3 Month Reflections

Now that I'm 3 months out from surgery I have a few reflections that I want to pass along:

1.  Most surgeons and physical therapists don't have a lot of experience with this surgery and the recovery.  Ask your surgeon how many ACI procedures he/she has performed.  I've worked with 2 physical therapists so far.  Neither of them had much experience dealing with ACI patients.  That doesn't mean they aren't knowledgeable and can't help you get better but I've had to be very proactive with my therapy.  My PT has tried to get me to do things that conflicted with the rehab protocol I was given.  Know the rehab protocol cold and don't do things you shouldn't do.  Also, unless you have a PT experienced with ACI you'll get a lot of blank stares when you ask questions about your recovery. I have often wondered if certain things I was feeling were normal and haven't got real answers to my questions.  I can't make an appointment with my surgeon every time I feel something weird or have a question.  So I've just stuck by the mentality that if I don't have a significant increase in pain or swelling and feel like I'm slowly getting better, then things are ok.

2.  Do patellar mobilization and scar massage every day.  I still try to do this on a daily basis.  Breaking up the scar tissue with massage has helped immensely with getting rid of the painful areas around my knee.

3. I don't feel worse after this surgery.  One concern I had with open knee surgery is that it would make things worse.  I can now safely say this hasn't made my knee any worse.  I'm still waiting to see if it made it better though.

4. I still have swelling and my knee feels warm to the touch.  I had no idea after 3 months this would be the case.  Apparently this can last for months.

5.  I'm looking for a new car because I didn't want to drive a manual anymore (surgery was on my left knee).

6. I can't wear heels yet.

7. I still have cracking and popping in my knee similar to before the surgery but it doesn't hurt.  Sometimes my other knee will crack and pop as well but I have no pain in it.

8.  When bending my knee sometimes I have painful popping sensations in the areas I have scar tissue build up.  This used to scare me but now I realize it's scar tissue breaking up.  At one point, I had a particularly painful "pop" but later that night it felt so much better because it had loosened up. 

9. I'm still waiting for the pain in the graft area to go away when I walk.  Weight bearing increases cartilage generation when the graft has healed enough support your weight.  So the way I see it, pain in this area is not necessarily a bad thing. It will take awhile to go away. 

10.  I can ride a bike normally with no pain.

11.  I can walk normally but I need to go up and down stairs one at a time with my good leg.

12.  I still have aching and throbbing at night but it's more of an annoyance than anything.  I typically don't take any pain medication for it now.

           

3 Months Post Op

Range of Motion:  I am at 155 degrees.  I'm just about at full range.  I can now sit crosslegged on the couch do most of the stretches I used to do.  However my right knee joint is still much more flexible and I think it will take a long time to regain that type of flexibility in my left knee.

Physical Therapy:  I started swimming this week!  My rehab protocol says at month 3 I am allowed to start swimming.  I used to swim a lot before my surgery since this was one of the ways I could get a great workout despite my knee injury.  I didn't feel comfortable just jumping in the pool and swimming like I used to.  So I use a pull bouy between my legs to mostly work my arms.  I practice my kick with a kick board.  My leg is extremely weak so I could only do 3 laps kicking.  It was also hard to stay in a straight line since my good leg was overpowering my other leg.  Here are my workouts for the week:

Sunday

• 20 mins arm bike
• 25 mins stationary bike (level 5)
• 3x10 reps leg press, hamstring curl, leg extension on good leg
• 3x25 reps abductor/adductor SLRs (3 lb ankle weight)
• 20 minutes stretching

Feels great to get back in the pool to swim

Monday

• 5 mins stationary bike (level 6)
• 3x10 reps leg press
• 3x10 reps toe raises
• Rolling stool hamstring curls
• 3x15 reps BAPs board

Tuesday

• 20 mins arm bike
• 28 mins stationary bike (level 7)
• Upper body weight lifting
• 20 minutes stretching

Thursday

I use a pool bouy like this lady since I don't feel ready to use
my legs to really kick

• 30 minutes swimming w/pull bouy
• 3x laps gental flutter kick w/kick board

Friday

• 20 mins arm bike
• 30 mins stationary bike (level 7)
• 6x30 reps SLRs (3lb ankle weight)
• Core work
• 20 minutes stretching

Walking: I am walking normal.  I have a normal gait and can walk at a normal pace.  But if I've been sitting for awhile or get out of bed first thing in the morning the stiffness makes me limp a few steps before it loosens up.  I'm not able to go up and down stairs normally yet.  I have to take one step at a time with my good leg going up and down.

Pain and Swelling:  I still have mild swelling about the knee cap.  This hasn't changed much since last week. I still have pain near the graft site like I had before the surgery.  I feel like it is getting better overall but some days it feels worse than others so its hard to tell.

Other Thoughts:  I feel good enough to take a work trip involving a commercial airline flight which I will be doing next week.  I feel comfortable about sitting on a plane and getting through the airport.  However, I'm screwed if I have to quickly get to a gate. 

11 Weeks Post Op

I no longer need the crutches!  It feels great to not have to use a walking aid anymore.

You can see how much smaller my left leg is

                =

Range of Motion:  I made it to about 140 degrees this week.  I
almost have full range of motion. Before having this surgery I was very flexible since yoga is a hobby of mine.  One of the worries I had concerning this surgery was losing flexibility in my knee joint and not being able to do certain yoga poses or only being able to do them on one side.  I'm not sure my knee will ever really be the same but I'm hopeful that I'll be able to regain the type of flexibility I had before.  Once I regain full range of motion, I'm going to start practicing yoga poses to further increase flexibility.

Scar Tissue:  I had two painful areas on my knee due to scar tissue which was causing me pain when  I walk or exercise.  It is starting to feel MUCH better this week.  I feel like I'm breaking it up with the range of motion stretching and massage.

Physical Therapy:
I'm not spending as much time doing range of motion stretching this week since I almost have full range.  But I make sure to at least spend 20 minutes working on knee flexibility after my workout.  Here are my workouts for the week:

Monday

BAPS (biomechanical ankle platform system) board:  I move
side to side on this to work on balance

• 20 mins arm bike
• 25 mins stationary bike at level 5
• Rolling stool for hamstring strength
• Upper body weight lifting
• 20 minutes stretching

Wednesday

• 20 mins arm bike
• 25 mins stationary bike at level 5
• 5x30 reps SLRs (3 lb ankle weight)
• Core work
• 20 minutes stretching

Friday

• 10 mins stationary bike at level 6
• 3x10 reps hamstring curls
• 3x10 reps total gym at 90 degrees flexion (I can only use my good leg to push up)
• 3x15 reps double leg BAPs (for balance)
• 20 minutes stretching

Walking:  By the end of the week I can walk with a normal gait without crutches.  I still walk fairly slow.  And I have to be careful not to pivot or twist on my bad leg.

Pain:  The pain in the evening is better this week.  I feel like my body has adjusted to being back at work and on my feet more.  However, I still have pain that is similar to before I had the surgery.  I feel it every time I walk.  It's not especially painful but I can tell the graft has not hardened to a point to where my knee pain will go away.  The skin around the incision is very tender.  I think this is due to all the stretching.  As I reach full range of motion the incision needs to stretch pretty far to accommodate the increased range of my knee joint.  This has caused irritation and the scar to become raised in some places.

The atrophy in my left leg is much more noticeable when I'm
sitting in a chair.  My knee cap is still hard to identify from
this angle due to swelling.

Stiffness and Swelling:  Although my range has improved a lot over the week I still have stiffness.  I feel the stiffness as I move my knee through it's entire range of motion.  I still have slight swelling which is mostly above the knee.  I can also feel spongy areas when I press around the knee cap.  I can actually feel the fluid moving around in the joint.  Along with the scar tissue this is also causing stiffness.

10 Weeks Post Op

This week I had an exciting first!  I'm now able to shower standing up.  Up until now I've been using a shower chair or taking a bath.

Range of Motion:  I feel like I am struggling with range of motion.  The goal of my PT protocol by week 10 is full range of motion but as of last week I was only at 105 degrees.  So this has been the focus of my PT this week and I've really ramped up the amount of stretching I do.  My therapist suggested I get at least 5x 20 min stretching sessions a day.  These are some of the stretches I do:

I pull on my ankle until I feel a stretch

I try to move my ankle towards me

I am trying to sit on my heels

Unfortunately the saying "no pain, no gain" does apply for increasing range of motion.  During these stretches I go to the point of discomfort then press a little farther so I'm at about a 5 on the pain scale.  I try to hold it for a minute then relax.  I do this several times for each stretch.  Although it's painful to do the exercises, I feel better after doing them because I'm less stiff.  After this more aggressive approach I am now up to 125 degrees by the end of the week.  It feels good to be making progress.

I can now ride the stationary bike continuously and fast enough to get the machine to turn on.  I will be increasing resistance and endurance over the next couple of weeks.

Scar tissue is unavoidable after surgery but it can be
broken up

A Note on Scar Tissue:  Scar tissue is a natural part of healing after surgery.  Unfortunately it causes stiffness and pain until it's broken up.  The amount of scar tissue produced and where it collects can be different for each person.  After open knee surgery scar tissue can form around the incision and deeper inside the joint.  I have a very painful area on the inside and at the bottom of my knee.  I can feel the knot and this is where I have the most pain when walking and doing exercises.  So I have declared war on my scar tissue.  Ways to break it up include range of motion stretching exercises and massage.  I'm already doing a lot of stretching and now I manually press on it each night to try to break it up.

Physical Therapy:  I now go to PT 3 times a week.  On days I don't go to PT I do my own workouts at the gym.  I also started electrical stimulation (e-stim) of the quads.  During e-stim, electrodes are hooked up to the quads and when current is run through them, the muscles contract.  This helps build muscle strength and decreases pain.

Here are my workouts for the week:

Saturday

• 20 mins arm bike
• 20 mins stationary bike at level 2
• 3x10 reps leg press, hamstring curl, leg extension on good leg
• 4x15 reps 4-way SLRs on bad leg (3 lb ankle weight)
• 4x 20 min knee stretching sessions through out day

Sunday

• 20 mins arm bike
• 20 mins stationary bike at level 5
• Upper body weight lifting
• 4x 20 min knee stretching sessions through out day

Monday

• 15 mins stationary bike at level 5

  

  E-stim of the quadricep

• 20 mins arm bike
• 5 mins SLRs/5 mins quad contractions w/ electrical stimulation
• Rolling stool for hamstring strength
• 4x 20 min knee stretching sessions through out day
• Core work

Tuesday

• 5x 20 min knee stretching sessions through out day

Wednesday

• 20 min stationary bike at level 5
• 20 mins arm bike
• 3x10 reps hamstring curl/leg extension on good leg
• 3x25 reps abductor/adductor SLRs on both legs (3 lb weight)
• Rolling stool for hamstring strength
• 10 mins SLR w/e-stim
• 4x 20 min knee stretching sessions through out day

Thursday

• 5x 20 min knee stretching sessions through out day

Friday

• 15 mins stationary bike at level 5
• 3x 20 min stretching session through out day

Walking:  I am now down to just one crutch which I barely put any weight on.  I use it mostly just in case I stumble or to help with stairs.  I still walk pretty slow and think about each step I take.  I have to concentrate on making sure I'm walking with a normal gait and not limping.

10 weeks post op

Pain and Swelling:  I have a little more pain this week.  It's mostly at night and my knee aches and throbs.  I think this is mostly due to being back at work.  I'm a lot more active than I have been anytime in the last 2 months.  Although I try to sit at a desk most of the day, I spent a lot more time on my feet this week.  The swelling has gone done a little from last week and it almost gone.

Other Thoughts:  This was my first full week back at work.  My work is very understanding and I was lucky to be able to take so much time off.  So now, no more 2x workout sessions a day.  It's difficult to balance work and PT.  Getting the 5x range of motion sessions in each day is tough.  Luckily I can do some of the stretches while sitting at my desk or take a break in my office.   Rehabbing from this surgery could be a full time job but that's not realistic for most people. I rarely have any time during the day when I'm not working or doing some sort of rehab.  In the evening when I would be relaxing on the couch, I'm either stretching or trying to rub out my scar tissue.