Friday, December 12, 2008

acl reconstruction: a personal experience (part two)

Soon enough it was the day of the operation. I had to get to the hospital at 6:15am in preparation for a 9am surgery. When I got there I had to draw an arrow on the leg that was being operated on, and asked numerous times which side the operation was taking place on (I was asked just before being wheeled into the theatre, "which hand is your right hand?" to make sure that I knew my right from my left). Taking my blood pressure and changing into the ever-so-flattering backless gown took up some more time, then I was taken up to my room where I would be staying for one night to drop off my things and hop on the bed.

Two cheerful orderlies came around 8:45am to wheel me down to the theatre. They said, "we'll wheel you down in your bed, you'll get put onto the table, then you'll wake up in your bed." This was the first time I'd undergone a general anaesthestic so I was a little apprehensive - I'm sure you've heard all those horror stories about people being awake during surgery but not being able to talk or move or scream. The anaesthetist put me at ease though by engaging in friendly chit-chat while inserting me with all sorts of sharp objects, then accurately stated "you're probably feeling like you've had a couple of drinks right now." The last thing I remember was being moved from my bed onto a hard surface in a room with lots of lights with it, and then having a plastic breathing mask placed over my face. Too late to back out now...

The next thing I knew I was in a different room altogether, along with some other patients. There was some strange contraption squeezing both my calves (to help prevent blood clots) and a drip going into my wrist. The nurse told me it was 11:30am, so I'd been out for 2.5 hours (the doctor said that the surgery would take between an hour and 1.5 hours). They wheeled me back up to my room (I was in my bed, as promised) where began half-hourly blood pressure and oxygen level checks by the nurses, which decreased to hourly checks, and then eventually to checks every two hours.

My drip was delivering a constant flow of hydration plus an on-demand dose of morphine. "Don't be afraid of pressing the button," advised the staff, "don't feel as though you should be in pain." It turned out though that I probably have a morphine sensitivity because I wasn't able to keep any food down from lunchtime on the day of the operation to morning tea on the day after. Or maybe I just got a bit too trigger happy. I wasn't able to get out of the bed on the first day because I was attached to it by the strange calf-squeezing machine, and besides all I felt like doing was sleeping. Zzzz.....

After quite an uncomfortable night (not being allowed to get out of bed + constant hydration = unpleasantness! Nurses definitely don't get paid enough...) the doctor came and saw me at 6am, telling me that everything had gone well and that I could go home as soon as I felt well enough. They unattached me from the bed so that theoretically I was free to roam the hospital corridors and antagonise the other patients. Unfortunately that was prevented by the continued throwing up, but I managed to struggle through a physio session without fainting (yay!) Finally hobbled home at around 4pm with crutches, aspirin (again to help prevent blood clots) and a crepe bandage over my knee.

The next couple of days was a blur of sleeping, ice to ease the swelling and feeble attempts at exercise. The pain actually wasn't too bad but I just felt very weak and sleepy. Having carers on hand to satisfy my every whim also didn't really motivate me to do much! On the Monday after (so 4 days after the operation, which took place on a Thursday) I went to the first of many post-operative physio sessions, which meant getting down to business (that is, going to the physio every day in the first week after the operation, plus exercises every couple of hours at home). The crepe bandage came off to reveal two waterproof dressings and a little hole on top of my thigh. Apparently the hole was as a result of a pin being inserted to tension the graft. Alarming!

So all the above is talk about my feeeeelings surrounding the operation. What, however, did the operation actually achieve? Turn away now if you don't like descriptions of medical procedures. Essentially it's performed arthroscopically, so all you end up with is two small incisions in the top part of your knee and about a 8cm incision in the lower part of your knee. The surgeon excises two of your hamstring tendons (some surgeons use patella tendons or an allograft from a donor) and inserts them where your ACL used to be, fixing the graft in with a screws in your thigh bone and calf bone. If you're really into medical procedures you can watch videos of it here. Then all the incisions are sewn up and you have an ACL again!

Previously the procedure involved opening up your entire knee, so that recovery would involve up to 6 weeks in plaster. The arthroscopic method now means there's no need for plaster or even a brace in my situation (different doctors may have different rehab methods). I was able to get off the crutches in about a week. After the stitches come out (a week or so after the operation) you're just left with two tiny crosses in the top of your knee, a raised line in the lower part (which settles down as the internal stitches dissolve) and a tiny scab in your thigh. Not bad considering part of your body has been transferred to another place!

Ultimately I've had a very positive experience with my ACL reconstruction. I'm allowed to get back into contact/ pivoting sports in 6 months, after 6 weeks of intense physio. The risk of rupturing the graft is about the same as rupturing a natural ACL, and there's little chance I'll get a blood clot because of all the calf-squeezing and aspirin-taking. The advances in surgical procedure are pretty amazing, although I've learnt more about knees than I ever thought I'd have to! I'll do one last entry on the operation to wrap up this little series, to sum up all the things I've picked up along the way.


  1. ah geez glad to hear youre back on the mend but im curious how was the hospital food...

  2. The food didn't taste too bad, although we found it curious that the choice was between lamb and fish for dinner :)

  3. ahahaha I've just noticed the label on your blog post, the bee's knees :)

    glad to know it was a positive experience! so... let's go rock climbing in 6 months? :)

    PS. I'll refrain from clicking on the surgery videos you so kindly provided

  4. Yes, I'll dust off the shoes in keen anticipation :)

    But surely the surgery videos would be a more worthy use of your employer's bandwidth than Maru?? :)

  5. oy! I'll have you know, I never look at videos from work. Only from home :)

  6. Sure sure... don't worry, I don't think there's anything identifying your employer here!!

  7. Glad to see that you're getting better and thanks for sharing all of this with us! :)

  8. Thanks Lorraine E! Should be storming a Sydney eating establishment near you soon!