Now that I had picked a date, the next step was to prepare for the surgery and rehabilitation. Though it is a routine surgery in US, it is a 2-3 hour diagnostic and repair combined surgery. My parents asked me to wait a couple of weeks so that at least one of them could come to take care of me after the surgery. I had always been an independent person and have taken whatever life has thrown at me till now. I thought I could handle this alone too. Here was my plan.
Thursday March 20th Surgery: If in morning then whole day off work else half day off work.
Friday March 21st Dressing the day after: Work from home
Saturday & Sunday: Full rest
Monday March 24th: Start going office...4th day after surgery.
Monday March 31st: Stitches cut and physio therapy start.
If you already know about ACL repair, you must be laughing really hard. I was way off mark and my planning was based on me taking it lightly as it was "Out-patient" surgery. I talked to a friend, Mandeep, who had ACL arthoscopy in both his legs. After opening one of his leg, the doctor found out that MRI was wrong and his ACL was intact:) He told me that I should not even think of staying along after the surgery for at least a week. So I modified my plan and decided to stay with my friend till Sunday night and go to work on Monday. Later I will find out that even this was way ambitious plan.
I was informed that someone has to be there to pick up from hospital and they would not let me go out on my own. Yes you guessed it right, I was planning to haul my ass back home myself using a cab. I collected all my papers and asked 3-4 friend to be there. They all agreed and that is pretty much what I planned.
Two days before the surgery, Dr Bach's office informed me that mine was the first surgery of the day, so I had to be in the office by 6am for a 7am surgery. As I knew that I will not be able to play racquetball again for along time 6-9 months, I spent the rest of the week playing racquetball as much as possible. In fact, I was playing racquetball the night before going under the knife.
Over all I was pretty cool about it. Though the thought not getting out of general anesthesia did come to my mind, I was not too much stress about it. I had an application Go-Live on Monday Mar 17th. Also, I crammed everything except hair styling before the surgery as I was not sure about the condition after the surgery. I also canceled the travel plan. In the short time (less than a week) that I had, I couldn't call as many friends as I would have liked to. And so the day of the surgery dawned.
Wednesday, March 19, 2008
Tuesday, March 18, 2008
The ACL Surgery Decision
Whether it was the effect of intensive exercise or wear, I started feeling recurring pain and went to Doctor again to have the knee checked. Finally, my PCP referred me to Dr Bach. I went to DR Bach on 14th March. When I told him that I have been very active in the last 4-6 months, he again suggested that if I wanted active lifestyle, I should go in for surgery. So, I took the plunge and booked the first available date of Mar 20th. I knew that if I delayed again, I would be in teh same situation 12 months from now.
The only main decision was, what I wanted to use as a graft. There are a lot of websites that will help you make a decision. Here is one that is one of the most comprehensive
In short with out the medical jargons, there are three ways (Disclaimer: do your own research and don;t use this as the sole basis and come after me)
1> Tendon from knee cap: They take one middle one-third of the ligament along with small bone fragment from each end from your the knee cap. They have to make additional 3 inch incision on your knee to get the ligament. As there is bone on both the ends, it has string bone to bone fix.
Issues to consider:
a>The main disadvantage is the it will weaken your knee cap and you have to take care of it as it can break if you have a fall after the injury. Some views mentioned that the knee cap ligament strengthens with time.
b>Another disadvantage is more pain (especially while kneeling) and longest recovery time.
c> Longer surgery time as they have to get the tendon from your body
2> Hamstring/Quad tendon: Instead of kneecap, they get a tendon from hamstring/quad. As there is bone on just one end, the fix is not as string as other two options.
Issues to consider:
a> No additional risk of knee-cap fracture during or after the surgery.
b>Less pain than knee tendon and medium recovery time.
c> Longer surgery time as they have to get the tendon from your body
3> Tendon from another body: Here they take tendon from another donor's dead body. This procedure is shortest and has the least amount of pain. There is no incision to get the tendon from your body. Also as most probably the tendon has bones on both ends, it gives similar strong fix at both ends as in knee cap tendon.
Issues to consider: Though this is the least painful and shortest recovery options, one has to consider the following issue.
a> risk of infection, including viral transmission (HIV and Hepatitis C), despite careful screening and processing. The risk is less than one in million and as per Dr Bach, last known case was in 90's.
b>Bacterial infection due to incorrect sterilization. According to doctor back the probability of this is 1 in 200 to 1 in 300 and he has seen 6 cases in his life. Using a well known hospital will help. If caught early, he mentioned that they can open the knee and flush the tendon. Some articles have mentioned that this has led to deaths too in extreme cases.
Finally, here are some facts to consider:
1> There were about 42,636 car accident deaths in 2005. An average of 115 persons die each day in motor vehicle crashes in the United States -- one every 13 minutes. According to the World Health Organization about 3000 people die in crashes each day worldwide.
2> There are 6 billion people in this world and 300 million in USA.
You are much more likely to die in a car accident in US or World (unless you live in remote part of the world) 300 million US population than get an HIV virus through donor's tendon.
Overall, which ever method that you feel comfortable with is fine as long as you use an experienced doctor and well known group. Success of surgery has high correlation with the skill of the doctor and post surgery physiotherapy discipline. If you are in Chicago, I would recommend Dr Bernard Bach, based on my experience with him so far.
Another decision variable is when to go in for surgery, I would suggest give it at least 2-6 weeks, but don't wait years like me. You will wear your joint unnecessarily.
The only main decision was, what I wanted to use as a graft. There are a lot of websites that will help you make a decision. Here is one that is one of the most comprehensive
In short with out the medical jargons, there are three ways (Disclaimer: do your own research and don;t use this as the sole basis and come after me)
1> Tendon from knee cap: They take one middle one-third of the ligament along with small bone fragment from each end from your the knee cap. They have to make additional 3 inch incision on your knee to get the ligament. As there is bone on both the ends, it has string bone to bone fix.
Issues to consider:
a>The main disadvantage is the it will weaken your knee cap and you have to take care of it as it can break if you have a fall after the injury. Some views mentioned that the knee cap ligament strengthens with time.
b>Another disadvantage is more pain (especially while kneeling) and longest recovery time.
c> Longer surgery time as they have to get the tendon from your body
2> Hamstring/Quad tendon: Instead of kneecap, they get a tendon from hamstring/quad. As there is bone on just one end, the fix is not as string as other two options.
Issues to consider:
a> No additional risk of knee-cap fracture during or after the surgery.
b>Less pain than knee tendon and medium recovery time.
c> Longer surgery time as they have to get the tendon from your body
3> Tendon from another body: Here they take tendon from another donor's dead body. This procedure is shortest and has the least amount of pain. There is no incision to get the tendon from your body. Also as most probably the tendon has bones on both ends, it gives similar strong fix at both ends as in knee cap tendon.
Issues to consider: Though this is the least painful and shortest recovery options, one has to consider the following issue.
a> risk of infection, including viral transmission (HIV and Hepatitis C), despite careful screening and processing. The risk is less than one in million and as per Dr Bach, last known case was in 90's.
b>Bacterial infection due to incorrect sterilization. According to doctor back the probability of this is 1 in 200 to 1 in 300 and he has seen 6 cases in his life. Using a well known hospital will help. If caught early, he mentioned that they can open the knee and flush the tendon. Some articles have mentioned that this has led to deaths too in extreme cases.
Finally, here are some facts to consider:
1> There were about 42,636 car accident deaths in 2005. An average of 115 persons die each day in motor vehicle crashes in the United States -- one every 13 minutes. According to the World Health Organization about 3000 people die in crashes each day worldwide.
2> There are 6 billion people in this world and 300 million in USA.
You are much more likely to die in a car accident in US or World (unless you live in remote part of the world) 300 million US population than get an HIV virus through donor's tendon.
Overall, which ever method that you feel comfortable with is fine as long as you use an experienced doctor and well known group. Success of surgery has high correlation with the skill of the doctor and post surgery physiotherapy discipline. If you are in Chicago, I would recommend Dr Bernard Bach, based on my experience with him so far.
Another decision variable is when to go in for surgery, I would suggest give it at least 2-6 weeks, but don't wait years like me. You will wear your joint unnecessarily.
Sunday, March 16, 2008
The Life during the next 24 months
Over the next 12 months, I started taking care of my knee to the extreme. My only exercise was walking. I had already given up skiing and soccer. I did play some volley ball games. During this period, my knee started stabilizing as I took care of it.
Slowly the rest of my muscles compensated for the ACL even more. I would experience some pain when I twisted in volleyball, but other than that, I could dive for the ball. I would say that as I cautious of my knee, I would experience pain on an average of just once (1-2mins) in about 2 hours of play time.
During the third year with the injury, I also incorporated tennis and racquet ball which require some twisting and turning and is considered medium level intensity with regards to ACL injury (skiing & soccer is high intensity, running and cycling is low intensity). During the last 6-9 months, I was playing competitive racquetball and pushing my self to the extreme (with care...I know it is an oxymoron). During this time, I had started weight training for whole body except the left leg. Since Oct 2007 - Feb 2008 I lost 10 pounds and again started enjoying my active lifestyle that I had been craving since my knee injury.
Slowly the rest of my muscles compensated for the ACL even more. I would experience some pain when I twisted in volleyball, but other than that, I could dive for the ball. I would say that as I cautious of my knee, I would experience pain on an average of just once (1-2mins) in about 2 hours of play time.
During the third year with the injury, I also incorporated tennis and racquet ball which require some twisting and turning and is considered medium level intensity with regards to ACL injury (skiing & soccer is high intensity, running and cycling is low intensity). During the last 6-9 months, I was playing competitive racquetball and pushing my self to the extreme (with care...I know it is an oxymoron). During this time, I had started weight training for whole body except the left leg. Since Oct 2007 - Feb 2008 I lost 10 pounds and again started enjoying my active lifestyle that I had been craving since my knee injury.
Saturday, March 15, 2008
The first 12 month with ACL tear
During the study abroad, I was careful about the knee, but still didn't take it seriously. I played basketball and did rowing. I even jogged for 2-3 days a week for a month in Paris.
I even played football (soccer) with some locals in Amsterdam during my roadtrip in Europe. I had a chance to play football(soccer) for the first time in a football crazy country and couldn't refuse the offer when some locals whom we had befriended there asked me. So, I just packed my knee with two layers of bandage and went to the field. While we were getting ready, I told my road trip mate that I shouldn't with my knee. Anyway, I started cautiously, but soon after scoring a goal became aggressive and hurt my knee again. As I was the only driver, I drove all the way back to Paris driving a manual car. Luckily or me my trouble knee was left knee and if I anticipated well, I didn't have to use clutch much on the highway.
After coming back from Paris, I gave up on all forms of physical activities and became more conscious of my knee and protected it. In Sept 2005, I got another MRI done and the prognosis was that I had arthritis. My doctor said that I was too young to have arthritis and it was just that the bone against bone has led to wear on my bone.
The second opinion was with Dr Bach, on recommendation from one of my doctor friend. His analysis was that the rest of my muscles are compensating for the knee and hence it is stable. I could lead a non active lifestyle with this knee and will not need a surgery. But, if I wanted an active lifestyle, I should get a surgery done.
As I was traveling to India, I postponed the surgery to after the India trip and then I had to go to London, so the surgery got delayed indefinitely.
I even played football (soccer) with some locals in Amsterdam during my roadtrip in Europe. I had a chance to play football(soccer) for the first time in a football crazy country and couldn't refuse the offer when some locals whom we had befriended there asked me. So, I just packed my knee with two layers of bandage and went to the field. While we were getting ready, I told my road trip mate that I shouldn't with my knee. Anyway, I started cautiously, but soon after scoring a goal became aggressive and hurt my knee again. As I was the only driver, I drove all the way back to Paris driving a manual car. Luckily or me my trouble knee was left knee and if I anticipated well, I didn't have to use clutch much on the highway.
After coming back from Paris, I gave up on all forms of physical activities and became more conscious of my knee and protected it. In Sept 2005, I got another MRI done and the prognosis was that I had arthritis. My doctor said that I was too young to have arthritis and it was just that the bone against bone has led to wear on my bone.
The second opinion was with Dr Bach, on recommendation from one of my doctor friend. His analysis was that the rest of my muscles are compensating for the knee and hence it is stable. I could lead a non active lifestyle with this knee and will not need a surgery. But, if I wanted an active lifestyle, I should get a surgery done.
As I was traveling to India, I postponed the surgery to after the India trip and then I had to go to London, so the surgery got delayed indefinitely.
The Pop that I never heard
I broke my ACL while playing in a Chicago Soccer league. We were playing the semi finals and I was late for the game. I took the field as soon as I reached there and hence didn't get a chance to warm up.
Within 15 minutes of the start of the game. I reached for the ball with my left leg, but my opponent removed the ball before my foot could reach the ball. I landed on my left foot. As I was expecting to move the ball forward with my leg and move ahead, my body was following my leg. When the ball was removed, my foot landed on the ground with my whole body behind it. Due to the forward momentum of my body, my foot got twisted and resulted in the initial ACL injury.
Most people hear a pop when they have an ACL tear. It happened so quickly that I didn't even know what happened. At that time, I thought that it was just a sprain in the leg and would get better in a day or two of rest. I couldn't put my foot on the ground and I remember a guy asking me if I heard a pop. He said it could be ACL injury, but I was sure it was just a minor sprain and nothing serious.
I stayed on the field cheering my team. planning to come come back for the finals. (Though we lost that match and reach the finals). Later after the pain increased that night and stayed on for two weeks, I realized that it was something serious. That was the first time I did some research of ACL injury and just the thought of surgery scared me to hell.
Of course, I was all set to go to HEC, Paris for a study abroad and hence didn't want to ruin my French vacation...er I mean study abroad. So, no surgery for me.
Within 15 minutes of the start of the game. I reached for the ball with my left leg, but my opponent removed the ball before my foot could reach the ball. I landed on my left foot. As I was expecting to move the ball forward with my leg and move ahead, my body was following my leg. When the ball was removed, my foot landed on the ground with my whole body behind it. Due to the forward momentum of my body, my foot got twisted and resulted in the initial ACL injury.
Most people hear a pop when they have an ACL tear. It happened so quickly that I didn't even know what happened. At that time, I thought that it was just a sprain in the leg and would get better in a day or two of rest. I couldn't put my foot on the ground and I remember a guy asking me if I heard a pop. He said it could be ACL injury, but I was sure it was just a minor sprain and nothing serious.
I stayed on the field cheering my team. planning to come come back for the finals. (Though we lost that match and reach the finals). Later after the pain increased that night and stayed on for two weeks, I realized that it was something serious. That was the first time I did some research of ACL injury and just the thought of surgery scared me to hell.
Of course, I was all set to go to HEC, Paris for a study abroad and hence didn't want to ruin my French vacation...er I mean study abroad. So, no surgery for me.
Friday, March 14, 2008
My surgery is on 20th March
I am starting this blog to inform friends and family about my Knee Arthroscopy surgery and rehabilitation. I will be updating this pretty frequently for the first two month.
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