Friday, October 24, 2008

ACL Reconstruction...Seventeen Months Later

This is an important post for me to write because this was how my blog started. When I was six months post-op, I was searching to find out what my knee would be like at a year or longer. I could not find many first hand accounts past nine months. I wanted to see the big picture. I wanted to know more. Now that I am approaching the year and a half mark, I finally know why there is not much written. It is because there is not much to is what it is.

There was a time that I felt defined by my injured knee. I longed to forget about it but each morning when I woke up my knee was holding me back. I searched the Internet looking for answers to my questions.

What will my knee be like in one year? Two?

Is karate changed forever? Will I need to stop training...forever?

What is in the incidence of re-injury?

How about the other knee?

What can I do to prevent re-injury?

So, what is my knee like today. Most days my knee is just a part of my leg. For those who experienced ACL reconstruction and recovery, this is a big deal! I have no pain or swelling during daily activities and full ROM. I try to go to the gym three (lately two) times a week to keep my knee healthy and strong. My knee functions pretty well during karate. There are a few movements that remind me that I once had knee surgery such as: kneeling longer than a few moments, jumping after a long workout and one-leg kneeling on my new ACL. I am cautious about flooring surfaces especially soft, mat-like flooring.

My knee has reached its potential and I accept its limitations.

Good luck to all those going through ACL reconstruction and recovery!


Jorge Morales-Santo Domingo said...

I suppose the real problem lies in the fact that you are an instructor, since you are the mirror in which a student sees him or herself. Although I've reached black belt, I've never had to be more than an assisting sempai. I'm 60 years old with more than 30 in Goju Ryu karate, and there are things that I can no longer do the "same", either due to injuries or just old age. But like a teacher once told me" whatever happens to you in karate, karate will cure or find a way to go around." Remember, the more that you cannot do externally, you must strive to do internally.
Good Luck!
Jorge Morales

Michele said...

Jorge: Thank you for your comments. It sounds like you have a wise teacher. Teaching while recovering from knee surgery was difficult. I was not allowed to kick for six months. It forced me to "find a way around" and be more verbal during class. Thanks again!

Slop -n- Goulash: Dinner of Champions! said...

I normally like to be able to identify with a blogger, but in this case, I'd like to just take yours and BBM's word for it. I have alot of knee pain but just due to arthritis and getting older in general. So, I can just imagine what the constant pain is like.

Michele said...

MAM: I am sorry to hear about your knee pain. The surgeon told me that I should expect to have arthritis in my knee someday. Arthritis runs in my family and I know that it can be extremely painful.

Hippy d I a N e said...

I am a 59 year old karate student and I have recently had a right TKR and things seem to be going slow in that I can't get the knee to move as much as I want it too. My flexion this week, on my own, was 100, but with a little pushing by my PT, I made it to 120; however, I can't just bend it to the 120 deg without help. My left knee moves just fine. My goal is to get it working better than it was so I can test for my 4th dan at the end of this year. Any exercise suggestions that may help?

Michele said...

Hippy d la Ne: Good luck with your TKR recovery. My best advice is to check with your PT for a list of exercises you can do at home. If you are reaching 120 degrees with assistance, it is probably just a matter of time before you are reaching it on your own. Knee surgery and recovery takes time and patience. Best wishes for a speedy recovery.

Anonymous said...

Hi Nice Blog . I don't really know a lot about Knee or art, but that's just my 2 cents. Really great job though, Krudman! Keep up the good work!

Anonymous said...

May be a little late on this comment but I will put my two cents in.

I had ACL reconstruction last April (2008) and this would be my 1 year anniversary. It was a patellar graft and I can do full leg extentions now along with playing tennis, running and snow skiing. However, cross country running still leaves a feeling of stress in my knees. For running and snow skiing I had to retrain myself all over again to achieve proper form fully utilizing my repaired knee but I did it.

Is the pain in the front of the knee and you had a patellar graft? If so, it still may be the nerve endings still repairing themselves around the incision area and that the patellar ligament still isn't 100% (maybe still a little tingling sensation going on)?

Can you kneel down on the knee that had surgery and it doesn't give you any discomfort (aside from a weekend hamstring or patellar discomfort)?

The biggest thing for me while snow skiing and running was mental while the other half was focusing on proper form, espcially when snow skiing. I can imagine with Karate the same.

I do almost everything I did before my injury and I do still think about it in the back of my mind. I believe I always will.

One suggestion...takes things slow and easy. Focus on proper form and keep with your excercise routine.

My doctor told me that even for top athletes, it takes 2 years to FULLY recover if it was their first ACL Reconsctruction. If you had more than one ACL surgery on that knee the best it may ever get is 80%-90% of pre-injury strength.

Good Luck!!!


Michele said...

Hi John,

Thank you for stopping by my blog and congratulations on your one year ACL milestone. I agree with you that this injury is physical and mental. It sounds like you made an excellent recovery.

Thanks again,

Anonymous said...

Dear Michele,
Thank you for a very thoughtful and sensitive blog.
I am the mother of a now 16 year old female who sustained an ACL tear in October 2008. She had surgical reconstruction, PT and now at 10 months post reconstruction, she is returning to the basketball court. Pre-injury, my daughter played soccer, basketball and ran track. She injured herr ACL in a soccer game and has now decided to concentrate on basketball which is her true love. Needless to say, as her mother, I am deeply concerned about re-injury and long term sequelae. There is debate as to whether a brace during sports offers any protection or stabilty. Do you routinely wear a brace when physically active? I know that you are not a physician and cannot make any recommendations but I find that the medical community, of which I am a part, offers no concrete advice. Thus, patients' experiences are of value.
The brace is expensive and I'm not sure if it's worth the investment when it has not been proven to be truly necessarry and offers no extra protection. My daughter's compliance with wearing it is anotherr issue!

Michele said...

Hi Beverly,

Thank you for your kind words. I wish the best for your daughters ACL recovery and return to sports.

The surgeon wanted me to wear a functional brace during physical activity (karate, hiking) for one year after surgery. I wore the brace for about six months and then switched to a smaller brace on my own. I wore the small Breg Short Runner during sprarring and contact drills. Around nine months I stopped wearing the brace.

I know several people who went through ACL recontruction with no bracing. On the other hand, I know someone who is required to wear the brace forever due to the manner in which the ACL was torn.

I was not involved in a sport where there is running and cutting. I would think the brace would give support for sharp directional changes. I had a non-contact tear where I planted on a soft surface and twisted.

Good luck to you both! As a fellow Mom....I know what it is like to worry.

Unknown said...

Hi Michelle:

I am so glad to come across your blog. Most of the ACL stories are from other sports (soccer, ski, etc.). I torn my ACL a month ago during practice. I do 3 martial arts & practice about 3 hr. daily. It has been hard for me to slow down. I am going to have ACL reconstruction on April 1. It seems that you are able to go back to martial arts full time which is my goal in 6 months. I'll be reading your blog after my surgery. Thanks.

Unknown said...

I know this is an old post but I still came to it after searching 'kneeling after acl surgery'. I myself am at the 16th month post-op point of my acl reconstruction.

Unlike most acl reconstructions, mine was done with a quadriceps graft. As you know, most of the information out there relates to hamstring or patella graft, which tends to have a shorter recovery time. The advantage of the quad graft is that it is stronger in the long term; however, it also carries a higher risk of patella tracking problems. I was given the quad graft because my mcl also suffered a grade 3 tear and needed my hamstring in place to allow it to heal without surgery.

I took my physio very seriously (I've lost 20kg since surgery - from 87kg to 67kg, from a total lifestyle overhaul), but because of the slower recovery time of the quad graft it took me longer to progress up to more difficult exercises. Even with my high pain threshold, it took a very long time to be able to bend my knee taking a load on the affected leg - such as being able to walk down stairs normally. That took me almost a whole year before that was possible. Due to slower recovery, part of my quadricep suffered some atrophy - in particular, the tear drop muscle in the quad. The other quad muscles try to compensate for its weakness and therefore there is an uneven pull on my patella, which is especially felt during quicker movements. The knee now has a permanent crunchy noise while it moves through its hinge motion, but it doesn't cause discomfort in most circumstances.

From month 11 when the weather improved i took up cycling as a means of transport again (mostly to and from the gym, where i do weight training three times a week). Within two months my leg finally just felt like a part of my leg. I can finally run again (albeit for just short times for now) without hobbling and lopping along.

Yes, the knee still has limitations, but usually they are so minor that they don't concern me, and just require a bit of extra mindfulness to make it feel OK.

For example, I've recently started adding yoga back into my routine. In yoga, there are a number of moves where you need to send your body weight into your knee while you press it into the ground for stability. I can do some of them fine, but there are other moves where I ease back on because it's too much for my knee. I've just purchased special yoga knee pads which i hope will solve the problem.

I thought I'd add my comment here because i know there is hardly any information on the Internet about acl recovery expectations for people who had a quad graft.

Everyday I am just so grateful now at all the physical activity that my body is capable of doing. Though my knee now has limitations, the rest of my body has never been so fit.