Wednesday, December 10, 2008
acl reconstruction: a personal experience (part one)
It's been nearly two weeks now since my knee operation so I thought I'd do a little review on what it was like. There's a lot of information on the internet already about people's experiences, for example these forum posts which I read before my operation and was slightly freaked by, and this information by a surgeon in the US whose technique my doctor uses, but I found some of it a bit technical and confusing. So this is just my personal experience - yours might not be exactly the same (and I sincerely hope you don't have to go through it, because it's not the most pleasant experience in the world!)
So firstly, why did I have to have an ACL reconstruction? In August this year I went to Queenstown, NZ with friends for a skiing trip. On the first morning on the slopes (Coronet Peak) I fell on my face (I can count the number of times I've been skiing on one hand... so I blame inexperience combined with incompetence) and felt this excruciating pain in my right knee. I knew that my skis had crossed at the front when I fell, so that my right knee buckled under in a most unnatural manner, but at the time I thought, "yeah, I'll just sit in the cafe and drink hot chocolate for the rest of the day, then I'll be back on the slopes tomorrow!" I apparently screamed loud enough though at the time to bring chapflap running back up the slope and a host of other helpful skiers to alert the ski patrol, who took me down to the medical centre in a sled (the snow looks very different when you're travelling with your face parallel to it at high speeds!)
At the medical centre they advised me to go back into Queenstown to have x-rays to ensure there wasn't any bone damage. They said they couldn't be sure exactly what had happened, and that only an MRI would reveal whether anything had happened to my ligaments. So into Queenstown we went, where an x-ray showed no bone damage, with the doctor saying that it was likely I had torn my medial collateral and anterior cruciate ligaments (MCL and ACL). The MCL runs along the inside of the knee on your right leg, and the ACL from the back of your knee through to the front. See the helpful diagram above.
The doctor sent me back to the hotel with instructions to keep off my feet and see the physio as soon as possible. Then began a flurry of teary phone calls and emails back home, as I tried to reassure my parents that (a) no, my leg hadn't fallen off and (b) it was really ok for me to stay in NZ for a little while longer... please? Ultimately it was decided that we should fly back to Sydney after a day or so. I went to see the physio the next day and she gave me a knee brace and applied ice to ease the swelling. At Queenstown airport the staff said that it was a particularly bad season for skiing accidents - they were seeing at least one person leave on crutches every day!
On arrival back into Australia I was whisked off to have an MRI. We were most worried that I may have damaged my meniscus as well as my ACL and MCL (the so-called "unhappy triad"), because that would require immediate surgery. Happily the MRI showed only a complete tear of the ACL and MCL and an intact meniscus. The MCL would heal by itself through physio and a knee brace, while the ACL would require surgery.
It's important to note at this point that ACL reconstruction is optional. You can get by without having an ACL, as long as you don't engage in activities involving a twisting of the knee (which could possibly give way without an ACL). The way the doctor put it though was, "well, you could twist your knee coming out of the kitchen - and eventually you'll want to be able to play with your kids in the backyard and stuff." In other words, if you do decide to go ahead with the surgery, it's better doing it as early as possible, to avoid further damaging your knee. Ultimately though it's up to each individual to choose whether or not to go ahead with the operation, depending on your own age, activity level and willingness to commit to a lot of physio (unfortunately the operation is only the first step in the recovery process...)
So we decided to book in the operation for late November, just after my uni exams. I had to wear the knee brace and be on crutches for about 5 weeks to allow my MCL to heal. There was also lots of physio to first re-build and then build up my rapidly wasting quad and calf muscles (it's scary how fast you lose things when you don't use them). These formed fantastic excuses not to do any housework, avoid public transport and generally act like a brat. Sadly, now that I've had the operation, those excuses are largely fading away...
I'll describe my actual experience of the operation in part two. Stay tuned...