This is the blog of Adam Kalsey. Unusual depth and complexity. Rich, full body with a hint of nutty earthiness.
This is the blog of Adam Kalsey. Unusual depth and complexity. Rich, full body with a hint of nutty earthiness.
11 Nov 2004
Google has my site ranked rather high for some searches about ACL injuries and some people have emailed and commented about my surgery. A number of those are people with recent ACL injuries that want to know what to expect for their surgery and recovery.
I tore mine playing indoor soccer. I planted my right foot and pivoted hard to the left, but the bottom half of my leg didn’t turn with the rest of my body. The knee sort of twisted and my momentum kept carrying me forward, bending my twisted knee sort of sideways.
The surgery and recovery will vary from doctor to doctor. Certainly tell your doctor if return to sports is your goal.
My surgery involved removing a portion of the hamstring where it connects to the shin. That was used as a replacement for the ACL. They inserted a metal pin into the femur and looped the hamstring over it and down into the knee. They drilled a hole through my tibia and threaded the hamstring down through that hole. They secured the hamstring into the hole with a screw that will eventually be absorbed into my bone. All told they cut six holes in my skin. The one where they removed the hamstring is about 3 inches long. one is a pinhole where they poked a wire into the skin to help align the hamstring onto the metal pin. The other four are small holes where they ran arthroscopes and tools into my knee.
Other replacement techniques include using a cadaver ligament or a portion of the ligament from your kneecap to your shin. It depends on what your goals for surgery and the preference of your doctor on what they’ll use to replace your ligament.
I was put under general anesthesia for the surgery and woke up about 4 hours later. The surgery itself took about 3 hours. I went home that day. I was nauseated for 3 days from the anesthesia and the Vicoden. I had the surgery on Monday and left the house for the first time on Thursday afternoon. The pain was mostly gone by then. By Saturday I was at the soccer field watching my kids play in a tournament.
I’ve heard from other people that this sort of fast recovery isn’t normal. Many people that I’ve talked to were in the hospital overnight. Most couldn’t work for three days, while I was doing some limited work the afternoon of the surgery. So don’t make any plans for about a week after the surgery.
The following Monday I had a physical therapy appointment and learned some simple exercises. They’re hard to do and quite painful, but if you don’t stick with them you won’t fully recover.
I’m on crutches for about three weeks. The recovery and movement is progressive. At first I had a brace that was locked straight. After a few days I was able to unlock the hinge and sit with my knee slightly bent, but when I walked I had to have the hinge locked. Now the hinge is unlocked all the time and I don’t need to wear the brace while I sleep. Each new step causes all sorts of new aches and pains. One of my PT exercises is the indicator of when I’m done with the crutches. When I’m able to complete the exercise, my leg is strong enough to ditch the crutches.
I’ll need to wear the brace for 4-6 weeks from the date of the surgery. As soon as I can walk without crutches without a limp, I can take the brace off.
It will be 6-9 months from the date of the surgery before I can play sports again. I can expect my knee to swell up at random times for no apparent reason for the next 2-3 months. I plan on going to Disneyland for three days at Christmas and will have just gotten out of my brace. The doctor tells me I’ll be fine, but expects that I’ll need to ice my knee at night.
Some links to good ACL information and arthroscopic pictures of my surgery are below.
The damaged ACL before the replacement. The metal object in the photo is a probe that is pushing apart the two halves of the ligament.
My kneecap as seen from the inside of the knee. The damaged ACL is visible.
The tunnel that was drilled in my femur. The new ligaments run through this tunnel.
The completed reconstruction. The hamstring is now in the place of the ACL.
The side of my knee the day after the surgery. It’s swollen about twice the normal size.
The front of my knee after the surgery. The yellow stains are some sort of antiseptic.
DM - Eek! I meant following Monday, not morning - that would truly be amazing!
I had surgery yesterday and it went very well. No pain even after the nerve block wore off thanks to the percocet. This afternoon I am able tp put some weight on it as long as I use crutches, The surgeon said I could go back in a week to work as long as I stay at a desk He removed a little section of my meniscus. I had some earlysigns of arthritis so he worked on that as well. He used a donor Patella ligament to reconstruct mine. PT will begin after I see the surgeon next week.
Holly Marie~ It depends on your job. I teach and my lectures are 3-4 hours at a time presented while on my feet. My surgery was 3 months ago and I’m still not back. I’m hoping to return this July. My knee swells by mid day and is very stiff. I, too, had allograft.
My friend just blew out his ACL (I think it’s 95% gone) and also injured (tore I think) his meniscus playing ice hockey two weeks ago. The doctor wants him to try to get mobility in the knee and to come back and see him in 2 weeks. But the doctor didn’t give him the CPM machine or prescribe physical therapy to do this. He just said to bend it and maybe try to ride a stationary bike. QUESTION: I’m a little angry at the doctor for not prescribing therapy right now to help him get mobility in his knee. In fact, a “little angry” doesn’t even cover y feelings. Does the doctor think he’ll be able to hobble around for 2 weeks in amazing pain and all of a sudden his ACL will have returned?? Why wait 2 weeks? I’m ready to “fire” the doctor for being stupid. Am I right to want my friend to switch doctors? Any advice is much appreciated. My friend plays high level hockey and would like to return to the ice.
Holly Marie - I was in the full leg brace and on crutches for the first week or so. My boss let me work light duty for a few weeks. I began physical therapy the day after the surgery. The nerve block had not even completely worn off yet! The PT had me walking on both legs with the crutches after that session. I went for my first follow-up visit with the surgeon about a week after surgery. By the time I went to see him, I was down to one crutch. After the visit I changed to the smaller ACL brace. I ditched the brace after my 4/17 visit and have done a little light jogging. This week I will start doing leg extensions on my weight machine for the first time since the surgery. I have been doing squats and leg curls since PT ended in February. Physical therapy is the key! I went three times a week and did all of my PT exercises 2-3 times a day on the days I didn’t go to PT. My doctor gave me no option but to start PT the day after the surgery. I can’t believe some of these doctors that wait weeks to put the patient into PT. I have had full flexibility since about three weeks after the surgery.
Hi everyone, I’ve posted 2x since my first and they are not showing up. Maybe I’m just wasting my time! I am 48 hours post op and am now able to walk with one crutch. I have a cpm machine and am on it much of the day and night. The cry-cuff (ice man) runs constantly as well. No pain, just a little bit of aching. The knee is tight but I am up to 70 * on the cpm. The surgeon said I could possibly go back to work in a week. I’ll know for sure at my first post-op (six days out of surgery) That is when PT will start. So far, so good!
DM - Thanks. I have surgery May 24, Surgeon F/U on June 3 and first PT June 4. I’m not sure why I can’t start PT sooner. I may ask again at the hospital day of surgery if I can start sooner. If I can get off the crutches/big leg brace in about 1 week or so, I can handle that (I hope). After that, I’m hoping to only need a “small” brace to go out and brave the world and work. I’ll need to take a bus to get to work. I recall how all of this was post-injury and know that leg/knee will be unstable and steps won’t be fun. But I got thru it once before and will get thru it again. I now dream of running in October, 10 months post-injury.
M- First…Calm down. The doctor is right. The doctor can’t operate until the initial swelling goes down. Most ACL patients have surgery about a month after their injury. You don’t use the cpm machine until after surgery. The doctor wanted him to ride a stationary bike. That is exactly what I was told and what other are also told. He needs to build up the muscle mass in his injuried knee. This will make the recovery much faster. He needs to bend it and and try to make it as fleible as possible. It isn’t easy, and trust me all of us on this site can tell you that doing anything with a both a torn meniscus and ACL tear was uncomfortable. I tore 25% of my meniscus, shredded my ACL and had a partial MCL tear. I was told to walk without pivoting or twisting…no crutches or brace.
As far as playing hockey…he really shouldn’t plan on playing for a year. Even professional football players wait a year before coming back to such demanding sports. If fact I was sitting next to Oscar Lua of the Patriots the other day during pt. His injury was 8 months ago and he is preparing himself for the upcoming season. Your friend will get back to normal but tearing an ACL and meniscus —to quote my pt —is a slow process…otherwise you will be back in about a year or two with another torn ACL or worse a knee repacement.
Alrighty…1st day post op…I am having minor pain where the bone was drilled..I’d say a 2 out of ten. I am taking hydrocodine about every three hours. (it is prescribed 1-2 every four hours, so I am doing one as soon as pain starts to return..about every three.) of course pain meds = dizzyness. It is still early, but I have to say the pain is much better than anticipated.
Yesterday was another story…upon waking from surgery I could feel everything..10 out of 10! It took about four shots and a half hour to control the pain. The rest of the night I was about 5 out of 10 pain. In the middle ofthe night it got much better. It is of course annoying trying to sleep on the back, but I have practice at this because the first three weeks of this injury I couldn’t sleep on my side.
M - the doctor is 100% correct in telling your friend to wait two weeks. It is very dangerous to operate so close to the injury date, and every doctor/pt I talked to wanted me to have full mobility back (sweling must go down) before the surgery. I didn”t do PT pre-op and got my mobility back in a little over a month. If he is a professional athlete he will have no problem doing this on his own. PT is highly recomended before surgery to strengthen leg muscles. I would also recomend finding a doctor who will do patellor tendon if he a professional athlete…this is the strongest. From what I have read..hamstring doesn’t seem to be a good option unless there is no other choice…a lot of people continue to have hamstring pains post-op, it’s weaker than the patellor, and the allograph is fine for people who don’t play professional sports. I would say not to be angry at a doctor! It’s a waiste of energy…if your not happy, see a second or third doctor…i would recomend a second opinion anyway…I went with the second doctor I found.
I would also like to add…I do not have a CPM machine..my doctor thinks is completely unessesary. I have an ice pack, and my pain is minimal…we shall see as time goes on weather I will invest in one.
cheers, Bianca
It’s great to see I’m not alone in this adventure. I was playing tennis May 6 and blew my ACL out, I herd the pop and feel to the ground. I’ve been through this before, 14 years ago, I had my right knee operated on after living with an unstable knee for 16 years. (I did that one skiing!) So I’ve decided I don’t have another 16 years to wabble around, so I need to go in, be brave and have my ACL repaired. My doctor (an Olympic gold medalist) told me to go a head and ride a stationary bike. I thought he was just pushing me to get a gold because it’s sore and swollen and I haven’t been real excited to jump on the bike because of the pain. But after reading everyone else I’ll stop being a baby and go to the gym. I have a wedding to get through before I can have my operation. No it’s not my own it’s my daughters. Wish me luck!
I tore my ACL and Meniscus in March. I fell off the dock while washing my boat, but my left leg stayed on the dock bending sideways at the knee. It was recommended that I have surgery as soon as possible because the Meniscus tear required immobileization. My Meniscus was torn out of socket and was pinched behind another ligament. I couldn’t bend my knee at all without significant pain. Surgery was April 14th. The lack of use for three weeks before surgery, caused significant atrophy of my quad muscles, which I am still having significant trouble with. If you have an opportunity to do PT or workout your quad muscles at a gym before surgery, do all you can. It will pay off with less pain and quicker recovery post surgery.
I was in taking a lot of pain meds the first week after surgery. I had a lot of swelling anytime that I did not have my leg elevated. Except for a few minutes per day when I had to move from one room to another, I had to have my leg elevated all the time. I can’t imagine having to get on a city bus to go to work.
Everything started getting better every day after they took the stitches out on day 10. Now 4 weeks after surgery, I still have my post-op brace on, but it’s finally unlocked. I switched from crutches to a cane two weeks ago, and I’m hanging up the cane today.
M - I will agree with the others here. The doc is right to get the range of motion back and the swelling down before surgery. My Doc also said if the knee is still swollen he cannot repair it as good. If your friend feels more comfortable with a second opinion get one. I was not so happy with the first doctor that I saw and was told by many people not to rush and find an experienced doctor that I was comfortable with. I ended up with one of the U.S. Olympic ski team doctors and have been very pleased. I think that everyone here would agree that ROM and no swelling before the surgery and disciplined PT after the surgery are key to your friends success.
Diagnosed yesterday with full tear of acl and miniscus damage. Doctor prescribed PT to get more range and then in 2 to 3 weeks acl surgery using a cadaver tendon. Anyone have any issues with the cadaver technique?
Thanks
trust me shawn, pre-op PT is a really good thing to do! I tore my ACL on March 2nd, 2008 and I had to do 4 weeks of PT before surgery to get my ROM back and strength .… had surgery Apr 18 08 and to tell you the truth, a guy that tore his the same day I did but had surgery 2 weeks prior and had a week of PT to get just ROM is doing about the same as I am … trick was pushing your knee but not testing it, muscle stimulation, lots of hamstring exercises and control the swelling so you get your ROM back faster .… granted Im much bigger than normal, 6’4 330lbs doc said it would most likely take me somewhere near 3-4 months to run and 6-9 months to play soccer again (leaning towards 8-9), my therapist said I’d most likely be back to jogging in about a month and soccer more than likely at the 6 month mark, if not sooner .… good luck with your surgery, keep with the PT, they tell you do 30 reps, do 50 instead, they tell you 5 minutes on elliptical, do 7 .… just keep doing more, the more work you do, the stronger youll be and the faster youll be back …
These are the last 15 comments. Read all 1371 comments here.
Adam Kalsey
Mobile: 916.600.2497
Email: adam AT kalsey.com
AIM or Skype: akalsey
©1999-2008 Adam Kalsey.
Content management by Movable Type.
Holly Marie
May 14, 2008 11:05 AM
DM - I am really encouraged by the fact that you had surgery on 1/10 and was in the office the following morning. Why was your recovery so quick? I am having surgery (allograft) on May 24 and hope to be in the office June 3. I won’t be able to drive like you did as it’s my right knee. Were you still using your crutches and/or a brace at work?