i need a new knee

week 12, day 2

2007-10-24T17:15:00.000-04:00

i'm embarrassed that it took me so long to write a new post - sorry! life has been busy.

four weeks ago was a big turning point: my physical therapist told me i had full range of motion back and wasprogressing nicely. accordingly, she cleared me to reduce my PT sessions to once every 2 weeks and told me that i no longer needed to use a crutch while walking around (!!!).

i still need to do daily physical rehab at home: i'm primarily working on strengthening (my quad and calf in my bad leg is still weaker than my normal leg) and balance. for strengthening, i'm doing a lot of leg lifts, calf raises, lunges, and assorted other motions. for balance, i'm doing theraband exercises, standing on one leg and catching balls being tossed to me, and standing on a pillow with one foot.

i'm still wearing a brace, just to be careful, but am definitely gaining in my confidence in my knee. when i walk, i dont notice my knee anymore. however, i notice a slight amount of pain in my bad knee when walking down stairs (though going up stairs isn't a problem anymore). nonetheless, i feel that my knee is slowly progressing, so i'm not concerned.

week 6, day 6

2007-09-16T16:14:00.001-04:00

It's been a while since I've posted. The good news is that there isn't much to report. Physical therapy is still going strong. We've added a number of new balancing exercises that involve me balancing on wobbly things. We've also been working hard on small steps, so that I can start to get back to the point where I can go up stairs with a normal gait.

On Friday I had a bit of a scare. I was in a restaurant with marble floors and didn't notice that the floor was wet. I slipped a little bit (even though I had my crutch with me) and it really scared me. Thankfully, I didn't fall or injure anything seriously. But for about an hour after the slip my knee felt a little sore - almost like I had a very minor sprain. Within a few hours, I couldn't feel any difference though. This was a good reminder that I still need to be very careful and that I'm still vulnerable to reinjury.

week 4, day 5

2007-09-01T17:13:00.000-04:00

so, i've been on my own here at grad school for about a week now. i'm wearing a neoprene brace on my knee and using one crutch (though i'm not bearing any weight on the crutch - i'm using it more for stability). so far, i've managed pretty well. walking on flat ground is pretty simple - my only concern is other pedestrians jostling into me, but the crutch seems to scare people away and give me some more space. stairs are still really difficult - i need to go up and down them like a baby does and it takes a long time - which is tough since i'm in a third floor walkup apartment. additionally, normally i need to carry my crutch in one hand and hold onto the rail with the other. this can be problematic, because i can't really carry anything up and down the stairs (such as groceries or my laundry) . i've been finding that a backpack is a time-saver because i can just stuff a bunch of things into it and still navigate the stairs.

i had my first physical therapy session since coming back to school yesterday. it was good - my new physical therapist seems great and she really knows her stuff. she said my extension is pretty good (about 1 or 2 degrees hyperextension), my flexion is good (about 120 degrees) and my leg strength is on track. she also tested my balance, by making me close my eyes and balance on my bad leg - i was so wobbly, it was kinda crazy. she said that it's normal and we'll work on it. she gave me a whole bunch of new exercises to work on at home in addition to the stuff i was already doing. the whole set of exercises will probably take me about 45 mins to an hour to do every day - a big time commitment, but necessary.

hamstring isometric exercises - sitting in a chair, raising my toes up and flexing so that my hamstring gets worked out. (there are a few variations based on positions for this).

quadriceps isometric exercises - sitting in a chair, with my foot flat on the ground and flexing so that my quads get worked out (again, there are variations based on slightly different positions).

balancing exercises - i tie this elastic band between a table leg and and my good leg, then i stand balancing on my bad leg and try to pull the elastic band with my good leg. at first glance, it looks like i'm working out my good leg, but it actually is helping with the balance issues on my bad leg.

week 3, day 3

2007-08-23T18:30:00.000-04:00

yesterday i headed back to grad school. up until now i was enjoying the comfort of living at my parents' home and having them serve as my personal nurses. yesterday my dad and i packed up the car and drove 12 hours to my school. the car ride was difficult at times as my knee got tight from being in the same position, since i couldn't really bend it that much. i was able to drive part of it and the trip went well. i'm now at school and my dad is staying here a couple of days until i set up shop. the real test will be in two days after he leaves and i'm here on my own.

week 3, day 1

2007-08-21T15:13:00.000-04:00

i've seen a lot of progress in the last few days. i've been practicing walking around without a brace and without crutches - i'm able to make it around with just a slight limp (but at a snail's pace).

yesterday at PT i was able to make my first revolution on a stationery bike - it sounds like a small feat, but it was totally satisfying to accomplish such a modest task for the first time. all in all, i'm seeing a little bit of progress every day and i'm pleased with how things are coming along!

week 2, day 5

2007-08-18T18:38:00.000-04:00

i had my second followup visit with my surgeon yesterday. he was really happy with the way my leg was progressing. he took off the steri-strips that were covering my sutures, snipped off the ends of the thread sticking out of my sutures and said that my incisions were clean and that i could finally shower without covering them with saran wrap. the sutures are bioabsorbable, so, they'll go away when the wound heals.

the doc also told me that i was cleared to stop using my crutches and my brace as soon as i feel comfortable. i am still not at the point where i can walk around, but i'm determined to become brace-free and crutch-free in the coming days. i've been walking around the house a lot without my crutches and am slowly gaining more confidence. my leg gets pretty exhausted quickly (because of the muscle atrophy), so i'm going to spend the next couple of days walking on it a lot without the crutches. when i feel comfortable enough, i'm going to lose the brace too.

all in all, yesterday was a good day, and i feel that things are progressing nicely.

week 2, day 2 - the usual

2007-08-16T11:01:00.000-04:00

everything seems about the same today. the biggest problem right now is the calf tightness that i've been experiencing for the last few days. i can't tell if it's swelling or a tight muscle, but whenever i stand on it, my calf is in a lot of pain. it's frustrating, because i feel like this tight calf is really holding back my ability to walk on the leg. no matter how much i stretch it, it still feels tight. i'll talk about it with the doc tomorrow during my follow-up visit.

week 2, day 1

2007-08-15T11:14:00.000-04:00

yesterday was pretty uneventful - did my PT exercises at home and worked on putting more weight on my knee.

had my second PT session this morning. my physical therapist said there was marked improvement from just two days ago. we did the same exercises we did last time, plus added a couple more.

stationary bike - basically sat on the bike with no resistance, and slowly rocked my feet back and forth to get improved flexion. i still can't make a full revolution, but it definitely helped my flexion.

hamstring and calf stretches - these muscles were really tight the last few days, so my therapist showed me how to stretch them out effectively.

week 1, day 7 - physical therapy

2007-08-13T20:03:00.000-04:00

today was my first physical therapy session. the first things my physical therapist did was measure my extension and flexion in my knee.

extension - how straight i could make my leg - i got to 0 degrees which is fully straight - a large part of that had to do with the fact that i wore a knee brace for the last week

flexion - how far i can bend the knee - at first, by myself, lying on my stomach, i got to a measly 30 degrees, because i hadn't tried bending my knee at all since surgery. later on in the session, after doing some exercises, i got it all the way up to 90 degrees, but i get ahead of myself.

the therapist then ran me through some exercises, with a few goals in mind: (1) regaining my old range-of-motion - full extension and full flexion; (2) strengthening my leg muscles so that i can get back to putting all my weight on it; and (3) preventing scar tissue buildup which will limit my
wall heel slides - basically lied on my back with my butt to the wall and let the knee bend under the force of gravity until i felt it was tight, then held it there. rinse and repeat. this was to get flexion back. by the end of doing this, i was up to 90 degrees of flexion.

various isometric leg lifts - basically got in in different positions laying down and lifted my leg to strengthen leg muscles. these were kinda tiring, as i hadn't done my much with my leg, but i felt a difference.

quad sets - flexing my quads (the muscle on the top of your thigh) and holding it for 10-15 seconds, repeatedly. this was surprisingly difficult - it's as if my mind doesn't quite remember how to do anything to that muscle - i had to really concentrate to get results.

patella mobilization - this involved me manually moving my kneecap with my fingertips in different directions to prevent scar tissue from building up.

finally, at the end of the session, the physical therapist taught me how to start walking with more weight on my knee using the crutches. up until then, i'd been mostly hopping around on my crutches, only putting weight on my good knee. it was absolutely liberating to put more weight on my bad leg and gain some confidence in walking (albeit at a snail's pace and with two crutches holding a lot of weight). the therapist said i should try to walk around like this as much as possible as it will help me get to the point where i can walk without crutches all the more faster.

on the whole, the first physical therapy session was great - i realized i can do a lot more with my knee than i thought, and i know some exercises to start actively recuperating instead of sitting around and watching law & order all day long.

week 1, day 6

2007-08-12T20:08:00.000-04:00

today was pretty uneventful. the only notable thing today is that i noticed that my ankle below my knee is a little bit swollen and my temperature is slightly above normal - 99.6 degrees F. my mom (a physician) thinks i should be watchful of these symptoms as these could be signs of an infection. the increased swelling has caused some more pain in my leg when i stand (and the blood rushes down to the leg), but otherwise, it's not a big deal. we'll see how things go tomorrow.

week 1, day 5

2007-08-11T11:21:00.001-04:00

prior to last night, i had been camping out on my couch all the time. last night i made my first attempt to go upstairs so that i could take a shower and sleep in a real bed. getting up stairs was kinda funny - i ended up going one step at a time on my butt. it was comedic, but effective. i had to cover my wound with saran wrap, then took a lightning fast shower. the shower was great - i was feeling pretty gross as i hadn't taken a real shower up until then. after that, my parents helped me change my dressings with some new gauze and a new ace bandage. then, i tried out sleeping in my own bed. sleeping in a bed was actually more painful than sleeping on the couch - i think it's because i tended to try and roll around more, which was more painful for my knee. who woulda thunk?

week 1, day 3 - first followup visit

2007-08-09T16:28:00.000-04:00

this morning i had my first followup visit with my doc. he changed my dressings, took an x-ray of my knee and said that everything was progressing normally. he also scheduled my first physical therapy session for next week. all in all, it was a good trip. i'm anxious to get to physical therapy so that i can start using my knee.

week 1, day 3

2007-08-09T09:30:00.000-04:00

last night was a lot better - i mostly managed to get a full night of sleep - woke up a few times from the pain, but was able to get back to sleep quickly.

my bandages underneath my brace have gotten a little pinkish and oozey, which is kinda gross. my doc's office said that this is okay, and i have my first follow-up appointment with my doc later this morning, where i expect they will change my dressings and stuff.

i'm a little nervous that my pain pump local anesthetic is going to finish this morning and that i'm going to have a lot more pain when it's done. we'll see.

week 1, day 2 - lots of different meds

2007-08-08T19:07:00.000-04:00

i'm one day post-op. i have a bunch of different meds that are all doing different things:

pain pump - this is a little device that is attached to my knee brace that runs a tube to my suture site and applies a slow drip of topical anesthetic. this is what is probably keeping most of the pain away. it is supposed to last for 48 hours, so i'll see how the pain is tomorrow after it finishes up.

antibiotic - i have a five day course of antibiotics to help prevent infections and stuff. i need to take this three times a day.

narcotic pain meds - the doc prescribed me some percoset to help deal with the pain. i took one yesterday at the hospital, and it made me feel really groggy and out of it (kind of like the day after you take a benadryl or nyquil). i didn't like it too much and the pain has been manageable, so i've been avoiding it.

ibuprofen - this over-the-counter drug has been my painkiller of choice. it's been doing a great job and is also supposed to help keep the swelling down.

aspirin - i'm supposed to take one aspirin a day for ten days as a blood thinner to help prevent clotting.

multivitamin - just to make sure that i'm healthy.

the knee brace i'm wearing also has these two little pockets for ice packs. i'm supposed to change the ice packs every two hours - the ice feels good and is supposed to keep the swelling down.

week 1, day 2 - the first night

2007-08-08T10:43:00.000-04:00

last night was my first night after the surgery. i slept pretty well until about 4am, at which point the dull pain in my knee kept me half awake for the rest of the night. i felt pretty unrested in the morning.

week 1, day 1 - surgery day

2007-08-07T18:35:00.000-04:00

today was surgery day. woke up at 4:30am to get at the hospital by 6am. i checked in, filled out some insurance information, then they dressed me up in a gown. the nurses had me shave the area around my knee, which was an experience in and of itself. a nurse attached an IV to my arm, and then the anesthesiologist came by and talked to me about what to expect. finally, my surgeon came by and marked the leg that was going to get operated on. by 7:30am, i walked into the OR with a nurse, lied down on the gurney. a nurse told me that she had attached my IV to something that was going to make me hazy. i remember looking around and seeing all the nurse and doctors getting ready for the procedure and then it was lights out.

i woke up around 10:30am in the recovery room - it was all over. my parents were there. i was still really groggy from the general anesthesia, but could definitely feel some pain in my knee. the nurse gave me some graham crackers and apple juice to eat, and then gave me a percocet for the pain - it was manageable, i'd say a 4 out of 10. my doc came by to talk about the results of the procedure with my parents, but i was so tired that i kept falling in and out of sleep. after about an hour of monitoring, the nurses got me a wheelchair and i was on my way home.

i've set up shop on my couch. i can't really do anything without my crutches. my parents have been saints. i've been half-napping for the last six hours. i dont have much energy to do anything, and get drained really easily. i've snacked on a grilled cheese sandwich, some triscuits, and ginger ale, but the idea of anything else makes me nauseous. the pain was sorta bad this afternoon, but i popped some ibuoprofen and it felt much better. i'm trying to limit my use of the percocet to a minimum, as i've heard horror stories on it's addictiveness and the way it makes you feel. i'll probably use it at night so that i can sleep, but use over-the-counter meds during the day.

i've been religiously icing the knee, as per the doctor's order. overall, the day has flown by. i'm too tired to notice much. the knee has a dull lingering pain, primarily in my hamstring (where they harvested the graft) and where the sutures are. we'll see how tonight goes.

last minute stuff

2007-08-06T15:13:00.000-04:00

tomorrow is my surgery day. i've been running around doing last minute stuff while i can still move around (dry cleaners, shopping, rented a bunch of movies, etc.). the hospital just called and told me that the procedure is going to be at 7:30 am and that i need to be at the hospital at 6:00am (early!). i guess there's no turning back.

patellar tendon graft v. hamstring graft v. allograft

2007-08-01T20:36:00.000-04:00

surgery is set for this coming tuesday (6 days and counting) and the last real decision i had to make was which kind of graft i'm interested in using. ligament tissue (such as in an ACL) is elastic, therefore, it's impossible for the body to naturally heal the ligament and maintain elasticity. the surgical procedure seeks to replace the ACL with a graft from somewhere else. there are three main options for this type of procedure and i've been researching them all to figure out what the best one is going to be.

patellar tendon autograft
your kneecap is also called the patella. it's connected to your upper and lower leg bones via some tendons. in a patella tendon autograft, the surgeon removes the central third of the tendon along with a bone fragment on each side that the tendon is connected to (this procedure is called a bone-tendon-bone procedure). the surgeon then drills holes in both bones, runs the ligament through the holes where the ACL should be, and secures the bone fragments to the bone using screws.

pros:
- this is by far the most traditional of the techniques. many call it the "gold standard" of ACL grafts.
- it heals pretty fast because the bone fragments fuse relatively quickly to your bone
- the technique for harvesting the patellar tendon can leave you in pain

cons:
- people tend to complain of pain in their knee when they kneel and sometimes when they squat too
- it requires a very precise surgical technique and is not forgiving of surgical mistakes

hamstring autograft
in this technique, the surgeon removes part of tendon that connects your hamstring (the underside of your thigh) to the bone. the surgeon then folds the tendon several times and stitches it together to make a strong graft, drills holes in your bones and screws it in place of your old ACL.

pros:
- the technique required for this surgery is a lot less difficult
- typically no knee pain when kneeling

cons:
- unlike the patellar tendon graft, there are no bone fragments on the end pieces of the graft, meaning that the recovery time for the graft to fuse into the bone is a lot longer, because it's trying to connect soft tissue to hard tissue
- it can tend to weaken your hamstring, so you need to do a lot of strength training to restore your hamstring strength.

allograft
an allograft is a graft taken from a cadaver donor. it's secured using screws into your knee, just like the other techniques.

pros:
- since the surgeon does not need to harvest the graft from your body, there is a lot less pain and the technique is easier and faster.
- your knee becomes part zombie, which is sweet.

cons:
- there is a small risk of infection or disease transmission because you are implanting somebody else's tissue in your body.
- there is little data on the long term strength of the graft
- the process required for sterilizing the graft using irradiation tends to weaken the graft, so it has less elasticity than a normal ligament.
- it takes longer for your body to vascularize the tissue (vascularization is when your blood vessels grow through the tissue, basically making it a part of your body).

based on all this information, i've decided to go with the hamstring graft, as it seems to be pretty solid for long-term use and doesn't result in pain when kneeling. i'm also authorizing my doctor to use the cadaver graft as a backup plan if he decides that my hamstring tendon is not suitably long enough after he opens me up (which is occasionally a problem with the hamstring procedure).

the date is set

2007-07-25T19:52:00.000-04:00

the doc's office called me and the surgery date is set: august 7th. i have a little less than two weeks until i go under the knife. the doc told me i should be careful with the knee, make sure the swelling goes down and work on getting full extension of my knee and as much range of motion as i can. i almost have full range of motion, so i don't think it'll be too tough.

second opinion

2007-07-23T22:26:00.000-04:00

i got a second opinion on my knee today and confirmed what i expected: i need to get ACL reconstruction surgery. according to both my first orthopedist and my second one, my ACL in my left knee is completely ruptured (as in, it doesn't exist anymore). the only way to fix a complete rupture is to remove the old ligament and replace it with a new graft (more on what kinds of grafts are available at a later date). the doc said that the surgery is really quick because it's arthroscopic - they don't need to cut the whole knee open, they can make a few small incisions and insert a scope and some instruments into the leg and do the surgery via video camera - neat stuff.

additionally, my medial meniscus is torn. the medial meniscus is the cartilage cushion on the inside part of the knee joint, and it likely got damaged during the accident. the doc will clean up and repair the meniscus damage while he reconstructs the knee.

right now, i'm deciding between a surgery date on august 7th or august 10th. i'd prefer the 7th because that way i will have two weeks of recuperation time at my parents' house before i need to head back to school. tomorrow i will find out whether the surgeon can get time in the operating room on august 7th. either way, i have a couple of weeks to countdown before the surgery date - yikes . . .

am feeling more mobile

2007-07-16T22:51:00.000-04:00

i'm definitely feeling more mobile than i was last week. i'm able to move around pretty well with just one crutch and can walk short distances without it altogether. stairs are still difficult - especially going down them. the swelling has gone down and i am trying to do some basic range-of-motion exercises to make sure my knee doesn't get too stiff. i'm scheduled to get a second opinion on whether or not i need to get surgery next week with a surgeon that came highly recommended.

back to work

2007-07-11T22:45:00.000-04:00

headed back to work for the first time. was able to move around pretty well with a crutch and the knee felt as good as could be expected. starting to research a little more into what surgery and rehab are going to entail - it looks grim.

MRI and meet with the orthopedist again

2007-07-10T22:44:00.000-04:00

went in the morning to get the MRI. had to lay still for 45 minutes during the process, which is a lot more difficult than it seems - my hand started falling asleep and my leg started to itch, but i couldn't do anything about it. met with the doctor to go over the radiology report in the afternoon and he said that i managed to completely rupture my ACL, tear my medial meniscus, and slightly sprain my MCL. he recommended arthoscopic surgery for the ACL rupture and miniscus tear. also, i got behind the wheel of my car for the first time, which was nice. thankfully, it was my left knee that got injured and i drive an automatic transmission, so aside from getting in and out of the car, i have no problems driving. also managed to start walking using only one crutch. the small victories feel good!

meet with the orthopedist

2007-07-09T22:42:00.000-04:00

finally went and met with an orthopedist. after an x-ray and a brief physical exam, he said i needed to get an MRI to find out more info, but that he thought i tore my ACL. i succesfully started to put some weight on my knee while using crutches for support, which made life a lot easier. i'm staying with my brother and sister-in-law for the summer, and they've been saints - they've been taking care of me and making sure that i can get around okay.

air travel isn't fun when you can't walk

2007-07-08T22:41:00.000-04:00

headed home after the family reunion, using crutches to get around. i couldn't put any weight on my knee and had to take a plane home from the reunion. we warned the airlines that i was going to require a wheelchair for the trip. the airlines at my departing airport were great at getting me through security, etc. with a wheelchair. however, the arrival airport was different story: instead of a gate with a jetway, the airport expected me to climb down a set of stairs to the tarmac. after the rest of the passengers left, i told them that i would have a tough time with the stairs as i couldn't put any weight on my knee. after about 45 mins, they brought this contraption that looked kind of like a forklift with a chair on the end of it to get me off the plane. the flight attendants and the pilot on board rolled their eyes at how ridiculous this airport was, since it would have been easier to just unload at a gate with a jetway.

bump, set, spike, pop

2007-07-07T22:39:00.000-04:00

during a game of volleyball at my family reunion, i landed poorly on my left knee, felt a loud "pop" and immediately collapsed to the ground. i felt some initial pain, but it was manageable. i thought that i could stand up on it, tried it a couple of times, but each time i felt another "pop" and couldn't bear any weight on my leg. with the help of some cousins, was able to get home and started icing the knee. luckily, with all the family around, i was well taken care of.