ACL Story - 10 Days Post Op

[co skier]

Frequent lurker, never poster, but decided to add my knee saga for others. This forum was a great reference for me prior to surgery and in that spirit..

Have been an avid skier since early childhood (33 years), never been seriously hurt, no surgery of any type, and rarely go the doctor.

The Injury:
Spent april 11 (friday I believe) skiing great spring powder at Loveland. On my way back to the truck decided to ski Over the Rainbow since it ends at the parking lot. Hit a patch of ice, buried a ski in a deep push pile, toppled (at high speed) and heard/felt the famous "POP" . Spent the next couple of minutes digging my leg out (tele - no release) and swearing. Pain that accompanied the "POP" faded quickly and after a lot of deep breathing, was able to kick turn and side slip to the bottom. Drove home in denial without even looking at the damaged area. Finally got around to looking the next morning and found a knee that resembled a grapefruit (something round, definitely no knee). Anyway, spent the weekend knowing the knee was f**cked. Called the ortho Monday and got an appointment for the following week.

The Process:
First ortho examined knee (recommended by gf), ordered MRI and sent me home. Not alot of information presented from him. After MRI - another visit to confirm my ACL looks completely broken, doesn't appear to be any meniscus damage. First question out of my mouth, "what happens if I don't have surgery and finish skiing the season". Doc obviously doesn't understand since he launches into a long discussion of further knee damage with probable damage to meniscus. Does finish up with John Elway played most of his career on an ACL deficient knee, but now his knees are shot. Also explains that I will probably not be able to ski next season until about the 1 year mark (his recommendation - the gold star patellar autograft). Definitely not acceptable to me at this point as the best corn season in years is approaching.

I decide to brace and keep skiing at least on a limited basis as I already had a trip planned to the San Juans for some steep spring skiing. Made the trip, skiied some good lines, but decided to go ahead with the surgery as a result of my endless research on knee surgery and my desire to ski next season. Also, performance of a braced knee was ok, but had fair amount of stiffness after every ski session and the approaches were tough.

Found another doc, got a second opinion and decided to schedule the surgery (same recommendation patellar autograft). Was nervous as hell regarding the surgery and recovery. I live by myself, have a dog and was concerned about being able to move around and all of the other things you have to do when you live by yourself. At this point, strongly considered Dr Mark as his recovery is far more in line with my thoughts on the subject. Thanks Dr Mark for your input into this forum. Decided to stay local and go with the surgery, but I like the way Dr Mark doesn't BS people about their conditions and his rehab is aggressive and gets you moving.

In my usual planning style, I cooked a few meals, stocked the fridge (lots of fiber, bought ice, mowed the yard, and did all of my laundry prior to surgery. The planning and chores at least kept me sane in the few days prior to surgery.

The Surgery:
After a few hours of restless sleep the night before, GF took me to surgery at 5 am on Wed 6/11 (almost bailed at last minute). Spent about 1.5 hours waiting, getting prepped and finally wheeled into surgery at 7:30 am. Next thing I know, I'm awake (with a big brace) and ready to get dressed and leave (left about 10:30). Doc gave GF some pictures from the surgery and said no other damage to meniscus or other knee parts.

Recovery:
First day was rough as I expected to be able to sleep, but was awake all day. No sickness after anesthesia, and hardly any pain until about 6pm. Heat started building in my knee, and stupid Cryo-Cuff gives no relief. Too little area covered andnot enough cold. Spent most of first night doing straight leg lifts since I couldn't sleep anyway. GF wakes up at 3 am and says "what the hell are you doing". She didn't appreciate the answer, but went back to sleep while I continued my program.

Day 2:
Went back to doctor on the day after surgery. Been about two days on 5 hours sleep and not much good sleep at that, but pain pills (about 1/2 of what was prescribed) are keeping the pain very tolerable and I feel ok. When doc takes off brace and removes surgical dressing, it was like heaven. My knee instantly felt better from the additional heat release. That day, I got a little smarter and removed the brace and went with the ice packs. Sooo much cooler than cryo-cuff, I finally get some sleep. Can't forget, eat lots of fiber..narcotics are killer on the pooping.

Day 3-5:
Started organized PT on Day 3. Easily got 90 ROM and started doing more exercises at home. Ice constantly, only taking ice off to keep skin from freezing. Getting around pretty good at this point. Doc has directed use of crutch until Day 7, but I got around a bunch with just the brace after day 3. GF mows my lawn on while I watch from chair. What a day GF stays at her place after Day 4 as things are looking up for me.

Day 6:
Back to work. Finally figure out why cryo-cuff is good and glad I didn't toss it around Day 3. Easy to use at a desk and keeps the knee cold. By this point, swelling outside of the cryo-cuff area is under control and heat is not as intense as earlier. Still tire easily and wouldn't recommend going back to work if you have to be active. I sleep for a couple of hours after work and then all night. Things look much brighter and pain is completely tolerable with only 1 painkiller after PT.

Day 8:
Another doctor appt, seems they haven't made enough money on me yet. Get most of stitches removed and full release from crutch (sorry doc, think that happened on day 3). He seems amazed that I walk into office without crutch, "that doesn't hurt too much". Everything looks good and staff seems amazed by my progress.

Conclusion:
PT will be ongoing (125 ROM at day 9), should get full ROM by next week. Daily life is getting back to normal, but I still tire easily and am not up for extended walking. Ice packs in the evening have become the norm even though swelling and heat are better. I spoke with Doc about brace and he indicated that I didn't need to sleep with it anymore. Big relief there as the thing is a bit clunky. Bodily functions are back to normal and I assume this is at least partly because I have stopped taking narcotics.

Sorry about the rambling, but this is the mostly complete story from injury to being mobile again. The process is not as bad as many seem to paint it, at least from my prospective. Of course, my injury was straightforward and didn't require any additional repair during the surgery.

Best of luck to all of you gimps.

[Woodlandclown]

piece of cake! good for you--wish mine was that easy.

[splat]

No shit.

I'm at day 4. Still hurt a lot, mucho swelling and rom of 0-45.
I need to hit 0-60 by Wednesday. A couple bad days I skipped exercising and feeling it in the shrinkage of my ROM.
How much can you force the ROM?
passive resistance machine isn't taking me far enough.

[Woodlandclown]

No shit.

I'm at day 4. Still hurt a lot, mucho swelling and rom of 0-45.
I need to hit 0-60 by Wednesday. A couple bad days I skipped exercising and feeling it in the shrinkage of my ROM.
How much can you force the ROM?
passive resistance machine isn't taking me far enough.

i wouldnt force it. being only at day 4, you still have a lot of swelling that is preventing full rom. dont skip the exercising. use that cpm 6 hours a day. once you can get to 90 you wont need it any more. you should set it at a degree that is very uncomfortable for you--not something easy. if you can get it to 45 easy, then push it up to 60. if you have your leg in the cpm for an hour at a time at 60, it will keep getting easy.

[co skier]

I had big improvements days 4-6. Kept on the wall slides at least twice per day, 20 reps per session. Trying to gain a little more ROM with each rep. I also don't think forcing it very much is a good idea. It will hurt like hell, let gravity help, stay diligent with the exercises. They do help over a few days. The straight leg raises I did really helped the pain of moving around after day 3. I know nothing about the passive resistance machine.

I know the shower at the end of day 3 was hard to get into and get clean, but was worth the effort and they only get easier.

stick with the ice, once you get the swelling to come down a bit, everything gets easier. and don't forget the basic exercises, just a little bit every day will get you to 60 by Wednesday.

[SkiBrain]

Day 3 out of patellar autograft and your experience is very similar to mine so far, co skier, although they didn't brace me and surgical dressing won't come off until follow-up appt this Thur. Been icing almost constantly since surgery, but easing up now. The narcotics and not pooping was really bad for me too. Should have started prune juice and stool softeners earlier! I also got 90 ROM pretty easily and can probably get even a bit more now. Been doing rounds of the basic exercises every couple of hours or so. Ditto on the shower! Had my 1st post-surgery shower yesterday evening and it was a bit tricky but felt great!

[TahoeAk1]

You guys sound like your doing great! Dont rush the ROM. I am now on day 23 and life is normal again.

Pool has been really good and PT basically every day. Swelling is almost gone.

Have you started with measurments on your leg? Get your swelling down below 1cm above/center and below the knee before you go beyond 130 ROM. Your extension should be good as well. Time is on your side.

CPM machine was good for the first few days then it was scrapped...

The wall slides, heels slides on the floor etc , Drmarks cannoballs were very good...they are actually my favorite now for warming up.

Only thing I dont feel comfortable with is stairs, but PT guys says wait anyway until week 4..and thats next thursday...

Again, time is on our side.....

Good luck...

[co skier]

No brace at all SkiBrain?? My PT guy mentioned that he does rehab for a surgeon that wasn't bracing after surgery, but was asking for a brace for sports. After a week, I was told to wear the brace when out of house and doing anything active. Not supposed to need a brace to ski after a year. First few days would have been much nicer without having to deal with a brace. They really keep the heat in and make sleeping tough.

[SkiBrain]

I was told that one of the hardest things after patellar autograft is getting full extension and that's why bracing right after can be useful, but my doc advised against it. Said I'd be better off just trying to do straightening exercises every couple of hours, which I've been doing. Feel like I have full extension but have reached a limit on my flexion ROM and can't seem to get past 90 degs. I have a donjoy brace that I used for skiing this season before the surgery. Perhaps after my follow up visit and starting PT later this week they'll have me start using it again for certain activities.

[co skier]

Isn't that donjoy sized for a quadricep that is probably starting to fade away? Seems that every dr has a different theory on rehab.

Have never used a brace for PT. 2x per week since day 3.

PT gave me some exercised that definitely helped with the straightening. Seems that your quad is the controller for the last part of leg straight motion.

[TahoeAk1]

It amazes me that some Dr's dont give you a brace.

It just does not make any sense as to why?

You just had major knee surgury and your let go without a brace...

Its the same here in Tahoe as well. The really good Dr's give you a brace and you come out of surgury in one. The Dr's here on N Shore are trying to make a name for themselves and they send there patients home without a brace.

Your Don Joy is sized for a quad correct? Its not going to fit you in a week or so....

Its crazy to me there are so many different ideas out there.....

[Woodlandclown]

i have a custom brace i bought for skiing last year aftre i injured and before surgery. the shrinking quad isnt the issue--its adjustable there, the problem with wearing it was the swelling of the knee. The giant brace i got after surgery, i found completely useless. i wore it for the first two weeks just because i thought i had to, but i stopped that nonsense. I still use my smaller custom one when i am out in the woods with the dog in case i trip or something.

[SkiBrain]

Definitely seems like there are 2 schools of thought out there on post-surgery bracing. My doc explained the pros and cons to me, but mostly steered me away and said he didn't really think it was necessary. I agreed with him and don't think I've suffered any adverse consequences. I was just guessing about whether they're going to have me brace for PT or anything else once I'm off the crutches and able to bear weight on it. Hopefully I'll be cleared to do that in a couple of days.

[GimpyKnee]

What's up guys?

Im currently Day 8 post op from ACL reconstructive arthroscopic surgery and reading ur guys posts put a lot of things in perspective for me. Just wanted to share some of my experiences so far to add to the help and perhaps even get a few questions answered.

Last couple of days have been alright. The swelling has gone down a little bit but there still is a significant amount. Also, since Day 3 Ive been developing some hematoma(bruising) along the inside of my shin.

I've been really struggling with knee flexion. Ive been reading up on this forum and others and people say at my stage they have over 100 ROM and no trouble walking around without crutches. Im am very far from that. Currently my ROM is approximately 25 although I can extend full. Ive been wearing the brace non stop for the first 5 days and the last 3 its been on only while Im mobile. My doctor did not specify any PT exercises (which is probably why I can barely bend my knee at all)
but I have found a few useful ones on youtube: http://www.youtube.com/watch?v=oCWhC9psl2M .
Also some useful tips here: http://www.youtube.com/watch?v=HIBWReLNDfE .

I have adjusted accordingly and I will tell you how it goes.

Currently, my main concerns are
1) I wanna do more PT but I am afraid of overstraining myself and injuring it. How do I make sure I dont do that? Its only my first day today...
2) Nights are rough. My doctor tells me to sleep with the brace but Ive had enough sleeping on my back. Im afraid to lay on my side as it also causes a lot of discomfort to my knee. Any suggestions?
3) I have no clue when I'll be ok to start performing normal everyday tasks. My birthday is comin up in a week and I dunno if I should plan something or not.

Any questions, let me know. I'll keep you guys posted on my progress and keep checking out on the forums.

As far as the brace thing goes, my knee extention is amazin, never get anything even close to pain when my knee is straight or even -10 (it actually kinda feel good). I attribute it to the brace. But I cant bend my knee for crap. Hopefully new PT exercises will help.

Thanks, take care!

[Woodlandclown]

gimpy - when do you see your doc again? I wore the brace at night only for the first week. on my follow up appt he told me to stop using it. you should be able to sleep without it now. i did sleep on my side with the braced knee on a pillow though when i was using it--the braced knee being forward of the other knee on the pillow. that seemed to help a bit.

your flexion seems extremely low. this is an instance when the CPM machine could be very ehlpful. Are you doing heel slides? you should be trying to bend it for a few hours a day. you arent going to overstrain it by doing simple heel slides. Your best bet is a follow up with dr and a good PT--definitely go see a PT three times a week.

good luck - the extension is definitely the first thing to focus on and you have that, so you are in good shape.

[GimpyKnee]

yea, just started heel slides yesterday
how many reps should i be doing
i do like 5 at a time twice a day.
is that too little?

[Woodlandclown]

yea, just started heel slides yesterday
how many reps should i be doing
i do like 5 at a time twice a day.
is that too little?

my personal experience was that I was to reach 60 degrees by day 2 and 90 after the first week. i used a cpm machine though to do it. i would ramp up the heel slides. the longer it takes to get your flexion back, the harder it is. i would try for 20-25 reps, three sets at least twice if not more a day. try heel slides, but when you get as far as you can, then flex your foot/ankle up to get a few more degrees--do heel slide, 5 pumps of ankle flex, then straighten and repeat. you have to get to 110-120 as quick as you can so you can start riding a bike. you may feel like you are going to do damage, but you arent with just simple heel slides.

[splat]

GimpyKnee - pillows between your upper legs and lower legs works for less pressure on the knees to sleep on your side.
I know what you speak. I'm a lifelong belly sleeper and just spent 30 days and nights on my back.
Best part of sleeping on my back has been a significant pain reduction from all my back injuries.
I usually wake up to backaches, but that's not been happening.

[Woodlandclown]

yeah forgot - when i was sleeping with brace i slept on my side with a pilloe under the braced leg. on side but with the braced leg forward on a pillow. i only slept with brace for a week though. you should be good to go, so ask your doc. call if you are not seeing him soon.

[fallin]

Hey thanks for sharing your story and I hope you are feeling better every day.

Currently my ROM is approximately 25 although I can extend full. Ive been wearing the brace non stop for the first 5 days and the last 3 its been on only while Im mobile.

I haven't had the surgery yet, but they told me to initially set my CPM to 45 degrees bent for the very first day post op and then increase 5-10 each day. I would say don't be afraid of bending it with heel slides and cannonballs constantly because your knee is meant to bend!

My doctor tells me to sleep with the brace but Ive had enough sleeping on my back. Im afraid to lay on my side as it also causes a lot of discomfort to my knee. Any suggestions?

FWIW the first doc I went to said I would need to wear an immobilizing brace while I slept for the first month post op. That's part of the reason that he won't be the one to cut me--my current doc says no brace at all. I would say go with what your doctor says because he most certainly knows more than we do, but dont' be afraid to take off the brace and bend the knee or you'll never get the flex you seek. As far as sleeping goes, sleep on the good side with pillows underneath the injured leg (forward or backward of the good leg) and let us know how it works out for you!

3) I have no clue when I'll be ok to start performing normal everyday tasks. My birthday is comin up in a week and I dunno if I should plan something or not.

Absolutely party on your birthday! I imagine you are already a ton better than you were immediately after the operation--hopefully you'll be that much better by the time the bday rolls around. Are you off pain meds? Will you be off crutches by then? And what were you planning for your birthday? So long as distance running isn't in the schedule, I'm sure you can prop yourself up for a beer with some buds, no?

[splat]

Shit, I wish I only had the acl injury. Getting the meniscus sewn back together adds a month to the healing. ROM for my acl is pretty much a breeze. Day 11 post-op and I'm at 75 degrees, and I'm taking it slow and easy. I could do 90 easy, but I'm gonna baby myself a little on this healing, seeing as I have another 30 days of no weight bearing.

[SkiBrain]

Gimpy, I'm at day 10 post-up so we're almost on the same time-line. There's still significant swelling and bruising almost all over my leg too. My ROM is about 90 degrees. It's been that since almost day 1 but for the life of me I can't seem to get much past that no matter how many heel slides I do. How did you have yours reconstructed? Mine was patellar autograft and the doc said that getting full extension is more important than flexion and that getting it back to normal can take months. If it doesn't come back all the way they can go back in to break up the scar tissue that's probably preventing full ROM.

In terms of PT, see how you feel and what you think you can tolerate. For example, yesterday was a very bad pain day for me (had to resort to the heavy-duty meds) so I didn't do anything in terms of PT, but feel better today and am back on the exercises.

I was not braced after the surgery so I can't sympathize or offer any advice about that issue, but I also found that a small pillow to rest the bad leg on or put between my legs sleeping helped.

Like fallin said, definitely do something for your birthday. You'll probably be miserable if you don't. I'm not that far ahead of you and have made it out to a bar to watch one of the Euro semi-final soccer matches and have drinks with friends and will be doing so again tomorrow to watch the final.

Good luck and keep us posted!

[SkiBrain]

Shit, I wish I only had the acl injury. Getting the meniscus sewn back together adds a month to the healing. ROM for my acl is pretty much a breeze. Day 11 post-op and I'm at 75 degrees, and I'm taking it slow and easy. I could do 90 easy, but I'm gonna baby myself a little on this healing, seeing as I have another 30 days of no weight bearing.

Sorry you have to deal with that too Pat, but hang in there. Sounds like you're doing really well otherwise!

[splat]

Having weathered a shitload of incapacitating injuries in my life, this is but an inconvenience for me when I'd rather be pressing skis, Nat. The back injuries I have suffered kept me down for what would be a total calculated in years instead of months, including this long in traction alone. The only bummer for me is noticing how fast my muscle deteriorates compared to my younger years.

[L&AirC]

What's up guys?

2) Nights are rough. My doctor tells me to sleep with the brace but Ive had enough sleeping on my back. Im afraid to lay on my side as it also causes a lot of discomfort to my knee. Any suggestions?
Thanks, take care!

I'm struggling with this too. I haven't had my surgery yet but along with tearing my ACL, my MCL has a tear in it which makes it very uncomfortable to sleep on my side; either side.

Sleeping for me has always been tricky as I have GERD, slight lumbar scoliosis and sleep apnea. Each of them needing to be addressed positionaly for sleeping. Throw in an injured leg and it becomes a bit trickier.

As a few folks mentioned, putting one leg in front of the other works but if you roll a bit, you'll end up bumping legs. Pillows or pads help but they need to stay in place. What I have done so I can sleep on my side is wrap a skinny pillow or towel to my leg with an ACE bandage. This way when I move, the bumper goes with it.

I prefer to sleep on my side and sleep better on my side. It's been two months and I can sleep on my back. It took a couple of weeks to get used to though.