1 Year Post-Op (Surgery #2)

[..Also, 4+ years post-op from surgery #1!...]

It's hard to believe a year has gone by since my ACL reconstruction surgery on my right knee.  I had the pleasure of getting back to indoor/outdoor soccer, indoor volleyball, flag football and softball too! I feel confident on the field (er-well, as confident as I did before) once I got over the fear of the first few games of soccer, which was the worst on the knees out of all of my activities.

There were a few plays in flag football where I had to cut side-to-side to keep the other team's QB from getting around me, and I told my team I needed to move to another position, because I remember those exact same motions were how I tore my first ACL, and I just can't "turn it off" when I'm in the middle of a play!

Otherwise it's been back to normal, even though I wish I would have committed more effort to my rehab the second time around. Part lack of effort, part full of excuses, I found having to entertain a toddler during some of the critical rehab times would easily distract me from what I really needed to be doing.  Luckily I think I had a good enough start to the rehab, I did not lose range of motion (ROM), but perhaps just don't have the muscle I once had.

The good and bad of having 2 ACL reconstructions on opposite legs is that if one quad was smaller before, now they're pretty much back to even! I have not felt that whatever muscle I might be lacking from before has been a handicap in my activities, so I must have done something right to get back to a confident level.

That being said, I was happy to be a part of a championship volleyball team, a runner-up flag football team and currently on a softball team that is running away with the #1 spot with a landslide! (Thank goodness for athletic friends to support these endeavors!)

05.20.2013 Indoor Volleyball CHAMPS (with our camping chair prize!)

I'm hoping I won't have to frequent this blog again, but I encourage anyone who's followed it or found it (and has been or is going through an ACL reconstruction) to not be afraid to get back out there and do what you love!

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



We Talkin' 'Bout Practice! [15.5 Weeks Post-Op]

Monday (7/27) I met with my surgeon, and despite the fact that I didn't see him until over an hour after my original appointment time, it was a good, quick visit. My physical therapist didn't give me any ammunition to go in with, since I seem to be on track (I just have to get back that muscle mass and control!!). Also, I haven't had any odd pains or limitations to speak of, so I feel like we're doing things right so far.

One question I had was about distance running. I've kept to 1.5 miles or less up until this appointment, because I don't want to develop bad habits since my surgical leg still has muscle to get back. [Yes, I do still favor my leg a bit when running.] I figure if I keep the distance low, I can pick up the speed, and when I run more quickly, it seems to lessen any limping. Dr. Shapiro said up to 2 miles would be fine, so I will stay under that until I see him again in a month. I hadn't planned on running the Detroit Marathon in October anyhow... ;)

While it's nice to get back into running, that's not all I've been eager to do! Since I'm up for most any sport (except basketball, which I've never been too great at) I had to ask, what ELSE can I do? Dr. S threw a blanket statement out there, "You can run some drills and practice pretty much all of your sports now, just don't participate in any competitive games." I eyed him skeptically because really, isn't it the motions, not the contact I need to be worried about? But I also wasn't going to look a gift horse in the mouth either. So, to be sure he meant 'all' I thought of one of the sports that would be rough on the knees and said, "Even sand volleyball?" His response: "Well, no. That'll be next year. Too uneven." Luckily that's the answer I expected, so I went for a more hopeful one... "Soccer?" "Yes." Woo hoo! Look out local high school turf field!

In hindsight I should have asked about more activities, but by the time I would have gotten through the list of sports I want to start playing again, I might have kept him there another 10 minutes. ;) For now, it's all about doing what I am comfortable with, and stopping if there's pain.

Round and Round We Go... [9 Weeks 4 days Post-Op]

Due to mixing it up in PT on Wednesday (and in the process, doing a handful of exercises until my muscles truly fatigued) I was awfully sore starting Friday morning. As a matter of fact, the limp returned [but before you are sad for me, read on], this time due to my muscles in my non-surgical (R) leg being so sore that I was then favoring THAT leg! Maybe it's nothing to be excited about, since the last thing I need right now is an ever-growing right quad. However, CHEERS to my left (surgical) leg for being strong enough to put up with the flip-flop of the limp! Luckily, the soreness has since faded substantially, and I'm back to a generally normal gait...

Instead of trying to bust out more PT exercises on Friday, I thought trying a yoga DVD would be better, to stretch and work on breathing. It was nice, including some lunging poses, however, about half way into it there were some poses I chose to skip. For example, one req'd kneeling and putting weight on the area where they took my graft, and by the time that one came about, I decided I had stretched enough for the time being!

To feel like I'm still doing what I can on my own, today I did some walking and a mile run on the track [where my new iTouch helped break the monotony of going round and round- Thx BB!]. That was followed by lots of stair work on the local HS bleachers. Since they're half-steps, I would go up taking 2 steps at a time, always leading with my surgical leg, forcing that quad to do most of the work. Going down I would step down with non-surgical leg, forcing the surgical quad to, again, bear the burden of controlling the balance and movement as I stepped down.

Stairs are one of the things I am using to track my progress. When I end up ahead of someone (going up or down) in the stairwell at work, I feel myself getting flustered as I hear them galloping closer, and I can't seem to go as fast. I am noticing some improvement, but for now they'll just have to deal with it - I refuse to take the elevator!

Now, back to enjoying the weekend! Happy (early) Father's Day to all the daddios out there, and especially the best one I know-- Papa John! ;)

My First 1-Mile Run [2 Months Post-Op]

Since my last PT visit, I hadn't made much time to get in quality exercise for my knee over the weekend. I blame being preoccupied, but a little of it was laziness. Over the weekend there was a lot of walking and standing, and the 'ol knee held up well. Occasionally an ache would find it's way around my knee, but nothing too painful. Either way, I was looking forward to today, since my last PT visit was finally a break from the monotonous routine I'd been doing.

Today's surprise was the 'timed 1-mile run'. As an ex-cross country runner and being an athlete in general, I know I used to be able to easily run 1 mile. Plus, I've done previous sessions of run-walk intervals in PT, covering more than 1 mile, but today's challenge was to do 1 mile running, and at a decent pace. So, once I'd done an 8 minute warm up on the elliptical and stretched a little, I headed for the treadmill. Drew was not over my shoulder during the run, so I didn't burn myself out on it, but I did make sure to turn up the pace from previous PT runs (from 6.0 to 6.5). I finished in ~9:30, and for my first mile back after knee surgery, I am OK with that! (Plus, I know I could have gone faster if I had to, but I still had a full slate of PT ahead of me!).

The run left me whipped, but as usual, I felt really good about it once I was done! I did a handful of other exercises (including shuffling side-to-side between cones; also pushing off side-to-side in a speed skater fashion on a slip board) which had me working on sideways movements and adding in a little squat motion as well. It's good to know I'm getting to a point where it's not all about the range of motion in a straight line!

While I did have to go down in weight on the one-leg press today by ~10#, I was fine with exhausting my leg muscles to the point where they were shaking throughout that exercise, and others. Lunging is still difficult to put the weight evenly through my surgical leg, but practice makes perfect, right?

Next Monday (just shy of 10 weeks post-op) I'll see the Doctor again and make sure I'm on track!

I haven't posted pics in a while, but then again not much is changing. Swelling seems minimal, the incision is healing up nicely, and the definition in my legs is coming back, little by little. The only thing I might ask about is the dark spot that still remains on the back of my knee where I had dark bruising after surgery. I am sure it's normal, but just out of curiosity.

Knees and Trees [7 Weeks Post-Op]

I am forced off work this week (it's all good!) and so that means daytime PT appointments and taking care of those little things that are often put off. Since I have been making improvements in PT and feeling stronger on my feet, it was decided that this week is when a big tree in our back yard would come down.

My dad, a seasoned tree-cutter-downer and general outdoors man, offered his services, but this is a big task for just one person. So, in addition to keeping him well fed and hydrated, I decided to monitor how my knee felt as I helped with the take down. I was aware that the backyard is a bit soft and, in some spots, uneven. Also, there is always the chance that a limb can come down more quickly or in a different direction than anticipated, so it meant being smart about where I was in relation to the action. Luckily Eric was able to be a big help when it came to needing extra elbow grease for the big cuts, and some of those times I was happy to stay on the sidelines instead of risk any injury.

2-day story short- and because you were surely holding your breath- there were no injuries, or even pain beyond normal use! There were even times I was able to plant both feet firmly and tug on guide wires, and I felt strong in my foundation. Or if I needed to step on a branch to hold it down as I broke it into smaller pieces, I could use either foot and wasn't nervous to do so.

This definitely isn't how I expected to be 'celebrating' my 7-week post-op anniversary. At the same time, if you would have asked me a few weeks ago if I would be helpful in an activity like this at 7 weeks, I might have thought you were crazy!

Meanwhile, PT is focusing on the same strength building exercises and transitioning me into running. Drew worked a lot on stretching my hamstring and really straightening out my leg at last PT, and I felt a lot better when I jumped on the treadmill immediately after. 10 minutes of speed walking followed by 3 minutes of running left me tired, sweaty, but most of all confident of my eventual return! Yay!

The backyard beast that had to come down:

Draped in chains that helped pull the tree down, limb by limb... it's not my limbs holding me back anymore! (OK, Cheesy, I know!)

"Rumping" [6 weeks, 4 days Post-Op]

When I left you, dear reader, I had told you of my first attempt at running. I have since undergone yet another PT session (which included about 10 minutes of 2-minute intervals of speed-walking and then 'running') ... but I wouldn't call it running. It's more of a cross between limping and running... which my good friend Jesse so cleverly coined "Rumping".

Today I gave the run/walk intervals another try. I was advised by Drew to go to a track (meaning level surfaces and a nice padded course) but since there was a soccer game going on in Berkley's track infield, I refused to run around the game and provide entertainment for the ~100 people there. So, I went outside of my trainer's wishes, and hit the streets (very carefully, might I add). First, it was taking my walk from a slow, to normal, to eventually quick pace. Then, once I felt comfy, I tried running again. It felt just as awkward as the first two times, but if nothing else, it felt good to be out, trying, and breaking a sweat!

I believe the reason I can't shake the limp while running is I am (1) still having a hard time mentally trusting my surgical leg, (2) my muscle mass in my surgical quad is substantially less than my non-surgical and (3) when I do run, I am not letting my surgical leg extend out all the way, therefore I'm running shorter strides on that leg versus my 'good' leg. This overcompensation caused a little pain in my 'good' leg's hip towards the end of the run, but nothing I feel when walking or going about my day-to-day.

Otherwise I feel I am reaching a point where I actually sometimes FORGET about my 'bum' knee! It is a wonderful thing. The more I find myself putting it out-of-mind, the more I realize I am getting back to that 'normal' lifestyle I so desire. In the coming week I'll still be seeing my trainer 3x, but after that we've decided I'm ready to go to 2x / week. This can only mean one thing... PROGRESS!! :)