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ACL – Repairing the Damage

Mind Games

Don’t you just love those games that the mind loves to play?  I’m sitting here in pre-op at Treasure Valley Hospital getting ready for my ACL surgery.  Everything is going smoothly.  We arrived right on schedule at 11:00 AM and after taking care of the paperwork, we are here getting all of the pre-surgery tasks taken care of.  The nurse is going through her checklist and then I have this question pop up in the back of my mind;  “I wonder if I should go to the restroom”?  I didn’t need to go the restroom, but it didn’t matter at that point.  Of course, the further along that we went the option to do so was becoming less practical.  And then, I’ve got all the wires and tubes hooked up.  So now the question of “should I go” is replaced with “what happens to that bodily function after they knock you out”?  That’s the last thing I remember, and then I’m coming to.  Woo-hoo!  I made it.

The Surgery

In spite of my “mind games”, I was able to focus enough to listen as Dr Hassinger reviewed the plan to remove the damaged ACL, (which was actually a graft of my own hamstring from the first ACL reconstruction 15 years ago).  The next steps would be to trim and remove the damaged portions of meniscus.  The primary meniscus damage was a large “bucket handle” tear on the inside front of the knee.  The reconstructed ACL was to be a 4-strand allograft patella tendon.

At my age, the option for meniscus repair is not on the table, and the hamstring was already harvested.  The only real option for me was the allograft.  Ten years ago when I had the right ACL reconstruction we opted for an allograft and the surgeon used the Achilles tendon.  I have not been disappointed.  It has performed admirably in all of my skiing, running and climbing.  For this surgery, the doctor elected to go with the patella tendon (4 strands).

The surgery was successful in removing the shredded ACL and trimming the damaged meniscus. Photos show the details of the before and after.  The allograft looks and feels great – time and PT will be the best predictors of long term success.  I am now down to 50% of my meniscus in the left knee and I do have some arthritis that is creeping in.  Dr. Hassinger’s comment to my wife immediately following surgery was, “That left knee has taken a real beating”.

Damaged ACL and Meniscus

Damaged ACL and Meniscus

Trimmed meniscus, anchor holes and new ACL

Trimmed meniscus, anchor holes and new ACL

Stupid, Tough, or Both

As previously stated, this was my second ACL on the left knee, another one on the right.  The first ACL, (left), was 15 years ago at the age of 43.  I landed a jump a bit off balance and in the “back seat”.  That blew the ACL right there.  After the initial pain and shock that was severe enough to leave me nauseated, I got back up and just kept on skiing – not just for that day, but for 6 more days on the mountain.  The fact that my left knee kept buckling on me when in steep terrain didn’t seem to register that this was probably more than just a bad “sprain”.  I was set for a trip to Tahoe with my brothers and decided I’d better have the doctor take a look at it.  After listening to my description of the accident and subsequent shenanigans he took all of about 1 minute to complete the diagnosis.  He then looked at me, (we already knew each other well), and said, “Cody, you are either the stupidest or the most pain-tolerant patient that I’ve ever seen — maybe it’s combination of both”!  I suspect that explains some of what Dr. Hassinger was referring to when he suggested that the knee had “taken a real beating”.

Have I Learned Anything

Everyone is unique and each incident can require a different approach, but from my experience, the following observations are worth noting:

  1. Personally, I would favor the allograft option at any age.  The hamstring is sometimes recommended, especially if the patient is younger and has high fitness levels.  The biggest drawback to this option is that this does involve surgically removal and the associated trauma/pain.  For me, I am always looking at getting back to 100% as soon as possible.  If I can reduce trauma and pain at the front end, that puts me into productive rehab quicker.
  2. Dealing with meniscus damage.  If the patient is younger, repair is an option, but there is a cost for this approach.  The repaired meniscus may require non-weight bearing for 6 weeks.  This will set the rehab and recovery behind by 1 – 2 months.  For my first operation, at age 43 the surgeon deemed the meniscus repairable.  In the end, it turned successful, but I was definitely at the upper end of the age bracket for doing this procedure, and it definitely set my recovery time back.
  3. Although each of my surgeries were performed by different surgeons, I think the one common denominator is the advances in techniques, procedures and materials.  The result for me has been that each successive surgery has produced less after-surgery inhibitors such as pain and swelling.

What’s next

Stay tuned for my next update where I’ll talk about some of the initial PT experiences.

 

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