Hello Everyone,

I spent a lot of time reading various diaries and posts over the last few months as I decieded, and then waited, to do the ACI surgery with a little bonus operation of moving my tendon and bones around(TTO).     I have not read any recent ACI/TTO surgeries on here so I thought I would write about my experience thus far.  I hope this helps someone that is trying to make this decision as well.   It has been three days since the surgery and so far so good.  My defect was on the patella so that is where my new little cells are.  After reading some of the other diaries I will admit, I was terrified!  If the doctors office had been open last Sunday night I would have called and cancelled the whole thing.  I had a major panic attack.  Luckily it past and I was rolled into the OR about 8:30 am this past Thursday. 

My surgery was done outpatient which had me a little worried about pain management but the doctor and anestesiologist told me I would be fine, and for the most part I am.  I was given a femoral block right before surgery which is a really weird feeling.  They sedated me slightly to do the block at my request, I don't like being out of it and not having control.  Only being lightly sedated I would say the procedure was slightly uncomfortable, but not awful.  Once they injected the numbing medicine my whole leg went numb and I had virtually no control over it.  Along with the block I am on a portable pain pump that contains 400 mls of Ropivicaine.  It is about 50% as strong as what they gave me in the hospital.  I can push a button for a"bonus" dose whenever I need it.  I anticipate that running out sometime today.  I also have 10 mg of Norco which works pretty well with the combination of the pain pump.   I have been taking 2 Norcos every 4 hours since I got home THursday afternoon.  I set my alarm at night so that I don't miss a dose.  They suggested this at the hospital and it has been successful so far.  Honestly most of my discomfort is in my upper quads, bottom and lower back.  I am using these muscles to compinsate for my leg I guess.  The bad thing I have had with the narcotics is I am getting some bad headaches.  REading on the Internet this is a result of my body coming down from the narcotics, somewhat of a mini withdrawl.  Has anyone had this before?  I have been taking  Advil for the headaches but hopefully can start to take less of the pain medicine all together. 

I have an ice machine as well which I really can't feel.  From the combination of all of the bandages and the nerve block it almost seems pointless, but maybe it is working.  Thursday night and Friday morning I was bleeding through the bandages and called the doctors office.  They said the oozing is normal and instructed me to take off the bloody guaze and replace with some new.  My mom has been playing nurse during the day and brought over fresh gauze.  At this point I did get to see the incision which was no where as bad as I thought it would be.  I have pictures if anyone wants to see what one day post op looks like, but I don't want to gross anyone out that might read this. 

Hopefully today I can take a shower.  I just have to wait for the pain pump to run out since it can not get wet and is attached via catheter to my femoral nerve.  I made myself coffee this morning, filled up a thermas and settled myself on the couch with my recovery dogs.  My Great DAnes have not left my side since I got home after surgery.  They are so receptive to knowing when I don't feel well. 

I looked online yesterday and saw what US Bioservices billed my insurance company.  $69,532!!  Oh my.  I hope I don't have to pick up any of that.  I have a $2500 deductable and am then covered at 100% once that is met.  Well, I met it!  So far the claim just says recieved.  I guess large claims don't go through automatically like the small ones do.  They have already processed my DME claim. 

I started the CPM machine the night of surgery at 40 degrees, did 45 degrees yesterday and am going to try 50 degrees today.  I have read many posts about people being on the CPM machine for 6-8 hours for six weeks.  I was told 4-6 hours for about two weeks or until I can get to 90 degrees.  Wow!!  I go back to the doctor next FRiday for my first post op appointment so I will confirm with him to make sure.  I also start physical therapy on Tuesday.  My overall goal is to be back at work in two weeks, or at least working from home in two weeks and back in the office at 3 weeks.  The way I feel now I think that might work.  This really has not been as bad as I thought, so far anyways.... 

P.S.-I am a horrible speller and I don't see a spell check so please excuse my misspelled words!

Hi Jwin,

I am glad to see I am not the only one getting headaches from the pain meds. So far I have only taken one since my 5:45 am dose. I am feeling pretty much pain free at this point. Hopefully that will continue once the pain pump runs out which will be sometime today since it only has 40 Mls left in it. I double checked the cpm protocol and it says 5-10 degree increase per day as tolerated. I'm doing 50 degrees right now and it is not bothering me. Of course when the pain pump ends I might have a different story to tell. I hope not!  Glad to hear you are managing well also. It does sound like we had very similar procedures just about a week apart.

Today is 5 days post op and I had my first physical therapy appointment this morning.  It went very well.  Some of the swelling has come down since the last time we took the dressing off.  Several other patients commented on how good my knee and leg looked considering I had surgery last week.  The swelling in my ankle is starting to look slightly better as well although the amount of bruising I have at this point looks like I have been beaten.  Today in therapy we did only a few excercises one being heel slides.  I made it to 62 degrees with no assistance and I was able to pull to 90 degrees with the help of a strap.  We also did some leg lifts and quad excercises.  I am now at home with ice on my knee and leg and had to take one pain pill.  According to the physical therapist my doctors theory on the CPM is once you reach 90 degrees in the CPM he wants you doing it on your own.  Yesterday I was up to 65 degrees and today I am going to try 70 or 75 depending on how I feel.  I am a little sore now from therapy.  All and all recovery is going well at this point.  I go back for more physical therapy on Thursday and have my first follow up appointment with the doctor on Friday. 

I am a little over two weeks post op and the last week has been relatively uneventful.  I went back to work after being out for two weeks.  I am only working from home right now, so we will see how long I will be able to do that.  It is still hard to sit up with just my leg propped up on another chair or stool.  I get very uncomfortable after an hour or so which makes it hard to sit at my desk for long.  My boss figured I would be more productive at home right now than in the office and she was right.  So far my work is being very accomidating.  Physical therapy is pretty boring this early in the recovery.  I don't even get to leave the table.  I do heel slides, leg lifts with the brace on, quad sets and ankle pumps with a thera band.  Until I hit the 6 week mark the doctor wants me only toe touch weight bearing which limits a lot.  I am also not allowed to go past 90 degrees.  I no longer have the CPM machine, they came and picked that up last week.  I had the machine for two weeks.  I can't say I was sad to see it go.  It was inconvenient to get someone to put it up on the bed for me to do and I can just sit in one spot for so long.  I am know doing what the CPM did for me on my own with the heal slides which is what my doctor wants.  Of course I am not doing heal slides for 4-6 hours per day!  I did have a slight set back, I think, and the doctor wants to see me tomorrow to check things out.  When doing the heal slides my knee will catch.  It almost feels like something is blocking me from doing them.  I can straighten my leg out and it will release and then I can continue.  I hope this is nothing to worry about, I have been doing everything that I have been told to do.  I have had a few minor bobbles on the crutches that caused me to put weight on my leg but nothing major. 

One of my biggest irritants right now is the muscle spasms that I get almost every night.  They are awful and wake me up or keep me up.  I sleep in about two hour intervels and I have tried everything to get past it.  The PA suggested a warm bath before bed and massaging my leg.  Tried and failed.  I would have found a doctor that does not believe in drugs.  I really want some muscle relaxers or something to help with this, I'm tired.  I plan on asking tomorrow when I see him.  I also can not get comfortable since I am sleeping on my back.  I try to lay on one side or the other but this darn brace prohibits that.  I bought one of those body pillows yesterday and tried that but the pillow has too much body.  It puts my leg up too high and that is uncomfortable. 

I have been having some pain on the inside of my foot where all of the blood has pooled and settled from the surgery.  My leg is still very bruised and sore.  I am hoping this goes away sooner than later and helps with the pain that I am feeling in my foot.  It is like having plantar faciitis pain all the time. 

I am also pretty frustrated about not being able to be independent like I once was.  I knew this going into the surgery as it was not secret that I would be on crutches for 6 weeks but the reality of it is rough.  I have been out a few times and I just don't last very long.  It is exhausting being on crutches and I was in really good shape going into the surgery.  I was at the gym several times a week working out and lifting weights but that did not prepare me for crutching around for an extended period of time.  The more I can get back to normal the better I think I will be.  I am hoping this week to get my brace unlocked up to 40 degrees.  Maybe that will help me sleep a little better. 

All in all it has not been that horrible.  My mental health I think is suffering the most at this point.  The surgery itself has been very tolerable.  Hopefully the doctor will put my mind at ease tomorrow morning and I will know for sure that I have not messed anything up. 

Week 3 Up Date

Well tomorrow I will officially be three weeks.  My pain has gone way down over the last week.  I take one maybe two pain pills a day if needed.  I try ice first and if that does not work I will resort to one of the pain pills.  I am having some catching/tightness right below my patella so I went back to the doctor on Monday.  They took an xray to make sure everything was ok and the doctor said it is probably just a little scar tissue and nothing to worry about.  I feel the catching/tightness when I am doing my heal slides.  It is not every time but every few it just gets hard to continue the heal slide.  I am hoping it works itself out.  Luckily the doctor is not worries about it so I guess I won't worry either.  Hopefully when my brace gets unlocked it won't get so tight. 

I am hoping to be able to do a straight leg raise tomorrow in physical therapy without the brace.  We tried it yesterday but I'm not quite there by myself yet.  Once I can master the leg raises without the brace I will get it unlocked 40 degrees.  I am hoping that will be enought to allow me to drive a little and give me some independence.  Work has been good so far about letting me work from home, but I know that is limited.  I already have to go in next Monday for a meeting so I figure that will likely be my first day to many back in the office.  I have to admit, I am a little nervous about going back to work.  Not many people except a few knew I was even going out for this surgery.  I work in a large clinic and they are going to be quite surprised to see me back and on crutches.  I am not one that likes any extra attention.  I kind of like to lay low.

The doctor finally gave me some sleeping pills to help me sleep a little better.  I took one Monday night and still woke up but was able to fall right back asleep unlike before.  Last night I took some allergy medicine as Spring has arrived in Houston!  I did not want to mix the two.  I slept ok, not as well as the night before but managed to get enough sleep to get through the day today.

I am about sick of the crutches and its only been three weeks.  I have a ways to go before I get to ditch them.  I don't go back to the doctor for another three weeks for my next xray.  At that point I might be able to put 50% of my weight on my leg.  I am hoping after that I will be able to ditch the crutches pretty quickly.  Crossing my fingers on that one!  Only time will tell.   
Jwin-

I get some pain around the knee especially under my patella when I contract my quad but it goes away after a few contractions.  Most of my pain is right below.  I noticed last night that while sleeping that is what was waking me up.  Luckily I was able to go back to sleep.

5 Week Update

Well not much has really changed over the last week.  Therapy is still pretty boring since I am non weight bearing.  I am still having difficulty sleeping.  I sleep for a few hours and then wake up unless I have taken one of the sleeping pills or something that makes me sleepy.  However, once it wears off whatever movement I make in my sleep usually wakes me up.  I am told this is normal but will find out for sure next week when I return to the doctor for my 6 week follow up.  At that point they take another x ray of my knee and if the osteotomy is healing well then I can go to 50% weight bearing.  I think I am still on crutches another 2 weeks after that according to the doctors protocol.  At 6 weeks I also get to attempt to begin to increase my range of motion.  Right now I am only allowed to go to 90 degrees.  I think that is going to be a challenge since seems pretty tough to go past 90 if I try.  Getting to 90 degrees right now is no problem at all and it feels good to stretch it a little.  I do still have pain under my patella when I tighten my quad which can occur both voluntary and involuntary.  Turns out stretching tightens the quad muscle which in turn is quite uncomfortable. 

I have been doing ok with the pain.  My most comfortable position is with my leg elevated and on my back propped up a bit, such as on the couch.  I went a few days without any pain medicine what so ever, not even a tylenol.  However, I must have tossed and turned a bunch last night because I woke up hurting pretty bad this morning and went ahead and took something.  After not much sleep last night, I am too tired to tough it out today. 

It is obviously still too soon to tell if this procedure was successful or not.  I can't say I am in less pain than before because I am still in the healing phase.  My pain prior to surgery was not constant but onset by doing various activities such as running, riding and being on my feet for a lont time.  I can't wait to get back to regular activities such as walking without crutches and going to the grocery store by myself.  I even miss going to work everyday.  I have been working from home for the last three weeks which has been nice, but I do miss the daily interactions with my co workers and seeing everyone. 

Crossing my fingers next weeks appointment with the doctor goes well.  I am really needing to hear something positive and a little change to my routine.  Honestly, the mental challenge has been much worse than the physical challenge.  Yes it hurts but the pain medicine kept that under control.  What I was really not prepared for was giving up my independence.  Even when I get out of the house, I am only good for a few hours before I get tired and am ready to go home.  I am not sure how you can really prepare yourself for the mental part of this.  You don't really know what to expect or how you will react until it actually happens.