Pain in the Knee

Things had been going great at the gym..... until I did the leg press. For whatever reason this one was on an incline, not like the one at physio which is flat. Only did about 12 reps on the lowest setting but my knee didn't like it one bit. Still sore after about 3 days of icing, hope I don't have jumper's knee!

Jump Tests

So this is one of the tests they do to see if you're ready to do sports. First you jump with your good leg, lifting off and landing on the same leg as far as you can (a big one legged hop, basically). Then do the same with your involved (injured) leg. If you get to within 90% of the distance of the good leg you're good to go.

Note you should build up to that exercise by hopping from one leg to the other and noting that while the jump or hop should be big enough to be a challenge, you must land the jumps in a controlled manner... More running and bike this week. Feeling strong.

Bring on more sports!

Longer Runs...

Doing some great biking and running now. Last visit to the gym was 30mins on the bike (setting 11) and 30 running on the treadmill (between 6 and 7). Did the biking all in one go and 2 intervals of 15 minutes for the running. Knee felt excellent after, no icing needed at all!

Feeling a lot more confident about returning to sports as well. Before I kind of felt like it might not be worth it to play again, to go through it all again with the other knee or another bad injury. Now that I'm back running and there is light at the end of the tunnel the whole experience hasn't seemed too bad. Can't wait to be back firing in goals!

Physio says soccer is a possibility in around 2 to 3 months...

Fore!

Got the all clear to hit some golf balls on the driving range today! Not that I intend to in the very near future due to this rediculously cold weather. Wasn't sure if it would be OK as there is a lot of rotation torque that goes through the left knee on a (right handed) swing.

Apparently Tiger Woods had ACL surgery as well, here is a little more info on his surgery procedure. Some new fancy "double bundle" method apparently... He took 9 months to come back which seems a little long though the fact I don't have a Tiger swing should mean I can get back a little sooner. Sage words from my surgeon: "While I don't recommend Tiger's judgement for everything, it was sound with respect to his knee..."

Ice Skating

Did a little ice skating at the Rockefeller Center today, felt pretty good even if a little precarious! Did some exercises the last week or two to prepare. Basically involves exaggerated skating motions, standing upright and bending the knee down whilst shifting the other leg sideways and backwards (about 5 o'clock if you are facing 12 o'clock). Repeat for both legs.

Running, Running and Running Running

Ran for the first time on the treadmill today! Massive massive progress. Did about 6 minutes with the treadmill on 6, no incline. Felt like I could have done a lot more but kept it short to see how the knee will feel over the next few days...

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

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.

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...

"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.

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 :)

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.

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.