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Author Topic: ACL Replacement, Meniscus Removal, Meniscus Repair  (Read 5129 times)

Offline GarzaG

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ACL Replacement, Meniscus Removal, Meniscus Repair
« on: April 08, 2009, 09:35:49 PM »
Hi,

I never thought I'd be here on a knee message board, but here I am, my Range of Motion machine cranking, ice machine working and me frustrated, exhausted, and full of questions. I'm hoping you all can help me.

I had a ski accident on March 14 in Snowbird, Utah. I tore my ACL and both meniscui. My orthopedic surgeon described the inside of my knee as a "garage sale" with stuff scattered everywhere. During pre-surgery physical therapy, I was doing a supervised wall squat and heard a horrible pop. The meniscus had gotten lodged and caused a Bucket Handle Tear. I had surgery three days later.

Today is one week post-op. In the end, the surgeon (Dr. George Thabit, SOAR) did an ACL replacement with cadaver; removed about 80% of meniscus on the outside (is that lateral or medial?), and did a meniscus repair on the inside meniscus. I spent the last week in a serious pain haze with Percocet and Ativan. Vicodin did nothing for me at all to control pain. Now I am just on Percocet every four hours, but still lots of pain.

My questions:

1. Is it normal to be in such pain a week after this surgery? How long to be in pain like this?
2. What should I do to control my hamstring from hurting? My butt hurts and I get shooting pain like sciatica from my bum to my toes. Ideas?
3. How long until I drive a car? The doctor will not specify, but the nanny I had to hire to drive me and the kids is costing a fortune and I'd like to know how much longer I can expect this level of disability?
4. What is your experience before the next phase begins (where I am generally mobile, can get around without such pain).

Thank you so much for your advice.

Best,

Garza Girl

vinnic

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #1 on: April 09, 2009, 04:30:25 AM »
Sorry to hear about your knee troubles, but you've definitely found the right place.  Since you tore your acl and meniscus, you should check out the cruciate ligaments board and the meniscus board for more detailed information on your particular situation.  You may want to repost your thread below on one or both of these boards as well.  Seeing you're only one week post-op with acl and meniscus issues, it's understandable that you have so much pain.  Everyone's situation is slightly different, so read up on others' experiences on both of those boards as well as in the post-op diaries sections.  Sorry to hear that you had so much damage to the lateral meniscus (outer) with the acl tear.  Hang in there though - I'm two weeks post-op tomorrow and just started taking pain meds again at full strength after starting physio yesterday morning (I was able to stop them while my leg was in an immobiliser for the first ten days).  Good luck to you and keep us posted! 

Offline nsibarra

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #2 on: April 09, 2009, 07:16:47 AM »
Hi,

I think pain is normal after that much having been done, especially after only a week. Not too sure about the hamstring, it could be a placement issue with the leg. Driving depends on which leg you had surgery on and if you have an automatic or manual car. I had only a meniscus repair and if it had been on my right leg, I'd probably still not be driving and it's two months later. I would say get ready for a bit of a long haul. I don't mean to be a downer or anything, but knee rehab is a long and slow process. Everyone is different and heals at different rates. Don't get down or frustrated if you don't see progress quickly, it will come little by little.

Offline GarzaG

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Thank You and Update
« Reply #3 on: April 18, 2009, 05:45:16 AM »
Thanks for the posts and encouragement.

I am now 17 days post-op and I'm hanging in there, but just barely. Knee pain has subsided a lot and I'm stepping down meds the best I can. My injury was on my right knee. Since I've got 5-year-old twins, driving is really important to me. I lose my babysitter on May 4. My goal is to drive by then. We'll see if I can do it.

I thought I was doing well, but in physical therapy today, I learned from the therapist that I am way behind. That was so defeating. He says I'm at 50 degrees range of motion (and that was after I tried 3 times to get there from 47) and that most people are at at 90 degrees by now.

Does anyone have experience with when we should be hitting range of motion goals? I am exhausted. Not sure how I can do more.

thanks much,

samantha

vinnic

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #4 on: April 18, 2009, 06:14:48 AM »
Do you still have a lot of swelling preventing the knee from bending much?  What types of exercises has your surgeon or therapist started you with in regard to flexion?  I'm three weeks post-op and see my therapist three times per week.  There, she does a variety of things to help with flexion such as bending the knee carefully while sitting and lying on my stomach; propping my heels up on an exercise ball while lying on my back and rolling it slowly toward me and away bending the knees; riding the recumbent bike slowly for ten minutes; and doing heel slides at home four to five times a day (sit or lie on back, and bend knee while sliding heel toward you - using a plastic bag to ease sliding and a towel to help flexion gently).  It hurt like crazy at first, but it's getting better now.  Since every rehab protocol is different be sure to talk with your surgeon and therapist about this and what you can do to help.  Be sure to post on the cruciate ligament board too about this - you don't want scar tissue/adhesions to form that'll prevent flexion down the road (you may want to read about arthofibrosis in the information section of this website too).  Keep us posted as to how it goes for you.  This is a great place for support.

Offline GarzaG

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #5 on: April 18, 2009, 06:31:09 AM »
Hi Vinnic,

You are three weeks post-op on ACL, Meniscus Repair? What's your ROM like now?

I'm going to PT 3x weekly. I'm doing similar exercises to you (not the ball). Are you icing still? Are you using CPM machine (I am, about two hours/day)? I assume you are not weight bearing or just? Can you drive? Which knee was it? Do you take pain meds still?  I am full of questions.

I'm trying quad flexes at home (about 3x/day, but only about 3-5 flexes), I just started to try to hang my legs off the side of the bed and dangle for a few seconds (nothing much yet, but I'm doing it). I try to stretch when I can.

I'm definitely not ready for the bike. But, I have to drive soon. I have little kids and they need mom!

thanks much for your intel. :)

Garza Girl

vinnic

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #6 on: April 18, 2009, 06:56:17 AM »
I had a scope last summer to trim both meniscus, and an aclr with more meniscus trim three weeks ago.  I was ten days non weight-bearing and in a velcro immobiliser with absolutely no exercises at all (not even a cpm machine).  From that, I had pretty good extension but my flexion was horrible on day eleven!  I've been at it for two weeks now though, and I've gotten up to 114 flexion. The heel slides at home really helped a lot, and the recumbent bike at therapy was a godsend.  If your surgeon/therapist clears you, see if your therapist can show you how to sit in the recumbent bike and just rock back and forth (not having to go all the way around).  The recumbent bike was also easy on my hip and I've heard good for people with bad backs.  I'm still icing several times a day, typically after each set of exercises at home (and at pt as well).  I just started a post-op diary too called Nikki's ACLr on the post-op diary section, but there are many more posters here who are way more experienced with knee issues on this forum who can probably help you out even more.  Again, good luck to you!   

Offline Kaputt_Knee

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #7 on: April 18, 2009, 07:38:01 AM »
Garza Girl

you have had a huge chunk of your lateral meniscus removed (80% I think you said) and a repair on the medial side - just remind your physio of that. Often a repair requires you to be non-weight bearing for a while, so that you are doing any physio right now is a huge bonus. And also remind them that FULL extension has a higher priority than the 90° flex. Without full extension you cannot walk without limping. That said the flexion exercises are necessary to work the joint and to keep the uninjured tendons elastic, but do not focus on some number set out in someone else's rehab protocol. Something we all learn here is that EVERYONE is different and your protocol should not have you compared to anyone else's.

As Nikki has said swelling plays a huge role in blocking flexion. If you are still badly swollen then the flex will be inhibited. Use the good old RICE method and ankle pump like your life depended on it. The swelling is your body's reaction to the huge trauma your knee joint has experienced, both in the original accident and the surgery. It is mostly lymph and needs to be dispersed. As the legs need movement to pump the blood and fluids around and you can't move that well, you need to elevate and basically just pump your ankle as if you are using a foot pump to blow up tyres.

Do you drive manual or automatic? With the right leg it is somewhat problematic starting driving as you have to be able to shift your foot from gas to brake and to be able to safely and instantly perform an emergency stop. When you can do that you should then inform your insurer to see if they will cover you if you have an accident.
May 5th is only 4.5 weeks from your surgery and that might be tight - have you asked your surgeon what he thinks?

Take a look at the information hub and you will find lots of info about what has been done to your knee. Here's a link to a rehab programme for ACL http://www.kneeguru.co.uk/KNEEnotes/node/775. Take a peek and then ask your PT what you can do.

Remember that this is a slow process - most of us refer to it as a marathon, definitely not a sprint. If you try to "sprint" you will end up with more problems.

Come and join us on the Cruciates Board - we have all been there and sympathize knowing exactly the frustration of this rehab process.

Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline Tabitha

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #8 on: April 29, 2009, 08:23:11 PM »
Hi there Garza Girl,

 I thought I would find some of your posts since you posted on my thread! Wow... looks like you've gone the same road as me. Its a long road especially since you said you have twins, wow.
I thought I have to post, she is havign a lot of pain like I had. I was really dissapointed when  I was reading others ACL logs and many of them stated that they were down for a few days and then back to business as usual, mine is and was nothing like that. It's still a bit of a pain but it gets a little better each day.

 I hope that you are continuing to improve. Also I hope that you reach your goal and are able to drive before you lose your sitter!

 Tabitha

 
ACL injured 2006- Snowboarding
Reinjured ACL + miniscus 8/18/08- Playing frisbeee
ACL Autograft/ Lateral Miniscal repair  9/12/08
Started PT 9/29/08
80 degree ROM

Offline GarzaG

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #9 on: May 05, 2009, 10:36:54 PM »
Tabitha, all --

Here we are at week 4.5 and I am driving, swimming and can get rotation around on the bike. I am driving and made my goal of driving by today.

At the same time, I am completely exhausted, worn to the bone and in awe of how all of you recovered over such a long period of time. I am, for all intents and purposes, crushed emotionally. The pain in my knee combined with the pain in the spine (L5-S1 spondy that flared up as a result of the knee surgery) is so severe, that there is barely anything in the world that exists other than pain.

Last week I was put on Prednisone, a heavy duty steroid to bring down the inflamation in the spine, which did, in turn bring down the swelling in the knee.

It's finally occurring to me that I am never going to be a long distance runner again. It's hitting me hard. It makes me angry. It makes me have so much self pity. It's occurring to me that I never want to ski again, which makes me feel like a loser and a quitter. It's occurring to me that my children (twins, age 5) have been so affected by my injury and that makes me feel guilty and sad and shameful. It's occurring to me that I have no earthly idea how I'm going to get the guts and the nerve and the strength to fight three more months of physical therapy -- one more quad set seems impossible. I am completely exhausted from being in pain.

Wondering if anyone had success with acupuncture? Meditation? Wondering how people dealt with their children's needs? Feelings of "never be the same again."

I'm having a rough, rough day trying to figure all this out.

thanks

Garza Girl

Offline blueberry09

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #10 on: May 11, 2009, 10:23:11 PM »
hi there

i'm usually over on the cruciates board but was browsing around today, and saw your posts.
like you, i had a ski accident, mine was back at christmas. i tore the acl, but the menisci look ok, i'm just waiting to get a date to get it reconstructed.  i've got kids too, aged 5 and 7.
i spent the first month on crutches, but from then on have made slow but steady progress. i have found it really frustrating knowing i have to go through it all again once i have the op.  at first i so wanted just to be straight into theatre and get it sorted, now i've had to spend 4 months slowly getting back to normal. just the last couple of weeks now i can jog across the garden and actually squat down to reach things.  it's bliss - for a few weeks anyway. in having read your posts though it's made me feel a bit better in that at least this time one) i know what i am letting myself in for with the rehab, and two) i can plan a little more in advance, get people to look after the kids after school, organise meals in advance etc.  i found it really hard not driving for 4 weeks too, i hated depending on other people for lifts or paying for taxi's.  but what i think i missed most was not being able to care for my kids fully. not being able to pick them up, give them a carry, or a hug.

i'm not sure i'll ever get back to skiing, i'm scared just rolling down the hill on my bike now. and yes that "life will never be the same again" bit has hit me quite a few times too.

not quite sure what the point of this post is - there isn't one really other than to say i could relate to quite a lot of what uyou said.
it's great that you are back driving again, swimming, and on the bike - well done, i think that's a huge achievement for just 4.5 weeks post-op.
out of interest, what's the trouble with your spine? has it given you trouble in the past?
i've got an l5-s1 spondylolisthesis which gave me severe scaitica while pregnant but not too bad the rest of the time.  i hope my op doesn't flare this up like it has you. i don't think any knee pain can be as bad as excruciating sciatica.

on the physio front, can you have a couple of days off so much exercise? just to give yourself an emotional break?  I am rubbish as prescribed exercises, but try to integrate things into day-to-day activities as much as possible. so if i'm sitting at the high kitchen stool i'll let my foot hang down and give it a swing to help the flexion, and going up the stairs bad leg first as soon as i could to get some extra quad exercises in.  my physio has always been pretty encouraging about buillding exercise in - and lets face it, with two little kids you can't sit on the sofa all day resting can you anyway.....

anyway, trying to send you some positive vibes.  think how much progress you have made on the past 4 weeks, you will get there

bluebe
acl tear skiing end of dec 08
mri - complete ACL rupture, tibial contusions, menisci ok, some plc soft-tissue damage.
ACLr 12th June 09 (hamstring graft)

Offline GarzaG

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #11 on: May 14, 2009, 01:01:59 AM »
Hi Bluebe, all --

Thanks for the note! :)

I am six weeks post-op today. I'm starting to realize that I had a big surgery -- not just a meniscus removal (80%!), not just a meniscus repair (holy cow, pain), and not just an ACL replacement (cadaver), but all three. I guess I'm glad I didn't know what I was doing when I went into surgery. I had the added bucket handle tear to make things even more complex.

Childcare and my care were essential the first four weeks -- my partner took four days off work and rotated friends in to babysit me. Then we had a separate schedule for the kids. I rehired my old nanny to take care of the children (age 5 twins) for a full month, five days a week for six hours per day. It cost us a fortune, but we really couldn't have done it another way. Being at the mercy of everyone else for everything from food to driving to my children's needs was a true life lesson.

Today, at six weeks post-op, I"ve got 107 degrees range of motion, -1 degree extension. My physical therapist thinks this is very lame and wants me to have 112 by Friday. I have no idea if I'm going to be able to do that.

I can ride a stationary bike for 20 minutes. I can swim but not much because of my back. I can do the shuttle leg press with one band, do stair exercises with some difficulty, but I can do it. I do the pully with 5lb weights in three of the four positions (not the fourth because of back). I can stand on one foot and throw the ball against the wall hard and stay balanced. I do the muscle stim and the Biofeedback unit with 2lbs of weights on them. Tough, but I can get it done for 20 minutes. Heel slides I do at home throughout the day, but they are so fricking hard and painful. Quad sets I don't do as much.

In life, I'd say I'm at about 25%. I can drive a car, take a shower by myself now and get around my house okay. I still have a hard time cooking or cleaning. I can't walk any kind of distance, but I am off crutches for the limited walking I can do. I still have a very hard time sleeping. I am stiff and in pain the majority of the time in a day. I take ibuprofin and, on some physio days, I take 1/2 percocet. Vicodin and codine do nothing for my pain and I have side effects from them.

I keep getting asked if I'm going to ski again and the answer remains: HECK NO. Never, ever do I want to go through this again. I can't do it to myself or to my children and spouse. And I guess I am slowly getting used to the fact that I'm no longer going to be a long distance runner. There are worse things in life, of course, but it is a very hard pill to swallow. It brings me to tears even just typing it. I logically know that I am a very lucky woman to have survived the ski accident, have my wits about me and that it's "just a knee." That said, there is a mourning process I wasn't expecting. Reality is a lot less fun without pain meds! :)

My back is another story. I have spondylothesis in L5-SI and generally have no symptoms ever (I even carried twins with almost no spondy pain). However, within 48 hours of my knee surgery, I had a horrible spondy flare-up. I went on steroids for the inflamation, I am in physio for the back separate from the 3x/week I go for my knee. The PT thinks I will get through the spondy pain once I get balanced and using my hips and knee properly. So far, the pain in almost unbearable. I have learned that many people who have back issues can have them flare-up with knee surgery. I would highly advise getting your ducks in a row with that. Be sure you are in the right kind of bed, be very careful with the CPM machine and work your butt off on using your abs for everything. For some reason, the nerves are so inflamed that it's affecting my hips and my hip flexors. What's that old song, "the hip bone's connected to the knee bone..."?

I hope some of this information helps you. Life will and does go on. it's a tough ride. From where I am, I can see the light, but not the end of the tunnel yet.

Good luck to you.

Sending happy thoughts.

Garza Girl

vinnic

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Re: ACL Replacement, Meniscus Removal, Meniscus Repair
« Reply #12 on: May 14, 2009, 02:33:44 AM »
Hey GG, congrats on the six week mark.  I hit seven weeks tomorrow.  It's nice to hear that you are coming along, even though I know it's grueling.  I'm sorry to hear about the pain and other issues regarding your back, but hang in there hopefully sooner than later you'll be back on your feet again and this will all be behind you.  For the walking, I've had a lot of cracking and looseness in the knee but find that some sort of quad work beforehand really seems to help make everything feel better.  I'm just starting to really do any real strengthening, and fnd that the leg press, squats, or step-ups really make the walking easier, but even some basic quad sets help too.  I'm not sure if this would help you any but just thought I'd mention it all the same.  Good luck!