KNEEtalk

The SPECIALIST'S OFFICE => Ligament damage => Cruciate ligaments => Topic started by: knee-will-be-great on June 13, 2007, 05:29:07 PM

Title: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 13, 2007, 05:29:07 PM
Well, Here I am getting ready for the ACL Allograft.  I am not in as good form or shape as I should be, having gained approximately 15 pounds since last September (2006).  The knee has a huge popliteal cyst that needs to be removed - and no doubt some floating bodies (knee mice - <in colloquial parlance>).

I am looking forward to this surgery in that the knee has been the rate-limiting step in many of my activities and professional endeavours. 

So ... I am to be operated on at 08:00 hours tomorrow.  Will report on results et al as time permits.

Cheers from Knee-will-be-great!

Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Plumb on June 13, 2007, 05:32:25 PM
Tons of luck.  The 15 pounds or so will come off when you knee/leg is not feeling like crap anymore.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: sazzle1 on June 13, 2007, 08:16:18 PM
Hay kneewillbegreat!!  Good luck for tomorrows op. :) Hope it all goes well for you. You will be fine i'm sure. All the best, post back soon after to let us know how you are doing :) :)sazzle1
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 16, 2007, 03:39:45 PM
ACL DONE June 14, 2007

DAY OF SURGERY - IMMEDIATELY POST-OP

Woke up from anaesthesia at 1:30 pm.  Surgery started at 8 am - ended somehwere between 10 am and 11 am.

Knee was fitted with an interesting contraption; not the Cyro Cuff, but a cuff with two pouches and therefore room for two cooling bags.  Two other cooling bags are kept in the freezer; you interchange the two that are wrapped around your knee with the freezer-bound ones - every 2 hours!  Good grief; that means that I will have to spend my nights on the couch if I am to follow that protocol.

Very drowsy from the general anaesthetic - as well as from the pain meds provided to me.  Was given a prescription for Percoset, but decided not to go with that perscription in that narcotics make me very drowsy, nauseous and cause me to gag.

Got home at 4:15 pm and started vomiting sour water.  Slept on the couch; better that going up the flight of stairs to the bedroom.  Knee actually hurt more that it did with my High Tibial Osteotomy surgery.  Fell asleep at approximately 6:15 pm - and slept until 7 am the next morning.

___________________________________________________________________

Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: jb-knee-geek on June 16, 2007, 03:56:26 PM
hey KWBG - congratulations! you're one stpe closer to a stable - keep the swelling down and best of luck in rehab.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: sazzle1 on June 17, 2007, 08:01:45 AM
Hi KWBG :) Glad you are back and surgery is all done, you sound fairly 'chirpy'. Keep us posted sazzle1
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Nola on June 17, 2007, 10:43:03 PM
Wishing you well!!! Hope you're feeling better today!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Abs on June 18, 2007, 11:20:24 AM
Good luck with rehab.

Sorry you vomited after surgery.  If it's any help I had a monster asthma attack and was back in casualty 2 days after surgery, so now not allowed to take any anti-inflammatories.  So you're not the only sickly child post-op.

I've put on approx 10lbs since injuring knee last august.  I am convinced it will come flying off once I can step up a gear.  Luckily most my clothes just about fit, so can't put on any more or it will cost my wardrobe.

All the best
Abs

Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 18, 2007, 05:08:40 PM
ACL DONE June 14, 2007

DAY I - POST-SURGERY

Woke up at 7 am and felt very naseous, weak and dizzy.

Got a ride to my orthopaedic surgeon's office for an 8:15 am appointment to have my "hemovac" removed.  For all of you uninitiated ACL allograft / other ligament replacement patients and wannabe's , the hemovac is a device designed to suction the blood out of your incision post-surgery.  The hemovac is a cylinder-shaped container with plastic end-plates about the size of Compact Discs.  A tube is attached to the hemovac; the end of the tube is in your knee - close to an incision site.  My hemovac tube was placed in an incision site approximately 15 centimetres (3 inches) above my knee.  The incision site in itself was very small; approximately 1 centimetre across. 

The sides od the hemovac are made of a flexible, clear plastic.  Inside the hemovac are a number of metal coils that can be compressed.  Compressing these coils creates an air vacuum, which results in suction force being exerted within the knee; the hemovac essentially "sucks" up some or all of the residual blood in your knee and general surgical area that has resulted from your surgeon's cutting tissue, bone, etcetera.

You can open a little plug on the top of the hemovac to remove the blood yourself (if the hemovac is near to overflowing), but generally it is expected that your blood loss will not be such that you will have the hemovac fill to the maximum.  But every situtation is different. 

My hemovac filled to approximately 7/8th fullness. 

At the OS clinic
My surgeon's nurse removed the hemovac tube from my leg ... She said "Okay, now on the count of three, I am going to remove the tube ... one, two, three !!!."  And out it came!  Whew, not as bad as I expected.  Not even painful; just uncomfortable - like, having (and feeling) some foreign object moving inside of your body - close to your skin.  On examination of my knee at that time, I had minimal swelling; (I actually could see my knee and patella quite well thank you very much).  In terms of incisions, I have three small 1 centimetre long incisions above my knee, no doubt created to accomodate the orthroscopic cameras and surgical instruments used.

Back at home
Attempted doing the list prescribed ACL allograft physiotherapy exercises that one MUST start on Day One - after the hemovac tube is taken out.  I was surprised that the pain in my knee truly prevented me from doing the exercises - because I am a person who can withstand significant amounts of pain.  But this pain was exquisite in nature.  So I gave myself a mental break and did not beat myself up about not being able to do the exercises.  Instead I tested my ability to weight-bear per tolerated ability on the leg (also required immediately post-surgery).  I did weight-bear as per my tolerance.  All in all, I am happy that this knee is looking up and will be better after the healing is done and over with.  God bless my surgeon and his staff - and my family and friends; I love you all!

Went to sleep at 6:15 pm and woke up a few times during the night because of the need to reposition my operated knee - and to replace the warmed gel-packs enveloping my knee with freezer-cold gel-packs!

Cheers to all from Knee-Will-Be-Great!  Keep your spirits up folks!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 18, 2007, 06:27:23 PM
ACL DONE June 14, 2007

DAY 2 - POST-SURGERY
Woke up at 7 am and again felt very naseous, weak and dizzy - but knew that I had to get UP and GO, GO, GO! (or at least make a reasonable effort to do so).  Still not at the point whereby taking a shower or bath is adviseable - because I still feel woozy.  I neglected to set up the plastic resin lawn chair in my bath tub - that I would need to sit on while showering.  The legs of the chair were just a bit too wide for the tub - and would have scratched the sides of the tub, but folks, don't let that stop you from finding a small resin chair to accomodate the dimensions of your tub / shower enclosure.  Make sure to take a tape measure with you when purchasing a resin "shower chair".  Measure the inner dimensions (width) of your tub - and then measure the outer reaches of the leg span of your proposed chair prior to buying it.  This will ensure that you purchase a "shower chair" that fits. 

In my case, I will expect to take a bath (possibly Day 4 or Day 5); lying down, with my operated leg well wrapped in a garbage bag - from ankle to top of thigh - with the tops (and open bottom) of the garbage bag secured against my skin with duct tape to create a water-resistant, sealed environment for the operated knee.  I cannot get the incision(s) wet until 10 days post-surgery. 

Primary Incision Site
In my DAY 1 - POST SURGERY comments, I had mentioned that I had three small 1 centimetre incisions above the knee.  I do have another larger incision - approximately 15 to 17 cm long - a vertical incision 10 cm below the knee and 7 cm to the left of the patella (if you are looking down at your knee).  The incision was used to access my Open-Wedge High Tibial Ostetomy hardware from my January 2006 surgery.  The surgeon had to remove all of this hardware prior to starting the ACL allograft procedure - in that the very area that he needed to use to drill through and/or affix the ACLr hardware to - was the area covered by the HTO hardware.  So out with the old (hardware) and in with the new (hardware).  Kind of a Happy New Year - of sorts.  At least, happy for me, because I am waiting for a positive end to all of this. 

This incision is closed with steri-strips which will peel off during my first, official, sanctioned non-garbage bag knee protecting shower - 10 days post-surgery.  The steri-strips will then peel off of their own accord and I wll be able to shower or bathe as per usual.

Painkillers
I was prescribed "Percoset" as a post-surgery pain reliever.  I elected not to fill the scipt because the stuff quite frankly makes my ill; in fact ingesting any narcotic makes me ill, nauseous, sometimesto the point of vomiting.  I had indicated this to my OS's nurse during my DAT 1 visit; she asked a resident at the OS's office to suggest another pain killer.  The residetn wrote me a script for the brand name "Tramacet" - a pain reliever without any narcotic agent.  I was given a few "Advil" samples and a few "Tramacet" samples to try.  So yes, Kneegeeks, I have not used any pain relief post-surgery, except a few Advil and some sample Tramacet - both of which still made me feel woozy and nauseous.  Now having said this about wooziness and nausea, I cannot isolate post-surgical, anaesthetic-related nausea from nausea associated with the ingestion of pain killers.  So I am attributing a bit of the nausea from the pain killers and a bit (still) from surgical anaesthetic.

Adviseable - Do This Often
Drink a lot of fluid to flush out the anaesthesia from your system.  Drink at least 12 250 ml (8 ounce glasses) a day. 

Out and About
Being on one's legs and walking / undertaking some degree of ambulatory activity (as tolerated) is promoted by my orthopaedic surgeon, his nursing staff and the physiotherapists.  It is not considered logical for an otherwise fully functioning person to sit on his or her bottom and do nothing; not healthy ofr the body - and ceetainly not helpful for the ACLr recovery process.  With that in mind, I went out to pick up an item of clothing with a dear one.  We subsequently went to a bistro to eat and talk.  Irrespective of my continuing cognitive fuzziness, I was happy to be in the 27 Celcius degree sun, albeit shaded by a lovely parasol.  I had been invited to a graduation party that evening, but decided not to go - owing to the fact that I would in close quarters and around at least 20 - 30 active kids aged 1 year to 17 years of age, their parents (30 -40) (my friends) - and I was tired and woozy - still an issue.  I DID want to go, but owing to the fact that I fell asleep at 6:15 pm that evening - and the party had started at 6 pm, I beleive that I chose wisely and pragmatically.  One outing on DAY 2 POST-OP is enough, two outings is stretching it!

Note of Caution
RE: Crutches:  The wingnut which secures one of the screws holding my crutches together fell off - and the screw came loos at the bistro.  The crutch collapsed.  Had I not been mentally acute enough to restabilze my body position, and remain standing, I would have been on my bottom - on the ground.  LESSON LEANRED:  Check the wingnuts on your crutches to ensure they are all tight against the crutch.  Wouldn't want to see any of you Kneegeeks end up falling and possibly injuring yourselves because of a crutch malfunction!

Sorry Geeks, I won't be spell-checking anything - just posting ... bear with me ...

Love you all,

Cheers from Knee-will-be-great!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 18, 2007, 07:22:14 PM
ACL DONE June 14, 2007

DAY 3 - POST-SURGERY

Woke up at 4:30 am but officially rose from the couch at 7:00 am.  Nauseous as all heck.  I had decided to try two Tylenol 3 tablets (with codeine) at 11 pm the night previous.  I woke up feeling quite out of it.

Still have not done any knee straightening exercises prescribed to me by the physiotherapist, but I started doing some leg extension exercises.  I have a minimal amount of swelling - save around the knee; no other complaints.

Painkillers - A "No Go" for my system
Ingested two Tamacet (non-narcotic) pain killers, which essentailly had the same effect on my system as the narcotic-laced Tylenol 3s - extreme dizziness and nausea.  Oh well, looks like I will have to go through this rehab process with very little or no painkillers.  Went the no-painkiller route for all of my other knee surgeries - so I think that will (logically) have to be the case for me during this current process. 

Dietary Considerations
I am eating protein, dark green leafy veggies and light non-sweetened juice as can be tolerated.  A friend brought over some excellent chocolate cake in the pm - great stuff!  My dear one made me ribs, chicken and an excellent salad - yum!

Ate supper - protein only (ribs) and pure, non-sweetened juice.  Still couldn't eat a lot of food owing to the general, (albeit gradually) dissipating sense of nausea.

I lay around all day and feel that I must get out and walk around the neighbourhood to regain some of the quadriceps and hamstring muscle strength.  That will be on DAY 4.

After some much-welcomed visits and time on the telephone with friends and relatives, I was more or less ready for bed by 9 pm.

Got up the stairs and went to bed at 11 pm.

Another calm and uneventful day in the life of a post-ACL surgery Kneegeek!

Cheers to all from Knee-will-be-great!  :D
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: miltonc on June 18, 2007, 10:20:16 PM
I read in a different thread that you are already walking with 1 crutch from Day 3.  Wow!  Is that possible?  Are you wearing a knee brace at least.  Also, did you climb upstairs?  Too many questions.  Sorry.  But I am 18 days post op and I am still struggling to walk without crutches. 
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Nola on June 18, 2007, 11:14:11 PM
Hi knee-will-be-great.  Hope you feeling a bit better.  Just wanted to give you a little insight on your analgesics.  Tramacet is a combination of Tramadol and Acetaminophen.  Actually Tramadol is a centrally acting synthetic opioid analgesic.  I was looking through the mail a couple of weeks ago and it was amazing the number of physicians who have lost their medical licenses over abusing narcotics and Tramadol (Ultram) was listed as one of the most often abused by medical personnel.  So if you are having the same reaction of N/V with Tramacet, that is because it is an opioid and obviously you are extremely sensitive to opioids. Rather than suffer with pain and not take the narcotics or suffer with the nausea and vomiting, why not call your OS and ask for either phenergan, compazine, or reglan to assist with the N/V?  I feel for you.  Hope you work through this.  Oh one other point, I am not sure how much acetaminophen your Rx of Tramocet has in it, but be careful not to take too much acetaminophen in addition to the combination drug.  Tylenol (acetaminophen) is very toxic to the liver.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 18, 2007, 11:49:10 PM
I read in a different thread that you are already walking with 1 crutch from Day 3.  Wow!  Is that possible?  Are you wearing a knee brace at least.  Also, did you climb upstairs?  Too many questions.  Sorry.  But I am 18 days post op and I am still struggling to walk without crutches. 

Hello MiltonC,

I will respond to all of your questions!

1)  RE: already walking with 1 crutch from Day 3
Answer:  Yes I am already walking with one crutch from Day 3 (yesterday).  I was told to start walking on the knee immediately post surgery as tolerated because walking on the knee would help me regain muscle strenth and therefore knee strength.  This is slow walking - not fast walking - or "normal walking" as one would expect if one was walking form the subway / bus / parking lot garage to one's place of work - but yes, I repeat, it is still walking with one crutch.

2)  RE: Are you wearing a knee brace at least?
Answer:  Yes, I am wearing a knee-brace of sorts, but the brace does not have any plastic components.  It is more or less a "neoprene wrap" secured around the leg by three bands - one band is below the knee - one band is at the knee - and one band is above the knee.  The "neoprene wrap" has two pockets into which gel-packs are put.  The gel packs cool the knee.  I have a total of four gel packs; tow to use for two hours - the other two to keep in the freezer as replacements when the tow hour time frame is up!  Essentially that is the only knee brace that I was given.  That is my OS's protocol - a soft, neoprene sleeve that, when affixed properly and contains two icy-cold gel-packs, holds your knee in position at all times.

3)  RE:  Did you climb upstairs?  
Answer:   Yes, I did up the stairs on DAY 3; in fact I did climb up the stairs on DAY 2 once - but felt too woozy to repeat this again that day.  Today (DAY 4), I am climbing up and down the stairs.  I find that using one crutch is easier than using two for either the climb up - or the climb down the stairs.  

Stair ascent: For the climb upstairs, I always put the crutch against my "good" non-operated knee side.  I hold the stair railing using the hand on my operated knee side - and I ascend the stairs one at a time.

Stair descent:  Forthe climb downstairs, I again have my crutch against my "good knee" side.  I am holding the stair railing using the hand on my operated knee side - and I carefully descend the stairs one at a time.

Cheers from Knee-Will-Be-Great!

In terms of time frames to achieve all of these land marks/expectations, I am of the opinion that the knee healing process involves but is not limited to a combination of factors as follow:
1.  The pre-operative and post-operative physical abilities and general fortitude of the patient.  Also, if the patient is taking narcotic-laced pain meds it is my humble opinion that one will feel poorly longer than one not taking narcotic-laced pain meds.  It depends on one's bondy's ability to incorporate the pain meds into one's system.  But that is my opinion according to my experiences; (narcotics and I do not get along - so I just will not use them.)  I would prefer to tolerate "good pain" from a healing process rather than being dozy and nauseous.  Sometimes even normal, non-narcotic pain relievers can make a person lethargic as well - and affect their physical as well as cognitive abilities.  Also, people perceive and feel pain differently.  It depends on our inherent biology, how many pain receptors we have per afflicted are, etc.  It also depends on our physical/sprots-related/dance/work-related training and background.  If your were trained to not think about pain and / or visualise pain as a blob - and then you compartmentalize the blob of pain in a box - and put it away in a visualised shelf (thus shelving the pain), you may perceive your pain to be less than what you actuall do in fact have.

2.  The mental fortitude and post-operative cognitive/intellectual/emotional state and general fortitude of the patient.  Sometimes fear of the procedure and worry about the sequela post-surgery affect out mid set and therefore our ability to "get up and go".  Sometimes other family, financial, professional, educational issues - or a combination thereof affect us - and therefore our ability to regain ground.  Let's face it; for some of us Kneegeeks, thour injuries/reuperation time and possible/permanent physical limitations may have had significant personal and professional ramifications - so we are or may be somewhat scattered/upset/nervous/depressed.  This is only natural.  But I heartily advise you to be in league with people who do not whine about their situtation - but instead find and surround yourself with people who look for positive solutions.  Staying down only keeps you down.  Let's face it, we still have our legs; they haven't been blown off in Iran or on some random minefield in another war-torn part of the world.  And two of my Canadian heores (Terry Fox and Rick Hansen) both travelled suboptimally (Terry from coast to coast across the span of Canada on one leg <the other was removed at the groin because of cancer> raising money for cancer treatment research ) - and Rick travelled across the world in a wheelchair (see Man in Motion) <Rick became paralysed from the waist down at 17-18 years of age - and THEN got a degree in Physical Education/Kinesiology as a paraplegic> and then went on a mission - raising $ for spinal cord research).

3. Expectations of one's surgeon.  (i) Surgical and Post-Surgical Protocols.  If your surgeon is at a teaching hospital, he or she may be self-motivated to be invovled in various and sundry "best practises" in terms of what works/what doesn't work.  This applies to your surgeon's nurses and the physiotherapists as well.  Individuals who formally study and follow the outcomes of sports injuries (over and above simply treating sports injuries) are (in my humble opinion) better positioned to evaluate what has worked and not worked in the past and what is working/not working in the present.  In my case, my first ACL allograft was undertaken in 1993.  My knee was put in a locked plastic/metal knee brace.  At that time, I was in hospital for four days.  I was not allowed out of bed for three days - and even after those three days I felt absolutely awful!  I would attribute feeling awful to being fed a patient controlled morphine drip, which subsided the pain from my surgical wound, but produced a myriad of problems such as constipation and a general ability to void urine.  Also, I was not moving around - another bad thing!  Hence I had to be catheterized and given stool softeners.  After four days in hospital, I had to be in bed for another for another four days straight - only leaving the bed to go to the washroom.  As I recall, I was instructed not to weight bear for at least two and one half to three months, thereafter I was given open chain as well as closed chain exercises.  Not a good combination - but my [physiotherapist was not directly affiliated with the OS who performed my initial ACLr.  Today, even with my being 17 years older, I have sprung back from ACL allograft surgery with a vigour I did not have in 1993.

3.  Expectations of one's surgeon regarding patient healing time / time lines / landmarks etc.  (ii) Involvement in Sports Medicine and Invovlement with Professional Sports People.  If your surgeon is involved with a professional sports team, or has habitually treated (as part of his/her ongoing practise), the expectations are that a sports professional rehabilitate quickly and safely with a minimum of muss and fuss.  So the surgeons work towards getting these people back on the road to repair and good health as quickly as possible - so I would imagine (logically) that the benefits of observing leading edge male/female sporters in their prime of life adds to our respective surgeons' abilities to work out practicable solutions for we weekend warrior athletes and others injured during the day-to-day rigours of life.

4)  Surgical Complications.  You may get an infection in the wound, deep vein thrombosis, Vancomyosin Resistant Staphlococcus Aureus (VRSA), or, you may get a cold/flu virus while in hospital, feel generally run down, etc., as a result of surgery.  This may endure for a few weeks post-surgery.

5)  Family / Friends Support.  Support by yor family and firends is good - but being babied sometimes keeps us in a patient mode too long relative to what our surgeon's expectations are.

6)  Other factors not specified at this point.  All in all, any treatment involves a partnership between the patient, the surgeon/surgical team and the physiotherapist.  A positive attitude on the part of the patient not only helps their physical and mental well-being - but motivates your surgical and post-surgical team.  And if you can't do it, then fake the positivity until it in fact becomes who you are.  It does work!  It can't harm you.  At least in my humble opinion.

Cheers from Knee-Will-Be-Great ... probably should change my name ot Knee-Is-Getting-Greater!!! or Knee-Is Great!!!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 19, 2007, 12:00:07 AM
Hi knee-will-be-great.  Hope you feeling a bit better.  Just wanted to give you a little insight on your analgesics.  Tramacet is a combination of Tramadol and Acetaminophen.  Actually Tramadol is a centrally acting synthetic opioid analgesic.  I was looking through the mail a couple of weeks ago and it was amazing the number of physicians who have lost their medical licenses over abusing narcotics and Tramadol (Ultram) was listed as one of the most often abused by medical personnel.  So if you are having the same reaction of N/V with Tramacet, that is because it is an opioid and obviously you are extremely sensitive to opioids. Rather than suffer with pain and not take the narcotics or suffer with the nausea and vomiting, why not call your OS and ask for either phenergan, compazine, or reglan to assist with the N/V?  I feel for you.  Hope you work through this.  Oh one other point, I am not sure how much acetaminophen your Rx of Tramocet has in it, but be careful not to take too much acetaminophen in addition to the combination drug.  Tylenol (acetaminophen) is very toxic to the liver.

____________________________

Dear Nola, thank you very much re: the informarion on Tramacet!  I did think that something was amiss - in that I was flying - and again nauseous.

What is your perspective re: Advil and other over-the-counter pain remedies?

Having stopped taking any type of pain meds 2.5 days after my last surgery prior to the ACL allograft #3 (a High Tibial Osteotomy done in June 2006), I am of the opinion that I again will simply stop ingesting pain meds.  Yes, I do believe that I am one of the population who is hypersensitive to opiods.  That has been my consistent experience - extreme nausea, dizziness et al - irrespective of whether I had knee surgery or dental implants (for molar affixation) surgery.  Essentially my post surgical protocol did not include pain killers, notwithstanding their being prescribed.

Cheers to you and many thanks for you input!!!

From Knee-Will-Be-Great!!!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Nola on June 19, 2007, 02:43:25 AM
OTC's you have to respect them first.  Advill is 200mg of ibuprofen.  Rx strength ibuprofen is 600 to 800mg three times a day.  I probably would go for 800mg of ibuprofen 3 times a day but would make sure I was also taking something like Pepsid (omeprisol) to guard my stomach while taking it.  You would get the advantage of the anti-inflammatory along with the analgisic effects of the ibuprofen.  I suggest you run that by your OS.   I don't want anyone here to think I am prescribing.

Apart from medication pain relievers, what about a TEN's unit, relaxation exercises (I know, more exercises??).  You are already using the cold packs so that should help too
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Mirek on June 19, 2007, 03:52:12 AM
k-w-b-g, Well done on the rapid progress!!  I got similar advice and was up on crutches from day 2 and abandoned them on day 3, preferring to hobble about carefully and re-build muscle strength and balance.  Also, although I do not think I am allergic to opiods, I was not happy with the oxycodone I was on and gave it all up on day 5 post op.  I had had no pain in my knee and just wanted to flush all that rubbish out of my body.  Had I been in substantial pain I would of course stayed with it, there is a time and a place, but I would suffer a little pain in order to gain mental acuity any day.

cheers,  Mirek
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 19, 2007, 03:02:43 PM
ACL DONE June 14, 2007

DAY 4 - POST-SURGERY

Summation of Day's Events
Most of the day was spent on the couch with my laptop computer - either posting to the Kneegeeks Board - or doing other stuff - responding to emails, researching knees/cartilage resurfacing, etc., taking phone calls et al. 

Pain Mediciation - None
No pain meds taken today at all!  The knee was painful after I did my first set of exercises - while in bed (at approximately 10 pm).  Could not sleep after that.  So watched/listened to the television until at least 4 am.  Luckily, I did get an endorphin/?serotonin? rush (at least one half hour of pure laughing) and therefore an extended "feel good" moment in that I watched Jay Leno.  His Monday Headliners last night were precious (laughed until I had tears in my eyes).  Then, I had the good fortune to watch Robin Williams (Leno's first guest); again another laugh fest I enjoyed with tears rolling down my eyes.  I know that it did the body good. 

Prescribed Knee Exercises
Did one series of ACLr protocol exercises at 10 pm to 11 pm while watching "The English Nanny to the Rescue of People with Really Poor Parenting Skills".  I was fascinated by watching the people (watching was painful <I felt for the mother> with the crappy parenting skills be guided into learning how to deal with their three children.  Probably helped psychologically motivate me to get over my knee pain (at least) for an hour or so while I did the exercises.

Sleep Pattern
Slept on and off again - then awoke at 6 am - but elected to stay in bed until 8:35 am.  All in all not a great day, but I certainly do know that I am making progress.  One set of ACLr exercises started - another "N to the nth power" (or) N! (N Factorial) number of ACLr exercises to go - with N and n being unknowns at this point in time.

Range of Motion
Flexion - 110 degrees
Extension - 15 degrees (maybe 10 - but I just can't adequately assess this measurement at this point in time - as I am currently only eyeballing - and I do not have my compass or protractor handy which which to make a better, more accurate measurement.  :P
_______________________________________

Thanks Nola for the pain med info; I do recognize that we try to help one another ... again thank you so much!  I scrolled back on your postings and saw your knee surgery - puts eveything into perspective.  I pray that you do well and continue to improve. 

Thanks Mirek for the input on your ACLr surgery.  Glad to know that we over-40s are being taken seriously - at least by some OS's.

MiltonC - chin up ... keep on going - okay?

As the great Canadian actor Steve Smith said - (immortalized through his portrayal of eccentric Canadian husband "Red Green") ... "Remember; we are all in this together!"  ... and "Keep your stick on the ice."  (a hockey metaphor <of course> relating to making sure you keep calm/focused/centred even when not-so-nice things (knee injury/surgery and sequela) are happening in your life.  The Red Green character was predominantly talking to the men out there - but I think that his two sayings could apply to all Kneegeeks of either gender.

Cheers to all you great Kneegeeks out there ........... KWBG

Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Annika on June 19, 2007, 06:25:53 PM
KWBG

Sounds like you are doing great and it sounds like you are high enough without painkillers!. Just a bit of comment. When your knee is fully extended ie straight you are at 0 degrees, starting to bend it you increase, right angle is abvously 90 degrees, 120 is normal for discharge, 135 is what a lot of people have max but it will be higher if you can 'heel to bum' it and so on. Hyper extending is when your knee has gone past straight. So if you are hyper extendning like me you would be -2 for example (I have very straight legs)  and if you are hyper extending like Nola you will get further like -10 or (sorry Nola can't quite remember what your numbers where but I know you hyper extend a fair bit more then me). Remember extension is the most important thing to start with.

Annika, -2 to approx 6 inches of my bum  ;)
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: miltonc on June 19, 2007, 08:41:16 PM
I ditched my crutches after I saw your post.  I am now climbing stairs and even going down stairs.  Funny, how I was so clingy to my crutches and all of a sudden mentally I was strong to get rid of it.  I am even thinking of going to the gym !
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: Mirek on June 20, 2007, 04:20:09 AM
KWBG - ...but remember that Red Green would have fixed his knee with duct tape (gaffer tape for all you Brits).

Mirek
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 20, 2007, 10:22:23 AM
Hi Everyone,

Hey Mirek, ha, ha re: using duct (gaffer) tape for a knee surgery self-repair.  Cute.  ;)

Red Green and another use for Duct Tape!

First Mirek, in answer to your commentary about Red Green using duct tape to do a self-repair on his knee, well, I have duct tape - and I am using the stuff to tape off the top and bottom open ends of the garbage bag enveloping my ACL allografted knee - to ensure a nice, sealed water-free environment for my still-healing ACLr surgical sites - when I take a shower.

Canadian Cultural Icon Explanatory

Just as an aside for all of you Geeks out there wondering who the heck the eccentric (but famous) and beloved Canadian television husband "Red Green" is, well, here is a link to his web site.  You can even purchase CDs of his shows.  Actually a great gift women can give to their hubbies/boyfriends et al.

http://www.redgreen.com/

Good, great morning to all Kneegeeks around the world!

KWBG
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 20, 2007, 11:15:36 AM
ACL DONE June 14, 2007

DAY 5 - POST-SURGERY

Summary of day's events
Exercises, posting on Kneegeeks bulletin board, eating, drinking decaf tea and soy milk, receiving visitors, reading ALIVE, Canada's natural health and wellness magazine, visualising knee/walking rehabilitation and successful activity/regaining muscles post-recovery, calling my OS' office to thank him/his staff and to give them my "all's well" report, reading up on knee/cartilage resurfacing et al for arthritic knees (for future knee surgery adventures).  Friend who is a nurse came over and we chatted about our knees.  Actually this can be a fun and bonding experience with buddies.

Pain level
Low, except when trying to straighten the knee - then a catch and some sharp pains, but I am taking the advice in my Physiotherapists'/OSs' ACLr protocol and putting the heel onto a towel (nothing under the knee) and then letting the knee drop from a more bent position to a more (relatively) straightened position.  Uncomfortable, somewhat painful but oh well, just part of the process.  To prevent from gritting my teeth/clenching my jaw while doing rehab exercises, am putting in night time "mouth guard". 

Pain Management
Took two Advil during the day - that is it!  Fabulous!  Things still are tender, but I would rather have a clear head and not be woozy/dizzy/nauseous.

Icing
Wrapping all four frozen gel-packs around my knee; two in front and two in back using the stuff provided to me post-operatively.

Walking
One crutch - and a bit of a hobbling "three step" (three steps is all I feel comfortable taking) without crutches - don't want to take any chance hurting the precious ACL allograft - so I don't push it past three small steps.  Walking on both legs feels great!  Crutch always on side of "good knee".

Range of Motion
Extension - 10 degrees (almost straight - but not quite there!)
Flexion - 100 degrees (need more quadriceps and hamstring development to, (I would imagine) flex moreso - also need the swelling at the back of my knee to subside in order to achieve this end.  But this will happen.

Conclusion
Interesting how I went to bed at 11 pm last night - and woke up at 4 am this morning, walking (with great ease) down the stairs - and felt so, so, so much stronger!  Must be the high protein breakfast (ribs/chicken breasts) I am eating - in concert with the fruit/dark leafy green veggies and soymilk.)  And the body's natural healing process.  Plus great surgery, good people around me - and all my fellow Kneegeeks.

*Thanks Nola for the info on pain meds ... a good perspective to have.

*Thanks Annika for giving me the "heads up" re: the proper way of reporting on Range of Motion.  I enjoyed reading your diary and got some valuable perspective from it.  Also, I changed my DAY 4 ROM measurements accordingly.

Cheers to all from Knee-will-be-great!!!!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 21, 2007, 01:59:29 PM
ACL DONE June 14, 2007

DAY 6 - POST-SURGERY

Summary of day's events
Exercises, posting on Kneegeeks bulletin board, eating, drinking decaf tea and soy milk, talking to friends/family, visualising knee/walking rehabilitation and successful activity/regaining muscles post-recovery, reading up on IRREDUCIBLE ANTERIOR TIBIAL SUBLUXATION  - also known as PERMANENT ANTERIOR TIBIAL SUBLUXATION.   NOTE: This is where the bottom bone in you leg (the tibia) moves forward relative to the top bone in your leg (the femur), because there is not "rope"/"cord" (i.e., no ACL) to keep the tibial where it should be - realtive to your "good"/"better"/"unoperated" knee/leg.  This is why having an ACL is oh so, so, so, so very important. 

Pain level
Low, except when trying to straighten the knee to full extension - and when trying to bend the knee past 110 degrees.  The catching feeling in the joint hurts when exercising - but this too shall pass or dissipate as time progresses.  Using my night time dental "mouth guard" is a good idea when exercising.

Pain Management
Took three Advil during the day - that is it!  A bit dizzy after the third!  Only the back of the leg is tender; the joint itself is fine, save for the catching that I am experiencing when trying to either fully straighten or fully bend.

Icing
Wrapping all four frozen gel-packs around my knee for two hours; the gel packs lose heat quickly.  Did not wrap my knee up last night when I went to bed; fell asleep like a log - and woke up at 4:30 again but stayed in bed until 6:30 am.  Tomrrow I will just go downstairs and start moving at 4:30 am.

Walking
One crutch - and a bit of a hobbling slowly gait if I take a few steps without the crutch.  The leg feels weak, but the joint does not hurt when I am on both legs, walking/crutching.  The issue is joint pain/grinding/perception of an endpoint that I just cannot get past (at this time) - when I try to extend/flex.

Range of Motion
Extension - 10 degrees (almost straight - but not quite there!)
Flexion - 100 degrees
ROM = 90 degrees - give or take a few degrees.

Conclusion
Went to bed at 11 pm last night - and woke up at 4:30 am this morning; down the stairs for brekkie at 6:30 am.  Tomorrow I will be up and at it for 4:30 am instead of lollydoddling in bed.
___________________________________________________________

Information on IRREDUCIBLE ANTERIOR TIBIAL SUBLUXATION  - also known as PERMANENT ANTERIOR TIBIAL SUBLUXATION ... here are the links and titles of the scientific abstracts and the titles of the abstracts.  Geeks, if you are not aware of the meaning of the words, Google the word and then type definition after the word as follows:
subluxation, definition   ........ Arm yoursleves with solid knowledge and evidence dear Geeks; it is very valuable for you to know this stuf so that you can make informed choices about your treatment regimes.
___________________________________________________________

NOTE: Geeks, note that I have tested each link by copying the links into my browser - and all the links do work. 
___________________________________________________________

http://www.acsm-msse.org/pt/re/msse/fulltext.00005768-200205001-00748.htm;jsessionid=G52YX8gSfdGZnnDH34HgG2TxpT0bYYv2q3J1yLSWv71D5k2ZybVC!1240718814!-949856144!8091!-1

Medicine & Science in Sports & Exercise:Volume 34(5) Supplement 1May 2002p S134
PERMANENT TIBIAL SUBLUXATION IN ANTERIOR CRUCIATE LIGAMENT (ACL)INJURED KNEES
[D18E FREE COMMUNICATION/SLIDE SPORTS INJURY AND CARE]


http://www.esrnexus.com/displayArticle.aspx?codedArticleID=451177

Knee stability following anterior cruciate ligament rupture and surgery. The contribution of irreducible tibial subluxation

http://www.ejbjs.org/cgi/content/abstract/86/5/983  

The Journal of Bone and Joint Surgery (American) 86:983-987 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.
Knee Stability Following Anterior Cruciate Ligament Rupture and Surgery
The Contribution of Irreducible Tibial Subluxation


http://ajsm.highwire.org/cgi/content/abstract/33/10/1579

Clinical Sports Medicine Update
Treatment of Anterior Cruciate Ligament Injuries, Part I


http://ajs.sagepub.com/cgi/content/abstract/29/3/280

Fixed Tibial Subluxation after Successful Anterior Cruciate Ligament Reconstruction

http://www.level1diet.com/research/id/906056

Anterior tibial subluxation in anterior cruciate ligament-deficient knees: quantification using magnetic resonance imaging.

http://www.level1diet.com/research/id/383067

Deformity in flexion of proximal tibia secondary to bifocal fracture and anterior instability of knee (deformity in flexion of tibia and ACL reconstruction).
____________________________________________________________

NOTE:   Geeks, I have cut and pasted this last article's introduction.  You will note the physician / surgeon's de facto scientific opinion regarding the necessity of having an ACL - and what happens to your knee when you do not have an ACL - meniscal damage, chrondral surface damage et al.  All other scholarly references are in the body of the article.

http://www.opnews.com/articles/oct.dec01/articles.php 

Femoral Fixation Of A Hamstring ACL Reconstruction Using Absorbable Cross Pins (RIGIDfixTM)

Authors: C.S. Fang MRCS, G.L. Eastwood MRCS and P. Hirst FRCS. The University Department of Orthopaedic Surgery, Manchester Royal Infirmary, Manchester, UK

Introduction

The anterior cruciate ligament is the most commonly injured knee ligament. Injury to the ACL accounts for 48% of all ligament injuries around the knee15. In the United States, it is estimated that 500,000 knees suffer ACL injury each year. This accounts for substantial morbidity within a usually young and active population.

Loss of the ACL has a detrimental impact on the function of the knee. The ligament functions as a major stabiliser of the knee. In this capacity, the ACL resists excessive anterior tibial displacement. Other structures (the menisci, collateral ligaments and joint capsule) do assist in this role, but the ACL provides the majority of the constraint4.

The ACL also provides restraint against excessive tibial rotation and varus or valgus angulation.

The loss of normal knee kinematics that accompanies rupture of the ACL may result in meniscal tears, as they are no longer protected from otherwise trivial trauma5.

Over a longer time period, the ACL deficient knee is prone to succumb to premature osteoarthritis.

Historically, it is thought that ligaments were first recognised as stabilisers of joints by Galen in the 1600’s. The first written description of ACL rupture appeared in the 1850’s. Surgery for ACL rupture developed over the course of the 20th century. The first ACL repairs were reported in 1901 and 1903.

It is now known that repair of the ACL yields poor results as the ligament has poor healing properties, in contrast to the MCL16. Surgeons have therefore moved away from repair, favouring reconstruction. The first ACL reconstruction was reported in 1917 and used a strip of fascia lata directed through a tunnel in the tibia and femur. In a series of 39 cases, Campbell reported the use of a fascial construct derived from the medial capsule, patella and quadriceps tendon. The patellar tendon has remained a popular graft choice amongst orthopaedic surgeons since Jones first described its use in 1963. Various refinements of the technique emerged in subsequent years. The major areas of improvement are in accurate femoral and tibial placement of the grafts, methods of graft fixation, the introduction of arthroscopic techniques to assist the procedure and postoperative rehabilitation.

Successful reconstruction is dependent on many factors. Let us now examine the biomechanics of the intact ACL and compare it with the two most common substitutes: the middle one-third patellar tendon graft and the semitendinosus/gracilis tendon graft.

(End of Introduction)

____________________________________________________________

Cheers to all from Knee-will-be-great!!!!
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 21, 2007, 03:02:21 PM
Here is another recent scholarly article about why we need our ACLs

This information was sourced from Poster 17 - which was the printed summary of a scholarly article outlining the results of a study conducted on ACL-deficient patients.

One of the authors is a Dr. Richard Steadman of Vail, Colorado - he of the world-renowned Steadman-Hawkins Clinic. 

Poster 17 was the abstract (summary) presented at a 2004 orthopaedic surgeon's Annual Meeting. 

The actual document you will see when you hit the link is 59 pages long.  NOTE: Read the OBJECTIVE, METHODS, RESULTS and CONCLUSIONS of Poster 17.  It will tell you what you will need to know.

Poster 17

The Presence of Severe Chrondral Damage in Patients with ACL Deficiency


https://www.sportsmed.org/secure/reveal/admin/uploads/events/POSTER%20Abstracts.pdf

 
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 22, 2007, 12:52:48 PM
ACL DONE June 14, 2007

DAY 7 - POST-SURGERY

Summary of day's events
A slow day, uneventful day.

Pain level
Still low, except when trying to straighten the knee to full extension - and when trying to bend the knee past 110 degrees. 

Pain Management
Took three Advil during the day - that is it!  Need pain killers to bend the knee - but this too shall pass.

Icing
Wrapping all four frozen gel-packs around my knee for two hours; the gel packs lose heat quickly.  Did not wrap my knee up last night when I went to bed; fell asleep like a log - and woke up at 7:30 am.  Tsk; yesterday I did say that I would start moving at 4:30 am. I didn't.  In fact after my exercises, I decided to sleep on the couch.

Walking
One crutch - and a bit of a hobbling slowly gait if I take a few steps without the crutch.  Called OS and PT's office; PT said to walk with two crutches for a while and to not overstress my knee.  The issue is joint pain/grinding/perception of an endpoint that I just cannot get past (at this time) - when I try to extend/flex.

Range of Motion
Extension - 10 degrees (almost straight - but not quite there!)
Flexion - 100 degrees
ROM = 90 degrees - give or take a few degrees.

Weight/Fitness Level
Feel like a blob.  Gained 15 pounds from Nov. 2006 to May 2007.  Long, lean runner's muscle has transformed into fat padded, undefined muscles and a meaty body.  Summer clothes either tight or cannot put on at all.  Can we say "sausage casings"? <yes we can>).  This too shall pass; but I am already realising that I will be working out at the gym/home with a re-fitness goal clearly in my mind's eye - after I am on two feet and the initial post-surgery healing is done.  No doubt I will be doing a goodly amount of biking - and of hamstring development, stomach crunches, etc.  Looking forward to having my body back.  Last surgery (HTO) I lost weight; not this time.  But proper eating (protein, greens, fruits, low glycemic level carbohydrates) is definitely required - as well as rest.  It's just part of the process (my mantra); and it's not like I am alone - lots of other ACLr rehabbing Geeks out there.

Conclusion
Went to sleep at 11:15 pm last night - and woke up at 7:30 am: brekkie at 7:45 am.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 22, 2007, 01:28:21 PM
Here's a good explanation of ACL injury.  One page of interesting reading.

*There are MRI and X-Ray photos here.

*There is a brief discussion as to why ACLRs sometime fail (3 reasons), and an explanation why additional surgery after undergoing an ACL tear and repair is often needed.

http://uwmsk.org/residentprojects/aclreconstruction.html
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 25, 2007, 02:43:39 PM
ACL DONE June 14, 2007

DAY 8 - POST-SURGERY

Summary of day's events
Another slow day, uneventful day.

Pain level
Still low, except when (still) trying to straighten the knee to full extension - and when trying to bend the knee past 110 degrees. 

Pain Management
2 Advil during the day and 2 Tramcet.  I was dizzy/flying/room spinning until 9 pm.  But then I could bend the knee without much trouble in this state.

Icing
Wrapping all four frozen gel-packs around my knee for two hours; the gel packs lose heat quickly. 

Walking
One crutch - and a bit of a hobbling slowly gait if I take a few steps without the crutch.  Called OS and PT's office; PT said to walk with two crutches for a while and to not overstress my knee.  The issue is joint pain/grinding/perception of an endpoint that I just cannot get past (at this time) - when I try to extend/flex.

Range of Motion
Extension - 10 degrees (almost straight - but not quite there!)
Flexion - 100 degrees
ROM = 90 degrees - give or take a few degrees.
Knee is just too painful to extend fully, but it is coming.

Weight/Fitness Level
Still feeling like a blob. 

Conclusion
Could not sleep at all so I (hobbled)/wandered around the house and read up on knee issues online.  Probably the effects of the pain-killers wearing off.  Finally got to sleep at 4:00 am - 4:30 am.  Woke up at 9:15 am - darn it.  Needed to be up at 7:30 am - but oh well.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 25, 2007, 02:52:44 PM
ACL DONE June 14, 2007

DAY 9 - POST-SURGERY

Summary of day's events
An eventful day of social activity outside the home.

Pain level
Still low, except when (still) trying to straighten the knee to full extension - and when trying to bend the knee past 110 degrees. 

Pain Management
2 Advil during the day.  Was involved in a wedding's activities during the day (ceremony) and at night (reception).  Man, I needed more painkillers than that today; got a Tylenol from someone at the reception.

The two gel packs lost heat quickly over the course of the day and evening.  The neoprene, wrap-around knee-brace/ice protector works well as a stabilizer - much needed over this long night of fun.

Walking
Two crutches - and a bit of jumping on the "good leg" if I take a few steps without the crutch. 

Range of Motion
Extension - 10 degrees (almost straight - but not quite there!)
Flexion - 100 degrees
ROM = 90 degrees - give or take a few degrees.
Knee is just too painful to extend fully, but it is coming.

Weight/Fitness Level
Blob-like. 

Conclusion
Slept like a log from 12:30 pm to 8:30 am.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 25, 2007, 03:00:33 PM
ACL DONE June 14, 2007

DAY 10 - POST-SURGERY

Summary of day's events
Another slow day, uneventful day, save for friends and family and good times at a post-wedding party.

Pain level
Higher than Days 6, 7, 8 or 9, no doibt because I was on my feet.  Lots of pain when (still) trying to straighten the knee to full extension - and when trying to bend the knee past 110 degrees. 

Pain Management
8 Advil; I do not like taking pain killers but obviously needed to.  Did not do any knee stretched/the exercises; moreover the knee fells loose and the joint is somewhat swollen ... ? overdid it? ... hope not.

Icing
Wrapping all four frozen gel-packs around my knee for two hours; the gel packs lose heat quickly.  I think that there may be a more effectacious device for wrapping aorund myself and reducing swelling.  Or need better gel-packs/hot-packs.

Walking
One and two crutches.

Range of Motion
Extension - 10 degrees (almost straight - but not quite there!)
Flexion - 100 degrees
ROM = 90 degrees - give or take a few degrees.
Knee is just too painful to extend fully and the joint is catching on some (no doubt bone spurs / rough edges).

Weight/Fitness Level
Feeling like a bigger blob after eating my way through the weekend.

Conclusion
Went to bed at 1 am and up at 8 am.  Off to see the physiontherapist on DAY 11.
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 26, 2007, 01:15:29 PM
ACL DONE June 14, 2007

DAY 11 - POST-SURGERY

Summary of day's events
First official visit to the physiotherapist; glad I have this PT.  The guy knows that I am very motivated; he therefore indicated that we would get along quite well; i.e. because I am a motivated type of patient.

Pain level
On a scale of 10, it is 2 to 4.

Pain Management
2 Tramacet and I was flyinging/dozy/nauseous until 11:30 pm, in fact aftertaking the second Tramacet at 7:00 pm, the room spun and I didn't trust myself to move off of the couch.

Icing
Wrapping all four frozen gel-packs around my knee for two hours; the gel packs lose heat quickly.  I think that there may be a more effectacious device for wrapping aorund myself and reducing swelling.  Or need better gel-packs/hot-packs.

Walking
Two crutches only.  Physiotherapist said that he would tell me when I xcould use one crutch.

Range of Motion
Extension - 5 degrees (no assisted)
Flexion - 118 degrees (assisted)
ROM = 113 degrees - give or take a few degrees.
Knee is just painful to extend or flex fully.

Weight/Fitness Level
Still feeling like a blob.  Somehow all of my clothing has shrunk since last September (LOL).

Exercise Protocol
PT says that I am doing fine.  Has added 10 minutes of biking on a stationary bike (low/no resitance) to my current protocol.  (I have a stationary bike at home, so I am happy about being able to use it.)  The biking should be once or twice a day - after icing of course.

Conclusion
Went to bed at 11:30 pm and up at 8 am. 

Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 27, 2007, 01:36:55 PM
ACL DONE June 14, 2007

DAY 12 - POST-SURGERY

Summary of day's events
A non-eventful day at home.

Pain level
On a scale of 10, it is 2 to 4.

Pain Management
2 Advil and I was lethargic all day.

Icing
Wrapping all four frozen gel-packs around my knee for two hours.

Walking
Two crutches only.  Physiotherapist said that he would tell me when I could use one crutch.

Range of Motion
Extension - 5 degrees (no assisted)
Flexion - 118 degrees (assisted)
ROM = 113 degrees - give or take a few degrees.
Knee is just painful to extend or flex fully.

Weight/Fitness Level
Feel like a blob ar 155 lbs.  Lots of "junk in the trunk"; i.e., the rear end is chunky, clothes don't fit.  Ripped one side of my goregous, form-fitting (sausage casing?) black evening dress - along the seam on the week-end (blush).  Lucky that I had another evening dress to change into.

Exercise Protocol
Exercise & recumbant bike.

Conclusion
Went to bed at 11:00 pm and up at 8 am. 
Title: Re: DIARY of ACL Allograft #3 - Surgery is June 14th
Post by: knee-will-be-great on June 27, 2007, 07:50:22 PM
Some musings on the ACL reconstruction (my 3rd one) and reasons for ACL reconstruction failure:

_______________________________________________________________________

1)    Graft choice, hardware removal, revision notchplasty, tunnel placement, and method of fixation are key points for a successful result.

http://www.arabmedmag.com/issue-15-01-2006/rheumatology/main02.htm

2)    [PDF] Tendon graft fixation in ACL reconstructionFile Format: PDF/Adobe Acrobat patellar tendon autograft and allograft used for anterior. cruciate ligament reconstruction in ... struction with Endobutton fixation: A 2-3 year follow-up ...
taylorandfrancis.metapress.com/index/D4HU4A92VER72M7J.pdf - Similar pages

http://www.informaworld.com/smpp/content?content=10.1080/00016470410001708170

I copied this reference straight from the internet.  You can open and download this as a PDF file.  Google endobutton acl allograft to find this article. 

The article describes my ACL revision surgery - a Tibialis Tendon affixed using an Endobutton.  Apparently a strong and competent way of doing a revision ACL allograft.

3)    The Future of Ligament Knee Surgery

http://www.josonline.org/PDF/v9i2p77.pdf (available as a PDF) of HTML document.  Link to HTML document is cited below.

http://72.14.205.104/search?q=cache:Iy3XKzYshm0J:www.josonline.org/PDF/v9i2p77.pdf+endobutton+acl+allograft&hl=en&ct=clnk&cd=78&gl=ca

4)    Types of ACL grafts - a 46 slide PowerPoint presentation.

PDF] PowerPoint PresentationFile Format: PDF/Adobe Acrobat - View as HTML
Types of ACL grafts. AUTOGRAFT. - bone-patellar tendon-. bone. - Quadrupled. semitendinosus/. gracilis tendon. - Bone quadriceps. tendon. ALLOGRAFT ...
www.fhs.mcmaster.ca/surgery/rescentre/eduresources/Orthopaedic%20Grand%20Rounds/Anterior%20Cruciate%20Lig... - Similar pages

Overviews types of grafts, the tensile strength of different types of grafts, shows an MRI of a ACL intact knee and an MRI of an ACL-deficient knee, natural history of progression of an ACL-deficient knee that is left untreated (i.e., without an ACL autograft or allograft), photos of the inside of the knee during surgery, graft positioning, interference screw positioning - plus many other little bits of information that all of us ACL reconstruction Geeks really should know.

Use endobutton acl allograft to search for this highly informative powerpoint presentation.

5)  The ACL Reconstructuon Question: Use of Bone-Patella Tendon-Bone OR Hamstring Tendon

http://www.injuryupdate.com.au/images/research/RationalePatellaACLreco.pdf

6)  Literature Review of the ACL

http://www.wimbledonkneeclinic.co.uk/literature.pdf

7)   Abstracts/Information from an Orthopaedic Surgeon's Meeting (2006)

http://www.datatrace.com/medical/MAOA_ABSTRACTS.doc

Check out Abstract # 22, 23, 25, 28, 30

8)  Interesting debates about types of grafts to use - and the operative protocol associated with ACL Bone-Patella Tendo and-Bone autograft harvesting and preparation.

http://www.sma.org.au/publications/sporthealth/v24i1/AutumnContents.pdf

9)   Graft Fixation Alternatives - with diagrammes and pictures of knees presented in the middle of surgery

http://www.bachmd.com/Articles/ACL%20Graft%20Fixation%20Alternatives.pdf

_________________________

That's all for today folks!

Cheers from Knee-will-be-great!  :)


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 28, 2007, 03:49:58 AM
Here is another reference to using the Anterior Tibialis Tendon for an ACL Allograft

http://www.aclstudygroup.com/Powerpoint-pdf02/Verdonk-tibialis.pdf

This is a 27 slide PowerPoint.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 28, 2007, 03:58:46 AM
1)    Here is an ACL Reconstruction with photos and good explanation of procedure.

http://www.westinghousenuclear.com/Community/WSHI/E3e_Fu.pdf

12 page colour document

2)    Here is a discussion about ACL repair techniques (single bundle vs. double bundle graft placement) and outcomes.

http://www.touchbriefings.co.uk/pdf/1857/grana.pdf

2 pages
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 28, 2007, 01:06:05 PM
ACL DONE June 14, 2007

DAY 13 - POST-SURGERY

Summary of day's events
A non-eventful day at home.

Pain level
On a scale of 10, it is 0 when sitting; 2 when cycling on the recumbant bicycle; 8 when trying to stretch the knee and get the knee to full extension - which is not possible currently.

Pain Management
2 Advil and (again) I was lethargic all day.

Icing
Wrapping all two frozen gel-packs around my knee; didn't do this continuously, however.

Walking
Two crutches only per PT's orders.

Range of Motion
Extension - 5 degrees (not assisted)
Flexion - 118 degrees (assisted)
ROM = 113 degrees - give or take a few degrees.
Knee is just too painful to extend or flex fully.

Weight/Fitness Level
A blob at 155 lbs. 

Exercise Protocol
Exercises as assigned & recumbant bike.

Scar
The OS and his assistants did an excellent job.  Aside from the three arthoscopic portals (which were not sutured and are healing nicely), the cut into my tibia has essentially healed.  In fact it does not even look like he cut my leg open - that's how good the repair is!  I am very, very impressed with this; the OS no doubt has a magic touch!  And my body is participating in a healthy healing - so aside from the bent knee (without complete extension), all seems well with the knee healing.

Conclusion
Went to bed at 11:30 pm and up at 7:45 am. 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 29, 2007, 12:51:05 PM
ACL DONE June 14, 2007

DAY 14 - POST-SURGERY

Summary of day's events
Another non-eventful day at home.

Surgical Stitches
Per doctor's orders, I cut both visible ends of my incision stitches off - by my skin.  I am amazed that the incision through which the OS accessed the top of my tibia (and through which he removed my HTO hardware <a plate and four titanium screws>) and drilled a portal for the ACLr allograft - is healed!  This is absolutely amazing.  I have small little scabs left on the three arthroscope portals, but that is it.

Pain level
On a scale of 10, it is 0 when sitting; 2 when cycling on the recumbant bicycle; 8 when trying to stretch the knee and get the knee to full extension - which is not possible currently.

Pain Management
2 Advil

Icing
Wrapping all two frozen gel-packs around my knee; didn't do this continuously, however.  Gel packs warm up after 20 minutes.

Walking
Two crutches only per PT's orders.

Range of Motion
Extension - 5 degrees (not assisted)
Flexion - 118 degrees (assisted)
ROM = 113 degrees - give or take a few degrees.
Knee is just too painful and mechanically, it does not look like I can extend or flex fully; (owing to anterior tibial subluxation).

Exercise Protocol
Exercises as assigned & recumbant bike.

Conclusion
Went to bed at 11:30 pm and up at 6:45 am. 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 29, 2007, 07:45:14 PM
ACL DONE June 14, 2007

DAY 15 - POST-SURGERY

Physiotherapy Session #2
Sheer, unmitigated _ _ _ _  #[email protected]%!*  :P Spent close to 2 hours there.

The results at the end of the session, however, were great.

PT's protocol for this session:  

*  20 minutes icing to straighten the knee
*  15 minutes of bikeriding; he told me that at home, I can increase the resistance - and that two 15 minute recombant bike session daily would be appropriate.
*  balance on operated knee for 5 seconds; ensure that operated knee's muscles are as tight as they can be. Three to four sets of 10.  The PT wanted me to start balancing on the bad knee for 15 seconds (without any bracing/holding on to anything), but I could only do 5 seconds comfortably - so we went with 5 seconds of balancing on one leg - unaided.
*  lying down on my back and using a "leg pushing machine", where I would start with my operated knee in a bent position (about 100 degrees) and then push on the plate that my foot was placed on - until the operated leg was a straight as can be (for today).  At the endpoint of the push; i.e., when the knee is almost straight, I was to angle my heel so that only my heel touched the plate; the rest of my foot was pulling forward towards me.  So I could feel this exercise in my calves and my quads and my soleus and gastrocneius muscles - to name a few.  Do this is a fluid motion; hold the leg stiff - with the quad muscles tight - for a count of 3 - and then control the machine so that you start again in a bent (100 degree) position.  This machine (to my mind) reproduces squats.  I only used one leg (i.e., the operated leg) to do this exercise.
*  biofeedback device that is attached to your quads - so that you can self-monitor how hard your quads are working as you simltaneously push the back of your knee down.  Hold quads tight for 5 seconds and then release.  I did over 100 of these exercises.
*  20 minutes icing at end of session to calm down the knee

ROM
The PT showed me that the biofeedback device is an effective way of incenting oneself to work the hardest at getting the extension and hyperextension one so desires in order that one has symmetrical knees.  I am amazed to say that the back of my operated knee did in fact touch the back of the Physio mat by the end of this round of highly motivated self-torture overssen by a professional PT.   :P

Biting down on something during active physiotherapy so that I don't clench my jaws/grit my teeth
I asked my PT to give me a clean facecloth to clench between my teeth during this PT session.  Better top have a cloth absorb the bone-aching tension of rehab - rather than gritting one's teeth and breaking a molar or developing jaw pain.  I usually do my exercises at home wearing my dental night guard.  I will remeber to bring it to the next PT session  in the upcoming week.

Assessment of Patient Population
My knee-healing colleagues at PT today were an interesting bunch; the "youngies" (fit, muscled, lean <relatively speaking>) were all there as a result of sport; the "oldies" (heavy, in obvious pain and obviously physically debilitated) were there as a result of old age and/or motor vehicle accidents.  The common denominator for both populations was that our knees had really and truly hindered us in the performace of our jobs/our domestic duties around the house/our personal lives (in other ways)/our recreational enjoyment of family/friend gatherings, sports and gardening and just plain walking around.

In one case, an aged mother (at least 75) was taking care of a duaghter that looked no older than 35; funny; I remeber my grandfather telling me that sports ruins your body.  He and my grandmother lived well into their eighties without a speck of osteoarthritis.  I am starting to feel that sports is debilitating more people - and at an earlier age that even 25 - 30 years ago - because of the rise in extreme sports and the increase in physicality of the population.  Oh well.

Conclusion
Watched Bee Gees videos on YouTube (wanna dance now - badly) until 12:30 am; woke up 8:15 am.


Cheers to all kneegeeks out there!

KWBG
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: miltonc on June 29, 2007, 11:42:20 PM
Why is your physical therapist asking you to use 2 crutches, when you feel you can walk around with 1 crutch. 
I got rid of my crutches around Day 18 or 19 (after seeing one of your posts) and feel great about it.  A week later, I also got rid of my knee brace.  Feeling good about it also. 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 30, 2007, 03:17:14 AM
Why is your physical therapist asking you to use 2 crutches, when you feel you can walk around with 1 crutch. 
I got rid of my crutches around Day 18 or 19 (after seeing one of your posts) and feel great about it.  A week later, I also got rid of my knee brace.  Feeling good about it also. 

Hi Miltonc,

Thanks for the posting ... good question re: me being instructed to go back to 2 crutches.

My Physical Therapist told me that he would be the one to determine when I stopped using both crutches; this is because I am a very "gung ho", "let's move forward" Type A kind of individual who is very motivated - and in my PT's and OS's opinion, I may just try to do a little too much a little bit too soon on my own.  "Wouldn't want to hurt that ACL allograft #3" is what he said to me. 

Back to one crutch:  The PT tested out my stability today.  As long as I do not wear sandals or flip-flops or backless or unstable shoes without support, he has given me the go ahead to walk with one crutch - and then revert to two crutches if I get tired.  He said that I don't really have too many more chances at having an ACLr if I tear this one - in that this one is the third ACLr I am having.  If you look at my posting immediately previous to yours, however, you will see that the PT made me work very hard today when I visited his facility. 

I am interpreting his instructions as him wanting me to be totally compliant - and that is what I will be - completely compliant. 

Cheers to you from KWBG. 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on June 30, 2007, 10:21:52 PM
Check out this link!

http://www.eorthopod.com/eorthopodV2/index.php/fuseaction/topics.main/ID/bc6117f6c5f98a17135e5aac6c0cf6d7/area/17

Explained in this link:

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 06, 2007, 06:06:10 PM
Hi Kneegeeks,

Here's a few videos of an ACL Reconstruction ...

http://www.youtube.com/watch?v=i8EpT3uCVWU

http://www.youtube.com/watch?v=3UogiiLRJ5I&mode=related&search=

http://www.youtube.com/watch?v=nOlpPMM_dZ8  This one is 63 minutes long.  It is of a teen-age boy who injured his leg playing football.  Lots of good discussion about diagnosing an ACL tear (using the Lachman's Test).  Other good discussion about ACL injuries; 200,000 annually in the USA.  Two doctors (in suits) sitting directly outside the operating room also add (essentially) play-by-play commentaries about what is going on in the OR room.  Almost like a hockey, football or soccer game folks!  The orthopaedic surgeons also discuss the different options for ACL replacement: Autograft (a patient's own tissue) vs. Allograft (a cadaver's tissue).  Very good!

http://www.youtube.com/watch?v=_DkdOQSHYkY - This one is 60 minutes long folks!  It is of a teen-age girl who is getting her hamstring tendon cut out - to thereafter be used for an ACL autograft.  The doctors give you a running commentary of what they are doing ... also a play-by-play of sorts!  Also very good!

Good to know and see what they are doing.  Helps make us Kneegeeks understand why the post-surgery time (first few days) is so very painful ... lots of instrumentation has been inserted into the knee cavity; the bones have been drilled through; tissues has been cut and moved with metal instruments; in some cases torn ACLs are debrided and menisci are trimmed/fixed; also, the leg will feel sore with part of its tendon removed for use as the autograft material.

Cheers from KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 06, 2007, 10:30:30 PM
ACL DONE June 14, 2007

DAY 16 to DAY 22 - POST-SURGERY

DAY 16
Exercised per PT's directives.  Took 2 Advil.  Knee swollen.  Had fun with my significant other who went fishing that day and then later prepared me a fine dinner of filleted perch/bass prepared in a sumptuous batter ... yum.  I did the gnocci, the tomato sauce, the herbed potatoes au gratin, the asparagus and the garden greens salad.

DAY 17
Junped on a plane for an 8 - 10 hour excursion to another city after spending 10 hours arranging alternative flight arrangements and undertaking a drive (someone else drove) of 200 km to get to another airport in another city.  Many stops; re-routed my flight to originate from another city because original plane developed engine problems.  Knee was swollen by the time I got to my hotel at 2:45 am.  Iced the knee - but it looked bad and felt quite bad.

DAY 18
Had a 2.5 hour sleep, woke up and got to another airport in another city at 6:15 am - to recommence my trip.  Jumped on 7:15 am flight and got to my destination at 9:30 am (11:30 am my home time).  Knee swollen.  Iced the knee and went to sleep for the afternoon.  Took 2 Advil.  Later, I awoke and used both crutches to walk about 800 metres to 1 kilometre to breakfast-lunch; had steak and salad and decaf coffee - yum!

DAY 19
Had my appointment; walked 800 metres to the appointment using one crutch.  Left my one crutch in the waiting room.  Had appointment then walked back to the hotel where I iced the poor, sad looking knee, slept for 2 hours and made my way back to the airport for a 7:15 pm flight out of one city.  After numerous stops, made it home on a red-eye at 6:15 am.  Knee swollen and tender.  Took 4 Advil.  The trip was great.  Too bad I couldn't walk all through the city centre.  PS - I was wheeled around every airport that I land at.  All you have to do is arrange to have an airport porter help you out.  These porters are very gracious and quite personable.  Offered to buy a few coffee/tea/a doughnut but they refused.  Probably something they cannot do; i.e., take food gifts of gratitutde from their clients.

DAY 20
Slept for most of the day after I got home at 6:45 am.  Knee swollen.  Took 2 Advil.  Wondered how I could get my now (bent) knee (from all that airplane sitting) back to the extension I had worked so hard to achieve.

DAY 21
Physiotherapy Session #3
Went for Physiotherapy (um, torture session #3).  All of the hard work I had done to get the knee straight seemed to have disappeared in two days.  The physiotherapist (great guy) helped get me back to near full extension (not hyperextension yet, however).  Physiotherapist told me to get rid of the wrap-around neoprene knee brace I was "installed with" post-surgery.  Did so.  Used 2 Ibuprofen and one Tramacet.  Tramacet has a sunthetic opiod as its active ingredient - and gosh do I feel its effects!  (I do not like the feeling) BUT it stops my feeling any pain and therefore allows me to get that oh-so-necessary extension.

New Exercise Added to my Routine
Stand against a wall with feet 14 inches apart; stand and have about 8 - 10 inches of wall between the back of the wall and the back of your sneakers.  Then slide down the wall at bit until you cannot see the tops of your (toed) sneakers.  Repeat five times.  Do two sets.  I now have two sets of five to add to the rest of my exercises.  The PT had me do as many as I could to start, (which was about 25), but the pain from the unused muscle strain and still sore joint was so intense that I had to sit down and have a glass of water before I recommenced.  So the PT said only do 2 sets of 5 at home - although I wanted to do more.  No sense in straining healing things.  Very little swelling.  Scars from the three arthroscope portal holes are more or less indistinguishable from the rest of my knee.  Just a bit purple.  Not using any stitches or staples on the portals allowed them to simply heal naturally.  The results are amazing.  The ACL cut in my tibia looks fabulous; this OS and his team are great!  Used 2 Ibuprofen and 1 Advil.  Am now instructed to use one crutch.  The quad muscles were very stressed after this PT session.  Felt good walking, though.  Am still finding my way in terms of re-educating my knee and leg to walk like the other leg.  The leg still does not feel like it is a part of me.  And I still walk with a gait that shows that the knee is still bent relative to the other knee.

DAY 22
Knee looks great today.  Straightened the knee using a large ice bag.  There is still some room for extension improvement, however.  Didn't take any meds.  Put in night-time mouthguard to protect my teeth while I am gritting my teeth doing these exercises.  Starting to feel strong.  Have lost 5 pounds as well ... yeehaa!!!

_______________________
Summary Comments for the Week

I am so very grateful to the OS who did this surgery.  Finally, I believe that the knee joint will be tight and not subject to that horrid grinding when I walk/bend/move slightly - stemming from laxity and instability.  Thank God!  I finally am seeing a light at the end of the tunnel - and it is sunshine and happy days without constant pain.  Now, to rebuild my career and get back to my ideal fitness level.  No more running; probably no more skiing - either alpine or nordic.  At least that is how I feel just right now.  I do not want to compromise this knee - but my PT says that I should consider that when one does sports, one always takes a chance - but one shouldn't sit in the house and knit instead of engaging in sports.

PT says it is, however, not adviseable to engage in any sports for 12 months.  Although he did say that he knows of some people who start running 3 months post-ACLr.  That won't be me, however ... will follow the PT's orders to a T!
______________________

Cheers to all dear Kneegeeks from Knee-will-be-great!   :-*  Keep your chin up and never, ever give up! ... and like Canadian television icon Red Green says ... Remember, we are all in this together!  Keep your stick on the ice!  ;D


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: garth on July 07, 2007, 10:43:26 PM
KWBG,
Thats a pretty exaustive diary that you have posted so far. Some of the links (the ones I've looked at so far anyway) that you posted are also pretty helpful. I can't watch the youtube videos though as no youtube content will play on my laptop for some reason. Something to do with their coding and not my laptop at least.
You sound pretty positive, which must be the best way to go about things. Keep it up.

garth
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Jaspy on July 08, 2007, 11:29:29 PM
Hi KWBG,,

I have been reading your post op diary with interest as I'm nearly 3 weeks post op now. (Hammy)

I watched the 60min you tube vid of the complete op you posted above and was amazed, it is very detailed and I'm so much more informed now, thank you. (I couldn't find one with comentary for the hammy op)
Maybe you could put it in it's own thread? I know there is one for the patella op already that has has some interest.

I hope your rehab and fitness continues to go well.

All the best
Jaspy
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 09, 2007, 03:03:49 PM
Thanks for the comments Jaspy,

I intend to collect a few good ACLr films and put them on a separate thread ... good idea!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 09, 2007, 09:59:54 PM
ACL DONE June 14, 2007

DAY 23 to DAY 25 - POST-SURGERY

DAY 23

Iced to regain extension.  Seems you have to do this every day in the morning to "kick start" your knee.


DAY 24

Knee feeling quite strong today.   Walked up the stairs at church without a crutch; after service, then walked down again.  Stood for all of service - also without crutch.  Went to a barbeque and walked around (slowly) without a crutch.  My friends made certain that they put their golden retriever on a leash because she likes to jump up on people - and hit against their knees.  Smart move; the dog is a nice dog, but large dogs and rehabbing knee surgery do not always get along. 


DAY 25

Physiotherapy Session #4
Saw the Physiotherapist who seems quite pleased with how things have progressed.  I can walk without a crutch and walk up and down stairs without a crutch, but the PT is saying that I should be judicial and prudent about this at this point in time.  Walking up the stairs is easy; I hold on to both side of the wall and help propel myself upwards to ensure stability.  I was told by the PT to walk down the stairs one at a time, pegleg style - so that I minimize/eliminate the possibility of twisting my ACL reconstructed knee (wouldn't want to do that).

The PT added straight leg raises to my exercise protocol today.  Essentially what I do is firstly tighten my quad muscles as tight as possible, push the back of my leg down to the mat (to get full/near full extension) and then pull my foot towards my waist.  With both the quad tightened as tight as can be, the leg as straight as it currently can be - and with the foot pulled towards the waist, I then raise my leg straight by about one to 1.5 feet off of the mat, hold for three seconds and then slowly let the leg down - all the while still holding the quads tight and having my foot pulled towards my waist.  Repeat at least 40 - 60 times in intervals of 10. 

The PT armed me with a biofeedback mechanism that would emit a gentle bell-like sound when I was straining the quads - very effective indeed.

Felt great after the PT session.  Getting strong again!  And no joint grindy-grindy loosie-goosie laxity pain when walking.  Nice to get into control of one's body again.
__________________

Without going into it, there are a variety of people that I have seen in physiotherapy whose circumstances are considerably worse than ours/mine.  If knees are all we have to contend with, we should consider ourselves blessed - even when the knees hurt.


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Plumb on July 11, 2007, 04:19:48 AM
Without going into it, there are a variety of people that I have seen in physiotherapy whose circumstances are considerably worse than ours/mine.  If knees are all we have to contend with, we should consider ourselves blessed - even when the knees hurt.

http://www.hbo.com/docs/programs/coma/synopsis.html   I cried when I saw this documentary on cable last night.  So your comment really meant something to me today
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 11, 2007, 05:58:26 PM
Thanks for that acknowledgement Wiki.  Yes, many of us have suffered a lot, physically, emotionally, career-wise and financially, but there are people who have severe brain injuries and are in comas and/or paralyzed or unfortunately amputee patients.

Hopefully some of us can help out people in worse circumstances after we heal.  I have done some volunteer work with cancer patients and feel very strongly about "giving back".

ACL DONE June 14, 2007

DAY 26 to DAY 27 - POST-SURGERY


DAY 26

Went out for a job interview - without crutches.  Lucky that I didn't have to walk too far because the knee felt quite weak.

DAY 27

Physiotherapy session #4
Am able to stand on ACLr leg (with quads tightened) for 15 - 16 seconds.  On Monday, I could only tolerate 10 seconds maximum.  Did 20 of these.

The PT added straight leg raises using the quad muscle biofeedback device.  Did 4 sets of five - straightened the quads when the knee is in full extension and on the mat; then raise the leg about 40 cm. and hold for 5 seconds and then slowly let down with quad still tightened.  Then when leg is on the mat, let the quads fully loosen. 

Today the knee fells loose and wobbly (yikes).

I am having a hard time ambulating with a normal gait; I feel like the lower leg is disconnected from the top of my leg - and that the lower leg seems to be missing something in the back in terms of holding it in place.  I kept this to myself at Physio; we'll see how it is in one week's time.  The physiotherapist says I am doing fine, however.

Extension
The PT did not measure the extension, however he did say I was doing well.  I note however, that when standing straight, I have the dreaded anterior tibial subluxation.  So the ACLr knee always looks/is slightly bent compared to the other knee; or more specifically, the tibia looks like it is forward relative to the position of the femur - when compared to the non-operated knee.  The tibia on the ACLr knee is bent forward relative to the non-operated knee.  Probably is this way owing to changes in the tibial plateau subject to living so many years without an ACL.  Sigh.   

Exemplar:  Think of the top stick as the femur and the bottom stick as the tibia (in side view).  Note this is a very rough representation. (lol)

              l    vs     l               
             \            l
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 12, 2007, 01:22:54 PM
ACL DONE June 14, 2007

DAY 28  POST-SURGERY
So I am officially at the four week mark. 

Observations:
The knee is:
1.   nearly fully extended (but not hyperextended like the non-operated one),
2.   not painful at all when walking without crtuches,
3.   still not as strong (muscle-wise) as the non-op knee,
4.   regaining quad muscle,
5.   seemingly hamstring muscle-deficient (need work on the adductor and abductor muscles - and rear end as well),
6.   still in a bent position when I walk (darn),
7.   able to be straight when I lie down and do my exercises but the joint appears to not be able to mechanically maintain this straightness when I am standing on it,
8.   not as painful when standing still (not painful at all), and
9.   all in all a lot more stable than the knee was prior to surgery.

Happy 4 week aniiversary to my new ACL posterior tibialis tendon allograft!  And many thanks to the family of the deceased donor who gave me this true gift of life and possibility for activity renewed.  Words cannot truly express how grateful I am for this gift.

I am preparing a note and purchasing a card to give to my Orthopaedic Surgeon's staff when I next see him on July 31st - to forward on to the family of the donor.  I hope that this is acceptable - and that the donor's family can receive the card of thanks and gratitude.  :D

Well, the knee isn't perfect, but it is better than what I had before.  And hopefully it will continue to improve.  After all, this is only 4 weeks post-op.


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 15, 2007, 03:40:51 PM
ACL DONE June 14, 2007

DAY 29  POST-SURGERY
So I decided not to do any physiotherapy on DAY 28 AND DAY 29; instead I stayed crouched up sitting at my desk working on my laptop - or sitting on the couch working on my laptop.  Big mistake because by the end of DAY 29, I was sore and feeling generally achy.  Now the knee cannot (again) be straightened.  I did not use any pain killers during these two days in that I have an adversion to using pain killers of any sort because I become woozy and non-functional during the evening and feel hung over the next day.  So I recognize the ramifications of not taking painkillers to alleviate the pain associated with doing my knee straightening exercises; I cannot do the exercises - which is counterproductive.  So ... back to the painkillers ... or risk going backwards with respect to knee rehabilitation.  Would be nice to have a localized pain patch placed on the knee (the equivalent of a novocaine injection into the knee) to alleviate this localized pain.  I certainly don't need my entire body (and mind) affected by the painkillers.  :P
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 16, 2007, 01:38:19 PM
ACL DONE June 14, 2007

DAY 30  POST-SURGERY

Observations:

Looseness in the Knee Joint:
Knee feeling quite loose on the medial side (like prior to surgery) and of course the tibia has the permanent forward subluxation - which appears to be greater DAY 29 and 30 (Sunday) relative to what it was on DAY 27 post-op.  I am aware that I do not have a medial meniscus to hold the tibia in place relative to the femur.  Moreover, I am aware that the knee joint's articulating surfaces have changed appreciably since this "adventure" started for me 30-odd years ago when I was in my teens. 

Hmmmmmm ... don't like the way that this is going ... but perhaps with more muscle development in my hamstrings I will see a difference.  I was concerned about developing my hamstrings (Biking, SLR's etc., without the comcomitant benefit of developing my hamstrings muscles.  Having said that, I am aware that this knee has been through the mill, so to speak, so any improvement is better than nothing at all.  But my little voice said to me at the start of this current surgical adventure that I would probably have to go out-of-country to get some needed other work done, which could in theory mean having work re-done, but we shall see.  Just ruminanting for now.  I recognize that Kneegeeks get a bit paranoid about the state of their knees, so I am taking my rumination and worry with a little grain of salt.  Call it cautious, justifiable worry.

Asking for Comments from the Peanut Gallery:
I am wondering whether anyone else who has had ACLr allograft work felt that their knee started getting loose after surgery.  In my case, the looseness started 28 days post-op.  Any postings/personal messages about this would be appreciated.

I walked yesterday without crutches, albeit nominally; i.e., from car  in parking lot to building and up the stairs, then down the stairs and back to car.  Then to another parking lot and a walk to another building and then back to the parking lot and my car; then to the bistro/groceteria to get a few things. 

Perhaps just my paranoia about these things - but my leg felt looser after doing the straight leg raises per the physiotherapist's orders.  Will ask physiotherapist about this the next time I go to the clinic for PT.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 16, 2007, 09:53:33 PM
ACL DONE June 14, 2007

DAY 31  POST-SURGERY

Observations:

Physiotherapy session #5:

ROM:
Flexion (aided) = 134 degrees
Flexion (unaided) = 125 degrees

Extension (unaided) = +2 <but only after I have iced the knee for 20 minutes and have done warm-up bending/extension exercises>
ROM = 132 degrees with assisted flexion
ROM = 123 degrees with unassisted flexion


New Exercises added to ACL Protocol:
1)   Tippy-toe extension and flexion while on some device with a plate.  Use only post-op knee/leg for the exercise.  I put both of my feet on the plate to initially establish balance and to not stress the post-op knee, then with the post-op knne/leg in proper position, I remove the other leg.  Then I do one set of 10 of these tippy-toe rolls holding the knee straight.  Hold for a count of 5 then go down on the flat of my foot - all the while keeping the knee straight.  The objective is to strengthen the calf muscles.  Then do a set of 10 (one leg only <post-op knee) knee bends and straightening on this machine.  I am recumbant while using this machine.  Then repeat protocol twice.

2)  Use a round, air filled pancake-looking thing that has the sideway prolie of being fatter in the middle ... (only way I can describe it at this point in time).  Without holding anything for stability, try to stay stable on top of this thing for as long as you can - with knee locked into a straight (well relatively straight) position and quads tightened.  Log about 120 seconds of staying this way - in total.

Just got back from PT.  Physiotherapist says that I am where I should be - and that some people feel (perceive?) their knee loosening as they rehab.

Knee still stiff after doing SLRs and tightening it / icing it.

Still walking with it bent - but today I saw others at my stage of ACLr at PT - also with knees bent while walking.  So I am not an anomaly.  Good to compare myself with others.
____________________________

ACL and knee structure website - explains the need for an ACL - and what happens to ACL-deficient knees.  Also shows exercises for rehab (actual streamed video of rehab exercises for the VMO muscle <on the medial side of your leg>).  Also describes, names/defines and shows drawings of different cartilage tears that often occur at the same time as the ACL tear.

http://www.kylepalmermd.com/knee/knee-doc-004b.htm

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: garth on July 16, 2007, 09:58:06 PM
KWGB,

Going from your diary, it looks like your are making steady progress. Keep it up :)

garth
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Jaspy on July 17, 2007, 12:26:56 AM
Hi KWBG,

Sounds like your Rehab is still on track, welll done.
I found as the swelling decreases the knee feels a bit more unstable but as you get use to it the stability returns.

I think you have flexion and extension the wrong way around on your last post, ;)
I found the best exercises for gaining exension were hanging legs off bed lying on stomach (I also did hammy curls while in this position) and the quad tightening and pushing knee down while heel is resting on a ball.
I have 135 flexion which my PT says is full at this point and I shouldn't push for more.

Best wishes with the rest of your rehab :)
Jaspy

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 17, 2007, 01:22:22 AM
Hey Garth,

Thanks for the encouraging words.  Hope you are coping/doing well/sorting out what you will be doing with that knee - okay?  Keep on working it!  You will get through all of this.  Good thoughts and my prayers are with you!!!

*******************************************

Hey Jaspy,

Thanks for telling me about the Extension/Flexion typo.

I switched the Extension and Flexion values; now they are correct thanks to your watchful eyes!

And Jaspy, keep up with that fantastic rehab you are doing!

Cheers to everyone!

KWBG!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 18, 2007, 04:29:06 AM
ACL DONE June 14, 2007

DAY 32  POST-SURGERY
An irritating day on some personal levels.  Fairly fit me (formerly fantastically fit me) with a bum knee ... Bum knee is still bent when I walk.  The tibia is more subluxated forward today compared to yesterday.  I am questioning the logic of a person like me not being fitted with a full leg brace post-op to keep the tibia in place.  I am also resigned to the fact that within two years, I will be getting natural, biologic re-surfacing done (no doubt in Europe) surgeons in Canada and the USA and UK seem to prefer to replace the knee with metal and plastic, whereas in some parts of Europe they are more progressive and want to work with the patient to preserve the knee).

Having said that, here's a link to the guy who works magic on old, crapped out knees.

http://www.knee1.com/hero/hero.cfm/30/1  The interview with this surgeon is fascinating.  Too bad we have only a few OSs who think along his line of thought.






Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 19, 2007, 02:04:44 PM
Hooray!

Today is exactly five weeks since the ACL Allograft reconstruction #3. 

I am happy with the outcome - and though I am expressing some concerns about looseness and am still in possession of a very fine (golf ball sized) Popliteal Cyst (Baker's Cyst), I find that generally, the knee gets better every day.  The popliteal cyst removal and the cartilage resurfacing will be staged and planned for a future date and time.

General Health Status:
Feel GREAT! 

Pain:  Knee does not hurt - except when I try to get the last few degrees of extension and flexion.
Swelling:  swelling is considerably diminished.  I go to bed/sleep every night with 4 chilled gel-packs wrapped around my knee and held in place with a knitted footless tube sock; this nightly planned "chilling" really has helped me considerably.  The cold dissipates from the gel packs within 20 minuites or one half of an hour - but I am usually asleep by then.
Jiggliness:  Has dimininshed - even from yesterday.  What a difference a day makes.  But exercise is cumulative - so I should be getting good results.

The Key to Good Knee Rehab:  Some Personal Observations

1.   Anti-inflammatory diet - lots of extra virgin, cold-pressed olive oil, dark leafy green, red, yellow and orange veggies - and dark red/puirple (blueberries) fruits, lots of fish in diet, some complex carbohydrates and lots of pure grapefruit and orange joice and pomegranate juice - and fish, chicken, (and for me, red meat <but red meat in large quantities is not adviseable).  Also lots of non-caffeinated tea - green tea, rooibos tea, camomile tea and vanilla tea.  Also eat raw ginger.  And goat's or soy milk.  8 - 12 glasses of water daily as well. 

Note to self: Feel considerably better after ridding myself of caffeinated beverages; i.e., coffe, tea.  Only drink decaf / herbal tea now.  As for coffee, have finally lost the craving and the desire to have it.  And I find that the nerves are not as edgy at all after dumping the caffeine. 

Musings:  I recently saw Sting (Google him or The Police on Youtube) perform in one of his/The Police's 2007 concerts.  Sting will be 56 in October 2007.  Has the body of, well, someone considerably younger than he.  Muscled and fit.  A generally healthy glow.  He does Yoga and adheres to a strict Macrobiotic Diet.

With that in mind, here are a few links to Macrobiotic Diet info. 

http://www.pccnaturalmarkets.com/health/Diet/Macrobiotic_Diet.htm
http://en.wikipedia.org/wiki/Macrobiotic_diet
http://altmedicine.about.com/od/popularhealthdiets/a/Macrobiotic.htm
http://www.macrobioticmeals.com/macrobiotic_recipes.html (my favourite) 

If Sting can look that way, so can we - irrespective of age. 

2.  Lots of High-Quality, Uninterrupted Sleep  Drink camomile or decaf green tea before your go to bed ... feel good ... washes out the impurities from your body as well.

3.  Knowledge about your body and about your knee.  Educating yourself about your knee and your general body's functioning.  Knowing how to work around your knee injuries to achieve the optimum health you can achieve.

Here's a great free resource:  It is called the ORTHOSUPERSITE.  Lots of information about what's new in the land of knee-related orthopaedic surgery, new cartilage regeneration techniques and longitudinal study research findings on knee patient outcomes with various knee procedures.  It is free, but you have to sign up for the website; it is worth the effort.

Conclusion:  Borrowing time/spending time writing posts on this website that will hopefully benefit other Kneegeeks.  Looking forward to an excellent final ACL allograft reconstruction outcome.  The end of the tunnel is a bright and happy light - even if the knee is not 100% perfect.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 19, 2007, 11:30:00 PM
ACL DONE June 14, 2007

DAY 33  POST-SURGERY

Summary of the Day's Events:
Did my series of physiotherapy exercises at home as per usual.  My knee felt GREAT by the end of the day.  Shaved the legs top to bottom for the first time in 2 months.  In fact, I felt so good that I got up and squeezed myself into a really nice charcoal/navy-ish knee-length skirt (which is still a sausage casing by the way).  ::)  I put on a cream-coloured, short sleeved, prim but v-neck silk blouse and my long double-breasted matching suit jacket and gold/silver/bronze strappy, low-heel sandals.  And walked very, very slowly to a nearby automobile dealership - to check out the new and pre-owned little, gas-efficient SUVs.  Pleased to feel good again.  No bathing suit this year.  Wouldn't want to frighten the seagulls at the beach! 

Exercises other than knee physiotherapy: Have not been cleared to do anything other than pectoral, biceps, triceps and deltoid muscle development with 7 kg. dumb bell weights - one dumb bell weight per hand.  But that is it.

DAY 34  POST-SURGERY

Physiotherapy Torture Session #6:
My physiotherapist is away on vacation; one of his sidekicks is subbing in for him.  This physiotherapist is also good.  BUT today she provided me with another exercise to add to my ever increasing PT daily exercise to-do list - which I am of course quite happy to do.  Every little bit of work contributes to a healthy knee.

The new exercise:  Use the operated knee to step up onto (sideways) and then step down off of a stairmaster step (also sideways).  Being the dutiful patient I am, I did five of these exercises.  My knee was still jiggling around internally from the first step up - and I could feel the knee joint bones clunk and grind against one another.  Oooooo, I thought that this would be problematic owing to the amount of (more or less) non-symptomatic osteoarthritis that I have in my knee.  Could become symptomatic - and painful !!! Yep, this is what happened.   So, I do the three sets of 10 the PT instructs me to do; I express my concern about the knee grinding and the PT says not to worry ... well ... okay I won't worry about generating a bit more damage to/stress on the knee - at least not yet.

After Physiotherapy Ends:
I walk from the physiotherapy clinic to the elevator and probably do about 200 metres of walking before I hitch my ride.  Then we head off to the big-box grocery store.  And wouldn't you know it, I get out of the car - and there's a painful twinge in the medial aspect of my joint - right on the part of the joint where I had that nasty patch of bone on bone grinding during the PT session!  "Oh well", I think, "not to worry; just part of healing - irritating the joint a bit during physiotherapy and now it is protesting to me."  Then I walk into store and proceed to go to the huge, super-duper grocery store's "Back 40 acres" to find some obscure product - and now I can't walk owing to the bone-on-bone griding pain in that same medial aspect of my knee.  How did that happen?  (I probably favoured the knee and leaned into the centre line of my body when putting all of my weight on my bent op. knee - and then tried to straighten it without any assistance from the good knee/leg - when doing the new exercise.)  So I slowly shuffled out of the store limping heavily - but I did purchase the groceries.  It has been a long time since I have been in that amount of bone-grinding pain.  It was reminiscent of my pre-high tibial osteotomy days when that part of my knee joint was in fact grinding, swollen and painful. 

In any event, after grocery shopping, we drove 11 km. to the gasoline station (petrol station for the Brits/NZ'ers and Aussies).  I insist on getting out of the car and gassing it up.  And the pain has now stopped but the joint is hot and swollen to the touch - and obviously fluid-filled around and above the knee.  Ahhhh the perils of physiotherapy.  As soon as I finish writing this post, I will walk to the freezer/fridge and extricate my four gel packs, get the footless tube sock and wrap the gel packs around my knee - snugly secured of course, by the tube sock. 

RE: Daily frequency of this new exercise:   I was told to do three sets of 10 of these exercises daily, but given the circumstance that manifested, I will be calling the PT in the morning and reporting to her - that I will not be doing this particular PT execise until we have a frank discussion as to the interior status of my knee and the fact that irritating the articulating but bone-on-bone surfaces (in the medial aspect) with this exercise will, in the long term, create some knee problems - at least that is my humble opinion until we talk.  For that which grinds will no doubt "grind" something off of the joint.  And then (again) cause irritation.  I think that she started me on this exercise too early on.  I need to better develop my quads and hamstrings on the bicycle prior to starting this particular exercise (in my opinion).  Because I need the quad muscles to hold the poor crap knee together and have them strong enough to prevent the knee joint from grinding loosely and hurting greatly when I do this exercise.

Conclusion and Point to Ponder:
I have posted to a number of other threads - where the individuals are asking questions such as "Is this exercise okay to do?  I am 3 weeks post-op ACLr and do not have a physiotherapist." ... or ... "I am not using a physiotherapist because they cost too much - so I have downloaded and exercise protocol from the Internet and am using this to guide my physiotherpay.  Is this okay?"


Update RE: the freezer to couch walkabout:
Ahhhhh ... just got back from the freezer/fridge.  The knee is just a slight bit tender ... but all seems well.   :)
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 20, 2007, 05:03:33 PM
ACL DONE June 14, 2007

DAY 35  POST-SURGERY


Call to physiotherapy clinic:
I called the physiotherapist's office; spoke to the PT in charge as my PT was not in today.  As I expected, the PT said that I should not do the exercise that caused my extreme episode of pain in the gorcery store yesterday.  We concurred that each ACLr knee is different - and that the exercises depend on the specific knee.  When I go back to see my PT next week, I am certain that we will be able to work around this issue.  No big deal ... just a bit of a setback. 

I noticed that my devloping quads (on the op. knee) seem to have atrophied - even 20 hours after the offending "clunk" and piercing pain incident in the grocery store.  I do have some swelling at the back of the knee today - moreso than what I had yesterday prior to physiotherapy - but this is to be expected.  I fell asleep before I re-froze the gel packs and therefore did not apply them to my knee last night.  So this morning I did have swelling - attributed in part to the exercise incident and to not adhering to my nightly gel pack icing protocol.  The knee definitely did not like the new prescribed exercise.  I am certain that the PT and I will work out some other quad/hamstring strengthening exercise that will be equally as good for the knee - but even more specific to my knee's circumstance.  Too bad - I liked the new exercise - even though the knee didn't.  I am eagerly anticipating being able to "give it" like I used to.

Physical self:
Continue feeling like a blob; have been oscillating between 155 and 150 lbs.  All my clothes fit a 140 pound frame.  At my height, (and fully clothed) I do not look either overweight or heavy, however the mirror late at night/early in the morning/after a shower tells a different story.  Fat that has accumulated is of a similar consistency to unbaked bread dough.  And of course I have spent a lot of time on the computer and Kneegeeks website - so I am sedentary to boot.  Ahhhh ... this too shall pass in time and with concerted effort.

Conclusion # 1:
Will get a ride to the leafy nearby park and walk slowly where I previously used to race walk (very quickly) and run.

As an Aside - Dreaming About Running (a Pipe Dream):
Once when I was at a conference which had a lot of medical types in attendance, I did a 10 km. run; that was the run/competitive event half way through the conference.  Most of the 500 people running were medical types - or affiliated with the medical industry.  I came in 172nd (not too bad) - and there were no separations for age or gender.  I was humoured at the end of the race (we had a post-race meal set up by someone/some company), when I saw a significant number of the medical types take out their anti-inflammatories and down them with Gatorade or some other beverage.  Seems that sports-related docs/physiotherapists/sports med researchers/kinesiologists and others invovled in the health care industry like running and suffer the consequences notwithstanding the potential contribution to long term knee issues.  You would have had to be there to see the humour of it all - guys and girls passing anti-inflammatories to each other ... and listing the potential benefits of their anti-inflams relative to those of their colleagues.  But I never saw a fitter group of people in my life ... all lithe, lean or just muscular - irrespective of age.  And many with sore knees resulting from doing too mush of everything and doing it aggressively at that.  Yep, a bunch of Type A individuals.  Just like we Kneegeeks no doubt. 

Running Prognosis:
I LOVE to run.  I get such an endorphin rush and a physical high from it.  I have never found anything yet to replace it - not even the stairmaster.  But I will have to settle for racewalking to ameliorate the potential for further damage to my overused knees.  While racewalking does wind you, it is not the same as running - which incorporates the jumping up and down and making one's muscles stretch and strain - all the while maxing out one's cardiovascular capacity.  I think that the thrill of runing is somehow tied to our inner cave man/ cave woman - when we no doubt had to run great distances to escape percieved enemires of the four-footed and bi-pedal kind.  I believe that our bodies were made to be exhilirated by the thrill of the chase or the thrill of outdistancing the chaser.  But running seems to exacerbate some underlying problems for some folks (sigh).

Conclusion # 2:
My grandmother at 82 had no arthritis in her knees - and her knees looked really great - muscular - taut - she once successfully beat off a man who tried to steal her purse (at 82 years of age); but then again she did not do any of the sports and dancing that I did - and she therefore had good knees.  But she worked hard - and her body was naturally muscled/sinewy.  The woman used to run up and down the stairs in her house and clean the house with a vigour I did not have as an 18 year old.  After her 83rd birthday, she said she started to "feel old".

So much for my musings of the day.  Happy 5th week post-op. annivesary to me.  May celebrate it with a glass of Chablis - or Merlot and family/friends/loved ones.

Happy healing to all you Kneegeeks out there - and have a great weekend!  :D

Title: Re: first-week recommended exercises
Post by: CBtoNYC on July 24, 2007, 03:48:27 AM
My surgeon is the team physician for a local major-league professional sports team (in a major US city), so I assumed he would be pretty cutting-edge in terms of rehab.  I had an allograft on Friday, and I must say that there is a world of difference, in terms of pain, between this and the patellar autograft I had 12 years ago on my other knee.  Given my lack of pain, and what I have read on this site and others, it seems that I should be getting going with exercises, no?  Yet when I speak to his office, all they say is to keep the brace on and wait until my post-op appointment with the doctor (11 days after the operation!).
My cooling unit wasn't working for a couple of days, and at one point I took the brace off to try and ice the old-fashioned way.  The knee felt much better, less stiff and sore, when I did this, particularly after doing some ankle rotations and knee bends.  I can lift the leg, I'm fit, I feel like I want to get after it, and not let this thing ossify and atrophy like last time (which was ages ago in terms of these procedures)!  Could there be any possible reason not to be doing exercises?  What were your first-week exercises?
Title: Re: first-week recommended exercises
Post by: knee-will-be-great on July 24, 2007, 03:54:36 PM
My surgeon is the team physician for a local major-league professional sports team (in a major US city), so I assumed he would be pretty cutting-edge in terms of rehab.  I had an allograft on Friday, and I must say that there is a world of difference, in terms of pain, between this and the patellar autograft I had 12 years ago on my other knee.  Given my lack of pain, and what I have read on this site and others, it seems that I should be getting going with exercises, no?  Yet when I speak to his office, all they say is to keep the brace on and wait until my post-op appointment with the doctor (11 days after the operation!).
My cooling unit wasn't working for a couple of days, and at one point I took the brace off to try and ice the old-fashioned way.  The knee felt much better, less stiff and sore, when I did this, particularly after doing some ankle rotations and knee bends.  I can lift the leg, I'm fit, I feel like I want to get after it, and not let this thing ossify and atrophy like last time (which was ages ago in terms of these procedures)!  Could there be any possible reason not to be doing exercises?  What were your first-week exercises?

Hi CBtoNYC,

Congratulations on your new ACL !  Glad that you are not feeling too much pain post-surgery.  :D

In terms of doing exercises, I would listen to what your Orthopaedic Surgeon has to say; follow his instructions to a "T" and then when you see him, you will no doubt be assigned to go to Physiotherapy and start your rehabilitation protocolIf he told you to do nothing until you see him, then do nothing until you see him.
_____________________________

Even though we have all had our ACL's replaced, much depends on your own knee's individual situation, for example, the amount of osteoarthritis you may have, and other knee mechanics considerations.  What may be a good time to start exercise for one person may be different for another person based on age, weight, pre-op fitness level, degree of existing arthritis/damage in the knee and the degree of surgery you have had.  Your OS may have also cleaned out loose bodies and shaved some of your meniscus if there were loose/damaged fragments within the knee.  This could be the reason for your being in a brace - or, there could be other reasons as well.
_____________________________

I cannot advise you as to the types of exercises you should be doing.  You should be doing only what your OS and your Physiotherapist tell you to do - no more, no less.

Every Orthopaedic surgeon also has his/her own preferred protocol for post-operative healing rehabilitation based on their accumulated experience with their patients.

If you have a sports medicine-oriented orthopaedic surgeon who is affiliated with a sports team, then I would feel confident in what he is telling you to do.  And right now he is telling you to do nothing.
_____________________

Please do not lift the leg or do anything until you see your OS and he assigns you a Physiotherapist (or lines you up with a Physiotherapist).

PS - When you do get a physiotherapist, make certain that the physiotherapist is one who is known to work closely with your OS. 

Sorry that I cannot help you with this one other than my comments (above) ...

______________________

On the bright side, you have only one more week until you see your OS.   :)

______________________

Best wishes ............

Knee-will-be-great!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: jb-knee-geek on July 24, 2007, 04:01:19 PM
Focus on reducing pain and swelling. Agree w- KWBG, check with the OS and PT before 'doing it yourself'.

ask your OS if these early phase rehab are OK for you. http://www.drmillett.com/pdf/acl.pdf

get yourself assigned a pro-PT (as good as the surgeon you picked).

good luck,
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 25, 2007, 12:02:57 AM
ACL DONE June 14, 2007

DAY 36  POST-SURGERY

Summary of the Day's Events:
The knee was still tender from the previous physiotherapy session;  tried to straighten the knee but could not; tried to walk with the knee straight but could not.  Elected to simply ice the knee and wait until the swelling went down from my minor setback.  I am patently aware that sometimes one takes two (literal) steps forward and one step back in terms of physiotherapy and recovery from the ACL allograft.  No worries ... went to a Boutique Winery in the coutryside.  The winery specialises in making wine from different types of fruit including but not limited to elderberry, raspberry, blueberry, peach, pear, gooseberries and a variety of other berries ... quaffed a few before making the purchase decision ... of course I was not driving ... someone else was!  So was literally feeling "no pain" by the time we got home.

DAY 37  POST-SURGERY

Summary of the Day's Events:
Cooked dinner for the males of the species who are in my life.  The knee held up, but was swollen.  So I iced it and did not do any exercises - because I wanted to give it a rest.

DAY 38  POST-SURGERY

Summary of the Day's Events:
Completely non-eventful.  The quads that I had worked so hard to redevelop were gone by today and I was having a difficult time going up the stairs.

DAY 39  POST-SURGERY

Summary of the Day's Events:
Physiotherapy Torture Session #7
I saw the physiotherapist today; I indicated my concern regarding the pain I had last Thursday.  I reminded the PT that I had a high tibial osteotomy 18 months ago to unload my weight from the medial compartment of my knee.  PT indicated that I would have set backs - and expect same.  PT stretched my knee to straighten it; (it is still less straight than it was prior to the last PT session, but I will work with what the PT is saying regarding the setbacks.)  I did all of the exercises as instructed even the exercise that aggravated my asymptomatic osetoarthritis - because the PT told me I needed that particular exercise to develop my quads.
_________________

My synovial fluid membrane is quite puffy at the back of my knee - and I also have the hard, large popliteal cyst on the postero-medial aspect of my knee.  It is quite uncomfortable, but I expect that it will be taken out in due time after I heal from the ACL allograft surgery.  I am ironically using a running analogy - in that this healing and rehab process is akin to a marathon and not a sprint.  So patience is required - and I will therefore be patient - to a point.  And then I will politely start making suggestions as to when the OS palns to undertake the next phase of my knee revitalisation - the partial synvectomy / politeal cyst removal.

Cheers ...........................

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 25, 2007, 04:30:41 PM
Here's a good article about ACL repair Knee Healing, Arthrofibrosis and Rehabilitation Protocol:

http://www.kneeguru.co.uk/insights/doku.php/healing/arthrofibrosis10
________________________

Here's two other good articles about ACL reconstruction in people with old, chronically ACL-deficient knees;  one article is written by orthopaedic surgeon Dr. Shelbourne, the other by a Dr. Craig Bottoni.

http://www.orthosupersite.com/default.asp?page=view&rid=22759

http://www.orthosupersite.com/default.asp?page=iContent&pid=oti

________________________

Here's more ACL repair and meniscal repair-related information.

http://www.orthosupersite.com/default.asp?page=iContent&pid=oti
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 26, 2007, 01:05:33 AM
Why do you need an ACL?

This is straight from the KneeGuru website:

--------------------------------------------------------------------------------

http://www.kneeguru.co.uk/html/steps/step_06_arthritis/pathway.html

(Scroll down to the bottom of the page)

How a torn cruciate ligament ends up in osteoarthritis:

When the cruciate is torn, it is usually the result of a significant injury, and meniscus and joint surface are often damaged at the same time. But even when this is not the case the instability of the joint introduces forces which eventually do stress both the meniscus and the joint cartilage, and the softening/fibrillation/enzyme cycle is triggered once more.
Title: larger questions
Post by: CBtoNYC on July 27, 2007, 03:25:47 AM
I cannot advise you as to the types of exercises you should be doing.  You should be doing only what your OS and your Physiotherapist tell you to do - no more, no less.

Every Orthopaedic surgeon also has his/her own preferred protocol for post-operative healing rehabilitation based on their accumulated experience with their patients.

If you have a sports medicine-oriented orthopaedic surgeon who is affiliated with a sports team, then I would feel confident in what he is telling you to do.  And right now he is telling you to do nothing.

KWBG, these are surely words to the wise.  Thanks again for your posts, and also the links to articles, videos, etc.

A few questions in the abstract, to all and sundry:
- What is the purpose of the immobilizer post-surgery?  Is it to prevent inadvertent twisting action on the knee?  Or is it to maintain extension?
- Do all docs/physios (as, for example, the Steadman-Hawkins pdf attached on this page) recommend sleeping with immobilizers?  What is the danger in sleeping without it?  Can one hurt one's knee while in bed and not doing anything weight-bearing?  (I must be honest, I find the immobilizer uncomfortable in bed.)
- What is the adaptive purpose of swelling in the body?  Is swelling simply a protective mechanism telling us to avoid stressing the body part that is swollen?  Or does it also have a healing function?  In other words, why the emphasis on stopping the swelling.

Thx.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 28, 2007, 01:41:01 AM
ACL DONE June 14, 2007

DAY 40  POST-SURGERY

Summary of the Day's Events:
An uneventful day filled with busy work and doing my exercises.  Am concerned because my knee has not regained the straightness it had prior to hitting some bone-one-bone on the medial side of my knee.

DAY 41  POST-SURGERY

Summary of the Day's Events:
Another uneventful day of exercises, busy work and spending way too much time researching cartilage restoration issues online.

DAY 42  POST-SURGERY  Today is my 6 week post-op anniversary.   :D

Summary of the Day's Events:
Grocery shopping, plumbing shops, docotr's office and physiotherapy plus writing letters/posts on Kneegeeks.  Looking forward to working again, running around the house again, doing things fast again instead of at a snails pace, exercising to get my cardiovascular fitness up again and my flubber body taut again, going to the gym again.

Physiotherapy Torture Session #8:
The PT stretched my knee into 0 degrees extension by putting her hand directly above my kneecap and slowly, in a controlled movement, pushing down and holding my straightened knee joint to the mat for a call of 20 seconds.  Seems that the setback during week 5 (after which I stopped exercising for four days <at the pace I was going previously> owing to swelling) effected (diminished) my Range of Motion.  I can get someone to help me do this stretching ... good!

Did my entire set of exercises.  Expressed concern that I cannot walk up stairs well, and cannot walk down stairs without taking one step at a time (like a peg leg/straight knee person).  Feel like I am missing my PCL, but my PT said this is because I have not yet redeveloped my hamstrings. 

Back of knee still swolen and tender.  The synovial fluid membrane is still inflamed; I expect this will continue as a permanent condition unless dealt with surgically.  Popliteal cyst on postero-medial aspect of knee is still golf ball sized and preventing me (in my opinion from comfortably straightening the knee).

New Exercises Added:
1)  Exercise Ball: Lie flat on the mat/PT bed.  Take a large, inflatable exercise ball.  Put both feet on top of exercise ball.  Keep legs straight.  Keep rest of body straight as you lift your trunk off of the mat.  Ensure the entire body - (from mid-chest level to ankles/feet) is in a 180 degree line - in other words straight.  Make certain to keep stomach muscles taut.  Raise yourself this way from the mat in a controlled manner.  Then in a controlled and slow manner, lower your trunk back onto the mat.  Keep buttocks muscles taut as well.  EXERCISE BENEFIT - Develops glutei maximus and minimus muscles and hamstring muscles. 

Today marked the end of the formal working relationship with my replacement PT.  She pushed me and I certainlly appreciated it.  Oh, and the exercise that she introduced to me last week (step up and step down from a staid sideways - barely hurt today <one week later>).  I did however have a few minor pain tinges in that same medial area where I had the big time pain last Thursday.  No doubt hit a bone on bone spot.  Oh well, I do expect that I will rehabilitate and acclimatise to the grinding, momentary pain twinge.

2)  Eliptical Trainer (on low resistance setting):  I am now allowed to use my eliptical trainer (have one at home)  Start with 15 minutes daily.  Make certain my movements using my knees are smooth - not jerky.

3)  2.5 pound ankle weights and hamstring development standing knee bend to 90 degrees:  I will start hamstring lower leg crunches; stand and put a 2.5 lb. weight on my ankle, then try to get the knee to bend to 90 degress with this level of weight on the ankle - no more than this 2.5 pound weight, however.

I think that I figured out why I am unable to maintain my straight knee when walking/standing ... more on that at a later date. 

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 28, 2007, 01:51:22 AM
Hi CBtoNYC,

Here is a great first step to strat with ... a PDF from the National Institute of Health in the USA - How the knee works and common problems of the knee.

http://www.niams.nih.gov/hi/topics/kneeprobs/kneeqa.htm

A really great portal, entitles INFLAMMATION and REPAIR  ... http://www.pathguy.com/lectures/inflamma.htm

keep in mind that there is a difference between acute inflammation and chronic inflammation.  Acute inflammation stems from surgery or and injury.  Chronic inflammation is longstanding.  It is a problem for many of us knee geeks - even after we have had out knee surgery.
_____________________________________________




......KWBG!
Title: Re: larger questions
Post by: knee-will-be-great on July 28, 2007, 01:06:40 PM
Hi CBtoNYC

Every Orthopaedic surgeon also has his/her own preferred protocol for post-operative healing rehabilitation based on their accumulated experience with their patients.

Quote

KWBG, these are surely words to the wise.  Thanks again for your posts, and also the links to articles, videos, etc.

A few questions in the abstract, to all and sundry:
- What is the purpose of the immobilizer post-surgery?  Is it to prevent inadvertent twisting action on the knee?  Or is it to maintain extension?
- Do all docs/physios (as, for example, the Steadman-Hawkins pdf attached on this page) recommend sleeping with immobilizers?  What is the danger in sleeping without it?  Can one hurt one's knee while in bed and not doing anything weight-bearing?  (I must be honest, I find the immobilizer uncomfortable in bed.)
- What is the adaptive purpose of swelling in the body?  Is swelling simply a protective mechanism telling us to avoid stressing the body part that is swollen?  Or does it also have a healing function?  In other words, why the emphasis on stopping the swelling.

Thx.
Quote

Hi CBtoNYC:

I am giving you comments from my perspective ...

RE: Immobilizer post-surgery:  To prevent inadvertent twisting action on the knee?  Or to maintain extension? 

I would think both.  I did not have an immobilizer for ACL allograft #3.  Instead, I had a soft, neoprene wrap-like device which I awoke from surgery wearing.  I was told to ditch this wrap after 3 - 3 1/2 weeks.  For my ACL allograft #1 and #2, I had a immobilzer brace which I wore at all times.  While it was uncomfortable, I would have (also) preferred wearing one for #3 as I would feel more secure feeling that I am not somehow knocking the knee around and uneccessarily stretching out the graft. 

I have head about and seen so many different ACL post-op protocols that I believe it is the surgeon's preference and training that determines in-part how the ACL will be dealt with post-surgery.  Also a patient's particular knee/knee injury qualities.

CBtoNYC, I see my OS this upcoming week - so I will ask him why he did not use an immobilizer on me - and why other surgeons (in fact those even in his clinic), use immobilizers.
___________

RE: Adaptive purpose of swelling in the body:  Simply a protective mechanism telling us to avoid stressing the body part that is swollen?  Or does it also have a healing function?

I would think both.  When one injures oneself and has an open wound, or is cut, or gets an infection (i.e., an acute situtation), the body's white blood cells (the body's defenders) work to try to fight off bacteria.  The reaction is pus, redness, swelling.  That is one kind of swelling - to get rid of bacteria and to heal a wound.  The wound healing is part of the ACL and other knee surgery healing - as with other parts of the body.

When one injures one's knee (i.e., as in a knee trauma - or when one has an unhealthy knee), this means there are enzymes that are activated in response to the trauma/unhealthy knee that mobilise in the knee, creating swelling.  Unfortunately, swelling in an arthritic knee, an injured knee or in a loose joint (i.e. an ACL-deficient joint), or in a post-operative knee that continues to be swollen suggests that these enzymes continue circulating in the knee.   Reducing swelling by icing and by use of anti-inflammatores in the post-operative knee is necessary because this will calm the knee and allow the knee to heal.  Enzymes that continue to circulate in the knee (as in a chronic knee condition) will continue feeding the osteoarthritic process and therefore a gradual, progressive joint damage.  That is why it is so, so, so very important to ice and to take anti-inflammatories post-surgery.  That is why it is also so important to get to the root of one's swelling in an "unhealthy" knee - and to fix the knee to decrease the progression of the arthritic process.

CBtoNYC ... Your questions are deep and thoughful.

Cheers ................ KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 30, 2007, 02:35:07 AM
Good Diagramme and Explanation of ACL autograft reconstruction using the gracilis and the semitendintosis tendons ...

http://www.genou.com/anglais/acl/pesanserinus.htm

The ACL portion of this website includes Anatomy and Physiology of the ACL and making a diagnosis of an ACL tear:

http://www.genou.com/anglais/lcadiagnostic.htm
__________

To access other information about the knee, click on home and then check out the menu which includes:

* Knee arthritis >>>>>>>>>>>>>>> http://www.genou.com/anglais/lcadiagnostic.htm

* Popliteal (Baker's Cysts) >>>>>>>> http://www.genou.com/anglais/poplitealcyst/poplitealcyst.htm

* meniscus >>>>>>>>>>>>>>>>>> http://www.genou.com/anglais/meniscus.htm

* Osteotomy >>>>>>>>>>>>>>>>> http://www.genou.com/anglais/arthritis/osteotomy.htm     

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on July 30, 2007, 10:06:52 PM
ACL DONE June 14, 2007

DAY 43  POST-SURGERY 
Summary of Day's events:
Woke up early in the morning, did my exercises; it was the first time that I did the eliptical trainer (I have a battery-run <therefore energy-efficient one>).  Only felt strong enough to do 6 minutes.  Best not to overdo it the first day.  The knees have to acclimatise to that particular "rolling/cyclical" type of motion again.

Grocery shopping in the huge "big box" super store (the operated leg/knee is still fatiqued even though I am walking with a rolling grocery cart.  Did a whole lot of cooking and entertaining that day and not much more.  House is still a mess, but I started washing clothes again and changed the beds myself.  My gait seems quite abnormal, however. 

DAY 44  POST-SURGERY 
Summary of Day's events:
Did the big gourmet food cycle three times today.  Blush pasta sauce, sliced potatoes and green apples with onions and parmesan cheese, tilapia in marjoram, pork loin with a honey glazed sauce and slivered baby carrots and green bell peppers.  Oh yes and a nice romaine/spinach salad with various veggies and a balsamic vinegar/extra virgin olive oil/garlic/black pepper/maple syrup dressing - with crumbled eggs and candied almonds mixed in.  Partly frozen fruit smoothie poured over fresh pine apple and chocolate covered almonds.  Green tea for after-dinner fare.

In the morning (while out of doors and walking on concrete pavement), I had one minor step go amuck - and I had to stop in my tracks.  I reasoned that it was some previously asymptomatic arthritis that had flared again - or that bone-on-bone spots in the joint had "kissed" and irritiated my knee ... badly (albeit for a second).  Talk about stopping in one's tracks.

Needless to say the knee swelled today after supper.  Then when I went upstairs to sleep, I was too fatiqued to walk downstairs and find my frozen gel packs and wrap my knee ... Ramifications: The knee was swollen when I awoke the next morning.

DAY 45  POST-SURGERY 
Summary of Day's events:
Awoke with a swollen, stiff knee.  I am finding that one Ibuprofen in the morning does the trick of helping the knee for its day of activity.  I also find that this knee joint is stiff and I need to bend it at least 10 - 20 times to unstiffen it prior to commencing my day - and prior to even commencing my exercises.

Tried to clean the house today, but the knee is still bothersome - feels loose - although it is straighter in the morning relative to its status a week ago.  I note, however, that I have list some flexion.

Physiotherpay Session #9
My regular physiotherapist has returned from holidays.  He measured my knee and confirmed that my flexion was 130.  He wrote on my note for my OS - that I am to bring with me to my OS appointment that my ROM is 130.  Therefore my extension is 0 degrees (as I thought).  I do not know whether I will be able to get the additional 2 degrees back to put me into negative extension - like my "good leg/knee.  Only time (and a lot of hard work) will tell.  My PT and my (now former) holiday replacement PT both told me that my extension had improved over the weekend.  That was my sense as well.

I expressed concern to my PT about my having not achieved complete flexion; he said give it time. 

My PT indicated that I had a tricompartmental debridement along with the ACL allograft - and that the tricompartmental debridement would be reason enough to experience some symptoms of soreness at six weeks four days post-op.  M PT indicated that I was doing better than expected.  He wrote that I was "doing well" on the report I am to bring to my OS tomorrow. 

Interesting ... my knee felt tighter prior to my doing the knee exercises at the PT's clinic when compared to my knee's overall feeling after PT.

Summary:  Seeing the OS tomorrow for a check-up.  Am rarin' to go and do something physical - but recognise that I have to wait. 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 01, 2007, 12:04:01 AM
ACL DONE June 14, 2007

DAY 46  POST-SURGERY 

Summary of Day's Events:

Activities:
Vacuumed the house; first time I did so in, (well), a very, very long time - ten months.  I took avoidance behaviour to a new all-time high - but given the degree of pathology in my knee and the looseness of the joint prior to the ACL reconstruction, there was no sense taking a chance with an unecessary twist or a turn - until this point in time.  Dragged the vacuum cleaner up two flights of stairs to the upper storey - albeit gingerly.  Knee felt good.  I love physical activity of all sorts - even vacuuming.  Here's for a return to the formerly clean, clean house of Knee-will-be-great!

General Feeling of the Knee - Stength:
Leg/knee felt stronger relative to last week, in fact stronger relative to DAY 44 post-surgery (two days ago).

Stair Climbing and Descending:

Still peg-leg style - one step at a time.  The quads are still weak.  So easy does it.

Swelling: 
Both the good old golf ball-sized popliteal cyst on the postero-medial aspect of the knee joint is still there (like it was pre-surgery) - and the entire back of the knee is still as swollen it was prior to this ACL surgery.  Today there is some swelling above the front of the knee; I would say that it is a combination of not having iced the knee for three days (owing to business relating to guests, people dropping by, etc. ... still no real excuse).  So it is back to a concerted programme of icing.  It is incredible the difference icing makes.  So essentially I have conducted a short little study (on myself) as to the ramifications of not icing when undertaking a series of rehab. exercises - and at night (prior to bed time) when the knee is six weeks post ACL allograft and tricompartmental debridement.  Again, back to icing - tonight.

Straightening the Knee in the Morning:   
My early morning protocol for establishing a straight knee includes bending the knee back and forth 30 times - prior to getting out of bed.   

ROM:
130.  From 0 degrees to 130 degrees.  I still have not regained the 4 degrees I lost after Week 5 post-op.

Gait: 
Getting more stable and natural - but it varies depending upon the time of day and whether I am self-assessing my gait after a round of rehabilitation exercises.

Visit with the OS: 
1.   OS is quite pleased with my progress.  He indicated that I am "ahead of the curve".  I thought that I was.  I am glad that the OS has believed in my capabilities to-date.  It helps by looking quite young relative to one's age - and being fit - although the clothes continue being sausage casings.  This too shall pass.
 
2.   OS indicated that he had done a tricompartmental debridement.  OS showed me before and after photos taken using the arthroscope's intra-joint camera capability.  The before photos were amazing; it is now clear as to why I had such a great degree of discomfort prior to surgery.  Not only was the joint extremely loose, but I had what my OS described as a "shag carpet" for cartilage.  (No doubt caused by the "back and forth" motion of the tibial plateau flopping and grinding against the condyles of the femur on a day to day basis - grinding at the cartilage and shredding the cartilage with every move I made.)  I was flabbergasted - the joint did look like a long, long wavy-fibred white shag carpet.  The tendrils were very, very long.  The post-debridement photos showed clean, flat surfaces.  My OS indicated that he had shaved just a bit off of the surfaces - thus cleaning them up.  OS says that I have Grade IV osteoarthritis in the medial compartment and diffuse osteoarthritis throughout the rest of the joint.  OS says that I have chondromalacia under my patella - but he said that since most of my knee pain relating to arthritis is asymptomatic, there is really no reason to habituate on what grade of arthritis that I have; I am paraphrasing his comments - but essentially that is what the long and short of it amounts to. 

3.   OS showed me a photograph of the ACL allograft in my knee - a beautiful, white, gleaming thing.  (I forgot to bring my anonymous thank you card - thanking the family of the deceased person who saw fit to allow their loved one's body to be harvested for such quality-of-life-saving surgery.)  I will give my OS's staff the card in September when I next attend to his offices.  OS indicated that it was a anterior tibialis tendon which was folded in half to create the allograft ACL.  OS indicated that the diameter of the graft was 7 mm - 8 mm.

4.   OS indicated that he would aspirate the popliteal cyst in mid-late September when I see next him.  OS surmised that the cyst's position is impinging my knee's ability to fully straighten.  I agree wholeheartedly.  This intervening 6 - 8 weeks will allow the knee joint to better heal.  Should the cyst re-occur after aspiration, then surgery to remove the cyst will be arranged and undertaken.  I expect that the cyst will re-occur after aspiration in that it has consistently reoccured after aspiration (an average of 5 days post-aspiration).  And I have had this cyst aspirated at least 7-8 times - so I know my knee and this "hanger-on", this unwanted cyst.  I also asked the OS to address the puffy state of the back of my knee - that being the stretched and expanded synovial fluid membrane spanning the entire breadth of the back of my knee joint.  I would suspect that my surgeon will maintain his conservative approach; therefore the back of the knee where the overgrown/overblown synovial fluid membrane resides (which is another ongoing pre and post-op source of great discomfort) will no doubt be addressed after the popliteal cyst is removed surgically and that incision site fully heals - in other words - in another one year's time from cyst removal (if my estimation serves me correctly <and it usually does>).

5.   I addressed my "kissing" lesions (the bone-on-bone area in the medial aspect of my knee which gave me such a hard time during the "big box store incident" in Week 5 - and which again twinged on DAY 44.)  I said "Hey doc, how about a cartilage transplant / or something else to address the bare, cartilage-deficient spot."  OS indicated that he would be amenable to addressing the spot, but to first give my knee further time to heal - because my pain twinges in the medial compartment may simply be as a result of the joint being touchy because it has been debrided - and that medial compartment is the one with the Grade IV osteoarthritic changes - so it is expected that it will be "touchy" (I agree).  OS also indicated (and showed me) that I do have a bit of cartilage left on the medial aspect - not much - but at least I do have some.

6.  OS warned me to not "overdo it".  OS indicated that he knew I was certainly not one of these knee patients who had to be prodded to do their exercises.  Quite the contrary.  So he warned me twice about resting and taking it easy - and not overdoing it.  Yes, I will cooperate fully.

7.  At 6 weeks, 5 days post-op, I have been cleared to drive again. 
______________________________________________________________________

Went to visit a friend and give her the good news. 
______________________________________________________________________

All in all - an excellent day; moreover, it is hot and dry and ever so slightly windy outside ... glorious weather feel like I am in the south of France or close to the Mediterranean.  Went to a bathroom fixture/faucet boutique and saw green grapes growing on a vine and up a tree - in the beautiful back yard behind the boutique's parking lot.  Oh happy, happy day.  ;D

And thus continues the saga of the nine times operated right knee of Knee-will-be-great!  ::)

PS - I wanted to get back into race walking (no running) ... oh well - perhaps will just be a race marshall for one particular 150 km race later this year ... hopefully next year I can compete - at least in some element of the race.

KWBG.  :D  :D  :D
_____________________________________________________________________

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
_____________________________________________________________________

Conclusion:
My knee has certainly been on a marathon of sorts - a 31 year marathon.  Today is the first day that I have been able to truly relax for eight years.  Some of the really big issues, i.e., High Tibial Osteotomy and ACL reconstruction have been addressed.  More remains to be addressed.  No doubt I will be going in for a regular "debridement" every few years to keep the knee joint clear rather than shag carpet-like and uncomfortable.  I am, however, relieved - but the race is still not over.  Probably will never be during my lifetime.

Now to regain work and regain some element of the big time wages and savings that I have lost during this knee surgery marathon I have been on for one too many years. 


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 02, 2007, 02:26:41 PM
ACL DONE June 14, 2007

DAY 47  POST-SURGERY 

Summary of Day's Events:

Enjoyed staying inside the house today as it ia quite warm outside.  The knee feels great, but I still cannot comfortably get up or down the stairs.  Quads need more development - obviously.   The physiotherapist said to give it time.

Fell asleep at 10 pm without wrapping myself in my cold packs ... tsk ... thought that I would go upstairs and take a cat nap and then go back downstairs to put on the gel packs ... but I fell asleep very quickly (as per usual).

No pain walking - this is good. 

The knee needs to be straighter, but this too will come - given the size of that popliteal cyst at the back of my knee joint, the joint is pretty good.

I am planning to take a long walk in the park tonight or tomorrow - yeah!

My August 1st resolution is to eat more veggies relative to the rest of my diet - as I always have in the past.  For the last year, I have been medicating myself with pasta, ice cream and chocolate covered almonds - which always leave me with excess body fat if I am not careful with amount and timing (during the day) when I eat the food.  My diet over the last year has transformed my body from lean and long muscled to looking "grain fed" and thick - with a 1 cm. - 1 1/2 cm. to 2 cm. layer of fat all over.  It is truly amazing what one's dietary preferences can do to one's body. 

After cutting butter and margarine out of my diet five years ago, my "belly pot fat" slowly disappeared. 

So now, with my pasta eating, my ice cream and my excess of chocolate-covered almond-eating and lack of exercise, I am thick(er) that I normally am, but still have no protruding belly; the body fat is equally distributed.
__________________________________

Back to broccoli and baby carrots and green onions and soy milk/goat's milk in the morning along with green tea and meat/protein/fish and hard-tack/rye crisp board.  It will take at least 6 months for the old body to return ... just in time for the new year!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 04, 2007, 01:50:53 PM
ACL DONE June 14, 2007

DAY 48  POST-SURGERY 

Summary of Day's Events:

Was able to walk around the house without feeling the knee. 
Knee is pain free - although I am still using one Ibuprofen per day to control - (or to think that I am controlling) the swelling.

DAY 49  POST-SURGERY 

Summary of Day's Events:


Happy 7th week post-op for me and my knee!!!!   ;D

I am so very happy and grateful that I had this life-giving surgery.  The knee (as I said in my previous posts) is not wobbly - nor is it painful.   ;D

Physiotherapy Session #10
My physiotherapist introduced me to hamstring exercises today - as the present for a successful Week 7 post-op.   ;) 

Every one is happy with my progress; my competent orthopaedic surgeon is happy to see my progress and acknowledges that I work hard to achieve all of the requirements for knee rehabilitation; my competent physiotherpaist is happy to see that I am working so hard - and I am very happy that this knee is not bothering me in the sense that there is something persistent needing to be addressed.  And there is nothing like sweating up a storm while cycling in physiotherapy (on the maximum resistance setting) and getting a "good job" told to you by one's physiotherapist.  As it stands, the knee is not a healthy knee in the sense that my unoperated knee is, but it is good - and will get better and better - and will be GREAT.

New Hamstring Exercise # 1
Put foot through a leather strap attached to a cable which is in turn attached to standing weights attached to a column.  Use minimal weight (5 lbs.? 2.5 lbs.?)  Pull leg from forward-of-body position to behind the body - and from bent to straight position behind the body using the strap.  As I write/type this post, it is one day (19 hours) post-exercise - and the back of my legs (my hamstrings) have a healthy feeling of soreness.  Do 3 sets of 15-20 repetitions.  This develops the hamstrings and get these muscles firing again.

New Hamstring Exercise # 2
Get onto stairmaster and take miniscule baby steps for 5-10-15 minutes.  In other words, depress the pedals ever so very slightly (maybe 3 to 4 to 5 inches) instead of doing a deep, complete step.  This trains the operated knee to lock and let go and then lock and then let go again - because the knee has forgotten how to do these things properly - or at all.

New Hamstring Exercise # 3
Use sitting leg weights on a fulcrum.  Put leg over the back-of-knee rest and from a slightly bent position (10 degrees extension), push down to at least 80 degrees of flexion.  Use minimal weight (7 lbs.? 5 lbs.? 2.5 lbs.? )  Do 3 sets of 15-20 repetitions.

New Hamstring Exercise # 4
Put inflated rubber waffle that you normally stand on to re-develop balance; (the waffle is approx. 18 - 20 inches in diameter and 8 inches in the middle-most inflated part <before depression with one's foot>) on the vertical metal plate used for leg pushes.  Use bare foot.  Balance bare foot in the middle of the waffle which is held to the vertical metal plate with your foot.  Push leg in a slow, controlled motion from a bent 90 degree position to a 20 degree bend.  Hold your leg and your knee tight at the 20 degree bend mark for 5 seconds and then in a controlled motion, bring your leg/knee back to 90 degrees.  Repeat for 5 minutes to 15 minutes depending on your knee's fatigue level (i.e., when your knee is shaking - STOP!).  This helps the proprioceptors in and around your knee learn how to re-establish balance.
_________________________________

Conclusion:
Well, I forgot to put ice on my knee again last night - so I am icing this morning (day 50 post-op).  I fell asleep more-or-less as soon as the moment when I hit the bed.  I hit the bed at 9 pm on DAY 49 because I wanted to read for a while and write in my daily journal - and then go downstairs and make and drink a cup of herbal tea and get the ice packs.  This did not happen.  This tells me my body needs sleep and rest for healing - which the OS told me I require.

___________________________

Well dear Kneegeeks, I am off to start preparations for a gourmet dinner - and then I am having a tasty intimate lunch in the woods (at a tea room/pottery gift shop) with my signif. other and perhaps a few kids as well ... then gourmet preparations for a dinner party cooked by me!

And as my Canadian hero Red Green says ... "Keep your stick on the ice."  (a hockey analogy) "We are all in this together!"  http://www.redgreen.com/
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on August 05, 2007, 06:37:58 PM
KWBG,

Just wanted to say thanks for this extensive journal!! It has helped me out quite a bit (I've been reading all of the Allograft Journals I can find). We have similar injuries(I had the wonderful terrible triad) and my re-hab seems to be tracking yours pretty closely.

All of the links you have posted have been great!

Just wanted to say thanks again for all the detail and information you included in your post-op diary and wishing you a speedy and complete recovery!!

Thanks,
Rob
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 07, 2007, 10:46:05 PM
ACL DONE June 14, 2007

DAY 50  POST-SURGERY 

Summary of Day's Events:

Went to a tea room in the middle of a forest (actually a very popular spot).  Had lunch and then walked along a variety of forest pathways wearing heeled chunky sandals that I have not worn for the past five years.  The knee was wobbly and unaccustomed to walking on irregular ground - but I walked slowly.  Then went to make weekend gourmet dinner #1.  Wrapped knee in iced gel packs while standing and preparing the dinner.

DAY 51  POST-SURGERY 

Summary of Day's Events:
Stood on legs for 5 hours straight preparing gourmet meal for 10 people; (it was a birthday party).  By hour 4, I had wrapped the knee in my iced gel packs and had prepared the dessert wearing the neoprene wrap-around brace and the iced gel packs.  Kneeled on the knees without any pain or discomfort whatsoever, however.  Concerned about still being at 130 degrees flexion; need at least 10 degrees more in the operated knee.

The gourmet dinner #2 / birthday party was a success.  Wish the knee would straighten completely - but I expect this too will come in time.

DAY 52  POST-SURGERY 

Summary of Day's Events:
Prepared gourmet chocolate chip cookies for the university kid; gourmet dinner #3 (some leftovers)

DAY 53  POST-SURGERY

Summary of Day's Events:

I am still healing because I see that I require at least 8 hours' sleep, whereas previous to my knee surgery, I required 61/2 hours sleep.  I was sluggish all day because I did not sleep well - no doubt because I fell asleep with the television on.

Physiotherapy Session #11
I concentrated on developing quad and hamstring strength and stability today.  I bicycled for 15.5 minutes (on the "9" setting on the stationary bicycle).  The physiotherapist then put 7.5 pounds onto my weights for my leg push-downs on the seated leg push-down device.  I did the hamstring/leg-to-the back raises using the 2.5 pound weights attached to the pulley (3 sets of 16).  The PT also had me step on the rubber waffle and try to balance myself on the middle of the inflated waffle.  I was to do this with my leg locked in a straightened position for 7 minute's time (total) without using any support (i.e., holding on to anything).  I could rest in between the balancing exercises.  The PT increased my weights (by one unit - for a total of three units) on the reclining leg pushes.  I was to lock and unlock my knee slowly and purposefully.  I also did 10 minutes on the stairmaster taking baby steps to relearn how to lock my knee and how to straighten the leg/knee.  After starting and ending the PT session with icing, (with a pillow under my heel <whilst wearing runners>), my PT told me not to do anything else today.  I still have an irregular gait, and a bent knee whilst walking - but I still have that golf ball-sized popliteal cyst at the back of my knee.

That's it for today folks.   :D

KWBG!


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 08, 2007, 12:07:31 AM
Hi Rob,

You are so welcome!

It was and is my hope to help out other Kneegeeks who are going through the rigours of ACL, meniscal and HTO knee surgery - or who are preparing themselves for ACL, meniscal and HTO knee surgery.

Cheers to you and good luck on your rehab.  Glad you are keeping us posted!!!

Knee-Will-Be-Great!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on August 09, 2007, 01:07:12 AM
KWBG,

Would you mind letting me know the cause of your prior 2 allografts failing - I'm sure like many this was one of my concerns when opting for the allograft. My PT has worked with 1,000's of ACL patients and has only seen 3 failures - 1 was a structural problem of the knee and the other 2 were people going back to full sports long before they were ready (and against PT orders). Any thoughts?

Thanks,
Rob
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 09, 2007, 01:16:25 AM
KWBG,

Would you mind letting me know the cause of your prior 2 allografts failing - I'm sure like many this was one of my concerns. My PT has worked with 1,000's of ACL patients and has only seen 3 failures - 1 was a structural problem of the knee and the other 2 were people going back to full sports long before they were ready (and against PT orders). Any thoughts?

Thanks,
Rob

Hi Rob,

Allograft #1 - taken out by a 100 pound dog who soundly whacked the side of my knee as he turned.  I heard the big rip - and knew I was going back to the ACL allograft starting line.

Allograft #2 - combination of things including injury, a structural problem and a twist (whereby I heard a loud rip! <like fabric being torn>) - My knee was structurally unsound because I needed a hgih tibial osteotomy to re-balance my knee joint and my leg prior to ACL allograft #2.  It was not done - so the leg was at a varus angle; in other words, the leg was bow-legged - because my medial meniscus had been cut out when I was a teenager.  So the bow-leggedness of the knee put stress and strain on the ACL allograft.  That combined with a direct blow to the front of my knee joint/leg did me 2nd ACL allograft in.

I had a high tibial osteotomy in Jan. 2006 to re-balance the knee and now in June 2007 I had ACL allograft #3.  I still think that this new ACL allograft is a tad too loose because my tibia is subluxated forward by about 1.5 centimetres - but I am resigned to the fact that I will have surgery again - for cartilage issues - or possibly for another ACL allograft in the future.  Right now all I want to do is be able to walk without a limp and without guarding of my knee - and to be able to do some high levels of physical activity and get back into shape.

Cheeers to you Rob.

KWBG

PS - I do expect to have further knee surgeries on this knee to continue trying to improve its state - and to prevent a knee replacement.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on August 09, 2007, 01:44:12 AM
Just curious - about how far along were you post-op when you were re-injured? When the dog bumped you did you have a brace on, and if not, would it have mattered? Sounds like it was primarily due to the other structure problems which sounds like you now have under control (or close to it).

Good luck with any future surgery's! This is my first surgery, and hopefully my last!!

Thanks again.
Rob
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 09, 2007, 02:16:50 AM
Hi Rob,

1)  Injury occured 13 months after ACL allograft #1.  I was walking with my dog when we encountered a number of large unruly dogs whose owners had let them run off of their leashes.  One or more dogs smacked into the side/back of my knee with their full force (100 pounds).  It felt like I had been tackled by someone.  I was not wearing a brace.  I do not know whether wearing the brace would have made a difference.

2)  Injury (big blow to front of knee and tibia) occured 4 years after ACL allograft #2.  Even with my structural problems and bow-leggedness, I was still running and feeling fine after ACL allograft #2.  The big whack to the front of my knee stretched my ACL allograft #2 - and then eight years after the allograft #2 surgery, structural instability and looseness caused the stretched ACL to finally rip.  I was not wearing a brace during either incidents.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on August 09, 2007, 02:36:18 AM
Thanks - Hopefully for you 3rd times the charm.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 09, 2007, 02:40:56 AM
Thanks Rob,

I also hope that the third time is the charm - but ya know ... I am concerned about this knee's current laxity and that subluxation.  In any event, I am prepared to be on crutches for another year - if that is what it takes to get my knee to its optimum condition - but right now, it is too early to note anything other than a generally pain-free status albeit with some anterior tibial subluxation.

Cheers to you and the rest of you Kneegeeks out there in Cyberspace ... and protect your knees!

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 09, 2007, 03:03:40 AM
ACL Autograft and Allograft - Operative and Post-Operative Complications (an informative/very good article).

http://findarticles.com/p/articles/mi_qa3767/is_200301/ai_n9200733/pg_1

Thanks to celinenj03 who found this article and posted it on another part of the Kneegeeks bulletin board.   :)
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 10, 2007, 12:15:13 AM
ACL DONE June 14, 2007

DAY 54  POST-SURGERY 


Summary of Day's Events
Went out to do some errands.  Wore a suit (tight suit/sausage casing) and two inch high heels.  Knee felt awful.  Did not do any exercises after I returned home from errands.  Medicated myself with chocolate covered almonds.

DAY 55 POST-SURGERY     Happy 8 week anniversary of my ACL allograft #3!!!   :) :) :)
Physiotherapy Session #12
Went out to do more errands and then went for physiotherapy.  Today the knee felt awful.  Loose and pain in one specific medial spot where the joint grinds.  The little spot on the medial aspect of my knee was grinding and creating a goodly amount of pain. 

Summary:
I am grossly out of shape; I am mentally motivated but avoiding exercise and movement.  The knee feels loose today and I am frustrated.  I have medicated myself again with chocolate covered almonds - and have noticed that the 15 pounds has climbed to 17 - 18 pounds.  This has been a frustrating day.  I concentrated my PT on my hamstrings - but the reclining leg push exercises which I had done with "three bands of resistance" on DAY 53, (up from two bands of resistance) had to be decreased to one band of resistance.  And even then I could not finish these exercise sets.  The tibia is (as per usual) subluxated forward and it feels uncomfortable to walk.  The quads are insufficient as are my hamstrings.  I am still using the hand rails for assistance when going down the stairs (still peg leg style - one at a time - or I am using my arms to hold both bannisters and I do walk down the stairs one at a time - but with most of my body weight supported by my arms).  My OS is one of the tops in his field - but I do question why he initially put the HTO wedge in such a position as to tilt the tibial plateau.  But I do know why he did so - to compensate for my not having an ACL - which I subsequently convinced him to put into my body.  Until I discussed my activity level and concerns about knee replacement (I won't have a TKR or PKR), my OS was seemingly (at least in my opinion) preparing me to be one of these younger folks with an old knee who would have had to have waited (in a state of agony and lack of strong physicial exercise) for an older age to be "rewarded" (not) with a TKR or PKR.  Moreover, I am quite cognizant of the fact that the tibial plateau bone has also remodeled itself after so many years without an ACL.  It has become accustomed to tilting forward.  Walking with a anteriorally subluxated tibia is awkward - and every so often (today), I had a strong twinge of pain as I walked.  The pain is of course in the medial aspect of the knee - no doubt where the bone-on-bone surfaces are rubbing against one another.  My PT told me to give it time; he feels that since I have had the tricompartmental debridement, then I will have a slower rehab at worst, or at best, will have days when my knee joint protests that I have done too much.  The PT told me to cut down the resistance on the recumbant bicycle - as I currentkly have the setting at 9 (high resistance). 

This is the first day that I feel down in the dumps (somewhat), but concomitantly "rarin' to go".  Very difficult for a Type A person high activity person who wants to run around and be (again) lean and muscled and feel vibrant and be on my legs for 18 hours a day doing meaningful work and coming home and doing meaningful decorating and painting and dragging around flagstones and such - to be inactive.  Today I feel/accept that I will definitiely be needing more surgery; i.e., cartilage restoration, and who knows, possibly an HTO revision and ACL revision in the future.  I will not get a knee replacement.  All biological means must be sought out and utilised. 

I am posting this day's somewhat down-in-the-dumps diary notwithstanding my usual positive mindset.  I hope to look back (in retrospect) and say this has been one of the most frustrating and disconcerting days of my post-ACL allograft #3 life.  Upon my pointing out that I have grinding on top of that medial focal bone-on-bone lesion, the PT indicated that I have scar tissue on top of the spot.  He suggested that I rub it for about 5 - 10 minutes daily in a circular motion in an attempt to break up the scar tissue.  He did not appear to want to address the fact that I am frustrated with my progress.  But I know that he has seen so many ACL allograft patients come and go, that he knows and no doubt is confident that I am just going backward in terms of rehab as a result of an over-extensive self-imposed PT regimen.

KWBG 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 10, 2007, 09:31:13 PM
ACL DONE June 14, 2007

DAY 56  POST-SURGERY  (Yesterday was the 8 week anniversary of my surgery; today is the anniversary of 8 weeks (56 days)  post-op, when day 1 = the day after my surgery.

Summary of Day's Events

A Walk in the Park
What a difference a day makes.  I am over my 24 hour funk.  :D  I went for a walk in the park; same park where I used to run and race walk.  Today I managed to walk slowly for 40 minutes.  The knee felt fine although loose.  This is because the quadriceps and hamstrings are still poorly developed.  Because of its laxity, my knee joint kept hitting the medial aspect's sore spot/area of cone-on-bone or whatever it is.  I am aware that the physiotherapist said that this spot may be where more debridement was undertaken during my ACL allograft surgery - so I will accept that fact that every so often my joint will have some stabbing pain - at least I will accept this in the interim. 

Walking Up/Down The Stairs
Today I could walk up and down the stairs normally, however when walking down the stairs, I had to hold on to one bannister.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on August 10, 2007, 11:22:14 PM
Glad to hear you are feeling better - it's amazing what 24 hours can do and just getting out.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on August 11, 2007, 09:06:13 AM
Hi KWBG

I have days like that and it is amazing what a day makes - down one day, pain, frustration and defeatist thoughts and then something happens in the night or sometime and I'm back on track. Weird isn't it.

I'm using stairs normally but am not all that crazy about it, especially going down - I always use the rail to hold on. Especially if I'm carrying anything. I look longingly at my mountains and hope to get going with some easier walks, but the weather is working against me - we've had rain now for almost a week  :(

Yesterday I drove over the Alps to Italy in order to get out and about in the warmth of the sunshine. Had a really good day shopping in Sterzing/Vipitano in the Süd Tirol where they speak German but with an Italian rhythm, sounds wonderful.

Today it is raining again here and my knee is hurting and feeling stiff but I will go out and work it later on.

Sue

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 11, 2007, 12:13:39 PM
Thanks Rob W and Kaputt Knee !

I really appreciate your comments.  Kaputt Knee (Sue), I am just imagining Tyrolia; gosh one of these days I will certainly look forward to touring Germany.  Ron, thank you for your perspective. 

I really had to slow things down prior to this knee surgery and I can say that my slowing down has affected my personality; I have always been a go, go, go and high energy sort who talks and expresses intellectual and emotional enthusiasm and movement with my body.  I am a very physical sort of person - that is an inherent part of my personality.  Since the exacerbation of my knee problems, I have become quite quiescent - which is good for instrospection in the short term but not good for career, physical health and life generally in the medium to long term.  Been this way - way too long - but then again, I am lucky to be alive and kicking.  I recognize the need to transform this quiescence back into action ... (this transformation issue is something that is currently an internal struggle).

ACL DONE June 14, 2007

DAY 57  POST-SURGERY 


Summary of Day's Events (to-date)
The day has just started and it is 7:00 am; I awoke at 4:30 am - but did not get out of bed until one hour's time had elapsed.  Incredibly, my entire body feels a "good sore/tender" - all from yesterday's 40 minute walk in the park.  I have used muscles yesterday that I had not used for at least three months.  Today I am to go out for supper - and I look forward to it - although I will be starting out for my destination in the morning.  I note that I still do not want to search within myself and redevelop the will power to not eat my "medicating" albeit fattening food stuffs - but this will come in time.  I always could consume 3,000 to 4,500 calories daily when working and working out - owing to my brain/body activity level - so I expect this will return with increased intellectual and physical activity.

Comment about yesterday's inaugural  walk in the park:  
When I stopped at the quaint brick washroom facilities building for a break and to take a sip of water from the outside fountain, I came across two people who I am surmising weere either brother and older sister or son and mother.  They had an old (older) dog with them, I would say a German Shepherd and Retriever mix.  The man was at oldest 25 to 35 years of age.  The woman's age I could not surmise, but I would think that she was between 40 and 55.  By the look of their facial features, I surmised that they were blood relations.  I saw that the womanv had a hospital tag on her clothing, but I did not know whether she was a patient, permanent resident or an employee of that particular hospital.  The striking thing about this woman was the fact that she was in a wheelchair - and from what I saw, she only had the ability to move her head.  She was inordinately obese - no doubt from complete and total inactivity resulting from her wheelchair-ridden state - and no doubt from a need to self medicate with food (here I am superimposing my habits and modus vivendi on someone else, but please bear with me dear Kneegeeks). 

In any event, just prior to my having met these folks at the water fountain/lavatory facilities in this beautiful park on this glorious sun-fulled mid-August day, I had been again engaging in some negative self-talk about how frustrated I felt with the right knee's acting up and all - i.e., the occasional hitting of that blasted "tender spot" on the medial aspect of my knee joint when I walked.

Then I saw the woman and the gentleman with this sweet old dog tethered to the lady's wheelchair; the man had obviously taken her out from wherever she had originated on that day - to enjoy the sunshine, the birds, the wildlife in the park, to look at the river - and to be around people enjoying their own respective lives.  No doubt the dog was her faithful life's companion.  I said hello to the lady and to the gentleman and smiled and then went on my way.  I encountered them again on a paved park pathway whilst on the way back to my car. 

At that moment I first met them, I realized that irrespective of how unlucky I was to have had my medial meniscus and partially torn ACL removed as a teenager - and to have suffered through years and years of activity with a painful knee - and also to have lost career ground with this seemingly never-ending merry-go-round of surgery - that I was and am extremely, extremely fortunate.  I can walk - and you my Kneegeek brothers and sisters can also walk - notwithstanding with some pain and discomfort.  This poor lady cannot walk and never will - but here she is outside and enjoying life.

It is so very interesting that I have had these life-affirming exoeriences whilst progressing in my healing; during the last physiotherapy session, I encountered a woman who had obviously been stricken with polio (poliomyelitis) during her childhood/babyhood; the last time we had an outbreak of polio in Canada was (as I understand it), in the mid to late 1950s.  But I digress.  Here was this lady who had come into the physiotherapists' clinic for work on her shoulders - because I would imagine that after a lifetime of using crutches to support her braced legs, her arms and shoulders had become (no doubt) quite sore.  Or she had sprained something.  The PT was not addressing her legs; essentially her legs were "a done deal"; they were there - braced and functioning.  No physiotherapy for them.  End of story.  The physiotherapist was addressing her sore shoulder and arm.

______________________

After my walk, I usually drive around the little hamlet on the north west end of the citiy that surrounds my verdant park.  This area is so pretty; the houses and shops are pretty; the people - be they in their vehicles or in the grocery store or on the street always seem to convey to me a feeling that it is Friday afternoon - irrespective of what day of the week it is.  Such is the comfortable comportment and cognitive mindset that these residents portray to me.  Or perhaps it is just me and how I see these people.   But in any event, as I was driving through this area and drinking in the visual elixir all of the flowers and trees and general beauty of the area, I saw the wheel chair-bound lady and the gentleman (she in her motorised chair and he walking behind her).  At that point they were at least four kilometres away from the park.  Obviously enjoying life and the golden, relaxed sunshine of a Friday afternoon.

_____________________

Conclusion:
Dear Kneegeeks, we are in our respective stages of pre-operative "waiting for something to be done" or post-operative healing.  But we are so, so, so very fortunate to be walking.  While we all need to be pain free, I truly appreciate the life's lessons provided to me by random encounters with people whose physical problems top mine by X to the nth power.  I have been asleep for so many years on some level - afraid to enjoy life fully for fear of precipitating pain - a prisoner of pain and discomfort; when I encounter humanity of the type and nature I have described above , it stirs in me a want to "be all that I can be" - intellectually, physically, cognitiviely - and to give back in some way, shape or form to help people whose mobility and physical lot in life has been hindered.
____________________

August 11, 2007 - the start of true renewal of mind, body, soul, spirit and career - the renewal of life as it should be lived.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 12, 2007, 08:57:15 PM
ACL DONE June 14, 2007

DAY 58  POST-SURGERY 

Summary of Day's Events (to-date)

Did Walk # 3 in the verdant, leafy park.  Walked at a brisk pace for 45 minutes.  Felt absolutely great save for that small painful focal point in the medial apsect of the knee that is worrying me - at approximately an 11 o'clock position relative to the centre of my patella (as I am looking downward at my knee) - and 4 cm. away from the centre of my patella.  But that small focal point only stopped me dead in my tracks once today - relative to Walk #1. 

The knee cannot hyper-extend because of the seemingly permanent anterior subluxation of the tibia - by about 1.0 to 1.5 to 2.0 centimetres.  The knee is also jiggly/floppy (although stronger today than on DAY 56 two days ago) - and this floppiness/jiggliness together with the knee's anterior tibial subluxation (I believe) contributes to the focal point pain.  The knee's two surfaces are not smoothing gliding against one another; instead they are flopping and hitting one another.  So because the mechanics of straightening the knee are somewhat off, I literally cannot replicate the movement that my left knee easily makes with every step. 

Moreover, because the mechanics are "off" relative to the "normal" knee, putting my heel down first remains a task that must be thought about and executed with some mental and physical effort - because my knee always has the appearance of being slightly bent when standing.  Standing still and equally balanced on both legs with both knees straight (and locked) remains an effort - as it has been for 31 years.  But I will continue on. 
____________________

I am darn well determined that this knee will be all that it can be - and I will never give up that "good fight". 
____________________

Knee Massage Attempt #1:
I applied pressure on that irritating focal point in an attempt to gradually dissipate the scar tissue that has grown there - and to massage that sore bone-on-bone area.  That focal point is bony and ridged and prominent ... hmmm wonder how that focal point originally occured !?  In any event, I rubbed myself a blister right on top of the bony, painful focal point.   ::)  And I didn't rub too long or too vigourously - the bony focal point is just that - bony - and a focal point of pain.  So I will have to be careful how I massage this bony focal point after the blister heals.

Report of Walk #2 from DAY 57:
Walked slowly yesterday for 40-50 minutes through a beautiful neighbourhood with loads of tall trees in the wooded area to the back of the stately houses on one side of the road.  Walked with the "pork chop" (affectionate nick name of signif. other), who consistently acted as my drill sargeant - "Remember what the physiotherapist told you ... heel down first ..."  The walk was beautiful.  The day was hot, sunny and dry; not a sound outside save for the whirring of household air conditioners.  All of humanity (or at least the humanity and various and sundry pets in that particular neighbourhood) all seemed to have been snuggled in their comfort-cool houses with air coniditioners on at full blast.

Okay Kneegeeks ... supper calls ... bye forr now!

KWBG

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 13, 2007, 02:43:12 PM
ACL DONE June 14, 2007

DAY 59  POST-SURGERY 

Summary of Day's Events (to-date)

Woke up with all of my muscles in my legs tingling a healthy "tingle".  Yes, the quads and the hamstrings - and the soleus and other muscles in the lower legs are firing.  The medial knee's bony focal point continues to be a source of trouble.  I awoke this morning with that area being painful. 

New Experience with the Knee
Last night as I walked around the house, the knee locked and nearly gave way in response to seeming pain under my patella.  I suspect that these problems will continue for a while - and then by six to 12 months post ACL allograft #3, I'll see what the residual problems are and deal with them at that time.

I do believe that some of these strange symptoms emanate from the anterior subluxation of the tibia.  Things are also not in the place that they should be - and with the new ACL trying to hold everything in place, jibs and jabs of pain will continue on (but will hopefully abate).

Dietary Considerations - On Track
My breakfast during this last few days included a home made fruit smoothie (orange, apple and soft mango combined/pulverised in a blender), two eggs seasoned with black pepper, one or two pieces of Rye-Crisp (or Finn Crisp) (dark whole wheat flatbread), a cup of green tea/decaf Earl Grey tea, one large glass of water and salad/uncooked green beans - plus five or six almonds (not chocolate covered, however).

A glass of milk (soy milk for me) finishes the breakfast.  It is a nice brekkie and keeps me filled and nutritionally balanced. 

I am cutting bananas out of my morning fruit smoothie - because I think that there is too much sugar available to my body from this fruit. 

Blood Pressure = 111/68

Heart Rate - 60 Beats per minute

Not a bad rating for someone who has been a virtual blob of inactivity for 12 months.

Well, off to do many things.  The Walk #4 will be undertaken later today.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 15, 2007, 12:06:24 AM
ACL DONE June 14, 2007

DAY 60  POST-SURGERY 

Summary of Day's Events (to-date)

I decided not to go for a walk on Monday (yesterday) as I recall the physiotherapist saying that I should 'take it easy' if I felt I was overdoing it - the 'overdoing it' sign being pain/discomfort.  Well, tha little focal point was irritating me - so I decided to not push my luck. 

I woke up today with the graft feeling rather loose (but it is close to 9 weeks - probably the close-to-weakest point for the allograft - and with that 'step then kick the tibia forward gait pattern, there is some irritation at every step - but not necessarily pain at every step.  I have been habituating on putting my heel down first - and every so often the tibia clunks against the femur and that irritating 'sore spot' is aggravated once again.

Physiotherapy Session #13
The PT told me not to push myself and to 'not go crazy' (with my exercise regime).  Up to today, I thought that doing PT every day was what was required.  The PT said that 'I am ahead of the crowd', and he wants me to nurse that knee somewhat owing to the tricompartmental abrasion and lavage that my surgeon performed when he did the ACLr.  So I am to do two days' exercising and then stay off for one day; that is to be my regime until told otherwise.  My great physiotherapist has consistently told me that I am doing well - despite my inner voice that says I should be doing considerably better in terms of my rehabilitation.  I ask him questions about the state of my rehab. every time that I see him - I would think a good sign that I am a go-getter and quite serious about rehabing to be "all that I can be".   :)

New Exercise  This exercise helps strengthen the "bad knee" and muscles around it - and it also helps establish "balance" proprioception/proprioceptors in the knee.

Stand on your ACLr leg with the quads tightened and the leg straightened when doing this exercise./i]

#1  Using the pulley weights (of 2.5 to 5 pounds), attach a strap to your ankle and then pull the pulley (with your good leg <fully straightened>) from in front of your bad leg to behind your bad leg; you are facing the pulley weigths.  Repeat 10 times, (2 sets of 10). 

#2  Turn a quarter turn and from a sideways stance (with your tethered leg closest to the pulley weights), take the tethered ankle from an outward postion and cross the leg over and in front of bad leg.  Repeat 10 times, (2 sets of 10). 

#3  Then facing away from the pulley weights, pull the good leg in front of your bad leg and then behind your bad leg, maintaining tension on the pulley weights.  Repeat 10 times, (2 sets of 10). 

#4  Then turn another quarter turn and from a sideways stance (with your tethered leg farthest away from the pulley weights), take the tethered ankle from an outward postion and cross the leg over and in front of bad leg.  Repeat 10 times, (2 sets of 10).

It is amazing how wobbly my knee is - but I will give this healing process its due course.  In the meantime, I continue to ponder whether I will have to have more surgery or a manipulation (or something) to deal with the very uncomfortable forward position of the tibia relative to the femur - and relative to its healthy sister knee. 

But my pondering is also mixed with a goodly amount of confidence in and expectations of getting (at some later point in time) all of the top quality orthopaedic care that I require for this knee/work-in-process.  In the meantime, I will continue on with the knee healing (specifically) and the body/mind/soul/spirit re-engineering process (generally). 

No walk for today.  I have done my good 1.5 hours of knee exercise. 
___________________

I have also attended to a variety of life-affirming, albeit necessary matters today - and life is transforming - from good to great!  I am convinced that life is all about attitude and how one sees ones trials and tribulations as well as one's successes. 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on August 15, 2007, 08:24:56 AM
Way to go KWBG!

The new exercises are similar to some that I have been doing. My proprioception exercises also involve standing on a thick foam cushion and doing single leg dips(?) The cushion is about 3 inches thick and I wobble all over the place. It is essential not to lunge during this exercise so that the movement is just through the vertical plane. Excellent for the VM as well.

Sue
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 15, 2007, 12:07:11 PM
Thanks for the heads up Kaputt Knee! (Sue).  I am reading about your gastronomical escapades in Germany / Austria and I am truly getting hungry! 

I am intending to have the knee be all that it can be.  I know that you are focused on doing the same.
_______________________________

On another note: 

Dear Kneegeeks,

Here is a collection of short Youtube videos that show various and sundry tests orthopaedic surgeons do to assess whether a knee has been damaged.

(Ummm ... enjoy ?!)  ::) :P :o
_______________________________

http://www.youtube.com/watch?v=xOmPm7SXfKs&mode=related&search=

Positive pivot test = knee instability = ACL tear (to test knee instability to see if there is an absent ACL)


http://www.youtube.com/watch?v=ILMWpup_6Hs

Negative pivot test = no knee instability = no ACL tear (to test knee instability to see if there is an absent ACL)


http://www.youtube.com/watch?v=_b48chNEtQ0&NR=1

Lachman’s test = Positive pivot test = knee instability = ACL tear (to test knee instability to see if there is an absent ACL)


http://www.youtube.com/watch?v=5_zUEzew9Rk&NR=1

Lachman’s test = Positive pivot test = knee instability = ACL tear (to test knee instability to see if there is an absent ACL)


http://www.youtube.com/watch?v=28mJFyHMXHo&NR=1

Positive posterior drawer test = knee instability = PCL tear (to test knee instability to see if there is an absent PCL)


http://www.youtube.com/watch?v=h2g5gEfkKAY&mode=related&search=

Normal anterior drawer test = Negative pivot test = no knee instability = no ACL tear


http://www.youtube.com/watch?v=ubP-1WaFeEc&NR=1

LCL  rupture test


http://www.youtube.com/watch?v=_fxKCDkOiJs&NR=1

MCL rupture test


http://www.youtube.com/watch?v=IwBW-X4n1fU&mode=related&search= 

McMurray’s test for meniscus damage

_________________

Cheers ... from Knee-will-be-great!  :D
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: JMCDERMO on August 15, 2007, 12:22:46 PM
Great information Kneedy and KWBG and I have to be careful when I look at the food thread.  It makes me very hungry.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on August 15, 2007, 06:56:36 PM
Hi KWBG

the gastronomical tour is definitely over as my guest is now winging his way back to the UK and my life returns to normal! So back to strength training and getting my life back on an even keel ready for starting the new job in 4 weeks.

Tomorrow I'm back in the gym in the afternoon and also the spa baths which are attached. In the morning I am walking up a 50m hill in order I hope to fly down it! I'm restarting my paragliding career by returning to the nursery slope and revising every single aspect of flying.

Keep up the good work KWBG (A..)

Sue
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: paraglider on August 16, 2007, 08:43:44 AM
@ Sue

Good luck flying today!

Be careful carrying the 20 kgs (in particular downhill!) when starting and landing - they tend to carry themselves.

Hope the weather holds long enough.

Hazel

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 17, 2007, 02:07:32 PM
ACL DONE June 14, 2007

DAY 61  POST-SURGERY 

Summary of Day's Events

Did a variety of things around the house.  The knee felt absolutely great!!!  No pain, no looseness.  I did not do any exercises, however, because I had overdone it the day before - at physiotherapy.  I climed up and down the stairs by "normal stair climbing" - and I only used one bannister to hold on to - not necessarily as support - but for protection/psychological support should I fall/trip/lose my footing.

Summary of Day's Events[/u]
DAY 62  POST-SURGERY Happy 9 week anniversary of the day of my ACL allograft surgery!

Had to go and do some adminsitrative stuff outside the house today.  Looked for vehicular purchase options on the Internet and with auto dealers directly. 

The knee felt great until I went out to do a variety of things.  Then that irritiating medial focal point really started acting up.  I also went out with some friends for the evening - and again that irritiating focal point kept on acting up.  Knee joint is also feeling a bit loose and I cannot straighten the knee today.  Ah, the joys and blessings and ups and downs of knee rehabilitation!   ::)

From the way my knee is feeling, i.e., its hotness and medial focal point soreness and inability to straighten, I would say that my knee rehab went backwards by three to four weeks (albeit in one day).  From yesterday to today, I am now struggling with stairs again; and the medial focal point is on fire.  Today reminds me of my earlier rehab days - from four weeks' prior.

I cancelled today's physiotherapy appointment in that it would have irritated my knee.  I talked with my physiotherapist on the telephone, however, and he instructed me to rest the knee over the weekend; I oild him that I was loathe to do anything strenuous on the weekend.  I rescheduled my next PT appointment for Monday (DAY 66).  I suspect abrasion arthroplasty and some cartilage filling works await my future - but I always knew that would be a probability/possibility. 

Somehow I cannot but shake the feeling that the lying down leg pushes are responsible for this medial focal point irritation - because I am putting a considerable amount of stress and strain on the medial aspect of the joint.  Plus the balancing on one leg - which again irritates the medial aspect of the knee.  I will discuss possible strangthening modifications with my PT when I see him on Monday.

It is quite psuchologically taxing to be such a go-getter and to feel like a super-duper, top-of-the-line high performance "mountain bike" - but be sidelined from activity because of one wonky wheel. 

On the positive side, the newly revised diet feels great; my body quite likes the mango plus orange, wheat bran and ground flax, green tea with ginger and cinamon morning fruit smoothie I make.

Hooray! - the body feels lighter, but the weight scale has just not caught on to the concept of reducing the actual recorded poundage when I step on the darn thing.

Oh well, I shall continue along this knee journey - visualising heavy duty exercise and heavy duty house cleaning and heavy duty yard work - and running around in a management job - and taking courses at night for professional development and personal interest - and decorating - and gourmet cooking for many - and having dinner parties - and doing all sorts of things with friends and family - all of which I do most certainly love - and which feed my body, spirit, soul, intellect and psyche.   :D :D :D

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 17, 2007, 08:49:39 PM
ACL DONE June 14, 2007

DAY 63  POST-SURGERY 

Summary of Day's Events

Woke up with a very stiff knee.  Decided to wrap it with gel packs (after of course), the gel packs re-froze again.  Did 6 minutes on the cross-trainer and felt absolutely better; this of course makes sense - because osteo-arthritic knees often do feel better (and stronger and thus more able to support the body) after exercise.  Exercise of course strengthens muscles - and muscle-legs better support the knee that do weak, non-muscled legs.

Knee has still got a bend to it.  I note that the more the bend, the owrse off the knee feels when I walk - because the knee joint is hitting the wrong articulating surfaces.

The re-energised diet is quite enjoyable.  Tip for the day - always eat until you are only 80 per cent filled - because it usually takes your body 20 minutes to figure out that it is full.  People who eat "a lot" and quickly vis-a-vis eating "80 % and slowly <at that>), often feel fuller and are at risk for weight gain. 

Currently walking around with a knee brace/frozen gel packs on.  Took two Ibuprofen whne awakening this morning.  I look forward to this knee getting out of this intermediate period of healing.

Have only walked three tuimes to-date.  Probably will walk again tomorrow and Sunday and Monday.  Expect to go to golf course tomorow, but only to act as a caddy/observer.  The physiotherapist told me that he would show me how to swing and to protect my knee - on Monday.

RE: Walking - Three times per week is not too bad.  I think of a Kneegeek who stated that he wanted to be back at work climbing ladders at 9 weeks ... not a very good idea I would think.

It is a lovely day out here - and I am truly enjoying the beautiful weather ... sunny with clouds floating by, apporximately 27 Celcius with a brisk wind blowing the trees around ... absolute paradise!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 18, 2007, 01:44:56 PM
ACL DONE June 14, 2007

DAY 64  POST-SURGERY


Woke up to a glorious, crisp morning; the sun is shining and today's high is expected to be about 22 Celcius; perfect pre-Autumn weather.  The knee was burning in the middle of the night (I had forgotten to put my neoprene gel packs and brace on prior to retiring with a cup of tea).  I thought that I would drink the tea and then go downstairs for the gel packs/brace, but I woke up at 6:30 a.m.   ;)

Knee feels okay - some aches.  Will get onto the eliptical trainer and do my routine.  Later, shopping and then a fresh fish dinner caught by a loved one whilst sport fishing last weekend.  Then golfing (me as observer/caddy).

The weight issue continues.  One pair of 135 - 140 pound "shorts" now barely fits the 151-152 pound frame.   :P  Will not purchase any larger clothes, however - no way! 
Will take a good walk today; life is good.   :) 

Love and good Saturday to all Kneegeeks ...

KWBG
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: JMCDERMO on August 18, 2007, 02:18:30 PM
Sounds like a lovely day you have planned KWBG.  Keep up positive spirit.   Jo-Ann
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on August 18, 2007, 05:04:20 PM
Hi KWBG

how was caddying? - I hope you player bought you lunch/supper at least for all the expert advice and help you gave  ;)

I made it to the Bunny Hill but did not fly as there was way too much happening. Tomorrow I will be doing some ground handling just to get the feel of things again and maybe at the end I will fly down. My friends are all rooting for me and are really supporting me in my attempt to return to this sport. I will take one very small step at a time and I will make it back into the air but only when I'm ready. Today I talked to the beginners and helped them lay out their wings and get ready for their flights. Although I did not do much myself it was good to be out and involved again. tomorrow I will take my wing and harness to the top of the Bunny Hill and just play in the wind getting a feel for the whole thing again. We have a big area behind the launching area where I can play helped by one of the instructors. I'll let you know how it goes.

don't forget to ice your knee tonight  :D

Sue

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 21, 2007, 12:56:06 AM
Hey Kaputt Knee and JMCDERMO and all other near and far dear Kneegeeks!

Well good Monday to you ... I didn't post on Sunday or today (as-of-yet) so here is my update!

ACL DONE June 14, 2007

DAY 66  POST-SURGERY


Woke up late on Sunday morning (9:16 am).  I am usually springing out of bed at 5:30 am - 6:00 am, however went out of town and slept on a bed that was soft, soft, soft.  It affected my sleep.  Also, stayed up really late (1 am) watching a goofy guy's movie (definitely not my choice) - so the entire diurnal rythym thing was out of whack.  Breakfast was a spot of tea and a Finn Crisp cracker.  Showered, went out with Sig. Other and one child, then came home and went out again and did groceries and a variety of other mundane tasks.  Cooked a great meal again - saw a variety of people I know - and then went and baked up a storm - or at least tried to (the gas stove went wonky for a bit and refused to increase its heat).
______________

Stood on the knee for at least three hours straight.  The knee felt very wobbly today and the knee cap's underside caught on the medial joint line's focal spot (which today was not painful).  Iced it during the day but forgot to put on the iced gel packs and the neoprene brace at bed time.  Thought of my Maternal Gtandmother who could do eighteen hours' work at age 82 - running up and down stairs, gardening at her weekend home and baking up a storm.  I recall her complaining that she had started feeling old/creaky at 82 - and was quite distrssed about this ... (fond memories of her).   :)  Her X-rays showed little to no arthritis - even at 82.  Only slight bow-legs - no doubt from childhood rickets whilst being cared for by her step mother in pre-World War I Europe.

Report of Golfing/Caddying from DAY 64
Caddied for eight of nine holes.  The course we golfed is filled with rolling hills and steep climbs on pathways linking the holes/greens and fairways.  The anterior subluxation problem resulted in my body's structure feeling fatigued because I was consistently changing gait/stance to accomodate for the one subluxed knee.  Kind of like/analagous to trying to adjust one's body when sleeping on an uncomfortable mattress - but not being able to get any relief. 

I have not done any exercises since DAY 60, when I last saw my physiotherapist.  We both felt that it was better to take a rest since I am (from a muscle development standpoint, flexion/extension standpoint and a pain standpoint, doing quite well. 

The focal point was, for a moment or two (whilst walking the greens) causing me some irritation, but not to the extent that it had been doing say, at DAY 60. 

I continue to feel like I am 18 (my body feels great/my energy level is consistently high), however, the consistent jockeying of my skeletal structure to get relief from have two knees with mismatching gait patterns continues to be quite situationally tiring. 

Went for a yoghurt ice cream after the 2 hour golf spree and then went and watched the cheesy movie.  Knee felt tired - as did my back - but the rest of the body was raring to go, go, go! 

Iced the knee for one hour and then the knee stopped burning - but the structural discomfort continued.  Sorry to say that I did not get taken out for dinner after being such a fine caddy; in fact I went and cooked dinner for three people; ahhhh, the joys of being a chef de cuisine!  It seems that people end up looking blankly at you around meal time and expect that you will perform your gastronomic magic to fulfil their palates' desires.  Strongly suggested being taken out for dinner next weekend - and it will happen.

DAY 65  POST-SURGERY
Woke up early; it was raining (good - the farmers still do need some precipitation on their fields).  The knee felt great and tight - but the knee was still subluxed when standing.  Had the patellar twinge again; also had the medial focal point twinge again - but both were not for long - although I still "feel" the medial focal point. 

Walked around feeling great (I love rainy days) whilst singing Sting's "New Day" song - envisioning a scar-free, well-formed knee - like its "virgin no-knee-surgery" twin. 

Purchased two Tiffany lamps for the study; funky 60s-like design with a hint of modern Italian as well.  Colours = cobalt blue, mauve-purple, orange, red, light mint green, avocado and off-white).  Very "Pop-artish" arrangement of the glass - geometric designs and curves with no set formulaic pattern to the layout of the stained glass.  Stands are antiqued wood with a antiqued bronze base.

Saw my GP today and explained to her my subluxing situation.  We will no doubt talk more about it in time - and perhaps devise a strategy for my to get the golf-ball-sized synovial fluid Baker's cyst excised from my knee - as well as a host of other things.  Had to cancel my physiotherapist's appointment, however.  Hope that I see the PT before he again goes on holiday.  The knee "to-do" list is a work-in-process - as am I (generally).  Can't wait to be lean and lithe and racewalking again (next year) - notwithstanding the anterior tibial subluxation. 

Determination will prevail!   :D

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 21, 2007, 10:55:51 PM
ACL DONE June 14, 2007

DAY 67  POST-SURGERY

Summary of Day's Events:
The knee felt great today, notwithstanding there being a considerable amount of dampness iin the air and rainfall.  Pre-autumn weather kssing the last one third of summer! 

I succumbed to my chocolate-covered almond addiction and pasta penchant, going all out last night and then today (as well) for good measure.  The clothes immediately felt tighter; the gut and dough-girl look to the abdomen returned with a vengeance. 

Physiotherapy Session #14
Only bicycled for 15 minutes at the clinic.  Talked with the PT about dos and don'ts for the upcoming two weeks whilst he is away.  Not cleared for golf; only cleared to caddy.  Now I can tell my S.O. that I definitely cannot play golf with him as-of-yet  :( - but I will caddy for him.  :)

Have been cleared to go to the gym and work on the machines per physiotherapy instructions provided to me.  Have been told in no uncertain terms to stop anything when it hurts - and to start exercising only with a non-swollen knee.  Good, then I can get out of bed at 4:45 and be at the gym at 5 am.  Morning is the best time for me to exercise.

The PT is very happy with my knee generally - and with my musculature; I expressed my concerns about the intermittent medial pain and the sub-patellar catching and pain - but he says I am in great shape (ahead of the crowd) - and to continue doing what I have been doing.  He also says that it is okay not to exercise when the knee is sore or swollen.  He evidently is not concerned about the knee being slightly bent as well as subluxed at this point in time - but he knows that I will try to correct these problems.

He told me to be patient for the next 6 months - so I will be - but always on my guard in terms of addressing signs and symptoms of possible knee problems.

Cheers to all Kneegeeks .......... from KWBG!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 22, 2007, 11:39:55 AM
ACL DONE June 14, 2007

DAY 68  POST-SURGERY

Woke up early (4:30 am) and felt great.  Went down the stairs without any effort expended at all.  I did hold onto the railing however - as the quads on this knee are still not as strong as the other knee.

I have a busy day ahead of me - and will be either adding more to this posting - or will be creating another posting for the next day - with a retrospective commentary on today's events. 

I am so pleased; A Kneegeek buddy from the USA has made my Gourmet Carrot Cake recipe - and a Kneegeek buddy living in Germany has made my Bran Muffin recipe - and she also expects to make the carrot cake recipe in due time.

Ahhh, these are the absolute joys of connecting with people from other parts of the world - sharing knee situations, knee solutions, knee injuries, details of operations, rehabilitation similarities/differences, exchanging ideas and names of sports physicians, and generally giving one another positive, heart-felt support, friendship and advice.

Thank you KneeGuru, for creating such a valuable website.

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 23, 2007, 01:47:20 PM
ACL  DONE - June 14, 2007

CONTINUATION OF DAY 68
I had an extremely busy and somewhat stressful day – but the knee held out.  Went to Home Depot three times, went to fax an important document because my fax does not work; it is tied to my printer and seems to have a mind of its own.  Doing some medicating with chocolate covered almonds and pasta.  Ripped the back seam of the lining of a beautiful black dress I was wearing for Home Depot visit #3.  Nothing like hearing that rrrrrrrrrrrrip and then wondering what one could sidle up to in order that one’s dignity was preserved..  Today I do not care.  Weight will come off and dress seams can be fixed.  Sausage casing suits can be endured.  Walked around on pavement with 1 ¾ inch heels for three to four hours – and the knee still held out.  It did not feel as good after I tripped over a wayward carpet at Home Depot – and then it swelled and felt loose and then tight owing to the swelling.  But at the end of the day, the knee still felt good.  I filled out an accident report at the request of a sales associate in that she saw me trip and then catch myself whilst holding three boxes.  The blinking carpet had folded over – and I caught the bottom of my foot on the carpet and the bottom of my leg (from tibia top to bottom of foot).  So the bottom part of my leg was stopped by the carpet – but the top of my leg was moving forward along with the rest of me.  Not a good scene – but we shall see.  I generally take things rather well, well, except for the self-medication with high calorie food stuffs.  The physiotherapist told me that only a very hard knock would cause an ACL re-tearing calamity.  I will trust his judgment.  My plumber/kitchen installer came to my home at 9 am this morning and left at 10:15 pm.  What a gem he is.  While the new countertops, faucets and sinks et al look fantastic, the house is in a pandemonium-like state.

Summary: 
The knee will be great!  Not as pretty, or possibly as mobile as the “virgin” knee – but it still will be great!  Repeat after me; our knees will be great!!!!

DAY 69 POST-SURGERY
Well, I woke up without the knee feeling sore - only stiff as per usual.  No medial joint line focal point pain or discomfort.  The knee is not swollen, save for the Popliteal Cyst that endures at the back of my leg.  That issue will be dealt with no doubt within one year.

The kitchen (new countertop, faucets and taps look great - black countertop on black granite chip sink with stainless steel "Country French" design faucets.  The bathroom - not as nice as I had expected owing to a serious design flaw that I did not recognise in my new, funky above-the-counter "bowl" sinks.   ::)  Oh well, the sinks are in, however; got to live with the design flaw for now (silly me for not realising the design flaw until after the sinks were in - the plumber also was concerned, but since he had drilled the holes for the sink and the faucet, we had to continue on with what we had at hand.  Burnished Tuscany-look bronze-black faucets, black countertop, white "bowl" sinks.  My plumber was at my house for 13.5 hours.  What a champ!  And he was wearing a knee brace and a back brace for the entire time that he toiled away.  He also installed my ice maker/water filter on my refrigerator!  Felt bad that I couldn't help him; in fact he was going great even with a bad back and a bad knee!   :o

Off to do a variety of things.  More to post tomorrow.  We will see how the knee holds up today wearing high-heeled (2.25 inch) slip-ons.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: paraglider on August 23, 2007, 02:27:17 PM
Hi Knee-Will-Be-Great,

High heels? You're brave!  I'm sending my couple of pairs into retirement unless I don't have to walk basically anywhere in them. Never liked the things anyway as my ankles like to give way and I can't imagine that would be too good for the recuperating knee. I'm more of a trainer sort of person. If you have plenty of past practice then I suppose why not.

Can you please direct me to the food / recipie threads? Cheers! I rather like the sound of muffins and carrot cake.  Enjoy the new kitchen and bathroom!

Hazel

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 23, 2007, 03:56:42 PM
Hi Paraglider,

Thanks for the good words.  I am a sporty but also a (chunky-style) high heels girl.  Actually I have been walking around the house today in high heels and a sausage casing/business power suit (above the knee skirt - with the glory of my multi-scarred knee exposed) - and my knee feels great!!!

Paraglider, I will personally email you my Bran Muffin and Gourmet Carrot Cake recipes.  I sent the recipes to Kaputt Knee - who is also in Germany.  Kaputt Knee indicated that there is a difference in measurement protocol between Canada and Europe; (we use volume - either the British Imperial Measures system or the Metric system <) - and apparently Europe uses grammes and measures by weight.  So you may have to convert the measurements a bit.  It is possibile, however.  PS - Kaputt Knee made the muffins and gave them to her flying instructors!  So I am assuming that she approves of the recipe!

Cheers from KWBG! 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: paraglider on August 23, 2007, 07:47:17 PM
Thanks for the recipies!  Sound very tasty. A quick review of the cupboard and fridge contents have revealed that the baking session will have to wait until after the next shopping trip.  I've just made a batch of savoury muffins which I had planned on doing. Just waiting for them to cool down a bit though I'm really hungry. Went for a bit of a jog earlier and didn't eat too much beforehand. Jog is exaggerating a bit, a quick walker would overtake me at the moment but I only started again last week with just a few minutes real slow with walking breaks between. I'm looking forward to getting back to 10km training some time in the near future.

Take care,
Hazel
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on August 23, 2007, 08:02:10 PM
Hi KWBG and Hazel

All the muffins disappeared in absolutely no time at all at the flying school. So I think we can take it that they were a success. I didn't actually get to eat one myself this time as I just was not quick enough.

I'm still working out the measurement ratios for the carrot cake so Hazel if you manage it can you share them with me - German and French were my strengths - Maths was my Bete Noir! I cheated with the muffins by using the ingredients from KWBG and the amounts from another recipe  ::)

Keep up the good work KWBG on the diary. I gave up on heels of any sort after the first knee was playing silly Bs now I've got 2 bad knees I'm not sure if the knees will be stable enough.

Sue
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 24, 2007, 12:31:05 PM
ACL  DONE - June 14, 2007

CONTINUATION OF DAY 69

Well, the knee held out whist wearing the 2.25 inch high heels.  I did a considerable amount of walking and the knee held out.  However, after sitting for 3/4 of an hour, the pesky medial joint line focal point acted up when I arose from my chair.  After walking to my vehicle with a limp, I got home, changed shoes and the focal point pain stopped.

DAY 70 POST-SURGERY  Happy 10 Week Anniversary of Post-Operative Healing!

Woke up feeling fine.  No knee pain.  Walked downstairs using the handrail on the right side for support.  The quadriceps are still weak on the operated leg; therefore the movement down the stairs was somewhat jerky.  A full day ahead.  More to report the next day.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: cactusknee on August 24, 2007, 01:03:11 PM
Hi knee-will-be-great,
I have just registered
I have had similar op.
ACL Recon ( Hamstring Graft)
HTO right Knee
I am new to this and I am in the chat room now
If your online please chat
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 25, 2007, 02:50:20 PM
Good to read about your story CactusKnee!!!

ACL DONE June 14, 2007

DAY 71 POST-SURGERY


Had a late night; tried to watch television - but fell asleep at 11:45 pm - with the telly on.  Woke up at 2:15 am to see the same movie (comedy) I had wanted to watch from 9 pm to 11 pm (the night before) being played again.  Started watching it again  - and again fell asleep with the telly still on.  Woke up at 7:30 am and felt great - well-rested.  I am quite stressed as to the nature of employment prospects, however.  I am giving myself a time line of two months for employment searches. 

I feel that I have found myself through all of this knee irritation; now is the time for action.  It has been a long, long 31 years of consistent pain (my entire adult life and part of my teen-aged years); even with a Masters level degree, I must say that this consistent knee issue has quite affected my career and career prospects.  Irrespective of looking fit, young, hale and hardy, work interruption associated with nine surgeries does not do good things for one's career.

I have not done any exercise since DAY 60; My leg and my body do feel strong - stronger every day.  I have to balance the necessity of exercise and strengthening with maintaining the necessity of a swelling-free, irritation-free knee.

Well, off to bend down/kneel and do some much-needed housework, then job applications.

Knee-will-be-great.




Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 28, 2007, 04:42:12 PM
ACL DONE June 14, 2007

DAY 72 POST-SURGERY

Spent the day baking, then socialising and eating with the S.O.'s family.  Stood for quite some time to help in the clean up.  The knee feels good. 

DAY 73 POST-SURGERY
Drove 450 kilometres to deal with some things.  I realised that I did not have the requisite identification with me - and that I required my passport.  Well, the drive did not affect my knee negatively.  I am happy for that.

DAY 74 POST-SURGERY
Today I feel very strong.  The legs feel strong; the body feels strong, irrespective of whether I have exercised or not.  And I have not exercised.  Mentally, I feel cognitively alert; this is something else that I need - badly <i.e., full command of my mental faculties>.  This is good; I need to feel healthy and strong - for a variety of reasons. 

Love to all you Kneegeeks out there!!!

Knee-will-be-great!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on August 28, 2007, 07:14:13 PM
Hi KWBG

I've not done any "training" since the doctor told me to take it easy because of the IT band problems. Well since then I've done a 10 km hike in the mountains and been down to the flying field for two days. The meniscus hurts like h**l and a "capsule something or other" behind the VM is hurting a lot as well but I feel like I have rejoined the human race! I will go swimming tomorrow and will return to the flying field to play with my paraglider (like a giant kite really) and meet with people learning how to fly their gliders on the winch tow.

I think that just doing "normal" things is what is helping me most of all. On Monday I will drive to Slovenia with a bunch of people for a week. No physio, no injuries amongst them, nothing but fun with the common interest in paragliding. It does wonders for the psyche. I've slept like a baby each night since this happened despite higher pain levels! And if I can somehow get to fly then it will be a double bonus. Today I was taking photos of everyone and actively involved even though I was not flying myself. All that you have done in the last few days are also "normal" day to day things for someone with no injuries, but for you it is a major change for the better and has a corresponding result in helping to raise your happy hormone levels  :D (translated that directly out of the German but I think you get the picture!)

Keep being normal KWBG and see how things just get better and better

Sue  :D
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 29, 2007, 01:16:40 PM
Thanks for the ^^^^^^ (above) comments Kaputt Knee (Sue)!!!
___________________________________

ACL DONE June 14, 2007

DAY 75 POST-SURGERY


Dear Kneegeeks,

I continue to do "just normal" things such as walk, climb stairs, kneel, etc.  No physio for now.  No extra exercises for now.  The knee feels great; no medial line focal point pain.

I wore 2.5 inch high heels yesterday and recognise that there is no knee pain.  Hooray.

Sue (Kaputt Knee), glad to see that you are doing well with your rehab - and that you are only doing "normal things as well".

Cheers to all ..... a very busy day ahead.  I feel strong physically and surprise, surprise, the weight has started to melt off.  Absolutely amazing.

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 30, 2007, 01:49:00 PM
ACL DONE June 14, 2007

DAY 76 POST-SURGERY

Knee felt great all day.  I wore 2.25 inch heels and narry a problem until bed time when I had a bit of a twinge in the medial joint focal point.

DAY 77 POST-SURGERY 
Happy 11 week anniversary to me and my knee!
[/b]
Woke up feeling great.  Body feels great.  Have stopped medicating with chocolate covered almonds and pasta.  High glycemic content foods are not good for me - and I recognise that they create mental and physical fatigue - which is no good. 

No need to use the handrails alongside of the stairs.  Knee feels strong - but I will certainly be careful with the knee.  From past experience (and past surgeries), I know that the knee is still healing - and will be for some time. 

I will have to forego the physiotherapy appointments next week as I will now be busy during the early morning / day.  I will start doing exercises and race walking (um slowly) during the weekend.  I can't wait!

Conclusion:
I believe that just conducting normal day-to-day activities of daily living and normal, careful physiotherapy exercises on my own (for now) will allow me to continue getting stronger and stronger.  I am very fortunate in that my body has been honed through years and years of physical exercise - so my body seems to be happy to spring back to "life".

Given the fact that I am an over-45 Kneegeek, my recovery has been absolutely great!  The body looks like a 35-year old's body (but still a bit chunky for my build (it would best be described as slightly "padded" with that 15 pounds of excess weight), and the body feels like it is 18 years of age!  This "feeling" has to do with past physical conditioning as well as healthy eating; lots of protein, veggies, fruits, almonds (not chocolate-covered, mind you) and (for me) soy milk. 

Enduring Mechanical Issues:
I still do have anterior tibial subluxation, but I can live with it for now - particularly if wearing high heels.  I also have the medial joint focal point pain out of the blue - and when I do the extreme physiotherapy with leg presses - so I will forego these joint-stressing exercises for a while.  The few degrees of remaining flexion and extension will, I expect, continue improving - with my walking on the knee and learning how to walk "properly", i.e. heel down first!  Heels are not too bad to navigate in - but one must watch out for the potholes and cracks in the pavement and cement, and spaces in between cobblestones.  The Baker's Cyst is still there until it is drained/surgically removed.
________________________

In sum, the leg feels strong and stable - this at 11 weeks post-op for an over-45 Kneegeek with nine surgeries and a 31-year crap knee history under her belt!  The excess weight started to fall off this week.  I am happy and grateful.  God is good!    :D :D :D
________________________

Best wishes and positive thoughts to all my dear Kneegeeks from KWBG!  :D :D :D

I always consider September 1st to be the start of a new year!

So ... to all similarly minded Kneegeeks ... prepare for the New Year!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 31, 2007, 03:09:24 PM
Thoughts from the Peanut Gallery on the 11 week anniversary of my ACL Allograft Reconstruction #3

___________________________________________

I find that without a stable, normally functioning and pain-free knee, I was in a depression-like state for many years.  :-[  I could not do even simple things like vacuuming without pain and discomfort - and for a doer, this is catastrophic.  Moreover, one needs the "feel good" endorphins generated when one exercises - to in fact feel good and function effectively.  Without proper exercise, generating the mood-elevating endorphins is difficult.  So some people self-medicate, be it with food or other comfort-producing things/foods/substances/events/circumstances/defense and self-protective mechanisms.

It is absolutely awful and perpetually distressing to walk and perform activities of daily living - and have one's knee jiggle and wiggle, hurt and swell - it is akin to being on stilts that one must consistently take notice of and jockey to keep in place and stable to avoid the feeling of 'falling off' the stilts.  I found that this consistent knee problem has darn near drove me wingy.  In this case, one must not only habituate on the task at hand, but also be "aware" of what one's knee is doing - and how to position one's knee so as to minimise the pain (if at all possible).  Just like when one becomes aware of one's body's breathing, then breathing stops being automatic/autonomic.  Then breathing becomes conscious and therefore uncomfortable because you have to think about doing it.  (Try it; become aware of your body's breathing - and you will find that the breathing effort will become labourious.  It, like moving and using one's knees is supposed to be natural; people should not have to think about their day-to-day ordinary physical efforts.) 

Similarly, when one becomes aware of one's knee, it takes away one's mental focus from our respective tasks at hand - be they work or personal or recreational.  Not a good way to live; hence the necessity of appropriate surgery to make the knee and therefore the person 'all that they can be!'
_______________________________

Now that the pain and instability is gone, I am the woman that I should be.  So time to recoup the losses from my career and personal life.  This has been one heck of a long ride.
_______________________________

I am a bodily-kinesthetic person who needs to move to express herself; I would think that many of us Kneegeeks who are in a great deal of distress about our respective situations are as well. 

Anyways, the knee feels good and I feel strong ... so off to do more things today!

Best wishes to all you Kneegeeks out there!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 01, 2007, 01:19:34 PM
ACL DONE June 14, 2007

DAY 78 POST-SURGERY


Woke up today and the knee feels great.  Strong.  I am forgetting about the knee as I walk.  I have not done any formal exercise since DAY 60 - and I feel that this is appropriate for me.  I truly believe that I was stressing the joint a bit too much with physiotherapy.  But then again I was working quite hard at it. 

So today I will be doing a lot of housework and cleaning and possibly painting if I get around to it.  It is currently 08:15 am my time.  I will post later today as to the success of my various physical endeavours over the course of today.  I have not been accustomed to moving fast and "cutting" motions in my home since 1999, owing to my many knee-related issues.  I recognise that there are still a few things that have to be done for this knee, but at least it is now stable and not supplying me with physical and psychological distress.

Happy New Years from Knee-will-be-great!

(September 1st is the start of my unofficial new year!)   :D :D :D
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on September 01, 2007, 01:22:08 PM
Glad to hear that things have turned around for you and that your knee is feeling much better!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 02, 2007, 02:06:59 PM
ACL DONE June 14, 2007

DAY 79 POST-SURGERY


I woke up with a bit of an ache in the medial joint focal point.  I did not do as much yesterday as I had planned, however - not because I could not but because I am not accustomed to working as hard as I used to.  I doddled and cleaned the kitchen - took out all of the pots, pans, spices, cans,small appliances out of the cupboards.  Then I cleaned the cupboards and rearranged everything. 

I spent a lot of time on the Internet looking at Kneegeeks and other related sites.

Today is another day.  Plan to finish at least cleaning the first floor today.  Should also get out for a walk as well - but we shall see what time I have left today.

Godd Sunday to all!!!

Knee-will-be-great.
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 03, 2007, 03:01:35 PM
ACL DONE June 14, 2007

DAY 80 POST-SURGERY


Good morning all ... the knee feels great - stable and getting stronger ... thank goodness!!!

The leg muscles feel a bit tingly from the Saturday "cleaning" escapade.  There is no swelling whatsoever.  It isabsolutely amazing as to how emotionally well I feel with this "new" old knee. 

Still some extension to maintain as well as flexion.  But I think that I am doing things that are best for me - by now going slow in terms of my healing.

Best wishes to all on this Labour Day (Canadian national holiday). 
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 04, 2007, 10:45:54 AM
ACL DONE June 14, 2007

DAY 81 POST-SURGERY


Good Morning all!

Just a short note to all dear Kneegeeks - near and far ...

I did 7 kilometres in the park yesterday.  The weather was glorious.  The regular route around the park is 8 km., but I took a shortcut back to my vehicle.  The knee felt a bit stiff when I awoke this am at 5:15 am, but feels fine now.  The popliteal cyst is still there - in its full glory.  No knee pain whatsoever - although I did have one twinge under the kneecap yesterday when I was 'fast walking'.  I find that now my physical endurance is gone - so I will have to build that up again.

Well, off to start my first day post Labour Day ... This is really the first day of the new year in terms of people's/kids'  jobs, school, etc.  "A Brand New Day" (as Sting, I beleives sings about.

I have a three hour drive today (regular commuter fare) ... love to all Kneegeeks.

Knee-is-getting-great!!!! (Knee-will-be-great!!!)
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 05, 2007, 10:44:42 PM
ACL DONE June 14, 2007

DAY 82 POST-SURGERY


Well Day 2 on the job was fine; the two one hour communtes were fine; the knee was fine.  I expect with the schedule of waking at 4:45 am, that weight I gained will come off; particularly now since I have to wear business/causaul business attire.

The knee continues feeling strong - although yesterday morning when I awoke (after my 7 km jaunt through the park), the knee felt somewhat loose - after the exercise ... interesting ... will watch for this 'loose' feeling every time I do something physical.

_____________________

I continue to be amazed that my mental clarity has returned.  It is like a cloud has lifted. I felt I was was at the point of near mental collapse prior to having found a surgical solution to this 31 year nightmare.  I was so stressed because the knee was SO extremely uncomfortable, wobbly, jiggly, ergo swelling and therefore painful.  Notwithstanding one's intellect or training, how can one be of a 'right mind' professionally and be 100% on-task when one has to think about how painful and/or uncomfortable every step one takes is!!! - or when one has to think about how to walk to minimise the pain !!! - what with the pain and discomfort I experienced with my knee since 1999 - 2000 when everything hit the fan.  Made some poor decisions because I was so focused on finding solutions to my knee problems (most <in fact all but two> OS's said they would not operate on me - and that I would have to wait for 10-15 years for a knee replacement (which is not a viable option for me).  Ahhhhhhhhhhh ... but now is the time to start rebuilding ... whewwwwwwww!!!!!!!!!! :D :D :D

Summary Statement:
Folks, it is imperative that you get your knee 'fixed' to as best a state as possible - else risk career and therefore economic losses and other personal, family-related losses as well.

Cheers to all ................ now I am off to eat and then do some work on the laptop computer ...

Knee-will-be-great!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 06, 2007, 11:51:07 PM
ACL DONE June 14, 2007

DAY 83 POST-SURGERY


The knee felt fine until lunch time;  The problem is that I am sitting for 8 hours a day - without any way to exercise.  So no full extension for me until weekend exercise time.  Of course, the high heels do not help the situation ... when I got home, I took off the heels and the medial joint focal point pain disappeared. 

That's it for today folks ...

Cheers from Knee-will-be-great!

______________________________________________________

Here is a link to a good article about ACL reconstruction surgery - and how it benefits the knee (and therefore the knee's owner).

http://www.orthosupersite.com/view.asp?rID=23487
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 07, 2007, 10:31:19 PM
ACL DONE June 14, 2007

DAY 84 POST-SURGERY
 

This is 12 weeks post-surgery today.  

Today the knee feels very strong - and I was wearing the heels that I wore on Tuesday, Wednesday and Thursday. 

There were no medial joint area focal point twinges whatsoever, however I do recognise that I have to exercise this weekend to prevent from slipping backwards in terms of my knee's progress.  The popliteal cyst is quite large and I believe plays a part in preventing me from achieving full extension.  Plus I have not done any exercise (aside from my last weekend's walk) since DAY 60. 

Yah ... and as for for these orthopaedic surgeons who say that the over-40 set will not benefit from ACL allograft surgery - or from any knee surgery of any kind to make them all they should be >:(   ... well I have news for them ... they are wrong, wrong, wrong!!!  >:( >:( >:( 

To think that I was in such pain two years ago (prior to my High Tibial Osteotomy and my ACLr) - that I literally coulnd not think straight!!!  Analysis: You cannot think and be a productive, optimised person if you are in a consistent state of pain and discomfort!!!       

I am trying to figure out what part of that statement some orthopaedic surgeons do not understand - but to no avail!!!
   ??? ??? ???
Weekend plan - working in the house (cleaning and reading).

Cheers and love to all Kneegeeks out there!!!   ;D ;D ;D

Knee-will-be-great!!!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 09, 2007, 12:02:00 PM
ACL DONE June 14, 2007

DAY 85 POST-SURGERY


Yesterdsay included cleaning the car, cooking and hanging out with S.O.  S.O. cut the grass in the backyard whilst I prepared a 6 course meal.  The knee is not amenable to bending quickly and holding that bend whilst cleaning the car.  I do believe that the angle in which the HTO surgery positioned my tibial plateau plays a part in this discomfort - as does the still-weakness (relatively speaking) of the leg compared to the other.  I have become so accustomed to moving slowly that I wonder when I will start moving quickly.  But by the same token, I am still protecting my knee - and justifiably so!!!  No twisting or sudden turns. 

My S.O. is a sportsman - who played hockey, futbol (soccer) and baseball (his love).  Still an extremely muscular guy (thick-muscled and stocky - not long and lean like <pre-ACLr> myself) - no doubt genetics has some part to play in his strength and musculature.  The S.O. worked so fast that he put me to shame ... but he has perfect, very attractive knees ...  :D

Knee started feeling sore and swollen at 18:00 hours ...

Wish I could run around like a squirrel on high test espresso - but oh well ... hopefully this shall come in time.   :D :D :D

Went to bed at 21:00 hours ... woke up at 05:00 hours ...
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 11, 2007, 01:55:20 AM
ACL DONE June 14, 2007

DAY 86 POST-SURGERY

Knee felt fine in the a.m. after stretching.  Felt weak at work whilst alking up and down stairs (limped a little).  Felt good by the time I got home after a 1.5 hour drive (traffic was slow).  Experienced some medial joint line pain.

KWBG!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 18, 2007, 12:37:54 AM
ACL DONE June 14, 2007

DAY 87 POST-SURGERY to DAY 91 POST-SURGERY

This covers my first five day work week (September 10th to September 14th) - as the week prior to this was a four day week - owing to a Canadian holiday (Labour Day) on Monday, September 3rd.   ;D  ;D  ;D

Summary of the Work Week's Events


The Routine:  ::)  ::)  ::)

Wake up at 4:30 pm to CBC Radio International - Europe and Deutchavella Radio Coverage (Germany, Poland, The Netherlands, Czech Republic, etcetera <I love it>).

Turn on nice Tiffany light on nightstand.

Snooze for another 10 minutes and believably state that today will be a fabulous day.

Bend knee at least 20 times (whilst lying down) to ensure that the stiffness comes out/plays out of the joint.

Walk slowly to bathroom for bath/shower and other morning ablutions.

Downstairs in work clothes by 5:15 - 5:30 am

Make breakfast and lunch and heat tea in a pot.  Clean out Thermi (plural of the now-generically used brand name Thermos insulated beverage container); sip tea, fill Thermi with tea and soy milk, have a veggie or a fruit smoothie to end one's early a.m. meal.

Apply makeup/hair curling or straightening iin first floor bathroom.

Take soft brief case,lunch satchel and purse out the door for 6:15 estimated departure time.

Gas up (or for you Brits, Aussies, New Zealies et al), "pour in the petrol", then get driving out of town and onto the highway to make my way towards work destination by 6:30 (approx. 112-112 km away <depending on the route>). 

Listen to Zen-like inspirational music, spiritual and positivity-building CDs for the one hour plus drive to work ... no sense in listening to the news; it will get you down in the dumps. 

Get to employment destination, park vehicle in company parking lot - but as far away from office as one can - for this will be the exercise highlight of my day, get out of vehicle stiffly, then briskly walk to office and make one's way to one's desk and workspace.  Store all briefcase and lunch/foodstuffs under desk.

Walk down the stairs at lunch and coffee breaks, walk up the stairs after the breaks.

Stay 10 or 11 hours and then walk down the stairs and get into vehicle and drive the 1 1/4 to 1 1/2 hour drive home (more rush hour traffic going home). 

Make supper; then go to bed at 17:00 hours; fall asleep at 17:30 hours. 

Repeat five (or sometimes) six times weekly.
_______________________________

Bottom line - no time for exercise - unless I take advantage of a staggered work day - and take a longer mid-day break to work out at a gymnasium close to my place of employment.
_______________________________

Status of the Knee:

Knee felt weak when walking up and down stairs - in fact I limped up and down the stairs at work.  I walk fine on level ground, however.  I recognise that I need to find and schedule time to resume my workout regime.  The knee is not painful save for the medial joint line focal point issue.  The synovial fluid membrane at the back of my knee and the Popliteal Cyst are still enlarged and impeding my knee's progress.  I will address the cyst and inflammation when I see the OS on Monday, September 17th ... (actually that is today's date - but I will be writing about it tomorrow ... still too much to do today before I go to sleep to spend any more time on my post ACLr diary.)

Love to all my Kneegeek buddies !!!!!!!!!!!!!!   ;D  ;D  ;D

Keep the spirits up - OKAY???!!!

KWBG!!!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 18, 2007, 02:15:14 PM
ACL DONE June 14, 2007

DAY 82 POST-SURGERY

Saturday, September 15th ... ahhhhh ... I enjoyed the relaxation of a Saturday.  Kicked around the house for the entirety of the day, then bought groceries, went to get some books sent to me by a friend - then had family/friend commitments starting at 4:30 pm 'till 9:00 pm.  Went home and went to sleep with a very enlarged cyst on the back of my leg ... no exercises at all ... went to bed at 10:00 pm.

DAY 93 POST-SURGERY
Woke up at 4:30 am for the drive to work ... yes I had to do some work on a Sunday ... got home at 7:30 pm.

DAY 93 POST-SURGERY
I took Monday off to see my orthopaedic surgeon for my three month (13 week and four day) check-up.  Along with the OS, came along a newly minted OS as well as a medical student.  I asked the newly minted OS (looks like he is 13 years of age) as to his feelings and thoughts about the over-40 set being 'offered' and provided knee replacements ... the newly minted OS said that he does not agree with knee replacements in anythong other than elderly, sedentary people.  I hpe that he maintains this mindset.  He was amazed when I told hime my age (no wrinkles on the face ... seemingly youthful body - save for the poor old right knee).  I suggested that the OS consider how he and his colleagues could re-engineer the mantra of "knee replacement, knee replacement" into "research, research for biologic means of solving the knee problems of formerly active people". 

My OS told Dr. Newly Minted and the medical student that my knee is the most beat up knee on which he has ever done reconstruction; it is not the most beat up knee he has seen, however, but I suppose the other knees he has dealt with have ultimately met with other surgical/non-surgical ends.

The OS essentially stated that my first knee surgery 32 years ago was a mess ... I won't go into it, but he was definitive in terms of the fact that the unique scar on the medial side of my knee - that I have from the first surgery was inaaproriate for the surgery intended (MCL repair attempt, medial menisectomy, ACL repair et al) - and the fact that horizontal cuts such as the ones I have create long term problems because veins are cut cross-wise <remember veins travel up and down the body as to arteries> ... the other side of my knee housed more scars from the first surgery - also of questionableintent.

My OS said he was loathe to excise the Popliteal Cyst because of all of the nerves he would have to navigate in the area where the cysts is.  Moreover the fact that the cyst is close to where the huge horizontal scars are gives hime great concern; he feels that there could be a possibility of the skin around the scar dying as a result of the poor blood supply that I have to my medial aspect of my knee as a result of this 32-year-old surgery and scar tissue formation.  He also told me that the fluid formation in the cyst is as a result of the knee's arthritic process.   >:( >:( >:(

I told my OS that this is the best that I have felt in eight years - however that the huge cysts is impeding my progress.  I more or less pleaded with him to help me with microfracture and/or abrasion arthroplasty ... he provided me with a hopeful respeonse that I will keep to myself at this point in time.

To alleviate my discomfort, my OS aspirated 20 plus ml of yellow synovial fluid from the cyst.  Aside from a very slight twinge when he initially inserted the needle, the procedure was painless and did provide immediate, much-welcome relief.  I felt like a teenager after that ... runnning around without a golf-ball shaped impediment at the back of my knee - I was even able to run up and down the stairs and do lots of physical work around the house - plus shop for garden supplies for the upcoming year!!!  ;D ;D ;D

My OS told me that he would deal with my cysts in the short term by aspirating them ... and that my healing from the ACL allograft is just very recent; in fact I am still in healing mode - of which I am aware.

I was rescheduled to see hime in three month's time - mid-December, whereupon I am certain that he will provide me with more of his thoughts secondary to how I am doing.

Dr. Newly Minted and the medical student were amazed at my rangfe of motion and felt that I was working quite hard to attain and maintain same; but in fact I stopped all "physiotherapy-type" of execises at DAY 60 - so I feel alhthough the knee is beat up, it is also attached to a very healthy body accustomed to heavy work-out - which no doubt helps the knee out physiologically.  The OS did mention that I not force the knee into further flexion (I am at about 130 to 135 degrees at this point in time) - for he feels that I may disturb some osteophytes and cause them to break off.  My OS states that the more surgery done on a knee, the more it can stiffen ... so he wants to stay away from entering and re-entering my joint.  Now I have differing opinions on this ideology - in that the very fact that the "shag carpet" cartilage surface of my knee, when cleaned up by my OS, created the substrate for a very discomfort-free knee for me.  The medical student tested my knee and state that I have about a 1+ Lachmans ... I was concerned about this, but he states that after three ACL allografts, this is not too bad!!!  The knee does feel stable to me - and I have started to pivot twist in my hoem when doing things around the house/activities of daily living.

I will now use my day/days off/extended lunch hours to work out and be a really great 40 plus specimen of female fitness when I see him. 

Summary:
I am bound and determined to have cartilage resurfacing although my OS says that my arthritis is diffuse and continuous throughout the knee joint - even the lateral side is affected.

I am bound and determined to have the cyst dealt with.

I expect to start seeing a Chinese Medicine Practitioner for acupuncture - so see whether there may be some benefit to that treatment modality in temrso reducing the size of the cyst.  An 80 + year-old lady I know swears by acupuncture; in fact she has said that her arthritis was abated and quietened after four years of acupuncture.  Judging by her high level of activity, I would think that she has found some real benefit in acupuncture.  I had seen and been interviewed by this particular practioner in the past, but did not proceed with any treatment at the time.  Based on my knowledge of him as a well-regarded professional in Canada and internationally, I will effect this change in my life.

DAY 94 POST-SURGERY
I am taking another day off to deal with various personal things ... am still running around like a teenager this morning ... ran down and up the stairs numerous times ... no pain, no joint impingement, no feeling of fullness at the back of my leg ... am cleaning out the vehicle ... including but not limnited to upolstery and carpet washing as well as window washing and exterior wash. 

I accomplished a lot since that wonderful knee aspiration late yesterday morning.  I will report same to my OS - and again reinstitute the political process of trying to get him to do as much as he can do for me within his frame of expertise.  And try to convince hiom to refer me to the USA to see one of his colleagues who may be in a psition to consider me for microfracture. 

My OS called me stubborn (in a positive way) although he considers me to be a good patient ... he said that most people with this amount of arthritis have had knee replacements, but since I am doing quite well pain and function-wise, the course of treatment (as undertaken to-date by him) seems to be working for me. 

Perhaps I do not have as many pain receptors as others in my cohort group - but by the same token, I was trained as an athlete and a dancer in a time when you did not complain about pain ... you used "active imagery" to channel your body away from negative feelings such as pain ... after doing 42 kilometre runs in my youth (up to that fateful knee surgery that started this mess), I always ran past the pain and achieved Nirvana through my body's naturally-induced "runners high".

I have a lot more things to say, but suffice it to say at this point in time that I recognise I will get more surgery to make the knee as best as it can be - and that I will be fitter in three month's time.  I always knew that I was correct in my assumptions that the first surgery was, um, (let's see, how does one delicately say this), a suboptimal attempt at surgery by a surgeon operating outside his area of expertise.  This has been definitively validated by many surgeons who then subsequently said that they would not operate on me - because they were uncomfortable dealing with someone else's mess.  In his own way, my OS restated the fact that this was a big mess created 30-odd years ago - and stated yet another reason why the surgery was so, so very inappropriate.

Final Note:
Dear Kneegeeks, I am not bitter about my circumstance; only bittersweet in terms of lost oportunities in terms of career/career interruptions and running an Iron Man (Iron Woman <for me>) something that I wanted to do since I was 18 years of age.  Something that some of my similarly-aged relatives/friends of both genders are doing at 45+ years-of-age!!!!

You take what you can get out of life; live it well and healthily - because your body is the temple that harbours your soul - and you make life into the wonders and joys that it can be ... and never, ever EVER give up!!!!!!!!!!!!!!!

Love and peace to all .........

Knee-wil-be-great!!!!  :D :D :D
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 20, 2007, 10:27:04 AM
ACL DONE June 14, 2007

DAY 96 POST-SURGERY


Another day off - with losts of running around to do.  I seem again to have medicated myself with pasta and cheese to the extent that the body has regained the hard-lost 5 pounds / 2.3 kg.  Lots of stress - but I have a positive approach to dealing with it all. :D

The knee feels fines, save for a few twinges.  Still feeling like a teenager.  Went to bed at 10 pm so that I could awaken at 4:30 am Thursday to go back to work.

Still no time or inclination for exercise.  My first priority right now has to be work.

Love to all Kneegeeks out there ...

KWBG!!!


Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 23, 2007, 01:14:26 AM
ACL DONE June 14, 2007

DAY 97 POST-SURGERY


Back to work and the 220 km daily round trip ... the knee felt great ... but the bvody does not like sitting for extended periods of time ...

DAY 98 POST-SURGERY   Happy 14 week post-operative anniversary to me and my knee!!!

The knee feels great - but I do need some strengthening ... I see it in my walking down stairs at work ... I limp down the stairs ...

DAY 99 POST-SURGERY

Again at work ... the body is getting quity gough-girlish in terms of physical shape and musculature ... the body is not happy about sitting for such a long period of time ... I will truly appreciate working closer to home and having regular work outs on the weekends ...

Off to do some computer work and then to bed at 10 pm ... starting work late tomorrow (Sunday).

Nothing else to report as-of-yet dear Kneegeeks.

Knee-will-be-great!!!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Kaputt_Knee on September 23, 2007, 08:40:24 AM
Hi KWBG

I can echo the sitting and stairs situation. I start off doing the stairs normally and by the end of the day I'm limping up and down! I had to stand for 2 hours last week as they showed me the production processes in the sterile room! All the work is by hand and every stage is sterilsed after the process, so it is labour intensive and very precise work. I was not allowed to sit down although I was covered from head to foot in protective clothing!

Today I am off to photograph people at the Oktoberfest before going on to my overnight accommodation for 3 nights.

Keep up the good work KWBG and like me keep looking for local work!

Sue  :D
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 24, 2007, 10:00:25 AM
ACL DONE June 14, 2007

DAY 100 POST-SURGERY


Another day at work ... knee feels strong but needs exercise (the quads need more work) ... will set up a plan to address same and work it into my crazy work schedule by Oct 15th ...

Kaputt Knee ... nice hearing from you ... yes hopefully both you and I will have employment that is closer to home soon ...

Best wishes ... to all knees and their owners !!!

Went to bed at 11 pm and here I am up at 4:45 pm for my Monday - last day of my work week ...

KWBG ...
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 25, 2007, 10:01:50 PM
ACL DONE June 14, 2007

DAY 101 POST-SURGERY


Forgot that I had a follow-up appintment with my Physiotherapist on Monday.  Called in to take the day off ... boss not too pleased ... understandably they want to know about these things ahead of time. 

The PT suggested that I start jogging  :o at Month 4 ... I told him that he and my OS would have to collaborate because it seems that my OS would frwak out if I did in fact run again.  The PT was happy with my musculature ... commented on my gaining a bit of weight (again - yeah another 5 lbs - back to the former post-knee surgery self) ... yeah wonderful I am thrilled about it as well ... no time for working out with a new job and lots of overtime being undertaken, however.   :(

But, the good news is that my knee is almost straight in tems of extension - and all of this without much effort on my part.  My PT was quite impressed by the fact that I have nearly all of my range of motion back - considering my nine knee surgeries, including three credible ACL reconstructions and one not-so-credible one (including meniscus removal) - which started this whole merry-go-round of right knee surgery as a major, ahem, hobby in my life. 

The PT also offered his opinion as to the original surgery being a mess ... and also added to my OS's comments as to the inappropriate way the first surgery was conducted ... yes evidently one should NEVER, EVER cut horizontally across blood vessels and nerves ... creates a great deal of problems ... the PT was surprised by how well I had done in that I am (in some circles) textbook case for knee replacement. 

Thank God that this is not the case for me, however.

ACL DONE June 14, 2007

DAY 102 POST-SURGERY


Well Kneegeeks, here I am, enjoying my lunch break at an Internet-friendly cafe ... just walk in and activate the wireless in one's laptop computer - no charges incurred, no muss, no fuss.  Grrrrreatttttttt!  ;D

A funny thing happened on the way to the cafe ...


I was leaning into the back of my vehicle in the cafe's parking lot ... wearing a short skirted (slightly above the knee <not tarty-looking, however> black suit, black high heels and bare legs ... when lo and behold, a man in a Volkswagon Jetta drives by, opens his driver's window and loudly yells a very lewd, albeit complimentary statement about what nice legs I have, and what he would like to see me do with said appendages as it relates to, um connecting with him on an, um, physically-based, coupling level.  I laughed to myself ... and thought that this gent was long gone after yelling said lewd comments while I still searched the back of my vehicle for my cell phone.  BUT, evidently the fellow circled the parking lot and returned to the side of my vehicle and once again loudly repeated said lewd, albeit complimentary and humourous comments as to wrapping my gorgeous legs around ... well you get the message - don't you dear kneegeeks.   ;)  I would have to correct his statement as to wrapping my legs ... wrapping one gorgeous leg and another gorgeous leg sans beat-up knee around ... yada ... yada ... yada ... his, um, (blush) mid-section ... (this is too funny)!!!!!!!!

If I were my former 20 year-old self, I would have been highly insulted and disgruntled by such comments.   >:(

But, as an over 45-year-old, I welcome such compliments ... nice to know that the ugly old beat up knee and its owner don't crack mirrors ... I really got a kick out of the guy and his comments ... made my day and made me laugh heartily.   :D
________________________

Cheers to you dear kneegeeks ... am leaving to go back to work and am staying late ... driving home late (as per usual) with inspriational, positive, spiritual CDs loaded into my vehicle's CD player!!!

Best wishes to all until tomorrow.

Knee-will-be-great!!!  :D



Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on November 28, 2007, 06:36:29 PM
Hi All Kneegeeks out there!

Well, the knee does feel great; I have not had much time for anything other than work and family - glad my body was accustomed to exercise before becuase it certainly is not getting any exercise currently.

The popliteal cysts is still there at the back of my leg.  I expect it will have to be surgically excised at some point in time.

My only real major incident post-ACL allograft #3 was tripping over a folded up area rug last Saturday (that was packaged and scheduled to be sent to the specialty wool carpet cleaners) - this trip occured while walking to the washroom in the dark - and yes, I could have (and should have) turned the light on to avoid such a possible knee disaster.  The knee swelled up the next day and felt loose for a few days; in fact it still does feel this way - although some of the swelling has abated. 

Worried about acl re-injury - YES - BUT I was told by my physiotherapist that only a strong, strong force would dislodge or stretch the new (June 14-07) ACL allograft.  Hopefully this is the case - because boy-oh-boy, my mind has played a variety of tricks on me in terms of acl being stretched since that "event".

Anyways, dear Kneegeeks, I thought that I would pop in and provide your with my greetings and salutations - and good cheer!!!

Keep on going everyone!!!  Get your knees fixed and NEVER, EVER give up hope!!!

Love and best wishes to all ....................... Knee-will-be-great   :) :) :)
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: mc_1_2_3 on November 30, 2007, 06:23:27 AM
My second ACL allograft failed when I stepped on a 2 inch round rock, 3 months post op, wearing my brace.  First one failed 10 months post op while backing up an outfielder playing softball.  The reason they failed was because of damaged LCL and MCL, undetected by first OS.  It DOESN'T take a strong strong force to damage a repair when there are other problems.  My first OS and PT both checked my knee after the last failure and said "No, that wouldn't have retorn your ACL".  They were wrong.  Went to a knee specialist, had ACL,LCL, and MCL repaired 7 weeks ago.  ACL and LCL were allograft, repaired existing MCL.

Not trying to scare you, but there is a chance that yours is in fact damaged, again, like mine.  Don't let it go too long before you get a second opinion.

Good luck,
Mark
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on November 30, 2007, 07:43:20 AM
Thanks Mark,

I see my OS in December.

Hopefully nothing has happened - but we will see.

Cheers.

KWBG
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on March 19, 2008, 05:28:00 PM
Greetings to all Kneegeeks!!!

Well, I am 9 months post-ACL allograft replacement and things are going quite fine.  I feel as strong as I ever was, however my popliteal cysts (outpocketing of the synovial fluid membrane) at the back and at the medial aspect of my leg (above and below the knee) need to be excised surgically.  My OS is somewhat reticient about removing the cysts surgically as he states that the cysts will return.  I did state to him, however, that the cysts became extreme and started bulging after being hit on the front of the knee (head-on motor vehicle collision 8 years ago - my knees hit the dashboard).

Since my OS knows how (highly) active I am, I certainly hope that I can convince him to do this surgery.

Best and most sincerest good wishes for all things excellent to all Kneegeeks ... keep the faith folks ...

Knee-will-be-great!!!  ;) ;) ;)
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 14, 2008, 07:18:32 PM
Greetings to all KNEEGEEKS out there.

I am now happily one year and exactly three months post-surgery and the knee feels GREAT!!!

I saw my OS in July 2008, and given my excellent shape and muscle tone, my OS has decided to provide me with the synovial fluid membrane surgery to remove the huge outpocketing popliteal cyst that I had spoken of in my last post (March 2008).

I expect the surgery will be done in 2009 some time, when work et al can be arranged around it.

Best wishes to all you KNEEGEEKS ..........

Hugs to all, ... from ...

Knee-will-be-great ... (the knee is great) ... and it wil be even greater YET!!!  ;D ;D ;D

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: Rob_W on September 16, 2008, 12:49:42 AM
Glad to hear it!!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: kblanchpatt on September 21, 2008, 04:12:09 AM
Just want to say that I've enjoyed reading your progress & have benefitted from your positive outlook. You're a bit of a knee hero to me. Sounds like you are super busy, but I'm wondering if you may have the time for an email. I'm facing a surgical decision and am wondering your thoughts on the matter...

Here's my brief history:
7/2006 -- ACL rupture (dog ran into me)
9/2006 -- ACL reconstruciton (rehab went great except I continued to have subluxations frequently after surgery)
9/2007 -- Big sublux which led to medial meniscus injury
9/2007 -- 2nd ACLr w/ MM repair
1/2008 -- scope with partial (most) medial mensicectomy due to continued swelling, pain, failure to progress
Current -- Significant pain and swelling with all 'exercise' modalities (jogging, cycling, long walking, etc.) My knee hurts mildly just doing nothing.

That's enough for now...hope I can have a brief exchange with you to hear your thoughts!
kimberleybpatterson at gmail dot com
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on September 21, 2008, 11:32:51 AM
Kimberly,

I have emailed you privately.

KWBG
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on December 23, 2008, 04:52:42 PM
Hello all Kneegeeks out there!!!  :D :D :D

I thought that I would pop in and advise all that my much-operated right knee is alive and well, thank you very much - and going strong!!!

The ACL alograft # 3 was performed 18 months ago - and all is well in that domain. 

I do have a few brief, minor tinges of a burning sensation on the medial aspect of the knee joint every so often (once a week, perhaps once a month) when I have done at least two hours of strenuous working out - but the tinges would not even be considered in the category of pain. 

I have read a variety of ACL postings and would wish to advise all of you folks that it does take at least one to one and one half years to fully recover from the ACL allograft surgery - at least that is what my sensory, corporeal body is communicating to my brain and spirit.

Best wishes to all this Christmas season, and for all the future ... from Knee-will-be-great!!!  :D :D :D
_________________________
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: luvmy4girls on August 15, 2009, 04:05:02 PM
Hello.  I would love to hear from any of you who have had multiple acl reconstructions.  I am 40 years old with four girls....they keep me very busy since all of them play sports.  Here is a little about my knee:

02/1991 - tore acl/mcl
03/1991 - had acl reconstruction using patellar tendon autograft and had a full recovery.
06/2008 - injured same knee playing basketball with daughter but waited several months before going to doctor.  Symptoms were a little different, so did not think I had re-injured acl.  Thought maybe I had cartilage damage.
07/2009 - Finally went back to same group of surgeons who did my first acl surgery......they are the best in my area. They also still had my surgery records from first reconstruction. The dr diagnosed me with an acl injury and said that I needed acl reconstruction again.  Had a second opinion in the same group and he said the same thing.
12/17/2008 - Had acl reconstruction revision and had a few complications due to softened bone. So, after 4 hours of surgery and one larger incision on side of leg, my surgery was a success.  He told me since the bone was somewhat softened, he had a harder time with graft fixation. That was the reason for the extra incision. Showed me the pictures from my surgery, and acl had not completely tore yet.....just VERY stretched and non functional. All cartilage was okay for now.
12/22/2008 - began my physical therapy which was on a slower pace due to my bone problem.  I also had to wear a large brace this time to protect the graft and bone in my leg.  But, anyway I did 6 months of physical therapy until released to finish on my own. I want to add that I have seen my OS 8 times since surgery and he as been excellent on keeping a close eye on my knee.

I am just about 8 months post op and am ready to be without any pain.  I know I really can't compare to my first acl reconstruction, so I just want to know if you still had pain when jogging and some stiffness after sitting for long periods? I am still working out and trying to rebuild the muscle I lost along with doing mild cardio on bike.  It might be normal since my physical therapy was on a slower pace to let the bone heal.  I do trust my OS when he says I am doing just fine, but just would love to hear from others and not feel alone.....

Thanks!

Mom to 4 very active girls!!!

Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: knee-will-be-great on August 31, 2009, 04:26:22 AM
Hiyah,

Glad to hear from you.

Sometimes, if I overdo it, I have stiffness and minor swelling.

Other times, I have no swelling at all, nor pain.

I find that if I stick to an "Anti-inflammatory diet" and / or a "Caveman Diet" (both are ways of life) as the way to eat on a day-to-day basis, any swelling or stiffness seems to be minimal.

Ploease email me with any other questions that you may have!!!

Note:  I would stop jogging as it does put a lot of strain on a joint whose integrity has been compromised.

Cheers from Knee-will-be-great!
Title: Re: Post-Op DIARY of ACL Allograft #3 - June 14th-2007
Post by: luvmy4girls on August 31, 2009, 05:22:24 PM
Thanks for your reply.....I think that I was having "one of those days" when I posted last.  I suppose it is normal for knee to swell some and be stiff if I overdo it.  But, I suppose I just get impatient sometimes and just don't want to have any pain.

As for the jogging, I really don't plan on doing it very much....I think I was just testing to see if I can without any pain.  I have recently joined a gym that has a great treadmill that I am using for walking.  I am gradually adding time and some incline to my workout.  I gained approx. 20 lbs.....UGH.....from the time of my injury, surgery, and now rehab.  I as so ready to lose the extra weight and feel better about myself. I do some of the leg machines in addition to the treadmill as I am still working on my quads.

Thanks for you reply....it's nice to have folks that understand the frustration and pain associated with having knee surgery.

I will let you know if I have more questions....or sometimes just need to know that I am not crazy and what I am feeling is normal.


Thanks again!  :)

Kim