ACL Class of 2017

[The Iron Horse]

IH,
What flavor of graph are you getting?

Allograph. Doc and I discussed it, and it seems to make sense with the combo of me being 52 yo and knowing that I will need a TKR sometime in the not-so-distant future.

Spent the entire day yesterday watching videos and reading research studies, and I feel pretty good about this. My only hesitation is that I wanted him to do the TKR now and get it over with. He wants to try and get me another ten years, to at least 62.

Been working out like crazy over the past several weeks prepping for the operation. Definitely feel strong and fit, with the exception that my knee occasionally buckles in a really disgusting way!

[mcski]

Based on the number of people I’ve met that aren’t happy w their TKR, put it off as long as possible. The success rate of satisfied customers seems about 50%. It’s def not anywhere near the satisfaction levels of hip replacement. I’ve met too many dissatisfied recipients and don’t want to have to make that call before totally necessary

Sounds like yours is very unstable. It’s a horrible feeling when it buckles. Did you feel improvement in stability from the exercise? Good luck!

[jerlane]

Based on the number of people I’ve met that aren’t happy w their TKR, put it off as long as possible. The success rate of satisfied customers seems about 50%. It’s def not anywhere near the satisfaction levels of hip replacement. I’ve met too many dissatisfied recipients and don’t want to have to make that call before totally necessary

That number is pretty low. Most studies are more in the 80% range. Setting realistic expectations prior to surgery is a big part of it.



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[mcski]

Purely anecdotal but I know/met around 10-12 first hand and the satisfaction is def under 80%. Mixture of lifestyles and ages. The two I know that were most active are the two most disappointed in the results as well and one of them did both to “get it over with” even though from his description his prior pain wasn’t that problematic , so he is worse off than his baseline going in. Eric Heiden being an Ortho and having both of his done at the same time gives me some reason to be optimistic

[Djongo Unchained]

IH,
What flavor of graph are you getting?

Snowshow, cool she’s the first first hand person I know of that had their quad used - unless I missed someone else checking in this thread earlier

I waited for you to adjust that.

In which case, I had my acl repaired with a chunk from the quad tendon.

Questions?

[mcski]

I had a feeling it had been said before but I was too lazy to go back and look. I think I even commented on it. I’ll reread and formulate some questions

[The Iron Horse]

Based on the number of people I’ve met that aren’t happy w their TKR, put it off as long as possible. The success rate of satisfied customers seems about 50%. It’s def not anywhere near the satisfaction levels of hip replacement. I’ve met too many dissatisfied recipients and don’t want to have to make that call before totally necessary

Sounds like yours is very unstable. It’s a horrible feeling when it buckles. Did you feel improvement in stability from the exercise? Good luck!

Interesting. I've met quite a few people this year on the slopes who were thrilled with their TKR. But, there is is surely some confirmation bias baked in! The guys who are skiing where and when I am are of course happy. The ones who aren't are home on the couch.

The bike is definitely helping, and I have gone from hobbling around to pitching batting practice last night. But it's still real unstable, and the brace is a requirement at this point (soft compression sleeve with some lateral rudders).

[The Iron Horse]

Had my strongest workout on the Kickr last night, just in time for surgery today! Sad to see that CP/FTP creep back up only to know that I'm going to be back in the basement again.

Doc told my wife it went well. ACL, meniscus, micro-fracture drilling. I didn't get to speak to him, but my wife said he made mention of a large amount of cartilage coming loose at the top of the tibia, and that perhaps down the road a MACE biopsy (? haven't researched it yet ?) might be a good idea. Hell if I'm going in for another surgery unless it's a TKR.

Nerve block was kind of useless. Fortunately I have not qualms about pain meds. Hell, after 16 years of sobriety, post-op is the only time I can get high!

Four weeks non-weightbearing. That is an eternity.

[eastcoasttreehugger]

I had exact same (quad graft acl reconstruction, bucket handle meniscus tear repair, and 2.5cm2 cartilage fragment repaired by micro fracture in the femoral condyle) and was 6w non weight bearing . lots of other restrictions and slower rehab as well but the cartilage is very sensitive.

the procedure he mentioned is MACI - they take some of your cartilage cells in the first procedure and send it to a lab to grow a new piece on a pig platform. seems to work ok but return to sport can be 1-2 years so i agree with you the goal is to deal until a PKR is in order

hope the recovery goes well

[Ørion]

Turns out I joined the club over a month ago but it took an unexpectedly slow recovery to break through my wishful thinking and for my GP to suspect it wasn't just a bad sprain.

MRI revealed the truth and apparently I have the royal flush of a tibial fracture, full ACL tear, and complex tearing of the miniscus. Doc was a bit surprised at how well I had been handling the pain, considering.

Gonna miss spring touring but at least the meat of the 23/24 season is over.

[The Iron Horse]

Turns out I joined the club over a month ago but it took an unexpectedly slow recovery to break through my wishful thinking and for my GP to suspect it wasn't just a bad sprain.

MRI revealed the truth and apparently I have the royal flush of a tibial fracture, full ACL tear, and complex tearing of the miniscus. Doc was a bit surprised at how well I had been handling the pain, considering.

Gonna miss spring touring but at least the meat of the 23/24 season is over.

Ouch! Sorry. If you choose reconstruction, hopefully you can get in asap for a possible return next spring.

[Ørion]

Ouch! Sorry. If you choose reconstruction, hopefully you can get in asap for a possible return next spring.

Doctor is advising allograft since I don't play contact sports and, after you factor that in and my age group, the success rates are virtually identical to autograft with less recovery time (according to him).

Sounds like we'll be scheduling as soon as insurance decides that knees aren't an optional joint despite me having a second spare one on my right leg.

[The Iron Horse]

Doctor is advising allograft since I don't play contact sports and, after you factor that in and my age group, the success rates are virtually identical to autograft with less recovery time (according to him).

Sounds like we'll be scheduling as soon as insurance decides that knees aren't an optional joint despite me having a second spare one on my right leg.

I'm 5 days post surgery. Allograft (52 yo), meniscus repair, micro-fracture drilling.

I've read a number of studies, and they seem to jibe with what your doc is saying.

Yeah, knees are pretty important. Don't they know that? Ha!

[Ørion]

Today was the day. Allograft with a side order of meniscectomy. Hopefully it's all uphill from here.

[mcski]

Keep us updated on the healing and PT progress!

[The Iron Horse]

Today was the day. Allograft with a side order of meniscectomy. Hopefully it's all uphill from here.

Tomorrow is one month post-surgery for me. Therapy has been going well, and I keep pushing myself as hard as I can... or a much as I'm allowed. Hopefully they give you the go-ahead to put weight on your leg sooner than they did for me, since due to the microfracture drilling I'm still non-weight bearing (partial, I guess, since I go up to about 20% in PT). I have a follow-up with ortho on Friday where I'll hopefully get the ok to ditch the crutches.

Ice is your friend. Ice and compression even better.

[Ørion]

Tomorrow is one month post-surgery for me. Therapy has been going well, and I keep pushing myself as hard as I can... or a much as I'm allowed. Hopefully they give you the go-ahead to put weight on your leg sooner than they did for me, since due to the microfracture drilling I'm still non-weight bearing (partial, I guess, since I go up to about 20% in PT). I have a follow-up with ortho on Friday where I'll hopefully get the ok to ditch the crutches.

Ice is your friend. Ice and compression even better.

Good luck on Friday, that's the date of my first PT session.

My ACL diagnosis was delayed a month because my pain tolerance led my GP to believe I had a simple sprain but my nerve block wore off earlier today and I just don't believe my surgeon when he said he prefers alternating max-dose OTC meds over being fuzzy-brained on opiates. This sucker aches something fierce. Quad is firing and I can do a single straight leg lift at least.

Since I had a meniscectomy instead of a repair (no choice in the matter there, it was based on what they saw once they started rooting around) I'm immediately cleared for weight bearing "as tolerated". Can't move while doing so but it does allow me the use of both hands which is a huge help.

Using gel ice packs behind the knee and on the femoral artery while I have my surgical bandages on but have a goodwill-find ice machine on standby once those are off.

Hopefully too late for you, Iron Horse, but for anyone else reading this thread trying to glean some tips...

Forearm crutches are miles better than the default style if you've got the upper body strength (pro tip: wrap the handles in tennis grip tape). They don't wreck your armpits and significantly improve maneuverability.

Practice with moving with crutches *before* surgery, you don't your first time getting up your porch steps groggy from anesthesia and no-weight-bearing.

...oh, and ask your doc for whatever's needed to get a temporary disability hang tag for your car.

[The Iron Horse]

Good luck on Friday, that's the date of my first PT session.

My ACL diagnosis was delayed a month because my pain tolerance led my GP to believe I had a simple sprain but my nerve block wore off earlier today and I just don't believe my surgeon when he said he prefers alternating max-dose OTC meds over being fuzzy-brained on opiates. This sucker aches something fierce. Quad is firing and I can do a single straight leg lift at least.

Since I had a meniscectomy instead of a repair (no choice in the matter there, it was based on what they saw once they started rooting around) I'm immediately cleared for weight bearing "as tolerated". Can't move while doing so but it does allow me the use of both hands which is a huge help.

Using gel ice packs behind the knee and on the femoral artery while I have my surgical bandages on but have a goodwill-find ice machine on standby once those are off.

Hopefully too late for you, Iron Horse, but for anyone else reading this thread trying to glean some tips...

Forearm crutches are miles better than the default style if you've got the upper body strength (pro tip: wrap the handles in tennis grip tape). They don't wreck your armpits and significantly improve maneuverability.

Practice with moving with crutches *before* surgery, you don't your first time getting up your porch steps groggy from anesthesia and no-weight-bearing.

...oh, and ask your doc for whatever's needed to get a temporary disability hang tag for your car.

Nerve block never worked at all for me. Anesthesiologist kept telling me to wait... wait... wait... and as he was wheeling me into the OR, he finally said, "Well, it doesn't work for everyone. Sorry." Ha! I think he screwed up and didn't want to admit it.

Fortunately, if I'm being honest, I can't say that the pain has ever been excruciating. Some days (first day of PT, for example) have been rough, but yeah, it's that dull/achy/throbbing pain. Doesn't mean I shied away from taking my pain meds the first week (I do love pills), but since then it's just been 800mg ibuprofen horse-pills.

I purchased the ice machine with compression, and they wrapped the pad on me while still in the OR, under my brace. I kept it that way right up until 4 days later when I took my first shower. At my one-week follow-up, I received permission to start using the compression, and I believe it helps. I coach two youth baseball teams, so I am on my feet a lot for practices and games. By the end of a double-header, my knee is pretty swollen and achy, but after a night hooked up to the machine I wake up feeling great. Oh yeah, forget that idea that you aren't supposed to sleep with the ice machine on... I've done it since day 1.

Hope your PT session goes well. I am incredibly lucky since I found a wonderful facility very close to my house. Just really top notch. I was able to get 90 deg of bend by Week 3 (their goal was Week 4), and now I'm beyond that. I know once I can start putting weight on it the progress will go even faster.

I hadn't thought about forearm crutches, as I've never used them before. Sadly, I have too much experience with the standard variety, and have spent a lot of time going up and down stairs. I told my wife next time we are absolutely buying a ranch!

Give 'em hell at therapy!

[Ørion]

A little over a week post-op and one PT session under my belt. Got the go-ahead to unlock the brace for walking if I'm feeling strong and using two crutches. One crutch allowed if the brace is locked, which has already been super helpful moving stuff around the house. Still have to sleep with it on and locked but if I'm relaxing I can take it off.

Which is great because in the past few days my leg has developed a lot of eczema. At first I though it was irritation or heat rash from the brace, but it has flared up in places that the brace never touches, its just worse where it does. Digging around online it seems to be a common and delayed reaction to something they used during surgery. The itch is honestly worse than the knee pain at this point, though topical creams and Benadryl keeps it in check.

Speaking of knee pain, I'm a little frustrated with how poorly my medical team prepared my expectations. The opioid epidemic has them jumping at their own shadows, giving conflicting and contradictory advice. Avoid taking them if at all possible and only as needed but stick to a schedule because its better to maintain than dig yourself out of a pain-hole, the surgeon's comments about not needing them, evasive comments about everyone handling pain differently, etc... Turns out I only really needed them for the first couple days and by day 3 I was fully OTC with only very rare breakout pain incidents. Not knowing what to expect and calculating out my consumption rate on day 2 in comparison with prescription quantity and landing on late Sunday during a holiday weekend made me sweat though.

Therapy went well, seems I have a pretty good starting point. After warming up I have 0° extension (if you squint hard enough), about 70° flexion, and great quad control given the timeline. I had my brace locked at -10° post-surgery (my natural ROM over-extends) which I think helped, though even with it locked at -10° my actual extension probably sat around 2-5°. PT at home is rough, waking up and finding out all that work effectively resets overnight and you have to start (almost) over is exhausting. Still, focusing on the small win of "almost" is keeping me going. Currently typing this while slowly inching my flexion back to where it was yesterday.

[singlecross]

Lateral Extra-articular Tenodesis

taking some of the IT Band and securing it to the femur to reinforce an ACL Reconstruction. Kind of a belt and suspenders approach.

Anyone have any experience with this?

Mrs. single in in surgery right now for a Quad graft ACL with this additional LET procedure.

[Djongo Unchained]

I'm feeling lucky compared to you guys. My nerve block worked perfectly. He asked if I want the 24 or 48 hour dosage...48 please!

My meds were pre supplied and everyone says stick to the med schedule of whatever opiate it was. I was good to go and onto ibuprofen in about 4 days. OTC meds to start? Fuck that.

[XXX-er]

After 6 days I switched to extra strength IBU's from hydro morphine and i took a large bottle of Tramadol back to pharmascist dude

at first i didn't think I needed Hydro morphine but I was wrong and that was painful til it kicked in

don't forget the laxitive or you will end up constipated and in pain

pharmasict dude told me i should have sold the Tramadol down at the ten city ... we always joke

[Ørion]

Throwing an update to the void, but I "graduated" PT this week, six months post surgery, and now it's all just exercise.

Still have some strength to build up until I'm back to 100% but it looks like I'll be back on snow in some capacity much earlier than expected.

Won't be ripping any time soon but it'll be nice to strengthen up on snow.

[montanaskier]

[emoji638]][emoji640][emoji639]][emoji637][emoji6[emoji640][emoji637]][emoji640][emoji6[emoji640][emoji638]][emoji640][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]Throwing an update to the void, but I "graduated" PT this week, six months post surgery, and now it's all just exercise.

Still have some strength to build up until I'm back to [emoji637][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji638]]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji638]]]% but it looks like I'll be back on snow in some capacity much earlier than expected.

Won't be ripping any time soon but it'll be nice to strengthen up on snow.

Keep up the good work


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[Ørion]

Keep up the good work


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Thank you! I'm wearing a fancy return-to-sport brace but will clock 20 days on snow this weekend. I feel strong and am skiing better than ever, but my endurance is half of what it should be.