I’m no stranger to ACL replacement surgery. In June 2007, I went under to replace a torn ACL -- the second surgery on that knee since suffering an injury in 1975 when I was in seventh grade. The first surgery, in 1986, was an attempt to correct chronic subluxation (a partial dislocation) in my left knee. A piece of torn cartilage was removed, and I moved along quite well until I again injured my knee 20 years later.
My knee finally threw in the towel on a camping trip in South Dakota. After 35 years of running, skiing, golfing, dodging, and just living life, a seemingly insignificant shifting of sand beneath my feet was the straw that broke the proverbial camel’s back.
My weight shifted on a downhill slope and my knee gave out enough for me to fall and experience some pain -- but nothing excruciating. In fact, many of the people with whom I have spoken since have said that when the ACL goes, it’s the feeling of the knee slipping side-to-side that’s most disturbing. There are no pain receptors in the ligament, so there is no pain from that particular break.
My final injurious moment caused minor swelling but did not prevent me from continuing my trip, which included the seven-mile climb up and down Harney Peak in South Dakota. It was only six months later, when I collapsed to the floor while walking down the hallway at school, did I realize that something significant might be wrong.
I spent several months in physical therapy to strengthen my leg before my surgery, which took place when the school year ended. Pre-habbing was key to preventing further injury by providing some stability. It helped me go into recovery with a modicum of muscle fitness.
I chose a surgeon who practiced the “Gold Standard” of ACL replacement, which uses a graft of patellar tendon as the new ACL. My surgeon was well-known from a reputable orthopedic clinic and came highly recommended from many of my friends. The surgery went well and I was home less than 12 hours from the time I entered the hospital.
The morning following the surgery, I immediately began my three-times daily stints on the CPM – continuous passive motion machine – which continuously moves your leg in an ever-increasing bending motion to speed healing. The CPM increases blood flow and flexibility and reduces the risk of blood clotting. I found the machine to be very relaxing and was even able to fall asleep while strapped into it.
The surgeon and his staff prepared me for a greater amount of pain than I actually experienced. I do have a high threshold of pain, so I found that taking Vicodin was overkill. After spending three days with my eyeballs rolling around in my head whenever I took the pills, I downgraded to Demerol, which also proved to be too much. After just five days, I switched to OTC ibuprofen and was fine. I was then stuck with enough medication to put my two kids through college on the street value alone.
Two things in the recovery proved to be difficult. The first, and most unexpected, was the pain associated with the rush of blood to my lower leg when I lowered it from an elevated position. I quickly learned that the more slowly I moved my leg, flexed my gastrocnemius muscle, and did some deep breathing, the more tolerable the pain. That lasted probably about a week.
The second difficulty was regaining the range of motion in my knee. You need to understand going into physical therapy that there will be pain involved. The therapist must push your knee and its new ligament into submission. At one particular point during a PT session, my therapist had me lying on my belly while she applied pressure to my lower leg as it was bent. We were trying to see how much closer I could get my heel stretched to my butt. My knee felt really tight and stuck. All of a sudden there was an internal POP and my leg bent further. I broke out into a cold sweat, felt slightly nauseous, and giggled nervously. “Did you feel that?” I asked her.
“Not as much as you did!” she replied. I first thought she’d broken my new ligament, but then realized she had successfully popped one of the lesions preventing my knee from moving further. It was a good kind of pain -- but not one I wished to experience again.
Eight weeks after my surgery, my then 14-year-old daughter, Lillian, tore her ACL in a basketball game. It took about six weeks to get an
accurate diagnosis because the initial exam in which the Lachman test was performed showed no significant movement, probably because she was in superior physical condition. The Lachman test is when the knee is bent at about a 30 degree angle and the tibia is pulled forward from the knee. A torn ACL will allow more movement than usual. This is considered to be the most reliable and sensitive clinical test for ACL injury.
Lillian’s surgeon chose to use a piece of her hamstring tendon to replace her ACL. Being 30 younger than I, she recovered with such lightning speed that at first I was concerned the surgery was unsuccessful. Her physical therapist was more aggressive and more in tune with an athlete’s mindset than mine so I began to follow her PT regimen.
Her recovery was so successful that eight months after her surgery she won the 800 meters race at the JV conference meet. And 16 months post-surgery, she placed third out of 76 competitors at the Midwest Regional Oireachtas, an Irish-dancing competition to qualify for the world championships.
She continues to succeed athletically as a high-jumper on her college track team with a real shot at qualifying for nationals. The only lasting effect she notices is that the quadriceps and hamstring muscles on her surgical leg did not develop as noticeably as her “good” leg. Likewise, I have residual pain that runs up the interior of my tibia that causes trouble when I want to perform certain movements like a quick reactionary movement to prevent tripping or a purposeful movement like a quadricep lift on a weight machine.
I had several people try to warn me away from the surgery altogether. One friend in particular said that I could learn to live without it. I can truthfully say that I have no regrets about the surgery and six years later, am thrilled with the results. I am back to running and work out three to five times a week. My athletic life is full and standing all day long in my career as a teacher does not cause me any pain.
And while no one really wants to welcome ACL replacement surgery into their family, we did and we are glad we did.