ACL surgery for dummies

ACL surgery sounds like cake. Just follow these 7 simple steps, and you can perform it in the comfort of your own home!

Equipment:

Scalpel

Arthroscope

High-speed shaver

Drill

Sutures

Sterile dressing

1) Arthroscopic exam of the inside of the knee. Cut three small gashes in the knee, then insert arthroscope (fiber-optic camera) so you can see inside the knee.

2) "Harvest" the graft from the hamstring: make an incision along the inside edge of the knee and remove the semitendinosus and gracilis tendons.

3) Arrange the tendons into four strips. Stitch these strips together to hold them in place.

4) Remove the old ACL with the "high-speed shaver." (Eep!)

5) Drill tunnels into the femur and tibia so the graft can be placed.

6) Pass the graft though the tunnels you drilled; tense it; and fix it in place using surgical sutures. (Some surgeons also braid the graft first.)

7) Close the incisions and use a sterile dressing to cover the wound. Ta da!

Some days are bad and then some days are pretty ok. I guess that's true of everyone all the time though...

The last time I wrote was on a bad day: last Friday definitely defeated me. Then the weekend was pretty mixed, because I did some fun things but had some serious knee pain and fatigue as well, which left me feeling frustrated. Today, on the other hand... Today for the first time since *the incident*, I woke up and had to think for a sec about which knee was hurt. I wasn't acutely aware of it, and I wasn't sleeping in a weird position to deliberately protect my knee. There were moments today when it felt almost... Normal. And the cherry on top: I went to the park with some friends to watch a concert tonight, and when I got there people remarked that I wasn't noticeably limping anymore! So yeah, I guess I'd call that a good day, at least in knee terms.

Doing normal things makes me feel more comfortable with the idea of post-surgery rehab. It's going to suck for awhile, but then it will be ok. And even though 6-9 months sounds like a really long time, for most of that time I'll be able to walk and get around fairly normally. I just need to remember that.

Would you like a little cheese with that?

What a long week! Especially considering I was only at work for four days. It definitely didn't help that we had a training until 7:00last night. I feel completely spent. Turns out my modified life is just like my old life but with less mobility and more pain.

I feel like I've plateaued a bit this week,

probably because--as expected--I haven't had much time to take care of myself or my knee. I went to the gym on Tuesday, had PT Wednesday, couldn't go to the gym Thursday because of the aforementioned training, and now I'm trying desperately to will myself to get out of bed and get on the exercise bike. My knee was ok for the first day that I was back at work, but it's been getting progressively sorer since then. Every evening, it's been really swollen and stiff.

I've always struggled with the idea of work/life balance, and that feels even more true now. I've worked about 38 hours in the last four days. Ok, I know that's not a lot for some people... But my job is mentally draining, and also requires early hours and a long commute. Now that I'm trying to get to the gym every day, I'm acutely aware of how few hours that leaves me to myself. If I get home at 6:30 and try to get to bed by 10:00, that's not a lot of time for exercise + making dinner + necessary mental detoxing (watching Friday Night Lights on Netflix). I just don't see any way around it though. I've tried to say I'm going to leave work at 4:00 every day, no matter what, but then things simply don't get done. It takes a lot of time to do a decent (not even a great!) job planning and assembling materials for everything, and my school doesn't provide prep periods.

My soccer team had a game at 7:00 last night--right when my training for work ended--and the field is literally around the corner from my school, so I went by to say hi to everyone for a minute. Turns out that was a mistake. It made me so sad! I hate that I'm not going to be able to play again, and I hate imagining my life without soccer and my soccer team. I know this sounds dramatic, but it's become a very important part of my life, and I hate that I have to give it up. I'm struggling to redefine myself as I am now, without things like soccer.

This has turned into a bitchfest, which wasn't what I intended. I shouldn't write when I'm tired and cranky. It's the weekend, yey! I get to sleep in tomorrow! Happy Friday.

Back to the grind

I made my triumphant return to work today! And I'm completely wiped. The commute actually wasn't horrible (or at least not much more horrible than it usually is). The nice thing about the summer is that my commute is a bit mellower since most other teachers and students are on vacation.

I felt a little out of it at first--I was out for over a week!--but it didn't take long for the kids to forget they "missed me" and get back to their old tricks. I teach special ed--ten boys on the autism spectrum--and in spite of how wild and wacky they can be, I adore my kiddos. That isn't to say that they never piss me off, but in general I really enjoy them. How could I not? They're all extreme personalities, to say the least. Exhibit A: this "get well soon" card one of them made me... Look closely... For some reason my roommates don't want me to put it on the fridge?

My knee is sore, but feels ok. It's good to be over that mental hurdle: now that it's over with, I can admit that I was nervous about going back. Hopefully it will only get easier from here on out. (Um, at least until I have surgery...)

Dormilon

Not back to work yet... I spent most of yesterday off crutches, but I'm still very unsteady, so I decided to give myself another day to take it easy. I feel like once I go back, it's going to be hard to take more time off if I need to, so I want to make sure I'm really ready. I'm also uncertain about how much I should be pushing myself vs. taking it easy. I'm erring on the side of not pushing myself too much.

I can't believe how much I've been sleeping for the last week! I don't know if it's me reverting to my natural, super-lazy state, or if my body needs a lot more sleep because it's trying to heal. I've been getting about 11 hours a night consistently since *the accident*. I hope I'm able to get as much sleep as I need when I finally go back to work. I feel like my focus will be very much on healing: going to the gym every day, eating well, and getting lots of sleep. So much for the summer... But it's worth it if it means a faster recovery after surgery.

On the subject of eating: I've been ridiculously healthy for the last week! Of course that's a lot easier to do when I'm not working and have nothing to do with my time besides going to the gym and

thinking about food... I'm going to really try to maintain some of that momentum when I get back to my normal schedule, but I know it will be a lot tougher. Tons of fruit and vegetables, lots of chicken and fish, whole grains, and less--although of course I couldn't go cold turkey--coffee and beer.

I've been going to the gym every day since my last PT appointment on Thursday, and I have to say that although it's frustrating to be so weak, it feels great to be doing something proactive about it. It also gives me some good concrete feedback about my progress. I do the exercise bike and light leg presses there in addition to the strength and range-of-motion exercises I do twice a day at home. At first I was doing the bike for 15 minutes at a resistance of 2, and now I'm up to 30 minutes at 8. And that's after only 3 days! So I'm feeling good about my progress. Again, I just hope I'm able to maintain that momentum once I get back to *normal* life.

In case you couldn't tell, I'm in a much better place than I was just a few days ago. Although it's still frustrating when I think about how far I have to go, it's nice to feel like I'm starting to get back to my normal life. Being off of crutches is HUGE. I will never again take for granted my ability to simultaneously carry things and walk! I think I'm going to bring them to work--at least at first--because I want to be sure I get a seat on the train and the bus. But hopefully that will be the extent of when I use them. Ugh, not looking forward to getting back to my commute... I haven't taken the subway since last Thursday!

On being old...

I would love to talk to someone who had ACL surgery as an adult. I know several people who did it in their teens, but although it's still helpful to hear what they have to say, I feel like my recovery will be pretty different than a teenager's. I know that my body takes longer to heal now than it did when I was a teenager. I know you're out there, adult ACL-surgery survivors!

Re-entering the world

Big news: I took my first steps without crutches today! I still rely on my crutches most of the time--my left leg feels a little like balsa wood--but it feels like a big *step* (pun intended!) in the right direction. I'm definitely a ways away from being able to leave my apartment without crutches, but it certainly makes getting around the apartment easier. I can carry food and water by myself! I don't have to sling a tote full of ice packs, water bottles, and reading material over my shoulder every time I want to move from my bed to the living room!

I've also been getting up my stairs by myself for a couple of days now. It's amazing what that little bit of independence does for my mental state. It's a good feeling to know that I don't have to schedule PT appointments around when someone will be available to help me get back upstairs.

I went in to work for trainings on Thursday and Friday afternoon--it felt amazing to be back around my coworkers. They've been so understanding and kind about everything, and it reminded me how fortunate I am to work in such a supportive environment. I also got to see my class for a bit on Friday afternoon, which was great. I miss the kiddos sooooooo much!

I'd tentatively said I was aiming to be back at work on Monday, but after an outing to get groceries today (with help, of course) I realized that I'm still a pretty long way from walking steadily without crutches. In a *normal* job that wouldn't matter so much, but since my job involves being on my feet all day, I think I may still need more time. There are also a lot of occupational hazards associated with being surrounded by 10 rambunctious boys all day. Especially mine, who are not exactly the most aware of their presence in physical space... I feel like I need to be pretty steady on my feet before I can safely go back to work.

I hate that I'm missing the summer program at work. I'm usually glad for any excuse to stay home and be lazy, but I was actually excited about our summer curriculum. But, I have to keep reminding myself that the timing is good: we have a student teacher right now, and our August break perfectly aligns with when I'll first be able to have knee surgery. I'm also not in school right now. So it could've been a lot worse. Yes, Must.Stay.Positive.

The bright side

One good thing about all this: tearing my ACL has been a good way to save money. Although I'm spending a lot on cars and co-pays right now, I'm not spending any money on going out. And with a looooong rehab process in front of me, hopefully I'll be able to save a good chunk of cash.

I want to to save up to buy a road bike. I think I'm throwing in the towel on soccer--psychologically I doubt I'll be able to play again even if I get the ok from the doctor about my knee--so I'm going to need something else to fill that hole in my life. I've been wanting to buy a road bike for awhile. Maybe this is a good sign that it's time for me to let go of high-impact sports?

Zombie knee? Bionic knee? Opinions are like @$$holes...

Which type of ACL graft is better? Everyone I've talked to has a different opinion, and they all make valid points. Ultimately I think there's no definitive answer. According to the North Carolina School of Science and Medicine, here are some advantages and disadvantages of each:

Hamstring

Advantages: Less disturbance, less pain, more comfortable kneeling.

Disadvantages: Not as strong? Healing is slower; slight loss of hamstring strength (about 10%).

Patellar

Advantages: strong

Disadvantages: knee pain may persist for several years after surgery; takes longer to regain full range of motion.

Allograft (Zombie knee!!)

Advantages: no pain or scars at donor site; shorter operative time

Disadvantages: infection; body may reject cadaver tissue

I'm getting a hamstring graft. Not because I believe it's better, but because that's the only kind the orthopaedic surgeon who's performing my surgery does, and he sounds like he knows his stuff. So basically, they're going to take two tendons out of my hammie and graft them to the ACL site.

I wonder what the ripped ACL remains are doing in there now? I picture it looking like a broken rubber band, the two snapped ends drifting in the current. Who could imagine a teensy-weensy tendon causing soooooo much trouble?

The doc also gave me some ballpark answers to my questions, finally! The orthopaedist I saw at Cornell was completely unhelpful and non-committal. I understand that everyone heals at a different rate so it's hard to give a firm number, but that doc wouldn't even help me out with a ballpark number to give work. The new doc said I should expect to be on crutches for up to a month after surgery, I should be able to jog after about four, and able to return to full activity after about nine. He also gave me a mission for the next month before surgery (cue Rocky song): to regain as much range of motion as I can in my knee and to strengthen my hamstring/quads. I started seeing a physical therapist yesterday, and I'm going to keep going once or twice a week until surgery. She gave me some simple-yet-excrutiating exercises to help with these tasks. So here it goes, Operation Quads of Steel is underway.

Viva Espana!

This was how I watched the World Cup final:

Instead of going to a bar or watching at a friend's place like a normal person, I set up a *command center* in my living room and watched on Univision's website with only my big fat left knee for company.

I wanted the Netherlands to win. I like Spain, but they played so dirty that game! And sooooo much flopping! All the ACL-tear-fakery was particularly annoying due to my current situation. Still, I'm glad Paul the Octopus was right. He seems like a good dude.

All Rest and No Work...

New York City is not a friendly place for people with ambulatory injuries.

I live in a fourth-floor walk-up, so needless to say, getting in and out of my apartment is *challenging*. I can manage the going-down now, but I literally have to be dragged/carried up to my apartment. That means I don't make many trips into the outside world. I'm fortunate to have a good support network around me to help out, but I'm still starting to feel a leetle bit like Jack Nicholson in The Shining.

This totally has me thinking about whether New York is worth the pain-in-the-assness of living here. Stairs aside, it's virtually impossible for me to go to work while I'm on crutches. I can either spend $90 a day on roundtrip cars to the Upper East Side from my apartment in Brooklyn (which, sadly, is probably about what I earn after taxes) or attempt to navigate the treacherous, stair-filled, over-crowded subway system with my bum knee.

My commute entails the following: a 2 block walk to the train down a steep hill; taking the local train 3 stops to the nearest big station; transferring to an express train (up one flight of stairs, down one flight of stairs, and up another, plus a walk of about one city block); 35 minutes on an insanely overcrowded train full of the worst, most selfish people you could ever imagine who would rather stab their own mothers than get up for a handicapped/pregnant/elderly person (I may be exaggerating slightly, but only slightly); then a 9 block walk (including 3 avenue blocks!) to work from the train. About an hour and 15 minutes on a normal day. Sucks, right? At least it keeps me in good shape... The point of this is not to complain about how terrible my commute is, but rather to illustrate the sheer impossibility of attempting it on crutches. So, that leaves me at home until I can put weight on my knee. I walked home from a physical therapy appointment last night, and it took me about an hour to traverse 3 avenue blocks and 3 regular blocks.

I'm really glad I'm able to go home for my surgery. It will be soooooooo much easier to get around in Eugene, where my mom and family will be around to drive me to appointments as needed and to generally coddle me. My roommates and friends are sweethearts and have been incredibly generous about everything, but you can only ask so much of someone who is not actually a blood relative or otherwise legally bound to care for you in sickness.

World Cup dreams smashed!

I've been playing with the same soccer team, the Faceblasters, for nearly two years. We recently joined a new league at Asphalt Green, and I was rarin' to go for our game last Thursday.

Sometime during the second half, I chased down the ball and planted wrong on my left foot. I felt a *pop* in my knee followed by shockwaves of pain. I dropped to the ground and nearly hyperventilated as I fought off blinding pain and nausea. Looking back, I'm surprised I didn't realize right away that I'd torn my ACL.

Someone insisted I straighten my leg, then my teammates carried me to a bench. I laid down with my leg elevated and ice on my knee for the remaining 20 minutes of the game. I was hoping the pain would subside, but it didn't. A teammate had just broken his ankle a few weeks before, so although normally I would've taken a cab home and waited until the morning, I decided to go to Urgent Care *just in case*.

While the entire hospital staff watched LeBron announce his move to Miami in the waiting room, I got the bad news from a doctor. I'd been waiting for nearly two hours to see someone, and the pain had subsided significantly by that point. I was convinced she was mistaken. But she described it as "textbook" and said that although she hoped she was wrong, the best I could probably hope for was a partial tear.