ACL Recon (hamstring graft) & Staph infection complication

[Bigman78]

Hi All,

I'm new to this forum but thought I'd share my experience with a recent ACL reconstruction and staph infection which has obviously slowed my rehab progress. There may be some others out there who have gone through a similar situation or who want to find out more about staph and how it has affected my rehab.

I've recently put my own blog together to share my experience along with some photos:

http://aclrehab.blogspot.com/

[Snowy]

Ouch - ACLr rehab is hard enough without a major infection to complicate it. I also had a staph infection hit my rehab, but fortunately it was at about 2.5 months post surgery and was a lot easier to deal with at that point as my leg was stronger and better able to cope with it.

I hope that you've beaten the infection and are now at a point where you can keep moving forward - it's a slow but steady road toward recovery...

[Bigman78]

It certainly is! I wasn't expecting it that's for sure but I've tried to be positive throughout the whole experience. It has set me back a fair bit which is frustrating as I worked hard leading up to my first op (knee recon). Since the 2nd op (clean out) which was on the 11th of October my progress has been slow but steady. I'm down to one crutch which is positive and I almost feel ready to walk without it but the main focus now is to get the swelling down. I'm still on anti-biotics (Cephalexin) but have been told that I should be off them in 2 weeks.

Thanks for the well wishes Snowy. I hope you're recovery is going well also. How long ago did you have staph and has it affected you since?

[Snowy]

My staph infection started about six weeks ago. It actually started with an infection in the large incision; fortunately I spotted it fairly early and was able to take it to the doctor and get it cleaned up before it spread into the joint, which was a huge relief. We caught it just in time, as it had already progressed to quite a deep level under the incision. The weird thing was that I then developed a series of secondary staph infections - nasty skin infections that kept resurfacing in different places on the operated leg. It took three courses of antibiotics to get rid of them and at one point they actually thought I had MRSA because it wasn't clearing up! In the end a different set of antibiotics resolved the problem. It's mostly been painful and annoying rather than severely limiting, but I'm still concerned that the infections may come back. The doc said I only need to worry if the incision reinfects, as that's where it could get into the joint.

Other than that, my recovery has been going pretty well. I'm at 4 months post-surgery now, and I'm regularly cycling up to 70k, running for up to 20 minutes on the treadmill, swimming, and pushing decent sized weights on the leg press. The knee still feels stiff and achy and a long way from normal, but it's definitely come on a long way from where I started. I did really well with weightbearing and strengthening (I was off my crutches completely after five days) but had a lot of trouble regaining flex, and I'm still missing the last few degrees. Lots of progress, but still a long way to go. My goal is to be skiing again in March, which my OS and PT say is on track at the moment. (Nothing like getting back on the horse that threw you...)

It's too bad that you had to deal with the infection on top of everything else, but at least it sounds like you're now at a point where you can start making steady forward progress. In the early days I found that focusing on the little milestones really helped; there are a lot of them at the beginning as you start to get various activities back. Later on it all slows to a snail's pace.

[Bigman78]

Great to hear that your recovery is now going well Snowy, it gives me even more reason to be optimistic!! Sounds like you had a rough time with the staph infection initially and hopefully it's the last you'll see of it! Sounds like you're making great progress since. I'm also concerned that it will come back however my surgeon thinks that's a very low likelihood. He basically said that if the infection comes back it's generally 2-3 days after initially getting it. He said that it most cases a 'flush out' followed by 6 weeks of antibiotics is enough to ensure that it doesn't come back but in some instances he's had to perform 3 'flush outs'. I guess it depends on the type of infection. I was told that mine was the most common type of staph but I do not remember the exact name as was quite groggy when I was told in the hospital!

As I've described in my blog the first signs of infection for me were the flu like symptoms I had - fever at night, night sweats and chills occasionally during the day. I also felt very weak and lost ROM in my leg.... it seemed like I lost all control in my leg after a while. I also had constant aches and pains and sleeping was a nightmare - I was up every 2 hours from the pain. This all occurred 5 days after the original ACL recon op and despite getting a blood test on day 6 (after the op) it did not confirm the infection. The infection was only confirmed on my 10 day checkup when the surgeon stuck a needle in my knee and pulled out some blood. It was a tomato red colour and he immediately knew it was an infection.

Anyway the main thing is they reacted quickly after this (had the flush out surgery the same day) and things have progressed pretty well since. I'm doing 5-10 mins a day on the stationary bike at the moment at home along with my usual exercises. I'm really looking forward to my first formal PT session this Thursday! You're spot on though, focusing on little milestones definitely helps. My next goal is to be walking again unaided - I hope to be doing this within the next 2 weeks.

Good luck with the next stage of your rehab and achieving your goal of skiing in March. I'm pretty sure I'll retire from playing outdoor soccer now (as I'm 32 and have played since I was 10) however my goal is to be playing cricket again next season with pre-season starting in August. I am also hopefully of training with my soccer club at some stage during next season (August - September?) which might lead to playing again haha 

[Bigman78]

Latest update (which is also on my blog):

Lectric Soda Crystals

The swelling is slowly starting to come down no doubt mainly due to the anti-inflammatory (Naproxen or NSAIDs) which I’ve been taking every night for the past 5 nights along with the elevation and constant icing throughout the day.  My knee is almost starting to take some sort of shape which is encouraging! I gave the Lectric Soda Crystals a go on Monday night and it seemed to have helped also. Basically the Lectric Soda Crystals were put in an old sports sock and it was tied just below my knee.

Then a plastic bag was put over it and the ends were taped using masking tape and finally a towel was wrapped around so that the bed would not get wet. I ended up keeping it on from around 11pm to 1:30am but finally had to take it off as it was so uncomfortable. I did notice that when taking it off the sock was wet due to the moisture which was drawn out. I’ll probably give it another go tonight but before going to bed to see if it works as effectively. I’ve been doing my usual exercises (quad tightening, knee slides, straight leg raises, side leg raises & calf raises) twice a day instead of four times a day mainly to give the swelling a chance to go down.

On top of that I’ve been riding the exercise bike for 6-7 minutes a day. I’m still on level 4 in terms of resistance (highest level is eight) but I have managed to lower the seat another notch. I’m really looking forward to my first formal physio session tomorrow at 1pm. Hopefully it takes me to the next level of my rehab.

[Snowy]

That's good news on the swelling. Very interested to hear about the Lectric Soda Crystals - wish I'd known about that back when I was struggling with the swelling!

I have an update on my staph infection; it turns out it wasn't quite done with me yet. The symptoms resurfaced again so I trundled back to the doctor this evening, where they informed me that I DO have MRSA! No wonder the antibiotics didn't clear it up. So now they're trying a longer, more intense course of the sulfa drug that we thought had cleared things up last time; apparently this strain of MRSA sometimes responds to it, but I probably didn't take it for long enough because we didn't realise the infection was so serious. If it doesn't work I'll be on IV vancomycin for a while.

The big concern now is getting the infection under control before it becomes systemic. If that happens and it gets into the joints, the consequences for my knee could be pretty serious.

[Bigman78]

I'm really sorry to hear that Snowy.... that's a real bummer. I've read a bit about it online and MRSA can be serious as you already pointed out. I really hope that the intense course of the sulfa drug clears it up for good. How long will you have to be on it for this time? How long were you on it last time around?

Were the symptoms this time around as evident as the original time? I'm still worried with my infection and although my levels are reducing by the week I'm still not down to normal levels - my current level is 23h whereas I have been told a normal level is 5h. What level are you at if you don't mind me asking?

Hope the next few days go well - keep positive.

PS the crystals seem to work well. Hopefully continues to help.

[Snowy]

They've given me a two week course this time compared to a seven day course last time. My doc said it's a good sign that the infection responded to the drug before, even though it clearly wasn't a long enough course to clear it from my system completely.

If it's any comfort, the symptoms were very evident when they resurfaced; I knew right away there was a problem and we've been able to catch it much earlier than before, when it had a chance to get in quite deep under the incision. I think having been through it already makes you very aware of the symptoms, so it's unlikely that you'd miss them.

I actually didn't ask the doctor what my levels were this time - I'll have to check next time I go back. I was so thrown by the diagnosis, and the doctor's main concern was that I know what to do as an MRSA carrier to minimize the risk of infecting other people.

Thanks for the well wishes - appreciated. Hope you continue to head in the right direction too!

[Bigman78]

No worries. Thanks for your well wishes also

Interesting that they didn't run you for a longer course last time.... I guess they may be worried by side effects? It's a good sign that you responded well to it last time and hopefully this time around it will be completely cleared from your system. What does this mean for your rehab programme? Are you going to put it on hold for the time being or continue but at a slower pace?

Ok. I'm definitely keeping an eye for the usual symptoms. It will be even more important once I finish with the antibiotics obviously.

All the best - keep me updated to how it goes.

[Bigman78]

Latest update from blog (http://aclrehab.blogspot.com/)

November 11th - 42 days post op

Another day passes and things seem to be going in the right direction! I didn’t get a chance to use the Lectric Soda last night but will make sure I give it a go over the next few nights. Last night I rested the leg for a while by elevating it about heart level and icing it. I’ve been icing my knee quite a bit and it’s definitely helping along with the anti-inflammatory.  I did my exercises 3 times yesterday along with riding the exercise bike for 10 minutes on level 4 (even on level 5 for a while).

So the real exciting part for me was seeing my physio for the first time today!  I have full confidence in him as I saw him 7 years ago (he reminded me it was 7 years ago whereas I thought it was 5!) to help with my ankle rehab. At the time I was meant to have been out for 10 weeks but came back after 4 thanks to him! His name is Roger Moore and he recently finished up at the North Melbourne football club (Kangaroos) after being their physio for 21 years! Lots and lots of experience there! Interesting enough he also knows my surgeon Hayden Morris through their kids! Small world!

Anyway the session was a good one. He initially looked at my knee and didn’t think the swelling was that bad (maybe it’s worse in my mind as its main concern right now). He got me to do one legged squats (1/4 of the way down) and I did 2-3 reasonably well. I was surprised as didn’t expect to be doing those so quickly! He then got me on the physio table to check the extension of my leg along with my ROM. He was happy with my ROM and basically said it’s enough to do my whole rehab program which was good to hear but that we needed to work on my extension (which was around 5 degrees from zero).  He then massaged the back of my knee for a good 10 minutes and that seemed to do the trick as he was able to get my extension to 0.

He then showed me a really good exercise using a medicine ball. Basically the medicine ball is against the wall with the injured leg slightly bent and pressed against it holding it up. He then got me to push back on the medicine ball which will help the teardrop muscles get some size and strength back as well as helping my gait (assisting walking). The focus of the session was to work on the areas which will help me walk again properly. He then briefly showed me how to use a sports cord in 4 different directions to help get my balance back. Overall the plan for the next week is as follows:

1)      Exercise ball on wall – 10 second squeeze for 6 reps x 4 sets
2)      Lying down with towel under ankle (pushing knee down) to regain more extension. He wants to get me down to -5 degrees. 5 seconds for 10 reps x 3 sets
3)      ¼ squat – he didn’t specify how many of these to do
4)      Using the sports cord on my good leg he wants me to balance on my operated leg whilst swinging the good leg in 4 different directions (forwards, backwards, left and right). He wants me to only start this one next Wednesday
5)      Upper body work in the gym – looking forward to getting back into it! Plan to start tomorrow!

Apart from all that he also wants me to continue with the straight leg raises (100 a day) and to start in the pool (walking laps, working on balance & leg swings) along with the usual elevating, icing and compression when I can. I also plan on continuing with my other exercises as well as the bike. Looks like I have a very busy week ahead!! Looking forward to getting into it!

[Snowy]

Wow, great stuff! Sounds like you're really into the full swing of rehab now. My PT tended to be very soothing about my swelling, too, even though it looked horrible to me. Doing quarter squats on one leg is pretty impressive at this stage. The medicine ball exercise sounds great too; the one I really liked for extension was to put a strong theraband around the back of my knee and do one-legged dips while pushing to full extension against the band's resistance. I did hundreds of those after my ACL rupture and they were key to regaining full extension. I didn't do them as much after surgery as I got back to full extension really fast. (Flex was another story, however.)

It's great you have a PT to work with that you know and trust. It makes so much difference. I struggled through some really inept and ineffectual treatment with my previous knee injuries back in the UK when I was reliant on NHS physio. Here I've had to pay privately (my insurance covered the first $800, but between the accident and surgery that ran out by the end of August) but the treatment I've gotten is first class. My PT is a knee specialist, also an escapee from the UK, who used to work with some of the top soccer players in the country. He's steered me through this really well and knows exactly when to rein me in and when to give me a bit more leeway than normal - I credit him not just for my recovery, but the fact I haven't gone crazy yet.

Regarding the infection, I think they gave me a shorter course before because they didn't know at that point that it was MRSA. My doctor tried the sulfa drug because the infection had survived two extensive courses of cloxacillin, and seven days is a standard treatment. This time he really wants to hit it hard in the hopes that he can spare me the IV treatment.

My plan is to continue rehab exactly as before. If I've been managing two hours a day of knee work (an hour on the bike and an hour in the gym) plus at least one 60km+ bike ride per week while oblivious to the MRSA, I don't see any reason to stop just because I have an official diagnosis.

Good luck with your exercises - hope they continue to go well!

[Bigman78]

Thanks snowy - yeah very positive about it all and the last couple of days have been great! I'm really happy just to be walking around now unaided although I need to work on my limp now. As mentioned all these exercises are designed to get my strength and stability back up so that I can walk properly again.

The swelling is now under control which is a relief and I'm able to do more. Doing the one legged squats was intimidating at first as I thought I was no where near that stage yet but when I did them (even if only 1/4 squats) I found them to be ok I still need to keep balance my holding onto something do but defnitely a step in the right direction! As you say working with a physio I know and trust is a massive plus. He has a good sense of humour as well which always helps!  Glad to hear you have a great PT now also - the key is for them to know when they can push you more or when you have to ease off as you mentioned.

Fair enough with the shorter course. I really hope that this time it hits it hard and eliminates it for good! Agree - I would continue as normal as long as your energy levels are up. I guess that's the only thing with antibiotics, the energy levels seem to drop off a bit when using them. Can't wait to get into the gym tonight. I will let you know how it goes.

Cheers

[Bigman78]

November 12th - 43 days post op

It’s been a massive day. So much so I’ll be struggling to keep awake this afternoon! I started the day with my usual exercises in the morning along with 3 x 10 straight leg lifts – these are getting easier by the day which is great.  I then packed my backpack for the gym and was driven in to work as usual. I decided to walk the 500 or so meters to the gym without a walking stick figuring it would be good for my leg. It was tough work especially carrying the backpack as well and I even had to stop for a break sitting on a bench when I was half way there!  The gym session itself was tough work but great – it’s fantastic to be back!

It was good to see familiar faces and a few asked how I was going. After a bit of a chat I got straight into some upper body working doing the following:

1)   Back - Lat pull down 3 x 10
2)   Chest – Flat bench press 3 x10 (was happy I was able to get up to 80kgs on this despite 6 weeks off, better than I expected!)
3)   Chest – Fly Machine 3 x 10
4)   Shoulders – Dumbbells overhead press 3 x 8 (15 kg dumbbells)
5)   Shoulders – Dumbbell lateral raises 3 x 12 (8 kg dumbbells)
6)   Biceps – seated dumbbell curls alternating 3 x 12 (15 kg dumbbells)

I didn’t have enough time to do my triceps but they got a decent workout from the flat bench press and overheard press. I’m planning to get back to my full 3 day program next week along with all the leg work. As for the leg work today I felt I did well considering the walk and upper body work out. I measured my legs as I was interested to see how much size I had lost and my measurements were as follows:

Right leg (operated leg)  Quad - 54cm  Calf - 37cm
Left leg   Quad - 58cm  Calf - 39cm

It was a bit of a shock as at my peak my quads were around 62cm and my calves were 42cms. I’ve got a lot of work ahead of me! I also weighed myself for the first time since the original operation and now weight 95.5kgs, approximately 2.5kgs lighter than before the op.
For legs at the gym today I did the following:

1)   Quad tensing lying down – 1 set of 10
2)   Straight leg raises – 3 sets of 10
3)   One legged squats (1/4) – 3 sets of 6
4)   Exercise ball on wall – 4 sets of 10 (6 sec squeeze)

I also did some ab work on the exercise ball and walked back to work. All up it was a 1.5 hour workout! I plan on doing another 10 mins on the bike tonight (did 12 minutes last night) along with my usual exercises. I am also planning to get into the pool tomorrow to do some walking, more partial squats and some controlled leg swings as advised by my physio.

I just hope I didn’t overdo it today but the knee is not complaining yet thank god!

[Snowy]

Awesome work! Sounds like you're well on the road to getting your quads and calves back to where they were before surgery.

In comparison, I lost 4cm off my operated quad and 2cm off the calf. I've gained about half of that back now, but the interesting thing is that strength is way ahead of bulk - there's currently only a 10lb difference in what I can do on the leg press with the bad leg and the good leg. My PT says this is normal, but it seems a bit weird to me.