

More doctor, physio, x-ray, MRI, and surgeon appointments than I care to recount have confirmed my long-held belief that when I do something, I do it to the fullest extent possible. Good or bad. In this case, bad.

So, what exactly have I done?

As well as rupturing my anterior cruciate ligament (one of the two cross ligaments in your knee), I have a Grade II tear to my medial collateral ligament (the one on the inside of your knee), which is hanging on by a thread. To complete the trifecta, I also have a two-centimetre tear in my meniscus (cartilage).  Add swelling, inability to straighten my knee, bone bruising (yep, apparently that’s a thing), and a few other minor matters that don’t deserve a mention in the context, and it’s safe to say I’ve screwed my knee up properly.

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Surgery and Recovery

Puerto Rico colourful buildings in San Juan
Little did I know when I took this picture in San Juan that I was days away from screwing up my knee for a year.

I injured my knee on 10 December. With the help of an amazing friend, I managed to get the most out of the rest of my time in the British Virgin Islands and a few more days in the Caribbean (cobbles, a knee brace, and an unsteady knee are not ideal travel companions, FYI).

After that, I went into ‘back to health’ mode. For an impatient person like me, that process was excruciatingly slow, particularly as the doctors weren’t happy to repair the damage until my knee was strong and mobile again.

On the plus side, after weeks of pushing my knee on bikes at the gym, tentatively incorporating weights, visiting physiotherapists, and finally managing to add my favourite bendy activity (yoga) back into my life, my knee was the strongest it had been since I bust it and I was finally fit for surgery.

On the downside, it took 9 months before I finally got my surgery on the British National Health Service. Months of physio followed. It hampered my travel lifestyle dramatically (though it was nice to swerve the risk of bed bugs for a while.

This post is part of a series. Here’s the full series:

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Got any questions? Leave a comment below. 

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Author - Jo Fitzsimons

Hi, I'm Jo, the writer behind Indiana Jo. In 2010 I quit my job as a lawyer and booked an around the world ticket. As a solo female traveller, I hopped from South America to Central America, across Asia, the Middle East and Europe. It was supposed to be a one-year trip but over a decade later, it's yet to end. I've lived in a cave, climbed down a volcano barefoot, spent years as a digital nomad, worked as a freelance travel writer, and eaten deadly Fugu. Now I'm home, back in the UK, but still travelling far and wide. You can find out more About Me.