ACL operation update #4

OK, I'm now 5 weeks post-op.  I had a therapy session this morning and my first post-op follow-up visit with my doctor since I went in and got my Baker's Cyst drained (which happened only once).

There are two pieces of fantastic news to report.  First, I am done with formal physical therapy sessions, so I'm on my own from now on to continue exercising, etc.  The second piece of good news is that I no longer have to wear a knee brace for day-to-day activities.

My doctor was pleased and surprised at how well recovery is going.  He says that I'm a number of months ahead of schedule for range of motion and leg strength...maybe those years of running really are paying off!

There is a down side to this though...my doctor said that the risk of a rapid recovery like this is that there is sometimes a tendency for someone to push their recovering knee too hard too early.  I assured him that I was more than willing to take it easy, i.e., be lazy.  Oh, I don't mean lazy, I mean not doing things I shouldn't do before I get the go ahead to do them.

If you are recovering from this kind of surgery, remember that recovery includes three things: 1) recovery of range of motion; 2) recovery of leg strength and balance; and 3) biological healing and vascularization of the grafted new ACL.  It will take at least 3 months post-op before I will be given the go-ahead to start jogging, etc.  So in the meantime I'll take it easy and give my reconstructed ACL graft a chance to fully attach.

No more brace, no more physical therapy sessions...just exercise on my own.  Woot, woot, woot!

ACL reconstruction operation Update #3 (9/9/2014)

I'm celebrating my operation two-week anniversary today.  The stitches are out and I've had 1.5 weeks of physical therapy.  If you recall from my previous posting I had a Baker's (a.k.a. popliteal) Cyst on the back of my knee that was causing some problems so the doctor was able to drain it.  Fast forward to this morning, well, yesterday morning.

BTW, the image below shows a Baker's Cyst located about where mine is.  It's about the size of a medium egg when it's full.  It is filled with excess fluid from the knee that is produced by irritated tissues there.

Image courtesy of the Mayo Clinic. (http://www.mayoclinic.org/~/media/kcms/gbs/patient%20consumer/images/2013/08/26/10/52/ds00448_im02893_r7_bakerscystthu_jpg.ashx)

I knew that the cyst was slowly refilling after it was drained a week ago, and while I was at physical therapy (PT) yesterday morning I pushed my knee hard working to increase my range of motion.  I accomplished that (150 degrees - mission accomplished) but also forced additional fluid back into the cyst.  Pain was present but bearable and mainly irritating so I got an appt. to have it drained again.  

This morning the doctor and I discussed the condition and he recommended that we not continue on a path where the cyst is drained over and over because of the (small) chance of infection.  He says that once the knee settles down and recovery is complete that the cyst will take care of itself.  So instead of draining it again he recommended that I increase my use of anti-inflammatories (e.g., ibuprofen) and continue to ice it after activity and/or in the evenings.  So pills and ice it is.

The good news is that I can now go up and down stairs with minimal pain and only a modicum of pressure and stretching in the knee.  Don't get me wrong, I'm not ready for the racquetball court or anything, but it's coming along.  

Modern medicine is awesome!

ACL reconstruction operation Update #1 (8/26 - 9/4/2014)

OK, a little background.  I'm an active person in my mid 50s and I've been blessed with good health all my life.  My right knee gave out on me in late April 2013 while playing basketball with my son and nephew.  I started to make a cut to my left and my knee kept on going to the right.  I crumpled in a heap on the court but was able to limp off.  My knee remained sore but I just didn't have the time then to do anything about it. I got it checked out about a month later and I learned that I had a cartilage tear and possible ACL failure.  

This image shows the anatomy of the knee.  

In my particular case, I had a torn meniscus (the cartilage that serves as a pad between the femur and the tibia and fibula) and the ACL (the anterior cruciate ligament, the one that attaches the center of the base of the femur to the head of the tibia) pulled loose from its attachment, i.e., my ACL was blown out.  The loss of an ACL means that the knee loses lateral stability.  

I had one other knee-related thing going on as well.  During the 16 months between my injury and operation I also developed a Baker's Cyst behind my right knee.  It never caused pain or inconvenience.  This kind of cyst is formed commonly when there is a meniscus tear and the irritated knee produces excess fluid.  This fluid leaks out of the knee and pools in the soft tissue behind the knee.

We did an MRI to get a better view of what we were looking at, and luckily my meniscus tear was minor...occasionally painful but minor.  All it needed was a trim.  The ACL, however, needed to be reconstructed.

My operation took place on 8/26/14, nine days ago.  I was in the operating room only 1.5 hours (BTW, generally speaking the shorter a knee operation is the better for recovery because you have to have a tourniquet while the operation takes place).  Man was I groggy coming out of anesthesia - then again, who's not?  

I saw my doctor the next day and he removed the drain from my knee.  He was amazed to see that I could easily lift my leg and had close to complete lower leg extension.  Pain was not a major issue for me, perhaps a function of short operation time?  I have been able to handle the entire event using only ibuprofin for pain and swelling and baby aspirin (to minimized the already low risk of blood clotting).

Two days after the operation was my first day of physical therapy (PT).  I guess that loss of muscle tone is common during surgery, but I lucked out and still had much of mine.  By the end of my first day of PT (leg lifts, side lifts, electrical muscle stimulation, etc., the therapist said I was probably about a week ahead of normal recovery schedule.  The therapist gave me a set of exercises to do at home, which I did faithfully.

There are really two major goals of ACL PT - recovery of range of motion and recovery of leg strength.

At the end of my second PT session, now three days after surgery I was able to achieve a 120 degree range of motion.  The PT goal of ACL recovery is to achieve a 145 degree range of motion.  The therapist just shook his head when he saw 120 in three days and said I was a month ahead of schedule.  Woot!

I continued to do my exercises over the weekend and I returned to PT the following Tuesday.  During the weekend I noticed that the back of my knee was getting swollen and sore.  My Baker's Cyst was acting up and swelling.  The therapist didn't seem concerned about it and I proceeded with my session.  My Tuesday night (a week after surgery) I was hardly able to put weight on that leg due to pain and pressure from the Baker's Cyst that had swollen to literally the size of a medium sized egg or golf ball.  

The pain was so intense that I contacted my doctor's office and I was advised to hold off on PT sessions and exercise until I could have my knee checked out.  That's the plan for this afternoon (9/4/2104).

So that's update #1.  Stay tuned.