ACL Surgery (Round 2)

[I've since written a series on ACL reconstruction surgery prep, recovery, training, and back-to-sport protocol. See here for the full series.]

This one's gonna last.

Surgery went really well and I'm seeing the light at the end of the percocet tunnel. Round 2 doesn't make it any easier. Physically, it's been more painful than the first due to its nature, and emotionally, "at least you know what to expect" is bullshit--when you don't know what to expect, you come in with naive ignorance. All said, though, it's going very well.

post-acl surgery coming home


The knee has 4 main ligaments, the LCL and MCL running on the sides, and the PCL and ACL running cross-wise through the center. The MCL and ACL are most commonly injured in sporting accidents, you know, the crunch inward you see in soccer and football. All but the ACL have a decent blood supply since they're outside the knee joint, but the ACL is inside the knee joint in synovial fluid so it doesn't heal on its own, hence surgery need.

knee ligaments Image credit

ACL Reconstruction

Surgery requires new tissue to form an ACL and drilling that into the femur and tibia. The graft can come from a cadaver (allograft), which is what I did the first time, or from your own patellar or hamstring (autograft). In any case, the tissue is a tendon but you're replacing a ligament, so there's a long transformation recovery period on order of a year.

ACL reconstruction surgery Image credit


Autograft patella. Your own patella tendon, the one that sits in front of the kneecap. They take the middle of it and suture the other sides together. Yeah, I'm squeamish too thinking about this.

ACL grafts Image credit

Autograft hamstring. Did you know you have more hamstring tendons than you need? The big one runs more on the outside of your leg, the biceps femoris, and is left intact. The other smaller ones attach on the inside, the semitendinosis and gracilis. Parts of these "accessory" tendons are taken, strung together, and used for the graft. I used this graft the 2nd time.

Image credit

Allograft (cadaver). I used an allograft the first surgery from a patella. There's very little risk of any infection since it's not like a soft tissue organ transplant (tendons are relatively devoid of blood; side: that's why finger tendon injuries take long to heal), and you don't have to harvest your own tissue. It should be as strong as your own graft.

ACL Revision

About 5% of ACL reconstructions fail and the do-over procedure's called revision. Luckily now most surgeons use biodegradable screws instead of metal so you don't need to worry about old hardware in the way. Biodegradable screws dissolve over about 5 years as your bone takes over. Most revisions occur much sooner than that, so the surgeon drills close to the original tunnel, or possibly right through, or they may take out pieces of old screws and do a small bone graft.

What's on deck

You want to get you knee moving as soon as possible to retain range of motion and prevent scar tissue, so you're pumped with painkillers and antibiotics from the moment you're out of the operating room. This time I got nauseous from the antibiotics and couldn't keep food down. It's a drug haze.

For the next 2 weeks, I'm hooked up to a continuous passive motion (CPM) machine for 6-8 hours a day. You program what degrees to move your leg, like 10-50 degrees, and increase that each day. It helps with scar tissue and keeps the joint moving. I have to sleep on my back with brace. I'm hooked up to a motorized ice machine to pump cold water through my bandages 24/7. Crutches with max 10% weight on the leg.

The first couple days I could barely lift my leg since my hamstring hurt so much (and sitting on the edge of a hard toilet seat was really painful). You even tug on your hamstrings when you sit up out of bed. I'm out of the thick of it and the next big milestone is week 2, walking. Jeremy's been an amazing nurse!

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