ACL Reconstructive Surgery – Be Prepared

imageAnterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted. The surgery is performed arthroscopically.

I tore my ACL during a skiing accident and had the operation 7 days ago. The purpose of this article to help others that are going to have the same surgery. There would be no need for this article if the medical profession had Communication as a subject in medical school. Unfortunately their ability to communicate and explain the procedures, reasons and what to expect during the operation and post-op is less than non-existent. It’s shocking that a surgeon can perform such an invasive procedure on a patient without carefully explaining everything.

I had my accident in France and walked around with a torn ACL and torn Medial Colateral Ligament (MCL) before flying back home. The day after arriving home I went to see the orthopedic surgeon. He looked at my knee and sent me for an MRI. Back in the consultation room he mused over the images of the scan and informed me that I need the operation – the next day.

I tried to ask some questions but it all happened quite fast. He answered them in the typical doctor tone. “It’s quick”. “You’ll be up in no time”. He gave me a brief overview of what he’s going to do in medical terms, of which I understood very little. “See you in the morning”, he said and rushed off to see another patient.

I sat there slightly dazed. Thinking, what the fuck just happened with a thousand questions going through my mind. How long will the recovery be? Will I be able to make my next international trip scheduled for 2 weeks? I was not prepared for what lay ahead mentally. Not in the slightest. In fact I had no fucking idea what was going to happen.

The next day I arrive at the hospital and get settled. At this point, one week after the accident I had very little pain. I was uncomfortable but could walk easily with the brace. The anesthetist comes in to explain that he is going to do Spinal anaesthesia, which basically means that my lower body will be paralyzed during the procedure. A few hours later I’m wheeled out to the theatre and the anesthetist proceeds to stick a needle, which feels more like a leather sewing awl into my spinal cord. It’s then that I have my first experience of what was to come. Excruciating pain shoots through your body as he moves this needle around to inject the liquid.

Within a few minutes my lower body is completely numb and the surgeon proceeds to butcher my leg. He cuts and drills and hammers and carries on like its a Dubai construction site. You don’t feel anything but it sounds horrific. The sound and vibration of the power drill is the worst because you lay there thinking, what the hell is this guy doing? And then you start thinking. It’s gonna hurt like a bitch when the anethesia wears off. It has to. The fucker is using a power drill to make fucking holes in your leg.

Back in the hospital ward your leg is put in a brace. You feel nothing and think to yourself, this isn’t so bad!

3 hours later the feeling comes back slowly. It starts in your feet. By the time you get the feeling back in your legs the pain hits. It hits you like a wrecking ball, and there’s no naked Miley Cirus sitting on it to distract you. It hits you hard.

5 hours in and you are buzzing the nurse to bring the pharmacy of mind numbing drugs. She injects you in your ass but that only helps for a few hours. Then the pain comes flooding back like a tsunami. You call the nurse again and she brings more tablets. The first night you have no sleep. Nada. I don’t care your religious conviction. I don’t care if you’re an atheist. You will pray. I prayed to every god possible hoping that one of the sons of bitches was listening. No, they weren’t listening. The fuckers were sleeping while you felt like finding a angle grinder to cut of the leg.

The next day they clean the bandages and remove the blood drain. The physiotherapist comes and starts explaining to you what you need to do for the next few days. Have to keep the brace on at all times, even in the shower. Do excersises in bed to activate your muscles. Ice packs to reduce swelling and they give you a little bag of pain killers to take home. I remember looking at the bag and asking the nurse where’s the big box. This is surely not enough.

You get home and immediately get in bed. You drink your pain killers but soon realize you can only drink the tablets every 6 hours but they only work for 4. Which means that for 2 hours you are gnarling your teeth and clenching your fists. The pain is excruciating.

The worst is the immobility. The muscles in your leg, especially the quads start cramping. The cramps turn into spasms that don’t go away no matter how much you massage them. You do your excersises as instructed but by god I was not prepared for this. Trying to sleep is impossible. I can’t sleep on my back so I try and turn on my side at night. Big mistake. Each attempt at turning wakes you up in a cold sweat. You can’t find a comfortable position because of the brace.

Day 2 it slowly starts getting better. At least you are not in pain 24 hours of the day. You have times when you feel ok. And then the constipation kicks in. Man oh man. The meds has fucked up your stomach and sitting on a toilet with a fully extended leg brace is not fun.

Showering is very difficult because you are putting all your weight on your good leg. It tires after a while. You have to wrap your leg in plastic because your bandages aren’t allowed to get wet. That in itself is a mammoth task if you don’t have any help.

Day 3 and you can start moving a little on the crutches without wanting to pass out. But you can’t remain on your feet too long or your leg swells up like the Hinderberg. Lots of ice packs reduce the swelling and help to manage the pain.

Day 7, and I am writing this blog. For the past 7 days I have slept a maximum of 3 hours a night. You can’t escape the pain and the discomfort. The cramps are excruciating and my heel is becoming extremely sensitive from carrying the weight of my leg. One forgets how easy it is with a normal leg to just bend it the moment you feel discomfort. With the brace on you can’t do that. It just remains straight and its rebelling.

At this point your muscles start deteriorating. You visibly lose muscle mass, no matter the excersises you do. Atrophy is a big concern because the more muscle you lose the longer it’s going to take to recover.

On day 10 I will be back a the doctor so that they can remove the bandages and adjust the brace for more flexion. I can’t wait to get back so that I can tell the surgeon just how bad his communication skills are.

Some people might be saying that I’m exaggerating or can’t handle pain. That’s bullshit. I can handle more pain than anyone I know. It’s also dangerous to listen to people that had the op a long time ago. They forget the early stages of recovery quickly and remember coming out of the recovery. My research indicates that what I am recounting here is the norm, not the exception.

So what is normal? What can you realistically expect?

You can expect:

  • Not just be down, but to be mind fuckingly depressed after this surgery
  • Not be able to do anything
  • Need someone around you for a while after the surgery. I don’t mean a few hours, I mean like a couple weeks.
  • Be in extraordinary pain
  • Be on so many drugs you can’t see or think
  • Be crying

Some tips that can help you through this:

  • Elevate your bed by placing books under the legs of the bed in front. Elevating the leg reduces swelling. Don’t put a cushion under you leg. That’s bad.
  • Ice, ice, ice and more ice. It helps the pain and reduces the swelling.
  • Make sure you have enough pain killers. You don’t want to run out on a weekend in the middle of the night.
  • Exercise your leg but don’t over exercise in the first 2 weeks. Exercise is critical to get extension and activate the muscles, but over exercise can cause bleeding and more severe cramps.
  • Be prepared to be in bed for the first 10 days.
  • Don’t worry about flexion. Focus on extension. Straighten you leg fully and flex your quads. Extension is more important than flexion.
  • Do lots of foot pumps to improve circulation
  • Use a cusion between your legs when you sleep. It allows your leg to rest on the cusion taking some strain of the leg.
  • Massage you leg muscles regularly. It will increase circulation and reduce cramping
  • Be prepared for a fairly long recovery. It will take 9 months for your leg to heal properly and even then most people only get their leg to 65%.
  • Think carefully about going back to sport. You can easily re injure the leg and will then have to go through all this again.
  • Watch you diet. Eat lots of fibre and drink lots of water. Take medication for constipation if it doesn’t clear up.

No matter what anyone says, even your doctor. You will have a bumb knee for the rest of your life. If you are one of the lucky ones that made a full recovery and got back to previous levels of activity you are the exception.

I hope this helps some unfortunate soul that has to go through the same procedure. Would I have gone through with the surgery had I known about all the above? Yes. But I wouldn’t have been trawling the Internet at 3am every morning trying to find out if there is something fundamentally fucked up with me. I would have expected it and would have been much more relaxed.

It gets better every day.

Good luck.

Marthinus

2 thoughts on “ACL Reconstructive Surgery – Be Prepared

  • 20th March 2017 at 6:56 am
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    Thanks for sharing.

    Reply
  • 20th April 2015 at 11:07 am
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    Just a quick update. It’s now day 11. The first 7 days were hell. I eventually decided on day 10 to quit the pain meds. It was screwing up my stomach so badly that I would rather have pain than deal with constipation and indigestion to this extreme. I did more exercises more often and increased my mobility. It helped with the pain. I found that the Quad was causing a lot of the pain and exercised it quite aggressively and this reduced my pain as well. Strong massaging of the thigh helped to release some of the cramps and spasms.

    Reply

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