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Author Topic: Tore my ACL + bucket handle tear of my meniscus. Where do I go from here?  (Read 2167 times)

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Offline reskoner

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Hey guys,
I am new to this forum I just stumbled onto it last night trying to find information about what to expect from a recovery/rehabilitation standpoint (obviously every knee injury/person is different).  I just wanted some general guidelines because it seems like everything is such a long process and it's incredibly daunting and disheartening to be at the start of what seems like a neverending journey.

What happened: I was playing basketball (after a few weeks off for the holidays) in my regular Monday night league, and I was driving full force down the lane, and someone passed me the ball a little behind me and I had to twist/reach back to get it.  I heard the most sickening disgusting sound, it sounded like a candy wrapper being ripped off, and fell to the ground in pain.  I went to the ER where they gave me crutches and took a useless X-ray (it's torn, not broken).  I went to see the Orthopedist the next day, and they gave a preliminary diagnosis based on the swelling and a brief examination of a torn ACL.  They sent me for an MRI that evening, and in the morning the doctor called me and gave me  the final diagnosis (which turned out to be much worse than they anticipated).

Diagnosis:
rupture of the anterior cruciate ligament with a displaced bucket handle tear over a portion of the lateral
meniscus as well as a vertical nondisplaced tear of the posterior  horn of the medial meniscus. There is a sprain of the MCL and the lateral collateral ligament and a focal chondral defect of the medial femoral condyle.

Surgery:
I am scheduled for surgery on the 20th (a week from today), and in the meantime I have had one PT session (and two more this week) so the knee can be in the best shape possible (with as little swelling as possible and as much range of motion) such that I have the least risk of arthofibrosis. I am in a knee brace that's unlocked in the meantime so I can walk around on crutches, but I live in a house with 3 flights of narrow/steep stairs and I am basically homebound which is incredibly frustrating (not to mention it's hard to take a shower).  Luckily I have a wife to help but I also have an 8-month old baby girl and I can't carry her around while on crutches.


My questions for you guys are as follows:
1)  What are the steps to recovery after this type of injury (assuming they can repair the meniscus tear.
2) How long will I be on crutches for, in other words, how long will it be before I can walk?  It's so unbelievably debilitating not to be able to walk without crutches. 
3) How soon will I be able to travel on an airplane and such? (I travel for work so this is a concern).
4) How long is the recovery process in general and what are the stages?
4) any other pieces of advice to help me out? I know the journey is long and painful so I don't want to lose heart.


Thank you so much for any advice or things to expect,
reskoner

Offline MDAL

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ACL ruptures are among the top ortho issues... far more common than it may seem.

Sometimes they come accompanied by meniscus tears.

1)  What are the steps to recovery after this type of injury (assuming they can repair the meniscus tear.


They will try to plug back what they can of the meniscus with stitches and remove the parts that have less potential to heal. Literature is variable but mentions a recovery time of around 9 months for ACLs, but some patients can walk after a few weeks... it is very individual and at the same time requires some patience so you don't break the graft.

Some parts will be permanent problems, like some loss of range of motion. It mostly depends on how fast you recover it in the early weeks.

If you loose parts of the meniscus it may lead to future cartilage problems since there is less shock absorbent material.

2) How long will I be on crutches for, in other words, how long will it be before I can walk?  It's so unbelievably debilitating not to be able to walk without crutches.

Depends from person to person... often a few weeks.

3) How soon will I be able to travel on an airplane and such? (I travel for work so this is a concern).


You can take crutches to airplanes... but it might be recommendable not to engage in adventures for a few weeks... You need to ask this to your doctor...

4) How long is the recovery process in general and what are the stages?


First a bit of patience and some attempt to recover ROM as soon as possible. CPM machine might be of help along with exercises but you PT and surgeon should give you instructions. Then comes build back the muscles (they do get wasted fast with low activity) and later stabilization exercises as well. Although the recovery to a point you can walk/limp around could be a few weeks, a recovery in a more wider sense could be of about a year.

4) any other pieces of advice to help me out? I know the journey is long and painful so I don't want to lose heart.


Yes, ensure that you have a competent and motivated PT to guide you from the earliest stage to do whatever is possible from the beginning. Don't let yourself go home to lay down and wait without guidance (this often happens) and scar tissue forms and then it's not so easy to fix.

Do all the home exercises recommended and don't pick just your favorites as we all tend to do.

Try to get a CPM machine as soon as possible and follow the protocol the doctor recommends in terms of angles allowed.

Try passive activation of the quads (laying in bed) activate them several times... or get a TENS machine if your PT and surgeon agree. The earlier you start activating quads the less they will shut (and quads are hard to recover).

Good luck in your journey.

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If wanting some straightforward info for patients, these primers are very good

http://www.kneeguru.co.uk/KNEEnotes/primers/meniscus-primer
http://www.kneeguru.co.uk/KNEEnotes/primers/cruciate-ligament-primer

For flying, you'll need to be cleared by your surgeon due to the increased risk of DVT.  I would expect not to be flying for at least 6 weeks unless essential and cleared to do so

There are plenty of ACL surgery stories around the forums, bearing in mind everyone is different, every surgeon and surgery are different.  The Post-op diaries and ACL forum a good place to start

How old are you, that may well have a bearing on whether the meniscus is stitched or trimmed (as the meniscus tissue becomes less conducive to repair as you get older, often as early as 30)

Good luck with the surgery :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline reskoner

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thank you so much guys for your responses.  i am 35, and in good health otherwise.  they are going to use my hamstring (not a cadaver) and I was told by the PT that this might add some time to the recovery process, but is better in the long run. 

mdal: the problem is it's not just an ACL, it's ACL + Lateral meniscus bucket handle tear + another medial mensicus tear, so is it really possible to walk after a few weeks post OP given those parameters? or should i be expecting more 6 weeks? really appreciate the answers.

Offline MDAL

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Reskoner:

About walking it's the ACL you need to worry about, mostly so you don't break the graft in the early days, not so much the meniscus (but depends). I had part of the meniscus cut off "to fix it" (actually both of them at the same time) and was told to get on my leg the day after.

The depends part is if some parts are stitched or just removed. If it's stitched the surgeon may tell you to limit the weight bearing for a few weeks, but each doctor has different protocols. There is no universal protocol in these things.

I think it's perfectly possible to walk after 6 weeks, I personally know an "idiot" in my own family who went running at that stage... but he regretted it... So walking with moderation yes, while I was in physio (as in patient) I saw several people walking without crutches at week 3 post ACL recon... but with a visible limp and with very reduced ROM...

Either way, I think you may be making a mistake if you want to rush things too much. After the surgery since the natural oil of the joint gets washed out and gets filled with nasty fluids, the cartilage will move with more friction, so you may both damage cartilage (which doesn't grow back), or open new tears in the meniscus... sometimes wanting to rush too much can be a serious mistake on multiple levels. 

I would do the possible exercise as instructed, but I wouldn't go rushing into causing more damage than you already have... better be patient for a few weeks, even if it causes troubles in other areas of your life, than make a mistake you will regret for the rest of it...




Offline garsonk

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Hey Reskoner - I think we're injury twins... I had the exact same injury, and with an 8 month baby girl at the time as well :).

I'm about 11 wks post surgery now, and can give you a few tips and perspective.

- The first week after surgery was really rough for me. The anesthesia and painkillers gave me a lot of nausea. Be prepared at home, especially with your wife taking care of you and baby; it will be tough on her too. Get a bathtub chair, pre-cook and freeze some meals, fresh sheets, take care of any outstanding issues around the house. Do as much as you can before the surgery to prepare, both mentally and physically.

- I was on two crutches for 3-4 weeks, one crutch at 4 weeks and then walking after 5 weeks with no limp. I started carrying the baby at 6 or 7 weeks, but very carefully.

- Listen to your surgeon and physiotherapist. Check with them regarding the airplane travel. A compression sleeve and some ice in a ziplock bag that can be refilled on the plane would probably help.

- At about 6-8 weeks my energy started to get back to normal and I felt a lot better. Currently at 11 weeks most every day tasks feel like they used to, except no running and my knee feels "crunchy" most of the time.

- The first 2 weeks were the hardest for me. Get past that and the recovery gets much better. You WILL get better and stronger, you just have to stay positive and focus on getting better. It will be incredibly frustrating not being able to do things like carry your daughter or take a shower by yourself, but just be patient and don't do anything dumb. Listen to your body and the doctors. Good luck!!




Offline reskoner

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These responses are fantastic, thank you so much. 

One more question I forgot to ask:
1) how long were you on opiate pain medications (I work a job where deep thinking is required and need to be mentally sharp).  I cannot risk working if I am not at 100% mental capacity.

Thank you so much, this has been extremely helpful,
reskoner.

Offline reskoner

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Also, a more general question,

1) I noticed discoloration underneath my arms on my torso from the crutches, what is the best solution for this? Right now I have my baby's burping blankets wrapped as towels for more padding lol. 

and

2) can anyone recommend a good CRM machine that won't break the bank?

thank you,
reskoner

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Guessing you're in the usa where they seem to favour underarm crutches? Can you perhaps in a pair of the elbow variety used here in Europe?

And it's a cpm machine, best ask the specialist about that, not all surgeons favour them. Rarely used in the uk for example
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline MDAL

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Also, a more general question,

1) I noticed discoloration underneath my arms on my torso from the crutches, what is the best solution for this? Right now I have my baby's burping blankets wrapped as towels for more padding lol. 

and

2) can anyone recommend a good CRM machine that won't break the bank?

thank you,
reskoner

Most people rent the CPM machine which makes more sense than buying... You only need it a few weeks max. Most of them only go up to 120 degrees, so you might reach that soon and the rest will have to go the old fashioned way. Perhaps a google search in your area could help you find a renting company. I am in Europe but I rent it for like 12 dollars a day.

Just make sure you ask the surgeon what degree is the limit at each point, you don't want to break the graft...

About the crutches is that an allergic reaction to some material or the actual mechanical force? Looks like to little time to be some mechanical thing, I suppose it could be some allergy to the material?

Offline MDAL

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These responses are fantastic, thank you so much. 

One more question I forgot to ask:
1) how long were you on opiate pain medications (I work a job where deep thinking is required and need to be mentally sharp).  I cannot risk working if I am not at 100% mental capacity.

Thank you so much, this has been extremely helpful,
reskoner.

Depends a lot from person to person... and surgery to surgery. Had surgeries where I almost killed the nurse for more and kept taking for weeks, others that I only took it 1 day.

Offline garsonk

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These responses are fantastic, thank you so much. 

One more question I forgot to ask:
1) how long were you on opiate pain medications (I work a job where deep thinking is required and need to be mentally sharp).  I cannot risk working if I am not at 100% mental capacity.

Thank you so much, this has been extremely helpful,
reskoner.

For me, I got Oxycodone and Tylenol 3. I used the Oxy for about a week and a half. I would not recommend any deep thinking while on it. I wasn't very functional. Tylenol 3 was OK though.

Quote
1) I noticed discoloration underneath my arms on my torso from the crutches, what is the best solution for this? Right now I have my baby's burping blankets wrapped as towels for more padding lol. 

Try to use your arms more when you use your crutches. Activate your triceps/shoulders and get a good grip on the crutches. Helps maintain some strength as well. If you dig the crutches in to your armpits too much you will get issues. You're basically bearing your weight on to your armpits while creating friction as you move, so you want to avoid that and use your arms more.















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