ACL surgery

[peregrinerose 0]

Hi All,

I'm sure you all saw Chad's incident in the appropriate forum. Unfortunately, I was already in the ER when he was injured, having blown out my knee. On Monday, I'm getting ACL reconstructed (patellar tendon autograft), meniscus most likely removed as I pretty much exploded it, and partially torn MCL repaired. Kind of excited about it, as I am getting a nerve block only, so hoping to watch the surgery
I'm getting mixed reviews regarding going back to jumping. I know that revascularization of the graft takes 6-9 months, so even though I'll likely have good range and strength at 3-4 months, that's also when the graft is at it's weakest, and I have no desire to go through this all again.

I've been pathological about doing my PT at home 3 times a day, and am currently walking with just a brace (no crutches). I can do stairs slowly and awkwardly, and my range of motion is about 120 degrees. I have to get better quickly, since Chad will be coming home from the rehab hospital in 1-2 weeks, and he is clearly not mobile, having had a burst fracture of L1 with incomplete spinal cord damage.

So... when can I drive? Of course it's my right leg. Chad's 3.5 hours away, and I only see him on weekends. I am hoping to be able to drive within 4-5 days of surgery. Is this reasonable?

Those of you that have had similar procedures, how long did you wait to return to jumping? I saw in doing a search that some are jumping at 2-3 months out, which seems quite stupid to me given the strength of the graft, so I'm not looking for a low bid, just a range of reasonable and safe given the revascularization process. I have seen two surgeons now, and several PTs, and have gotten a very wide range of answers.

Thanks for any feedback!

Do or do not, there is no try -Yoda

[eeneR 1]

I had mine done a few years (quite a few) I had hamstring tendon graft, not patellar. things have come quite a long way since I had mine done, but my brother had his done recently. 3-4 days driving is probably not reasonable. You will lose range of motion and some strength in your leg. The reaction time to hit your brakes will not be there nor will you have as much strength as you think you might.

Everyone is different, each doctor has a different protocol, but normally the first week or two you are not completely weight bearing, thus driving really is far too dangerous.

Just my .02.

Edited to add: Unless you have been a regular two footed driver, used to using left foot to brake, if not now is not the time to learn.

She is not a "Dumb Blonde" - She is a "Light-Haired Detour Off The Information Superhighway."
eeneR
TF#72, FB#4130, Incauto

[wildcard451 0]

Renee is right for each doctor is going to have his own postoperative protocol. When I had a patellar tendon reconstruction 9 years ago, I was in a locked straight brace for 6 weeks. I was on crutches for about 2 weeks before I started weight bearing.

Best of luck. I am POD1 from shoulder reconstruction right now. Do not let yourself get behind the ball on pain control. Be sure to start well before your nerve block wears off,.

Also the nerve block, you may not remember much of surgery due to the amnestic agents.. Expect to be in more of a twilight state.

[peregrinerose 0]

They are only doing nerve block on me, no other sedation (I refused). I had the same thing for my ganglion cyst surgery. It was too weird an angle to watch directly, but my surgeon twice hiked up my wrist to give me a tour of my own arm innards. I loved it. My only fear in life is general anesthesia.

I've been doing nothing for pain management now, pre-op, so that I won't be used to pain meds when I really need them.

I noticed that surgeons are totally different. I first saw a surgeon in Phila, not knowing how long Chad would be there, so I entertained doing my surgery there. He wanted me completely non weight bearing for 3 or more weeks, no skydiving for a year, no motion at all to knee for a week post op. Since Chad may be coming home soon, I opted to see a surgeon at home. He is sending me straight from surgery to physical therapy, as in that day or the next depending on when I get out of the surgery. His protocol is completely different than the first surgeon, even doing surgery a month earlier than the first surgeon recommended (probably in large part because my swelling is very reduced now and range of motion is almost normal... I've been pathologically good at doing everything I'm supposed to).

Cadaver and hamstring were both options for me, but I read the primary literature and seems autograft has the best long term prognosis and elasticity, although recovery time is significantly longer and higher pain levels. I'm ok with short term misery in favor of long term prognosis.

Just found out that Chad may come home on Saturday, which would be awesome!!!

Do or do not, there is no try -Yoda

[JohnMitchell 14]

What a rough time for you two.

How's Chad's lower body strength? Do they think he'll have a full recovery, given time?

[peregrinerose 0]

He's very very weak, a large part of that due to being fairly immobile for the last three weeks. He started out with a lot of left leg weakness, but that seems to have resolved. He still has impairment of bowel and bladder, but both have improved significantly since the injury. Guess we'll find out if there are any sex effects, eh? It'll be fun experimenting with that end of things!

He's got a great attitude and has been doing wonderfully in PT. He hates his back brace with a passion, but hopefully that will be more comfortable now that his staples are out (removed this morning). I'm really proud of him. He's come a very long way.

Do or do not, there is no try -Yoda

[eeneR 1]

I had my knee done in '93, I went right from surgery directly to PT that night! They kept my knee moving in a CPM machine overnight as well. I had my knee fixed in Vail, CO. They know a thing or two about ACL. I did not do Patella primarily because I am an Avid skier and the surgeon felt Hamstring (mine, not cadaver) was my best option. Cadaver wasn't even an option actually LOL

I will note I had no other damage, just a clean ACL tear. The other stuff should slow you down a tad, but you should never be completely immobilized from the start. Full weight bearing should be limited the first week or two, but not completely immobilized and non-existant. When I came back to IL the doctors here freaked the hell out as 2 weeks post op I WALKED into the office sans crutches LOL. Mind you at this time there were still a ton of Othro's casting for weeks post ACL!!

My advice, as Wildcard mentioned post surgery stay on top of the pain meds (Brandon....I will kick you via the inter-webs over this as well) If you get behind it will be that much harder to catch up. No matter how much it hurts do the PT, they will torture you it will hurt but you will recover faster. One of the dumbest things I did with my shoulder (this is sad that I can reply to both of you) is I didnt spend enough time with range of motion, what you have now you will have to rebuild. Get that shit good and flexible before pushing strength too hard.

Any thing I can do to help let me know, even if it is to whine, it sucks but you will be so grateful on the otherside!

Edited to add: I had an epidural so I could watch mine!! There were TV's so I can see what the docs were seeing on the scope. Though when the table started vibrating from the drill, that was just weird I almost tried to sit up and actually SEE what was going on down there, I felt like a stump! HAHA

She is not a "Dumb Blonde" - She is a "Light-Haired Detour Off The Information Superhighway."
eeneR
TF#72, FB#4130, Incauto

[peregrinerose 0]

Oy, I'm so glad I won't be immoble like 'back in the day'. Although surgeon number 1 wanted me pretty much immobile. Glad I ended up with surgeon #2 due to geography. And he's quite hot, so that is an added bonus

Do or do not, there is no try -Yoda

[JohnMitchell 14]

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And he's quite hot, so that is an added bonus

Well, my ortho is a cute blonde, so there.

[peregrinerose 0]

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And he's quite hot, so that is an added bonus

Well, my ortho is a cute blonde, so there.

I firmly believe that eye candy is very helpful with regard to recovery.

Do or do not, there is no try -Yoda

[eeneR 1]

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And he's quite hot, so that is an added bonus

Well, my ortho is a cute blonde, so there.

I firmly believe that eye candy is very helpful with regard to recovery.

Agreed 100% both docs were hot. Actually this reminds me of a story.

Sitting in the pre-op area with my best friend waiting for shoulder surgery. She and I are both wound up from everything going on and had reverted to our 13 year old selves (we have known each other that long) Anyway dude walks up to the counter across from us, she comments about his ass...and the fact his scrubs were 2 sizes too small. 1 min later he walks up to us and introduces himself as my anesthesiologist, oops. HAHA

Then this other dude comes and goes, then a third guy, taller but we didn't see his face, just his ass, which by the way was a fine one. From behind I did not recognize him, but she nice and loud "damn look at that ass!!!" He turns around and before I can say a word "Damn look at those eyes" He had these amazing piercing blue eyes... Yea it was my doc! HAHA He walked over smiling.

She is not a "Dumb Blonde" - She is a "Light-Haired Detour Off The Information Superhighway."
eeneR
TF#72, FB#4130, Incauto

[guppykf 0]

I just set up my ACL reconstruction surgery for June 26th. I chose the Patellar tendon autograft on my right knee as well. My surgeon says I will start PT in the recovery room and will be on crutches 4-7 days depending on my weight bearing abilities. He says I should be able to drive after I am weight bearing and off the pain killer meds. He agrees with your doc in regards to the revascularization so he says I should be back to skydiving and other activities in approx. 6-9 months; 6 months is December timeframe so I'm not worried about wanting to get back in the sky in the dead of winter, but by March timeframe I know I will be itching for some airtime.

Like you I did a lot of research online and got a lot of varying opinions from different docs and PT's, even met with the team physician of TN Titans. You gotta go with your gut and hope you made the right decision. I dislike being injured as I am sure you are as well. I wish Chad and you a speedy recovery! Good luck to you both!!

THRIVING IN MY DASH!!

[peregrinerose 0]

My first surgeon was one of the team surgeons for all the Philly sports teams.... I went to the Rothman Institute of Thomas Jefferson University. He was much more conservative with movement though, which surprised me. The second doc I saw seemed much more in line with the current research, so I feel more comfortable with him.

Yep, I went in having researched my three options thoroughly, and I have friends that have had all three types, all happy, so I am fairly sure that I can't go wrong no matter which I choose, but I felt better about autograft vs. zombie knee due to risk of rejection.

I wasn't given a time frame for weight bearing, but I can live with 4-7 days.... and aiming for 4

Do or do not, there is no try -Yoda

[SWATcop 0]

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Those of you that have had similar procedures, how long did you wait to return to jumping?

Ten years.

Kevin

Muff Brother #4041
Team Dirty Sanchez #467

[peregrinerose 0]

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Those of you that have had similar procedures, how long did you wait to return to jumping?

Ten years.

Well, I'm not waiting that long. I'll amputate the fucker before I wait that long. Was your wait due to the ACL surgery or something else?

Do or do not, there is no try -Yoda

[SWATcop 0]

I'm sure you will be back much quicker. One of my friends had a canopy collapse two weeks after I got hurt. He ended up paralyzed from the waist down and had a leg amputated. I decided I couldn't afford for that to happen. Ten years later I got brave again.

That patellar tendon graft is a bitch to recover from. Going aggressive on the PT was the key for me. I was wakeboarding (with the brace) in less than a year.

Kevin

Muff Brother #4041
Team Dirty Sanchez #467

[peregrinerose 0]

I absolutely will be aggressive with the PT. Been very good about pre surgery therapy. I even go up and down stairs like this. It's sore, but I can do it.... just want to keep the musculature up.

Do or do not, there is no try -Yoda

[DSE 3]

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Those of you that have had similar procedures, how long did you wait to return to jumping? I saw in doing a search that some are jumping at 2-3 months out, which seems quite stupid to me given the strength of the graft, so I'm not looking for a low bid, just a range of reasonable and safe given the revascularization process. I have seen two surgeons now, and several PTs, and have gotten a very wide range of answers.
!

Call me "stupid."
June 8, broken L1-5, Pelvis(7 fracture points with bolt, plate, 8 screws), sacrum, coccyx, ACL/MCL on right, ACL on left. Bladder torn in three places, severe colon damage, in ICU for 2 weeks, one week in traction prior to later surgeries.
September 17th, ACL replacement (allograft, not my own).
Oct 27, first exit from 5K.
Been jumping most every day since (although I wear a DonJoy DefianceIII for all jumps, the MCL isn't a forgiving ligament)

No problems in more than 2K jumps following the above.

[SWATcop 0]

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Call me "stupid."
June 8, broken L1-5, Pelvis(7 fracture points with bolt, plate, 8 screws), sacrum, coccyx, ACL/MCL on right, ACL on left. Bladder torn in three places, severe colon damage, in ICU for 2 weeks, one week in traction prior to later surgeries.
September 17th, ACL replacement (allograft, not my own).
Oct 27, first exit from 5K.
Been jumping most every day since (although I wear a DonJoy DefianceIII for all jumps, the MCL isn't a forgiving ligament)

No problems in more than 2K jumps following the above.

Damn!

Kevin

Muff Brother #4041
Team Dirty Sanchez #467

[peregrinerose 0]

Uh, June to nearly Nov is almost 5 months, not 2-3 months... My PT told me I'd feel great in 2-3 months, full strength and mobility, but the graft is weakest due to lack of blood supply, and from 3-9 months post op is when re-injury is most likely as a result of weakness in the graft, which the patient can't feel at all. This is based on autograft surgery, may be different for hamstring or cadaver. I'd rather be grounded an extra few months than re-injure and be out much longer. Besides, the extra few months are over the winter anyway.

Do or do not, there is no try -Yoda

[DSE 3]

Uhh...you might want to review the dates again. ACL replacements surgery in September, (not June).

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September 17th, ACL replacement (allograft, not my own).
Oct 27, first exit from 5K.

Most any ortho will recommend allograft over hamstring for persons over the age of 30.

I do not advocate anyone follow my example; my circumstances were a bit different and my needs (plus ability to do very intensive rehab) were likely different than most. Nevertheless, 5 weeks post-op, I was back in the air, and was back in the air full time less than 2 weeks later.
But hey...I'm stupid.

[peregrinerose 0]

You're right, I brain farted and went with injury date... yep, you are stupid when it comes to that. Look up revascularization of patellar autografts. All the rehab in the world will not make blood vessels grow quicker. You were lucky. I'm not generally quite so lucky, so not going to roll the dice on a graft that I know is not fully healed, despite the fact that according to my PT and surgeon, I'm going to feel perfectly fine in 2-3 months. They both know I'm bull headed and extremely compliant with rehab. Neither one can understand how I'm walking around including doing stairs now.... but as they both said, I already destroyed everything in there, so it's not possible for me to damage it any more!
Oh.. both orthos I talked to actually recommended patellar over hamstring due to my level of activity (moderate to high). Both said hamstring is not as flexable, so can cause a slightly less range of motion, and long term may contribute to sooner osteoarthritis as a result (I'm going to get osteoarthritis very young due to the meniscus having to be removed, there won't be any padding in there).

Both said that auto vs. allo of patellar was up to me. Pain level is far lower with allograft due to no insult of my own patellar tendon. However, I could be getting a 90 year old ACL, so no guarantees there, as well as the risk of rejection (low due to limited vasculariztion there, but still possible), so I opted to go with autograft to eliminate both of those risks, and they both agreed with my choice and said they would choose the same. The only reason they recommend cadaver over autograft is the lower pain level. I have a very high pain tolerance (walking around on a blown out knee with absolutely no pain meds now), so that's not too much of a concern for me.

Do or do not, there is no try -Yoda

[DSE 3]

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You're right, I brain farted and went with injury date... yep, you are stupid when it comes to that. Look up revascularization of patellar autografts. All the rehab in the world will not make blood vessels grow quicker.

Having had ACL's replaced 3 times in my lifetime, I'm fairly familiar with the risks, rewards. Having broken nearly 60 bones between rodeo, motocross, and skydiving, I'm also somewhat familiar with my body.
My risk mitigation was well-calculated, and as things turned out, it was worth it. Different strokes for different folks, I suppose. Had I listened to the hospital orthos, I'd have been in a wheelchair until December, and on crutches til at least February. I'm glad I didn't listen, and glad that the two orthos that I've worked with for nearly 30 years knew my body, my drive, and were willing to work with me.

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They both know I'm bull headed and extremely compliant with rehab. Neither one can understand how I'm walking around including doing stairs now....

Fancy that....people not understanding how you can physically do something you shouldn't be able to do based on actuarials and traditional experiences. Be careful, they *might* even call you stupid.

[peregrinerose 0]

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You're right, I brain farted and went with injury date... yep, you are stupid when it comes to that. Look up revascularization of patellar autografts. All the rehab in the world will not make blood vessels grow quicker.

Having had ACL's replaced 3 times in my lifetime, I'm fairly familiar with the risks, rewards. Having broken nearly 60 bones between rodeo, motocross, and skydiving, I'm also somewhat familiar with my body.
My risk mitigation was well-calculated, and as things turned out, it was worth it. Different strokes for different folks, I suppose. Had I listened to the hospital orthos, I'd have been in a wheelchair until December, and on crutches til at least February. I'm glad I didn't listen, and glad that the two orthos that I've worked with for nearly 30 years knew my body, my drive, and were willing to work with me.

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They both know I'm bull headed and extremely compliant with rehab. Neither one can understand how I'm walking around including doing stairs now....

Fancy that....people not understanding how you can physically do something you shouldn't be able to do based on actuarials and traditional experiences. Be careful, they *might* even call you stupid.

I can not damage myself any more right now... I was told it was good that I can do this as it keeps my flexibility and strength up. I was told post op that I will FEEL wonderful 2-3 months. Like you, I know my body well. If you can feel blood vessels growing into a graft, you're a freak of nature in that good kind of way. Muscle, bone, those tell you when you over do it... I've broken my fair share of things as well.... ligament is a different animal, particularly knee due to the vascular issues.

Honestly, the only reason I'm arguing with you is because I don't want someone to do the same search that I did, see that you were fortunate in not getting re-injured and not even acknowledging that you pushed a very weak graft beyond what it was meant to do and were, as a result lucky. I don't want to see someone get hurt because they decide to follow in your footsteps. Months three through nine are going to be awful for me, as I'll feel ready to jump. The risk of re-injury is one you managed to escape... and I'm glad. If you were not so fortunate, your tune would be very different on here. Luck is not something I tend to go with when it comes to making medical decisions.

Do or do not, there is no try -Yoda

[DSE 3]

Remember, uneducated and inexperienced people also think jumping out of airplanes is stupid too.

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Luck is not something I tend to go with when it comes to making medical decisions.

Neither is luck part of my path. Hence the reason I spent several months prior to ACL surgery, and several weeks following ACL surgery in the same rehab center, under care of two very experienced orthopods, that many NFL professionals use. Had I not been cleared, I wouldn't have jumped. As said in this thread and every other, my circumstances were unique, my access to services and time were a bit unique too.

Were I to do any of this again, the only change I'd make is waiting long enough to remove the hardware.

I do not endorse, recommend, nor tell anyone to follow my footsteps. At the same time...it's often ridiculous to accept the stats on conservative tables that aren't specifically registering sports medicine, specific rehabilitation techniques, and human drive. Just one example, under water treadmills are not available to everyone, but they are a godsend to those that have them. Having a dedicated PT at your side for 9 hours a day is a huge benefit. Having spirit and drive make a difference.

It's good you're "told you can do this and do that." With many more years and broken experiences than you've likely had, I'm pretty familiar with my level of recovery comfort and time. Horses, motorcycles, cliffs, and parachutes have all contributed to my bucket of knowledge and nearly 60 broken bones.

Granted, it's not a recommended path, but those who follow it are not "stupid."
OTOH, if you're gonna be stupid, you'd better be tough, and I'm the toughest SOB you'll ever meet.