Yet another ACL reconstruction diary.

Before injuring my knee less than a month ago while skiing, I'd never heard about ACL injuries or ACL reconstructions.  In the last four weeks, I've been reading and learning a lot about it though, mostly through the internet. I had my reconstruction surgery yesterday, and I decided to write a diary under the influence of percocet, to remember this lovely times and just for kicks.  This is the first surgery of my life, and it was really nice to know what to expect, to know what they were doing and to have so many people to ask for advice and suggestions.  So here's my story...

The accident. 05/09/99

I went skiing on mom's day to A-Basin, the only ski resort still open by May in Colorado. In the last run of what was probably my last day of the season too, I was really tired and I wanted to get down fast. So I decided to go straight down in the last stretch of the East Wall basin. The snow conditions were pretty bad, my ski cut and edge and I starting falling. I heard a pop coming from the outward rotation of my right knee while I was in the air. I looked down and saw my right ski hitting the ground while I was facing down. I tried to move my body in the direction of the ski not to injure myself more, when I heard another pop. I got really scared and I thought my kneecap was going to be backwards by the time I will hit the ground. When I finally hit the ground my right ski was still attached to my boot and I couldn't move. I was in a lot of pain.  My friend asked me if I was ok and I couldn't talk or move, I was just laughing because of the pain.   He came by and removed my ski. A minute or so later, I was able to sit down. I was happy to see that my knee cap was in place and that my leg didn't look swollen or bad at all. My knee started getting really warm and my leg got numb from the waist to the toe. I tried to stand up but my knee felt really weak, and my boot sunk in the snow. I rested some more and decided I could ski (mainly on my left ski) to the nearest lift to get the ski patrol to take me down. They spline my knee and took me down in a stretcher. That was fun. The ride was bumpy and wet (a combination of ice, water & snow were falling in my face, since you go head down) and I was scared that the girl that was taking me down will tip over and that I will start falling with no control. I raised my head and looked around. Everybody was looking at me with a scared face. The ski patrol staff looked at my knee and gave some ice. They said that if I had heard pops it could be the ligaments. They took my skis to perform some safety tests on them.

My friends drove me back home. My leg kept going from pain to numbness. When we arrived home I couldn't bear weight on my right knee so I was jumping with my left leg. I iced my leg some more and rested for the rest of the evening.

The diagnosis. 05/10/99

I was in pain and decided not to go to work until I found out if the injury was serious. I called every doctor in town and got an appointment with Dr. Wieder at 1pm that day and an appointment for a second opinion with another doctor on Tuesday morning. I was very lucky since it turned out that Dr. Wieder is one of the best orthopedic surgeons in Boulder. He performed several tests on my knee, got some x-rays and then told me that my x-rays looked great but that I've completely torn my acl and sprained my lcl and that he recommended surgery but that I could go ahead and think about it. What?! I didn't even know what the acl was or how was he able to diagnose it. To show me, he did the Lachman's test again on both legs and asked me to see the difference. I was really scared when I saw how much my right tibia moved with respect to the femur. Then he explained how they reconstruct the acl and he draw the cuts on my knee. I wasn't really paying attention. I had never had surgery before or a serious bone or ligament injury, so my brain was taking it's time to process the information. He said I should try to walk as normal as possible to start strenghtening my musles and so that I wouldn't loose my extension. They gave me a brace to wear for the day and I left for work. With the brace I felt safer and was able to bear weight on my right leg, but I was still limping for that day and the next day. Stairs were hard, especially going down and turning around. I was using the handles as my crutches. I couldn't drive since I couldn't do the pivoting motion between accelerator and brake. I started browsing the web to learn more about the acl and the consequences of doing and not doing the surgery. I was very happy of being able to find so much information so fast.

Second opinion. 05/11/99

On tuesday morning I had my appointment with a different surgeon. She told me that yes, I was a clear case of 3rd degree acl tear and that the bet thing for me given my life style was to do surgery. She said now the only thing I had to decide was the method. Quadriceps tendon vs Patellar tendon (nobody in Boulder seems to be using the hamstrings anymore), Bioabsorbable screws vs Titanium, etc. I thanked her and started surfing the web some more looking for the different methods and options. The Quadriceps usage is realtively new and I couldn't find a lot of information about it. Among the advantadges are an easier and faster recovery and the fact that the bioabsorbable screws disappear in about 24 months. Among the disadvantages is that the fixation to the bone could be weaker (due to the fact that the tendon has bone only on one side) and the fact that the bioabsorbable screws can cause swelling and some other problems while they are being absorbed.

Physical therapy. 05/12/99

I started my physical therapy today. Dr. Wieder said I should get my leg motion and strength back as much as possible before the surgery. He said this usually takes about three to four weeks so I scheduled my surgery for 06/04/99. Patrick Naylor, my PT, is a former professional skier, so he knows a lot about injuries and their associated pains. He tells me I must not limp and I should walk normally even if its painful. He gives me a massage on my lateral ligament which is really painful. The rest of the staff gives me a set of exercises to strengthen the quadriceps and hamstrings and to improve my equilibrium, and they use four electrodes around my knee and some ice for 10 min to reduce the swelling. My quadriceps are completely shut down today and I can't contract them no matter how much I try. That feels really weird.

Vacation. 05/13/99 - 05/18/99

I took a small 6 days vacation visiting friends at the UIUC. My knee got progressively better. At the end of the vacation it was almost back to it's normal stage.

Star Wars. 05/19/99

As a starwars fan, I got together with my friends for dinner and went to the movie theater near midnight to watch the first show of the Phantom Menace. We got there only like an hour earlier, so all the good seats were already taken and we had to sit very near the screen which was not good. That together with the fact that I'd woken up at 5am that morning and with the fact that the movie sucked in my opinion, made me torture myself by bending my knee to keep myself awake. It worked. And my PT was very pleased with the results the next day too since I've recovered my full flexion and extension by today.

Washington, D.C. 05/22/99-05/26/99

Given that I don't know how bad the surgery is going to be or how long will it be since I will be willing to take another vacation, I decided to go to Washington for another 5 day vacation. I had a lot of fun and visited a lot of places. Walked an average of 13 hours a day!. Every part of my body hurt except my knee. It took me the rest of the week to recover.

Memorial Day Weekend. 05/28/99 - 05/31/99

I spent Saturday buying stuff for the surgery, like loose clothes (because I'm usually on jeans and T-shirts), footstools, a chair for the shower and a beach chair for my balcony. Also ice packs and a water bottle.

Monday I spent at the Boulder Bolder, a 10K run and a very big event here in Boulder. I was going to register but now I decided to just watch the people arriving at the stadium. It was a lot of fun. Then I went to the Boulder Creek festival and spent the rest of the day there. My knee was feeling perfect.

Fear of Surgery. 06/01/99

I woke up today having nightmares about the surgery. So far I hadn't given it a lot of thought but now I suddenly got really scared. I've been calling the doctors office just to make sure I have all the information and nothing gets cancelled or goes wrong. Finally I got in touch with the doctor's assistant and he gives me all the specifics about where to go and at what time. I get my croutches at King Suppers, and I start practicing going around on crutches. It's actually fun. :)

Pre-Op. 06/03/99

Today was the pre-surgery appointment. I went to the clinic first, at 11:30. They ask me the usual questions and ask me to sign the authorizations for anesthesia and surgery. They drew some blood for tests and checked my blood pressure. Then I went with the doctor at 12:45. He checked my range of motion and explained to me the MRI and what the surgery was all about. He said I was looking very good range of motion and strength wise.

In the afternoon I took some pictures of my legs the way they look now, to compare them with the way they will be looking soon.

Today was the big day. My surgery was scheduled for 7:30am and I was asked to come to the clinic and hour before for preparation.

At 6:30am Susan took me down, told me to put the gown on and take away all my jewerly. She did some standard checks like blood pressure and temperature, asked me some questions and check all the paperwork. Then she did the intravenous. A shot in my left hand to numb the area and then the intravenous when she found a vein that was straight enough. :) She put some antibiotic throught the IV. I kept going to the bathroom because I was nervous I'll be wanting to go after I've gotten to the surgery room, and because I always do, anyway. Then she scrub my knee with a desinfectant and wrap it around. I met Dr. --- the anesthesiologist, and Dr. Wieder, my surgeon came by to say hi, to give me my pain prescription and instructions on what to do and what not to do during the weekend after the surgery.

Then they took me to the surgery room. I didn't get a chance to see much since they've taken my glasses off and by that time they were starting to put some anesthesia. That's all I remember. Entering the surgery room while it was still empty. Looking around and falling sleep. I didn't even get to the gas part everybody remembers. Or maybe I did and just forgot. The next thing I remember is the anesthsiologist coming to tell me that I've been out of the surgery room for about 10 min, that I've come out 40min early and that everything went ok. I thought to myself, this can't be possible, I didn't even feel when I was going in! It was 10:05am in the clock in the wall in front of me. 5 min later, Dr. Wieder came by to tell me what he had done, and to show me some arthroscopic pictures. Of course I didn't get anything of what he was saying, except the fact that he said he trimmed a little bit of one of the meniscus (he wasn't sure about he meniscus damage before the surgery). Then I was semiunconscious again for another 5 min, and I was shivering. Susan said I've been shivering for a long time and they kept bringing warm blankets and measuring my temperature, my blood pressure, electrocardiogram, etc. My throat was a little dry and irritated, so I was coughing for a while (nothing to bad though). Then I sat up to have a glass of ice chips Susan brought me and I started feeling the nausea building up. Fortunately it only lasted a couple of seconds and then it went away. The ice chips made my throat feel better and helped me wake up. It was around 11 am when my parents (who are really nice and came to visit me for the surgery) arrived. Susan asked me for my phone number and that stuff to make sure I was fine and then I was able to walk to the restroom with my crutches. Since they put some local anesthesia in my knee and gave me some pain medication at 10, I haven't felt any pain yet (nothing worse than what I felt the day I injured my knee, I mean, which wasn't unbearable or anything). I almost felt I could walk normally without crutches even. I certainly can walk normally with the crutches so far and because my swelling is not bad I can extend and bend my knee pretty much in the same way as before the surgery. I have a little bruise on my thigh due to some blood pressure band they used during the surgery. I came home and call everybody that cared to tell them I was much better than what I expected and sooner, and no pain yet. I'm icing and elevating my knee right now while I write this. I'm about to have my lunch and my first set of pain killers.

Haven't felt any pain yet. The local anesthesia and the Percocet had made it for me so far. I think I've been a little euphoric maybe because of the Percocet or something.   I'm very happy. I called my friends and relatives all afternoon, and slept for about 3 hours. At 2pm I had a soup and salad and two percocet pills. Then I slept for about an hour and then call some more friends and took some pictures. At 6:30pm I had some vegetables and icecream, one and a half percocet and the antiinflamatory pills I should take every 8 hours. I started feeling a little bit of pain around 6:20pm but it went away very soon with the new set of pills. After that, I felt really tired and could barely make it to bed. I fell soundly sleep until about 9pm. I called some more friends and talk to my mom until now. My brother just called to tell me he might have tore his acl playing soccer too. :( Now I'm feeling a little bit of nausea, and I'm hungry too. There's a little bit of blood on my bandage but my circulation is ok and my foot is warm. I've been walking around with my crutches (it pretty much feels like I could walk without the crutches, since I have no pain and not too much swelling yet) every now and then, doing some extension exercises and contracting my quadriceps.

Saturday 06/05/99 10:30am.

It's been 24h from the time my surgery ended and I'm still doing ok. I have full extension and at least 100 degrees flexion, although I can't tell how much more since I still have the bandage and it doesn't allow me to flex my leg much more. The dressing is usually removed the next day but in my case it will be removed on Monday afternoon.

Yesterday the nausea got worse at around 10:30pm for like about 10 min. Then I had a bowl of chicken bouillon with rice and my medicine (one pill of Percocet and one of Toradol), went to bed and started feeling better. I kept my knee iced and elevated and fortunately I didn't have any problem sleeping. My leg was still feeling numb from the knee to the ankle from the local anesthesia.

At around 2am I was dreaming I was going down the stairs and stepped to hard on my injured knee and almost fell. I must have been trying to move my leg too and I woke up with some pain (nothing worse than what I was feeling the first night after the injury). I looked at the clock and saw that it was time for my next percocet. This time I took one pill and a half, got some more ice and started talking to my mom who was sleeping in my room. The pain went away in about 10 min and I fell back to sleep at around 3am. And again, I walk up 4 hours later like by magic. This time I was dreaming I was riding my bike, the pedals locked and I had to use my injured leg to stop from falling. Again I woke up in pain. The effect of the local anesthesia was completely gone by now. I took one and a half pills of percocet and removed one of my pillows. This time I was in pain for about an hour, fell sleep again and woke up at 9am. I decided to fall sleep again until the time of my next set of pills not to feel the pain in the back of my knee. I woke up at 10am. I had ham & eggs and orange juice that my dad had prepared. My leg is starting to get a bit swollen and the dressing is bothering me, not too much though. I had one and a half percocet and one Toradol).

Saturday 06/05/99 7pm.

I've been sleeping most of the day but I feel fine now. I stopped taking the pain medicines since 10am (I didn't take the one at 2pm or the one at 6pm) and so far I haven't had any pain. The bandages started hurting so I loosen them up a little bit and I've been surfing the web for the last two hours. This day has been a lot better than what I expected.

Saturday 06/05/99 10:30pm.

I've been feeling as if I had a cold and fever for about 2 hours. I've been looking on the web to see if that's maybe like a withdrawal effect of the Percocet or just from the surgery. I didn't find what I wanted, but I found a lot of fun stuff about the long term effects of this medicine. I've been feeling pretty bad. My whole body hurts. My face and stomach are really warm. My feet and hands are dead cold. I finally took half a Percocet pill to see if that helps and went to sleep.

Sunday 06/06/99 3 am.

I had my alarm on to wake up at 2:30 to take my Toradol. I was soundly sleeping when the alarm sounded. I was feeling much better from the fever. But when I stood up to go to the bathroom, my leg started hurting really bad and I was able to fill my pulse in each and everyone of the cuts. I got worried because I've never felt anything like that before. It felt as if the wounds were going to burst due to the blood pressure. My parents calm me down and said that was normal, and that I shouldn't stop taking the pain medicine so early. I took one and a half Percocet and talk to my parents for a while. The pain went away in about an hour.

Sunday 06/06/99 11:30am.

I woke up around 7am and took another Percocet. I slept for another 3 1/2 hours. The pain has gone away and the fever. I feel pretty good and energetic today. I'm about to take another Percocet. I'm trying to increase the interval between the pills.

Sunday 06/06/99 11:00 pm

Everything has been going good so far. I can walk without crutches with no pain and feeling safe, so I've been walking with one crutch to have the other hand free to carry stuff around. I also went for a walk around the block. The neighbors were having a barbacue with dancing and everything outside the pool. That cheered me up. The only pain I had is one of my usual headaches. I took naproxen sodium as always and it went away. And as yesterday, I've been sleeping mostly all day because the Percocet makes me really sleepy.

Monday. 06/07/99 8:45 am.

Yesterday I decided to take my Toradol 2 hours early so that I wouldn't have to wake up in the middle of the night to take the pill. And it worked out pretty well. I walked up just now after a very good night of rest. I'm feeling very good. Today is my first post-op appointment with the doctor and he will take off the dressing. That will be nice since it's getting really itchy down there. I would also like to be able to take a shower.

Wednesday.  06/09/99 3pm.

lots of things have happened lately. Monday was the first day I didn't need to sleep all day, so I was able to do stuff. I had my first appointment with Dr. Wieder and he removed the bandaged, so it was the first time I saw my knee after the surgery. It looked kind of swollen and a little different from what I had imagined, but he said it looked very good. I almost have my full extension (4 degrees on my injured knee vs -2 degrees in the normal knee) and I have 80 degrees of flexion. He said I shouldn't go past the 120 degrees limit on the first 6 weeks due to the meniscus repair. Since Monday I have been able to walk without crutches, although I use crutches to go outside as a precaution. My leg hasn't been hurting at all, the only thing that bother me on Monday was again the fever and the chills when I stopped taking the Percocet. Fortunately the Dr. gave a new medicine that has hydrocodone instead of oxycodone and it's supposed to be less strong. I got that on Tuesday and I've been much better since. Yesterday I went to my first Physical Therapy. My leg was very swollen by the time I went in, but it was looking much better after the icing, the electric shocks and the exercise. I was actually able to do the full cycle in the bike, which made me really happy. The massage was painful on my bruises, but I hope that will get better very soon. I don't have any sensitivity on my knee yet. They say it might take months to recover sensitivity on the right side of the knee, but the rest should come pretty soon. My knee gets very warm if I stand up or sit down, ie, anytime I don't elevate and ice it. So I elevate and ice it.

Tuesday 06/15/99

wow!  it's been a while without writing.  After Wednesday, I was finally able to get out and get some energy to do stuff, so I wasn't that much at home anymore and I didn't sleep that much either until Sunday, when my parents were gone.  Although my thighs have been hurting because of the physical therapy, I think I crank to hard on the electric shocks machine.  Maybe it's just that I'm weak. 

My knee started feeling much better on Sunday.  The swelling has gone almost away and my knee is not warm anymore.  I came back to work yesterday for the first time and it was fine.  A friend lend me a leg raiser and it's been comfortable.  I haven't done as much exercise as I should, but I plan on going regularly to my gym again to do some biking.

Yesterday I went to my second post-op appointment with Dr. Wieder and he says I look very good and as long as I don't bend my knee pass 110 degrees for the first 6 weeks to protect my tore meniscus, I should be ok.  I can bend my knee past 135 degrees now, so I don't need to worry about my flexion for know.

I went to the Physical therapy today, and I'm -1 degree of extension now instead of -2, so I'm almost there.  It hurts to fully extend my leg, though.  They gave me a lot of new exercises.  A lot of them regarding equilibrium.  I seem to be doing fine.  I haven't had a problem.  My muscles are far away from good though, I should work on that the most.

Monday 06/21/99

My knee looks much better. I'm finally been able to see my patella again.  The wounds are starting to heal. Yesterday I went biking for a long ride around  town (like for 3 hours). I did hills and all kinds of terrain without a problem.  My muscles are starting to regain some shape.

Tuesday 07/13/99

I went to see my doctor yesterday.  He said I'm doing fine.  My extension is good and now I can start working on my flexion without worrying about the meniscus injury.   He said I shouldn't do any knee-stressing activities yet and for the next 6 weeks.   So I can bike, which is what I've been doing.  Sometimes I get bored I can't do anything else, especially because it's summer in Boulder!.  But I've been biking and walking.  I went to NYC for the 4th of July weekend and walk a lot.  And run in the stairs of the subway, etc.  My knee was ok at all times which was good.   It is still swollen, though.  I'm going to therapy twice a week.  Both Patrick & Dr. Wieder said it will take months for the swelling to go away.  The scars are looking better and smaller, but they are still violet color.  I haven't had any weird pains on the patella or patellar tendon.  My knee is still warm most of the time.  I've been doing a lot of balancing exercises with my injured leg, and now that leg is much better than my good leg for most exercises!.

Wednesday, 08/04/99