First Surgeon Visit

The appointment at HSS today went really well. The surgeon patiently answered all of my questions which he has probably answered a million times before. We went through the MRIs in detail which was interesting and got a much better picture of what had happened in my knee.

On the MRI you can see the bone bruising on the front of the femur joint and the back of the tibia joint in the form of light white speckles. This shows exactly where the two bones jarred against each other when I dislocated my knee.

Also, the meniscus tear is evident on the MRI. It's torn on the edge and goes right the way through. The surgeon said he'd shave off the area around the tear in a semi circle so that the tear is basically cut out of the meniscus and cannot tear any further.

Surgeon tugged around on my legs and wiggled my knees to get an idea of looseness in my knees and also tested range of motion which was good, I think he said zero to 140 degrees.

So turns out there is another choice to make. Either the ACL reconstruction surgery can be done with a donor tendon from a cadaver (allograft) or it can be harvested from another part of my body (autograft). We talked a long time about this and seems there is no easy decision to be made here, there are pros and cons to both. Mmmm... more research required here.

In the meantime the surgeon has ordered a donor tendon (achilles I think) in case I decide to have the allograft. Apparently I can make this decision as late as the day before my surgery without any financial penalty.

Got given a bunch of instructions for pre-surgery, some exercises to do with the knee.

Surgery scheduled for October 13th.

Picking Up My X-Ray and MRI Files

So I needed to pick up my X-Ray and MRI images (conveniently on CD-ROM) along with the report from Beth Israel to give to the surgeon tomorrow.

After forking out my $40 the radiology assistant looks at my diagnosis on the file and says "Were you in a car crash?"

"Errrrr, no."

Great.

Crutches

So in Europe we have a different style of crutches than the ones in US where I am being operated. The American ones go under your shoulder and frankly tend to hurt a lot in my armpit, I know this from fooling around on friend's crutches when they have had their operations. Also, this style of crutches has not been used in Europe since the Second World War!

So I picked up these in anticipation of my surgery and recovery, I think they'll be much better. Each to their own I guess, gotta do what's comfortable.

Choosing My Surgeon

So I decided to have the operation in my last post. I certainly haven't ever had to choose my surgeon before but here's what I've decided what my criteria should be:

1) Must be a specialist in ACL reconstruction, not just a general orthopedic surgeon.
2) Must be recognized as an excellent surgeon by his/her peers.
3) Must frequently perform ACL surgeries and be aware of the latest techniques.
4) Must come highly recommended by patients.

Ask your friends for recommendations of hospitals and surgeons, you will be surprised how many of your friends have had ACL surgery that you didn't even know about (4 in my case!).

I'm based in New York City and the hospital that wins hands down for these types of sports injuries is the Hospital for Special Surgery (HSS). So I called my insurance company and got a list of the 5 best surgeons covered by my insurance who are at HSS.

I've chosen my surgeon now and couldn't be happier. The department works with the New York Mets, Giants, Knicks, Nets, Red Bulls and a bunch of college teams. Appointment scheduled for Wednesday 29th.

Click here to go to the website.

Anatomy of the Knee

A great website that explains the anatomy of the knee with regards to the ACL much better than I ever could!

Click here.

MRI Follow Up

So the knee is feeling a lot better today and I'm thinking I might have gotten away with a strain of some kind or a small tear that will heal itself. With a bit of physio and better stretching I should be OK in a week or two I'm sure.

The doctor walks in, I shake his hand and I'm quietly confident.

"So Nick, it's as we though. You've torn your ACL..... and your Meniscus."

Boom.

The doc walks me through the MRI and it's not even close. The whole ACL is not even visible on the MRI, it's completely disintegrated. The meniscus also has a tear in it (turns out about 70% of all ACL tears have some meniscus damage because of the twisting motion needed to tear the ACL).

The doctor tells me I don't have to have surgery right away, and in fact he says I don't ever need to have it. "With physiotherapy you could live an active lifestyle, but a return to "cutting sports" is unlikely."

It's a no brainer, I decide right there and then to go for the surgery because:
1) I want to play any sport I damn well please;
2) I don't want to risk further injury to my meniscus which may lead to arthritis; and
3) Physiotherapy to compensate for not having an ACL will probably take as long as rehab from surgery anyway.

The last thing the doctor tells me is that if I choose surgery I get to choose my own surgeon and that I'm not restricted to the ones at Beth Israel Medical Center. Interesting...

MRI

Once again Beth Israel came good and I got an appointment today for 12.30, again at short notice! I don't think there are any specific guidelines for a diagnosis but I just want mine as quickly as possible! Was a little wary as I've heard that people get dizzy and disorientated with all the strong magnetic fields. In the end they placed me half in/half out of the big MRI cylinder (my own non-medical term!) with a smaller cylindrical scanner just around my knee.

The MRI machine seems to be unnecessarily noisy, like the smoke monster from LOST or something with lots of loud banging. Got some headphones with mellow music to drown out the sound a bit which was good. Anyway, in the end the whole thing lasted about 30 minutes but remember to keep still or they have to do them again! The MRI technician gave me a glimpse of the end product but couldn't make head or tail out of the black and grey swirls. Made me wish I'd googled knee MRIs beforehand so I knew what I was looking at.

You don't get any interpretation when you get the scan done, a specialist will review it within a few days and write a report on what they see. MRI results appointment scheduled for Friday 18th.

No dizzyness or disorientation by the way. Result.

First Doctor Visit

So, worried about my knee I made an appointment to see an orthopedic specialist. I didn't bother to see my regular doctor as I knew he would just refer me to a specialist. In any case my insurance does not require the referral so I figured this way would be much quicker.

I have to say that getting an appointment at short notice was extremely difficult. The only advice I can give you is to call the bigger practices and see if you can be squeezed in or go on a waiting list. In the end I went to the Beth Israel Medical Center in NYC, and I can highly recommend them and also thank them for seeing me so promptly!

More important though, is to check with your insurance companies to get a list of eligible specialists. What you don't want in addition to your knee injury is a great big bill from the hospital that your insurance company won't cover!

So I went to see the doctor who requested several x-rays be taken of my knee in different positions. Not a lot of fun if you can barely walk, let alone stand still with bended knees in front of an x-ray machine! They did give me lead padding to shield my crown jewels which was thoughtful.

The doctor pushed and pulled both my knees in several directions and compare the two. He seemed quite happy with everything and was surprised at how little swelling there was in the knee which I took as a good sign. As far as the bones went everything was OK, however ligaments and tendons don't show up on an x-ray (they don't contain calcium) so I have an MRI scheduled for next week.

The Accident

So most people who tear their ACL do it while playing sports with "cutting" movements involving sharp changes in direction such as Basketball, American Football or Soccer as in my case. I'd like to tell you I went down in a blaze of glory being tackled by 3 defenders but alas there was no one even close to me when it happened!

I usually shoot with my left foot but I found myself in front of goal with the ball sitting up on my right side. As I went to lash the ball into the top corner of the goal *cough* I pivoted on and extended my left leg full stretch to shoot with my right. As I went to shoot my left leg buckled "the wrong way" and felt my knee dislocate and twist with a "pop".

I have to say that even though I'd had the dislocated feeling I also felt everything get pulled back into place and though that maybe I'd been lucky and got away with a twisted knee and a few weeks on the sidelines. It wasn't until a team mate told me about his previous ACL injury that I thought there might be a problem. According to him the "pop" was probably my ACL........

Got a ride home from the field but walking around my apartment felt weird. Knee felt weak and unstable and also nearly buckled on me a couple of times, though thankfully only the "right way" this time.

Urban Soccer League Champions, Summer Season 2010

(I'm at the back, last one on the right. Also, last known picture of uninjured left knee!)

Reason For Blogging

So..... I don't normally do this kind of thing! I tried looking around the internet and there is enough information about the actual ACL surgery and rehab but not so much about the actual experience of going through a process like this.

The best I've seen are Henry (ACL Allograft Revision) and Eric's (ACL Hamstring Autograft) blog which is here. However, now I have done my surgery (ACL Patellar Autograft) I am noticing big differences between their blog and my experience, probably due to the different graft being used, so decided to start this blog up.

I'll put up the links that I used in doing my research, hopefully this will be useful and save you a bit of time and help making some difficult decisions a bit easier! In the interest of keeping everything chronological I'll backdate this post and some of the others. I'm currently 10 days post op, but wanted to keep everything in order you can read it through logically.

Please feel free to add comments with your experiences, or just check in from time to time and follow the ride!

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