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Author Topic: ACL + PLC Reconstruction - 23rd March 2011  (Read 9543 times)

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Offline DaVinche14

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ACL + PLC Reconstruction - 23rd March 2011
« on: March 24, 2011, 07:23:09 PM »
Hi guys,

A bit of history about my injury. In 2003 I suffered full dislocation of my right knee joint. Torn ACL, LCL, grade 2 tear of MCL and avulsion of biceps femoris. I had initial surgery to 'repair' LCL in the week following. I was told by the surgeon that due to the nature of the injury, I won't need ACL as my legs are strong enough to cope without. Following that advice, I attempted to play football and torn lateral meniscus...  Needless to say I pretty much gave up on sport. Especially after my OS's reluctance to recon ACL and revise LCL.

2010 and now I am blessed to have a little boy. I'm due to go to university to study physiotherapy in September, so spoke to my GP who referred me to a Mr Calder. He detected my deficient PLC/LCL with a number of dial tests etc…

From what I was told, the grafts (for ACL) will be gracillis tendon and semitendinosus tendon, however he kept them attached to their insertion on tibia and then doubled them up to make a four-strand graft. For my PCL/LCL semi-t graft which was 'looped' through head of fibular. I am aware that PLC reconstruction is rare-ish compared to straight ACL surgery so I'm going to try and update my progress as much as possible. Also if anyone has any questions, feel free to ask :)

Day 0


Day 1



Day 14





« Last Edit: April 06, 2011, 10:27:16 AM by DaVinche14 »
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #1 on: March 24, 2011, 07:48:15 PM »
Day 1&2:

Both legs are immobilsed, plus I have had a femoral nerve block. First thing I did when I came around was dorsi flexion of toes, which eliminated damage to fibular nerve. I have felt a few sharp pains in hamstring harvest site but nothing too concerning. The main source of pain comes from the LCL area and especially back of knee. I have to take dressings off tomorrow so I'll be able to give an indication of swelling and skin sensation. 
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline CamillaLuise

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #2 on: March 25, 2011, 10:28:23 AM »
Hey!

So how long will your rehabilitation period be?
Hope you are feeling better and that your swelling isn't too bad!

I have surgery in three weeks, TTT and lateral release. Be a long rehabilitation period and as you I want to get it over with so I can get a job (as I am just finishing my last year of 5 years at uni) sometime in the autumn, but it depends when my second knee will be done!

TTT and lateral release 15th April 2011 in London, UCLH
LR was not done when he was in there as he wanted me walking quicker rather than non weight bearing with an LR. He proposed he might do it later if there was still a lot of scar tissue.

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #3 on: March 25, 2011, 11:29:42 AM »
Hi, thanks, my rehab is set over 12 month, although I'm a quick healer I don't want to rush too much. I'll be on crutches for 12 weeks though :s. I've taken bandages off today too. Was lots of blood, more than I expected for sure
« Last Edit: March 25, 2011, 11:32:56 AM by DaVinche14 »
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #4 on: March 27, 2011, 01:39:25 PM »
Day 5 and nerve block has DEFINITELY worn off now! On the whole, pain is tolerable, and sometimes none existent. On the odd occasion though, I do get the most severe pains around head of fibula and tibia drill site. This has happened mostly when I have had a folded towel behind knee. On a scale of 1-10 I'd easily give the pain a 9! I have found that putting towel under ankle releives the pain.

Muscle wastage around quads has already kicked in big time unfortunately (to be expected) although I was building up muscle before the op. Still un-able to use vastus m&l as I have drill sites going through both muscles and just cannot get them fired up! I'm going to listen to my body though on this one.
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #5 on: March 31, 2011, 09:52:14 PM »
Well had my first session at Physio on Wednesday. And on the whole it went well. I've got 50-70 degrees rom, with the latter after getting the joint warmed up.  Exercise wise I was doing the right thing, although I had trouble with straight leg lifts, isometric quads and general activation of that area.

First hurdle set, first hurdle passed! During the assessment I was unable to do a straight leg lift! Well I could do one bent at around 30 degrees whilst letting hip flexors take over, but that defeats the object doesn't it! So that evening I went home and focused on quad work at full extension and by the end of the night I had mastered it! Just going to increase volume now. Will have something to show Physio when I go back on Monday! :-D
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #6 on: April 04, 2011, 07:45:10 PM »
Second session at Physio today, Physio is happy with my progress and I can now do full extension and 80 deg flexion. I can now do straight leg raises at full extension, although there is some lag because of swelling.

My quads are a disgrace at the moment so there is lots of work to do in coming months. My rehab can't really 'start' until 12 weeks post op when I can fwb.

So far the pain has been manageable, but night times are horrendous, meaning pain killers are a must (even though I'm not a fan of tablets).

I'm going to try and post more pictures tomorrow as well so you can see how much things have changed within 0-2 weeks.
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #7 on: April 06, 2011, 10:39:57 AM »
As promised I have added pictures (to the original post) and plan to continue doing this as a visual timeline. Initially I'm thinking to take next pics at 4 weeks, 6 weeks etc… but if I notice any major difference in swelling or scaring I will upload also. I have found the pain which keeps me up most nights is starting to fade now, which coincides with reduced swelling and a slight increase in RoM. I should be nwb for 6 weeks, but there are some scenarios where anything less than two feet just won't do! I would say that at the most I am putting 10% down. On the rare occasions that I've had to do that I have noticed no pain or discomfort. Still at this early stage, graft protection is the main priority.
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #8 on: April 07, 2011, 04:54:10 AM »
Not for the first time I have been woken by pain during the night! It 'feels' like it's coming from the drill site on the head of my fibula. The pain sharply decreases when I fully straighten leg and lock brace in zero degrees Ext.... Along with 2 x Dihydrocodeine ;-) On the whole this isn't worrying, as it is happening less frequently, but it sure is painful! When I palpate the area after an 'attack' (of pain) there is no residual pain at all. Whilst during one of these episodes, I cannot even think straight! Maybe it's part of the healing process of bone re-growing at drill site + nerve endings as well. I'll definitely keep this in mind when I see my Physio on Monday and again when I meet my OS at month end.
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline Clean_Tackle

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #9 on: April 11, 2011, 01:23:50 PM »
Hi DaVinche,

I want to wish you the best of luck w/ your rehab. Those pictures are gruesome bro. I thought my knee looked bad... but yours... well... that's a different story.  ;)

Hang in there dude.

- Clean_tackle


Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #10 on: April 11, 2011, 01:36:43 PM »
Lol cheers. I will do CT ;) got my 3rd Physio session in just over an hour. Hopefully I'll be cleared to drive! I've got the 'required' 90 deg flexion so fingers crossed!
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #11 on: April 11, 2011, 11:59:59 PM »
Well, had my 3rd Physio session today. It had it's ups n downs... Physically I'm fine, which is the main thing. Physio said I'm coming along fine with muscle strength and RoM, I can get 100 deg flexion which is great. This leads onto the 'downside' though! For whatever reason I was under the pression that I can drive when I have 90 deg flexion (must've seen it in a post or a protocol for another lig maybe). When I asked the Physio he said I won't be able to drive until fwb which is 9 WEEKS AWAY! has really messed up my plans for work, which I hoped to attend after 6 weeks. It now leaves me with two options: taxi which will be around £20-£25 per day or a half mile walk, followed by a bus to trainstation. Train to Bradford, and then a 5-10 min hobble on crutches :(

Anyway, that disappointment aside, the Physio taught me something which I thought was handy. He compared the movement of the skin on scar site to the same spot on oposing leg, and then explained scar tissue will heal in a 'block' from skin through to fascia so I need to massage to separate those layers, which will help prevent restriction in movement etc... I found the way he explained it was really clear and easy to understand.

So that's it for now. I have Physio again in three weeks time as pt is happy with progress and there is not much else I can do between now and because I'm nwb.
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #12 on: April 13, 2011, 08:27:04 AM »
Day 20/21
Yesterday was my first 'low' day so to speak. Bothersome pain from this surgery as well as one a week ago (unrelated to knee), argument with partner and the realisation that I am more or less 'housebound' for 9 more weeks all took their toll! I was mentally prepared for this, but just not the impact it would have on me and the others (loved ones) around me! Everyone has been great, but when looking after a child of 2 years it is easy to see how tension can mount. I really just cannot wait until I get to week 6 and can start pwb to atleast get some independence/social life back.

Well that's that off my chest, so I guess it's chin up and hold tight 'til May 4th (week 6)...
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #13 on: April 18, 2011, 12:30:50 AM »
Day 25

Once again I have noticed pain is decreasing steadily, as well as swelling. I was 'out n about' for a full day yesterday which was nice, seen as weather has been amazing recently. I've found two comfort zones, standing or laying down. When I am sat with my knee bent for a prolonged period of time it tends to bring on the onset of lateral joint pain. Coming up to the four week mark on Wednesday, so 1 (month) down 2 to go in terms of the first stage of rehab.

The scar itself is healing nicely too. My OS used the same scar laterally as in my first op, which means I won't be 'too' butchered. In my last post I was a bit down, but that was a small blip which I am now over. Thankfully I've a very supportive family around me :)
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft

Offline DaVinche14

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Re: ACL + PLC Reconstruction - 23rd March 2011
« Reply #14 on: April 29, 2011, 04:37:21 PM »
Okay, I'm well past the 1 month mark now. I've just had a week away, which was good as it gave me less time to dwell on progress. Not much to report really as I'm still 'NWB' but I do use affected leg to aide balance etc... At first, leg was very swollen as I was sat in car for A LONG while.

After a few days, the swelling settled down. What I have noticed though is the pain shifting every couple of days between drill sites: tibia, fibula and femur. Still doing exercises daily, but I now find more pain on tibial plateau when in full extension. If anyone has had this after ACLr (h/sing) please get in touch :)

Apart from that, I've got a Physio apt on the 3rd of May. I've had to cancel my first apt with OS on 16th May as I have an exam at same time. Because he is REALLY busy + all the bank holidays, the next available slot is 20th June: AFTER the 12 week NWB/PWB/Non-driving phase of rehab, which is disappointing as I would like to know how I'm doing! :-s
My Post-op Diary: http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=55672.0

Sep 2003: Major trauma to right knee; ruptured ACL, LCL, biceps femoris.
Sep 2003: LCL repair
Mar 2004: Lateral meniscus trim
Mar 2011: ACL + LCL/PLC recon w/L+R hamstring autograft















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