ACL - Auto Patella Update

[hocky88]

Wow, 5 weeks post-op this week. Just thought I would check in a share my progress and of course ask for some help. My progress up to right now has been decent/good. I have been without a brace since the beginning and lost the crutches about the 3rd week. So I am walking well and most times without any limp. My range of motion is 0 degrees to about 125 degrees. I do have swelling issues from time to time as I try to incorporate new things. I am trying to balance what my PT says and what I read and using the feedback from my knee as the primary gage of what is helpful and what is overdoing it. Honestly, I am amazed at the lack of real experts that I have encountered in this field. I am sort of happy with my PT but I am not getting any specialized care. Most of them are very youg kids following a protocol and they take you thru the motions. Maybe I am expecting too much. I ask questions about symmetry for example and I get no real response. I do so much training on the injured leg and they ignore the uninvolved leg. If it were not for me reading and doing stuff on my own there would be a much bigger imbalance. Now I know how others injure their other leg after the first...I can see when I get further along and want to get ready for hocky, I am going to have to find someone else to help me. Recently, I have begun more advanced exercises like, some weight machines such as leg press and hamstring curls. I have been doing all the basic stuff since the beginning like SLR’s, quad sets, etc. I have been doing stool scoots across a carpeted floor which are difficult but feel great for hammys and glutes and flexion. I began using an elliptical for just 2 minutes in each direction along with the stationary bike. I have been doing 10-20 minutes, 1-2X day and just recently started to push closer to 45 minutes each day with a goal of 1 hour a day (thanks DrMark) and we will be there by next week. My plan going forward, especially for the short term is to give moderate attention to the strength stuff and focus primarily on getting all of my flexion back. I saw my OS doc last week and although I did not think my knee looked too bad, he did not like the swelling and asked me to begin taking ibuprofen, 600mg 3X/day for awhile and even suggested removing fluid with a needle - yikes! I passed on that suggestion since he gave me a choice! He does not offer much help with the therapy part. He just says that my therpist knows his protocol so just do what they tell me. Its part of a bigger therapy group so there is not real strong communication going on. Next thing is the stiffness…It kind of wears on you mentally. I liken it to the movie “groundhogs day” with Michael Keaton where each day everything just repeats itself. I know I have made progress as 0 to 90 degrees does work real easy now after I get going, but each morning begins with a stiffness which sometimes feels like a block of concrete and we begin…I really just want my flexion back. DrMark or anyone out there have any good ideas on how to finish off this flexion, stiffness and swelling. I know I am only 5 weeks, but I want this to progress along. And I must say that without the internet and places like this I would be lost! Thanks!

[Mr. Multiglisse]

Hocky88, it sounds like you are going above and beyond the call of rehab and progressing pretty normally, IMHO. You did not mention ice - are you still doing that? If not, it will definitely help with the swelling. I am 10 weeks post-op, still have some swelling and still ice every day. If you don't have one get the ice-pack wrap thingie. This holds the ice in place and provides some compression as well. Here is a good summary on the value of RICE from my physio clinic's site. They just starting using these inflatable Bodymedics compression cold therapy packs, which are the cat's meow:



I have a velcro/neoprene/wraparound version at home which works well and is probably 1/3 the cost of the unit above.

Saw my ortho last week, he says I am progressing normally and should keep doing the ice at least once a day till swelling is completely gone, then as needed after that. FWIW, I am also taking some supplements to improve blood flow and aid healing: vitamin C, co-enzyme Q10, grape seed extract and essential fatty acids.

If anything, I think you need a new physiotherapist. The clinic I go to has only two physios, one of whom is the owner. Each patient is assigned one or the other. Both are very experienced at sports injury rehab, take a high level of interest in each patient and because you are always dealing with the same person, you develop a good rapport. My physio, Stella, is always pushing me to take exercises to the next level if they become "too easy." You sound like the kind of person who would appreciate that kind of approach.

[hocky88]

Mr Multiglisse -So your 10 weeks eh. What types of things are you doing now? Cn you touch your heel to your bum yet. Someone told me the other day that they could touch but only after an extensive warmup in the gym. I was like your kidding!; when the heck will the stiffness be gone forever! Do you still experience stiffness? Yes, funny you mention the ice...I have one of those cryocuffs with the cooler and some compression. I use it constantly! I bring it to work and wear it about 1/3 of the day! You would laugh if you saw my setup. I work by myself in a small research laboratory and basically do what I want all day. I do fit in my work...but we a have small gym on site and I get to ride the stat bike, elliptical, etc. then I ice. Supplements? I think like most in that there is no harm so I take them and hope they are helping. I take an essential fatty acid sup which has omega 3,6 and 9 in it and I swear that it makes my joints feel better after about a week and if I stop taking it again after about a week I feel like crap, sore more stiff, etc. My other key supplement is protein. I do alot of reading on bodybuilding.com not because I am weighlifter (I am not) but because the have awesome fitness articles and generally it is a very uplifting website. The have a nutrition section where I read about protein helping with weightloss, muscle growth, etc. overall a great supplement. I start each morning with a protein shake (just powder and water). I love "Muscle Milk" chocolate malt. Then I use it once or twice during the day to curb appetite, or after a good workout. They say that after a workout is a great time. Anyway, it is hard for me to stop talking once I get rolling... Good luck to you and I d love to hear about yours and others progress.

[attwater]

hockey88,

Sounds like we had ACL reconstructs about the same time, me 5/18. Are you in Houston, sounds like you either used or are getting advice from Sanders?

I tore my left ACL on 4/1 making a gentle right turn in 21 inches of powder at Targhee at 12:15 on the fourth run of the day. Man was I aggravated at wasting four hours of powder on my last and best day of the season. I did preop PT from 4/20-5/16. Think it made a big difference. I am apparently a little further along than you, even though my Dr.'s rehab protocol is less aggressive than Sander's. My PT's protocol is aggressive however, and I have 0 degrees extension and about 140 degrees free flexion (lack about two or three inches touching my butt on the quad stretches). Knee is still pretty tender, and has a few spots of swelling, but I am getting around well.

The advice I will provide is I think key to my rapid recovery (I am 58). Pay very close attention to form in your PT exercises. For example, in the SLR's, you have to press your knee down for full extension, point your toes towards you, and engage the quad before you do each lift. Most PT's will show you once, then ignore your form, but it is key to getting the most out ouf PT.

[hocky88]

Man we are neck and neck at the finish line! I would escribe my flexion almost the same...i kneel on all fours then lower back to sit on my heels and I have less than the width of my hand left, probably about 3-5" maybe...Damn 58! you're doing great! I got advice to focus on strengthening my posterior chain and I have done alot of work in that regard. Thank goodness for the internet and places like this where I learn a lot more than from my Doc or therapist. Tell me about some of the exercises that you are doing and what types of troubles you have? For me, the hardest thing is idenitfying what I do that causes swelling in my knee. I have it under control but I would like to do more work. I have been trying to do 30 minutes on a stationary bike each day. Others mentioned doing 60 minutes...I don't think my knee or my doc would that very much...I will post as soon as I reach my bum...the race is on!

[ska21]

I'm 7 days post ACLR with microfracture. Every time i get upright, it feels like my leg is filling with blood and is going to explode. It's quite painful and really prevents me from sitting upright in a chair for very long and from moving very far on crutches. Is this common? How long did it last?

[hocky88]

Well -I guess I'm glad it is keeping you from sitting in a chair because you are best situated on your back with that leg elevated and iced. I literally stayed in that mode for 2-3 weeks. Don't get me wrong, I got up often to do my exercises several times a day, but if I wasn't PT'ing I was on my back. And I did alot of exercises in bed. I remember doing quad sets while it was elevated. I remember that feeling when I would first stand up in the morning...whew that was rough - I thought I would never be able to walk around again, but that particular feeling did pass and I think it was in the second week. You should be seeing your OS doc soon right? Other than that, how is it going? You got some good drugs? I took percoset for almost the first week, but this varies for everyone. Some hardly took anything that strong after the first day...Tell me that you have full extension and that you continune to keep your heel propped so you don't loose it. That's the idea early on. Hang in there; time goes fast!

[ska21]

Hey Hocky, Thanks for the quick reply. Sounds like better days are ahead, in fact, today wasn't that bad. I was on percosets for 5 days and then switched to advil 600 mg a 3 times a day. I have full extension on the leg and your last post reminded me to prop it so i don't loose it. I have a meeting two weeks out, not with OA but physicians assistant. I hope to get started on PT at that time (beyond quad sets and heel slides). This is a long road and a slow one the first 2 weeks.

[attwater]

Hockey88,

Heel touched my butt Friday on the 10th quad stretch. PT said I only need to do 5 daily now.

They have me doing so many different exercises that I would run out of characters listing them, and they change them up every couple of weeks. I do only 9 minutes on the bike though. The bike seems to make parts of my knee swell and seem stiff, not to mention painful. I am doing 180 lbs on the leg press for both legs now, and 120 on my bad leg. That seems to be the new biggie. Doing a lot of propioceptive work also, which should improve my skiing, especially if I start doing it on the other leg as well.

Another thing is that my PT tells me specifically to rest on my days off of PT. When I do, and I get good sleep, I improve from PT session to session, but the days in between after a PT session seem like a setback. Seems like I am recovered though the morning of my next PT session, just in time to get knocked back. You may be pushing too hard. My PT tells me that until the biological healing gets far enough along, if I work at it too hard, or the wrong way, I can rip out the new ACL (patella tendon). That would not contribute to my goal of skiing this December, which is looking possible right now.

One thing, you mentioned that you are taking Ibuprofen. My orthosurgeon will not let me do that just yet. In Houston, ibuprofen and pseudophed are one of the basic food groups with all the humidity and allegens around. So I am not interested in it for my knee, but my sinuses. I take it your doc said it was okay.

[hocky88]

Right about the ibuprofin - doc said 600mg 3 times a day (1800mg total) to help control swelling. were/are you really doing 10 quad stretches a day? You doing these just standing or more like a heel slide? Wow, no wonder you have you flexion back. I am only doing flexion stretching maybe once a day and my progress in that regard has only improved by a small amount recently. I am probably still a good 5" from my butt, maybe 132 degrees or so. I think the differences with the time on the bike is for example I believe Dr Saunders reccomends about an hour a day but his patients may not be in his office for an hour riding. When I go to formal PT I would only ride for 10 minutes. At home I just pushed myself to ride longer because I was reading that many feel it is one of the safest ways to build up strength and also to help your flexion. Sounds like your PT is very well thought out with changing things up often. Your doing great! I am hoping that you can tell me exactly what you have been up to in order to finish off you flexion. Thanks!

[BadGalSkiier]

You are correct in that riding a stationary bike is one of the safest ACL rehab exercises. My surgeon says at least an hour a day if not more. There really is no limit as to how much you can ride the bike. It's great for your quads and since I recently had my ACL done with my quads tendon it's the best thing for me. I ride at least 2 hours a day.

Another interesting point is that my surgeon said no anti-inflammatories (advil, naproxen, cox-2 inhibitors etc.) for 12 weeks because they interfere with bone healing. I couldn't find much info on the Internet so I don't know how many docs follow this guideline.

I am almost 6 weeks post-op now and I still have some swelling but it doesn't really affect my ability to exercise. However, I am supposed to use crutches for a full 6 weeks (allowed 50 lbs of weight bearing on the leg) because I also had an osteochondral allograft. The 6 weeks will be over on Saturday so I tried walking a little crutch-free over the last couple of days and I can barely do it. I hoping things really improve over the next week but at least I have no pian.

The problem is that no one I know has ever had a quad graft so I have no one to talk to. No Physios I have spoken to have had a quad graft patient either.

Good luck

[attwater]

Hockey88,

The 10 quad stretch reps I was doing (now only 5) were lying on my stomach using a strap to pull my heel towards my butt for 30 seconds. I have been touching for a long time now, not quite as freely as the uninjured leg, but both my PT and orthosurgeon don't really care so much about flexion, just extension, which has been at zero almost since about two weeks post surgery.

I am at 12 weeks post surgery in two days, and see the orthosurgeon tomorrow. I am afraid he may cut off my PT prescription. I am hoping for another 12 weeks of PT, to prep me for December at Targhee. My PT says I am doing extremely well, way ahead of schedule. Of course, it is not fast enough for me, but I am not going to push it. Apparently, I am in that mode where I have to literally wait for bone and sinew to heal, and there is nothing to speed it up. But that proprioceptive work is phenomenal. Actually, my injured leg has better balance now than my good (well, unsurgered) leg.

I am sure you are caught up with me by now, hope so anyway.

[attwater]

Hockey88,

Quick report. Skied 12/9-14 seven months out of surgery. Wore my brace (great by the way), and skied as if I never injured my ACL at all. Obviously, I was very attentive to my left knee, and felt a few twinges, but nothing more than I get walking on a sidewalk. I think the PT actually improved my skiing. I have to admit, I did not do any climbing though.

Going back in January, then a couple of weeks in March/April. Should get 21 days in this season living in Houston with an ACL repair within the past year.