5 Months Post Op Dr Appointment

I went back to see my surgeon to see how I was progressing.  Here are some of the questions I asked him and the answers (in red) and my reactions (in blue).

1.  Why do I still have pain in the same area as before the surgery?  Is this normal?

It is normal to still have pain until you get your quad strength back.  Cartilage injuries are difficult and it's sometimes difficult to see what is causing the pain.  However, it's too soon to think about other options because the graft is still hardening and adhering to the bone (I'm definitely NOT having another surgery for this.  At this point I'll live with what I got if this is as good as it gets).  The pain should slowly decrease over the next couple of months as your quad becomes more functional.

2.  It's hard to strengthen my quad when my rehab protocol is so restrictive.  When can I start doing more intense exercises such as lunges and squats?  Do you have any recommendations of exercises I can do now to strengthen the quad?  What about stairs?  Are those ok?

At this point you are okay to start doing squats and lunges (Well this is good to know!  Apparently my rehab protocol is very generic and fits worst case scenario for this surgery.  I'm excited to try out some new exercises over the next few months).  Your lesion is in a location that those exercises should not put excessive pressure on the graft.  But you'll need to start slow since your quad is very weak.  The leg extension weight machine is a good way to build the quad.  You'll have a lot of trouble dong stairs right now so you might want to avoid that until later down the road (Too bad my house has stairs.  But I just go up one leg at a time).

3.  I have cracking and popping in my knee now.  Is this ok?  Should I be worried?

No, this is nothing to be worried about.  This is normal after open knee surgery.  To access the cartilage lesion the tendon attaching your knee cap was cut so the kneecap could be flipped up.  The tendon was then glued back together.  The cracking and popping is the scar tissue releasing and breaking up.  This should go away in a couple of months (This was a relief.  I thought these sensations were my messed up cartilage).

4.  Would an MRI show how the graft is doing at this point?

No, an MRI would not show much at this point.  If you still have pain a year post op then is would be appropriate to get another MRI to see what's going on.  Right now there is no reason to think anything is wrong with the graft as you seem to be healing well.  

5 Months Post Op

No swelling at 5 months

Pain, Swelling, and Stiffness:  At 5 months I finally have no swelling!   My knee looks like the other one except for the scar.  I still ice after I go to physical therapy but I don't feel the need to ice after I do workouts on my own.  I still have stiffness in the morning when I get out of bed but I don't notice it throughout the day.  As far as pain goes, I still have minor pain in my femoral condyle similar to before I had the surgery.  Over the last month, this pain has come and gone.  I have good weeks where I don't notice it at all and think the surgery worked.  Then the next week I feel it again.  This is the most frustrating part of this surgery.  I'm not sure why the pain comes and goes.  Sometimes I think it's my body reacting to upping my workout routine or trying a new exercise.  Interestingly though, I find that I feel better after I increase the weight or reps of any exercise involving my operated leg as long as I don't overdo it.  So maybe strengthening the muscles helps relieve the pain, I really don't know.  Additionally, I still have slight warmness when I touch my knee. It's not hot, just slightly warmer than the other one.  Everyone I've asked about this says it's ok and normal.  It just means there's still healing going on, which makes sense.

Physical Therapy:  The exercises I'm allowed to do hasn't changed since month 3.  However, I've been increasing the resistance, time, and reps of each exercise.  The exercises I do include:

Stationary bike (up to 45 minutes with varying degrees of resistance)
Elliptical (up to 15 minutes)
Treadmill walking (forwards/backwards for 15 minutes)
Swimming (up to 45 mins freestyle stroke)
Leg Press
Hamstring Curl
SLRs
Heel raises

Here's a short clip of me doing leg press.  I'm still limited to 45 degrees of flexion so it's hard to really  gain much strength doing this.  In this video I'm lifting 35 lbs which is difficult.  Note how skinny my leg is and how hard it is to see much definition as the muscles contract (I call it my baby deer leg).  My surgeon told me at one point I'll probably lose 30-40% muscle strength during the first 2 months of recovery.

Here is another clip of me doing straight leg raises (SLR) working the abductor muscle of the thigh.  I started doing these a week after surgery and I'm still doing them.  This is a good way to work the four major muscles of the thigh:  quads, hamstrings, abductors, and adductors.

A Note on Backwards Walking:  One exercise I recently started is backwards walking on the treadmill.  Backwards walking is good for people recovering from knee surgery because it primarily works the quadriceps and calves unlike normal walking which works the hamstrings and glutes.  Additionally, backwards walking produces less of a sheering force on the knee joint as opposed to forward walking so it is a good exercise to strengthen the muscles without causing too much stress.  So I'll be doing this a lot and trying to increase speed and endurance over time.

Other Thoughts:  Stairs are still difficult, especially going up.  Going down is much easier and I can almost do this normally as long as I'm holding onto the handrail.  I am still very careful not to overdo it with my knee.  I had a giant snow storm this month and was forced to shovel snow to get out of my driveway.  I was very careful to avoid putting too much weight on my operated knee or do much bending with it.  However, the next day I felt more sore than usual and was worried I overdid it.  But I felt ok a few days later.  So what this taught me is that even though I'm feeling a lot better and stronger, I need to not rush the recovery and stick to the exercises I know I can do safely.