# My ACL story part I



## daugela (Aug 21, 2007)

*****WARNING*****

I'm bored out of my mind and decided to make my mot elaborate post with hospital pictures and all! I think ANYONE will empathize with me whose had reconstructive knee surgery.

As I posted in the 'Arizona' forum a month ago, my right ACL and meniscus fully ruptured upon riding National Trail South Mountain, Arizona. This was a trail that I rode often and never had any serious accidents until the day that some person placed a large rock on a blind drop to make the route "easier."

Long story short, I cleared the spot but at the last moment, noticed the rock, fell and the rest is history...

*Official diagnosis*










Approximately 5 days post injury, I had my appointment with Dr. Anikar Chhabra from the Orthopedic Clinic Association in Phoenix, Arizona:

http://www.tocamd.com/doctors/chhabra.htm

I was referred to him by a friend who is a former professional athlete. Dr. Chhabra is currently the orthopedic surgeon for the Phoenix Suns and the Roadrunners. Not to mention, a prior athlete and a great guy!

As I laid on the doctor's table, he placed my injured leg under his armpit and placed one of his hands on my thigh. He then lifted my lower leg up and down, independant of the femur. This was an absolute diagnosis, despite having the MRI. The diagnosis was a full ACL and meniscus rupture. Surgery was scheduled in which I chose the Hamstring Autograft as my selection. The doctor went over all my options and gave me the 'pros and cons.' After discussing my love for mountain biking and the fact that I no longer participate in contact sports, I felt the autograft was the best route.

As some of the other ACL posters have mentioned in the past, including my doctor, the "gold standard" for the use of the patellar ligament is becoming less popular. Meaning, that type of surgery has its place in the medical world, but it's not the 'only' way to go anymore for ACL surgery. Each patient has their own stories to tell regarding their injury and long term needs. Some choose no surgery and can live without an ACL for the remainder of their lives. Everyone is different and requires different needs and procedures.

*Surgery Day*

November 19th, 2008, I was up bright and early around 4:00am and had my wife drive me to the Gateway surgery center in Phoenix, AZ.










Prior to arrival, the girls from the surgery center called and reminded me about the things to bring and not to bring. One of the things she told me was to NOT wear underwear. I thought this was strange since I was only having surgery on my knee. Her response was - "You'll be wearing a gown and it's standard procedure." OK - no underwear.

Once I was escorted into my room by a fairly attractive female, she gave me my surgery gown, told me to undress, BUT keep my underwear and socks on!!!! I chuckled and asked her if she or her friends were the ones who called me and told me NOT to wear underwear. She laughed and thought I was kidding. She told me the "girls" at the scheduling center should have never told me this. SO......I stripped and laid on the bed in my gown with no underwear. Must I remind you that the gowns are short.

In desperate fear that the family jewels and the 'copper penny' would be exposed during surgery, I called my wife into the room and DEMANDED she respond to WALMART and buy some underwear! LOL AFter buying the underwear and putting them on, I was more at ease.

After speaking with the anesthesiologist about my 'pain control' options after surgery, I elected to have a femoral nerve block. This is a procedure in which the doctor numbs the nerve of your leg from the waist down by way of a big syringe. To be honest, I don't remember the actual shot because he gave me some thing prior which knocked me out within 3 seconds - literally. When I awoke, the procedure was done and I was off to the recovery room.

My leg was completely bandaged with ACE wrap and the leg brace was already affixed. The ACE wrap couldn't come off for 48 hours and since the meniscus was repaired, NOT removed, I am to NOT bear any weight on that leg for 4 weeks!!!!!!!!!!!!!!!

An hour later, my wife drove me home and I slept for hours. The nerve block worked wonders for 48 hours, but after that, the pain set in and I was miserable.

Despite the narcotics they give you, there's no way around the discomfort of the first week. The days following the surgery were awful. You never get comfortable, the leg is always elevated, you gain 10 pounds the first week and you're sick to your stomach from watching TV.

I was also given a 'Game Ready' icing machine which applies cold compression for 30 minutes on and 30 minutes off - 24/7. I use it religiously to lower the swelling and stop the pain.

*Day 1*

Bandages came off and I took this picture:










*Week 1*

The swelling has come down a bit and the pain isn't nearly as bad as it was during the first few days. You can actually see the right calf has atrophied already. But at least some definition is returning in my thigh.

After coming home, they give you a sheet of post-operative excercises to do to prevent further muscle loss. The excercises are pretty general - leg lifts, tighten the quad of the bad leg, attempt to slide your heel towards you while sitting on the ground.

Even though these excercises sound simple, they are TOUGH AS HELL - Believe me!

The number one thing the surgeon said to do is always sleep with your brace locked in the straight position. This is critical in preventing scar tissue from forming and not being able to straighten your leg in the future. They say removing scar tissue to straighten the leg is MORE difficult than dealing with scar tissue upon flexing the leg.










I'm currently approaching week 2 and will post more after several weeks.

My first day of physical therapy is on December 4th and I'm ready to really recover.

I have been doing all the excercises and more.....I currently pedal the recumbant bike at the gym for 20 minutes on top of the home excercises. My range of motion as become remarkably better during the past 3 days. I'm happy to say that I can bend my knee nearly as far as my good leg - with assistance of course! I'm hoping the PT will be "easier" with my progress.

As I've read other posts regarding knee surgery, I understand that SIXSIXTYSIX is the ACL guru. Hey SIXSIXTYSIX, if you chime in, let me know how that Donjoy is working for you. Any issues with getting pads over it? For those who don't know what a Donjoy is, it's a top of the line athletic brace company. Nice but very expensive.


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## .:MTB:. (Oct 3, 2008)

Hi there. I am new to MTBR and mtn biking, but not to knee surgeries. I have torn the ACL and medial meniscus in BOTH legs and have had a total of 5 surgeries to date. I believe I can give you some interesting reading while you recover. My history:

1994 
I tore the ACL and medial meniscus in my RIGHT knee. It took 3 operations fix me. 

Surgery 1. 
Separate Meniscus repair b/c tear was so bad (6 weeks no weight bearing on crutches) 

Surgery 2. 
Manipulation operation was needed a few weeks later due to scar tissue build up. (another month of recovery)

Surgery 3. 
ACL repair (patellar tendon). 

NOTE: For me I noticed I continued to improve over the course of 2 years after the ACL repair. Of course you actually recover faster than that, but there is a natural confidence that must be regained. I remember that I would seem to reach a new level of recovery at almost regular intervals 9, 12, 18, and 24 months. I would look back and suddenly realize that I was still getting better.

A few years later I tore the medial meniscus in RIGHT knee again. My fault. I should have staid away from lateral sports but I was younger and stupider back then. 

Surgery 4. 
Had arthroscopic repair.

A few years later I tore ACL and medial meniscus in LEFT knee. My fault again. I still hadn't learned to stay away from lateral sports. I was older and still dumb.

Surgery 5. 
ACL repair (hamstring graft) 

After tearing the left ACL I had a drastic drop in overall stability and I finally had learned my lesson. My left leg had never been injured before and had been my "good leg", but no longer. As a result I now only walk, hike, bike, and swim. No more running, no more lateral sports. At this point my goals are to maintain what I have and not have any more surgeries! :madman: 

With all that said I think YOU will be fine! I am a freak of nature (in terms of # of knee injuries). One ACL repair is something you can definitely recover from and you may actually end up with a stronger ACL in the operated knee. My original graft from 1994 is still good to go.  

ABOUT THE GRAFTS:
I like the hamstring graft in my LF knee over the patella tendon graft in my RT knee, and I consider myself an expert since I have both done.  

The patella tendon graft hurts me the most when I am hiking down hills. The stress is too much on my knee so I use hiking poles. However, my graft was done in 1994 and they supposedly use a much smaller part of the patella tendon now...

My left hamstring (where graft was taken) is still a bit smaller than my right hammy. I don't think my hamstrings will ever look exactly the same again. They work equally well though! 

Your left leg looks to be pretty muscular and it sounds like your pretty good on a bike. I think you will be totally fine by summer and riding again all over the place. Just remember to start out easy and work slowly back to your old self from there. Especially with the jumps and drops. Your knee won't like that impact for a while. The best advice I can give anyone with an ACL repair is to stay away from ALL lateral sports - especially ones with contact like basketball and football. I would never had needed the last 2 surgeries had I simply done exactly that. It is not a certainty that you will get reinjured playing lateral sports, but the probability does go up. 

You are an example that you can also tear your ACL while riding. It sounds like your injury is a freak accident, but most ACL tears are. Both of mine were. One was playing football but no one even tackled me. I was running with the ball, made a turn, and BAM! The other one was from playing tennis (again no contact). For some reason I must have cursed knees or something... I had a donjoy brace once. I eventually got rid of it and currently don't wear any braces on either knee. I was not into riding at that time but the brace always starting slipping as soon as my leg got sweaty. Very annoying. I am not a downhill rider and don't have those skills. If you are a DH'er or really aggressive you should either tone it down or I would recommend some sort of brace. It might be difficult to find a pad to fit over the Donjoy brace. If a pad exists I would love to know about it!

I currently do wear the Kyle Straight SixSixOne knee pads AT ALL TIMES NO MATER WHAT because my knees are definitely sensitive to any impact that would occur from falling (especially where they took the petella graft).

Well dude, I definitely know what your going through. You will recover and be A-OK! Stay positive, and follow your PT instructions! Peace.:thumbsup:


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## daugela (Aug 21, 2007)

Awesome post! You are definately an ACL expert with that many surgeries. 

I'm pretty confident I wil recover, but the idea of no weight bearing for 4 weeks, let alone your 6 weeks has me bummed. What an you do? nothing. It seems my left hip is always hurting now since all my weight is on that leg. I'm sure that's normal. 

I'm curious, was your hamstring NOTICIBLY weaker after the surgery? I mean, 50% of the swelling has come down in my leg and I can bend it to a point, but beyoind that, it's impossible. It's not neccessarily the pain or the swelling - it's like the hamstring isn't communicating with the brain to make the leg move. If I have my wife push my knee beyond that sticking point (leg curls), I can go from there, but there's alot of involuntary twitching of the muscle like it's rebuilding and growing and being REALLY confused.


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## lornibear (Aug 14, 2006)

Fair play there, I am now ten weeks post ACL surgery. I had a fully ruputured ACL and 2 meniscus tears. My leg is still slightly swolen, but I am now starting to run, (intervals of three minutes only) and I am also riding my bike, albiet on the road but no heavy trail riding.
I had a platella tendon graft and it's solid, perhaps even more solid than before. I have full movement now, although not first thing. I am very happy with my op and my current rate of rehabilitation. If anybody needs any advice, let me know.


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## .:MTB:. (Oct 3, 2008)

The leg that had the hamstring graft was noticeably weaker at first, but over time it eventually regained the same strength as the other leg's hammy. I wouldn't take that as a sign that you will also experience exactly what I did - every person's injury is unique to them.

As *lornibear* posted, even at 3 months you will likely not be able to do any heavy trail riding. This is what I was referring to in my prior post about taking it nice and slow in your recovery. You WILL be able to do ride hard again, but not for at least a few months. I am very much a goal-oriented person. Put a goal in front of me and I won't stop until I reach it. This is a good attitude to have when recovering from ACL repair! The ACL repair recovery process is kinda long...there is no getting around that.

Just follow your PT to the letter, and don't push yourself too hard (like Tom Brady did). He pushed too hard in recovery and got an infection in his knee. That is not a good thing! I bet he will never return 100% to his pre-injury form. (Please take that statement with a grain of salt since he is one of the best NFL quarterbacks ever. We don't have to worry about 300+ pound linemen hitting us every week!)

GET WELL SOON!


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## 93tankus (Jan 19, 2007)

hey daugela, thought i'd chime in quickly.

i'm just coming up on my 2 year annivesary from when i blew my RT acl and tore the meniscus. similarly, i had the hammy autograph as well. i can't reiterate enough what was said about following your PT to the letter. it was really paramount to my recovery. treat it like it's your job. it absolutely pays off...and will continue to pay off.

from the sounds of it, you're still a bit early on in the recovery. i can only speak from my personal experience, but my hammy harvest site was considerably weaker for a long time. it took a while to get the strength back, and that came with time in the gym. i also had the strange sensations and muscle twitches, etc. that you're experiencing. the thing is, your leg went through some pretty intense and gnarly trauma with the surgery, so i think it's sort of expected to have that sort of thing. at least, that's what i chalked mine up to. heck, i still have the odd sensation and crackle-and-pop here and there. probably always will.

anyway, stick with it. like people have already said, you'll absolutely pull through this. and you may even have a better idea of what your body is capable of doing after it's all said and done. last winter was my first season back skiing...and everything felt great. was back on the mtb about 8 months or so after the surgery. so, what i'm saying is that you'll be back to where you were in no time flat.

best of luck!! if you have any other questions or whatever, please feel free to ask. there's a wealth of knowledge out there. and if you haven't already, check out the 'gimps' forum at tetongravity.com.....it's a great source of info on acl injuries and whatnot.


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## pakdoc (Dec 4, 2005)

1988 ACL complete tear with PTL graft. 20 years and doing well!
Had cortisone injections around two staples in year #1.
Thousnds of miles of biking and running and OK. 
Quit running in 2000 per se just occasional fun run with family
or 2 mile jog on dirt.
Saw orthopedist in Oct 08, took some x rays and things look good. 
Still numbe just below the petella but only notice if kneeling.

Good luck with your healing, do your therapy but you will be ahead of the curve 
with your pre surgical fitness and biking.


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## Techz (Jul 10, 2007)

Yesterday was eight weeks for me after ACL replacement with patellar tendon graft. Looking at another week before isolated quad strengthening. I am on the elliptical, roadie trainer, stairmaster and specific weight training (hams, calves and leg press but not quad extensions). The only thing I can do daily is the trainer per my PT. I was PT'ng about 8 hours a week but my therapist shut that down because technically the graft is dead at 7 weeks and has not revascularized yet....weakest point of my entire surgery. No jogging yet either. I can MTB when I can jog, so it has been said.

Daugela:
It gets better. Hang in there. Any questions, PM me? I got loads of advice in my post below. Regarding your hammy tightness. You probley know this but your strong side leg can help the flexion excercises of the week side. PUSH. My PT has me tie a rope around my foot and pull while on my stomach. I got three finger widths to my goal.....that is touching my butt with my heel.

http://forums.mtbr.com/showthread.php?p=4446758&mode=linear#post4446758


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## ATLRider (May 12, 2004)

I am one week into recovery from ACL and PCL replacement using donor tissue and a meniscus repair. Start therapy next week. Daugela, I too am experiencing hip issues. I assume those are skateboardng hippers coming back to haunt me. Goodluck with your recovery. I managed to drop a few lbs the first week. My Dr. seems very conservative in his predictions of my return to activity/biking. He keeps saying 1 year. That will be brutal.


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## saf-t (Nov 6, 2008)

Ice is your friend.

Don't ask me how I know..............


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