Pre-surgery, Surgery & Post-Surgery
Let's get this out of the way right now !
This is my opinions based on what I went thru for my partial ACL tear in 1990 and my severed ACL and subsequent reconstruction in 1998.
"0" represents no pain at all. "10" represents unbearable pain. It is hard to factor in what a pain for a 1/2 second is on the pain scale versus a pain that lasts throughout the day but this represents the overall feeling when thinking about the experience. Here goes:
At time of injury - 1 to 3
5 seconds after injury - 1
The next day - 0 (cartilage/other ligaments - maybe higher)
MRI - 0
Paying doctor bills - 2 (A lifetime)
Getting IV in the wrist - 3 (5 seconds)
Epidural needle in back - 1
Operation - 0
Recovery room - 1 (Depending on what was on TV)
At home 1st week - 1 (2+ if pain meds not taken on time)
PT (First 5 weeks) - 1 (flex exercises - 2,)
Draining - 6 (lasts about a minute or two)
4 (with extra local anesthetic)
Cortizone shot - 6 (lasts about 15 seconds)
PT (5 wks to 3 1/2 mos) - 1 (A good 2 for some strength challenges)
Pre-Surgery Exercises
These exercises vary depending on the protocol of your OS and your injuries.
I was given very basic exercises to do at home. These consisted of flexing my leg to regain full flex and the basic leg lift exercise which can be done on your back, sides and stomach.
There are others that have done much more intensive pre-surgery exercises. Since atrophy sets in the injured leg, rebuilding the muscles prior to surgery helps to get a heads start on the muscle rehab that will have to be undertaken in the post-surgery. The injured leg will also have atrophy set in after the trauma of the operation. So, in many cases, that leg will pretty much turn into a vegetable no matter what you do.
While it is good to do pre-surgery exercises, in some cases, certain exercises such as the regaining flex may not be possible. If an individual has a cartilage tear that interferes with joint movement , well then certain exercises may not be possible or will result in discomfort.
In those cases, where extension/flex cannot be regained, the OS will square that away during the operation. So, it's better not to force things or get too carried away in the pre-surgery period.
Typical exercises that form the home program for pre and post surgery recovery are accessed from the Index page.
Surgery/Operation Day
An ACL reconstruction is normally done in a day clinic or the oupatient section of a hospital. The operation itself takes about 2 1/2 hours for an ACL reconstruction and cartilage trim/tear cut out. If the operation is for a cartilage tear trim/cut out and no ACL reconstruction, then the operation is about an hour. It is also possible to do a repair of cartilage but I'm not sure how long that takes.
My OS had me stay in a hospital recovery room overnight. Since my outpatient insurance coverage defines it as a max of 23 1/2 hours, my OS decided to keep me in for the max period. Of course, I was worried what happens if I had to stay longer ????? There is always something to worry about !! It wasn't necessary but all that means is that the insurance coverage percentage changes - they don't start sticking pins in you or torture you somehow !!
While the operation takes about 2 1/2 hours, there is the check-in time and the changing room time and the operation prep time and the post-op initial recovery time. So, it is not in and out in 2 1/2 hours.
Everything is pretty much a piece of cake as far as the operation goes. The only real concerns are when you enter the changing room area and you first glance at where the Exits are, in case you want to make a bolt for it. But then you realize that with your injury and those little paper or cotton socks they give you, you would be fairly easy to catch. Besides, one reason they have all those nurses is to make sure they sound the ALERT in case anyone makes a break for it. They certainly o not want to be done out of their money this day !
The other thing is that little wimpy needle for the IV. What is it with that thing. I think it is because you can see them doing it that makes it seem half bad. But if you can survive the changing room and the IV, then you are on easy street.
Iniitial Recovery Period
This is basically the period from when you just get out of the operating room until about 2 weeks later. First, if you are in the hospital overnight, then get used to sticking your tongue out a lot because those nurses like to take your temperature.......and even through the night as well.
This is a period when the first thing you do is check to see if you still have two legs down there.
The next thing you may or may not find out is if the pain medication your OS prescribed causes you any discomfort/stomach distress. It is important to notify the OS right away if the pain meds and you do not get a long. Your OS can easily prescribe something else.
If you had the classic ACL reconstruction and cartilage tear type operation, then most OS will have you start to do extension/flex and basic muscle strengthening exercises. The typical exercises for pre and post operation are acessed from the Index page.
My own experience: I woke up in the recovery room to find a technician hooking up a CPM machine to my bed. (See CPM on the ACL Lingo page.)
I was flexing my leg within only a couple of hours since my operation. I also had a CPM machine at home which I used for about 10 days.
A CPM is not necessary but in those early days when your head is zooming from pain meds and you do not feel like doing much of anything, a CPM is good to exercise your knee while you rest on your duff watching TV. If you don't have a CPM, check with your OS. Frequent flexing of your knee in the early stages is usually of benefit to reduce chances of scar tissue buildup.
Individuals that have had multiple ligament deficiencies may not get a frequent flex protocol in the beginning. So, check with your OS and get an understanding about your initial recovery protocol.
Scar Tissue
This is how I understand it after discussing this same issue with many others that have had an ACL reconstruction. Those that started flex and extension exercises right after the operation rather than at some time later like 2 weeks or more, had less problems achieving full extension and full flex. (Also, at some point early in this period, the OS will probably recommend some scar tissue massaging exercises.)
That does not mean that if you did nothing, you are guaranteed to have problems. It just means that a higher percentage of those having scar tissue problems comes from the group that did not aggressively start the exercises and scar tissue massaging techniques early in the recovery process. Those that have had multiple ligament tears may have to forgo the flex exercises because some OS may have a protocol to encourage healing of the PCL and MCL since those ligaments are capable of healing if the tears are not that severe.
What it means is that for most people that undergo an ACL reconstruction, an early start of extension and flex exercises is of benefit. Never undertake any exercise without your OS permission. The above serves to inform you of what others are doing and serves as information to discuss this issue with your OS - not to start exercising without his permission.
