ACL Repair Rehabilitation Works
Tempe, Arizona, October 2, 1996 around 5:45 PM, I was on my bike traveling Eastbound on Guadalupe Road approaching its intersection with Hazleton Avenue. A van and a car fly past me (in the same direction)they are going at least 50 mph. I see my nemesis waiting to make a left turn from the west bound lane of Guadalupe. He is stopped. As the cars that passed me move past him, he starts to move. I stop pedaling the bike. He hesitates, I take this to indicate that he has seen me and resume pedaling at my top rate. I am hoping to get through the intersection before he starts again. The pulse of traffic coming up behind me sounds close by. Oh no, the driver of the Lincoln has decided to try and beat the pulse.
I have to decide what to do in less than a second. Swerving to the left into the traffic pulse is ruled out first, I'm not suicidal. Perhaps, a sliding right turn, no aside from the road rash, my legs would end up under his wheels and the bike would be totaled. I am left with ramming him.
I brake hard leaning in towards the car, my center of gravity kept low. If he has enough speed, the bike will be wiped out, but I'll be able to flip over his trunk and minimize my injuries. About 3.5 seconds from when started his turn, I impact with his car at its mid point with my front tire. There's no way to get overt he entire car now, so I brace myself and my left knee slams hard into the rear door. Pain shoots from my knee, my helmet hits the top of the door, and I fall backwards to the pavement.
Shock settles in very quickly, numbing my pain and allowing me to assess my damage. I know my knee is in bad shape. My rear view mirroris a few inches from my feet. I find almost no damage toanything except my left leg. My left hand has the knuckles scraped, butnothing else is wrong! I succeeded in minimizing my injuries.
Unfortunately, the injury to my knee was muchworse than I had anticipated. My wife, Sue, scolds me for riding mybike to work, and acts concerned. Insurance companies being what theyare, Iwas given very good advice from the urgent care center's doctor oncall. She tells me I'll need an MRI of the knee, and if I intend tocontinue riding my bike I should be sent to a sports medicinespecialist.
She isn't my primary care provider, and hechooses to ignore her advice, since his first goal is to save thecarrier money, not to let a woman doctor tell him what is best for apatient that had never been in his care prior to this case. It took him weeks, and I had to send several email letters to both the president of my health insurance, and noticeably copied were every news organization in the area, before the MRI is performed, and the same day he got the results, miraculously I was referred to an Orthopedic surgeon that specialized in sports medicine.
It's at this point I entered the care of Dr.Randall Hardison. I was told my anterior cruciate ligament had been partially torn. The injury was repairable through surgery, but I wasn't considered a viable candidate for the operation due to my age. At 43, a little over the halfway point by the actuarial tables for living, I would be left permanently disabled because some bean counter's statistics said it would be cheaper to teach me how to live with the injury than it would to fix the problem! Time to send out more letters!
Dr. Hardison and I decided to see what kind of recovery I was capable of achieving without getting the surgery. For six weeks, I went 3 times per week for physical therapy. I did exactly what the therapist asked of me, and my condition continued to deteriorate. The knee became more unstable at every session. Where I had been able to balance on my left leg for about 60 seconds (with a fair amount of pain) at the start of the therapy, by the end I was down to less than 15 seconds.
Something more radical would have to be done, or I faced losing all my favorite activities. I was being forced to give up playing volleyball, tennis, hiking, biking, kayaking, rafting, and I couldn't drive my car very well (it had a clutch). All parts of my life were affected.
The insurance carrier said a brace would be the next step, I felt it wasn't. Dr. Hardison and I talked it over and concluded that a brace would only get in my way, and would never be able to give me the ability to participate in my sports. A brace would have to be worn every day, for the rest of my life, in addition to limiting my activities, in order for me to have any kind of enjoyment. Surgery would have to be performed.
January 13, 1997 about 8:30, I entered the Desert Samaritan hospital for my ACL repair. I felt nervous, but glad to be there. All forms were signed and I waited in the staging area for Dr.Hardison to finish with his first patient of the day. The anesthesiologist injected me with Sodium Pentathol and Demerol; my head started spinning and then oblivion. I have no recollection of the operating room.
For those of you who are curious, but not squeamish, scroll down to see actual photographs of the operation that was done by Dr. Hardison.
I came to and noticed the sounds of machinery.I could hear a water circulator, and some mechanical device. I knew that my surgery was done. I felt very thirsty and soon I was given some water. I drifted off to sleep a while longer.
By 6:00 PM I felt as if I was starving.Since I hadn't had any solid food since breakfast on the 12th, this was not very surprising. Unfortunately, food and general anesthesia don't mix very well, and the after effects of the anesthesia won the first round. I would have to wait until breakfast on the 14th, in order to keep food inside of me.
Dr. Hardison makes his morning rounds before most people are awake. I was alert and ready for him when he came by about 6:00 AM. I wasn't quite ready for what he said; "I want you to do a leg raise for me." I did my best to comply. "Now I want you to bend your knee as much as you can." Once again, I did my best. The woman making rounds with him that morning seemed astonished at the result, and measured the amount of bend I was able to achieve. Even Iwas surprised. It was around 80 degrees. There was some pain, but nowhere near the amount I had anticipated.
Dr. Hardison was excited and happy. Here was a guy the insurance people had said was too old to get good results from the ACL repair, out performing most of his younger patients immediately after surgery. If I continued on in this way, I would be one for his record book.
I was given instruction in the use of crutches and told to walk placing some weight on my left leg as long as it didn't bring on a sharp pain. I was told to walk as often as I felt could, but not to over do it. Good advice, difficult to adhere to without knowing exactly what was meant of me. So I asked what overdoing it would be. "If you experience any sharp pain, stop immediately.If you still feel the pain 5 minutes after stopping, you over did it.Your goal should be to exercise without feeling any sharp pains." Dr.Hardison replied.
I was given an exercise guide, and a note that apatient had written concerning what I should expect to see. It started out saying "Day one, ouch, not much you can do except leg lifts for now. Do about 1,000 a day until you can walk without crutches." It seemed far fetched, but he must know something, so 1,000 a day would be my goal. With that, I was sent home.
Oh no, somethings not right. It said on the note, and Dr. Hardison had told me that a machine was to be sent home to circulate ice water through the bandage, and to keep my knee in motion when I wasn't exercising or walking. I was home for over an hour and neither machine had gotten there. Pain was starting to set in very hard.
I took a pain pill and waited some more.The motion machine arrived. No ice water machine. I put ice packs around my leg, no relief from the pain. I took another pain pill. Sue was now very worried, as I almost never take medicine for pain. She called to find out what had happened to the other machine. I need more ice, I can see my leg is swelling, and there is nothing I can do except put ice packs around the leg and wait. The pain is more than I have ever encountered and I am told that I can take one more painkiller, but would experience an overdose if I took any more than that within then ext 4 hours. It doesn't help! I try using the techniques for pain relief Susan and I had been taught when she was about to deliver our sons. I agree with her, they don't work very well!
At 5:00 the ice machine arrives, and input into immediate action. By 6:00, My pain is diminished. It's amazing how just cooling off the site of the surgery miraculously eases pain.The swelling also noticeably improves. The relief is such that I nod off from my near over dose.
Day 2, by keeping the leg in motion through the night, I am able to tolerate a bit of weight, but not as much as I had while in the hospital. I am able to get 1,000 leg raises done, and find that I can tolerate the pain better. I try to flex my ankle up and down, as that is supposed to aid in decreasing the swelling.
Day 3, in the morning, I take what I hope is my last pain pill. I know from past surgery on my elbows, that rehabilitation of any joint can only be done safely when medication for pain is absent. The leg lifts and the flexing of the ankle seem to go better.
Day 4, I make another mistake. I decided that I needed to take a shower. I prepare for entering it, and find that although I was able to unwrap all the bandages, and I can bend my knee a bit more than 90o, I can't raise it from the floor to a height that allows entry to the tub. I washed off with a washcloth as best I could.
Day 5, I feel pretty good. It's a nice day, and I try taking a walk outside with my crutches. Life is good! I make it around my apartment building twice! No sharp pains were felt.I'm beginning to think the surgery has been worthwhile.
By the time I saw Dr. Hardison 8 days after surgery, I had increased my walking distance with crutches to about 1/4 mile. I still had felt no sharp pains, and was still doing about 1,000 leg lifts a day. He seemed elated with my progress, and a bit concerned, as the area he had removed the graft from was still too tender to remove the stitches. He decides to have me return in about a week, and then tells me, "If you want to recover fast, you'll have to get rid of the crutches. If you're up to it, I'd like to see you walk in to my office without crutches."
I continued exercising, and walking as much as I could. It seemed crazy, but by using the crutches less, the pain seemed to subside more. I had to ice my knee more often, but not to get rid of pain as much as it was to keep the swelling down. I found that no amount of exercise was too hard to do, as long as I adhered to the exercises given to me. Getting in the shower, took a lot of effort, as the movement required of my knee in bending to get over the edge of the tub was not among the ones listed for me to practice. I could do it,but it didn't feel too good.
On the 14th day after surgery, I put my crutches in the closet. I then went out for my walk. I got my first quarter mile lap completed, no problems! I started around the lake a second time, I heard someone walking behind me, I stepped off the path,and one of the elderly ladies walked past me (she used a walker). I started around behind her, but she was too fast for me to keep up with,what an embarrassment! She lapped me 2 more times, but I was now determined that even if she was faster, I was going to out last her! I walked for 4 laps longer than she did, making my walk 2.5 miles that day. When I reentered the apartment, I collapsed into the sofa and begged my wife for ice. She chastised me for overdoing it, but even shews proud of the distance I was now able to walk.
My next appointment with Dr. Hardison was on the 16th day after surgery. I walked into the waiting room and took my seat. When my name was called, I got up and walked towards the door.I got into the examining room and the nurse who had been looking at my chart suddenly realized I had no crutches. She started to scold me,when Dr. Hardison stopped her with the words, "That's my protocol! I want to see how well he does, and he's doing exactly what I told him to do." When he entered the room, he seemed very surprised that I had an excellent range of motion, and very little pain. If I continued to improve at this rate, I would be among those who made the fastest recovery, but I had to watch out as it was very easy at this point to tear the joint apart by doing the wrong kinds of things.
I looked at my new set of instructions,and asked questions about things on it I didn't understand. Physical therapy was scheduled so that my exercises could be introduced in proper form, and order. Range of motion was going to be more important at this stage of recovery than strength. You can increase strength at any time, but if you strengthen a joint that has limited motion, you can easily build up too much muscle mass to allow the joint to regain its full range of motion. So I did lots of stretches and used "baby weights". I felt very foolish going to the gym and using less weight than everybody else did, but I only have this one chance to regain my lifestyle and I was not going to let my pride ruin it.
I stuck to the schedule, and Melissa and jenny (my therapists) made sure my form was correct. When exercising,using the correct form is extremely important. Your goal is to train your muscles to do their job, and your recovery is dependent upon using the correct muscles in the correct order. With all the torture it seemed like they were having me put through, I knew that hard work at this time would pay off nicely when I was allowed back on my bike, or when I hike out to Sunrise Arch in the Fall. My favorite activity, at this time, came from going in the pool. All of the exercises I was doing in therapy were repeated in the water, but because water eliminated the weight and is cooler than body temperature, I didn't need to ice the knee after the pool workouts.
Every week, it seemed that progress was clearly being made. Melissa would increase the number of reps or the weight if I looked like the workout was going easy. The lazy me wanted to act like the knee was too sore, it was much harder to work at recovery than I had thought it would be. The truth was that I was motivated more by my desire to get back to being active at play, than I was lazy, so I struggled through the workouts. My knee wasn't really in pain from the activities, and I actually found that most of them were helpful.
Six weeks and a day after surgery,another visit to Dr. Hardison, my knee has shown tremendous progress. I am pleased with the results, and so is he. I am now able to walk faster than the old ladies, and I regularly am walking 3 miles or more. My range of motion is close to 125 degrees in my left knee. My right is 146. I'm given anew set of instructions (I am able to cut down to 200 leg raises per day), and told to keep up the good work. I am still told not to over do it, as the graft won't be healed well enough to stand up to any abuse no matter how minor. Just one more thing to talk about!
We are moving into a new house before my next visit with Dr. Hardison, and I am concerned as to what I will be able to do to aide my wife in this endeavor. She had to pack up 90% of our house when we moved out to Chandler, AZ from Trenton, NJ, and I don't want to have her repeat that much work again. Dr. Hardison's advice for me, "If it's at table height and you can lift it and carry it without pain, go ahead. Under no circumstances try to lift anything off of the floor. If you do this correctly, you can be riding your bike again on March 15th."
Had I heard him correctly, I can return to my bike by March 15th? I'll be able to feel wind in my face, and hear the chain as it rolls through the dérailleur? There's no way I'm going to lose this chance. I give my new instructions to Jenny. She tells me I'm in for a much tougher workout each time I come in, but that I'm probably going to like the last exercise. She's right on all counts, but I'm ready for anything (boy was I wrong)!
It's now time to work on the dreaded step exercises. None of the exercises prepares you for the step-downs. Theyare harder than everything else combined is. Melissa scolds me about my form,and the exercise doesn't get any easier with the right form. I'm asked to do 2 sets of 15 reps each. My knee starts to shake by the 20th one,and Melissa mercifully tells me to just do 5 more. Somehow, I made it through those, and determined to finish my set.
"I did it, now is it time for the ice?"I asked. "Not until you finish 10 minutes on the bike." She replied. I get to ride now, after 5 months I get to place my feet on pedals, I'm elated by the thought of using a bike after all this hell (so what if it won't get me anywhere)! I pedal the bike, imagining I'm out on the road with a cool breeze blowing across my face (it helped a lot to choose the one nearest the air conditioner's vent). I ride the stationary bike with a steady pace and wish the timer hadn't been set for such a small amount of time. When the timer bell rings, I continue to pedal until Melissa touches my hand and I am asked to go lay down and ice my knee. I nearly fell, as my knee still wanted to make my feet travel in the perfect circles of bike pedals, instead of the linear motion of walking. Sheepishly I allow her to assist me to the table. If a stationary bike could feel this good, I could hardly wait for the real thing!
The move to the new house went off without too many problems. I found that I could carry much more than expected, but I stayed true to Dr. Hardison's orders, and if it wasn't already at the specified height, I had Susan get it to that height for me. Movers took care of the furniture as planned, but I moved most of the smaller things.
I returned to work on March 14th. I chose to go for several reasons, not the least of which was that it was a payday. My boss was glad to have me back, and I was happy to be back.I still had limits on lifting things, and at least twice a day I climbed the stairs for exercise (seven floors up, 3 floors down and an elevator ride the rest of the way (as per Dr's orders). By returning on the Friday before Spring Break at ASU, I also avoided having lots of new work dumped upon myself (the general thought was I'd be out until after the break). I thus had plenty of time to continue exercising.What a life!
Saturday March 15th, dawn came and I woke my son and told him to get my bike ready to go. He pumped up the tires,and I checked the rest of it. I would be taking my first true ride since my accident. It also happened that most of the route would be the same as that fateful trip. Shortly after 9:00, I kissed Sue and started off with David, my oldest son. The plan was that if I had any trouble at all, we would either turn back, or call for assistance. With only 1 bridge that would have to be crossed twice (a minor rise that was considered verboten by the Doc.), there were no hills on this route.
As the wind hit my face, the sun warmed my back and my feet traveled in their perfect circles, I felt once again the joy of riding! Strangely, it was David who tired first, I guess teenagers are lazier these days. To think, my first ride in five and a half months was a 25 miler. The ACL repair must have been done right!
At my most recent visit, I have 146oof motion in each knee. I have no difficulty walking or going upstairs. Swimming is a no problem sport! I'll follow the orders, for they have given me more freedom than my insurance carrier could have expected (even with my current limits I'm better off).
It's now been over 12 years since the surgery. My range of motion is equal. the strength of my left knee is about 98% of my right and I have no problem with regards to weather changes. Life is real good!
For those that would like to see photographs taken during my operation, continue scrolling down.
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