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My ACL rupture, surgery and recovery.

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Monique

Monique

bounceswoosh
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So while we're here, can someone explain something to me?
Tendons attach muscle to bone. Ligaments attach bone to bone. https://www.nlm.nih.gov/medlineplus/ency/imagepages/19089.htm

How, then, is it possible to harvest the patellar tendon for the ACL repair the way I understand, which is that they take a chunk of bone out with either end of the tendon? If it's a tendon, why is there bone on both ends? *confused*
 

Kneale Brownson

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The patella is cartlidge that ossifies as we age, I believe.
 

James

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I guess it attaches to the patella which is bony too:
----------------------------------------
The patellar tendon is a thick and strong band of connective tissue on the front of the knee. It starts at the bottom of the patella and fastens just below the knee to a bony bump on the front of the tibia, called the tibial tubercle. When using the patellar tendon as an ACL graft, surgeons remove a strip from the middle of it. The graft includes the bony attachments from the bottom of the patella and from the tibial tubercle.
...
A small incision is also made below the patella. Working through this incision, the surgeon takes out the middle section of the patellar tendon, along with the bone attachments on each end. The bone plugs are rounded and smoothed. Holes are drilled in each bone plug to place sutures (strong stitches) that will pull the graft into place.
---------------------
http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/knee/patellar-reconstruction-acl/
 
Thread Starter
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Monique

Monique

bounceswoosh
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I guess it attaches to the patella which is bony too:
----------------------------------------
The patellar tendon is a thick and strong band of connective tissue on the front of the knee. It starts at the bottom of the patella and fastens just below the knee to a bony bump on the front of the tibia, called the tibial tubercle. When using the patellar tendon as an ACL graft, surgeons remove a strip from the middle of it. The graft includes the bony attachments from the bottom of the patella and from the tibial tubercle.
...
A small incision is also made below the patella. Working through this incision, the surgeon takes out the middle section of the patellar tendon, along with the bone attachments on each end. The bone plugs are rounded and smoothed. Holes are drilled in each bone plug to place sutures (strong stitches) that will pull the graft into place.
---------------------
http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/knee/patellar-reconstruction-acl/

So then shouldn't it be a ligament? :huh:
 
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Monique

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Quick update - As of last week I have started feeling markedly better. My knee is no longer so hot to the touch - having a blanket on my knee is no longer miserable. I'm sleeping pretty well. I've actually had days where I forgot to ice. I can sit in a chair or walk around quite a bit without my knee heating up. And finally, finally, my PT actually looked pleasantly surprised at my extension, which is very very close now to my "reference" knee. Apparently the passive stretch I do for 15 minutes at a time with two five pound ankle weights, one above and one below my knee, is doing wonders.

We were invited to our friends' house for wake surfing. I couldn't do it, and didn't even think being in the boat would be a good idea, but I joined them for lunch on the patio. It was so nice to be outside somewhere other than my own house, socializing and catching some sun.

I've been doing a lot - probably more than my PT would appreciate - while planting in our new veggie boxes. There's so much to learn about drip systems and planting - it's a great way to occupy my brain and my body. I love playing in the dirt. I have always heard that 3 months is where you start feeling like doing more than your graft will allow, but I feel like I'm there already and need to be cautious. My back feels pleasantly, mildly sore.

My PT assigned my empty-handed deadlifts and squats, but we've since pulled the squats because they irritate my knee just a bit. Doing deadlifts is another happy place, along with being on my bike, so spinning a bit and doing deadlifts every day has definitely improved my mood.

I'm going back to full-time work this week, so that should be quite an adjustment.

My biggest struggle is with walking "normally." I default to limping. I'm supposed to focus on extension every time I take a step, but it's hard to remember and feels awkward (though I'm told it looks less awkward than the limping).

All in all, I feel pretty great!
 

Jim McDonald

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:golfclap::beercheer::thumb:
 

VickieH

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Congratulations!

If it's a struggle to walk normally, then keep struggling. :D You do not want limping to become a habit. When the fracture of my proximal tibia healed, I was afraid I would reinjure it, afraid the compromised ACL wouldn't hold. Walking had to be a very conscious activity. If people wanted to walk with me, they were welcome ... I was going to walk very slowly. If they wanted to talk, fine ... but I wouldn't be listening or responding. I was counting. Counting was my way of maintaing the same rhythm with both legs. You don't have to count. IIRC, you sing ... go ahead and belt out some "Henry the 8th" as you walk. Then you can walk alone and focus better. ;)

Not saying you need to do this or that this would be appropriate for your knee, but to convince my brain that my leg was able, I started walking like this at home -- swing my right leg forward and, as it would start to swing back toward me, I'd step onto that foot. Basically, swinging my legs into each step. I wanted to ensure I was fully extending the knee and staying loose at the hip.

Even with all of that, I felt something off in my gait. I couldn't isolate it. The PT got down on the floor and watched me walk. She noticed that she couldn't see as much of the sole of my right shoe as she could my left. I wasn't rolling heel-to-toe on the right side as well. So I focused on that too.

Your brain wants to protect you from reinjury. You're not only retraining those leg muscles, you're training your brain to trust those healing parts.

Congratulations on all of the progress this far! You're weeks closer to getting back out on skis!
 
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Monique

Monique

bounceswoosh
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Congratulations!

If it's a struggle to walk normally, then keep struggling. :D You do not want limping to become a habit. When the fracture of my proximal tibia healed, I was afraid I would reinjure it, afraid the compromised ACL wouldn't hold. Walking had to be a very conscious activity. If people wanted to walk with me, they were welcome ... I was going to walk very slowly. If they wanted to talk, fine ... but I wouldn't be listening or responding. I was counting. Counting was my way of maintaing the same rhythm with both legs. You don't have to count. IIRC, you sing ... go ahead and belt out some "Henry the 8th" as you walk. Then you can walk alone and focus better. ;)

Not saying you need to do this or that this would be appropriate for your knee, but to convince my brain that my leg was able, I started walking like this at home -- swing my right leg forward and, as it would start to swing back toward me, I'd step onto that foot. Basically, swinging my legs into each step. I wanted to ensure I was fully extending the knee and staying loose at the hip.

Even with all of that, I felt something off in my gait. I couldn't isolate it. The PT got down on the floor and watched me walk. She noticed that she couldn't see as much of the sole of my right shoe as she could my left. I wasn't rolling heel-to-toe on the right side as well. So I focused on that too.

Your brain wants to protect you from reinjury. You're not only retraining those leg muscles, you're training your brain to trust those healing parts.

Congratulations on all of the progress this far! You're weeks closer to getting back out on skis!

*nod* thanks for your input. My issue seems to be that I think I'm walking normally, but I'm not. So it's hard for me to do what the PT says to do, because then it feels like I'm walking weirdly, even though she says it looks more normal. So yeah - very much the definition of a habit. I seem to also be pulling my right hip up when I walk - no bueno.
 

Doug Briggs

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I found that if I focused on the heel strike, I usually got the extension I needed to walk more normally.
 
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Monique

Monique

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I found that if I focused on the heel strike, I usually got the extension I needed to walk more normally.

Yeah, it works, it just doesn't feel right anymore =/
 

cosmoliu

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So while we're here, can someone explain something to me?
Tendons attach muscle to bone. Ligaments attach bone to bone. https://www.nlm.nih.gov/medlineplus/ency/imagepages/19089.htm

How, then, is it possible to harvest the patellar tendon for the ACL repair the way I understand, which is that they take a chunk of bone out with either end of the tendon? If it's a tendon, why is there bone on both ends? *confused*

You are right to be a little confused. You see, the patella isn't a "bone" in the usual sense that we think of bones that make up the skeleton to support weight or withstand stress. The patella is a sesamoid bone (I guess you can google that). Sesamoid bones are centers of ossification that occur within tendons that improve leverage of a muscle/tendon unit acting across a joint. The patella is the best known example, but sesamoids happen all over: at the base of the thumb there are two, same for at the base of the big toe. Examples abound. Therefore, when harvesting the center third of the patellar tendon, in addition to the insertion at the tibia that can be used, there also happens to be a handy ossified chunk of bone at the other end to be used. Nifty bit of surgical hocus pocus.

But I digress: great to hear that you are doing well. WP next March?
 
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Monique

Monique

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You are right to be a little confused. You see, the patella isn't a "bone" in the usual sense that we think of bones that make up the skeleton to support weight or withstand stress. The patella is a sesamoid bone (I guess you can google that). Sesamoid bones are centers of ossification that occur within tendons that improve leverage of a muscle/tendon unit acting across a joint. The patella is the best known example, but sesamoids happen all over: at the base of the thumb there are two, same for at the base of the big toe. Examples abound. Therefore, when harvesting the center third of the patellar tendon, in addition to the insertion at the tibia that can be used, there also happens to be a handy ossified chunk of bone at the other end to be used. Nifty bit of surgical hocus pocus.

But I digress: great to hear that you are doing well. WP next March?

Thanks! That is helpful.

WP is unlikely - especially since I'm to avoid bumps all next season. I'll inquire further about that once I can prove to myself I can ski at all on the groomers I'll be allowed to ski in January. I've never developed the love of bumps (or the skill at bumps) that you have ... so bumps, I won't miss so much. Trees, on the other hand! And of course the freedom to ski wherever without worrying too much about what's beyond my vision.


Further update - after week 6 I was allowed to go up to 120*. Doc is having my take flexion slowly because of the meniscus repair. Anyway, first PT session with 120* allowed, I was at 120* and we had to stop pushing. This is all going much better than I expected. And my PT says I shouldn't need to do my extension stretches much longer - I'm pretty much at full extension match as near as I can tell. That'll be nice. I do 15 minute passive stretches three times a day, which is a lot of time on top of the other stuff.

My PT listened in horror about the gardening - apparently even walking on river rock is more pinching than my meniscus appreciates right now. It never occurred to me that walking on uneven surfaces was itself an issue - I had just assumed they didn't want me to fall because of it. The yard is now mostly mulch and grass, but there's river rock between the drip system I've been developing and the sprinkler controller.

My joints are just snap crackle pop these days, not just the healing knee but my other knee and everything else. I freak out every time I feel the slightest twinge or hear a pop. Just have to tell myself it's impossible not to move around, and that the various pains are just healing, not indications of damage.

Also, very important, I can work my way down to the floor (and back up again!), so occasional snuggles with the dogs are possible. That's pretty huge.
 
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Monique

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Hey, new milestone - I walked from Warrior's Mark area (but close to the gas station) in Breck to Park & Main (next to Empire Burger). And back. And I didn't explode!
 
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Exploding is never good. Congrats.

Google Maps says it's half a mile each way. Surely a little shorter since we went through the little plaza to see if we could get a table at Quandry first, but still ... that's a lot! Don't tell my PT!
 

Tricia

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Congrats on the mile without exploding and the snuggles with the dogs:mojito:
 
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I ended up walking about 1.5 miles total today because, well, Breck = walking. I had lunch with my fave ski instructor and all-around cool person Jenn, and a friend of hers I'd skied with last season. Saw another instructor/friend, Jane, selling her art in the courtyard in front of the Quandry. Saw our neighbor walking his dog as we walked to Jenn's car - and found out Jenn knows him, too. I forget how small-town Breck really is, when you discount the vacationers (said with tongue firmly planted in cheek).

I'm curious to see if my PT will be horrified by 1 and 1.5 miles. Honestly sitting in the car for 2 hours to and from Breck created more discomfort than the walking. I'm not having delayed pain from walking, either. So I feel like it's probably okay as long as I stay on stable flat surfaces. We'll see what she says.

I've found myself googling "ACL surgery 6 to 9 months" trying to figure out that middle part. Trying to understand what exactly is going on in that timeframe. Just read an alarming newschooler thread where the guy asked how big a deal it would be to hit 50'+ jumps at 6 months. OMG. But still, I understand, because while I'm not jonesing for jumps, I'm jonesing for trees and bowls and all the stuff my doc would rather I not do at all next season, because of the greater risk of sudden sideways movement.

Ran across a real downer of an article talking about how full recovery is years out and that most people never fully recover, and how most people think they'll be outliers for that statistic. Well, dammit, I've never been most people, so we'll see about that!

Kind of a Breck ski school insider baseball thing, but Jane's husband Pete may be teaching a level 6 Sundays class. Sundays are only for "custom" groups, so I thought I might be SOL even though I organized a Sunday level 9 group. Missing out on Matt Belleville's classes - two weekdays, so TWENTY actual lessons - next season is just one reason I'm so traumatized. But maybe I can sneak into Pete's class. Some finessing required if indeed there's a Pete class, but I'm not above begging favors.

I was thinking "well okay, I'll do a few level 6 classes when I start at 6 months (January), then promote myself to level 7" - but my husband reminded me that 7s still sometimes go to Whale's Tail and such when the snow is learner-friendly. Right now the thought of even gently skiing sideways into that cornice gives me the willies, and it would definitely be against doctor's orders. Jenn seems surprised at the idea of waiting till 9 months for serious skiing, called it conservative. Then again my first doctor said I shouldn't ski at all for 9 months. (I fired him, but for other reasons. I think.) Maybe because he could very well predict how I'd immediately start trying to rationalize skiing harder stuff the moment I start skiing.

There's something cruel about going back to skiing and having to ski the scariest stuff on the mountain - blues and greens. My husband requested that I flail and wedge like a newbie so that people give me wide berth. I told him the wedge would put too much strain on my knees, and anyway I wanted to start with good movement patterns if I can manage it at all - no silly games for me next season.

If it seems like I'm overthinking events four months away (OMG January is 4 months away!), it's because I have too much downtime on my hands, so I need to fill it somehow. I have read all the books and watched all the TV. As a kid, if anyone had ever told me I could get bored of reading books, I would have thought they were nuts - but that was before I discovered outdoor sports.

Jeez, some articles make it seem like even 9 months is way too soon. But I'm not sure if skiing is considered a level 1 sport like football and basketball. And of course it all depends on how diligent I am with PT, how well I listen, and ultimately how well my body responds even if I do everything perfectly.

*insert gif of dog with head on paws, sighing loudly*
 

Tricia

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Slight disclaimer here: I had a cocktail (or two) with dinner and may not be capable of giving you solid advice but......what the heck.
Skiing is fun. Lets get together and ski the next time I'm in Colorado. It should be fun, and your knee should be fine by then. :rocks:
 

Karen_skier2.0

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I have too much downtime on my hands, so I need to fill it somehow.

Well, I believe NBC is airing about 4500 hours of coverage of the Olympics, so that could keep you busy. ;)

And if you see the photo of the gymnast that broke his tibia and fibula vaulting or the cyclist that broke 3 vertebra, it will put everything into perspective.
 
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Slight disclaimer here: I had a cocktail (or two) with dinner and may not be capable of giving you solid advice but......what the heck.
Skiing is fun. Lets get together and ski the next time I'm in Colorado. It should be fun, and your knee should be fine by then. :rocks:

:mojito:

Won't you be here in December? It'll have to be your second visit. But that's fine. I look forward to it :)

Well, I believe NBC is airing about 4500 hours of coverage of the Olympics, so that could keep you busy. ;)

And if you see the photo of the gymnast that broke his tibia and fibula vaulting or the cyclist that broke 3 vertebra, it will put everything into perspective.

We don't have cable, so, not so much ... but honestly I have watched one million hours of TV since the injury. It doesn't appeal!
 

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