ACL Class of 2012

[climberevan]

Have fun gitd. Tomorrow will suck, but the next day will be much better, and so on. I just rode rollers for an hour and had a great time...this shit will change your perspective on what constitutes fun....

As a side note to emphasize just how incredibly fucked our medical care system is: my surgery is at $40k already without the surgeon's bill, which may be as much as $20k. I just can't believe that the hospital was spending $7000/hr to provide the facility for my surgery. Something really has to be done about this.

[bendtheski]

Jeebus Evan, did you get the Steve Austin bionic procedure???!!!

Hopefully the next statement you see will show what was billed, what your plan allows, and a patient balance of zero.

Goingthedistance, ice is your friend. I'm pretty sure I've said that about 100 times by now.
Also X2 on Evan's new definition of "fun".

[gointhedistance]

Have fun gitd. Tomorrow will suck, but the next day will be much better, and so on. I just rode rollers for an hour and had a great time...this shit will change your perspective on what constitutes fun....

No truer words have been spoken... Surgery was Tuesday. Wednesday AM I woke up in a world of pain. My leg block had worn off and even though I had kept up on a heavy dose of meds, I was floundering to even move a small bit.

My perspective of fun will stay the same (though well said)... but I think my perspective of what ACTUALLY sucks has changed... PT sucks. Everything else is just a minor annoyance.

Goingthedistance, ice is your friend. I'm pretty sure I've said that about 100 times by now.
Also X2 on Evan's new definition of "fun".

Ice is definitely a good friend of mine...

It's been 6 days now... extension is easily 0 to -5 degrees. Flexion is about 90 doing the towel pull method... I'm able to lift my heel from the ground with a straight leg and towel under my knee... which I am pretty happy about.

I do not feel comfortable though to put any weight on it yet... so I haven't really tried that yet.

Also - my crutch balancing record is up to 72 seconds.

[bendtheski]

I do not feel comfortable though to put any weight on it yet... so I haven't really tried that yet.

Also - my crutch balancing record is up to 72 seconds.

Understandable, you'll get there. My ortho sent me home with an immobilizer which I used for the first couple of days till I gained some confidence.

72 seconds; impressive. But have you tried it on an icy porch with a dog leash (and dog) in each hand? Extra G.N.A.R. points for doing it without spilling your coffee...

[Kiwiskier]

As a side note to emphasize just how incredibly fucked our medical care system is: my surgery is at $40k already without the surgeon's bill, which may be as much as $20k. I just can't believe that the hospital was spending $7000/hr to provide the facility for my surgery. Something really has to be done about this.

Good Lord! We pay nothing here if it is an accident. In fact I was paid 80 percent of my salary and travel costs to medical/PT visits. $15 part charge on each PT visit though.

[gointhedistance]

72 seconds; impressive. But have you tried it on an icy porch with a dog leash (and dog) in each hand? Extra G.N.A.R. points for doing it without spilling your coffee...

I did successfully navigate my own way down my grandmother's porch steps on Thanksgiving... They were icy, and since they are so old, they have developed a significant forward cant (10deg or so) that encourages the most able bodied folks to fall on a somewhat regular basis. I impressed myself with my successful descent.

Stitches are coming out this afternoon... took my first few steps yesterday. Unsupported without an immobilizer... I was pretty cautious and made sure to keep a good bend at the knee as to not over extend.

I don't know why I did not pursue this earlier - pretty significant mistake on my part... but I had not been taking Ibuprofen since the surgery. I was taking Oxycodon for pain - but nothing for inflammation and swelling... I didn't know if there was a drug conflict (which there is not), and for whatever reason it did not register to me the value of adding it to reduce knee swelling.

Well, the other day I called the pharmacist and confirmed they can be used in conjunction, so I have been taking 400mg every 4 hours to reduce swelling (and aid in pain), and man has it been a huge success. Swelling and tightness of the joint has gone down appreciably. Thus, making exercises and therapy much more enjoyable, productive and effective. I highly suggest doing it earlier, especially if swelling is inhabiting your motion and exercises. What a stupid mistake that I wish I would have read more on/paid more attention to.

[gointhedistance]

72 seconds; impressive. But have you tried it on an icy porch with a dog leash (and dog) in each hand? Extra G.N.A.R. points for doing it without spilling your coffee...

I did successfully navigate my own way down my grandmother's porch steps on Thanksgiving... They were icy, and since they are so old, they have developed a significant forward cant (10deg or so) that encourages the most able bodied folks to fall on a somewhat regular basis. I impressed myself with my successful descent.

Stitches are coming out this afternoon... took my first few steps yesterday. Unsupported without an immobilizer... I was pretty cautious and made sure to keep a good bend at the knee as to not over extend.

I don't know why I did not pursue this earlier - pretty significant mistake on my part... but I had not been taking Ibuprofen since the surgery. I was taking Oxycodon for pain - but nothing for inflammation and swelling... I didn't know if there was a drug conflict (which there is not), and for whatever reason it did not register to me the value of adding it to reduce knee swelling.

Well, the other day I called the pharmacist and confirmed they can be used in conjunction, so I have been taking 400mg every 4 hours to reduce swelling (and aid in pain), and man has it been a huge success. Swelling and tightness of the joint has gone down appreciably. Thus, making exercises and therapy much more enjoyable, productive and effective. I highly suggest doing it earlier, especially if swelling is inhabiting your motion and exercises. What a stupid mistake that I wish I would have read more on/paid more attention to.

[climberevan]

I would check with your Dr. about taking Vitamin I. I think they recommend against it in many cases... I'm no MD, but I think the anti-inflammatory effect of it can interfere with healing when you have a surgery-type injury as opposed to simply smashing yourself up.

Did any of you get advice to not stand/go hard while riding bikes early on? I was cleared to ride the trainer at 6 weeks, and immediately started getting after it. (I'm a Cat. 2 road cyclist.) I remember reading or hearing that standing was bad for some reason, so I've been trying to stay seated, but the better I feel the more tempted I am to just start riding like normal. I think the big concern is falling and re-tearing, but I wanted to reach out and see if the collective has anything to say. The last thing I want is to compromise this thing and have to do this all again! (I'm now at 10 weeks.)

[culcrsr]

I started riding the trainer at 3 weeks and was outside on my bike in 6 weeks. I tried to minimize the amount of time out of the saddle but in my opinion it will help strengthen your knee stabilizing muscles.

[bendtheski]

I realized the other day that I passed the one year anniversary of my injury without doing anything special to mark the occasion (except go skiing).

I'm glad this year is behind me, but it really wasn't as bad as I thought it was going to be. I continue to remind myself that things could always be much worse.

Stay positive and keep at it. You'll all get there before you know it.

[gointhedistance]

3 weeks ago today I had my ACL done... Seems like forever ago already. I don't know whether that's because it's been going well and has gone by fast, or because my expectations are to be back to normal very quickly....

I've been 'walking' without a brace or crutches since the 2nd of December. It took about 4 days before I could fake a normal walk good enough so that you might not be able to tell I was limping, i.e. normal gate and range of motion (which included a bit of pain yet).

Swelling has gone down significantly. Scars are healing nicely. ROM when unaided (no towel under heel) about positive 4-5 deg extension. With towel, I can get to about -4. Flexion was measured at PT yesterday to be 130 range - which is about 10 degrees off of non-affected leg.

I am adding exercises like shallow squats (0-25 degrees knee bend), single leg balancing, core and glut strengthening.

I still have some minor to moderate pain in the patellar tendon when doing extension type movements. I'm assuming that will stick around for a while. Also have noticed some tingling in the ankle and foot if I rotate my foot just the right way - I'm assuming a nerve near the pateller gets affected somehow which causes some tingling... it doesn't happen all the time, just every now and then when I point my toes in a certain direction.

Edit: I'll also add that I started driving on the 7th (2.5 weeks post surgery). I felt comfortable driving. Only getting in and out of the car was slight painful.

[bendtheski]

GTD,

I've still got some residual tingling around the main incision, but if that's the worst side-effect of surgery, I can deal with it. Sounds like you're doing great otherwise. Maybe you can get a note from your ortho that will get you out of speeding tickets?

Returning to snow seems to be the last piece of the puzzle for me. I'm still doing some strengthening exercises, but the early season groomers are probably doing more in the way of conditioning than anything I'm able to simulate in the gym. Tentatively skied some bumps on Sunday and nothing fell apart, so that helped my confidence and actually made things easier.
Skiing tentatively is a good way to get hurt again. OTOH, over-confidence might not be the best thing either. It's a balancing act for sure!

[Dave Marshack]

I am skiing well. I'm a month into the season and about 8 months post op. been dropping sizeable cliffs riding crud and bumps and nothing has phased the knee yet. I'm using my brace on surgeons recommendation whenever I'm really going for a ski but for groomer days no brace... I have been snow skating lots and none of those falls have tweaked it. Good luck to all

[bilkovet]

Just had my ACL surgery 3 days ago in Banff after 9 months of waiting - that's living in Canada for you. Post-op is definitely more painful than I'd expected but I've also discovered the benefits of alternating the Oxycodon with Ibuprofen. I also had my MCL repaired - which is where most of the pain is coming from - and that could also slow my return to normal range of motion. I found it took me about 4 weeks after the original injury to get back to normal.
It's really nice to hear so many of you are getting back to skiing within the first year. Until then I'm going to stick to watching movies. Currently watching Swift.Silent.Deep

[bendtheski]

Evan, I think I waited 8 or 9 weeks before riding outdoors, but was riding a stationary recumbent half an hour a day with light resistance within the first week. My ortho said it would take around 8 weeks for the graft anchors to be solid enough not to have to worry about them slipping and messing up the graft tension. Once I did start riding, he didn't place any restrictions on standing out of the saddle, but it definitely felt awkward at first, and I let pain be my guide as to how hard I would go. Of course everybody's injury/recovery is going to be a little different, but for me, being able to ride outside was a major step towards not feeling so "injured", and really helped keep me positive! It probably didn't hurt that I finally broke down and put compact gearing on my road bike so I wouldn't have to push too hard, and tried to stick to less hilly terrain for the first few weeks.

If your ortho isn't telling you not to ride, or not to stand up, I'd say try it and let your knee tell you whether it's ready.

[bilkovet]

Did anyone else have their MCL repaired, or know of someone who did? I was originally just going in for an ACL reconstruction but when the surgeon was in there he felt my MCL hadn't healed as well as it should have and the increased laxity would cause problems later. Most of my pain appears to be coming from this part of my knee, especially when doing the flexion and extension exercises the physio recommended. I'm wondering whether this is normal as it sounds like I'm behind everyone else based on various comments. There is no way I could weight bear currently without crutches for example. I'd really appreciate any advice as the last thing I want to do is push too hard, and cause problems with healing.

[climberevan]

BTS: I just went ahead and started getting after it as soon as I felt like I could. Last week that meant a lot of trainer time and 75 miles on Saturday with a lot of climbing. The local hotshots are strong, and I'm not. Wah. More training!

blikovet: It's not a race. Everyone has different stuff going on, and little things like adding an MCL can dramatically impact the speed of your recovery. My meniscus repair meant that I was basically unable to do anything for almost a month, and regular ACL people get on bikes in the first week. I am still amazed at how the little niggle type pains are going away gradually. I can do more and more on a weekly basis...you just have to get excited about finally being able to stand on one leg and pull your foot up to your knee in the shower, for example.

Just follow the recommendations and be patient. If your physio and OS start to worry, then you should be concerned. You have to distinguish between the kind of pain that serves to warn you you're doing something wrong, and the kind of pain that is just annoying and can be worked through. I personally think the former is sharper and more abrupt, while the latter is more like the kind of pain all athletes deal with regularly.

[bilkovet]

climberevan: Thanks for the advice. I guess I need to reset my mental targets as I had researched the crap out of ACL rehab before the surgery, but without the MCL component. I would agree on the pain side of things, and I'm normally pretty good at being able to determine what I should be doing. I'm finding this difficult probably because I'm a little paranoid about damaging the repair. First physio appointment on Wednesday so hopefully that should help out, and I'll just continue to take it easy until then.

[climberevan]

I've definitely been there wrt the paranoia. The info I got from my OS was basically to avoid twisting and eating shit, and that normal stuff wouldn't hurt it. He said the grafts are pretty strong.

If anyone needs it I have a universal ROM brace that will probably fit up to L size legs that you can have for the cost of shipping. No good keeping these things around!

[gointhedistance]

So I am about 4 weeks post op... and things are going pretty well by my standards.

Had a PT session this morning, and for the first time I got on the bike. Did about 7 minutes with no resistance, just spinning, and 3 minutes with low resistance. It felt really good actually, and when I was done, I felt a little fatigue in my quad and stabilizing muscles surrounding the knee, which to me is a good thing... It was not an over-exertion, but just a good first trial. Frankly, I'm a little surprised I didn't get on the bike last week, but caution is a fine thing for now still. I am curious though - what surgery type did you all choose who were on bikes within a week or two post op? I had BTB, and I'm thinking my PT did not want to rush the patellar tendon to soon.

Now, I am trying to find a reasonable exercise bike online to use for home use and have continued adding exercises to the regimen.

I do have a little tenderness near the back of my lateral hamstring, which I was told is normal - just other muscles in the leg compensating for the loss of muscle in the quad.... which has now reached about a 10lb loss in muscle and about 3" in circumference (I have pretty beefy legs, so there is alot to lose).

Ice on the sidewalks and such give me the willies too.

[bendtheski]

GTD,

Same knee hamstring autograft. PT had me on a stationary bike prior to surgery, and within a couple of days post. I'm fortunate to have a full gym at the office, including a pretty nice programmable recumbent bike. I started out post-surgery just spinning with no resistance, then gradually increased over the first few weeks. Surprisingly, I didn't lose much muscle mass or strength, but had similar pain to what you're describing. Almost a year out of surgery, and I still have some very slight residual pain, mostly in the back of the knee, and a little bit of popping when doing squats. No hitchiness though, and it doesn't cause me any discomfort riding a bike or skiing, so I'm probably not going to worry too much about it. The prospect of going back for a scope doesn't appeal to me that much...

Looking through this thread, you'll probably notice a lot of variation in the types of surgeries, extent of injuries, recommendations for rehab, etc. Even with the exact same injury, one ortho's approach to surgery and recover may vary widely from another's. Weight bearing, non-weight bearing, brace, no brace, biking (outside) at 8-9 weeks with few restrictions, biking at 12 weeks with flat pedals only and no mountain biking, etc.

I think over-all my PT routine was fairly aggressive, and my ortho possibly less conservative than some others as far as restrictions on activity, but in the long run, I was told not to expect full recovery for up to 18 months. The takeaway for me is, a few weeks one way or the other, weight bearing/non, biking/not biking, isn't going to make a world of difference over the long haul. Just try to avoid pushing too hard, too soon and risking re-injury and/or revision surgery. Also don't be afraid to back off on your PT for a few days if your knee starts to get cranky. IMO working out an already inflamed knee will likely lead to more inflamation and soreness, which may further inhibit your recovery, and I can never stress this point enough; ice is your best friend! (with intermittent compression, even better)

edit: I lied, looks like I did lose some muscle mass after all...

[bilkovet]

Finally starting to feel better at two weeks post-op, and I'm down to one crutch. Extension about 0 degrees but struggling to get flexion past 90 degrees. PT started me on the exercise bike this week but I can currently only manage a half revolution. It's been a long time since I've been this inactive. Any ideas on how to keep cardio fitness while resting so much?

[bendtheski]

bilkovet,

I mostly used the bike with no resistance for the first week or so, and then gradually increased resistance and time. I don't think any of the other strengthening excercises do much for maintaining cardio fitness. Obviously if you're having trouble with mobility you may just have to be patient for a little while. Just keep working at it; it's a long recovery and a week or two of little or no cardio won't set you back too much.

The most uncomfortable part of the cycling movement for me was the transition at the top of the pedal stroke. I found it was less uncomfortable with the seat slightly higher so my knee didn't have to bend as much at the top of the stroke. Overall I think the cycling motion really helped increase my ROM, and maybe helped to push some of the fluid build-up out of the joint which probably contributed to the increase in ROM. Also ice and intermittent compression; which some people are probably getting tired of hearing me say.

[gointhedistance]

bilkovet - also one thing that worked for me as you move into the coming weeks is to listen to your pain level and swelling.

I was very diligently doing my exercises and maybe overdoing them just a bit... to the point where I would have sore muscles and a dull general pain. Also, my swelling was minor after week 4, but not improving. So this past weekend (with christmas gatherings contributing), I took a break from difficult exercises for 2 days. I only did ROM stretching and balancing. What this seemed to help was to reduce swelling quiet significantly as well as reduce pain the dull pain (which makes sense - less swelling=less pain). I started back on my previous routine and have been doing that for a few days with improved ROM, strength and stability.

I know all of the literature says, do these things everyday, no questions asked... but I feel that I made a pretty dramatic improvement after pushing reasonably hard for several weeks and then easing up to let things recover a bit more.

My $.02

[flyman683]

I know all of the literature says, do these things everyday, no questions asked... but I feel that I made a pretty dramatic improvement after pushing reasonably hard for several weeks and then easing up to let things recover a bit more.

The way my PT and Surgeon explained it to me was as follows:

In the beginning you are mostly trying to increase ROM and get your nerves back to talking happily to the muscles/ligament down there. Swelling and pain fights against both of those goals - angry knee and angry nerves.

Don't worry so much about pushing until it hurts and take days off as needed but continue with stretching/ROM. The strength will follow easily once your able to get into those movements mote comfortably.

Overdoing it and pulling my grafted hamstring set me back like months on getting my hamstring to be able to curl/squat right, so I want to save you all that pain and delay.

On biking: Top of the pedal cycle is awkward in the beginning. It Helped me to concentrate on really keeping my foot glued to that pedal even if my other leg & momentum was doing most of the work. That way the motion was there even if my muscle wouldn't fire when I told it to.

Edit re: cardio - bilk, the aforementioned "1.5" legged biking was really my only cardio I could do for a long time... Until MB season quite a few months later.