Cruciate ligaments :
4 days postop - advice on pain and getting around? - - Posted by libertynm (libertynm), 12 December 2004
Hi everyone,
I just had my ACL reconstruction 4 days ago. It was an allograft surgery (bone-patellar-bone) as my surgeon doesn't do autografts. Originally, I was concerned about a meniscal tear as well, but it turned out that my floppy ACL was what was making my knee catch and that both meniscii were in tact (very thankful for that). The ACL was split through its length and very frayed.
For the women out there, I recommend getting wide (long or short) skirts for the surgery day and immediate post-op period. A wrap around skirt would have been fabulous, but I didn't have one of those. I went in for the surgery with very baggy pants (zip off legs), but ended up using the baggy skirt I had packed as a back up option because I couldn't bend my leg at all after the surgery. I've been using XL shorts for around the house as well (they fit over the brace with a lot of room to spare).
I have been using a Polar Care 500 ice machine from day 1 and that has been a real lifesaver. The cold feels great and it reduces the throbbing. Initially, the bandages on my knee were rather thick, so I found putting the cold pad at the back of my knee worked better. On my first post-op visit (day 2), my surgeon commented that I had 50% of the swelling he usually sees. I think that is because of the continuous icing.
There's also no way I could have made it through the days following the surgery on my own. If you are considering this surgery, do recruit someone to help. I still need help getting in and out of bed or even onto a couch. Also, having someone available to bring you food or cook for you is important. I did find that I had lost my appetite following the surgery, but it's still important to get those calories in for healing purposes.
Oh, and strengthening your *other* leg, abdominals, and arms prior to surgery is also helpful. I find myself doing one-legged squats quite a bit when getting up and down from different surfaces (chairs, sofas, etc). Also, the ab-strength helps with general stabilization and getting up from being flat on your back.
Having a relatively high stool in the bathroom has been useful. I have been sitting while washing my face, brushing my teeth, etc.
Exercise-wise, I have only been cleared to do heel-slides in bed (haven't been able to get very far but have had some improvement), flexion over the side of the bed (almost at 80 degrees now. . .up from 0 degrees yesterday!), quadricep contractions, and straight-legged leg lifts (still can't do those, really). Other than that, I'm supposed to take it easy and wait for my next post-op visit on Thursday.
Pain has been a real issue. I'm curious as to what those of you who have had this surgery have been doing for pain management. I was sent home with a low dose vicodin prescription which only marginally touched the pain. I tried a higher dose and that works better but has the side effect of making me rather dopey. My OS suggested adding ibuprofen to the list, which I did today (400mg), but I then felt very heavy-headed. Any advice?
Also, has anyone figured out a way to get in and out of bed before you were able to bend or lift the operated leg very well? Currently I need someone to hold my leg at the heel while I slide out using my good leg, and then I need help lowering the leg to the ground. Once that happens, I can use crutches to get around. What has everyone else been doing?
Sincerely,
Nesanet
Posted by imnotpunk (imnotpunk), 12 December 2004
In terms of getting in and out of bed, a very good technique to use is hooking your foot (of your non-operated leg) behind your other foot and lowering the leg down using the support of your good leg. Having your foot hooked behind the other foot (of the operated leg) stabilizes your leg and helps a lot with control so you can slowly lower your leg down to the floor without your leg crashing down and causing pain or further injury. It actually works very well.
Hope that helped!
Best wishes,
Patricia
Posted by Christian (Christian), 13 December 2004
Yep. take Patricia's advice with the hooking your good leg under your bad leg's ankle. This works a treat!
As for the pain thing, I took Panadeine Forte for four days after the operation, this was really just to get to sleep.
Anyway, good luck with the rehab!
Cheers,
Christian
Posted by heather_k (heather k from wales), 13 December 2004
Hi,
If you find it difficult hooking your good foot behind the bad, then try using a scarf around your heel as a sling and gently lower your leg down to the floor.
The height of your bed will make a huge differance. My bed is very low and I managed to just slowly slide my leg to the floor unaided, but whilst in hospital I needed the good leg on the floor to stop me from toppling out of bed whilst I got the bad one over the edge.
Another way is to wear pyjama bottoms, then you can hold onto the ankle bit to lift it gently to the floor. Bit of a pain wearing PJ's though when icing and all that stuff 
The other way is to have a Butler at hand 24/7 
Good luck, and I hope you soon have the strength to jump in and out of bed without such a drama!.
Heather 
Posted by libertynm (libertynm), 13 December 2004
Thanks Patricia, Heather, and Christian,
I tried getting into bed with my good leg hooked behind the operated leg. I got up to about a third of the height of the bed and then had to lower again. My bed is relatively high up, though. I think if I gained a bit of strength in both legs (or perhaps either leg) I'd be able to do it. Working hard on those quad contractions. . .
I tried a variation on the scarf method as well. . .and I almost got there. . .chickened out because of pain but i'll try again.
Thanks again for the advice and the well wishes!
Sincerely,
Nesanet
Posted by libertynm (libertynm), 15 December 2004
Found a way to get in and out of bed! It's a bit of all of the suggestions in this thread! The addition is the placement of a relatively stiff bean bag next to the bed or sofa. My boyfriend shaped the bean bag into a wedge.
Getting onto the bed:
(1) one legged squat onto end of bed (bean bag wedge is immediately next to the operated leg)
(2) lift operated leg onto bean bag by lifting the leg to the side of you (using good leg or a scarf to lift)
(3) slide back onto bed, using scarf to keep leg straight (knee may bend close to the end). Free hand/arm and leg are the motors for sliding back.
Getting off of the bed:
(1) slide operated leg over to edge of bean bag
(2) use scarf to keep leg relatively straight and slide leg down bean bag. You may need to pull on the top of the bean bag to keep it in place next to the bed once your foot gets to the bean bag.
(3) bring good leg down to floor (sideways motion).
(4) lift operated leg from bean bag onto the floor (using unoperated leg or scarf)
(5) one legged squat to standing position
Thanks guys for all of the responses and I hope this addition helps someone else in turn! 
Posted by Jennie82 (Jennie82), 15 December 2004
Hey There
I had my ACL repaired 3 years ago and found that taking my pain medication (i was on Percocet) plus Motrin or Aleve really helped. What helped also was my OS prescribed 1 to 2 tablets every 6 hours and that was not cutting the pain so he said I could take 1 tablet every 3 hours and that helped the most!
I really hope you do wonderfully and get some relief!
Good Luck
Jennie
Posted by Keston (Keston), 15 December 2004
Did you have a Femoral Block?
I had my ACL repair & menisectomy on the 9th, so as of today I am now six days post op. Seven years ago I had a meniscus repair on the same knee and let me tell you, that was a painful post op. So painful that I did not opt to have the ACL reconstruction for years because of it.
I am grateful that this time the surgeon choose to do a menisectomy, because while I have some pain, it is nothing like the last surgery. This time I can already bear weight, I have already gone on the bike in the rehab (which was excruciatingly painful and caused me a night back on Percocet).
So what I am saying is the pain could have been so much worse had you had meniscus repair. Keep up on your CPM machine and your rehab, take your pain meds on time until you feel they are uneccessary and what may have helped me was a heavy dose of pain relief in the OR with the Femoral Block which for me lasted about 48 hours, no joke.
Trust me, the pain could have been so much worse and it will get better.
Posted by libertynm (libertynm), 15 December 2004
Jennie-
spreading out the pain medication does help. Thanks!
Keston-
I didn't have a femoral block. I had general anaesthesia and then something like lidocaine injected right into the joint at the end of the surgery. When I was coming to, I remember someone asking me what my pain was like and I said 8. they kept on putting fentanyl in my IV until I said 5. I'm usually good with pain, too. I know I had a cyst removed too, but you're right, this can't be as painful as it would have been if I had meniscus repair or resection at the same time.
I do wish I had a CPM machine. My surgeon doesn't believe in them. I've been doing heel slides (active and assisted) to try to increase my ROM. Up to about 90 deg now.
I will plan on staying on top of the pain medication schedule. Originally, I was trying to take as little as possible, skipping scheduled doses when things didn't feel so bad, but that wasn't working.
All the best to all of you!
Posted by Keston (Keston), 16 December 2004
Well, I wish you had had a Femoral Block which is something I learned from this board to ask for. When I talked to my doctor and asked for it, he said absolutely and I really think it got me thru the first several days... I kept up my pain med regimen after that (something else I learned from this board) and all is well. Have you gone to PT yet? Now that can be excrutiating!
Posted by libertynm (libertynm), 16 December 2004
I wish I had discovered this board prior to my surgery. . .it is an awesome board!!! Of course it's been lots of help post-op as well. =)
That femoral block sounds like it would have let me sleep through the night my first night post-op.
I have my second post op visit today (in 2 hours actually). I was told no PT for the first week, but hopefully I'll get clearance for PT today. I don't want those muscles to waste too much!
Speaking of which, I am having the hardest time doing a straight leg lift. My OS gave me three assignments for the past week: (1) work on flexion, (2) isometric quad contractions, (3) straight leg lifts
Actually, I can't do straight leg lifts unassisted at all. Anyone have tips? I called my pre-op PT and he suggested getting the leg up vertical with a towel around the foot, using my muscles to lower the leg just a few degrees, and then pulling the leg back up with the towel. I tried that and my knee wobbles uncontrollably (reminds me of Jell-O. . .jelly in the UK?). I stopped doing it because I was scared that in not having control, I might actually do more damage than good. I am able to do quad contractions against a flat surface, even though I can't see the VMO I worked so hard on pre-op, I have full extension and I have about 90 degrees flexion. I also have been doing both passive and active heel slides. Any suggestions?
Posted by hmaxwell (Heather M.), 16 December 2004
Don't be scared of the trembling jello muscles--that means they're working. If you can only do three leg raises, do three. Wait 20-30 minutes, and do three more. Very soon you will be able to tolerate more before the trembling sets in. It's very, very common for the quad to shut down after surgery, and your job is to wake it back up. You might want to talk to your OS about a home TENS unit (rental or purchase--my insurance company purchased mine because my doctor wrote a 6 week script, and it was cheaper to buy it than to rent it for 6 weeks!). Most PT centers have an e-stim/TENS unit that is large and bulky. They will likely put electrodes on your quad muscles, then turn on the e-stim unit--it will send an electrical current into your quads and cause them to contract, just as if you had done an isometric exercise on your own. It's really cool, and often it just takes a few treatments to 'wake your quads up.' You can boost the effectiveness of the exercise by consciously contracting your muscle along with the contraction that the machine does. Often, once youare able to do that you will be able to actually initiate the contraction on your own. Same principle applies to quad sets and straight leg raises done at home--sometimes if you get a little help from a towel or a belt or a friend lifting your leg, then you will be able to hold the leg up in the air. Hold it for as long as you can control the motion.
Also, remember that form is everything. So if you are just lifting the leg and putting it right down immediately, you won't get as much benefit as if you hold the lift and use good form and technique throughout. One way to start is to do the straight leg raises from a seated position, with your back against a wall or headboard. For some reason, it's just easier to do it this way, where you are making a 90 degree angle out of your body with your back straight up against a wall and your legs sitting straight out in front of you. Get a rolled washcloth and put it under your bad knee. Contract the quad muscles first in an isometric exercise--no movement except that of the muscle contracting. Then, while still holding the isometric contraction, press the back of the bad knee into the washcloth. Next, while still doing the first two steps, lift the bad heel off the ground/bed as much as you can comfortably--it may only be an inch, but that's great.
Once you've done all three things and are still actively doing them, slowly lift the leg as a whole unit--stiff as a board, as it were--don't just lift the quad and allow the lower leg to lag behind. Lift the leg up in the air a few inches--it doesn't have to be far. Then HOLD it in the air, with your quads contracted and the leg straight, holding all the earlier steps. Then slowly release the leg in a controlled motion--only put it on the ground, don't stop the isometric contractions yet. Put the leg on the ground, then lower the heel to the ground, release the isometric move keeping pressure against the washcloth with the back of the knee, then release the isometric quad contraction. If you do it all in order, and think of the exercise as a series of 6-8 steps that have to be done in a controlled way and then reversed and undone in the same order they were done, you will be able to break it down, and suddenly it won't be so hard. A proper straight leg raise (SLR) can take 10-15 seconds to do--form is everything. If you can't actually lift the leg off the ground yet, then help out with a sash or belt. Soon your quad will remember how to work and you will be able to do a straight leg raise lying down.
Good luck and don't worry, your muscles will wake up and remember how to work soon enough.
Heather
PS Here's a link to good exercises to get back full flexion and extension: http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=4;action=display;num=1102740090;start= check out the last two posts for 5-6 things you can do at home.
Posted by libertynm (libertynm), 18 December 2004
Heather--
Thanks for the exercise tips! I've been having a little bit more success with the quad contractions. The certainly are more easily elicited with something behind the knee. Actually got a few visible contractions (even with all of the swelling which is now all the way up my thigh).
I asked my OS about E-stim and he doesn't recommend it. I guess that means I won't be getting a prescription for one. . .(shucks). I really want to get this quad up and going as soon as possible. I worked on those quads for 5 months prior to the op and I feel that I may be losing all that work. 
Well, hopefully it won't be too long before I get the SLRs going! The flittering quad contractions give me hope. My OS did say that I would feel like I was getting nowhere for awhile and then all of a sudden, my leg will go up and it will be as if my leg had never forgotten how to do them.
I've been stuck at 90 deg flexion for a few days now (it has gotten easier, though). I'm getting the feeling that the swelling is really in the way and my knee has become more swollen and warmer recently despite extensive polar care icing. How does one fight the "battle of the swell?"
Right now I'm icing a lot and using 3-4 pillows to elevate my leg. . .I've just added ibuprofen (800 mg per day) at my OS's suggestion, but ibuprofen has never worked for me.
Prior to the operation, I was taking Vioxx and that was a miracle worker in terms of both swelling and pain, but that's now off the market. By the way, it looks like the other Cox-2 inhibitors may have a similar effect on heart disease risk. ..read it in the news today:
http://www.guardian.co.uk/medicine/story/0,11381,1376527,00.html
As the holiday season is here, happy holidays to all!
Posted by hmaxwell (Heather M.), 18 December 2004
How to battle the swelling? Time, patience, ice, and elevation. If you are getting heat in the knee with the swelling, it can be a lot of things. First off, believe it or not you can over-ice your knee! In the first few days it's apparently okay to ice around the clock (love the Polar Care unit!), but I kept doing it...sleeping with the Polar Care unit running all night with a fresh batch of ice. Then I noticed that my knee was flaming hot and red in the morning. Yup, I'd over-iced it, even though I had cotton between the pad and my skin, and even though I set the temp on 45 degrees...I felt pretty dumb, let me tell you, because it was pretty logical that it would happen that way! Anyway, my OS then gave me very specific instructions to ice no more than 20mins on and 20mins off. Better still, he said, was 20 mins out of sixty with ice, the rest off.
Beyond the ice, try to keep your foot above your knee and your knee above your heart as much as possible--it's a tough position to get into on the couch. I used to lie on the floor and prop my leg on the back or side of the couch. The ibuprofen should help lots as well. And using your crutches--not sure what your instructions are on this.
Then just give it time. You had a very traumatic procedure, and it seems like you're recovery is going really well so far. Keep it up and be patient, take your cues from your knee. Swelling can definitely have a negative impact on your ROM, so don't stress. Do the exercises the doctor gave you. When I had no quad, I was given home exercises to do every 90 minutes or so--my job was knee rehab...anyway, once you are up and around, moving more normally, the swelling will slowly subside at its own pace. You're definitely not calling the shots, I'm afraid, although you can do so many things to ensure good rehab and outcome. A positive attitude helps, and a good PT is a lifesaver. Keep up the communication so that you understand your doctor's goals, expectations, and timeline.
Keep us posted.
Heather
Posted by libertynm (libertynm), 29 December 2004
hi all!!
I'm exactly 3 weeks post acl reconstruction and straight leg lifts started working today!! I feel like jumping up in the air, but that would be a really bad idea. 
I guess it's hard to believe it when everyone else says you should just keep on trying and then all of a sudden you will be able do them. My OS went as far as saying that it would be as if I had never forgotten how to do them. . .well, it wasn't quite that as the lift off part still seems uncertain until it happens and I'm only doing two at a time. Anyways, if anyone else out there is getting frustrated about SLRs, hang in there!!
Still battling the swelling, though. I was up on my feet a lot on Christmas day cooking. By the end of the evening, my knee was more swollen than it was right after surgery. It has come down a bit since then, but it's still a balloon of sorts.
I think the swelling is hampering my ROM, too. I'm still hanging out around 90 degrees flexion. 90 degrees has b ecome reasonably easy, but if I push past that, I feel like a balloon is about to pop and that balloon is inside my knee. I'm not sure how far I should push as it's not really painful per se.
Well, the new year is coming up, so Happy New Year to you all!!!
Much Aloha,
Nesanet
Posted by libertynm (libertynm), 21 January 2005
Well, I'm about 6 weeks post op today. Thank you all for the great suggestions. I must say that I have used all of your suggestions on getting out of and into bed as my abilities increased (one day lifting the bad leg with the good wasn't so hard anymore!!). Now I'm mostly getting the leg up on its own. . . particularly after the look my PT gave me when he saw me assist my leg onto the table. He has my best interests in mind. His logic was that if I can do a straight leg raise, I can lift that leg onto the table without assistance and I'll be better off in the long run for it. He's right, of course, but initializing the movement still takes quite a bit of concentration.
I've been in PT for almost 2 weeks now (started at 4 weeks post op instead of the anticipated 2 weeks post op because of an incision infection) and am making small gains in strength. Boy do those muscles melt away quickly. Funny thing was that you wouldn't have known it by measuring my quads. I had made up for the muscle mass in swelling apparently. The operated leg looked smaller, but it was honest to goodness less than half a centimeter smaller in circumference. My PT was about to retake the measurements, when I told him that I had read the same numbers from both legs as well.
On the swelling front, the massage I've been getting at PT has helped a lot. They've been trying to "milk" the excess fluid up toward my thigh. I can really feel the difference in my knee right after the massage (it feels lighter). After the first session, I could see some semblance of a kneecap! I've sort of plateau'd at that, though.
ROM:
118 deg unassisted (jumped up from 90 deg at 4 weeks post op)
132 deg after much effort and with assistance(ouch!!! )
PT: 3X per week for approx 3 hours.
ON MY OWN: Do quad contractions whenever my leg is supported. Also an hour to two of light stationary bike, stretching plus abdominal work, and straight leg raises on the days inbetween PT sessions.
Still using my crutches as walking is very difficult (catching kneecap, lack of strength to push off, and old ankle injury are all interfering). My OS wants me to get rid of the crutches ASAP. I do, too, of course, but I would all of a sudden be confined to home again without them. One of my PTs said I just needed confidence. I replied that the situation was circular: you need confidence in order to be able to walk and you need to be able to walk to have confidence. He laughed. Neither OS nor PTs have seen me walk without support. It's unstable at best and scary at worst (have almost fallen 3 times when my kneecap has jumped and locked up and that was with crutches). That being said, I've been trying to walk without the crutches a little bit at home: step-wobblewobble-step-wobblewobble. It is getting a little bit easier. . .I have got to be the slowest recovering ACL reconstruction. Got a look at my post op report (apparently there was a bit more to it than just the ACL and the cyst. ..oh well, at least the meniscii were intact).
Better stop before this message becomes a mile long!!
All the best to everyone!
P.S. Heather M, thanks for the info on e-stim. It lets me use ankle weights during short arc quads and straight leg raises. My PT thought I was weird for requesting it, but I look forward to it at each of my sessions!
Updated Mon Oct 6 2008