 Poster: A snowHead
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| noggy wrote: |
I had my procedure this morning to trim my meniscus in the left knee and the appraise the condition of the ACL. The good news was that the old repair still looked good, and the new trim seemed successful. But two bits of bad news. Firstly, as suspected the ACL is completely ruptured. It has connected in some way to the PCL, but is very loose and offers little support. So naturally a reconstruction might be the obvious step. But the consultant noted that my knee was very worn, almost bone at the front and the patella, so maybe an ACL reconstruction would be a bit pointless if I needed a new knee in the near future. (I'm 60) He wouldn't comment on how long the knee will last. Actually that knee isn't really painful on a day to day basis. I was rather hoping he would offer some thoughts on the best course of action, but he wouldn't. He wants me to see him in 6 weeks with my conclusion. Without an operation my golfing days are behind me, but maybe I could ski although I'd be extremely nervous of falling. The consultant skis a lot, himself. Interestingly he said that all din calculated settings are far too high. I ski on 5.5, he says he (and I) should be on no more than 3.5.
Thoughts, advice. Please! |
I wouldn't write you off at sixty or with as symptomatic patella wear.
Get another opinion.
If you (or anyone else interested) pm me your email I'll send you a guide on setting DiN
Jonathan Bell
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@adao, I am just over 12 months list op and still get swelling and have some residual swelling. I get swelling when I have been standing for a while - not active on my feet, just standing, and after heavy loading such as a couple of hard days at the gym or a fall skiing. The best remedy for me is to get back in the pool. I hold the side and kick like crazy for 4x5 minute stretches. It's hard work and squeezes out the swelling. I am surprised that cycling might set it off, but not to football. Unless your hamstring is really responding as it used to the knee will find football stressful. Is it getting worse or better over time? The goal should be to get everything right by about 15 months.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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First physio appointment was yesterday. In the end was just a case of touching base, seemed like an experienced guy. Went through the do's and don'ts and how things will progress from here on in. I see him again in a fortnight for now it's just walking and simple exercises where there is either heal or foot contact with a surface and walking.
Interestingly I got a little more detail on the anatomy behind the graft. I knew the graft was from the hamstring which is a tendon. Tendon's have good blood flow whilst ligaments not so much, they have a kind of mesh of capillaries surrounding them. The graft is most at risk between 12-14 weeks as at this stage this mesh of capillaries starts to form.
Very interesting. I voiced concerned about wanting to keep the leg straight but he wasn't overly concerned at this stage and said I shouldn't force it.
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@Grizwald, how is your flexion (bending)?
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@22 dropout, It's not too bad. I imagine the swelling is the limiting factor at the moment!
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You'll need to Register first of course.
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@Grizwald, and at 8.5mm they took a good chunk of your hamstrings meaning you probably feel like you've got the strength of a baby in one leg!
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@22 dropout, The surgeon said I was in the upper range in terms of the chunk he took. Said they largest he's ever taken is 9mm!
It's not too bad, as I say it's mostly weak IMO through not using it much in the last 6-7 months 
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Thanks @skimottaret, There have been a fairly high number of injuries and accidents this season for some reason!?
Looking forward to getting the rehab started in earnest as I ideally need to be skiing with the PSGB team by October/November.
Update on my progress:
I apparently also had a lateral meniscus tear, which was sutured during surgery, which I didn't know about in my original post about the injury.
This will apparently put me coming off crutches (ca. 3 weeks) and my leg brace (ca. 6 weeks) a bit further along than I originally thought.
I have had 3 physio appointments this week and they have just been working on soft tissue massage, mobilising the area and my extension. My flexion appears to be good at this point. Extension improved markedly after the physio appointments.
Knee is not too swollen but it was fairly warm to touch yesterday, for the first time really, so I am hoping that is just a natural reaction to the exercises I have been doing.
I have started using a Squid Compression system as of yesterday, which is similar to the Game Ready system and hopefully that will lead to an acceleration in recovery.
I am walking better on crutches, but my knee fatigues and starts to ache fairly quickly. I wear the knee brace whenever moving around, but keep it off when lying down.
Still not sleeping amazingly yet, as the leg does ache a fair bit through the night.
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@Touchguru, are you not taking painkillers during the night?
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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@miranda, taking one Proxen (Naproxen) at night and one in the morning. Doesn't seem to help much at night unfortunately.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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@Touchguru, I wonder if it's worth temporarily considering something to help you sleep if the painkillers aren't fully masking the ache? Hopefully this won't go on too much longer though as you are nearly 2 weeks post op (I think).
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| miranda wrote: |
| @Touchguru, I wonder if it's worth temporarily considering something to help you sleep if the painkillers aren't fully masking the ache? Hopefully this won't go on too much longer though as you are nearly 2 weeks post op (I think). |
Possibly, but I have been trying hard to avoid taking too many drugs. It's not like I don't sleep at all. I just wake up often with my leg aching.
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You know it makes sense.
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It's an interesting parallel to the treatment that I've received. The time-scales are impressive but as previously stated the approach by a UK based surgeon would be to leave a period of 6 weeks to let things settle down. I much prefer idea of the continental approach having now being off my feet unable to have an active lifestyle for 6 months!
I just used the ibuprofen, the codeine etc were giving me stomach issues. Cryo cuff was great for pain management.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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@Touchguru, how are you finding the Squid? (strange name). There was a discussion a while back about cuff systems, with the problem being that the Game Ready was very expensive. As I understand it, Game Ready is constant cold and pressure for many hours, the Squid is cold for 15 minutes with pressure over an hour cycle. Was this recommended to you? At $700 this is something that people could buy and resell at a modest net outlay.
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Poster: A snowHead
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@Grizwald, I think that both ways work. It is just that with one you can hopefully get back into things quicker and with possibly less muscle atrophy.
@22 dropout, still early days with the Squid, but it seems to work OK.
I am not completely sure of its efficacy versus say, wearing skins (which I do) and normal cold pack icing, other than offering more compression for the time whilst using it.
It was recommended to me by the PSGB team Physio who will buy it off me for the team once I have finished using it so ultimately no cost to me luckily.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@Grizwald,
Priority is knee swelling, extension, quads activation. Then heel strike followed by flexion.
Swelling and lack of extension are powerful inhibitors of quads activation, all three prevent heel strike.
You should not prioritise flexion if still very swollen.
Lots of simple double stance calf raises can help drive out swelling and are often overlooked/ not prescribed early on.
Jonathan Bell
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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@Jonathan Bell, I've pm'ed you.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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How long have people generally been told to refrain from driving after a right knee reconstruction?
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@Grizwald, the difficulty is getting in and out of the car. I gave it three weeks, but mine was a right leg op. That's not to say driving is good for your knee, it's just that you don't actually use your knee much, it's more ankle driving. Give it a test drive before you need to find out and wait until you feel safe before doing much.
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You'll need to Register first of course.
You'll need to Register first of course.
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@Grizwald, Every time I had a right knee op I waited until I could safely and instinctively use the brake pedal for an emergency stop. I'd practise in a local supermarket car park when the shop was closed. You also need your surgeon to sign you off as capable of driving safely, otherwise if you are involved in an accident you may find your insurer refusing to cover you.
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@Grizwald, haven't tried driving although I realistically could as I have an automatic and it is my left knee.
2 weeks yesterday and I saw the physio again today after the long weekend. He was happy with the quad muscle, increase in extension - ca. 5 degrees at the moment apparently - as well as the swelling and heat, which have both subsided a lot.
I am also sleeping a lot better now and off all forms of drugs.
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@Touchguru, 
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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I went to physio yesterday and they worked on the scar tissue around the incision points on my leg with the most time being spent on the main scar below my knee.
The physio then took me into the PT room and got me on the stationary bike for VERY slow pedalling for 10 minutes at level 1 and limited flexion position and I cycled forwards and backwards.
Backwards was much easier than forwards initially, as forwards was really stiff and fairly sore in the left inner fleshy part of the knee probably from fluid, but after about 2-3 minutes of motion, it became a lot easier.
However last night was probably the worst night for pain (mainly on the scar areas where the physio had worked) since the surgery.
I took a Proxen tablet before going to sleep which didn’t do too much as I woke up at 1am in quite a lot of pain and so put on my Skins and iced and that provided the most relief and I managed to get to sleep again about around an hour.
Not as sore this morning as last night, but it still hurts on some points.
Two steps forward, one step back...
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@Touchguru, 
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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@AndAnotherThing.., it seems to be the new "miracle cure, but let's wait and see! Those of us who have been through this know that there is no quick fix. The bit about plastering is really old, I was plastered from hip to toe for over 3 months way back in the 80s, but that was not the protocol advised by the surgeon who operated on my knee in Austria. I was also told I would develop arthritis, but here I am nearly 30 years later still with minimal arthritis despite 3 open knee surgery reconstructions and countless meniscus trims. Considering the abuse my knees have taken over the years from sports and surgeries I would question a lot of the assumptions stated in that article. If it sOunds like snake oil, then it probably is!
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@Samerberg Sue, Yep, time will tell. I quite like the theory that the ligament will regrow along the scaffold but the use of screws implies to me ( a layman !) that the arthritis risk would still be there with the damage to soft tissue ?
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You know it makes sense.
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I was slightly irritated by the fact that if you go on the clinic website and want to follow up on its offer to read a paper on the technique, you have to pay 89 dollars (although I think I found the same paper elsewhere).
What does Mr Bell think of the internal brace concept? I'd be interested to hear, for sure.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Poster: A snowHead
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Thanks - I hadn't spotted this. Well, it's too late for me anyhow as I'm now 9 weeks post injury. Am now out of my brace and only really using a crutch to keep people away from me on the train when I go to work. Trying not to limp, doing my physio religiously and hoping I will get the surgery go ahead (appointment on Friday, surgery the Friday after if I've got enough ROM for it). I've got good extension now, but still feels as though I've got a compression bandage around the knee when I try flexion. On the positive side, I've got addicted to Downton which I'm watching on a free trial of amazon prime!
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@legalista, Good luck, hope you get the go ahead.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Good luck @legalista. Let us know how surgery goes if you get the go ahead.
3 weeks today since the accident and surgery and I had my 6th physio visit.
Was told that I could start walking without crutches inside the house for now and if it goes well, progressing to walking outside in the next few days.
My knee brace has been set at 10 degrees extension and 60 degrees flexion up until today, but has now been set to 0 and 90.
I apparently already have 0 degrees extension and the physio is working on getting me slowly into hyperextension now.
I could get straight to 90 degrees flexion quite easily, but anything just beyond this was really stiff.
I can start doing non-weight bearing double legged squats and one legged balance on the injured leg with a slight bend in the knee.
Took my first few 'no crutches' steps fairly gingerly, but it feels good, if a little weak.
Onwards and upwards hopefully! 
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You need to Login to know who's really who.
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Thanks - good to hear that you're making good progress, touchguru. I keep being told that this is a marathon not a sprint which I know is right but it's still a long and frustrating process, isn't it? Little steps, I keep telling myself before I inwardly scream ….
How are you doing, Grizwald?
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| legalista wrote: |
I was slightly irritated by the fact that if you go on the clinic website and want to follow up on its offer to read a paper on the technique, you have to pay 89 dollars (although I think I found the same paper elsewhere).
What does Mr Bell think of the internal brace concept? I'd be interested to hear, for sure. |
We will have to wait for studies with at least two years follow up.
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You'll need to Register first of course.
You'll need to Register first of course.
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| legalista wrote: |
| ...but it's still a long and frustrating process, isn't it? .. |
Yes it is, but each little bit of increased strength, flexion and extension range and balance, is one little bit closer to recovery
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You're right, Touchguru - glad you made that comment.
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@legalista, Thanks for asking. I went to the pyshio on Monday but have lost a bit of confidence in the NHS provided physio so I'm going to replace or at least supplement with a private physio. The first appointment he told me to get walking unaided, but I queried with the fact I'd always been told not to walk on a bent knee (as mine is). He said it will be uncomfortable at first but will help to straighten. Dubious I kept using one crutch on longer walks.
On arriving to my next appointment without any crutches, his first comment was 'you really shouldn't be walking unaided with a bent knee' So now I've been given a stick.
I'm persevering, he said he'd usually not recommend driving for 12 weeks.
The cabin fever is setting in!
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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@Grizwald, a good physio is VITAL to recovery, much like a good surgeon for the surgery.
If you don't feel confident with the current one, then you should 100% find a good one you have trust in.
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I have been progressed to bungee/theraband 'above knees and around ankles' exercises (which I didn't think I was very good at at all) and lateral and frontal balance board exercises which I felt I did a little better than I thought I would!
I have also been given latitude to use the foam roller on my legs, but just not directly on injured knee.
Although I could probably walk outdoors without the crutches now, I was told to keep using them for the minute as, and I quote 'it is not a race at the moment...!'
Heading to Scottish Institute of Sport tomorrow for weekend, to meet with the team physio and S&C staff for the first time since my injury...! The road is long...!
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