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ACL Surgery with Patella Tendon? Help!

HellaRuby

Certified Ski Diva
#1
Going in next week. I know I am in good company as the Ski Diva's are no strangers to torn ACL's. Back in January on good ole' Cannon I tore my ACL, Meniscus and my MCL. Yay! Then I skied on it for the rest of the season cause, well after all the that I was pretty much doomed to surgery any way so why the hell not enjoy the season?

I have been doing PT since then and finally got the go ahead for surgery. Never mind the waiting list to get in with this particular surgeon was also a mile and a half long and specializes in ACL. So now I need some advice. I need to know from some ACL veterans what to expect? I keep reading about donor grafts but not about too many ladies going with the Patella tendon surgery? My OS recommended this one in particular because of the strength and I was very adamant I did NOT want to be back in this position again if at all possible.

Did I mention I only have a week off from work? This makes me a little nervous but I ride a desk on the daily. So I am hoping I can make it bad without too much trouble. Its the day to day that I am worried about. I have kids, a dog, a husband (who's like a bigger kid). This is when I wish I had a sister wife to take over...
 

Skier31

Ski Diva Extraordinaire
#2
I had the patella tendon graft surgery almost 15 years ago and have had 0 problems. I have a desk job and was back at work in less than a week. I was very tired and wore out quickly so I am not sure if I worked full days. The first day in the CPM machine was not that great but overall the pain was not that bad. Do follow the instructions about icing and meds. The area where they take the graft from is VERY TENDER AND SORE. Do not touch it and be careful to not bump it or hit it, you will know. I slept with the brace for a period of time which was annoying but not horrible. Other than that, I really don't remember very much.

Good luck. I hope everything goes well.
 

Little Lightning

Ski Diva Extraordinaire
#3
Can't help you with patella tendon surgery, mine was donor. I will say my experience has been that you will recover stronger and better off than before. Good luck, for me it was one of my easier injuries.
 

Peaheartsmama

Ski Diva Extraordinaire
#4
Out of curiosity, how did you manage to ski the rest of the season with the injuries? When I tore mine a couple weeks ago, I could hardly turn my skis. I haven't tried since though...
 

altagirl

Moderator
Staff member
#5
I was able to ski the season on my torn ACL way back when as well. Mine would give out again every so many days, but at the time I thought -well, it needs surgery anyway so might as well not miss out on skiing, as I was living in Europe at the time. Couldn't pass up skiing the Aguille du Midi on a powder day, etc. etc.! Probably not the best call for my meniscus, but anyway...

I have a hamstring graft in one knee and an allograft in the other. I had issues with the cartilage behind both kneecaps already (various injuries falling hard on my knees), so a patellar graft didn't seem like a good call. Both of my knees ended up having later meniscus injuries, but both repaired ACLs are still intact something like 16 and 13 years later. I do still hear that patellar grafts are the gold standard, so if your doctor recommends it, it's probably a good way to go. And with my more recent one, I went back to work around a week later and spent the days with my leg up on my desk. DO really elevate it well above the heart as much as possible. It makes a huge difference.
 
#6
Sorry to read about your injury - and wishing you much luck with surgery, rehab/recovery!

Just to differentiate: donor graft (allograft) can be any type: hamstring, patella tendon. Autograft means the graft is from your own body.

DH had allograft patella tendon ACLr in 2009.
DS had autograft patella tendon ACLr, right then left, 2006, 2007.
Sorry to say this, but the surgeries that were closest to the injury date had the fastest recovery.

All 3 knees are holding their own. As the caretaker, I can hopefully provide some input.

As with most surgeries, post-op protocol is reduction of swelling, inflammation and prevention of infection. Thus, the first week-plus is critical. You will likely be very low to completely non-weight bearing. You will likely be required to wear a full immobilizer for several weeks and diligently use a cryo-cuff. Thus, the one week of leave might be tight. I recall that my family members were not released to drive for about 3 weeks, when the immobilizer could be removed while they were driving (and put back on as soon as they were leaving vehicle).

DH went back to work after 29 days, but his job in heavy industry involved a lot of walking and stairs (and, per OSHA, no ambulation devices).

Be frank with your family about your needing THEIR help, no questions asked, for at least one week. End of story. Your full recovery depends on this. The first few weeks are confining and frustrating - but they pass.

With diligent PT and being mindful of any/all restrictions, all 3 knees were back in full service in 5 months.

There are many surgical protocol variations. What one surgeon allows, another will not. A good end result is your goal, as well as faith in your personal choice of orthopaedic surgeon and physical therapist.
 

pinto

Ski Diva Extraordinaire
#7
Sorry to read about your injury - and wishing you much luck with surgery, rehab/recovery!

Just to differentiate: donor graft (allograft) can be any type: hamstring, patella tendon. Autograft means the graft is from your own body.

DH had allograft patella tendon ACLr in 2009.
DS had autograft patella tendon ACLr, right then left, 2006, 2007.
Sorry to say this, but the surgeries that were closest to the injury date had the fastest recovery.

All 3 knees are holding their own. As the caretaker, I can hopefully provide some input.

As with most surgeries, post-op protocol is reduction of swelling, inflammation and prevention of infection. Thus, the first week-plus is critical. You will likely be very low to completely non-weight bearing. You will likely be required to wear a full immobilizer for several weeks and diligently use a cryo-cuff. Thus, the one week of leave might be tight. I recall that my family members were not released to drive for about 3 weeks, when the immobilizer could be removed while they were driving (and put back on as soon as they were leaving vehicle)....
Great info. I will say, as a counterpoint, DH had ACL surgery a full three years after his tear, and recovered super fast. So don't worry, necessarily We managed the swelling and that is key, as MSL says. Well, I say "we" -- I'm sure it was a combination of a lot of things, including the surgeon, but he recovered so quickly that we felt kinda dumb for putting off the surgery so long.
 

HellaRuby

Certified Ski Diva
#8
Wow! So many different scenarios but all very positive outcomes

Feeling a lot better about it! Thank you for the reassurance. Hoping to be back on the slopes next season. Sounds pretty likely giving the timing and the rehab plans.

As for how I skied on it, with a really great sports brace recommended by another injured Diva. It was the Shock Doctor, and I waited about a month and did some PT was feeling pretty good by then. It worked well. My OS did not agree however, but hey those extra days were pretty sweet! Also refused to admit I was injured when it happened, skied the rest of that day and the whole next day on the bunnies...it wasn't until I got home that sought out an emergency visit...not smart I know. But I just didn't want to face reality! I kept thinking I just twisted/bruised something it will be fine in a day or two. NOT
 

Peaheartsmama

Ski Diva Extraordinaire
#9
Which model did you use? The 875 Ultra one? I just had a consult with my ortho and she raised the possibility of not doing surgery and using a brace this winter instead -- it will depend on how my PT sessions/ stability goes over the next couple months.
 

Pequenita

Ski Diva Extraordinaire
#10
There are many surgical protocol variations. What one surgeon allows, another will not. A good end result is your goal, as well as faith in your personal choice of orthopaedic surgeon and physical therapist.
This.

Also, do your best to find a balance between working yourself hard vs. being kind to yourself. Some people just are faster healers than others, so try not to create expectations based on what others have experienced. I was bearing weight (per my protocol) 24 hours after surgery, and a friend visited me. Several years later, she had ACLr and expected to be, like me, quasi ambulatory. She tolerated pain differently than me and was disappointed.

I think the one x factor that you sort of can control depending on your physician's schedule is at what point in your cycle you have surgery. Some women's pain thresholds vary based on hormone levels, so if you know that there is a time of the month where you feel more super woman-like, maybe that's the optimum time for surgery.
 

altagirl

Moderator
Staff member
#11
I never had any real problem driving in the "immobilizer" brace. It's got a range of motion setting to it and I've only ever seen it locked out if you also have an MCL injury that's healing in addition to the ACL, so if you have the range of motion to sit comfortably in the car and operate it, THEN the key is whether you are on pain killers or not. That has typically been the main concern from doctors. I know personally, being off pain killers in a few days was typical -- with the exception that I'd take one just before going in to physical therapy per their recommendation to be able to work through things a bit better there. (I live close enough to walk to PT, even on crutches, so that wasn't an issue).

I do think personally that icing and elevating the knee is the real key to going back to work. If you have to stand much - no way. If you have a desk you can throw a leg up on top of and a chair that tips back and you can put your keyboard on your lap? And keep ice on it? That worked just fine for me. But if you're going in and sitting at a desk like a normal person? (Like if you work somewhere that propping a leg up on your desk wouldn't fly?) That sounds like a recipe for way too much swelling. You really need to spend a LOT of time with it elevated, and not just propped up on a footstool or end table. UP.

And it is really hard to predict how much pain or swelling you will have. It's all very individual.
 

altagirl

Moderator
Staff member
#12
This.

Also, do your best to find a balance between working yourself hard vs. being kind to yourself. Some people just are faster healers than others, so try not to create expectations based on what others have experienced. I was bearing weight (per my protocol) 24 hours after surgery, and a friend visited me. Several years later, she had ACLr and expected to be, like me, quasi ambulatory. She tolerated pain differently than me and was disappointed.

I think the one x factor that you sort of can control depending on your physician's schedule is at what point in your cycle you have surgery. Some women's pain thresholds vary based on hormone levels, so if you know that there is a time of the month where you feel more super woman-like, maybe that's the optimum time for surgery.
Yeah - my first ACL reconstruction also included a meniscus repair and because of that I was fully non-weight bearing for 6 full weeks. Second ACL reconstruction I was allowed to be weight bearing immediately and the crutches were more to prevent me from limping (and therefore developing other issues) and to keep passers-by from bumping into me in public. There are a LOT of variations to it all...
 

Love to ski

Diva in Training
#13
I am currently sitting in my cpm machine after my surgery. I had surgery 12 days ago.

The first week was hell but it is getting better. I have a continuous ice machine which helps. I had to shower with my husband after the first few days...could not get in and out of the shower

Meals are coming from friends. I cannot prepare a meal as I cannot carry anything.

No work. I am relegated to the cpm machine for 6-8 hours per day. Then pt exercises after that. It seems all consuming.

Hoping to gain mobility. I have 4 kiddos and a traveling husband. Life continues even if I am down.
 

altagirl

Moderator
Staff member
#14
My trick for carrying things while on crutches is to keep reusable grocery bags handy. You can hold the straps while walking with crutches. Throw your food and drinks in sealed containers, put them in the bag and you're set.
 

HellaRuby

Certified Ski Diva
#15
So it's day 5...I ended up having an allograft from a donor hamstring. OS changed course right while I was getting my nerve block done. He said with little help at home this would help my recovery time as I wouldn't have the large incision down the front. All in all, it hasn't been too bad. First few days were pretty painful and I was happy to have plenty of meds but I have been able to taper off considerablely in the last 2 days.

Today was first day of formal PT which was a walk in the park. All the same excercises I was doing pre-op and every day since surgery so not much of a surprise. More of the same of those. Going back to work tomorrow (desk job). I got the go ahead to ditch the crutches and hopefully will be out of the brace by next week.
 

HellaRuby

Certified Ski Diva
#16
Which model did you use? The 875 Ultra one? I just had a consult with my ortho and she raised the possibility of not doing surgery and using a brace this winter instead -- it will depend on how my PT sessions/ stability goes over the next couple months.
Yes I used the 875 Ultra one for the tail end of the season. It provided great support and if you are unsure on size go up, not down! I barely got the one I ordered to fit. I was super impressed with how well it worked for $50 (Amazon!) It wasn't until after lunch when I started to fatigue that I really felt shaky. I will also reiterate that I did not get the OK to ski from the OS he would have said NO and when I was honest he was not super happy but hey, I needed the surgery anyway and at the end of the day it really made no difference.

I will say how OS treat their patients is all over the place. I specifically sought out Dr that specializes in sports medicine and he is all about PT from Day 1 post surgery and getting you off crutches and walking right away. No CPM machine, which I am ok with but it always makes me wonder if one method is better than the other? I am super super happy that I did a lot of PT pre surgery. It really has made a huge impact on the post the recovery.

And yes today day 6 is my first day back at work. Leg is kicked up on an upside down garbage can so far so good. Wish I had brought my cryo cuff to ice it down every now and again because 3 hours in, its feeling a hot.
 

Pequenita

Ski Diva Extraordinaire
#17
Most US insurance companies don't cover CPMs, and their efficacy is mixed. I unfortunately know a lot of people who underwent ACL reconstruction, and the only person I know who had a CPM as part of their recovery had the surgery in the late 1980s. Recovery protocol also depends on what, exactly, was wrong with your knee in the first place. :smile: I think a lot of times when we're posting about our procedures, we don't often include the shredded meniscus and bone bruising, etc.
 

HellaRuby

Certified Ski Diva
#18
Well that explains the whole CPM thing. You hear so many mentions, I was scratching my head a bit! Ahh, gotcha! Yes I had meniscus repair as a "bonus"! And some bone chipping. Lucky me!

Yes insurance...isn't it a wonderful thing? I only meet my PT once weekly in person so we can stretch this process out otherwise those nice fellas over at insurance would have me all wrapped up way before I am ready. Sad isn't it? They would much rather risk a person not progressing properly than offering up enough PT visits to fit the procedure!

All the rest of my PT had to be diligently done on my own. Thankfully I do it! And it sounds like most Divas here are also pretty self motivated but I bet for most that's not the rule.
 

altagirl

Moderator
Staff member
#19
If I'm remembering correctly, my insurance covers a CPM, but my doctor didn't recommend it, so I've never used one. Thankfully, my insurance was good with lots of PT visits and they even covered my $2000 custom Donjoy functional knee braces. But then didn't cover one of the foam braces that I woke up in after a surgery. I had one sitting at home, and then had to pay $500 for a second one. Argh. Go figure.
 

HellaRuby

Certified Ski Diva
#20
A little over two weeks in and NOW the depression is starting to creep in! Why, why, why? I have been off crutches since 1 week post op, been kicked out of the brace early because my knee is "freezing up" and they would rather repair my meniscus again than have a frozen joint. Yes, two weeks post op it feels just as lousy as it did weeks and weeks pre-op...

Anyone else deal with this stiff joint business? the idea of facing surgery again is quite discouraging considering I am not even remotely recovered.
 

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