Operation day
Looking back on the day of my operation is all a bit of a blur now. I had to be up at 5am to make the journey over to Bristol, with Linkin Park songs blaring out the speakers the whole way there - I had to find some way of psyching myself up for the day!
This time around went so much smoother than my first op. Before my operation I had met the nurse looking after me, the Surgeon, the Anaesthetist and the other members of the team, this was really comforting and it felt like the most seamless process. I was really impressed. To be honest, I remember only two things, which was having a cannula being put in my hand and then waking up, I didn’t have the ordeal like last time... I cant believe I had got myself so worked up!
Once I was awake, Dan was able to come and see me (with presents yay! ) and I felt so RELIEVED. I was visited by the Surgeon and was told that the operation had gone as hoped. We had a plan A, B and C and fortunately we were able to go with plan A. There was a slight possibility that it could have been a 2 part procedure but fortunately enough that wasn’t the case. I was also visited by a Physiotherapist who made sure I was not a liability with my crutches and then I was off home.
The operation I had was a revision ACL reconstruction with Patella tendon, iliotibial band tenodesis and medial meniscus stabilization. I have to be in a range of movement brace for 6 weeks, which doesn't let me bend my knee past 90 degrees. This is not as far as you think, but I am allowed to completely weight bear... Once I can. Most people haven't heard of the iliotibial tenodesis. In the simplest of terms it involves taking a piece of your IT band which runs down the side of your thigh, and then stretching it around the ligament on the outside of your knee (lateral collateral ligament - LCL) and then attaching it back on to your femur. This then creates extra resistance to knee internal rotation and supports the natural function of the ACL, which in short, helps to provide more knee stability. Because I was having revision surgery and reaallllly didnt want to be doing this again, I chose to have the additional stabilising procedures. It is potentially harder to rehab with a tenodesis but it my case it made sense. Definitely worth the extra scars I will have! I cant actually say anything negative about my experience at all. So thank you Southmead hospital and everyone involved in my care.
Day 1 – 4
I probably didn’t get any sleep the first night home. I could not get comfortable at all and the pain was unrelenting. I spent most of the night reading. I thought I was made of tough stuff and would be able to cope on paracetamol alone but that was definitely not the case and for the first few days, I was taking codeine as often as was allowed. This bit was shit frankly, as Codeine makes me feel like a zombie and I definitely did some very weird things the first few days, not to mention the other side effects im sure we all know about.
Not being able to wash is the biggest thing, at one point I tried to put shower gel on my toothbrush... Luckily I realised before I put it in my mouth.
I started to use my powerdot. Which is a neuromuscular electrical stimulation (NMES) machine, basically like a TENS machine but you're using higher frequencies. I’ve been using a resistance setting, meaning its working on strengthening the muscles. It’s a 20 minute workout where each muscle contraction is 6 seconds long and you have 8 seconds rest between each contraction.
I ramped it up to the strongest contraction I could tolerate. It’s such a weird feeling when your muscles moving when you haven’t asked them to. The instructions say that some people can faint when they first use it. It’s been brilliant though. I actually find it helps reduce the pain, so it’s been on 3 times a day for pain relief. However the main reason I am using it is because research shows that using NMES post ACL surgery can reduce the amount that quadriceps muscles waste during the early days... I don't want to have peg leg!!!! (1, 2, 3)
The exercise programme I’ve done 3 times a day consists of the following:
Heel raises 3 x 20 reps
Static quads. 10 second isometric hold 3 x 10 reps
10 minutes active knee flexion on foam roller
Single leg balance 3 x 20 seconds
Calf stretches 3 x 30 seconds
Standing hip flexion 3 x 10 reps
Standing hip abduction 3 x 10 reps
It doesn’t really take that long. Plus I’ve had nothing better to do. The goals of week one were to achieve full knee extension and 90 degrees flexion which I’m pleased to say I’ve been able to meet.
Day 4-7
My pain improved a lot! I have weaned off the codeine, so only taking it before bed to allow sleep which has definitely got easier. Perhaps too much information now but codeine really affects your bowel movements. Not going to the toilet for 5 days is not fun!
I’ve managed to go back in the gym. Been doing some upper body workouts and doing some arm only rowing and hand bike, we have been sharing many of these workouts on the instagram page in the stories. Lots of people have questioned whether I’ve gone back to the gym too early. However I’ve not been exercising my right leg and Its been a way of keeping up the rest of my strength amongst all the other health benefits of exercise, the last thing I wanted to do was become sedetary and lose all of my hard work. More importantly I’ve also continued to train my left leg - Again most people wonder if that will lead to muscular imbalance and have questioned why I continue to do so - There have been studies that have found that training the other (contralateral) leg can actually help produce strength gains in the non trained leg post ACL operation (4). This is called cross-education and is key method of early stage rehabilitation when loading the rehabing leg is still a few weeks away.
Also the bruising has been spectacular!
So to summarise week one, I would say that taking effective pain relief is key. I’ve made sure that knee extension has been the priority and I’ve worked hard on keeping my quadriceps muscles in use. The next stage would be to improving my balance and try and introduce some closed chain (meaning the foot stays in contact with the floor, like when you squat for example) provided I do not bend my knee past 90 degrees, I’ll start walking more with only one crutch, and the dressings come off - hello gory photos!
Week 2
The second week after the op, I started to try and progress my exercises considering that I still had the required range of movement at this stage. I got off all the strong pain relief, thank goodness, but I still take some paracetamol when I am feeling really sore. This tends to happen after working it hard, but no need for the strong stuff anymore. You'll also be relieved to know that my bowel movements are back to normal (YAYYYY).
I’m walking with one crutch outdoors and even some short distances indoors with no walking aid. I am keeping my knee brace on though whenever I’m mobile to make sure I dont push my knee past 90 degrees as I feel like if I’m not careful that could happen without the knee brace on. The swelling is so much better!! The knee itself if still puffy but I’m sure I am starting to see the shape of my knee cap! I’ve had my dressings changed. The incisions are looking really neat so very pleased with that!
It looks pretty savage, you can see the scars are pretty significant because of the patella graft and tenodesis but everything is healing nicely!
My daily exercises are starting to get a little bit more dynamic at this point as I can stand comfortably; I am still using my power dot 2-3 times every day and I added some standing exercises in to start to bring back my ability to walk!
Standing knee extension against red theraband (closed chain) 3 x 20
Clam 3 x 20
Standing knee flexion 3 x 20
Towards the end of the week my standing bilateral (meaning on 2 feet) balance was getting much better so, Dan got me throwing and catching with a Netball. The idea behind this is that it adds a small amount of instability through my body which my core, hip and leg muscles have to account for which makes it a little harder and is also specific to me for getting back to playing netball. But mostly, IT WAS REALLY FUN! It helpes me to feel like I'm on the road to recovery.
In the gym I’ve also included my legs when on the rowing machine, provided it’s not going past 90 degrees and its comfortable
These exercises I’m trying to do 3 times a day. Along with my powerdot. I’m listening to how my knee feels all the time and not pushing it when it doesn’t feel ready. I’ve got a lot of pain around my bicep femoris tendon (one of your hamstrings) and I feel it doesn’t want to be pushed too hard so I’m going to just take it steady.
I’ve also managed to take a proper shower. I’ve still got waterproof dressings on and I’m not getting it completely wet but it felt GREAT! To feel clean again, The simple things!
Next couple of weeks I hope to start some box squats and step ups provided I have the control because my quads are still a bit wobbly at times. However I feel optimistic and after watching some netball on TV this week I’m definitely feeling motivated!!
References:
1. Currier, D. P., Ray, J. M., Nyland, J., Rooney, J. G., Noteboom, J. T. and Kellogg, R. (1993). Effects of Electrical and Electromagnetic Stimulation after Anterior Cruciate Ligament Reconstruction. Journal of Orthopaedic and Sports Physical Therapy,17(4).
2. Kyung-Min K., Croy T., Hertel, J. and Saliba, S. (2010). Effects of neuromuscular electrical stimulation after anterior cruciate ligament reconstruction on quadriceps strength, function and patient-orietned outcomes: A systematic review. Journal of Orthopaedic and Sports Physical Therapy, 40 (7).
3. Hauger, A. V., Reiman, M. P., Bjordal, J. M., Sheets, C., Ledbetter, L. and Goode, A. P. (2018). Neuromuscular electrical stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery. Knee Surgery, Sports Traumatology and Arthroscopy, 26 (2).
4. Harput, G., Ulusoy, B., Yildiz, T. I., Demerci, S. Eraslan, L., Turhan, E. and Tunay, V. B. (2019). Cross_education improves quadriceps strength recovery after ACL reconstruction: A randomized controlled trial. Knee Surgery, Sports Traumatology and Arthroscopy, 27(1).
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