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!

Knowing me is not bad luck... I swear! [6+ months post-op]

[Alternate title..." If only Dr. Shapiro gave cash for referrals, I'd be rich!"]

3 days of snowboarding in Colorado and all I had to show for it was a nice scratch on the face (thanks, tree run...), an all-over soreness of muscles I forgot I owned and a lovely bruise on my knee from a chairlift-exiting gracefulness not often seen in those parts! The knees held up great, I felt confident out there and was happy I could keep up with the lovely ladies I traveled with!

And in the spirit of returning to things I love... Last night I had the pleasure of playing volleyball again with some fantastic folks I played with about a year ago, who I really enjoy playing with! The unfortunate part of it all was that one of the girls (Miranda) was out due to a knee injury the week before, so that's why I was subbing. When arriving to the gym I asked if anyone had heard how Miranda's doctor's appointment had gone I learned that she had, in fact, torn her ACL ("NOOOOOOOOOOOOOOOO!!!").  Boo! Hiss! Dislike!!

Miranda is already set with a doctor (thought I'd happily recommend my own) and it just got me thinking how common ACL tears seem to be. I blame fun, active lifestyles and surrounding myself with people who enjoy the same activities I do! It also reminded me of when my girlfriend, Wendy, got the unfortunate ACL diagnosis on the same day I had my last appointment with Dr. S from my first surgery! That's why I must reiterate - knowing me isn't bad luck. But if we're pals, there is a good chance you enjoy a good soccer, volleyball or flag football game as much as me, and I'll keep my fingers crossed that you won't ever have the pleasure of an ACL reconstruction. But if you DO... I know a decent blog you can reference..  :)

Getting Back Out There.... [6 Months Post-Op]

While I dabbled in yoga a few months ago as my first activity back (outside of rehab), that fell off the table when the hubby had his own ACL reconstruction and I focused on making sure he wasn't having to carry our daughter up and down stairs or be sure that he was R-I-C-E-ing while he had the compression/ice machine at home.  Since his recovery is going smoothly (he's just begun to run again last week at ~5 wks post-op), things around the house are getting back to normal and I've gotten more comfortable with the idea of playing soccer again. 

2 weeks ago was my first game back (indoor, co-ed), and BOY was I nervous!!! I don't remember having this intense anxiety before my first game back last time, but I was pretty sure I was either going to have a heart attack or pass out, just due to pure nerves pre-game! But between a calming talk from teammate Johnny Drama and the fact that we got there exactly at game start (read: no time to get worked up anymore -- just had to get OUT there...), these old knees jumped on the field.

I was (probably too) careful, but felt comfortable running up and down the field and doing the stop-and-go required. Luckily the cardio side of it didn't make me feel too out of shape, but I was EXTRA careful in any side-to-side stop-and-go.  Sure, they were able to run circles around me and I probably took 1 or 2 awkward spills (more to get out of the way than in the heat of the battle over a ball), but an hour later I walked away a little more confident that the "first game" was behind me and that I was uninjured and just happy to be active again!

Another game under my belt since then has gotten a little more confidence in me, and I even have a snowboarding trip booked for this weekend to hit Winter Park, CO!  I'm excited to get back on my board (due to the baby, I haven't boarded since... December 2010!) and think it'll be a great time! I've already decided -- if I must -- I will happily call it quits if I feel my legs getting too fatigued (or my brain getting too anxious). If that means warming up and enjoying an adult beverage in the lodge-- So be it!

Here's hoping that 2013 brings good things for all (and keeps knees strong)!!

Eric's Cadaver Graft ACL Reconstruction [12-06-2012]

After a quick meeting with my physical therapist, an appointment later with Dr. Shapiro and an MRI to confirm the diagnosis, we learned Eric did, in fact, tear his ACL. The difference between he and I is that he went on to simultaneously finish championship seasons of flag football and softball, whereas I wanted surgery done with ASAP!

On surgery day Dr. Shapiro said to me a handful of times, "It's nice to be on the other side this time, right?", but no one likes to watch their loved one go through surgery and rehab, let alone one that I know to be a long and, at times, painful recovery!

Eric and Dr. S decided to use a cadaver graft. When I asked Dr S why the patellar tendon graft from Eric's knee wasn't in the cards even though that's the route I went (twice!), he said my first surgery went so well (at age.. what, 26?) that he didn't think doing it differently just 3-4 years later would be a wise choice.  Had I gone cadaver graft on the second knee and anything went wrong or just didn't seem the same, we might have questioned the graft and regretted not using my own.  But for Eric being a little older and cadaver grafts being so advanced these days, that's what they went with.

While Eric was in recovery, Dr Shapiro came out to tell us that Eric's surgery took all of 26 minutes. Amazing. And that there was "the world's smallest" meniscus tear, but that it was repaired while the good doctor was in the knee.

Now begins Eric's road to recovery. He's already had a few meetings with Drew (physical therapist) and unfortunately Eric now knows the feeling of having his knee bent beyond comfort to the point where it feels like the knee wants to explode just to relieve the pressure!! Eric and I tease... If only I could comprehend the pain he's feeling! ;)  I try to remember what it was like being on the "other side" and keep telling Eric to RICE and follow his PT routine, because those are the best ways to get to feeling normal again, even if that day is months from now.

Meanwhile, a week and a few days later Eric is moving around the house pretty well (with an all too familiar limp) and slowly we'll get back to life as we knew it!

12.06.2012 Eric Pre Surgery

Leaving the hospital that day

12.07.2012 - 1 Day post-op (cadaver graft)

Light at the End of the Tunnel... For Me... [3.5 Months Post-op]

A few weeks ago I had yet another follow-up with my surgeon and since I didn't have a slew of questions for him this time, it was the typical visit. He asked how things were going, I said they seemed to be fine.  He felt the knee, said it was stable and that my quad muscles were looking like they were getting close in size to one another. All good things.

I mentioned to him that I seemed to get a discomfort / catching feeling when I go from a straight to just bent knee.  I remember this happening last time around, and it felt like something that kept me from progressing on a normal schedule.  Just now I was removing files from my phone and I came across this little video (which was before 1 month post-op) but it shows the "pop" of something - perhaps a sac of fluid? - moving from one spot to another all at once. [My apologies for the poor video quality]

Now, around 3 months later, it is not as severe, but it still catches me off guard (no pun intended).  Doing some of my exercises (specifically my leg extensions where I flex/straighten my leg against a resistance band) makes it more evident than others, but never is it truly "painful", just uncomfortable.

I'm still trying to get to PT 2-3 times per week and I feel like I'm probably at 70% strength, if that. In a normal day-to-day however, I am feeling good. And, according to a woman who was waiting in our PT room (perhaps for her son to do his own PT), I look "very athletic" and she "wishes she had my legs"...!  I was flattered, but informed her it was my love of sports that not only got me these legs, but also got me under the knife twice!

So as my recovery starts to wind down and I dream of getting back to all the sports I love, my husband has now had the pleasure of having his knee checked by my surgeon, and he had an MRI two days ago..  If we had to guess, it looks as if his ACL may be torn!! We're waiting for the official report, but if what we think is true, my hubby will likely be referencing this blog about the joy of the surgery and rehab that he may have to undergo!

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

Bruising, Home PT, Getting Out and 2nd PT [4-6 days Post-Op]

I must be doing something right! When I tried Friday (3 days post-op) to bend my knee, after a little "warming up" I was able to go beyond 90 degrees. This had me pretty excited considering last time around that was my goal at 6 days post-op.

07.22.2012 5 Days post-op and bending well beyond 90 degrees!

Also, I feel I am able to stand for longer periods of time, take less pain medication and just feel more mobile in general.  I can even go up and down stairs (veeeery carefully) by taking one step per stair, instead of the prior oh-so-cautious 2 feet on each stair as I make my way. (Of course, when carrying my daughter I revert to the most careful stepping!)  Perhaps part of my successful recovery is having the cutest little buddy to distract me...

07.20.2012 - Playing in mama's full-leg length ace bandage..!

Ironically the bruising this time around is much worse, but at least it doesn't feel as bad as it looks!

07.22.2012 - 5 Days Post-Op

07.22.2012 - 5 Days Post-Op

07.22.2012 - 5 Days Post-Op

Yesterday (5 days Post-Op) we got out to watch my hubby and friends play softball and get some fresh air. It went well, many asked how the rehab was going and it was another nice reminder that I can't wait to get back to my normal mobility so even things like spectating are enjoyable again!

Tommorrow will be 1 week post-op. Crazy to think, but grateful this time around seems to be going smoothly. The only hiccup I feel so far is today at PT I was asked to scoot forward in a rolling stool by using both feet to "pull" myself along, and at times my kneecap would catch and pop a little. Drew had me change the exercise so I was "pushing" (going backwards) and perhaps we'll try again on Wednesday when (hopefully) swelling reduces even more.

First PT, Walking W/O Crutches, Firing the Quad [2-3 Days Post-Op]

I spent the first day after surgery at home resting, icing/compressing using the thermocomp machine while trying to keep my leg elevated. I was mostly on the couch and attempted to fire my quad muscles a handful of times, or when sitting on the floor I would try to lift my heel off the ground.  The good thing about this being the second time around is I knew what I could expect going into physical therapy, and I wanted to be capable of doing the first "easy" things without much pain.

Between surgery and 2-day post-op PT, I kept a steady diet of pain pills, assuming if I didn't the pain would be close to unbearable. I popped one before PT and my brother drove me in.  I had the immobilizer on and utilized the crutches going in, but once we were in, Drew had me doing a handful of exercises I expected:  straight leg raises, heel slides (knee bends), balancing on my surgical leg, walking across the PT area and back, straightening my surgical leg while laying on my belly...  Luckily I was able to do all these things without too much pain or needing any outside assistance.

That being said, Drew told me I didn't need the crutches anymore, and would only need to wear the immobilizer when in public so people around me would be cautious of my leg! This was huge (and, perhaps a little over-confident) but it made me glad that I was already on the right track.  At home I keep the crutches nearby, but can tell I'm not leaning on them heavily anymore (literally!)!

We even cancelled the 3-day post-op PT, as Drew knew I would take the at-home PT seriously, and he handed me a sheet of suggested exercises.  Today I've been doing them (rather) religiously, and each set of reps builds my confidence a little more.  I even ventured across the street to do my exercises in the park while my bro and hubby played some tennis at the courts there. All in all this is not a bad way to start recovery!

On top of that, after a pep talk from Drew, I was encouraged to scale back the pain meds and only take them when I'm in need of them, instead of as a preventative measure. The 4-6 hour schedule turned to "as needed" and I was surprised to find myself successfully doing at-home exercises well after the meds were no longer in my system.  I still have one now and then, but am grateful that it's more for achey pain than for anything more serious.

I'll be back at PT bright and early Monday morning (day 6 post-op) and my only concern is getting my knee bending back. In the meantime I'll work on it at home and try to go beyond 90 degrees so that the forced bending doesn't reduce me to the puddle of moans and tears I was when it was done to my other knee!

ACL Surgery - Take 2! [Surgery Day Re-Cap]

It's been just over 6 weeks since my right knee ACL tear/MCL sprain playing outdoor soccer. In this time I was able to celebrate my 30th with some great friends and family, as well as attend a beautiful and super-fun wedding up north this past weekend (Congrats Schindlers!!).  Once the fun was over, it was time to get my game face on for surgery.

I tried to prep for surgery by doing the expected the day before- clean up, prepare the couch where I'll be sleeping the first few nights, do some grocery shopping to have snacks on hand... And luckily I also got to meet the brand-spankin'-new addition to the Schwartz family, Mr. Ashton Reid who was born on Friday the 13th! (I forget how small babies are in those first few days-- he is an absolute CUTIE!). It was a great distraction, and Congrats again to Jordan and Katy!

I had my reservations going into today's surgery.  This injury was a lot worse, with the sprain of the MCL and just general muscle tone already fading pre-op.  I also had pain when bending my right leg or putting weight on that leg while standing with it completely straight. I thought to myself that feeling "injured" pre-op (as opposed to feeling fabulous like I did prior to my other knee surgery) might mean that recovery would be more difficult. I can't say if this is true or not (seeing as how I'm not even a half day post-op as I type this) but Dr. Shapiro assured me that the two things were not necessarily linear, and that the pain I was feeling when standing was likely still from bone bruising.  This was good to learn, that apparently it can take 3-6 months for some bone bruising to completely heal, because I had started to convince myself that it was a mental thing. Going into post-op with a mental hurdle already in place would have made for a rough start, since learning to use your knee and surrounding muscles again is very much a mental challenge!

In the last few weeks I'd popped in to talk to Drew, the physical therapist I'll be seeing again. There were no Doctor's orders to do pre-op rehabilitation ("prehab" as I call it), so Drew gave me some at-home exercises with the goal being to fire my quad muscles. In the same visits he mentioned he's "got a plan" for me this time around, to hopefully avoid the oh-so-frustrating hiccup I had last time around 22 days post-op.

When this morning rolled around, the nerves really started to hit me. Which, in my defense, I think my way of being anxious or nervous is relatively laid-back... But still I felt my heart rate rise at times, or had a mental flicker reminding me that I'd soon have drilling done to my bones! :/  Luckily I was sent a ridiculous amount of texts and facebook messages of support from friends and family who knew I was going under the knife today, wishing me luck and a speedy recovery. Have I mentioned how absolutely lucky I am to be surrounded by such great people?! My nervousness must not have showed much, since the nurse anesthetist asked if my husband and I "were in the medical field" since we seemed so calm about the whole thing just minutes before surgery!

The schedule was very much like last time, just 2 hours earlier.  Today we had a 10:30a arrival, 12:30p scheduled surgery (which started closer to 1pm, I think), 3p-ish awakening from anesthesia, and by about 5p we'd already gotten home, got our daughter from a friend and were chillin' on the couch with the thermocompression unit (similar to THIS, but with a sleeve for the leg) wrapped around my knee!

Post-op at the hospital, Dr. Shapiro informed my hubby that they had to remove about 5% of my meniscus. This isn't much to speak of, but according to MRI they were not expecting meniscus damage.  Otherwise it sounds like surgery went as planned.

At home I focused on getting some water in my system, a little food, and using the thermocompression unit to keep me comfortable. For fun I decided to try to flex my quad of my surgical leg, expecting it wouldn't be possible since it normally "shuts off" due to the trauma of knee surgery. To my delight, it DID flex without having to focus too strongly on it, and it doesn't cause any additional pain to do so.  Granted I am not flexing with all my might, but firing at all is the goal, and I was excited to see I could do this (and, continue to do it) as a nice prep for upcoming physical therapy!

I also remember last time I had this surgery that standing up and taking my leg out of an elevated position was very VERY painful as the blood rushed to the knee. Today I've been up and around just a few times since I've been home from surgery, and either the pain meds are better this time around or I'm just having a more positive experience! I am hoping for the latter, and this is giving me a glimmer of hope that post-op will indeed be easier the second time around.

This does not mean that I expect to "get away" with taking it easier in physical therapy (PT). I still fully expect to have to feel the burn as I get back range of motion (ROM) and fire the muscles. I am grateful that I know what I'm in for (even if I'm not looking forward to it) and am ready to commit to the physical therapy to ensure a full recovery!

Let's just hope this positive attitude and committed demeanor don't get too shaken as the reality of it all comes upon me! Meanwhile I'm looking forward to my visitors/helpers and spending a little extra time with my 11-month old daughter, Ellie... Even if it does mean we'll be learning to walk at the same time!!