PFJR post op activity

[Dave33]

Will report on the skiing in 2-3 weeks.

Hi RGB - how did it go? Any improvement over the last trip?

I had a "bit" of a setback at 8 months... I played a hockey game about two weeks ago, and a day or two later, the knee responded with a fair bit of delayed pain and swelling that took a full week to get back under control. I had been pushing it more and more over the last few months, and perhaps I went past the envelope of function.

 I was initially worried that perhaps I'd damaged the implant, but there was no fall or impact of any kind during the game, and no pain during or even in the hours post-game, so I've chalked this up to simply overload.....

My quad/vmo is still drastically underdeveloped vs the non replaced side; I've started a regimen of 1 leg cycling on the ergo (the other knee can't tolerate the cycling motion) to try and get the supporting muscles stronger. Hopefully this provides better results.

I remember that you mentioned in the first year of your recovery that you were limited to one "hard" sporting effort a week; is what I mentioned above similar to your experiences when you overdid it? You were mentioning that your results and tolerance had improved past the 1 year mark, so I'm hoping I'm following in your kneesteps, as it were.

cheers

[RGB]

Hi Dave33. Just finished 4 days skiing and no ill effects. Yes! I'm back. The season is pretty poor here and it's early so there was only man-made snow on intermediate piste. However, I skiiied reasonably quickly for the 4 full days and my knee felt very close to normal. So much so that I invested in a pair of ski boots so as to make all the days I intend to ski in the future a bit more fun. I don't mind renting skis - if you pay enough they're pretty good and you can pick models to suit the conditions. However, I hate renting boots.

As regards your temporary set back, it doesn't sound anything more than that to me. I've had a few and I may get a few more although it's been a while since the last. You're right, for the first year or so, I couldn't do any more than one hard session per week - by hard session I mean something like a one hour continuous uphill ride. Also, I couldn't really do any 'normal' squats or similar. Any of this would lead to some mild discomfort and swelling so I knew to back off. The most notable set back was my previous attempt to ski last season which was a full 15 months post-op. The knee swelled and was quite sore. It took at least 2 weeks to get it back under control. As part of that episode, I noticed that my glutes were still not firing properly to support the knee and that led to a minor change in my rehab exercises. So I wouldn't worry too much although I accept that's hard to do - I'm still hyper-vigilant wrt the knee and any small pain has me contemplating the worst. Anyway, my main message is that my knee is still improving noticeably even now and so you are only part-way through the rehab process. So keep listening to the knee and changing your rehab activities to suit. It's finding the balance between expanding the envelope of function and not irritating the knee which is the trick (lecture over!).

Over the last year, my improvements have been significant. I can now do normal squats and the occasional one-legged full squat. My muscles are firing close to normally. When I'm doing vigorous exercise I really don't notice the knee at all. My muscles are not quite as large as those on my normal knee but that's quite a common consequence of ACL repairs (which I had 25 years ago) - even for athletes. When I'm walking, there's still a slight hesitation when I climb the first few steps on a flight of stairs. My main restrictions are that I don't run or do jumping activities (although I jump the mountain bike - the suspension takes care of the jarring), I haven't been on a full-on hike with a heavy pack (and I'm not sure I would) and I try not to bend the knee under high loads at more than 90 degrees. That last restriction is not from my surgeon but I'm certain that the plastic kneecap moves onto native cartilage just beyond that angle and I'm not crazy about the thought of plastic on cartilage.

Best wishes and keep those updates coming. I'm slightly invested in your recovery!

[Dave33]

Hi Dave33. Just finished 4 days skiing and no ill effects. Yes! I'm back.

Terrific news! I'm really pleased to hear that; I remember you were a little down after your last trip, and the fact that you're still improving years later is great to hear, and makes me think that my "setback" is merely an issue of time and rebuilding strength/tolerance in the joint.

To that point, the PFJR knee is back to normal, and I've got it on a regular more intense regimen of one leg cycling/static squats, and I'm seeing benefits already; hockey no longer causes post-game pain, and it feels more solid doing regular activites, like descending stairs, etc.

I went on a vacation recently to some mountains (summer here), and looked enviously as a constant stream of happy mud-caked mountain bikers came in and out of trails around the hotel. So, of course, I'm back to considering having my other knee done, which would get me back out on the bike... the problem with doing a little, is that you want a little more.

I have my 1yr appointment with the surgeon in October, so I'm making this deal with myself - i'm going to gently spin on my road bike 2x a week outside for 25km until October; I know my pfjr knee will love it, and if the other knee can tolerate it, I'll delay the other other knee for a year; if it causes significant discomfort, then I'll commit to getting it done asap, and get on with life. Sound reasonable?

Heh, I know what you mean about the 90degree loads - you're right, it doesn't feel... "safe" if it makes sense. It's a weird sensation that feels damage prone. I can certainly live without that range of motion regardless.

cheers

[RGB]

Sounds like a good plan. If you can do enough activity to remain fit and happy then it doesn't seem worth the risk of it going wrong in either the short or long term. If you can't though.....