A week ago today I went into the operating room and came out with a different knee – hopefully a better knee. The surgery took over three hours, but my surgeon Dr. Armando Vidal of CU Sports Medicine / UC Health wanted to make sure that everything was just “perfect” with this procedure. What was fixed? The torn ACL and meniscus.
I originally tore my left ACL back in 2009. At that time, my doctor repaired it with an anterior tibialis allograft (cadavar). I am not certain exactly when that graft failed, but it did. And somewhere along the way, my medial meniscus was torn as well.
My current surgeon was concerned with the location of the tunnels in my bones from the previous repair and thought they would overlap too much with the tunnels he wanted to create for a new repair. So I first had to undergo bone graft surgery (allograft bone cores) to repair the bone. This was done in August, and I had to wait a minimum of 12 weeks before having surgery to repair my ACL and meniscus. Due to better timing in my personal life, I waited 14 weeks.
ACL Graft Selection: Quadriceps Tendon
In the process of deciding who would be my new surgeon for this knee I had the opportunity to visit several doctors. All but one severely steered me toward autograft repair instead of allograft. Apparently, recent studies have been showing that allograft repairs have a tendency to fail even years down the line. And given my high level of activity, autograft is often recommended. After hearing this a few times, I gave in. I had my right knee repaired using autograft 20 years ago and that repair always felt more solid than the allograft in the left knee. That said, the patellar tendon autograft came with additional long term pain. So, I considered other graft options. Hamstring tendon autograft was of course highly recommended. But, I have had some hamstring tendonitis issues in the past. In the end, I decided on using a graft from my quadriceps tendon – a more rare choice, but one that seems to be gaining in popularity.
Medial Meniscus Repair
I had a torn medial meniscus which was repairable. Dr. Vidal put 4 stitches in it, I believe, to repair it. Due to this repair, I am required to wear a straight leg brace whenever I walk. Basically, if my left knee is weight-bearing, it needs to be locked in extension. Otherwise, I can bend it without weight and work on my range of motion. I will remain in this straight-leg brace for 3 to 4 weeks.
The first couple of days post-op were certainly on the rougher side. But, overall, my knee has not been excessively painful. Because I was immediately locked in extension, I never really lost my ability to extend my knee. However, with increased swelling, I have lost quite a bit of flexion. On Thursday, I couldn’t bend my knee more than a few degrees at physical therapy. But, I worked on reducing swelling and improving range of motion at home. Now I can bend my knee far more than 90 degrees – probably around 110 or 120 degrees.
With my meniscus repair and being required to be locked in extension when weight-bearing, my physical therapy is limited. I won’t be able to bike until 3 or 4 weeks post-op, when I will lose the straight leg brace. For now, I’m work on exercises to strengthen the VMO, heel slides both assisted at not, and a few other similar exercises. With improved motion I was hoping the straight leg raises would come, but I was only able to do my first set today in physical therapy. These are definitely limited due to pain at the quad graft site, which is to be expected. But, this too will improve over time.
I can generally get around and do the simpler things that I want to do, including driving. But, walking around in the straight leg brace is slow, and irritating to my lower back. So, I try to minimize my walking and not walk long distances. I acquired a temporary handicapped parking decal which helps with this.
As with so many things including ski mountaineering itself, recovery is as much mental as it is physical. I’m not gonna deny that I’ve had a couple of breakdowns. But, I worked through them. And overall, I’m feeling pretty positive about my surgery and recovery.
My road to recovery has just started and it will be a long, long road… But, it’s off to a fairly good start!