2 Weeks Out (S+12)

About 2 weeks out you’ll have a follow up with your surgeon. He or she will make sure that everything is going as planned in physical therapy and check that your small scars are healing properly. I’m sure it’s different for everyone, but for me it’s finally time to get the stitches and staples out. I’ll actually be able to shower without using waterproof bandaids!

Must get out of the house!

You will quickly learn that sitting at home, relatively immobile gets old very quickly. Getting out of the house is 100% necessary. There are some perks too — you should ask your surgeon for a temporary handicap pass. When you’re on crutches you’ll want that up front parking, I promise.

I have always wanted to drive the carts at the grocery store. Finally I have a reason to. Who knew they were SO slow. Be prepared for stares!

What a difference a day makes (S+3)

Well last night was MUCH better than 2 nights ago. I finally got ahead of the pain with the medicine, and it was amazing. I actually slept through the night! At this point I felt comfortable rolling onto either side (with my brace on of course) which made all the difference in the world. I set an alarm for the middle of the night when I needed to take the next pill, and it was certainly worth it.

Me on CrutchesToday I was going a little stir crazy so we decided to get out of the house for some breakfast. Getting around really isn’t that hard at all. The worst part is once you get to the destination figuring out what to do with your leg. I ended up sitting in a long booth so I could put my leg up.

Later that afternoon I went back to my exercises — more of the same from yesterday. I was able to get my knee to 90 degrees using the CPM, which was my goal. Hopefully at PT on Monday the progress will show.

I was able to actually take a good shower by myself today for the first time (it was much overdue). Waterproof bandaids and Saran wrap helped to keep the incisions completely dry. I’m still in need of a shave and haircut, but those can wait a while since my looking a little rough is still excused.

KneeHere is a new pic of the knee with the 3 incisions. You can see the knee is still incredibly swollen. Guess I need to spend more time with ice and the Game Ready. I’m off to bed now — hopefully it goes as well as last night!

Stay ahead of the pain (S+2)

Here is a very important lesson. You MUST stay ahead of the pain by taking your pain medicine BEFORE you are in pain. Once you’re in pain, it’s too late and you’re going to be miserable. That was my night last night. I think I may have slept for a total of 1-2 hours (and subsequently my girlfriend slept even less). Last night was easily the most pain I have experienced in my life. Let me reiterate — set an alarm and stay ahead of the pain! I am not a huge fan of pain meds in general, but trust me, you’ll need them.

Lesson #2: It’s all about the supporting cast. Before you have surgery make sure you have a really good parents, girlfriend/boyfriend, wife/husband, someone/anyone who is going to take care of you. My parents who would love nothing more than to pamper me unfortunately live about 800 miles away, and I opted for a pretty quick surgery so they aren’t here to take care of me. Needless to say, this time around was pretty scary. Without my amazing girlfriend (and her supporting cast) I would not be surviving! If you don’t have a good supporting cast, before surgery is the time to acquire one.

So, day 2 after the surgery my pain meds from last night finally kicked in. Now I’m dizzy. Apparently I just can’t win! This is exactly why I’m not a huge fan of pain meds. Physical therapy lasted about an hour and a half today. More of the same drills (leg lifts, stretching, stem/stim) and some new exercises. The worst of the day was either the leg lifts combined with the stim/stem (electrical stimulation), or the hamstring stretching. This time I lie on the table face down with my legs hanging off the end of the table right above the knees and let gravity begin work on my tight hamstring. Painful yes, but that’s not it. Try adding a weight to the ankle (2lbs, but trust me it’s enough). Bring on the pain. Lesson #3: Get a good physical therapist! Thankfully I hit the PT jackpot after my shoulder surgery, and I’m back on her rotation. A little bit of pain can be a good thing and a good physical therapist will push you right to the correct threshold.

The rest of the day is more of the same — walking with the assistance of the crutches (b/c there was minor meniscus damage I am able to be weight bearing already), lots of recliner & tv time, and lots of pain medicine assisted naps. The other thing I forgot to mention that has been added to the regimen is the CPM. The CPM is a great machine that is used to get my flexion back (extension is usually easier). The goal is to get to 90 degrees. I feel a little ahead of schedule since the CPM rep told me to start at 30 degrees, and today I was able to hit 80 degrees. Tomorrow hopefully I’ll push it to 85 or 90 degrees. I’ll upload pictures soon. For now, more tv and hopefully I’ll actually get some sleep tonight. I’m ahead of the pain with the medicine this time!

Day after surgery (S+1)

Can I reiterate how amazing the nerve block is? I slept through the night, without waking up once in pain. Oh yeah, I did take a percocet to help. You should set an alarm in the middle of the night to wake up and take your next dose of pain medicine. Trust me, you do NOT want to get behind on the pain. If you stay in front of it your life will be so much easier.

My Knee!Now it’s off to the Dr.’s office for a little post op checkup. The surgeon went over my surgery pictures, showed me the “not just torn, shredded” ACL, and had me take an x-ray. It’s pretty strange looking at an x-ray of your leg with screws in it. Overall the surgery went really well, and I’m ready for physical therapy day one. Can you believe they start you day 1? Oh yeah, I forgot they changed the bandaging on my wounds and cleaned up the incisions — there are really only 3 main incisions. It’s hard to believe they can do that much work through 3 little holes.

Physical therapy on day 1 is pretty relaxed, and since the nerve block wasn’t completely worn off there really wasn’t much pain. Now I’m headed back to the recliner for some dinner and TV before bed.

D Day

Pre-op PictureWell today is finally the day of the surgery. I’d be lying if I said nerves didn’t kick in at this point. I just signed my life away. The only time I have ever signed more papers was when I bought my house. Surprisingly skydiving has way less paperwork… go figure! After I signed all of the paperwork I was taken back to the prep room. There my vitals were taken, I changed into my amazing gown and hair net, my leg was shaved, I was given an iv and the best part… the nerve block. The nerve block is an absolute must! The nerve block will completely numb your extremity. I had this done with my shoulder and was incredibly thankful to have this done for my knee. I will say that it is the strangest feeling ever after the surgery b/c your leg seriously feels like it’s not there. Try as hard as you can, but you simply cannot move your toes! After the nerve block was administered, I said my goodbyes to my amazing girlfriend who was taking care of me. The next thing I remember is waking up in a wheelchair — where I asked when we were going to start. Nice how that works huh?

Asleep with the Game ReadyGetting home and onto the recliner was a breeze. Again, thanks to the nerve block. I instantly hooked up to my new best friend, the Game Ready (ice/compression machine), and started watching TV. It is imperative to elevate your heel, and not prop the leg up from under the knee. You will fee a bit of a stretch, but it will pay off. I didn’t really have any of the post anesthesia nausea, so I consider myself pretty lucky. Now I’m off to bed!

Graft Options

As I mentioned there are quite a few things to think about when it comes time for ACL Reconstructive surgery. One pretty large decision you have to make is which type of graft you would like to use for your new ACL. There are 2 initial classifications – an autograft (your own body) vs. allograft (cadaver).

Autograft

  1. Patellar tendon: A piece of your knee cap (bone) is taken with the tendon still attached – on the other end a piece of your tibia is taken with the same tendon attached. This is the “gold standard” when it comes to ACL reconstruction. This method however leads to a largely increased risk of tendinitis of the knee. This risk kept me away from using this method.
  2. Hamstring: A piece of your hamstring is taken to be used as the new ACL. Everything you read references that the hamstring is not as strong as your original ACL, although there are methods which increase this strength. I passed on this type of graft b/c I didn’t want to take a chunk of my hamstring, and I’m a little paranoid about the strength of the new ACL (I don’t want to go through surgery again!)

Allograft

  1. Patellar tendon
  2. Hamstring
  3. Achilles tendon: I went with the achilles tendon for 2 reasons. 1. The achilles is incredibly strong (feel how tight it is!) and 2. My surgeon just so happened to have a really good graft lined up from a 24 yr old. (Crazy that they share that information, huh?)

There is a lot of conflicting information regarding what type of graft to use. For every good article you read, you’ll read another that is completely opposite. At the end of the day you need to find a surgeon who you trust — and you can always get multiple opinions.

Most every surgeon and physical therapist will tell you that the most important part ends up being physical therapy, rather than the graft itself. No matter how strong your graft is, if you don’t work hard at PT, you’re bound to have another failure.

Pricing

If you have ever tried to get a quote for surgery you know that the medical industry needs some oversight or change. I had a SLAP repair of my right shoulder a few years ago, and I’m still receiving bills from companies I have never heard of. This time, I was determined to know everything up front… easier said than done. The surgery center where my surgery was to take place gave me a call with “all of the fees” I was to incur. According to them there are 3 people who will be requesting money.

  1. The surgeon
  2. The facility
  3. The anesthesiologist

Lucky for me, I knew this wasn’t the case. In reality there are quite a few more people who will come knocking on your door. Here’s the full list I was able to compile.

  1. The MRI
  2. The surgeon
  3. The facility
  4. The anesthesiologist
  5. The company who provides the graft
  6. The ice/compression machine (I opted for the Game Ready)
  7. The CPM machine (continuous passive motion)
  8. Prescriptions (trust me, you’re going to need some pain meds)

Hopefully that will give you a better idea of who you need to talk to in order to come up with pricing.

MRI showing torn ACL

Why an ACL Reconstruction Blog?

As soon as I found out that I might need knee surgery I instantly started researching the procedure online. I was hoping for a dummy’s guide to ACL Reconstruction… unfortunately it just didn’t exist! Therefore I decided to put together this blog to not only track my progress but also to potentially help someone who ends up in a similar position as me.

I injured my knee about 2 weeks ago while playing flag football. I was running right to avoid a rush and tried to throw back across my body. My right leg planted while the rest of my body pivoted. My knee buckled/dislocated and popped, and I instantly knew I had really hurt something. The pain was severe and instantaneous but really only lasted a few minutes. Then I was able to get up and walk around with minimal pain which really surprised me. It swelled later that evening which lasted a few days. When it finally came time to see the orthopedic surgeon I was wondering if I was just overreacting b/c the pain had subsided and there was just a small amount of lingering swelling. Of course since I’m writing the blog, the MRI did show a torn ACL. Once it was determined that surgery was necessary, I began the daunting task of trying to come up with the cost of surgery.

Hint: When your MRI comes back like this, you need a new ACL.
MRI showing torn ACL