Things I've learned

With plenty of time on my hands, I've done a *lot* of web surfing gathering information on everything about acl, meniscus, surgery, and recovery. I had the quadrupled hamstring graft for my surgery. They took parts of 2 of my hamstring tendons and looped them 4 times over. The outcome is about the same as the patellar tendon graft but it takes longer to heal.

The initial period of the bone healing overtop of the graft is the most critical point in the recovery. A Patella graft takes about 6-8 weeks to heal, whereas the hamstring takes 10-12 weeks. The only reason the the graft stays in the bone tunnels are the fixation devices used. My surgeon used an endobutton for the femur, and bioabsorbable screw for the tibia. This fixation method can withstand about ~ 612 N of force before it'll come lose.

So, of course, I ask myself, what activities put a lot of force on the ACL? Well it turns out going down stairs or going down a ramp can put up to 445 N of force on the new ACL. Going up stairs only 67 N. Walking can reach around a load of around 169N. Jogging is around 630N. Doing a leg extensions with weights is probably the worst, which is why no acl rehab program does them. So basically, I have to be very careful going down stairs and ramps.

I also found out the amount of force required to break a native acl, patellar graft and hamstring graft:

Native ACL: 2160N
Patellar Graft: 2977N
Quadrupled Hamstring Graft: 4140N

However during the revascularization phase, the new ACL will go as low as 50% of the strength of the native ACL. (about 1050N). It can take up to 6 - 12 months before it gains about 80% of it's original strength). So the new graft after a year is about 50 - 100% stronger than the native ACL.

Most of this information was found here (warning: they have all the information regarding the animals they used for testing: monkeys, dogs, rabbits):

ACL Research

And for the amount of force the grafts can withstand and the amount of force on the ACL when doing various activities (plus lots of other info) was found on google books:

ACL Info

Here's another blog who details the ACL life timelime:

Adam's Blog

Take it easy!

So it appears I've worked a little too hard on my knee on Saturday as it was very sore on Sunday. My Physio said to go easy on it the next few days then ramp it up again. I've decided to take a break from the one legged squats on the bosu ball since that's by far the most strenuous, and I'll leave out the stair climbing. I have to continue to work on massaging the scar tissue as that's the biggest bottleneck right now.

I also got a chance to throw around the disc on Sunday which was nice! My flick hasn't deteriorated much which is comforting.

3 Weeks in Review

My knee is shaping up quite nicely! Although still stiff at times I've achieved a lot goals. My physio says I'm ahead of the curve and I only need to see him once a week now.

Status:

• Knee flexion to 115+ degrees
• Can ride a bike now without grunting every revolution
• One legged Bosu Ball balance for minutes without falling
  
• Easily climb up stairs, going down.. not so easy
• Calf raises are a piece of cake
• Walking is getting to semi-normal. Because of the tightness it's still not smooth to bend the knee
• I can ditch the leg raises (my least favorite exercise)
  

Goals + New Exercises:

• 120+ degrees flexion
• Break down more of the scar tissue
• partial squats while doing one legged bosu ball balance (very tough!)
• Calf raises on stairs
• Hamstring curls
• Walk Normal
• Walk down Stairs normally without pain.
  

Now that the weather is finally warming up I should be able to go for longer walks. I still tire pretty quickly but that should change once I hit the bike more.

Chirowhat?

So today was chiropractor day. As many people have questioned "what the hell is he going to do?", I took the liberty of visiting him to find out. He is technically a sports chiropractor and was recommended to me by the surgeon.

It turns out he doesn't do any back breaking stuff on me, just tons of pressure and knee bending + acupuncture to help bend the knee. He worked on my knee for about 40 minutes. Overall he was very knowledgeable and explained why / how to get the scar tissue to break up so that I can have more freedom bending. I also checked out his skill set on the website and it's very similar to my physios except he has a chiropractor degree. So technically, the visit didn't involve any chiropractor stuff at all. He also plays Ultimate Frisbee which was cool! He got my knee to 100 degrees flexion and it's definitely not as tight as it was before!

This morning I had a dream I was chasing a disc and I jumped up to catch it. As I caught it I woke up. Ohhh what a tease! But only 164 days and I can play again!... although I've decided (along with the advice of the chiro dude) I won't be playing 4 nights a week.

Booya!

Andrew is at 90 degrees flexion after only 6 days! ... although it's still quite tight. I've also started on the hamstring strengthening, which gets strained very quickly.

2 Weeks in Review

It's hard to believe it's been 2 weeks since the surgery. It's nice to know I'm on the road to recover rather than just prepping for surgery. I'm currently behind schedule with the progress of my knee due to being told not to bend my knee for 10 days after surgery. I should never have been told this but it's water under the bridge now.

Status:

• I've gone from a 30 degrees bend to 60 degrees in 3 days due to extensive bending while programming.
• I have full extension
  
• I'm currently able to step up stairs (albeit, very slowing) but going down stairs is very difficult at this time.
• My legs feel like they've retained a fair amount of muscle which is great.
• The glider is fairly easy with 3 bands (lying down quad squats).
• I can do lots one legged calf raises.
• Balance is fairly decent: I can last for minutes without help while doing a one legged balance on an unstable pad.
• My hamstring is currently the weak part. It gets pulled fairly often, but this is normal considering 2 of my hamstring tendons are now inside my knee pretending to be an ACL.
• Walking is not normal at this time due to having to force my knee to bend.
• I haven't felt pain in awhile, but I still take ibuprofen,aspirin, tylenol a couple of times a day to help with the soreness and reduce some of the inflammation
  
• Sleeping is almost normal again. My body enjoys waking up at 4am for silly reasons.
  

Goals:

My exercises, 3 times a day, are: squats, calf raises, hip raises, leg raises, one legged balance, quad crunches, glutes extensions. Plus the usual non stop bending of my knee to catch up. My goal is to get to 90+ degrees bending within the week

At this point my moral is fairly high, although at times it's hard not to think about the lost meniscus + cartilage cracks which will eventually lead to osteoarthritis. When I get back into sports I'll have to decide between 2 options: Reduce the number of nights a week I play or face the consequences of pain in the knee in 5 years.

Regardless of the downsides, positivity is my best option at this point. How to remain positive? Watching ultimate frisbee videos of course! This college team to have recorded all their tournaments and packaged all the highlights into one video.

11th Day Post Op + Meet the Surgeon

Met with the surgeon today and he went over the details of the surgery, also had my stitches removed.

60% of my lateral meniscus was removed. It was apparently a bucket handle tear, which must have worsened since the MRI was taken. There's some cracks in the cartilage of the lateral side too (near where the impaction fracture occurred). In his own words: "Don't worry about it now, you'll be playing Ultimate Frisbee in no time, but you'll hate me when you're 60"

I also received the protocol for rehab, which mentions bending the knee right after surgery. Still not sure why they told me not to bend the knee... grr. Oh well, I had lots of practice bending my knee after the initial injury, I should twice as good / more experienced this time!

And on the bright side, there's no real restrictions for the next month, just no running / jumping. I don't have to wear the brace anymore (woohoo!) and can bend as much as I can. I've also been referred to a chiropractor to help with the bending.

9th Day Post Op

Shin pain has slowly been creeping downwards, but it's minor pain now. I no longer fear getting up.

I went for 2 20-30 minute walks today with just the brace. I'm slow, but I'm getting quicker! My knee swelled up quite nicely after each walk. I can also do the 2 sets of 10 leg lifts 3 times a day with ease now.

2 more days till I get the stitches / staples out!

8th Day Post Op

The pain in the shin has dwindled down quite a bit. Massaging, ibuprofen, and walking around seemed to have helped it out. I've noticed my leg size has shrunk a bit as the brace slowly fell down to my shin while walking.

Unfortunately the cryo-cuff died last night... I'll miss that cold touch on my knee during my sleep. Although I had the best sleep ever last night (possibly due to the lack of noise from the cryo-cuff).

1 week!

1 week down, 25 more to go!

I've managed to reduce the shin pain by massaging it while I stand up. This seems to help quite a bit. I've also ditched the brace most of the time as I just rely on crutches. (The brace makes the shin feel much worse). Overall I'd say the shin pain has gone down a little bit. I don't have any intense / unbearable moments of pain anymore.

I took a 20 min walk around the block with Alice today. I used the crutches but tried to put full weight on the leg. There wasn't any pain, but my knee did swell up a little bit.

6th Day Post Op

Well the shin pain is now extremely strong when going from a sitting position to standing. Putting weight on the foot after standing doesn't really change the pain much. Having the brace on makes it a lot worse. From what I've read this is normal, however, I'm more hesitant to stand up now and have relegated to crawling around most of the time. I'm still sticking to the extra strength Tylenol instead of the pain killers. I finally realized I should be icing the part that hurts. Maybe it'll make a difference. Hopefully this pain will go away soon so I can venture outside more!

5th Day Post-Op

Today was physiotherapist day. He threw out my slacker routine of just quad crunches and gave me 4 extra ones: leg raises, calf extensions, hip raises, and knee bending. He found it odd that the instructions I received didn't mention bending my knee. Either way, bending will occur!

Sleep wasn't very good last night, 2am 3am, 5am, 7am wake ups. I felt pain in the back of my knee for the first time. It went away after some massaging.

4th Day Post Op

Slept from midnight till 5am this morning, which is the best sleep I've had in awhile. Took my first shower on my own today. It's a long process of taking all the wrappings / bandages off, showering, and putting them all back on.

As for the knee, It's about the same as yesterday, painful when I first stand up, but after time I can walk around without the pain. I can already feel myself loathing the brace and then I realize it's quite a few weeks till I can ditch it.

Tonight was extremely painful when standing up and walking around was slightly painful. I suppose all the walking I've been doing has been too much!

3rd day post op

I stopped taking the pain meds yesterday and just relied on some extra strength Tylenol. So far I feel a lot better waking up this morning and there's no more nausea. The knee still needs the ice packs and although it's painful to stand on it initially, it usually subsides and I can walk around (with crutches)

I'm also practicing walking without crutches and just the brace, I go about a snails pace, but I'm hoping to hit 1meter / hour by tomorrow.

The doctor also confirmed I shouldn't be bending my leg until 7-10 days after surgery so that the sutures won't break.

2nd day post-op

Slept a little better last night, I've slowly weaned myself off the painkillers, I'm currently 6 hours and no pills... Hopefully I'll be able to eat better as my appetite has slowly gone downhill. I've also taken off the large bandage covering my knee and checked out the incisions. Quite gross!

1st Day Post Op

I hardly slept at all last night as the nerve block and anesthetic slowly wore off. However the cryocuff + pain killers helped. My leg has feeling again and standing up no longer makes me sick. The pain killers make me very drowsy. I'm able to eat more foods now which is good as my stomach has been whining non-stop.

I have my post op exercises / instructions to do. However, it doesn't mention anything about bending my knee, which I find a little odd. Most of the blogs / post-op rehab I've read consists of bending your knee asap.

My brand new ACL!

I was up at 5:45am to get to the hospital at 7. Surgery was at 9. I met 5 different people before surgery: the surgeon, the doc, the nurse, the anesthesiologist and his assistant. I had a nerve block and lots of drugs. At one point I kept looking at the air duct, and I thought it was moving and couldn't stop staring at it. After that I woke up in the recovery room. I had quite a bit of pain under my leg so apparently they might have missed the back side of my leg for the nerve block. They gave me some morphine and I was good. I was still pretty drowsy after waking up and had some issues standing up as I would start sweating heavily and felt very nauseous. Once I lied down again I was fine. Because of this I didn't leave the hospital until 3:30.

Because of the nerve block I couldn't feel the front half of my leg, which was kinda weird. My mom, being a physiotherapist, was able to hook me up with a cryo cuff! which has made icing a lot easier (although I didn't feel the cold at this time)

My girl Alice has been great at taking care of me and hooking me up with food! Although it's tough to eat at times.

All systems go!

I've received a call from the hospital with instructions on what to do / not do before tomorrow. Looks like everything is an "ok to launch!". No midnight snacking and no morning tequila shots!

My leg is feeling pretty good. It's hard to believe it's been 7 months since the injury. I've lost some enthusiasm over the past month or so, but now that the day has come I can feel it creeping back.

Breaking News!

I just received a call from the surgeon. Apparently new research has shown that the ACL is a myth and doesn't exist hence why it didn't show up on my MRI. Woohoo! But apparently they still need to remove part of my hamstring because "We planned to take it out, so let's take it out" so I'll still require surgery and the 6 months of rehab. Doh!

Here's the article debunking the acl myth: ACL Enlightenment provides relief to millions of injured athletes who tore nothing