6 Week Check-Up and Update

Today I'm at 6 weeks 2 days post-op and while I've been away from the blog a while I'm still doing 3 session of physical therapy a week and gradually getting back to "normal". I think my physical therapist slowed down the rehab in comparison to last time to avoid the hiccup we hit last time that was either tendinitis or something else that kept me from progressing. 

Dr. Shapiro asked if I was running yet in my check-up Monday and when I said no he was surprised, but then again I feel as if I only just started walking without a limp and am gaining confidence on stairs -- so I was not in a hurry to run.  Of course, that day I went home and ran on my treadmill at home to prove I was capable!  Also, in physical therapy yesterday I started running (or, "rumping") in walk/run intervals, but it got more fluid as time went on and towards the end of 15 minutes I was cramping in my side, not my leg, that made me want to stop!
Some of the questions I asked of my doctor at 6 weeks, since I am always seeking more information:

Q: Can I kneel (while playing with my daughter, etc)?
A: You can't "damage" anything by kneeling, so if it doesn't hurt, you can kneel.
Note: YES! It HURTS to kneel, and this will go on for quite some time... But eventually it will subside to a manageable feeling!

Q: In my surgical report (which I had to request from medical records) it says "The core of bone from the tibial tunnel was then cut in half and placed withing the patellar defect".   Can you explain? Did you do this in my left knee 3 years ago?
A: Yes, it was done both times. An oscillating U-shaped saw is used to cut the patellar tendon graft from the kneecap, leaving a semi-circular void (defect).  An O-shaped saw is what is used to create the hole in the tibia where the graft is threaded (instead of a drill) so that a cylindrical bone plug is a byproduct of the preparation of the tunnel instead of the bone equivilant of sawdust. The cylindrical bone plug is cut in half so it's rounded on one side (to fit in the patellar defect) and flat on the top.  Once placed, it's then shaped down to match the kneecap surface. Before this method started being done, when the void was left there was sometimes cracking of the patella (stemming from the void) later down the road.
Note: I thought this was pretty awesome to learn! I tried to tell my husband twice, and I was excited to get in to enlighten my physical therapist who didn't know this was part of the procedure.

Q: Is the reconstructed ACL "stronger"?
A: I feel like doctors are hesitant to say "yes" to this one because there are lots of other factors to consider, but Dr. Shapiro said yes, the graft is stronger than an ACL because of how it's anchored, but without building the muscle back up around the knee and being mindful of the activities that cause the original ACL tear, it doesn't mean this couldn't happen again.

Q: What is the longevity of the graft?
A: As long as I'm alive, the graft is alive. It's a little different than the original ACL (clearly) and doesn't have exactly the same connection and responses to and from the brain, but for all general purposes, it's a living, breathing tendon and will keep on tickin' as long as I do.

Q: Will I tear the reconstructed ACL?
A: The good doctor then mentioned there was a girl who just entered the office while I was waiting who was there to be diagnosed for a potential 3rd ACL tear. He pointed out she was 14 and rail-thin for the first surgery, it happened again a few years later (same knee) but that she was a competitive cheerleader and by now she was much "thicker" than during her first two injuries. So the combination of her activity choice and her build let him to believe that in her instance, yes, it's likely it could happen again.  Although I play many different sports, none of them are particularly high-risk and even the cutting sports (like soccer) are played recreationally and just once or twice a week for an hour. That, combined with the fact that I'm relatively physically fit, committed to my rehab and (this one I'm guessing:) my activity level may decline as my kid gets older and we consider adding another one to the mix...  means it's unlikely that this should happen again. Not impossible, but, unlikely.

Q: I've done patellar tendon reconstruction on both knees. If this happens again, what do we use?  I have no more tendon to spare!
A: Cadaver patellar tendon. A cadaver ACL is not used because each body is different and there's no telling if the length of the ACL from a cadaver would be an appropriate fit for someone else's ACL reconstruction. The patellar tendon (cadaver or not) allows some flexibility when positioning and anchoring it into the holes created in the tibia and femur.
Note: Every doctor is different, but this was the recommendation of mine...

Q: Likelyhood of arthritis or pain in the knee in the future because of these surgeries?
A: More likely than someone without knee surgery. Not very likely for me in particular because I had no miniscus damage on my L knee and only about 5% on the right knee. Others who have more meniscus damage have more pain later on.  Also, future pain is much more likely in those who do NOT have their ACL repaired because then the knee can slip at any time without the stability of an ACL and cause meniscus damage, worsening over time with each slip.  Overall this puts me in a good position, even if there is potential down the road.

Q: Let's be honest. I'm 30... This is the second time this has happened...  Is it time to start suiting up with a brace on my knee(s) to prevent additional injury?
A: No.  A brace becomes a crutch and provides no benefit.  The braces you see professional football players wearing are generally to prevent MCL damage, not bracing their ACL.  Dr. S pointed out that professionals don't come back wearing braces. I thought I am far from professional, but I see his point. It is just a reminder to stick to the physical therapy to build supporting muscles back up, and maybe make some smarter decisions on the soccer field like focusing my efforts on things that don't require as aggressive side-to-side movement.
Note: Again, I feel this is something doctors may be divided on, but my physical therapist and doctor both agree there's no reason to start bracing.

And there you have it. I see the doctor again at 10 weeks. In the meantime, here's a fun image showing the screws from the post-op x-ray!

One week post-op x-rays showing titanium screws


Every Surgery is Different [2+ wks post-op]

I kept such close tabs on my recovery from the last surgery that it's hard not to go back to the blog and see if I'm "keeping up" with myself from last time.  When I'm "ahead" it's a good thing to have that comparison, but when I have unfamiliar feelings, pain or am not "on track", it can be very frustrating.

In the first week I felt a lot of improvement over the last surgery, but during the 2nd week it tapered off a little and I started to focus on my pain level and how much bend I was getting. There was a lot of aching when at rest and it constantly feels like the kneecap would catch, which kept me from improving my gait and working on things like going down stairs. More than either of those is the pain I'm feeling on the outside of my thigh, even just to the touch. Drew tried to explain that it might be coming from the bruising I have irritating some nerve endings and causing the sensitivity... I am not sure that's what he meant, but whatever is causing it, I think it's something that needs to run it's course.

There has been improvement now as I'm closer to 2.5 weeks. The general aching pain has subsided, but the thigh sensitivity is still present. I can stand/walk for longer periods of time and we've added some strengthening items to the PT exercises. Those exercises include angled squats (knee bending from 90 degree bend to straight), mini-squats on the Bosu and balancing on my surgical leg while throwing and catching a weighted ball. I feel strong in these exercises and have been doing them at home to stay on track.  Only once has Drew had to do a little "forced bending" at PT to work on my range of motion (ROM), but it was not nearly as bad as last time, and hopefully we can avoid it going forward!

One thing I have to remember is that I can't compare myself to myself... When I mention feeling "behind" to my physical therapist he stopped and (quite seriously) claimed that it doesn't matter that I've had the same surgeon, same procedure and same physical therapist... Every recovery is different and I just have to listen to my body and work on the rehab!

Photos from 7/30, 13 days post-op:

Yes, I'm trying to flex my right quad!

Working the bend, bruising starting to fade

Crazy bruising; waaaay more than last time