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Author Topic: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!  (Read 53691 times)

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Offline Hobblescotch

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ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« on: June 12, 2013, 06:41:48 PM »
Welcome!

Hi kneeguru friends! I have been reading the forums since my diagnosis last November, but since I knew I was in for a long wait, I didn't participate. It's been incredibly educational to read everyone else's experiences. Although my wait was long, the bright side is that I feel about as mentally prepared as I can be :)

I'm having a hamstring ACLr on June 20th, 2013! I'm absolutely thrilled. I completely tore my ACL in August 2012, and while I can still run, bike, and swim, I have career and lifestyle goals that require side-to-side movement and even *gasp* going down hills. My ACL rupture happened the usual way - jumping and landing badly, pop, swelling, etc. Somehow I managed to just get the ACL though, and my MCL and meniscus are fine - I was lucky!

I've known I needed surgery for a while, but expected to wait until Sept or Oct before it happened. As mentally prepared and psyched I am to get this over with, I'm not prepared in many other ways! My pre-hab has been a bit sporadic; my motivation declined with the wait, I admit. I've been reading threads about stuff that's helpful, which I need to make sure I pick up! I decided to start a post-op diary, even though I'm pre-op, to share the preparation stage and also to keep myself on track.

Any pre-op or post-op ACLr'ers with advice? Things you wish you'd known or had?
« Last Edit: September 14, 2013, 10:14:09 PM by Hobblescotch »

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #1 on: June 12, 2013, 07:19:47 PM »
T-8 days: Nesting

I've been checking out the "useful things" thread for ACL surgery, and looking around my house to see what I'm lacking. My spouse and I have recently moved, so I'm lacking several regular household things. Here's my "to get" list!

Cryo/Cuff
Ice cube trays (for anyone who has used a Cryo/Cuff, how much ice do you need per batch?)
Shoes with good grip and no laces
Skirts (strikes me that getting dressed is going to be difficult!)
Footstool for bathroom
Ankle weights
(eventually)
Stool softener
Books for my ereader
2 new video games!
Sheets for the spare bed
(don't want to get kicked in the night, so I'd better get the second bed set up!)
Frozen peas (lazy backup)
Anti-inflammatory, over-the-counter meds
Gauze, tubi-grip, other first aid stuff
Exercise mat
(my place is all carpet, so I think it would help with heel slides and stuff)
Extra pillows
Meal replacement drinks
(expecting a few days of nausea)
Stationary bicycle (check!)
Anti-bacterial soap (to wash the leg on the morning of surgery - found a surgeon's guide which recommended it to decrease infection risk)
Tape measure (for comparing legs)

Whew, that's quite a long list! The only thing I have is a stationary bike. I've ordered the Cryo/Cuff, and am going on a shopping spree tomorrow! In addition to all of this stuff, there are lots of things I have to get done. Here's my pre-op "to-do" list:

Send confirmation letter to hospital
Get a haircut
Do all the dishes
Do all the laundry
Cook some meals in advance
(spouse is around, but working, so best to be prepared)
Set up bed, with entertainment and drugs nearby
Do pre-hab exercises!
Get groceries
Clear floor space



Does anyone have any advice for the shower? I have a tub/shower, and the tub is very high and narrow - I have trouble getting in and out now, and my knee feels almost normal! I'd get a shower stool, but I'm not sure I'll even be able to get IN the tub. Once I can get to the gym I can shower there, but I may be in for a stinky couple of months :P

Can you think of anything I'm missing?



« Last Edit: June 12, 2013, 07:54:18 PM by Hobblescotch »

Offline WonkeyDonkey

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #2 on: June 12, 2013, 09:34:49 PM »
Hi Hobblescotch

I used a Cryo cuff after my HTO and instead of using ice cube trays I bought small plastic pots (about 2 inch square)with lids to make larger ice cubes. However after a while my husband stopped using them and started to use some baby food plastic pots as they were larger and I only need one of them in the cryo cuff at a time. I always had four in the freezer at a time though. They were about five inch square and inch and a half deep.

Good luck with your op.

WD

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #3 on: June 13, 2013, 08:25:32 PM »
Thanks for the info WD - I think I'll start saving some small yogurt containers to make bigger ice cubes in, and keep an eye out for other appropriately-sized packaging. I have a tiny fridge and freezer, so I'm glad I don't need a whole lot of ice :)

Offline gottarun13

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #4 on: June 13, 2013, 10:44:17 PM »
I had did to do sink bathing for a couple of weeks because our tub is so high.  However, a shower head that removes is awesome.....or a kitchen sink with one of those removable heads is great.  I would sit in a chair and wash my hair sitting down at the kitchen sink. 

I use my exercise mat for everything except heal slides.  My mat is a yoga mat and my foot sticks to it, so if you wear a sock and do heal slides on the carpet you may find it goes much better.

I had to get a couple of skirts, a pair of shorts and I also got a pair of larger yoga capris (they tie at the waist).  They fit over the brace and, for me at least, have been the most comfortable.

I wish you and easy surgery and a speedy recovery!!

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #5 on: June 14, 2013, 07:53:35 PM »
Yeah, sink bathing may be the way to go for a while. I have a removable shower head, but will need some help to get it down :) At least there's no worry of getting the knee dressings wet!

It's strangely fun doing all of this prep work. It helps me think of something other than the long recovery after - not to mention helping out the future, hobbly me. I'll add wide-leg yoga capris to the shopping list!

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #6 on: June 15, 2013, 01:06:18 PM »
T-5 days: Resources

If you're reading this message board before your op, you're probably one of those people who likes to know what they're getting into. I'm definitely all about the research. Since my torn ACL was diagnosed in November, I have scoured the internet for info. By the time I saw a surgeon in June, I knew I wanted surgery, specifically a hamstring graft, had a good theoretical understanding of the recovery process, and a general idea of the variations in surgeon protocol. With my op fast approaching, I'm going back to read a lot of the helpful articles, and figured I'd post them here for those who are interested (and for me to refer back to when I'm panicking about my progress)  :)

Blogs and Discussions
I found it incredibly helpful to read about other people's experiences - it really highlights how every recovery is unique, and bumps in the road aren't necessarily the end of the road. Here are a few of my favourites:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=52154.0 - one of Kneegeek's finest, Snowy's diary was one of the first I read. She's kept a comprehensive record of her ups and downs, and it's incredibly inspiring to see how far she's come despite some obstacles! Thanks Snowy :)

http://yeskneecan.com/ - a great account of a young woman's patellar tendon ACLR, with an active comments section. Great pictures,videos, information - it's an excellent read!

http://aclrehab.blogspot.co.uk/ - The last post on this blog was in Feb 2012, 16 months after his hamstring ACLr. He describes his progress in detail, and I enjoyed the pictures of the post-op knees (don't worry, nothing gory)

http://board.crossfit.com/showthread.php?t=24293 - this thread on a crossfit forum now has 130 pages of first-hand accounts from people considering surgery, discussing options, and sharing their post-op experiences. Patellar tendon, hamstring, allograft, quad grafts; incredible recoveries and failed grafts; common and unusual concerns; all discussed in one thread.

http://myaclreconstruction.blogspot.co.uk/ - an active tennis player/skier his early 50s kept this blog of his hamstring ACLr in 2007, and came back almost 5 years later to give an update.

Articles and studies

http://www.mikereinold.com/2013/03/rehabilitation-following-acl-reconstruction-surgery.html - Mike is a physical therapist who has a great series of articles on post-op rehab. Obviously, always follow the advice of your OS and PT, since they know your situation and condition. However, this article concisely outlines the priorities in the early post-op phase.

http://www.kneeguru.co.uk/KNEEnotes/courses/cruciate-ligament-rehabilitation-course-lesley-hall-msc-mcsp - a kneeguru course that broadly covers the ACL basics; what the ligament does, post-injury rehab, making a surgery decision, and post-op management. I found this very useful when first making sense of my injury.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015903/ - This fairly recent review of patellar tendon vs. hamstring grafts for ACLr was done in 2011, and outlines the pros and cons of each.

http://informahealthcare.com/doi/pdf/10.3109/17453674.2012.704563 - I was directed to these recommendations from the Dutch Orthopedic Association from a thread started by 'The KneeGuru' on this forum. It reviews the scientific literature and makes recommendations for optimal diagnosis and treatment of ACL injuries. It's not an easy read, but well worth it.

Videos
I've not yet had the stomach to watch any live ACL reconstructions, but I found some animated explanations very helpful to understand how the reconstruction is performed and where the incisions will be. If you have any video recommendations (even the graphic ones, I think I'm up for it now!), let me know!

http://www.youtube.com/watch?v=Xsq0sQp6DwU - this is my favourite hamstring ACLr animation. It answered a lot of my questions about incision sites, harvesting, and drill placement.

http://www.massgeneral.org/ortho/patienteducation/videos.aspx - the patient education section of the Massachusetts General Hospital ortho unit has a number of animations showing ACL repairs; B-PT-B, hamstring, quad and allograft. Just click on 'knee', and select whichever graft interests you.

That's it for now - I'll update when I stumble across my other favourites, or if someone is kind enough to suggest theirs :)
« Last Edit: June 15, 2013, 01:14:53 PM by Hobblescotch »

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #7 on: June 20, 2013, 06:12:04 AM »
Today's the Day!

I'm just about to head in to the hospital, and was so excited and nervous last night that I couldn't get to sleep! It doesn't seem to have affected my energy, however. I'm raring to go and get this over with. I'm walking to the hospital, 25 minutes away, and enjoying the outdoors and a functional knee for the last little while!

I have a knot in my stomach for the things that could happen - I've never been admitted to hospital before, let alone had surgery! But in order to live the life I want, I know I have to get a bit sliced and diced!

See you on the other side :D

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #8 on: June 21, 2013, 10:12:26 AM »
Immediately Post-Op!
Well, that seemed to go well!

I arrived at the hospital a little before 7am, and decided to walk up the stairs to the 7th floor; you know, one last hurrah. The hospital fashion was incredible, and I was fitted up in a hospital gown, the weirdest cotton mesh underwear, and a compression stocking on the non-operative leg. Eventually, the OS and anesthetist came in, I asked a few last-minute questions, and signed off on the op. The anesthetist warned me that this was a painful surgery, and it was actually a relief to me to hear that and know what to expect. I didn't get a femoral nerve block, since my OS doesn't like the loss of muscle control after.

They wheeled me down, and I remember them chatting with me and telling me that they were giving me the anesthetic. I never even saw the operating room.

A couple of hours later, I was in the post-op room. I remember being in a lot of pain, but I was so groggy that it didn't matter that much. It was like waking up with a headache - before it actually wakes you up, you kind of notice it but you can kind of put it off. Honestly, it felt like someone had been drilling in my bones (crazy, right?), and felt a lot like when I first injured the knee, and was desperate to bend it slightly to get the worst of the pain to stop. They gave me a bunch of tramadol, but I still had a lot of pain so I got some morphine. Since then, the pain has been completely tolerable.

I was back on the ward about 3 hours after they took me away, and was there for about 4 hours, dozing, before they sent me home. I was really woozy from the anesthetic. Eventually I was able to get up and go to the bathroom, and had no problem on crutches partially weight-bearing. Standing or sitting made my head swim, and it was kind of difficult to pee! But I was expecting to have hamstring pain when I sat, and it didn't hurt at all. I got a chair ride downstairs, and took a 5 minute cab ride home. That was super uncomfortable, and the driver was really loud and inappropriate! But we made it, and I had to sit with my head supported for a few minutes before I could get up on the crutches. Not trusting my balance, I went up the 4 flights of stairs on my bum, very slowly :D

Despite my wooziness, I was able to take a few steps without crutches, my extension is at 0 and even hyperextension after some heel hangs, and my flexion is over 90 degrees once I'm warmed up. I didn't have any trouble sleeping on my back with my leg straight on a pillow ramp, and just had to get up to go to the bathroom. No calf rush yet! Today I'm feeling more sore, since the exotic pain-killers are wearing off. On the plus side, I can eat normally and sit up without the dizzies.

The cryo cuff is working great for compression, but I have such thick bandages on that I can barely feel the cold. Did anyone else have this? I'm supposed to leave the bandages on until tomorrow, but it'd be great to be able to ice the knee before then.

To be honest, I expected to be way more sore and groggy than I am. I'm very happy with how things are progressing, and starting to do some basic exercises every hour or so when I'm awake (I've mostly been asleep). Ankle pumps, quad sets, heels slides and heel hangs. The physio also told me to do some standing calf raises and hamstring curls on my stomach, but I'm a bit confused; I thought I wasn't supposed to do open chain exercises (the physio told me that, but then gave me the hamstring curls)?

Also, when did people start on the stationary bicycle? I can't wait to get this stiff knee moving a bit more.

So, yeah, not so bad. Staying on top of the meds. When I had my original injury, I didn't do anything to make my life easier - I kept my leg bent at the knee, had the occasional ibuprofene, and maybe an ice pack on occasion. No crutches, no exercises, no consistent pain meds. Surgery with good support feels no worse than the injury for me, so far!

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #9 on: June 21, 2013, 10:17:37 AM »
Oh, I forgot to add - apparently I have two small tears in my meniscus that my OS didn't touch during the surgery. He thinks with a stable knee they may well resolve themselves, and if they give me trouble we can deal with it later. Considering I had no pain before the surgery, I'm not anticipating any problems, but it has me a little worried. I'm planning to get more detail from my OS about what these tears mean in the long-term when I go back for my 2ish-week checkup.

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #10 on: June 22, 2013, 10:09:39 AM »
Days 1&2 post op

After writing my last post, some of the anesthetic wore off and I started getting some really painful aches and graft site soreness. It was especially bad at night, about 36 hours after the surgery, and just keeping my knee straight on a pillow ramp felt like too much. I'd been trying to space out my drugs (co-codamol and diclofenac) every 6 hours, since I'm only supposed to take them 4 times a day, but I caved and went with 4.5 hours in between my nighttime doses. Wow, does that feel better! It also knocks me out, so I slept right through the night.

I'm trying to do my exercises every hour or so when I'm awake, but I sleep a lot and even just doing 3 or 4 exercises takes a while, and I elevate and ice in between. So really, it's more like 5-6 times per day.

So, this morning I got to take off the bandages. It was like Christmas! My knee had been covered by thick cotton gauze and a tensor bandage, so it was pretty bulky. When they sent me home the bandage was snug, and I could tell my swelling was going down quite a bit by how droopy the wrapping was getting. When I took the bandages off, I was surprised to see so little swelling - my knee cap is clearly visible! My leg is still all pink from the antiseptic :)

I started to worry last night. I read another post on this forum that said not to bend the knee past 90 degrees, or you risk stretching the graft. I've been able to get around 110 degrees comfortably, and I was starting to panic that I'd been doing my knee damage. I re-read a bunch of rehab protocols, and while I see that ACL/meniscus repairs are restricted to 90 degrees, it's rarely mentioned for just ACLs. In fact, some surgeons encourage far more flexion ASAP. So I'm taking some deep breaths, doing my exercises gently, and being conservative with the flexion (just in case). It's unlikely that bending my operative knee to 110 degrees a few times yesterday will have done any harm to the graft.

On the bright side, now that the bandages are off, the cryo cuff feels amazing. Ahhh.

While I don't walk much (only to the bathroom and back), weight bearing is much more comfortable today. I can extend my leg much more when I walk, and feel much more in control. Still using the crutches, but I could probably limp around on my own now a bit.

Most people who injure their ACLs are athletic, energetic people. I like the occasional activity and serious workout, but I'm much more lazy at heart. Video games, movies, shows, books, and a puppy to cuddle here and there - I am having a great time staying in. No boredom here :D

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #11 on: June 24, 2013, 02:38:54 PM »
Day 3

It's officially been 72 hours since my surgery, and my confused little ACL is still adjusting well to its new home. Hang in there, little guy!

I had a bit of soreness in my hip/groin, probably from compensating with those muscles for the quad weakness. I still had some ability to use the quad; could do a couple of leg lifts and unassisted heel slides, but it was a struggle the first two days. Today, my quad is much stronger, and the leg is easier to move. I gave my hip a bit of a massage, and that soreness is going away. I can't really complain if the worst thing going on is a bit of hip fatigue!

I'm still taking co-codamol, and the codeine knocks me right out. I slept through the night, and napped in the morning. My leg was pretty stiff and swollen when I woke up, despite having been elevated overnight, but a little movement and ice brought it down to reasonable levels. It's amazing how much the knee likes to move - a few heel slides, and the entire joint feels more relaxed and comfortable. I still don't have much swelling, and just have a tiny bruise on my shin so far, but I'm expecting that to change as I usually bruise quite easily.

I'm not getting up often, though I am doing exercises and ankle pumps regularly, so I've not tested the weight bearing much. It feels okay, no more painful than any non-weight bearing movement, but I still don't want to trust it without the crutches. Knowing what's been done to the knee, it's hard to trust that it's capable of so much, even though it's proven strong and stable! Since I don't have a brace at all, I'm being doubly cautious. I don't put much weight on the crutches, but I'm not going anywhere without them.

I'm managing okay with the detachable shower head, though my bathroom's getting a good wetting as well! I wash my hair with that, and otherwise sponge-bathe. My spouse has been just lovely, bringing me food and drink and ice. I'm so lucky to be able to get lots of rest and have the opportunity to avoid risky activities!

Lastly, I'm cutting my cocodamol dose in half, since the pain is manageable and my supply is running low. Still setting an alarm during the night to take meds though - really don't want the pain to get ahead of me.

One more day of healing accomplished!

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #12 on: June 24, 2013, 02:58:26 PM »
Day 4!

Woke up this morning to more pain and stiffness, but considering that I cut back on the drugs, it was no worse than I expected. A few exercises and a bout with the cryo cuff, and I was feeling better than ever! The most painful site has been on the inner side of the tibia, presumably where they drilled and screwed. For the first few days, I've felt some moderate twangs whenever the leg was raised and the foot was unsupported (doing leg raises, getting into and out of bed, repositioning pillows, etc) and when doing quad sets. I supported the operated leg at the ankle with my other foot where possible, but it made doing exercises less than comfortable, though not usually painful. Today, that site seems to be much improved, and it's much easier to move around. It makes me more confident about walking, too, since I can use my quads to stabilize the leg without aggravating that area.

On the other hand, the hamstring harvest site is starting to twang, and is bruising nicely. I had begun to suspect that my surgeon had used an allograft, since I hadn't felt anything there before :D  It is sore enough to reassure me that the surgery actually happened, but not painful enough to be a bother!

I'm excited and nervous to have my first physio appointment tonight! I'm going to a private physio at a clinic that comes very highly recommended by my OS and other clients. There are so many different rehab protocols out there, and I'm so worried about doing something to damage the graft, that it'll be a huge relief to have someone I can trust to give me directions. Rehab is a huge factor in a successful ACLr, and the only one I have much control over, so I want to make sure I do it right! Or at least, don't do anything stupid :) I hadn't made arrangements for physio before surgery given how quickly things happened, but when I called yesterday and asked how soon they would want to see me after an ACL repair, they said usually 4-5 days.

In a week from now, I can take off the steri-strips and look at my incisions. These are the coolest things - it's like my leg is vacuum-packed! They do look a bit gross where the blood has been absorbed, and things sure are itchy underneath, but that's a good sign. Once I've been to physio, I'll post back what my new day 4 exercise routine will be!

Offline Hobblescotch

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #13 on: June 24, 2013, 07:49:02 PM »
Just got back from physio, my very first outing since my new ACL! I hadn't tried stairs yet, but they weren't as much of a challenge as I expected. I could feel my knee swell up the longer I was up and about, and tried to keep it moving. Since I've mostly just been crutching to the bathroom and back I didn't have a good feel for how the walking was going, but once I was out and about the gait became more smooth and I got much more confident.

The physio clinic is lovely, and all the staff very nice! My physio asked me a few questions, and had me bend and flex. He seemed impressed with my mobility - my quads are firing, and I can bend my op knee almost as far as my good one after sitting for half an hour and no warmup. He showed me how to walk around on one crutch, but advised not to ditch them totally, since there's no rush and I'm already doing well. He also showed me how to get around the stairs, which I never got to at the hospital. He briefly showed me some exercises I can slowly work up to in the next week, but said that the 3 main goals in the first week - control pain, improve ROM, and get the muscles responding - are all well on their way. I was worried that bending past 90 degrees would be bad for the graft, but he encouraged me to bend as I was able and that the graft was at its strongest right now. He's emailing me an exercise plan, and I'll go back next week. It seems like there's a lot of fun stuff I can start at 1 week postop, like stationary bike and patellar mobs (although I may not need them since my ROM is working well!).

It was a real ego boost, I tell ya.

I've ordered a swiss ball (surprisingly inexpensive) for later exercises. Right now I'm so happy to be back with my leg up and my cryo cuff providing sweet, sweet relief. I'm officially off the codeine, and while I had no pain at physio, I'm starting to get the sharp twang on the inside of my tibia, and weird spasms up and down my leg. What a wonderful and tiring day!

Offline gottarun13

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Re: ACLr Hamstring - Hobblescotch's Pre-Op and Beyond!
« Reply #14 on: June 24, 2013, 09:58:56 PM »
WOW, all very excellent!!!  Congrats on a good beginning recovery!!















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