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.

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.