Three weeks post-op

This week, I've finally returned to a more or less normal workout regimen. I'm now alternating upper and lower body workouts with miscellaneous knee and shoulder rehab exercises on each day. Yesterday at PT started doing what you might call side lunges on the involved leg. Also did alternating lateral raises on each side to help improve balance and prioprioception in the involved leg. I was surprised doing these that I'll have to work a bit to regain a good sense of balance on the leg.

The PT cleared me for riding a stationary bike for as long as I'm comfortable. To this point, I haven't put in more than 15 minutes. After a session the other day, I was a bit sore afterwards, but that could be the resistance training too. I pushed 50#, barely, with the involved leg, being careful not to flex or extend too far. It might be better to go down to say 45# and shoot for more reps.

Up to 130 degrees

At PT this morning, my therapist was impressed with the ease of my pedaling stroke. I went in cold and my knee flexion was 120, about the same as two days ago. After pedaling the bike for about 5 minutes, flexion measured out at 130. He had me do some leg presses, the first I've done since surgery, and was able to very easily push about 80 pounds, being careful not to straighten the leg or flex too far.

Before my injury, I could push my own body weight (170) without too much trouble. Hamstring was sore later in the day. Best to combine workout, stretching, and ice. Friday is two weeks post-op, and on 4/12 I see my orthopod again. I'm still using crutches when I leave the house, but I'm hoping I can give these up in another week or so. Also, I'm hoping to get cleared for riding an actual bicycle soon. Leg strength is the key to health -- that is my conviction.

A bit sore today

During my workout yesterday, did my usual low cable leg exercises (abductor, adductor, etc.) and then also threw in a set of very conservative squats on the squat rack, with no added weight. Was careful to keep the back straight and the knees over the feet (sticking butt out behind), and not going too low. Also was able to ride the bike for 10 minutes and get the rpm's up to about 70. Earlier this week I was just barely able to turn the pedals over. As a result, I am sore today, especially in the hamstring at the graft site. But a little icing and ibuprofen should take care of that.

Yesterday, I iron-transferred the following onto a t-shirt:

It's the year of pain
Get used to it

Careful of the hamstring

In the last day or two, I've tweaked my hamstring a few times with very painful results. One time, I was just pulling on a shoe, another time I got up from a chair too quick. The trick is to avoid putting any real pressure on the hamstring until it fully heals.

Pedaled a stationary bike at the gym today for ten minutes not even fast enough to turn the bike on really, but enough to loosen up the joint very nicely. Then did three sets of low cable hip adductor, abductor, and leg lifts (quads) at low weight settings without too much trouble. It was easy enough to ride and do the exercises, that I should be able to increase the duration and intensity on the bike next time, and the amount of weight I'm pulling on the cable machine.

Pedaled a bike today

Went into PT this morning feeling a little tight. First thing I did was get on the stationary bike and use it to stretch the knee. After a few minutes of stretching, I was able to do a complete pedal stroke, so I then pedaled the bike for another 5 minutes or so. It was great to get to this point, since now I can go to the gym and start working on the bike. Afterwards, knee flexion measured out at 120 degrees, 10 degrees more than two days ago. After stretching and icing, the knee felt pretty good. Excellent progress, very pleased.

PT today

Knee flexion measured out at 110 degrees today. I feel pretty weak in my hamstring, but that will improve. I'm now doing leg lifts, adductor, abductor, and stretching 2x/day. Also, I'm going to step up the icing to try to get the last bit of swelling to go down so I can get some more flex in the knee.

The PT put me on a stationary bike today, and while I couldn't actually pedal a full cycle, I'm pretty close. Their recommendation is to use it for now as a way to stretch, and before long I should be able to pedal continuously.

Day 10

Doing well, though I'm still not consistenly getting a great night's sleep. I'm finding it tough to get settled for some reason. However, my knee flexion continues to improve. I'm well beyond 90 degrees, say about 110 at this point, and walking around is pretty routine. I'm not having any significant pain at all, just achiness after doing my exercises, or if I've been walking around a bit. When I leave the house for any significant walking around I take my crutches which just help me take some of the weight off the leg. I'm also not having any trouble with the rehab exercises so I'm really hoping to be able to pedal a stationary bike this week. If so I can start going back to the gym.

Had my first day back at work today, and found it pretty tough to sit at my desk for very long before the knee got sore. I think I'm still tight enough that sitting for some time, even at less than 90 degrees flexion, I get a little sore, which makes concentration a little tough. So I'm still icing the knee a couple of times every day, after which it feels better.

First week post-op

Had the best night's sleep yet since the procedure a week ago. The knee was feeling a little tight so I took an 800mg ibuprofen before getting into bed. Also, with the sutures out and the ace bandage and knee brace off, I was finally able to get comfortable. Felt great.

This morning I combined my knee exercises with shoulder rehab, and even swung a racquet a bit. It's been 4 months since I played tennis, and I'm definitely missing it. The shoulder felt pretty good. It had been bothering me a lot the week leading up to knee surgery so I knocked off the shoulder exercises altogether. I had just been overdoing it I think. The break really helped.

Next week I'm hoping to be able to start working the knee on the recumbent bike at the gym. I need to burn some calories doing something real or risk fattening up, which will only put my knees at further risk.

6th day: Looking a lot better

This is starting to look like a good knee. That's 90 degrees of flexion, baby! and no more Frankenstein staples.

New 4-strand ACL image

Here's an image of my new 4 strand ACL. Each strand is very distinct. This was created by taking a length of my hamstring tendon and folding it twice into a 4-strand graft. You can also see how tightly it fits into the guide hole at the top right of the image frame. The PCL crosses behind the ACL from top left to lower right.

Do you have imagery from the inside of your body?

Sutures removed

My orthopod had me in today, a day early because of a snow storm coming tonight and tomorrow. They removed the sutures and the staples, and I came away with a CD of arthroscopic still images of the procedure.

My doctor also explained that the ACL is at present probably 150% the strength of my ACL prior to injury. He said that this strength actually declines over the next 8 weeks or so, as the graft develops a blood supply and so on. At 8 weeks, he said it would have about 75% the strength of a normal ACL, but that the knee would feel very good. A lot of people who have the procedure might wonder at that point why they couldn't return to normal athletic activity, but it's important to allow the healing process to continue, and not to risk re-injury by doing anything too vigorous too soon. He also sat with me and talked me through the arthroscope images.

First PT visit

Saw my physical therapist for the first time yesterday and came away very encouraged. My quadriceps strength is still very good, flexibility is also good. You start losing strength and muscle mass very quickly if they're not used, but especially when you spend a lot of time in bed. My PT thought I'd be playing some tennis this summer, which could be one of two things: Either she assumes tennis is like croquet, or she thinks I can progress rapidly.

Didn't sleep well last night, but did manage to do so without my brace. I had started off with the brace on, but it was pressing against my ankle bone and really irritates the incision above my knee. For some reason, that incision is the most bothersome. After wearing the brace for a little while last night, I just took it off. I don't think I'm going to injure myself in bed. I think the main risk is taking a fall. My quadriceps is in good shape which is what will protect the stability of the knee.

Post-op day 4

Yesterday, walked without crutches to and from the kitchen, slowly, but steadily and with no pain. I wouldn't do this, of course without the knee brace, which helps stabilize the leg and gives me some confidence that it won't collapse under me.

I had two 800mg ibuprofen tabs yesterday, one in the morning, one at night. Otherwise no pain meds necessary at all. Now and then I do feel a sharp twinge at the incision highest on my leg, but if I stay relaxed, it doesn't bother me at all.

Back on the CPM this morning, my butt is getting permanently numb. Even so, my goal today is 70 degrees. With the ability now to walk around, I'm thinking rehab should probably include some walking with crutches on a smooth surface, like at a mall, so I'm going to check with my PT tomorrow.

I'll be seeing how well I can get in and out of a car today, including a test to see if I can drive. Our Subaru, which is a manual shift, is out of the question, but the Corolla should be no problem.

I have always hated being injured, but this is a little different knowing recovery is long term. I just hate crutches -- these things will kill you.

Post-op day 3

Good progress so far. Up to 61% flexion on the CPM, and started moving around the house on my crutches and putting some weight on the leg, and it's feeling very good. I'm now off Percosets and switching to ibuprofen for the little bit of residual pain and to reduce swelling. I'm not feeling a lot of pain except for some achiness when I wake up, and I think that's mainly the result of swelling overnight and not being able to use the Cryo/Cuff.

Got the dressing off this morning and had a look for the first time at the leg. There are actually four small holes, plus the long stapled incision beside the shin. I haven't yet seen the video or any stills of the surgery, so I'm not yet sure which holes were used for what.

One thing that surprised me is that I was sure before removing the dressing that I had an incision on the lower back of my thigh where I assumed they harvested the hamstring graft, but there's nothing there! I've felt some real tenderness there. I'm guessing the long incision is where they did this work, but I can't quite figure out how that would have worked. I'll have to get the whole story later this week when I have the stitches/staples removed. The incision that is the most sensitive is the one at the top, highest on the leg, but it's mostly just surface tenderness.

Post-op day 2

Awoke a bit sore today, though I've been scaling back the Percosets. Once I reloaded the Cryo/Cuff and popped a tablet, I felt a lot better. Today, I'm planning three 2-hour sessions on the CPM (and three movies to go with) and to get the bandages off for the first time and have a look at the holes in my leg. Before bed last night, I was feeling pretty good and even boasted I'd be able to give up the Percosets altogether, but that was crazy talk. My goal on the CPM is 10 more degrees today, up to about 58. Sleeping a bit better, though I do wake up a lot with a completely dried out mouth and tongue.

Last night I dreamed I was playing tennis even though I knew I shouldn't and without a brace. It felt scary and I didn't move at all for fear I would do something bad. There was also a part in the Alps, and though there was snow, I wasn't skiing.

My family has been great, especially my wife Diane, who doesn't want to let me do even the most trivial things, like refreshing the Cryo/Cuff with ice water. I haven't tried putting any real weight on the leg yet, and I think that will have to wait maybe a couple more days.

Post-op day 1

Here I am wearing my Cryo/Cuff, riding the CPM, and plugged into my iPod.

Interesting day yesterday. It was like being prepped for space travel was all I could think.

After changing out of my clothes, getting the IV put in, and being wheeled into holding, I waited for about 4 hours before the anesthesiologist gave me the femoral block. It was a little painful, but also fascinating as he probed for the right nerve strand. With each probe, a different part of my lower leg jumped. Then as I'm sitting up, and signing forms answering the "are you allergic to anything" question for the hundredth time, one of the nurses slipped some kind of narcotic into my IV, and as I'm talking to her things began to swim a bit. This was just a taste, as she put it, to keep me relaxed.

Finally, they were able to wheel me into surgery. I noticed as I shifted from the gurney to the operating table, that it had a nice memory foam kind of bed. They put a mask over my face, I took one breath and I was gone.

It took at least two hours post-surgery to wake up, I kept trying to open my eyes, but they wouldn't cooperate. The nurses were getting a little anxious since it was now pretty late on a Friday in the Day surgery department, and everyone no doubt wanted to get home. They were ostensibly dangling the option of staying the night since I was feeling pretty out of it, and very nauseous, but I could tell they didn't mean it. So with the help of my wife and daughter, I was packed into the back seat of the Corolla and driven home.

It wasn't a particularly good night, but I didn't expect it would be. I had a lot of pain, and slept fitfully, not being used to sleeping on my back at all. But the meds helped a lot. By mid-day (today) I'm feeling a lot better and managed my first two-hour session on the CPM. I've got big plans to work on my gardening strategy, a design for an arbor for the front of the house, posting to my blog of course, and watching a movie on my PC. Today's choice is Smiley's People, a PBS adaptation of John le Carre's cold war espionnage novel with Alec Guinness.

Pre-op minus 1

My knees before. My left is the one being repaired.

I have my instructions for appearing at the hospital tomorrow (10:15 procedure starts 11:40). And earlier today, the CPM and knee brace were delivered to my house and fitted. The CPM is very quiet to use, and, no surprise, passive. I could easily see falling asleep with the thing on. The tech who delivered it has been through two ACL recons himself quite a while ago, but thought the machine would probably make a difference in short-term rehab but not so much long term. I'm not sure how to reconcile that, but I feel like I still need a definitive plan from my OS following surgery tomorrow. I'm really hoping to get some imagery or video I can post here.

My dad (retired orthopod) is planning to visit tomorrow to lend moral support.

I'm stocked with movies and a couple of good books. The only thing I don't have that I wish I had was a Tivo unit. Hmm, BestBuy is open tonight...

Pre-op minus 2

Expecting tomorrow to be fitted for a post-op brace and to have a CPM (Constant Passive Motion) device dropped off. The medical tech who called to schedule the drop off said that most people use the machine for a week to 10 days or so. I have a lot of uncertainty about my immediate post-op condition, like the amount of swelling to expect and so on.

Just heard from my doctor that an Aircast Cryo/Cuff, will be provided for post-surgical cryotherapy, which is a good thing. I was thinking I'd have to get my own. Definitely something you want to have:



Otherwise, I'm starting to let people know at work that I'll be out next week. I'm a little nervous not having ever had general anesthesia before, or surgery really, of any kind. The Fallon system is so full of complete idiots that I feel like I have to be super-proactive. Keep hope alive! I will survive!

Pre-op minus 3

Three days to go -- this Friday. Just saw a post from a 44 year old USTA 4.5 who explained he was doing great after his procedure. He was back on the court in 5 months with a brace and near 100% at 7 months. Of course, he could be like those new parents who claim that their baby is sleeping through the night.

Bob's ACL forum

Discovered lively and active forum on ACL reconstruction: Bob's ACL WWWBoard. I'll be posting regularly to the forum and cross-referencing this blog as I work my way through this.