(Anterior Cruciate Ligament is a ligament that plays an important roll in stabilising the knee)
by Lorna Richardson
I am writing this Blog, as this is the first time I have been a proper patient and having to go through rehabilitation, I am seeing everything through new eyes, you see I am a physio and used to telling others what they should and shouldnâ€™t do not the other way around. I really feel sorry for my physio now, as I am truly a terrible patient â€“ very impatient as it turns out.
I feel I should set the scene that lead me to have this surgery in the first place.
I was a gymnast from the age of 8-15 and did multiple other sports to relatively high levels. Unfortunately my growing body was under constant pressure from the relentless training (back then there was little understanding in the sport world of how the teenage body reacts to extreme levels of exercise). I had to have 2 arthroscopy operations on my left knee to trim the meniscus my first at 11yrs old (apparently way too young for such surgery according to my ACL surgeon). It has left my knee in a raggedy state.
I am now 41 and I discovered in August of last year that I had done something relatively problematic to my knee. I was trying to do box jumps in the gym, all seemed quite good until I landed slightly wrong and felt pain in my knee. I tried to ignore it as normally I shake off injuries quite easily. I rested it, did the RICE and I also had physio. Physio was great and reduced my pain significantly for a few days but it always came back. My long-suffering doctor (Iâ€™m very accident prone!) referred me to Dr Lucy Holtzhausen a physician that is specialised in pain. She had a very long waiting list so it was a while before I could see her â€“ March the year after in fact. In my first appointment she did a very thorough assessment and sent me for an MRI. The news wasnâ€™t great however, she gave me a cortisone injection into my knee (no anaesthetic â€“ utterly terrifying to a needle phobic like me) but she was a master at it and it was fabulous. Got rid of the background, nawing constant pain but not the weight bearing pain. This led me to the surgeon and the decision for the ACL operation. My particular surgery was to have a graft using my hamstring (usually these days the patella tendon is used but mine had several tears in it so couldnâ€™t be used) and meniscal debridement.Â Surgery isnâ€™t always chosen for someone of my age unless they are very active and as in my case where the pain was preventing function. The surgeon had a very good bedside manner and gave me the rehabilitation plan prior to the surgery which is very helpful for you to be able to organise your life after the surgery and helps you to set your expectations.
From seeing the surgeon to my operation date was only about 3 weeks, which was fast and this was because it was being covered by ACC. Also a very good thing for me â€“ less worrying time.
The morning arrived; I was due to report to Ascot hospital at 10.30 nil by mouth for 6 hours prior to this time. I was very nervous but keen to get going with the job at hand (I was very keen to reach my exercise goals). They gave me a standard hospital gown and paper knickers â€“ yuck! And actually some quite good socks, however they did give me a blanket â€“ alarm bells should have rung, I was in for a long wait and so were the other half dozen or so patients all similarly dressed in the small but clean waiting room. Strangely we all sat in stony silence occasionally glancing at one another with a knowing nod of people who are all slightly dreading what is about to happen. My time came and the lovely anaesthetist give me a pre-op chat and a couple of pills which I was supremely grateful for as I was gasping for water which I was allowed to have to take the pills. It wouldnâ€™t have mattered what the pills were I would have taken them just for the water alone. It was a short trip to the icy cold operating room (but being a private hospital they had heated the blanket in the operating room for me, not sure if that happens in the public hospitals) and from this point on I do not remember anything until I woke up in recovery. Turns out Iâ€™m hard to wake up, I do remember the lovely nurse trying to gently wake me up before getting louder and louder to break me up! They moved me to a fabulous room by myself with a TV and my own on suit â€“ lovely. I found it hard to stay awake when my family visited and I had a very husky voice from having the tube down my throat. I had previously filled out a form for my post op evening meal but found the form confusing so ticked almost everything, so when dinner came it was massive and really, really good.
The first nights sleep was terrible as there was constant checking of me and all my fellow Orthopaedic patients who seemed to ring their bells all night â€“ they probably drank a lot of water too! Pain wise I was in much more pain than I thought I would be in, but according to the surgeon my knee was very small and he didnâ€™t use much local anaesthetic. They gave me morphine (which I hated, I felt like I couldnâ€™t breathe) and various other concoctions and I found a mix of tramadol, paracetamol and the ice cryocuff to be most effective.
I couldnâ€™t, I should probably rephrase that to I felt too nervous, to move my leg until the nurse came in in the morning when I realised that I really did need to go to the loo so I would have to move. The nurse found me a frame and instructed me on how to get up and walk with it â€“ I promptly ignored her instruction and did it all wrong despite teaching patients for years how to do it the correct way. For this I will just blame the anaesthetic for addling my brain. This all went without a hitch and for the first time I inspected my new knee. It had 3 mid sized bandages covering the incisions and this was in turn covered by a crepe bandage. The nurse later replaced this outer layer with a doubled up tubigrip that went from ankle to hip.
After this I dressed into my going home clothes (I had carefully thought this out and wore a stretchy jersey dress which covered up most of me and meant I didnâ€™t have to fiddle with trying to get trousers on â€“ top tip!). My physio came and we had a lovely chat as well as doing the obligatory stairs test (have to be able to go up and down the stairs on crutches without help). Another top tip â€“ ask for crutches that have the hand molds, they are much more comfortable and less likely to give you bruising. It is also worthwhile getting someone to fill your medication script for you to save time and so its all ready for you at home when you need it.
Going home was easy apart from having a very small car â€“ it is good to have a car that the seat can slide back a long way so you donâ€™t have to bend your knee too much.
I had a good set up at home with the sofa facing the TV and I had bought extra Ice packs, as you have to ice your knee up to 6 times a day for the first 2 weeks. I was sorted. There are other things that you need to consider for the first few weeks.
- You wonâ€™t be allowed to drive (insurance wont cover you until you have been signed off by your surgeon and you are no longer taking the strong medications)
- You need someone to make your meals for you.
- For the first few times you may need to have someone hovering around just in case when you are having a shower â€“ I was fine but I have very good balance and I wasnâ€™t taking the strong meds as they made me vomit.
- Make sure you have an ACC case manager who can help you if you need home help and income support (you will probably get 4 weeks paid as you need 4 weeks off work if it is a sedentary job â€“ 8 weeks if it is physical like my job).
- Make sure you get anti nausea drugs and donâ€™t drink coffee it can make you very ill.
I will keep you posted with the rest of the recovery