ACLr - Quadricep tendon autograft

[Hockey98]

Hey guys,

I am currently one week removed from acl reconstruction and meniscus repair on my left knee.  My procedure was performed at UPMC in Pittsburgh by Dr. Freddie Fu.  I was starting this thread to not only shed some light on my recovery process, and perhaps provide some information to anyone looking to use Dr. Fu, but also to gain some feedback on my progress from those who have already been down this road. 

Most of my story can be found in a separate thread that was started a couple years back when I was originally slated for reconstructive surgery.  That thread can be found here:  http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=53949.msg572334#msg572334

In terms of my progress thus far:

To say I am frustrated would be an understatement.  I still have absolutely no quad control and the burning sensation when I stand is still very much prominent.  I need someone to physically lift my leg up for me to help move from the couch to a seated or standing position.  I have not yet graduated to crutches and am still utilizing a walker, which better allows me to lift myself up as I move and provides much better balance.  I have reached 65 degrees of flexion on the CPM, however when the machine falls into extension I feel as if I don't achieve those last couple of degrees.  This, coupled with the fact that prior to surgery my meniscus was locked in the joint preventing full extension, have causes considerable difficulty in my post-op recovery and achieving any sort of quad control.  I am sure that the quad tendon autograft compromised things further.  I am currently a graduate student obtaining my Masters degree at a local university and have already missed two entire weeks of class, and anything more will undoubtedly prove disastrous to my grades.  Essentially, I am looking to see if anyone else has had such progress in the immediate aftermath of the surgery.  Any questions about my procedure I would be happy to answer.

[Kaputt_Knee]

Get in contact with EmergRN as she had an ACL REVISION using a quad tendon graft done in Vancouver last November. She is the most recent, still active member who had this particular graft. She may pop by of her own accord as well. She is also having a few issues with her rehab, but they may not be exclusively a result of the choice of graft.

Good luck, it does get better but how quickly is always hard to generalise. so far I've avoided having my quads harvested but that may be the only source of autograft if I mess up my ACLs again! 

Sue 

[Hockey98]

Thanks Sue!

I found that member's profile but for some reason cannot figure out how to send a message!  So much for my presumed computer literacy.  Dr. Fu seemed certain that the graft side morbidity would be less than that of the other options, so that is why I agreed to go with that option.  I am sure this extension is going to be a real challenge.  I feel as if those last few degrees of hyperextension are really being prevented by swelling at the moment more than anything else, but that being said, my operative leg still feels as if it's not under my control. 

[Kaputt_Knee]

You need 20 posts to be able to send PMs. You can easily get the last 7 or so you need by answering some the fun questions in the Who's who section in Games Room (right at the bottom of the Home page index).

Sooty I thought you had enough posts already.

[emergRN]

I saw Quad tendon graft...and here I am..lol!

Don't be frustrated!  I was comparing everything to my first ACLr with hamstring autograft, and the quad graft is a different monster all together.  The rehab is MUCH slower.  I was freaking out because I could not lift my leg.  My surgeon told me that I could I'd be superwoman.

It took me almost a month before I could get in the front seat of a car, and even then, I had to lift my leg in.  I used to have to sit in the back seat, and have someone lift my leg for me.  Snowy can attest to this.  I had no strength what so ever.  I am almost 6 months out now, and I still have a lot of quad weakness, but I am having troubles that may have nothing to do with my graft.

I did figure out how to get in and out of bed by myself fairly quickly.  Put your good leg under your bad one, and use your stomach muscles and just swing it up.  It's hard to explain.  Don't try this without someone present the first time.  If you drop your leg, it will hurt like h***!  I didn't have the meniscus repair that you have had, so I am sure that this will change things somewhat.

All I can tell you at this point is to try to remain patient.  Ice and elevate as much as you can.  Do your ankle pumps.  I would say that heel slides are an impossibility, but you have a cpm.  Try to do you quad contractions to get those babies woken up.  When I started PT, we had to use E stim quite a bit.  I even had to take the unit home with me, and use it for 15 minutes twice a day.

I will also tell you that the SLR's are going to be a real challenge when the time comes.  Things really won't start progressing too much until you start PT.  Even then, do not expect things to move fast.  It will be baby steps.  It took me three PT sessions using the recumbent bike, with my foot strapped in because I had no quad strength, to gain enough flexion to get all the way around.  It hurt, but I remember that being a happy day!

I will not lie.  This is a frustratingly slow recovery.  It wasn't what I was expecting.  Then again, I also had three knee surgeries in 14.5 months.  You are only one week out right now.  I think it helps to look back even a couple of days, and you will see that there are small improvements.  The pain is a little less, you have a bit more flexion, getting around is a little easier..etc.

Take the small victories at this point!  They all count in the end!  Feel free to ask away!  If I can be of any help, I would be more than glad to answer any questions you may have.

W

[Hockey98]

Thank you for your response!

That is very disconcerting considering my surgeon (his fellow, to be exact) told me I would be able to return to school two days ago!  Meanwhile, I am still at home struggling to complete even the most mundane task.  I have begun to use my good leg to assist me in some things, but there is still a pretty significant amount of pain in the leg and it is much easier at this point to have somebody actually help me with it.  The pressure and burning pain I have upon standing is getting more localized, and I suppose that is a positive sign.  All of the pain now is directly beneath the joint on the medial size of the knee, extending into the calf.  I am sure this is from the extensive repairs done to my meniscus and the two large incisions just above that area.

I have always been a very active person, and I hope that that works in my favor in regaining some control of the quads relatively quickly.  Prior to reinjuring the knee I was typically free-squatting 315 pounds for sets of 10, however in the week leading up to the surgery full extension was not possible at the meniscus was stuck.  This, I'm sure, has a hand in the considerable weakness I am experiencing.

My plan is to get back to school on Monday (4 and a half days from now).  Actually, this isn't so much a plan as an absolute necessity.  The likelihood is increasing daily that my 5 hours of class time will be a codeine-fueled daydream, but hey, at least I'll be there!

[emergRN]

You are probably at the point now that when you stand, you will be experiencing "blood rushes".  These will disappear in time.  I hope your quads do bounce back fairly quickly. 

I am assuming that you have someone to drive you to school?

W

[Hockey98]

I will have to see where I am on Monday, but if the pain is still as significant as it is now and mobility hasn't improved any then yes, I will certainly require a chauffeur.  However, I would much like to have at least gained some level of independence by that time - enough to drive up and be able to get into and out of my car on my own.  This may be a bit ambitious, but we shall see.

Also, I was given an electrical stim machine that I have been using for the past two days.  It has three different settings: one that is meant to help retrain my quads (this setting actually contracts the muscle for 20 seconds with a 10 second rest, and is not super comfortable), one that is meant to reduce pain and swelling and one specifically for pain control.  During the contraction setting I am supposed to attempt to contract my quads for the 20 seconds that it is on but I have yet to make any progress on that front.  Still going to keep plugging away though.

[emergRN]

It sounds like you have an estim/tens unit.  Which leg did you have surgery on?  I am hoping that you say left! 

W

[Hockey98]

Oh yes, left leg, and my car is an automatic transmission, so I'd like to think that there wouldn't be too much of an issue there.  I am currently sitting outside on my porch, which is a huge milestone for me right now!  However the trip back up, including the three minute walker-assisted trek to the door (which should really only take 5 seconds) and crab-walking up the steps with someone holding my leg up the entire time is sure to quickly bring me back down to earth.

[emergRN]

Slow and easy!  I will just caution you not to do too much too fast.  I crutch walking around Whistler Village three days post op.  When I got home on 7 days post op, I crashed!  I did too much too soon!  I thought I was fine at the time!

W

[Hockey98]

I will certainly do my best to heed that warning.  I have been cooped up inside for an entire week now, with crutching pretty much totally out of the question and the walker my only means of movement, and even that is very slow and painful.  That being said, it may be hard to contain myself once I am finally able to get up and around on my own with the crutches 

[Hockey98]

Couple more days in the books now, and luckily some progress to report.  I can finally get off and onto the couch on my own, using my good leg as support to swing it as you suggested.  That is obviously a huge step for me.  The burning sensation, while still present, isn't nearly as debilitating as it was a few days ago, and I am able to get around pretty good now with the crutches...no more geriatric-style walker!  I also managed to get in the car today and drive a couple miles to Office Max and crutch my way to purchase a posterboard.  The true test is going to come tomorrow when I attempt to return to school and sit through 3+ hours of class - which will be by far the longest I have been out without my leg elevated at any point.

I have reached 90 degrees on the CPM machine, and that is the farthest I am allowed to go until at least the 1-month mark as they don't want to stress the meniscus repair.  However, when I get on the machine I usually have to ease my way back up to 90, sometimes starting as low as 40 degrees until the knee loosens up a bit.  I have tried some heel slides and usually can't get anything moving without at least a little outside assistance.  I have topped out at maybe 25 degrees on those, as the knee just feels very heavy, tight and awkward.  I have regained a very small amount of quad control, but the contraction is very weak. 

All in all, I guess those are some good steps since my last post 4 days ago.  Still a looooong way to go.  Wish me luck for class tomorrow.  Two presentations and some extended sitting periods are going to be pretty taxing, both mentally and physically.

[emergRN]

You have made some really significant progress since your last post.  Glad to hear it!  Good luck with your classes tomorrow!  Ice like crazy and elevate when you get home!!

W

[Hockey98]

Well, a few more days in the books.  Class on Monday wasn't too bad, however I had to return to school Wednesday and Thursday and during this time stayed at my apartment just off campus.  I didn't really have a lot of help at this point and as a result wasn't able to pack most of the stuff I wanted to take for the night - namely my cryocuff.  So two consecutive days on my feet (or crutches, I should say) for upwards of 5 hours and no ice made for some excessive swelling.  It's been wonderful to relax at home and keep the knee iced since I got home last night, however the swelling in the knee seems like it is going to be my big problem right now...

My heel slides are suffering badly from the amount of swelling still in the knee, and this was the case even before my two days without ice.  Once I reach a certain point the pressure in the knee is pretty extreme, and there's simply no moving past that point.  I have been keeping elevated and iced but the residual swelling is very stubborn.