Overview
ACL reconstruction is a surgery to replace a torn anterior cruciate ligament (ACL) — a major ligament in your knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as basketball, soccer (my case), football, downhill skiing, gymnastics, etc. They can also occur with other activities including dancing (I guess dancers have to be careful too). In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor (my case). This surgery is an outpatient procedure that's performed through small incisions around your knee joint.
ACL reconstruction is performed by a doctor who (hopefully) specializes in surgical procedures of the bones and joints (orthopedic surgeon).
My Case
After having one ACL reconstructive surgery, or any type of surgery, you think of every physical activity differently, and psychologically you are always worried about re-injuring yourself. In most cases, you find yourself trying too hard to avoid tearing another ligament (my case). At least, that’s how I felt.
It’s similar to being in a war zone; you find yourself ‘dodging’ bullets or experiencing a form of Post-Traumatic Stress Disorder. Even when I am at a concert, a football game, a bar, or a club, I find myself watching my steps and being extra careful about how people walk or interact around me. You pay attention to who is around you and stay away from those that are drunk. I was never like this with the first two surgeries, but after four ACL re-construction and one Medial Collateral Ligament (MCL) surgery, your mind changes. I had even given up on soccer. Now, this was hard, because soccer is my heart and giving up on a sport that I have played my entire life was very hard, but I had to give it up.
Although I could not play again, I could still watch or be around the game. It had been 16 months since my last surgery and I was starting to miss playing again. My company has a soccer team and with all the temptations of joining the team and playing, I knew I couldn’t play for the team. Your chances of getting re-injured get higher with every surgery. I knew this, and I was not going to risk it. So, I did the next best thing, I decided to coach my team instead. We were one of the companies in the Tech Soccer League in Pittsburgh, PA. Every company in the league was a tech company or tech start-up. It was fun coaching and I just love being around soccer and watching any type of soccer game. I have been playing this game since I was 9. I have played in England, Asia, Canada, and the USA. I have played in college, the military, and on a semi-pro soccer team in South Korea. Soccer was my thing and I just wanted to be around it. I managed to go over half the season just coaching, then suddenly, one sunny Saturday, I was drawn into the temptation of giving it a shot. I just wanted to try it out and then I was hooked. The team needed my help, so I said I would only play for 20 minutes, but I liked it so much I played the entire game.
I went home that evening feeling so ‘good' and happy. I had missed playing and although I knew I should not be playing, I was hooked and there was no stopping this guy. Time went by and I was three games in and I was having fun. The 4th game was when it all happened. I really wished I didn’t play this particular day as I had a feeling something was wrong, but I pushed myself even though I was tired and didn’t feel too well.
Fast forward from then to now and here I am with a recently reconstructed ACL on my right knee, lying here and heavily medicated writing this blog for my daughter.
When I had my first serious knee injury at 18, I was not too sure what an ACL or MCL was. I did not know much about all the ligaments in my knee. Now, it's been several years since that first surgery and now I just got my fifth surgery and the second ACL reconstructive surgery on my right knee. It is 2019 and I am beginning the year in bed with this pain. I wish I could go back in time and do things differently. When you are young, active, and in good shape, you tend to get this feeling that nothing serious will ever happen to you and if it does, you can always bounce back like a superhero.
With my experience and history with this injury, when I play now, my focus is on avoiding a collision at all cost. I try to position myself to avoid any chance of colliding with anyone. I believe this fear is partly the reason I tore my ACL the second and third time. The fourth surgery was because I had a lot of pain from the third and I had to have another surgery to fix the previous surgery.
Timeline
09/15/2018 – The soccer game was happening on this day and although I didn’t feel like playing, I knew I could not let the team down, so I decided to give it a go and play. I was playing up front as the striker, but I decided to run back for the ball. With the ball on my right foot and running to pass the ball, I had a defender approaching me and I decided to quickly change position and pass the ball to the midfielder to my left. I believe the quickness of the change in position caused my knee to twist and I heard that pop sound and the pain followed immediately. I knew I had torn my ACL. After all, I had been through these a few times already. The weird thing about tearing your ACL is that everything happens so fast and after a few minutes it feels like your knee is normal again. I even jogged around, and I thought it was just a false alarm. I was actually thinking of jumping back in and playing. My knee was swollen but it felt stable, but I decided to sit it out and just watch the team play. Although it felt stable, I felt the pain when I got home. I took a long bath and iced it. This is when I believed I had torn my ACL for real.
09/19/2018 – My first appointment to evaluate if I had torn my ACL or if it was just a sprain. Physical examination tests can accurately reveal the injury with some simple movements of the knee. These ACL tests easily demonstrated a lack of stability in my knee. I took some x-rays, but x-rays are not best at showing results from your ligaments. My doctor then referred me to get a Magnetic Resonance Imaging (MRI) and to have an orthopedic evaluation.
10/04/2018 – The day I took my MRI images for evaluation. Having MRI images of the ACL is a very important step and most orthopedic surgeons want to see these images to confirm a tear or not.
10/09/2018 – My appointment to see a specialist to get my MRI images and my knee evaluated. Normally, the ACL is a dark structure in the center of the knee. In this case, the ACL is completely blown apart. There was also evidence of an MCL tear which was scary to me. I am now not only going through an ACL tear but also MCL tears. This appointment was very important to me as we had to make some decisions on if I wanted to go along and have surgery and if so, what type of grafts to use. I could have elected to try to rehab my knee and hope to get it strong and healthy, but I elected to go for surgical reconstruction. Even with this decision, I still had to think of the type of grafts.
The three common types of materials used for ACL grafts are a portion of a patient's patellar tendon, a portion of a patient’s hamstring tendon, or a portion of a tendon from a cadaver. I am not too sure which is more superior to the others, but it is good to do some research and try to go with which one your surgeon is more familiar with. I have had all three of the ones listed above, and to me, the most important thing is to get a good surgeon that can give you a strong graft.
01/15/2019 (A day before surgery): I got a call from the hospital with the time of my surgery. I was scheduled to check in at 6:00 AM the following day. I was asked not to eat or drink anything after midnight and I had to shower that night and the following morning with an anti-bacterial soap like dial. I was very anxious and worried. I couldn’t believe I had to go through this surgery again.
01/16/2019 (The day of the surgery):
I woke up at 4:00 AM and started getting ready for my surgery. It was a 15 minutes' drive from my house to the hospital, so getting there by 6:00 AM was not a rush. The entire team at the hospital was super professional and helpful. This has to be the best experience I have had in all my experiences with these surgeries. Everything went smoothly and everyone at the hospital answered all my questions. The surgeon went through the procedure again and answered all my questions. I was moved to the surgical room and general anesthesia was used. All I remember was talking to the nurses one minute and the next minute I was lying in bed with a brace on my leg. I had just gone through the surgery and I was highly medicated. I had no pain but could hardly open my eyes. I was very tired and sleepy.
01/17/2919 (The Day after Surgery): By 5:00 PM, the following day, I started feeling like I have a knee. The past 32 hours, I did not feel my knee or have any pain because of the nerve block. Why don’t most hospitals use this? I have gone through a few ACL reconstructive surgeries on both knees, but this was the first time I was given a nerve block.
Post-Surgery: The nerve block weaned completely out after about 46 hours and you start feeling pain but I stayed on my pain medications so that was not an issue for me. I did not see my Physical Therapist until day 8, so, I had to do some light exercises on my own. I will do leg raise exercises while I am watching TV. Showering is hard, and you will find doing most things very difficult in the first few days after surgery.
This will include, using the bathroom, eating or just going from place to place. Even though you will find these things difficult to do, they are not impossible. You just have to plan ahead and before your surgery.
Conclusion
