Knee Update : 50% and ALL!

Recent headline making scientific news is the discovery of a "new ligament" in the knee called the ALL (Anterolateral ligament).

A short summary is that majority of ACL injuries also tear this ligament, and this ligament controls the pivot shift or rotational torque which a traditional ACL reconstruction will not account for. Studies of NFL football players have shown those that have torn their ACL once, have a 50% higher risk factor of re-tearing it again. Even with a strong patellar tendon graft, the knee is still more susceptible to the pivot shift since it is not "fixed".

I brought this article to inquire with my orthopaedic during a follow-up visit, and, once again, confirms that doing the diligence to research helped me in choosing the BEST orthopaedic! He confirmed that the additional procedure of adding the extra-articular augment is in fact the ALL ligament. I am doing the limping happy dance!!

I have hit the 3-month post op mark, my 50% point of recovery. Rehab has been tough, especially with incorporating it with work and family schedule. Rehab is still painfully sore, but gets easier and the knee gets stronger every week. I do rehab EVERY SINGLE DAY. I think of it as not a choice, but something I have to do... just like brushing your teeth. It's hygiene... knee hygiene. I stand on one leg and do half squats while washing dishes, brushing my teeth, or.. yes.. even while I'm in meetings at work! I am not allowed to run yet, but I am allowed to incorporate light weight while doing squats now. I'm almost able to go down the stairs without assistance (hand rail or holding the wall). If I keep at this for the next 3 months, both the doc and PT thinks I'm on track for a 6-month recovery of 100%. That's the goal. If all continues smoothly, I can start light running and top-rope rock climbing in a month. I've been given the okay to do Pilates Reformer classes and easy weight-lifting (front and back squats).

For my future reference, this is my current exercise list for strengthening the knee and surrounding muscles:

EXERCISE LIST:
20min bike (L9) - incorporate 4x 1min intervals
10min incline walk (L10 @ 3.2)
20min elliptical (L10) - incorporate 4X 1min intervals
band exercise --> leg raises (4 sets x 30 reps/leg)
band exercise --> one-leg squats (3 sets x 5x)
wall-sits --> (5 sets x 60 secs)
250 body-weight squats --> (5 sets x 50 reps)
stationary lunges/dips --> (5 sets x 15 reps/leg)
side step-ups --> (5 sets x 15 reps)
side bridges --> (5x - hold)
bridges --> 5x @ 90sec, one or two legs
bolsa ball --> 1 leg stance/hold (3x)
bolsa ball --> squat fast wobble (3x)

50%!! The past 3 months, on one hand, seems to have passed by fast, though also feels slow. 3 more months... soon... very soon! =)

Knee Update : "No Pain, No Gain!" @ 14.75% Recovery

The saying "No Pain, No Gain" is true! I am at week 3 post-recovery, 14.75%. Surgical cuts are healing, bruises are gone, and swelling is down.

Let me tell ya, it has been a very slooow and painful 3 weeks. Slowly, but surely I am making progress, with each knee-workout session to bend that knee past the point of comfort and then some more, as much as the pain is tolerable.

The doc has a detailed protocol and outline of where my knee should be each week. I started off a little behind the curve at week 1, with a 60 degree knee bend. I had a target of 90 degrees by week 2, and did due diligent with extra pain sessions from the PT and from Ryan, the knee was able to flex an additional 30 degrees to hit 90 in 4 days time. Those were 4 insufferable days. End of week 2 was uplifting to see the progress and a little bit of leg strength coming back, enough that I felt comfortable (at home or work) to walk about without the robo-leg brace on.

However, the suffering must continue. Week 2, I continued the due diligence. PT prescribed 10 reps of leg lifts. I did 25 reps/3x a day. I did multiple sessions on my own to work on range of motion to increase the flexion. In addition, I do 1-2 hours of rumble rolling a day. Yes. This is a full time job. Week 2 was, like the prior week, difficult. My ROM did not budge from 90, even with all the additional rehab I was doing. I was stuck there. Not only did I not see progress, but even these simple exercises of bending the knee and leg lifts, by the end of the day, the knee was so sore and painful, that I could barely walk. Week 2 was tough to not see the same progress as week 1.

First day of Week 3, I hit a minor break through. Ryan continued to do nightly pain PT sessions with me and last Thursday, I finally broke through to 102 degrees flexion. This Monday I measured 112 degrees flexion. Getting past the 90 was key. Now sitting is a little bit more comfortable. Moving about is a little easier. The surgical cuts are healed and scar lines now remain. Bruising is almost gone and swelling is now only in the knee area. The focus has shifted from ROM now to getting the quad to fully activate. It is still sub-par. Quad muscle is currently below the curve, while ROM is now above the curve. In addition, PT has been working on breaking up scar tissue that has formed in the knee area. PAINFUL! There is this torture cupping device that uses suction with the intent to "lift" up the surface layer skin and to break up the scar tissue that keeps the skin from moving around the knee. PAINFUL! I feel sharp twinges as the various scar tissue is snapping underneath the skin.

I look forward to when I can finally have a full night's sleep without waking up with knee pain to change out the ice pack. I'm hoping that'll be the next break through... in the meantime, I'm going to keep chugging away at rehab with the motto "No pain, no gain".

Knee Update : 8.2% at 2 Weeks & A Day

It is getting better...

I am now at 2 weeks and a day of ACL post-op surgery... roughly 8.2% of full recovery. The past two weeks seemed to have taken forever.. and I'm really just looking forward to hitting the 1 month mark. It is suppose to be significantly better with each passing week. So far, it's true. Week 2 is definitely better than week 1. But it is still not out of the pain/uncomfortable zone yet. The knee has all sorts of aches and pains and stiffness and swelling and twinges. On one hand, I don't want to move it, but on the other hand, I have to move it often to break scar-tissue and regain my range of motion. Intense physical therapy started this week. And let me tell ya, it is NOT fun, nor therapeutic. I am re-training all the nerves, muscles, tendons on how to move again, breaking down scar-tissue with new scar-tissue forming and then repeat of the cycle until the internals of the leg stabilizes.

I was foam rolling out the muscles and doing ROM (range-of-motion) exercises as early as I could withstand the pain in week 1. But my first PT session clearly demonstrated why PT is required for this sort of thing. My ROM going into my first PT session was at 60 degree angle. The orthopaedic had laid out a very detailed protocol for the PT to follow, and from that, I was already behind the curve. PT said I needed to be at 90 degrees by the end of the week! That's a 30 degree delta I needed to achieve in 4 days! Prior to that.. I had a 4-5 degree change doing exercises on my own.) The first session was not pretty. The PT cranked down on my leg past pain tolerance threshold. End of the session, she had gotten me to 72 degrees bend (though I couldn't keep it at that degree AND my leg was so numb and sore from the session that I couldn't walk.)

Right away, Ryan started working with me and doing our own massage/PT sessions every evening. Ryan is not as nice as the PT. When I scream out in pain, it does not even phase him. All in all, my life is mainly consumed with rehab - icing and elevating the leg every hour, throwing in foam rolling/massage/stretching as often as I can (usually prior to icing), PT sessions 3x/week for this first month post-op, and then my own exercises every morning/night, along with Ryan's version of PT. Emilia has joined in on the fun and she works on my good leg.

Today was the 3rd PT session...and deadline day. My knee is achy and sore, and twinges of pain are currently radiating at the site of the patella. But.. I DID hit 90 degrees today. Never mind that I can't get it to 90 automatically or even keep it there for long. The week of pain sessions have paid off. I have hit my first recovery milestone by the due date. I have another 2 weeks to hit the next marker, 125 degree ROM plus regain full quad activity and contracted definition. (Right now my quad is like jelloooo).

So..recovery is coming along ssssslowwwly. Brusing and swelling are much better now, and the stitches are off. Check out the gnarly!

All in all... I'm at 8.2%. Only 92% left to go til I can be back to my old self...

Knee Update : ACL Surgery - Done. Recovery at 3.27%

ACL surgery went smoothly. All the other ligament injuries appear to have healed. No sign of bone fractures. No additional repair needed for meniscus. ACL reconstructed with patellar tendon, and extra-articular augment was done with hamstring tendon. Doc says my knee looks like a 12-year old knee with no sign of age degeneration, arthritis, or wear-and-tear. All good.

Recovery though has been a different story. Today is day 6 post-surgery. According to calculations (assuming a 6-month speedy recovery), I am only at 3.27% of being recovered. Sigh. The doc did say that unfortunately it will take making my knee worse (with surgery) before it will become better.

The first 36 hours post-surgery were... indescribable, excruciating pain. It radiated from every, single pain receptor of the innermost knee and throughout the calf and thigh. Even with max dose of oxocodone, the pain was relentlessly sharp, burning, and stabbing. There was no relief, and as painful as it was, if I tried in vain to move to find a more comfortable position, intense throbs of pain attacked leaving no nerve untouched in the wrath. If flexed any muscle.. again surging, intolerable pain. I ran a low fever at 101 and went from feeling hot to cold. All I could do was recall my hypno-bithing mantras to make feeble attempts at mindfully pleading with my leg to not move and let the pain engulf. Managing child birth was successful. Managing ACL reconstruction.. failed. It made child birth seem like a walk in the park.

Break-through relief came after I was able to get a few hours of drug-induced sleep at which point I knew the drugs were finally working. The pain was still present, but felt more manageable. Day 4, I was able to stop taking pain meds all together. I choose to get off meds early because I don't like the side-effects. However, it means I have to tolerate the lingering throbs of pain and frequent sharp twinges randomly in all areas. In hindsight, maybe I should have stayed on the pain meds longer... Day 4 also allowed us to remove surgical dressings and see the extent of the damage. Yikes! It is definitely one unhappy knee right now. Swelling is still very much present in the entirety of the leg and lots of bruising.

It is now Day 6 post-op. I started rehab on Day 3 by spending 2-3 hours a day using a Continuous Passive Motion (CPM) machine which automatically bends and extends my leg. I also have a list of exercises to do with the first initiative to reactivate my muscles and work on range of motion (ROM). The quads, hamstring, calf muscles have pretty much shut down due to the trama from the surgery. So until they start taking orders from higher up (aka the brain) versus the nervous system over-ride, I am pretty much still very limited. Standing, walking, even sitting upright can only be done in short spurts. Lying down with the leg elevated, while uncomfortable, is still, at this point, the best I can do. I'm fully understanding now why they say recovery typically takes 6-12 months... it's definitely been tougher than I imagined.

Update : The Details of the Knee

Apparently, we forgot about this blog. Thanks for the emails asking how things are! Here is the latest update on the knee.

I will be undergoing knee surgery for ACL reconstruction very, very soon. The extent of my injuries from the mishap in June was a torn-ACL, a couple other partial-tearing of surrounding ligaments -PCL and MFL. Small tear in the backside of the meniscus, and bone fractures and contusion on the outside corner of the tibia and femur bones. I was on the borderline for knee dislocation if the other ligaments had been damaged worse than they are. So, the past two months were spent researching and becoming a knee expert. I obtained referrals from friends (especially thanks to Kelly!), co-workers, and strangers (befriended Ninja Warriors for their feedback and lots of random strangers would stop to talk to me about their ACL surgeries), sought out review for best surgeons in town and ultimately met with 3 different well-regarded orthopaedic surgeons. I researched different methods of ACL reconstruction, the pros and cons, different recovery methods, statistical analysis and medical journals on alternative approaches as well as newer techniques of reconstruction, yadda, yadda, yadda. Pretty much, I had three people (two of them being doctors) ask me if I'm an engineer from my line of questioning and detailed analysis. I guess at least it validates my profession. =P

The point to note here is that the surgeon, choices for reconstruction method, and physical therapy will impact future athletic ability. The first docs recommended a standard procedure and emphasized a lifestyle change with no more high-impact sports. The third doc said the whole point of ACL reconstruction is to hopefully allow one to go back to being active. His recommendation was for a standard procedure as well, but using a donor tendon which would allow for the fastest/easiest recovery. Statistical data, though, shows donor has a higher rate of re-tear. His comment was that it would not matter since I am "older", which puts me in the "less active". Obviously, he didn't watch my video...

So... we know of great comeback stories from NFL football players. Not only football players, but Tiger Woods, Steph Davis (rock climber), even Ninja Warriors (Drew Dreschel and Luis Moco). Some are "older", and have recovered to being stronger and better than before. Changing my lifestyle is unacceptable. So, the second doc was my doc of choice, a newcomer in town, with no personal referrals for him, but his background was head physician for the sports' team at a well-known college for NCAA Division I sports. As well as he has published papers on newer methods of ACL reconstruction. So I knew he was up-to-date on latest research AND that he's performed the newer, complex methodologies. During our meeting, he watched my video of the injury incident and identified how the injury occurred. In fact, my injury is very common among women athletes. He took into consideration that I would like to return back to ninja-ing and obstacle racing, and recommended a procedure to provide the best, strongest knee possible for a comeback. The surgery will combine the best of the traditional, Bone-Patellar Tendon-Bone ACL repair for strength (which is the golden standard for football players) combined with an additional extra-articular augment that compensates for rotational torque (which is what is lacking in traditional ACL repairs based on latest research). This method is an alternative to the controversial double-bundle approach (short terms studies show it controls rotational torque better.. no long term research data, but downfall is a complex procedure with 2x recovery time) which Tiger Woods and Steph Davis both had used. Long story short... I'm so glad I did my research.

Anyhow, it's amazing how fragile the ACL is. I have been stopped by so many strangers and engaged in half-hour long conversations about their ACL injury, surgery choices, and recovery. Two people jokingly welcomed me to the ACL club, as this is so common. It seems as if anyone that's gone through this experience, recognizes the robo-leg (I have been wearing for the past two months) and is more than eager to extend their sympathies as well as share their experience along with advice and tips. I have had young and old stop and talk to me and injuries ranging from tripping on the last step of the stairs, to major skiing wipeout, to someone stepping on their foot while pivoting in basketball, or jumping off a roof (okay.. that one, you know who you are!).

Ryan's also been keeping me up to date on the latest football statistics. This year being unusually high for the number of ACL injuries sustained already, and it is only pre-season! The great news is that there have also been exceptional comeback stories.. with players coming back stronger than before and shorter amount of time of rehab. The typical rehab will be 6-12 months. And Adrian Peterson came back in 5 months from surgery!