Advertisement - Hide this advert





Author Topic: Impending Surgery  (Read 2042 times)

0 Members and 1 Guest are viewing this topic.

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Impending Surgery
« on: January 26, 2011, 07:07:23 PM »
My name's Phil and I'm a 20 year old college student.

Recently, I dislocated my left knee for the 3rd time (4th overall dislocation, once on the right knee). After having several Xrays, an MRI, and a CT scan my orthopedic specialist has decided that surgery is necessary to ensure proper functioning of my left knee.

Essentially the current problem is three-fold:

1. My ACL is torn and needs reconstruction.
2. Part of my patella has fractured from the rest, which could be idiopathic. There is edema around the fragment, which suggests that it fractured during the most recent dislocation - but the possibility that this small fracture is old has not been ruled out, and is not clinically significant at this point.
3. My patella does not rest properly in relation to the femur. I don't think he gave it a name, but research suggests something along the lines of a femoropatellar problem. He attributes this to the frequency and ease by which I have dislocated my knees.

To expand on that, I've dislocated my knee in 2005, 07, 09, and 11. Respectively: playing hackey-sack, swimming, slipping on wet grass, and losing footing whilst throwing a snowball.

I've been reading posts on this forum for a couple days now and while certifiable experts are few and far between, there is a lot that I can learn from you all. With a bit of apprehension, I registered this account just minutes before making this post.

My main question is, what sort of pain and recovery process can I expect?

My specialist told me crutches for ~2 weeks and a flexible knee brace for ~6 weeks with PT lasting roughly 6 months.

Any input would be greatly appreciated, as I'm quite nervous for the procedure and whatnot. I've never had surgery beyond wisdom-teeth removal done before.

Thanks,

Phil.

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Impending Surgery
« Reply #1 on: January 26, 2011, 11:21:02 PM »
Hi Phil,

You have my sympathy - I was in the same position last year (facing my first surgery ever at 34 years old) and it's pretty daunting.

I had a straightforward ACL reconstruction, so I can speak to this aspect of your surgery based on my experience. Did your OS say whether he was going to address the other issues at the same time, or deal with the problems separately?

The first thing to find out about your ACL reconstruction is what kind of graft your surgeon prefers to use. There are three main options: autograft (where they take part of your patellar tendon or hamstring tendons to turn into a new ACL); allograft (where donor tissue is used) or a synthetic ligament (these are only available in certain countries, and not in the US). There are advantages and disadvantages to all three, and most surgeons have a strong preference for one or the other.

During the surgery they'll remove the remains of the old ACL, drill through the tibia and femur, and then thread the graft through these holes and secure it in place with interference screws or endobuttons. Pain levels vary considerably; I know folk who have almost no pain, and others (like myself) who found it pretty rough. In my case it was partly my own fault, as I didn't get on the pain meds fast enough after going home from the hospital. As soon as I got them back on track, the pain actually became quite manageable. (Learn from my mistake - take your pain meds on schedule, including setting an alarm to take them through the night, and don't let it get ahead of you!)

Recovery is long and slow, but straightforward. The early stages are about allowing the knee to recover from the immediate trauma of surgery, then regaining flex and extension and getting your muscles firing again. You then work through a very careful rehab program for 6-8 months; this focuses on protecting the graft initially while it heals and develops a blood supply, and then gradually works you up toward more testing exercises and a return to sports. The exact protocol will vary depending on the graft and fixation used, your surgeon's preferences, and any issues specific to your own recovery. It does take a fair bit of commitment, and it's really important to stick to the protocol. The good news is that the surgery has a good success rate provided you do this.

Hope this helps. There's a ton of information over on the Information Hub about graft choices, rehab protocols and so on, so I definitely recommend doing some reading to find out more. There are also lots of tips that folk here can share as you get nearer your surgery, like getting a Cryocuff to help with icing the knee right after you get home. If you have questions, just ask - this is a very helpful community with a ton of experience. :)

Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #2 on: January 27, 2011, 02:15:16 AM »
Thank you for your sympathy and reply.

My OS will remove the patella fragment during surgery, and I was told this surgery would help fix the femoropateller misalignment. My other leg will still have a misalignment, but I have fewer problems with that leg as is.

I'll be using an allograft because my OS explained that taking hamstring tendons would reduce the structural stability of my leg and knee, if only slightly. He recommended the allograft and I trust his opinion. He's the head of his department at a well-known hospital here in Boston and quite knowledgeable.

I've read about the Cryocuff and I think I'll be purchasing a self-contained unit. I'd definitely use it on those days when my knees bother me (during atmospheric pressure changes prior to storms, etc.) too.

To your knowledge (or anyone else reading) are there non-slip or traction-enhancing crutch tips? I'm in Boston, and during the winter it gets extremely icy and treacherous even for people who don't have stability issues. I've already got plans to order those non-slip things you slip over your shoes, but I fear that using crutches on the ice is an accident waiting to happen.

Pre-surgery, pending the approval of my anesthesiologist and OS, I'll be taking Bromelain supplements. I've had success with Bromelain in the past with reducing pain, inflammation, and bleeding during and post-surgery with my wisdom teeth. I know it can interfere slightly with some narcotics and sedatives, so I'll need to make sure prior to use. Has anyone else had any success with Bromelain in regards to knee surgery?

Thanks again,

Phil

Offline knee always hurts

  • Forum Faithful
  • ****
  • Posts: 233
  • Liked: 0
Re: Impending Surgery
« Reply #3 on: January 27, 2011, 06:16:17 AM »
Hello to a fellow Bay Stater! The winter has been particularly nasty this year, hasn't it?

I've been using crutches almost continuously for the past few months as a result of the severity of my knee condition, and more than once I've found myself in places that were treacherously icy. I have to say, though, that the regular crutch tips seemed to be OK so long as you are careful about it. A couple of times I almost took a nasty fall, but it was as a result of my shoes and not the crutches! But if you are still concerned about it, look at these tips on amazon.com:

http://www.amazon.com/Retractable-Snow-Spike-Canes-Crutches/dp/B002W7CZ3Y/ref=pd_bxgy_hpc_text_b


There are a couple of other ones linked from that page, as well.

That looks like quite the surgery there. Good luck to you!

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Impending Surgery
« Reply #4 on: January 27, 2011, 06:42:12 AM »
Sounds like you've done your research, and you also have a good surgeon - that's two of the main hurdles out of the way. :) An allograft is a good choice, especially if you have other knee issues; I don't regret having an autograft, but having seen all the various experiences of folk on the board there's no question that the immediate post-surgical recovery from the allograft reconstruction is easier. A lot of the pain I had in the early days came from the hamstring harvest site.

I'm trying to think of other useful tips for your surgery. As someone who'd never undergone any kind of surgery before, I was really freaked out about the anaesthetic but it turned out to be no big deal at all. I still don't really like the concept of being knocked out, but I came around really quick and didn't have any bad after-effects. The worst thing right after surgery was that I was incredibly thirsty and had a sore throat from the breathing tube, but for an hour or so they wouldn't give me water and would only let me have ice chips to suck.

Will you have someone to look after you for the first few days when you get home? You'll be pretty incapacitated for a day or two, so it's good to have someone around to help out. Having a small backpack handy is really helpful when you're on crutches, too. If you're elevating your leg, make sure it's above your heart. Also, don't give in to the temptation to put a cushion or pillow under the bad leg, even though it's more comfortable - this actually stops you regaining normal extension. Instead put the pillow under your foot, and gravity will encourage your knee into natural extension.

I definitely recommend the Cryocuff. It was my best friend during the immediate post-surgical period. :)

Do you have a date for your surgery yet?
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #5 on: January 27, 2011, 10:21:21 PM »
My surgery is scheduled for February 3rd, approaching pretty quickly!

I received a call from my doctor and he said he was reviewing my CT scans and MRI results and noticed a problem with my Medial Petellofemoral Ligament itself.

In addition to the ACL, he's going to need to replace that via allograft as well. The news just gets worse and worse unfortunately.

The surgery is on a Thursday, and I don't have classes on Friday so I'll just end up going home (which is only 30 minutes from campus anyways) for the weekend. The Beanpot (College Hockey tournament) is the following Monday night, and I'm really hoping to be able to make it to it somehow. But I'm not going to put my leg in any sort of jeopardy to do so - it's important that I'm there, but my health is more important.

Offline Snowy

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • Posts: 2555
  • Liked: 93
Re: Impending Surgery
« Reply #6 on: January 27, 2011, 10:53:21 PM »
Yikes - that's too bad about the MPFL. If you head over to the post-op diaries section and do some searching for MPFL reconstruction, you should be able to find some diaries that walk you through the immediate recovery from this procedure. I think it's not uncommon to tear both the MPFL and ACL in a dislocation, so hopefully you'll be able to find something from someone who's been through both reconstructions at the same time.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #7 on: January 29, 2011, 11:14:30 PM »
I definitely plan on writing a post-op "blog" of sorts, detailing my recovery - if people are interested. I'm sure someone will be interested eventually, seeing as this topic has gathered 126 views (this is a mighty busy forum!).

I just ordered my Hibiclens and Cryocuff from Amazon. 4 dollar one day shipping is great, and it beats walking to the pharmacy for sure.

My knee's been in a good deal of pain lately, but is managed fairly well with acetaminophen. It was beginning to feel better last week, but it's definitely taken a turn for the worse recently. Any doubt that this surgery is needed have flown out the window.

Right now I'm just trying to enjoy being able to walk in a brace, not having to depend on others to help me with things. There are fewer things I hate than relying on others to live my life somewhat normally. This is going to be extraordinarily difficult and trying for me.

To be honest, I'm more concerned about managing school through all of this. I'm in a fairly fast-paced doctoral program for pharmacy and I'm worried that I won't be able to think clearly while taking the narcotics I'm sure I'll need post-surgery. I have a low pain tolerance but I don't look forward to taking them.

I have at least 2 labs, a quiz, and a test every week until the end of the semester in mid-April.

If I can make it through this, next year will be a piece of cake.

Thanks for reading (and replying)!

Phil

Offline smillie

  • SuperKNEEgeek
  • *****
  • Posts: 1438
  • Liked: 1
Re: Impending Surgery
« Reply #8 on: January 30, 2011, 12:15:04 AM »
I'm currently trying to focus and function and take narcotics and it's harder than I remembered. I can't seem to spell to save my life! LOL

Definitely go read some post-op diaries for the mpfl procedure. Most people (all?) find it pretty painful. Your schedule is definitely going to be impacted. It's better to go into it with some realistic expectations and contingency plans in place. You don't sound like you are planning on taking any time off to recover. Read others' experiences and make sure you know what you're getting into.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #9 on: January 30, 2011, 12:24:36 AM »
I've definitely already made plans as far as my schedule goes.

I dropped my elective which was optional to begin with. One of my classes' lectures are recorded, voice and video. And my 3 roommates attend all of my other classes and can provide me with notes and whatnot.

The hardest thing will be getting food, but my school has a place where you can use meal card swipes for take out food (healthy stuff too, everything from fruits and veggies to burgers and whatnot). I can give my roommates my card to get me food while they're there.

I plan on getting in touch with my professors to let them know what's going on. I am one of (sometimes) 300 people in a lecture so I doubt they care much to be honest.

Offline smillie

  • SuperKNEEgeek
  • *****
  • Posts: 1438
  • Liked: 1
Re: Impending Surgery
« Reply #10 on: January 30, 2011, 02:50:38 AM »
Good, your earlier message sounded like you planned to be back in class on Monday. I didn't want you to think you would feel like crutching across campus and sitting in a lecture hall for an hour or more or standing at a lab bench for a while.  Also consider your bathroom and bathing situation. It's more challenging than you might expect at first.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #11 on: January 30, 2011, 04:58:09 AM »
My suite is the handicap suite, by random chance. Our bathroom is already fitted with support bars everywhere.

I imagine it'll still be tough, but manageable.

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #12 on: January 30, 2011, 11:26:22 AM »
Having major anxiety about this surgery...

I've been up all night studying organic chemistry and reading/watching blogs about recovery and it just seems like the most painful thing known to man. People unable to sleep because of the pain, doubled-over in agony.

I have no idea how I'm going to manage this and not failing out of this semester.

There's no use in getting all anxious about it now, it does nobody any good.

Also, excuse the stream-of-consciousness writing. I don't have anywhere else (or anyone else) to vent.

Offline cole.p

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Impending Surgery
« Reply #13 on: January 31, 2011, 05:13:48 PM »
Does anyone have any experiences with CPM (Continuous Passive Motion) machines after surgery?

I just got a call from a DME supplier saying that my doctor has ordered one for me to take home, to use for roughly 6 hours a day after surgery.

How long did you have to use a CPM after surgery?

Offline smillie

  • SuperKNEEgeek
  • *****
  • Posts: 1438
  • Liked: 1
Re: Impending Surgery
« Reply #14 on: January 31, 2011, 05:39:24 PM »
I've used one before. It keeps your knee moving without you having to use your muscles to do it. The length of time you have to use it depends on your doctor. You could call his office and ask, though.
patella pain began early teens
'94 TTT/LR/VMO adv.
'94 MUA
'10 tried PT again
1/11 scope/hardware removal
4/11 (Finally!) dx medial instability due to LR
5/9/11 LPFL reconstruction scheduled















support