17 Weeks Post-Op ACLr Allograft (BPTB) & Meniscus Trim

[steved]

Hello everyone!

I'm new to this site but it seems like it's going to be a great place to come and chat, vent, and hopefully gain some feedback while i undergo what will probably be a very frustrating period in my life. I got "injured" playing soccer about 6 weeks ago (8/28/10) but just found out on October 1st that i indeed tore my ACL and will require reconstructive surgery. The news was devestating. I've gone from playing soccer (Football) 3 times a week to almost being immobile. I've been going through Physical Therapy for a couple weeks now working on gaining my range back and strengthening my muscles for surgery and it has really paid off.

Briefly, my Ortho suggested I should consider an allograft for the procedure so I've been reading up on it as much as I can. Still no surgery scheduled but I'm hoping that will change once i see my Ortho again this Friday (Oct. 15th). I'm pretty damn nervous. I'm curious to know what your knees felt like before surgery? Pain, sore, stiff? I can bend my knee WAY better but cant seem to really straighten it ALL the way. Should i be able to? Any advice or suggestions on ANYTHING will be greatly appreciated. Thank you so much! 

[mouk786]

I think the amount of movement each person has before surgery depends on their own injury

The best thing you can do is keep going hardcore on physio until the op comes around

I lost SEVERE amountsof quads and hamstring muscles after mine so the more muscle you have to start with the better.

I had a hamsring graft which I understand is the most popular in the UK

The surgery itself wasn't too bad, It wasn't painful for too long

I have had a buildup of scar tissue which limits my mobility so need another OP, Best advice is try and get the straightening and bend back in your leg ASAP after surgery and keep your leg totally straight when resting (not slightly bent)

Its just a waiting game til the surgery unfortunatley.

[Deepclue]

My ACL tear was 7/8/2010 and my surgery 8/4/2010. Three weeks of intensive PT in between, I went into the OR with full extension, 135-140 degrees of flexion, 90-95% of quad strength (vs. uninjured leg), and some residual swelling. Morning stiffness and inability to walk up/down stairs was the norm during the first 3 weeks; after that I conquered the stairs and was walking at normal speed and gait (with a brace). I used e-stim and worked on extension a lot.

After surgery (10.5 weeks at this time), not as good. Post-op I had full extension and could do straight leg raises right away (after reconnecting muscles and brain, that is). I was completely off prescription pain meds in 2 days, and completely off Tylenol in 1 week. (I did have a femoral nerve block for 3 days.) My ROM is better than pre-op at this point, however I have PFS with some crepitus and very noticeable quad atrophy. I still have some swelling which I assume further inhibits the quad. I reckon I can push 25% of the uninvolved leg's strength on the leg press. MY injured leg's VMO is quite small compared to my other leg's. (I will say that I pushed 430+ lb on the leg press sled prior to the injury, so the leg I am comparing against is quite strong.)

How old are you? Allograft is somewhat unusual for younger people based on what I've read. I went for hamstring (ironic that I have PFS now). My hamstring is fine, but the pes anserine region (where they harvest the tendon) is still tender.

Work hard on PT to regain your ROM and strength. Be careful not to overstress your patello-femoral joint.

[steved]

Thanks guys! I got my surgery scheduled for November 2nd. I'm anxious! I'm doing really well in PT and i can almost walk around "normal" with no limp really. i have thin legs as it is but im starting to see my definition in my quads again. I can easily go up & down stairs with no problem at all. I pretty much have a week and half to keep strengthening my leg(s) before surgery. I want to make my rehab as easy as possible ya know?

Deepclue, I'm actually 28 years old. I have read dozens of conflicting reports & random readings on the choices of the graft so i was baffled before i made a decision too.  I went with the allograft because it was highly recommended by people i know are my age whom have had it AND the fact that my Ortho (Dr. Stetson of Stetson Powell) HIGHLY recommended it to me. In his words, "if you were family or a friend i would definitely recommend the cadaver graft to you". He's fully aware that i play soccer & it's an important part of my life and he made me feel it was the optimal choice which put me at ease.

The tissue will be a bone-patellar tendon-bone graft.

Mouk, thanks for the advice. I will definitely work on my ROM soon after surgery and will take your advice on straightening my leg asap as well.  I just hope it all goes well! If you can think of anything else i should know, feel free to post as much as you want, haha. I'd appreciate anything you have to share. 
Thanks again guys!

[dm]

One possible reason for not being able to straighten your knee completely is a possible meniscus tear which they didn't see on the mri (mri scans aren't perfect) and won't find until they get the scope in your knee. they'll fix that while they're fixing your acl. It's not an uncommon occurrence to have a meniscus tear with an acl tear. The other possibility is that a piece of one end of the acl remnant is hanging up in things.

A reason for choosing allografts in athletes is that they don't have to make another incision to harvest the donor graft in the same leg, or the other leg to obtain either a patellar or hamstring donor graft from you, which creates another injury site to heal in addition to the existing injury. With athletes, particularly professionals, minimizing the downtime so they can get back on the field is an important consideration, as it might be to an "up and coming" athlete being scouted, for example. Allografts from carefully selected companies that are properly screened and prepared usually don't cause issues.

Hope this answered a couple of your questions.

[sherwooa]

Just chiming in for my first post as well. Discovered this site doing my research for my upcoming Oct. 28th ACL reconstruction (plus meniscus repair or shave, depending on how bad it looks once the doc goes in).  I'm getting a bone-patellar-bone allograft as well, which is what my surgeon recommended (he's a sports medicine specialist and handles a lot of athletes).  In my case I injured it Oct. 7 playing basketball and I Crossfit and play lacrosse all spring and summer, so definitely looking to get back to pre-injury function in due time. 

Due to the nature of the injury (complete ACL tear, meniscus tear and PCl/MCL sprain) I'm still somewhat stiff and sore, but I have been walking around with a temporary brace.  I've been doing some quad sets, leg raises and a few step ups to keep the quad firing pre-op, and my extension is close to full, but I can't flex past 90 degrees - most likely from the meniscus and some residual swelling.  Going up stairs feels weird too - a little unstable and sore, perhaps from the meniscus, perhaps from the MCL sprain. 

steved - good luck with your upcoming surgery.  I will post my experiences as well.  My surgeon said to expect to be in a brace and to not start real PT (beyond ROM stuff) until after 2-6 weeks, depending on the state of the meniscus, i.e. whether it's a shave or a repair. 

From all I've read, I am going to work hard in rehab but be cautious.  I want the graft to be strong over the long run.

[mouk786]

Post Op you need to focus on physio - get advice from the hospital physio and from this site - its all basic stuff

If you are in the UK and get NHS physio dont be afraid to ask your physio questions if you are not happy with your progress.

I had a very relaxed NHS physio, I ended up seeing someone private who noticed some problems that the NHS person didn't.

[steved]

Sweet Sherwooa! We can keep tabs on eachothers progress since we're almost on the same surgery schedule. I know i want to be back playing ASAP as well but gonna have to relax and wait until everything is healed properly. Also good to know you're having the same type of graft. As far as i know, the only thing i completely tore was my ACL and i have an MCL strain. We'll see if they find anything else during the procedure though. My injury occured a couple months back so my knee is feeling great right now. I hope this really helps with my post-op rehab.

Good luck next week! I hope it all goes smoothly. don't forget to keep us posted!

[sherwooa]

steved - Thanks for the good wishes and I'll absolutely keep you posted!

This board really helps to know many of the things to expect pre and post-op.  What a great find...

[sherwooa]

It's very strange to have my knee feeling a bit better every day and to have my gait returning closer to normal and then to know that after Thursday I'll be hobbling around for a while.  I don't know whether to hope for a repairable meniscus (longer time in brace but better long term prognosis for staving off osteoarthritis) or a non-repairable one (shorter time in brace but worse prognosis for OA).  I just know I want to be up on my feet and starting PT as quickly as possible. 

I'm going under general for my surgery, which I've never had before, so a little nervous about that - mostly about experiencing nausea afterwards.  Plus I sort of want to watch the surgery, but hopefully I can see a video later.  CPM machine is supposed to get dropped off later this week, and I borrowed an old spin bike from some friends so I can use it at home to help with the rehab and cardio when I'm cleared to use it.  Also got myself a couple of cold knee wraps (re-freezable) so I can always have one ready.  Now I just have to figure out where to park myself for the first few days, i.e. upstairs or downstairs!

[LARSknee]

GOOD LUCK for your surgery and post op recovery.

I found this site before my surgery and have found the post op diaries an invaluable source of information and support.

I will be 12 weeks post LARS ACL and meniscus trim tomorrow,and have had an amazing recovery from day 1 post surgery when i could fully weight bear pain free without crutches.

I am 51 and worked out at the gym and had full extension and flexion before surgery,the day after surgery my extension was normal and flexion not far off normal.

Hope all goes well for you.

Shelli (Australia )

[sherwooa]

Thanks Shelli!  I did some 3/4 air squats and step ups last night and have been trying to fire the quad as much as possible pre-op...hoping it helps.

[steved]

Exactly 1 week away from surgery today! Sherwooa I know you're only a couple days away. Almost! I just got out of physical therapy, feeling good so far. Did a bit of bike work, some leg curls, pilates, I'm feeling good heading in. Gotta do my part this week and be prepared! 1 more PT appointment but still enough time to do stuff on my own at home or at the gym. I live in an upstairs apartment so I'm assuming that's where I'll be spending my first week. My post-op dungeon haha.

I also started to get some stuff together for my post-op, i.e. comfortable slippers, some loose PJ pants, books & magazines by the bed (and my macbook), I added tons of movies to my Netflix Instant Playlist, already picked up my vicodin prescription, i also got a stool for the shower in case it's a lil' tough to stand. It may also come in handy if you're sitting to go to the bathroom I'm sure. It's all starting to set in, the anxiety, nervousness, and of course the determination to get on with it and start feeling like my old self again.

[sherwooa]

Right there with ya steve...definitely getting a little anxious now...but eager to get it over with.  Hang in there buddy!
Got my shower stool and cryo cuff, the DVR is full (Boardwalk Empire episodes) and got a few books in the queue too.  The CPM machine comes tomorrow.  Now I just need to get my percocet Rx and some stool softeners

Maybe I'll start a post-op diary post in that forum as well.

[tez27]

Hi there Sherwooa and Steved just wanted to wish you both good luck with your upcoming surgery's I had my acl reconstructed using the hamstring on the 19th July and have had a great recovery so far, you both sound pretty ready for what is to come and it looks like your both going into this surgery in good condition which is deffo a bonus, I ruptured my acl 2 years before reconstruction as it took everyone a long time to diagnose the problem, it wasn't till a scope in Jan that the rupture was spotted even though I had an mri, so at least your both having your surgery soon after the injury, and I'm sure you'll both be back to normal before you know it, just remember ice and elevation as much as possible for the first week or so is the key to keeping the swelling under control I got myself a cryocuff which I spent the first 2 weeks using at every possible moment and I think because of that I didnt have a lot of bother with swelling.
I will look forward to reading how you both get on good luck with your surgery's
Take care Tez