2 Week Post Op Appointment

Went to see the surgeon today, very quick visit which is a good thing I think! Managed to sneak a peek of the x-rays:

Small victories this week:
- Walking without brace and on only one crutch.
- Stitches taken out.
- Showering without brace and being able to wash my leg, 1st time in 2 weeks.
- Being able to bend knee enough to sit normally in a cab rather than across all the whole back seat!

Fourth Day of Physical Therapy

Last session today before my 2 week post op appointment with my surgeon. Really good session as was able to do full revolutions on the bike and also hit my target of 110 degrees ROM 2 days early.

Worked a lot on the swelling above my knee today and by the time I walked out of there is was almost completely gone! Something that really helped was the electric stim on my knee, we changed the order of the program so that some of the swelling would be worked out by the pulsing quad.

Physio said the progress so far was excellent and will update the surgeon ahead of my appointment! Feels good to be making progress. Target for the next 2 weeks is to get me off crutches he says. That's what I like to hear!

Knee felt so good I walked home with the brace unlocked to 40 degrees ROM. Still on crutches but felt really good. Ran into a friend on the way home and found out he's had his ACL done as well (Hamstring Autograft, 5 years ago) and hasn't had any issues with it. Count of friends with ACL operations I didn't know about is now 5.

Electric Stim picture as promised, knee looking good and much less swelling

Third Day of Physical Therapy

New exercise thrown into the mix today, dragging back a large beach ball with my heel is helping me straighten my leg as well as activate the hamstring.

90 degree ROM today which is great! Slightly ahead of schedule. Now have to hit 110 degrees ROM before my 2 week post op visit to the surgeon.

Straightening the leg fully is still difficult, I seem to have swelling right above the knee which is stopping my from achieving full extension. Got a new exercise to do where I lie face down on the bed with legs hanging off just above the knee. Hold for 1 minute and then 15 hamstring curls, repeat. Let's see how it works.

Walked home from physio today, I'd say it was about a mile...

Second Day of Physical Therapy

Second day basically a repeat of the first, except that my range of motion (ROM) is now 87 degress and electric stimulation has been increased to 12 minutes for each setting (24 minutes total).

Here are some examples of some of the exercises I'm doing. Obviously don't start doing any of these without the guidance of a trained physiotherapist.

Doing 3 sessions a week now for the next few weeks.

First Day of Physical Therapy

Today was my first physiotherapy session and also my first time out of the house since the surgery. Felt great to be outside and the physio is only located a few blocks away in a cab.

During the session he measures my range of motion (73 degrees) and does some passive movement on my knee to loosen it up. The main thing is straightening the leg to zero degrees. Not there yet (about 3 degrees) but have exercises now to improve.

Also started electrical stimulation in the knee. This helps to get my quads to "fire". Two different settings, one which makes my quad contract repeatedly with an ice pack on my knee. Second setting where busts or current are passed through my knee as I flex my quads at the same time. This will help get the muscles and brain going again, getting used to using the muscle. Will post a picture soon.

The physio seems to know exactly what he's doing and has also rehabbed a few other patients operated on by my surgeon. This is definitely comforting, specially at the end when he says he's seen this a bunch of times before and that everything will be fine.

Current daily regimen is:
- 100 leg raises
- 100 passive knee bends
- 100 quad bursts
- 100 heel slides

No painkillers for the first time today even with the physio, so far so good. Still icing like crazy with the Game Ready.

Femoral Nerve Block Wears Off!

So my femoral nerve block wore off at about 3am this morning, not pleasant! Made up for it with a few extra doses of pain killer. So far so good.

Shower felt great and a lot easier to get in/out than I expected. Still needed help though. Get those swim trunks on in the shower!

Game Ready still a regular fixture, doing about 3 to 4 hours a day at the moment. It really seems to help with the pain and the swelling is way down already.

2 Days Post Op, Bandages Off

Last 2 days have been a bit of a blur. Spent a lot of time on the Game Ready and popping Percocet. My folks are here now to help me out (thanks Mum & Dad!) which is a Godsend as I really can't do too much at all!

Bandages and dressing comes off today, as long as there is no bleeding I can take a shower tomorrow. You'd think that would be good but my leg is so weak I'm not sure how I'm going to step into the shower. Should be interesting.

Looks kinda gnarly but a lot less swelling than I expected. No bleeding or leakage.

Slightly concerned about my shin, there is a numb strip from my knee right the way down to the top of my foot. Think this is just the femoral nerve block but not sure. Hope it's not any damage from the surgery...

Day of Surgery

Got the call from the surgery late last night, surgery time set for 12.15pm and need to be there 2 hours before to get prepped up. Filled out a bunch of forms (including my will!) at the hospital and escorted to a pre-surgery ward. Once there I'm visited by a nurse to insert an IV into my hand, resident physio who gives me my post surgery exercises already. The surgeon stops by for a chat and to sign the knee I'm going to have surgery on. In fact, every single person who stops by asks me to confirm which knee is being operated on. Also confirm the autograft and the allograft is sent back to the tissue bank.

Last pre-op picture of my knee, already signed and shaved ready for surgery.

Most interesting conversation was with the anesthesiologist. If they offer you a femoral nerve block, take it! it will greatly reduce your pain over the next few days, trust me.

I get walked over to the operating theater and it's a pretty serious feeling walking in there with equipment all over the place. I get up on the operating table and am covered with what I can only describe as an awesome heated blanket. The assistant tells he's putting some sedation into the IV, do I feel it yet? Nope, I say as they push me forwards to insert the epidural into my back. That's the last thing I remember....

I have no idea if I was asleep during the operation. When I came to it wasn't like I woke up, more like a livening of consciousness. I woke up back in the pre-surgery ward and was not alarmed at all, felt very relaxed. They kept me there for an hour or so to observe me and then my buddy was escorted in to take me home. Whole thing took about 8 hours, 10am to 6pm.

My leg looked and felt great (as in no pain). The knee was nicely bandaged up and strapped in to a serious looking brace as well. I was able to swing around on my crutches without much difficulty and we went home. Note they only give you enough pain killers to last you the journey home, so good idea to have one of your friends fill your painkiller prescription ASAP!

For the record, Percocet makes me talk non stop and not remember too much of what I say!

Be warned...

Pre Surgery Diet

The surgeon has told me to follow a special low fiber diet leading up to the operation. Makes sense really, if you're going to have an epidural and lose feeling from the waist down you don't want any accidents during the operation!! 

Anyway, I have a whole list of eligible foods. Opt for spaghetti Bolognese without any cheese or onions. Should be fine for tomorrow.

Made up my mind on the graft (finally!). Going patellar autograft. It's gonna hurt more and tougher rehab but ultimately has the best long term prospects which is the most important thing I think.

Time Off Work

So after discussions with the surgeon I'm going to take 2.5 weeks off work (Operation on October 13th and back at work November 1st). This is slightly more than usual, though everywhere I've looked people have said they wished they had stayed home a little longer.

Anyway, I can always come back earlier from 2.5 weeks off if things go really well.

Animation of the Surgery

If you were wondering how exactly it is that the surgeon is going to get my patellar graft into my knee, here is the answer:

Click HERE to see the video on YouTube

Click HERE to see the video on YouTube

Disaster!

So to add insult to injury (literally) my wisdom tooth got infected and was removed today! Following discussion with the knee surgeon the tooth needs to be removed as the infection could spread to the knee after the operation if it gets into my blood stream. Apparently the metal would attract it somehow and if I were to have a total knee replacement the operation would have been postponed due to significantly more metal being used in the operation.

Anyhow, the surgeon says that as long as I take the 5 day course of antibiotics following the surgery I will be good to go. Sweet.

Got an advance taste of Percocet pain killers. Can see how people get addicted to these, they make you feel great! Not a care in the world and not nearly as nervous about my surgery on Wednesday... :)

"Game Ready" Icing Machine

So the surgeon has recommended I get one of these. Looks pretty cool and should help a lot with the swelling in the first few weeks after surgery. It ain't cheap (rental for 21 days is about $300) and not covered by insurance, at least not mine. If you want one new I hear they are about $3,000 so maybe renting isn't a bad idea!

Click HERE for the website

There is another cheaper option called Cryo Cuff which only costs around $125 to BUY. Also looks good but in the absence of having time or opportunity to try them both out I went with the more expensive one on the assumption that it would be better.

For the Cryo Cuff website, click HERE.

ACL Discussion Forum

Great forum here to ask any questions or just read through, helped me a lot...

Click HERE.

Autograft Vs Allograft

So what is the difference between autograft and allograft reconstructions? Basically, the autograft is a tendon that is harvested from elsewhere in your own body and used as a replacement ACL. The ones that are typically used are part of the patellar tendon (it joins the kneecap to your shin) or a part of your hamstring. The allograft is a donor tendon from a cadaver, usually the achilles tendon is used.

I've been researching autografts and allografts for days now and there doesn't seem to be a clear favorite. The patellar autograft is often referred to as the "Gold Standard" for ACL repair, but research on other grafts is scant. Here is a summary of what I've found so far:

Allograft (Positives)

- Less pain in recovery as the surgery is just for reconstructing the ACL, there is no donor site.

- Rehab is much shorter as there is no donor site to rehabilitate.

- Surgery is quicker and less expensive.

Allograft (Negatives)

- Risk of disease transmission such as HIV, Hepatitis and more.

- Treatment of tendon for disease and preservation may weaken it.

- Takes longer for the tendon to vascularize (around 9 months).

- Higher failure rate than autografts.

- May not be sufficiently strong to endure frequent sporting 

Patellar Autograft (Positives)

- Considered the "Gold Standard" by which other grafts are measured.

- No doubts about tissue quality or disease transmission.

- Quicker vascularization (around 3-4 months).

- Higher success rate.

Patellar Autograft (Negatives)

- More pain and rehabilitation required.

- Possible numbness at donor site

Here are some of the articles I read to come up with the list. Click on the links below to see, plenty of details here:

Graft Choices for ACL surgery
Risk of Disease in Your Allograft
A Systematic Review of Anterior Cruciate Ligament Reconstruction Rehabilitation 
Graft Selection for ACL Reconstruction: A Level I Systematic Review Comparing Failure Rates and Functional Outcomes
Beliefs and Attitudes of Members of the American Academy of Orthopaedic Surgeons Regarding the Treatment of Anterior Cruciate Ligament Injury


There is plenty more if you google as well, either you will find all the info useful or it will drive you crazy :)