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Author Topic: Fultonius' PCL and PFL reconstruction.  (Read 3692 times)

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Offline fultonius

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Fultonius' PCL and PFL reconstruction.
« on: May 13, 2010, 02:27:05 PM »
Hi everyone,

I'm just out of surgery 2 days ago where I got my Posterior Cruciate reconstucted with an allograft and my Popliteofibular Ligament replaced with a hamstring graft. So far, so good. Not too much pain and the surgeon was happy with the results.

I was inspired by Skinnygurl's blog: http://skinnygurl-mypclsurgeryandrecovery.blogspot.com/ so decided to document my progress. The main aim of the blog is for a personal record and to keep me motivated; however, it might also give others some usefull information and insight into the process of recovering from this type of surgery.

Feel free to ask me any questions, either on the blog itself, or here.

Cheers.

Alasdair.

P.S. My blog can be found here: http://pcl-rehab.blogspot.com/
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline Beda

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #1 on: May 13, 2010, 08:58:20 PM »
Hi There.!  Just read you thread. have courage and do your PT when the time comes, and I really hope you had a clever OS to do your surgery! Hope you arnt in too much pain, dont be shy of asking for analgesics, its what theyre for!!
The best of luck to you, and I hope by next year your will be climbing and snowboarding again as new!
Greetings Beda
'79 trauma v.knee
'81surgery patella lux.
'84 osteochondritis dissecans
'86 osteotomy
until now 16 knee surgerys ink. 6 failed tkr. pretty much exhausted all areas and types of surgical proceedures for knees
all TKR's loosened & failed
2008 wait for Final arthrodesis
constant pain

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #2 on: May 13, 2010, 09:34:38 PM »
Hi Beda,

Thanks for the encouragement. I'm actually really looking forward to be able to get cracking on the physio work.

I've not actually taken any painkillers today, and it's not painful, which is both surprising and encouraging.

I think the surgeon is one of the better ones in Scotland. Time will tell... He certainly seemed fairly happy with my stability ofter the operation. Another 5 days and I'll get the staples out and my first physio session the day after.

Cheers,

Alasdair
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline fultonius

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Day 4 Update
« Reply #3 on: May 14, 2010, 12:22:26 PM »
Just updated my blog: http://pcl-rehab.blogspot.com/

Here's the jist of it:

Quote
Four days since the surgery and all seems to be going well. Yesterday I only took painkillers in the morning and before bed - slept from 11 till 6 then dozed till 8. Today I'm avoiding them altogether but I'll put some by my bed in case I can't sleep. Swelling doesn't seem too bad, but it's under about 4 layers of bandage, so hard to tell!

Four more days till I get my staples and stitches out. Then I can get into my locked, but releasable, knee brace.

Happy days!
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction. Day 5
« Reply #4 on: May 15, 2010, 08:52:55 AM »
It was all going so well - no painkillers at all yesterday.

This morning...Aaaaaarggghh! I noticed some other people mentioned that the pain got a bit worse at about day 4/5 so I'm not too bothered.


To any other climbers who have had a hamstring graft taken - how does it affect your heel-hooking ability once your back climbing?
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline fultonius

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A question: Is it OK to loosen the splint/brace?
« Reply #5 on: May 15, 2010, 04:31:32 PM »
I am due to get my sutures out in 3 days and my first physio/PT is the day after.

Is it OK to loosen my brace off while lying on the couch? I have been doing so and can't think of any reason why not; I keep it tight in bed and when moving around.
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline tez27

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #6 on: May 16, 2010, 01:36:17 AM »
Hi Fultonius where abouts in Scotland are you and what hospital did you have your surgery in I am in Greenock and due to have my aclr in approx 12 weeks so any info would be appreciated.
I hope your recoery goes well and you get back to your climbing soon.
Take care Tez
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #7 on: May 16, 2010, 10:23:01 AM »
Hi Tez,

I'm based in Glasgow, but I'm staying at my parents in Perth for a while - it's a right pain in the ass to do stuff for youself, even silly things like putting a sock on is impossible! 

I was in the Southern General, in for about 07:30 and was first on the list. There was a few problems in the morning (like the main generators were failing...  :o ) finally into surgery about 10, general anaesthetic and a femoral nerve block. Pretty sore when I got out of surgery.

I stayed in overnight and got out about mid day the next day. All the general anaesthetic and stuff a bit weird, but it's not as bad as I was expecting!

Hope that helps.  :) 
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #8 on: May 18, 2010, 07:27:21 PM »
Day 8 - My parents drove me to Glasgow from Perth to get my staples taken out and to get acquainted with my new friend Donjoy, my knee brace, who I'll be spending a lot of time with over the next 3 months.

The nurse was happy with the way my wounds were healing.

The physio tested extension by putting he hand flat under my knee and I managed to put some pressure on it, so she seemed quite happy by that. She then tested flexion but it wasn't as good as I was expecting, only about 40*  :-\   Is this normal?
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline Kaputt_Knee

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #9 on: May 19, 2010, 06:15:42 AM »
There is no such thing as "normal" in these things! We all heal differently, respond to pain and swelling differently, etc. Comparisons with "norms", others, etc are useless.

You are only on day 8 your knee has been through the mill and there is a lot of trauma related swelling in and around the repair sites. 40° is fine, but if the PT/surgeon have not said anything else, work it gently upwards up to whatever the stops are on your brace.

We (as the patient/victim) always tend to over estimate the degree of flex as we cannot really see the side profile, just the top and bottom of the flex!

Take it slowly and steadily - you are not in a race. Recovery from any kind of surgery like this on your knee is a marathon, so pace yourself. Listen to your body but don't let it get lazy.

 ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #10 on: May 21, 2010, 08:01:27 PM »
Very true! Also, looking at some of the stuff over on the Posterolateral Corner forum, it seems like limited ROM is common with reconstructions.

I was actually over estimating my ROM. It was only 30* but in 3 days it's up to about 38*. Don't want to push it too hard...

The brace is limited to 70 just now (and has markers ever 10, handy for working out how far it's gone), but I doubt I'll be anywhere near 70 for a while.

Latest blog post:  http://pcl-rehab.blogspot.com/2010/05/getting-bends.html
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #11 on: June 08, 2010, 09:49:28 AM »
Day 30. I'm scared!  :-\

Last night I was doing my daily ROM exercises, I've progressed to wall slides and had got up to about 80*. What seems to be limiting my ROM is the LCL/PFL graft, which feels like it comes under quite a lot of tension.

Well, back to last night, I was sitting on the arm of my couch with my leg hanging down at about 80* (I was using my brace to measure the angle) but it seemed a lot slacker than before and went straight to 90*. I previously had a firm lump around the LCL/PFL area but now it's gone a bit soft and squishy and my knee feels a bit looser than before.  :o

So, this morning I phoned my physio to get an appointment (my next one isn't for a week) and she didn't seem too worried. We're both hoping it was just a release of an adhesion or some scar tissue breaking down.

Anyone got any advice?
« Last Edit: June 08, 2010, 10:07:21 AM by fultonius »
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline Kaputt_Knee

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #12 on: June 08, 2010, 12:01:08 PM »
Had a similar OMG  :o moment when my LCL recon suddenly freed up. If you were wearing your brace then what could have happened? The brace is protecting you against over-exerting the graft too soon. Mine was blocked at 90° for a long time. I had difficulty reaching 80° but then suddenly it just went.

My physios and surgeon all said it was adhesions loosening up and likened it a bit to a scab falling off a cut - prior to it falling off the skin is taut and inflexible, movement "pulls". When it falls off the movement is free and easy.

Actually looking at your time frame, my "OMG what have I done" moment came at around the 4/5 week as well. It was the defining moment for me as I was then permitted to drive!  ;D

Could be that you start to see a lot of improvement now!

 :D
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline fultonius

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #13 on: June 08, 2010, 12:10:17 PM »
That's encouraging.  ;D

If I were to guess, I would have thought it was the LCL graft that has "released". (I'm pretty sure my OS did anatomical reconstructions of both the PFL and LCL)

I was actually doing my exercises with the brace off (as my physio had done them this way the last time I was there) but being very carefull not to allow it to twist at all. I think I'll keep the brace on from now.

The most worrying thing was the area around where the graft is has gone from taught/firm to slightly squishy. (However, there was quite a "lump" which was presumably haematoma/scar tissue/adhesion prior to this)

It's really hard not to worry about these things.  :o

How much tension did you feel in the LCL graft area? How uncomfortable/painfull was it when it got to the end of ROM?

Thanks for the positive thoughts!
Climber, Snowboarder and Mountainbiker. Complete tears of PCL and Poplliteofibular Ligament Jan 2010, reconstructed May 2010.

Offline Kaputt_Knee

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Re: Fultonius' PCL and PFL reconstruction.
« Reply #14 on: June 08, 2010, 02:40:20 PM »
My surgeon kept reiterating that the LCL recon was the weakest part of my knee repair. I still HAVE to wear my brace when I ski climb, mountain walk or paraglide. He wants me to use it at least until 2 full seasons have passed by. I do not wear it at all for anything other than those sports.

Mine was a reconstruction using some of my hamstring tendons, along with the stuff he harvested for my ACL graft (semitendinosis/Gracilias double bundle) The LCL had ruptured at some point during the initial injury and had been missed for 2.5 years, so there was no chance of using any of the original ligament.

I was allowed out of my brace for passive therapy and when the physio did manual therapy, but at all other times I had to keep the brace on as the risk of unintentionally twisting when the leg was tired was just too high. I came close one day just getting off the stationary bike after a long high revs/low resistance session. The leg was weak and almost gave way! So the brace stayed on until he told me I could leave it off for training.

The squishy sensation is horrible isn't it! On one hand you want the adhesion to go but when it does you worry like hell that this soft stuff means you've snafued the graft!  ::)

Keep talking with your physio and if it does not improve and you feel continued weakness there then contact your surgeon directly and ask for a consultation. Going via their secretary usually helps to by-pass the NHS blockades! ;D ;D

Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee















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