(Last Updated on 3rd November 2011)
On the 21st of May 2009 I got an ACL reconstruction operation on my left knee at the Whitfield Clinic (Waterford, Ireland) which was ably performed by leading sports injury surgeon Tadhg O’Sullivan. In this post I’m going to take you through my experience and hopefully help others with their operations.
I was blown away by the clinic when I went around the various sections of the building. Its less than 3 years old, a fully private hospital that is kitted out to world-class standards. Its like a very plush shopping centre, no hospital smell or noise anywhere. The building is full of light and has a lovely café/dining area as you come through the main central reception hall.
Now there is an issue with timing for my consultant Mr. O’Sullivan, and if you get an appointment for 11am you probably won’t see him until 1.30pm or perhaps even 3.00pm in the afternoon. Once you arrive armed with this knowledge you won’t become as frustrated and you may even time in your arrival a little late etc to counteract the painful waiting process.
My girlfriend accompanied me on the trip from Limerick to Waterford and we booked a room in the Tower Hotel for that night so we wouldn’t have to trek home with me in a fragile state, post-op. (Its a basic hotel in a convenient location.)
Once I got to the Day Care Centre at the hospital I did some routine surveys and a nurse took all my vital statistics. One of the surgeons came in to mark the area to be operated on with a purple marker, this was strangely reassuring because it made sure there would beno mix-ups and they would operate on the correct leg!
I was given a robe to wear and special undergarments for the operation and then I waited a couple of hours for the surgery team to wheel me up to the theatre. At the theatre I met a friendly anaesesthist and soon I was out cold. The next thing I remember was waking up back in the same Day Care cubicle as before and starting to come to my senses. After that I was served tea and toast and the nurses began to assess my readiness for departure. As I looked quite pale they were afraid to let me stand up for a bit because it would be very hard to lift me up if I went down and it could also risk the integrity of the operation. When I finally got up to go they wheeled me to the car in a wheelchair. The first 24 hours are critical so its very important to get into cars carefully and keep the leg straight all the time and preferably raised.
Post-Op: First 24 Hours
My first night went fine as I had plenty of drugs in me and couldn’t really feel much. I was very hungry so I ate a prawn salad, biscuits and tea. In the morning I continued with a full Irish. This was all a big mistake! Once the drugs began to wear off and the food hit my digestive system it was not a happy experience. I was sick most of that day and didn’t feel right for another day or so until all the drugs had passed through my system. Don’t eat much after your operation!
The leg looked pretty huge for the first while, there was a lot of dressing on it and a good bit of mess from the orange stain of the disinfectant coupled with dried blood etc. The leg was not a pretty site at all and soon it increased swelling to about double the size of my good leg, it was huge looking!
For pain killers I elected not to take the prescribed Diaphene, I tooke this before and it only made me feel worse as its very hard on the stomach and the head. Instead I took an Over-The-Counter product recommended by the nurse, Neurofen Plus. This drug was excellent with limited side-effects and very affordable/accessible too.
Post-Op: First Week of Recovery
Regular use of painkillersis vital for the first week, you need to take them all the time so that you can perform the initial rehab activities like straightening the leg and just getting around the place. I didn’t take much time off work, but I did work from home for a week. Ideally you would take 2 weeks off work and do as little as possible apart from the prescribed instruction manual of rehab activities.
I was not able to fend for myself during the first week that well, I needed my girlfriend to drive me around and get me things from the shop as well as household chores etc. The single most difficult thing with an ACL operation is the total inability to look after oneself for the first week or so. There’s no getting around the fact that you can’t get around and you can’t carry anything because of crutches. One tip I would offer is to use a small backpack to carry objects around the house while on the crutches…going up and down the stairs is another day’s work!
Life on Crutches: Week 2-6
Dr. O’Sullivan warned me not to walk on the operated leg until after my Week 4 check-up back at the hospital. He was adamant that I needed to use crutches for the full 6 weeks to ensure proper healing and mitigate against mishaps or an early recurrence of the injury.
Therefore I observed the exact procedure as per my instructions from the clinic. After week 3 I was able to resume driving and this was a great relief and brought things almost back to normal in terms of day to day living. I weaned myself off Neurofen gradually up to about week 4, by which time I wass just taking an occasional dosage if I felt in a lot of pain and couldn’t complete my exercises.
The most important exercise is the full straightening of the leg, this is mad difficult by the fluid from the swelling and the pain in the operated areas. If you do not do the straighening exercises the graft inside the knee will set in a slightly stretched position and then will be longer and looser in the final analysis, resulting in a less successful reconstruction overall. Daily living was difficult during the 6 week period on crutches, I was still dependant on others to cut the lawn, clear the dishes and wash my clothes etc. That’s the big problem with crutches, you can’t carry stuff from A to B.
Walk Before you Run: Week 7-14
Once the crutches were discarded life became much easier and I began to attempt some simple bending exercises to build up the hamstring and quads. Walking uphill and up flights of stairs was difficult at first and I chose to use an elevator at work much of the time. After about week 9 I started climbing the stairs and it is very good to build the normal function back into the quads and hamstrings.
Walking downhill and descending staircases is not recommended and can damage the joint. Its better to avoid this as much as you can for as long as you can because its the wrong type of movement. Lifting weights on a leg extension machine is also completely out and will only de-stabilise the knee.
As well as just walking around I took up regular Aqua Aerobics 3 times per week during this phase for about 5 weeks. Using an Aqua Belt you can float in a deep swimming pool and simulate a jogging movement as well as performing squats in reduced gravity mode. After the 5th week of Aqua Aerobics it was becoming too easy so I reverted to cycling and walking. I’m now ready to start jogging and a lot of the swelling and abnormality is gone from the knee, its starting to go back to the way its supposed to be. I have a check-up tomorrow with the surgeon so fingers crossed.
Taking it Easy: Week 14-30
I got my final “All Clear” from the surgeon during week 14 of my post-op and he advised me not to rush into running or walking just yet and to focus on cycling and low impact exercise. There was still a degree of swelling in the knee for a further 8 weeks at least before it started to look like a normal knee. There was also a tingling sensation at the front of the knee which was weird and my hamstring remained weak and small on the affected leg.
With the bad weather and the long nights of Winter I concentrated more on work during this period and just took it easy mostly. Rightly or wrongly I just didn’t do a lot of exercise for a couple of months and decided I would wait until January to kick-start my training campaign again, it is probably a combination of laziness and seasonal factors that account for this.
Building Strength and Confidence: Week 31-52
When I returned to regular exercise on January 4th 2010, I was quite unfit and not in great condition. My brother keeps himself fit and he came as my “Gym Buddy” for the first couple of months which was great. We just did strengthening and core body sessions at first so I could build up my basic fitness and confidence.
I continued to use the exercise bike mostly rather than running, which was still a little painful. With stretching and conditioning exercises I greatly reduced the stiffness in my affected knee and eventually began to do some light jogging in recent weeks. The initial feeling when out jogging was very disconcerting, and my natural coordination in my left leg was way out…its mostly psychological but I almost felt sick at times when I got back running on it, just the thoughts of it “popping” again I would imagine to be the cause of that.
From Week 38-46 I started attending a regular slot at Circuit Training and this has been fantastic for my confidence, fitness and coordination.
I’m now able to run at a reasonable pace again as a result and looking forward to building up the speed and intensity of my running. I hope to recommence contact sport again within the next 6 weeks and begin training with a team again in the next few days. If I find that the knee is unstable during the intervening 5 weeks I will have to re-consider my plans for playing contact sport, or at least defer them for a couple of months.
First Season Back (2010): Week 52 to 78 post-op
I am writing this update retrospectively and in less detail, but its worth documenting none the less.
After taking a reasonably relaxed approach to my rehab I finally engaged in a couple of competitive games with the club’s 3rd team in contact sport (hurling) in July-August 2010, a full 12-13 months post op. While me overall level of fitness was pretty dismal and I suffered a lot of psychological fear and anxiety during the games, the knee held up well mechanically.
I was basically afraid to go into full contact, even at only jogging pace or in a stationary position. I suffered a lot from flashbacks since I had the original injury, driving in the car to the game or watching sport on TV I would still wince and feel a flash of nausea at times. That stayed with me for well over 18 months post-op, talk about PTSD, it was almost 4 years after my injury before the psychological anxiety started to fade.
Second Season Back (2011): Year 2
I started back on a proper pre-season training campaign with the club’s 1st team in February 2011 with the intention of making a full comeback to top-level sport (back to my original level). I was hugely unfit starting back and about 15kg overweight, but most of my lack of in stamina and underlying conditioning was the most shocking aspect.
The pre-season training was exceptionally intense and gruelling and that probably helped me a lot in overcoming a lot of my fears about recurrence and my flash backs. Engaging in regular contact in a controlled environment outside of a competitive championship game is the way this happened, it was gradual. I built more confidence as I became fitter and as I engaged in more risky contact.
With the help of a good physio friend of mine I managed to get into good enough condition by Summer 2011 and played in several competitive games up to a certain level with the club’s 1st team. I did not manage to regain my full speed or aggression/competitiveness in the course of the season but I hope to return next season starting from a much higher base and at least get back to 95% of where I was. Having just turned 30 its not as easy but I feel I don’t have much mileage on the clock so I’m a young 30 in that sense having missed the bulk of 3-4 years at the real competitive edge in my late 20’s.
So that’s where my story ends for now, medically they would say I am a success story.
- I don’t have any pain or loss of function in the reconstructed knee/leg.
- The knee has proven to be stable even under pretty significant stresses, I am 95kg after all, and that’s when I’m fit!
- My only regret was that I didn’t get the op done back in 2007 when I was talked into just getting a cartilage repair
- So the conclusion is, if your doctor says you only “half-tore” the cruciate and you might be ok, then just ignore that and go to a recognised successful sport surgeon and get your ACL patched back together
- The ACL is a very black and white topic, its either stable or unstable, there is no in-between.