ACL Reconstruction Surgery

My knee surgery was a simple procedure by today's medical standards and I equated it with a visit to the dentist: you check in, go to the work room, the dentist does his stuff, you leave and he goes about his business for the rest of the day. While my procedure was slightly more complicated than a tooth cleaning or slapping on some porcelain veneers, the basic idea held up.

Upon arrival I checked in with the receptionist and had a seat in the waiting room where one other patient had already taken a seat. I noticed at least one other person come in after me and sit down before my name was called and I was whisked away to the back rooms of the surgical suite. There I was given my gown and was told I could keep my shorts on and they gave me a bed to lay in. Various nurses and doctors came and went all verifying what the procedure was going to be and which leg it was going to happen on. I had to point to the leg being worked on and a nurse drew a large neon green circle on that leg that the doctor later initialed. They started an IV on me and after having the area around my knee shaved they gave me a few pills to help start the anesthesia process. They wheeled me into the surgical suite, had me transfer to the surgical bed and told me to lay back and relax. By now the pills had begun to work pretty well and I was feeling light headed. They were still asking me questions which I fully remember still but I could tell I was getting loopy. A lady held the oxygen mask over my face and before she set it down over my nose and mouth she told me to just take a few deep breaths and relax, that it was "just oxygen." Being a little loopy, I didn't quite believe her and I thought this was the moment that I would be put under completely so I asked her, "Is that code for knock-out gas?" I remember taking two breaths and thinking I should take another one. That was it. Next thing I know I am waking up, freezing my ass off and shivering like I took the Polar Plunge. I knew immediately where I was and what had happened but my body didn't intuitively know that it took two to two-and-a-half hours to complete. They put me in a chair and put some blankets on me and maybe my fleece. After a very short time they wheeled me to an exit door where my ride had already positioned the car. I easily got up and entered the car and was transported home. That was it. In and out, assembly line style with the casualness of getting a dental check up.

Beginning that night I was supposed to begin using two devices. One is a fancy (and expensive) ice pack-like machine that pumps ice water from an insulated container (resembling an Igloo Cooler) through some tubes to a bladder designed to fit around the target body part. The ice water then circulates through and continually cools a large amount of area without having the aggravation of traditional ice packs. The blue bladder around me knee in the photos is the bladder. The other machine is a Continual Passive Motion machine (CPM). You strap your leg into the machine and it will slowly and quietly bend your knee over and over for a doctor-prescribed six hours a day. The purpose of this machine is to keep your knee flexibility so the scar tissue doesn't shorten your range of motion. This machine was only needed for about six days.

On the seventh day I had my follow up appointment. I went back to the doctor's office and was examined by a few medical personnel and had my sutures removed. The doctor took a look and thought I was progressing nicely. They also provided me with a few photos taken on the inside of my knee with their arthroscopic camera. Just as a reminder, I had a portion of my patellar tendon removed to replace the missing ACL. Here's a basic idea of how they remove the tendon:

When they took the brace and bandages off I was met with a bruised and shriveled leg. Blood from normal bruising had been pushed away from the knee by the bandages and had surfaced on my lower leg and mid-thigh. It was very dark and colorful but basically residual "bruising." I was too busy looking at my sutures and bruises that I didn't notice my quad muscles (the ones on the front of your thigh). Or I should say, I didn't notice where my quad muscles had been. I was told they would atrophy but I wasn't expecting it to happen within the first week. Apparently, it happens quickly because once some of the nerves are cut, as they would be with any knee procedure, the muscle dwindles away and "falls asleep." Through physical therapy you are able to reawaken some of the remaining muscle tissue but you will need to build some also. In the below first and second photo you can see the bruising or discoloration of my lower leg. In the third photo you can see the sutures, the entry point they used to remove my patellar tendon, and you can get a feel for how emaciated my leg now looks. My thigh is to the bottom of the photo, leading up to my knee, with my calf in the upper portion. And while my calves were small to begin with, the right calf is now slightly smaller than what it was. The striations you see on my leg were left from the bandaging.



The following will include links to the arthroscopic photos. Each photo is actually four photos together.

Let's examine the first photo. In the upper-left corner is a general photo from inside, looking across the knee to the other portal (a "portal" is the term used for the site where the arthroscopic scope/tools are inserted). Through the other portal you can see another scope. In the upper-right corner you can see what I was told was knee "junk." Just stuff in the knee. I cannot remember if that is natural or related to the injury. I do remember that the darker color is due to bleeding from the intial injury. It is supposed to be more white, like in the photo in the bottom-right. That photo is of my knee and looks pretty good. The last photo in the bottom-left is damage to the bone from the injury. That chip-mark is damage caused from bone-on-bone contact.

Looking at the second photo you can see where my ACL used to be. It would normally be extending from the bottom-right corner to the upper-left corner, heading through the little tunnel. The fibrous strands are what's left over of the ACL and they were removed during my procedure. In the upper-right photo is more of the torn ACL. I don't remember exactly what the two bottom photos are.

In the two upper photos of the third photo is my meniscus. The upper-left photo shows the damage done in the injury. It's roughed up a bit. The doctor trimmed it up and smoothed it out. The bottom two photos are of my new ACL, made up of my patellar tendon. This is the same location as the shredded ACL photo but after they threaded the patellar tendon through. The doctor told me that when they removed the patellar tendon they remove the middle third including the segments of bone it attaches itself to at the top and bottom. The patellar tendon is approx. the same length as your ACL and it's a somewhat natural pairing. They drill holes in your bone at a diagonal of your knee (so, above your knee to the outside, and below your knee to the inside) and thread the patellar tendon through the whole length. To secure the tendon in place they wedge the piece of bone the tendon was cut out with inside the drilled hole with a screw. Think of putting nails or splints into the handle-portion of an axehead to keep the head from being too loose, with the handle being the patellar tendon.

Each day I notice an improvement with the functionality of my knee. It doesn't necessarily hurt, but it's very tight from the swelling, very warm, and the bones ache from all the trauma. I still have a limp but it gets better. The pain is also helped by percocet, my new best friend. I don't get a high feeling from it or any crazy sensation that would make me want to abuse it, but when my knee is hurting the most, the percocet certainly make it feel more comfortable. Speaking of, I think I might go take some now.