5 Weeks Post Op

Range of Motion:  According to my rehab protocol I am now able to increase the CPM from 40 degrees to 5 degrees per day until I get up to 90 degrees.  This week 5 degrees a day has proven difficult so I usually increase the CPM 5 degrees every other day. I am now at 70 degrees and the last 5 degrees are very stiff.  I am now allowed to unlock my brace to 30 degrees and will continue to unlock it more as range becomes available.

Physical Therapy:  I am still limited to the same few exercises:  4 way SLRs with weight above the knee, quad sets, patellar mobilization, and scar massage.

BFR:  This week I have been introduced to blood flow restriction (BFR) theraphy which I do in conjunction with the SLRs.  BFR is a new therapy that has been developed in the last 2 years and there's only a few places in the US that does it.  However, the results and studies are very favorable.  BFR involves exercising with a tourniquet.  The science behind BFR is that when a person exercises with limited blood flow to a muscle it allows the person to lift very light weight but still get the same effect as lifting heavy weight.  For instance a person that leg presses 200 lbs would instead apply the tourniquet and leg press only 20 lbs to get the same benefits without wear and tear on the joints and muscles that is caused by lifting heavy weights.  This is good for people with injuries such as myself that are unable to put weight on joints and have surgeries with long healing times.  Additionally, there are added healing benefits.  As a result of BFR, the body produces human growth hormone which speeds healing.  Here's how it works:  An ultrasound is used to find out what pressure completely stops the blood flow.  This is done by raising the pressure on the tourniquet which is similar to a blood pressure cuff and recording the pressure at which a pulse can not be found.  Then the BFR cuff is set to 80% of that value during exercise so the blood flow isn't completely cut off.  For each exercise you do a set of 30 reps then 3x sets of 15 reps with 30 secs rest in between each set.   

This is a picture of the machine where you set the pressure in
mm HG.  The cuff is attached to the machine which continually
inflates/deflates the cuff to maintain the selected pressure

 
I've set into a routine where I do BFR on my bad leg Mon, Wed, and Fri and my good leg on Tues and Thurs.  I am still not allowed to lift weights or do any other exercises on my bad leg so I just do the 4-way SLRs.  I do 3 exercises with my good leg with the BFR cuff (leg extension, hamstring curl, and leg press).

BFR is pretty miserable.  The first day I felt light headed, dizzy and almost passed out.  There was an intense burning sensation in the muscle being exercised.  The first exercise I tried was leg extension on my good leg.  I was lifting 5 lbs but it felt like 100 lbs.  I wasn't able to complete all 4 sets on the leg extension.  But as with anything new, I'm sure it will get better with time.  

This person is doing SLRs with the BFR cuff on.  This is
what I spend a lot of time doing.

Pain:  My overall pain this week is good.  I'm totally off the Percocet.  I still have pain around the incision when I have to lift my leg to move but it's manageable.  I still wake up in the middle to the night with throbbing and the occasional spasm.

Sleeping:  Much better this week.  I can now lay on either side and switch positions much easier.  But I still have to be careful how I move my leg.  If I move it wrong I get a sharp pain on the inside of my knee.  Since my brace is unlocked now it will allow me to bend a little so it's easier to get into a comfortable sleeping position.

The Fall:  At the end of week 5 I had my first serious fall.  I was icing at PT and there was a fire alarm so I had to go down the stairs.  I stumbled on the last stair and fell forward.  I caught myself with my bad leg.  My knee bent and stopped at 50 degrees because that's where my brace was locked out at.  I put my full weight on my leg and jammed my knee pretty good.  My first thought was "OMG I just ruined the graft!"  Then my second thought was "Ow that hurt."  My therapist immediately grabbed some ice and called my surgeon who was in surgery so he left a message.  I was terrified I had ruined my surgery.  After an hour or two I calmed down a bit.  My therapist said he thought is was ok since I didn't have any additional swelling, bruising or pain.  If something was really wrong I would have felt it.  My surgeon called a few hours later and concurred with my therapist and he said I didn't need to come in unless things got bad later that night.  I felt about the same that night but I was still very worried that some damage had occurred.

These pics were taken during an arthroscope to show how long it
takes for the graft to harden.  This demonstrates why non weight
bearing during the first few weeks is important to prevent damage.

    


The consistency of new cartilage at various stages:

• after 1 week like WATER
  
• after 3 months like YOGHURT
  
• after 6 months like DOUGH
  
• after 9 months like CHEESE
  
• and after 12 months like RUBBER