K.C. as finisher of Women's Half Marathon 2013, San Diego.
Updated: 2 October 2020
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K.C. as finisher of Women's Half Marathon 2013, San Diego. |
Everything you need to know about having Anterior Cruciate Ligament Reconstruction (ACLR)! So long as you're exactly like me, with exactly my injuries. ACLR is an umbrella name for a wide range of fixes, which you can read about in these medical journal articles (gzipped tarball). First, an anecdote: I was hanging out several MIT post-docs from various departments. I was chatting with a biologist, and I brought up the topic of evolution versus "intelligent design." I disparaged the latter and said there's obviously several designs in nature that are not intelligent (top of my examples is the human eye, for having the light-detecting rods and cones underneath the obscuring retinal blood vessels). The biologist surprised me with a, "Yeah, like the human knee." I've never heard this, but since ACLR is one of the most common orthopedic surgeries in the U.S., I should have figured this.
I'm not organized yet but here are my detailed notes about my experiences with the advantage of hindsight.
On 3 February 2008, I tore my (original) right ACL playing soccer on an astroturf field. It was the 2nd half, and I was shielding the ball in the typical manner. Therefore, I was in a slight squat position. I planted my right foot and "stood up" to make my get-away move. At the same moment, my opponent bent her knees so that one struck the back of my thigh, right above the knee joint. I immediately fell down, not so much from pain or because of a disturbing noise, but because I knew something was amiss without even thinking. I crawled off the field and didn't think anything was seriously wrong until a week later.
Timeline| Date | Description |
|---|---|
| 3 Feb 2008 | Tore my right (original) ACL while playing soccer. |
| 12 Feb 2008 | Appointment with general practitioner to get checked out. MRI prescribed. |
| 22 Feb 2008 | MRI. |
| 26 Feb 2008 | Results of MRI returned. |
| 26 Feb 2008 | Belly-dancing performance for the class I had been taking. No problem participating (other than the fact that I'm not a good dancer.) |
| 3 Mar 2008 | First opinion: I had an appointment with Dr. Welle (orthopedic surgeon) at Santa Cruz Sports Medicine Center, Dominican Hospital. He was a very nice surgeon who communicated well. However, he first suggested an auto-graph (using my patellar tendon), so when I finally decided on an allo-graph, I figured he wasn't as proficient with them and did not decide to use his services. |
| 6 Mar 2008 | Pre-surgical physical therapy with an amazing PT, Jonathan Holtz at Capitola Physical Therapy. It was important to increase my strength prior to surgery, since I would definitely not be exiting surgery with more strength than with what I entered. He prescribed 4-way leg lifts and bicycling. |
| 20 Mar 2008 | Second opinion: I had an appointment with Dr. Thabit (orthopedic surgeon) at the Sports Orthopedic and Rehabilitation Center (SOAR). I knew about this man because a good friend (and fellow soccer player) had had an ACLR with him a month previously. She had decided that he was the best in the greater San Francisco Bay Area for allo-graphs, which we both decided was the preferred surgery. (Who wants to undergo two surgeries at the same time, as is the case with auto-graph reconstructions?) Frankly, though, Dr. Thabit was a man to talk more with his hands than with his mouth. He was difficult to get answers from. (In this respect, Dr. Welle was a much better man. He even called me back to answer follow-up questions.) |
| 21 Mar 2008 | I decided to go with Dr. Thabit and that auto-graph ACLR. |
| 24 Mar 2008 | Another pre-surgical PT session. I also scheduled the surgery for 26 Mar 2008. I had to get a physical, including an EKG. This was all a very quick turnaround. (Read about my 2nd ACLR.) |
| 26 Mar 2008 | Surgery: I had an allo-Achilles tendon graph. The drill hole was 10 mm in diameter. The drill was inserted in my tibial and continuously into my femur ("trans-tibial") so that the new ACL would have an angle of 52 degrees. A trans-tibial repair gave me less rotational support since the graft was more vertical. It also made getting full extension back post-op more difficult. The cadaver Achilles tendon was presumably shaved to be the right size. They had to pick one that was mostly the right length, though. Even though I did not have an meniscus damage, Dr. Thabit required that I be non-weight bearing for two weeks. (I was quite proud that I had no meniscus damage.) |
| 28 Mar 2008 | First post-op appointment with SOAR. They took off the bandages, inspected the incisions, and re-bandaged. They left me un-wrapped and on a bed for a while, and I fainted for the first time in my life. That was horribly disconcerting. |
| 31 Mar 2008, 2 Apr 2008 |
Physical therapy with Jonathan Holtz. He had me cycle a little bit with very little resistance, just trying to get my knee to move around the full circle. He unwrapped my knee and showed me how I was bruised from the bandages being bunched and pinching my skin. He also did this awesome massage thing to help with swelling in my knee. I laid on my back, and he supported my leg. He massaged the fluid down towards my abdomen for awhile. Then he coordinated my breathing with his downward massage, so that I exhaled sharply while he moved fluid down my leg towards my abdomen. My sharp inhalation made a suction of my abdomen, drawing the fluid into it, where it could be absorbed (more surface area, less congestion). This worked! I heard the gurgling! |
| 2 Apr 2008 | I visited the emergency room because I had such pain in my calf. I called SOAR, and the physician's assistant said I might have a blood clot. It turns out that I just had the most severe trigger points ever. The brace that I wore after the surgery put a lot of pressure on my calf (in order to stay on and up when I moved around). (The best book to inform you about trigger points is The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, 2nd Edition (ISBN-13: 978-1572243750).) |
| 4 Apr 2008 | Physical therapy. |
| 4 Apr 2008 | Sutures were removed at the UCSC student health center. I was finally able to shower! |
| 8 Apr 2008 | Physical therapy. |
| 9 Apr 2008 | Physical therapy. Also, I was allowed to put weight on my leg. I had lost 14 pounds, presumably of muscle. Ok, and I guess this is as good of a spot as any to mention this: prescription pain killers (and possibly the stress of surgery) made me so unbelievably, painfully constipated. For my second surgery, I knew to drink fiber (in the form of whole psyllium husks). |
| 11 Apr 2008 | Physical therapy. By this time, physical therapy was becoming a serious workout. I would really sweat it up. |
| 13 Apr 2008 | I was able to walk without crutches or brace (though I would wear a brace to let the rest of the world know that I shouldn't be bumped.) |
| 16 Apr 2008 | I flew from San Jose to LA to attend a workshop. I brought my brace and one crutch. |
| 21, 23, 25 Apr 2008 | Physical therapy. |
| 28 Apr 2008 | Second post-op appointment with SOAR. Dr. Thabit just tugged at my knee and read the PT report from Holtz. |
| 29 Apr 2008, 2 May 2008 |
Physical therapy. |
| 5 May 2008 | Physical therapy. I was allowed to run on a rubber track. My quad was at 70% strength and 0.75'' thinner, compared to my other leg. |
| 9 May 2008 | Final physical therapy. To paraphrase Jonathan: 'The insurance companies like when we cut therapy as soon as possible. You're ready to go it by yourself. Just call me if you need anything, or come in less frequently.' I opted to use the fact that my out-of-pocket expense allowance from my insurance was maxed out, so I got a prescription for physical therapy for my repetitive strain injury problems. (The reason I had maxed out my out-of-pocket expenses was because I had had surgery in October 2007 to "cure" my sleep apnea, e.g., UPPP, tonsillectomy, tongue shrinking. The surgeon was not in-network with my insurance (or any insurance), so it was a bit expensive.) |
| 22 Sep 2008 | I played soccer again for the first time. Mostly I played goalkeeper (my position by training), but I quickly started playing some time on the field. I wore no brace; I reasoned that I shouldn't be playing soccer if I had to wear a brace. Later (say c. 1 Aug 2009, after I bruised my knee bones in a soccer tournament), I learned that even a neoprene knee brace would help prevent injuries. Apparently when you reconstruct your ACL, you don't repair the "proprioceptors" that help your body intuitively know where your knee is in space and how it's moving. With out proprioceptors, you can't tell if you're stressing your knee. A simple neoprene sleeve will help give feedback on your knee position. For more about knee braces, see the next section, about my 2nd surgery. |
| 28 Feb 2009 | I went downhill skiing for the first time. By this time, I weighed 5 to 7 pounds less than I did before surgery. |
| 26 Apr 2009 | I ran my first marathon, the Big Sur International Marathon: 26.2 miles and one 500+ ft climb (among other smaller ups and downs). I started training c. January. I went to a going-away party afterwards. One friend, who just "happened" to have it in his car, left and came back to show off his "50 is the new 26.2" shirt. (0h, yeah, he's an ultra-marathoner.) |
| 19 Sep 2009 | I completed my first triathlon (Olympic), the Santa Cruz Sentinel Triathlon. |
On 16 November 2009, I tore my (reconstructed) right ACL, tore my medial meniscus, and detached my dorsal, lateral meniscus (though the latter wasn't known until I was on the operating table). The surgery was technically a "revision ACLR."
Timeline| Date | Description |
|---|---|
| 16 Nov 2009 | Tore my right (reconstructed) ACL while playing soccer. |
| 23 Nov 2009 | Appointment with a general practitioner at MIT Medical. He didn't say anything definitive, except say I needed to see an orthopedist. He offered me a brace; I declined and thought him silly. |
| 8 Dec 2009 | Appointment with orthopedist Dr. Ferullo, who gave me the referral to get an MRI. (This was a superfluous step in the health care system.) Maybe at this time I had X-rays made of my knee; it might have happened during the first opinion appointment. |
| 9 Dec 2009 | Luckily I was able to have the MRI quickly, and they gave me the CD of the images immediately. |
| 10 Dec 2009 | Since I was able to confirm that the radiologist had read my MRI and faxed the results to MIT Medical, I was able to have a follow-up appointment with the orthopedist. Then I was officially informed that I had indeed torn my graft. I cried, frankly. This was the worst feeling. Dr. Ferullo as quite nice. He explained that my knee could be fixed and that the meniscal tear would likely be very fixable. Since the was on the exterior of the meniscus, it received a lot of blood flow. The menisci are not vascularized; there's just diffusion of the blood from the outside in. |
| 5 Jan 2010 | First opinion: I met with the surgeon Dr. Schena at MIT Medical. I discussed my options. He recommended another allo-graft ACLR. He inspected the X-rays and guessed that my old drill holes would not cause great problem for the new drill holes. He said that he would have to verify, once he was inside my knee. He |
| 13 Jan 2010 | Second opinion: As a practical matter, to help inform myself, I made an appointment for a second opinion. Unfortunately, due to the nature of my insurance, I ended up back at MIT Medical, seeing Dr. Burke, which means he knew that I had talked to Dr. Schena, what Dr. Schena had said, and that he should maintain a good rapport with Dr. Schena. So it wasn't an altogether unbiased second opinion. In any case, he had a slightly different way of explaining things. I decided to go with Dr. Schena, since Dr. Burke really did not seem interested. |
| 2 Feb 2010 | I had another appointment with Dr. Schena to discuss logistics of the surgery. Unlike Dr. Thabit (i.e. my first surgeon), Dr. Schena is quite a good communicator. Perhaps working at MIT Medical, he's used to dealing with academics who ask a lot of questions and expect to be spoken to with some respect for their ability to understand. There was no pre-op physical or EKG necessary. Dr. Schena just checked that my vitals were good. I did not do any formal pre-op physical therapy. I just did strength training on my own, which I should have been doing all along. I gained two pounds, which means I was still 3 to 5 pounds lighter than before my 1st surgery. |
| 19 Feb 2010 | Surgery: I had an allo-tibialis anterior tendon graph (that's a tendon from your foot). Apparently this graph is more round than an Achilles tendon. It would be stronger than my original ACL. During surgery, which caused it to last about 45 minutes longer than expected, Dr. Schena noticed that my lateral, dorsal meniscus was detached. To repair it, they had to cut another slit in my knee and drill an anchoring hole. Then they scored the bone and sutured the meniscal pad to the tibia through the hole they drilled. Such serious meniscal damage has the best chance to repair when there is also an ACLR since there will be lots of blood and fluid flow in the area. As I mentioned previously, the menisci are not vascularized, so they have to receive nutrients through diffusion. I had to be non-weight bearing for six weeks in order to give the menisci the best chance to heal. |
| 23 Feb 2010 | I had a diagnostic visit with Melissa Buffer-Trenouth at Sports & Physical Therapy Associates in Cambridge, MA. I did not know it was only an evaluation, and I didn't meet with Melissa but Jason Trenouth. He checked out how straight I could make my knee and how it felt to let it dangle over the edge of the table. I could straighten it completely, which was way faster than with my 1st surgery. He said that since I was non-weight bearing, that there wasn't much they could do for me and that my new insurance only covered 26 physical therapy sessions a year. For my first surgery, I thought the physical therapy right after my surgery was so very useful. |
| 23 Feb 2010 | I was able to shower after only 4 days this time. I just couldn't let the sutures get very wet. |
| 26 Feb 2010 | So I tried a physical therapy session post-op, without being able to bear weight. This time it was Melissa who helped me (as well as the junior associates.) Basically nothing was done. It was nice to get a bit of massage. It was worthless, a waste of one of my 26 allowed sessions and of my time (and energy because it's hard to hobble around on crutches). So I stopped going to PT until after I could walk. I did my own exercises (a perk of having been through the whole rigamarole before, I suppose). |
| 2 Mar 2010 | First post-op appointment with Dr. Schena. I believe he removed the sutures at this time. |
| 30 Mar 2010 | My second post-op with Dr. Schena. This was 4 days shy of a full six weeks of non-weight bearing, but Dr. Schena said I could start walking. I was now about 10 pounds lighter than before my 1st surgery. |
| 5, 7, 12, 14, 19, 21, 26, 28 Apr 2010 | Physical therapy with Melissa and whatever junior associates were on duty. They were not good sessions compared to my sessions with Jonathan. I learned one new thing in the last week of therapy. Before that, Melissa had never talked to me about why she had me hold my body the way she did. It just came up because I started a line of questioning. |
| 18 May 2010 | My third post-op with Dr. Schena. You can already see how much of a better doctor he is compared to Dr. Thabit, since he cared enough to see me. |
| 12 Oct 2010 | A little over 32 weeks post-op, I returned to Dr. Schena with problems in my knee. It occasionally would hurt and swell and, as far far as I could tell, for no apparent reason: no random tweaks or overdone exercising... He concluded that the ACL graft was fine but that perhaps the menisci hadn't healed properly. If I continued having problems, they would schedule an MRI and possibly an arthroscopy to check things out. |
| 30 Oct 2010 | I played some pick-up soccer. I had my simple neoprene brace (since the custom-order one was not ready). I ran around some on the field but mostly played keeper, which everyone else appreciated (since almost no one likes playing keeper). I was pathetically sore over all but nothing felt wrong in my knee. |
| 1 Nov 2011 | Two days after my grand return to soccer, I gave a talk at Boston University. As I was biking there, I suddenly had great pains in my bad knee and could hardly peddle. Over the course the day, my knee became swollen and very painful to bend and to put weight on. I contacted Dr. Schena, and he sent me to get another MRI, which occurred on 10 Nov 2010. |
| 23 Nov 2010 | Follow-up appointment with Dr. Schena to review the recent MRI proved inconclusive. The radiologist suspected that there was a new tear, but since it was near where the old tear was, Dr. Schena wasn't sure. Apparently, old and new injuries look the same in an MRI. We decided that if my knee continued having problems, I would have to undergo arthroscopy to view the problem and likely clean up the meniscus. |
| 18 Mar 2011 | Surgery: Almost exactly 13 months after my 2nd ACLR, I had the arthroscopy (meniscectomy). I had had terrible incidences of a very swollen and painful knee, uncorrelated with any activity. I was playing some soccer (as keeper) and running (typically at the Observatory). I was not doing my strength training, and my leg is obviously atrophied. I have not yet talked to the surgeon, but as far as I can tell, there was a tear to be repaired and some material to be removed. The word is that he says I shouldn't play soccer anymore. So what do I become when I've considered myself a soccer player for 24 of my 30 years? |