Since I started writing for Flyers Faithful, a lingering thought has been in the not-so-distant depths of my mind to write about ACL injuries. It was not so long ago that a torn anterior cruciate ligament of the knee was a death sentence of sorts for most athletes. It is an injury that is near and dear to my heart, or knee, rather. This will be a multi-part contribution as I am able to give medical, surgical and patient perspectives on this particular injury. I’ll start with the patient perspective.
It was a gorgeous, albeit hot, Saturday in May in 1998. I was a senior in high school and my lacrosse team was competing for an unofficial state title. We were playing well and it was just before halftime when I was carrying the ball up the sideline. There was a midfielder from the opposing team running with me that was exceptional at stick checking, though at the time she was swinging, missing and coming awfully close to my head.
So, there I was, running up the sideline, looking for a teammate to pass to and planning to time my move with one of her swing/misses because I knew I can take advantage of her momentum going the opposite way that I wanted to go. She swung; I ducked and planted my left foot to cut around her, simultaneously. As I planted and began to cut I felt a “pop” in my left knee. Most people say they hear a pop with this injury; I didn’t hear one, but the people in close proximity to me did. I feel a huge pop, but there wasn’t really any pain right away, so I made a feeble attempt at another couple of steps. I knew in the back of my mind that I wouldn’t be able to finish the game. In that instant, a million thoughts swam around my head like a heavy dark storm cloud. The logical part of me knew exactly what I did, but the hopeful part of me tried to convince the athletic trainer on site to tape it up so I could finish the game. He was pretty sure I had torn my ACL and would not let me finish the game.
I had to keep it together on the sideline, but my heart felt like it was in the pit of my stomach as I cheered my teammates on. I had not yet made a decision on where I was to continue my playing career at the next level and I feared this injury would force a decision that I did not want to make, and most of all, I hoped that the decision would not be made for me and that potential coaches would be willing to work with or around this obstacle.
I spent the rest of the day on crutches; still bearing weight on my unstable knee, but trying my best to walk as normal as possible. The next week was a blur. I had a knee immobilizer to wear until some of the swelling decrease and was put on a strict RICE regimen. Crutches? No thank you. I avoided those like the plague. A trip to the orthopedist and an MRI was ordered. The MRI was painfully difficult to remain motionless during because I was having some muscle spasms in my quads. The MRI nonetheless gave further confirmation of my injury: a complete rupture of the ACL and a 2nd degree sprain of my MCL. Surgery was scheduled for early June; an ACL reconstruction. I was told it could take 8-10 months for rehabilitation and it would probably be a year before I was 100%. In an ACL reconstruction, a new ACL is fashioned from tendons harvested from the patient (an autograft) or tendons harvested from cadavers (an allograft) and then grafted into place. My choices for graft material included: hamstring, allograft (from a cadaver) or patellar tendon graft. I opted for the patellar tendon graft and surgery was set.
I made some much dreaded phone calls, but luckily most of my potential collegiate coaches were still willing to gamble on me and some suggested that I would be better off red-shirting my freshman year of college even if I hadn’t suffered the injury. I missed out in playing with my state’s team in the national tournament later in May, but I made the trip with the team for moral support. I wish I could say I stayed in shape while awaiting surgery. The swelling in my knee went down and I had full range of motion, but I did not participate in any formal physical therapy prior to my surgery as most athletes do.
In June I was set to have surgery and was all but in the operating room, when my irregular heart beat made the surgical staff nervous and they decided to postpone surgery until I had clearance from a cardiologist. What was one more obstacle, right? My heart was fine and I learned that I could jog at an incline on a treadmill for a stress test with a torn ACL. Hopefully, I won’t ever have to use that particular hidden talent ever again.
The part of this whole injury process that I didn’t expect, was the degree of mild depression that I went through when I was suddenly unable to play sports. I was cautioned not to run. A pickup basketball game with friends was out of the question. I went from being a part of the team to almost complete isolation. This is an often overlooked part of athletic injuries and there is a definite sense of loss when your favorite way of spending time is suddenly taken away. I believe this to be common to every athlete at every level of play, but it is very overlooked and not commonly discussed part of athletic injuries.
Fast forward to when I actually had my surgery in July. My surgeon decided inpatient surgery complete with an overnight hospital stay was the best option because, even though I was fully cleared by cardiology, my irregular heart rhythm made the staff too nervous to proceed in an outpatient setting.
Surgery day was a blur. No eating after 8pm the night before. Arrived at the hospital and checked in. Put on an awful hospital gown. IV started. Said bye to mom was taken to the O.R. via stretcher. Got on the O.R. table and chatted to the anesthesiologist about who knows what. I can’t remember what was said, or if she had me count backwards or say the ABCs, but in an instant I was out and it seemed like it was only for a minute because the next thing I knew I was woken and freezing cold. The warm blankets that were piled on my shivering body were very much appreciated.
I was in a continuous passive motion (CPM) machine from the start of my recovery (in the hospital). A CPM machine basically moves your leg in a set range of motion in a continuous cycle. I was a groggy mess in the hospital because they had me on a morphine pump and it was recommended that I stay ahead of the pain. Midway through the stay I was moved to the cardiology floor, because of the heartbeat thing. Unfortunately for me, the cardiology nurses actually dropped my leg at some point and if I never experience that kind of pain again, I will count myself lucky.
They did have me up walking around with crutches that first day and I had exercises to do from my first day post-op and on. Aside from my leg being dropped the most excruciating pain came from dangling my legs at the side of the bed before getting up. The feeling of blood rushing down the length of my leg was pretty intense, but after being up and walking on it over the next few days it got a lot better. It was also extremely difficult for me to “remind” my quad muscles how to function when doing my first few sets of prescribed exercises.
Formal physical therapy started 2 weeks later and I was lucky enough to have an excellent therapist that entertained the no pain, no gain philosophy where range of motion was concerned. I could take the pain and it worked, but wow did it hurt. I can proudly say that I didn’t cry, but there were times when my therapist was working on my range of motion where my heal was on a foam block and my therapist was practically laying on my knee to work on full extension that I wanted to pick up the neared object that I could successfully bludgeon him with. Flexion range of motion was more of the same with me laying on my stomach and my knee being bent into flexion by the therapist. we both escaped without any extra bloodshed or violence, but that was one of the more unpleasant aspects of rehab and also one that I am thankful for, since range of motion will often dictate the pace and speed of recovery. The goal was to get from 0 degrees to 130 degrees and I had only been allowed right around 90 degrees of flexion for the first couple of weeks.
Physical therapy progressed to strengthening exercises and at around 2 months into my rehab, I had to leave for school, so my therapy was put in the hands of the athletic trainers at school. It was here that I was introduced to ice baths and even more unpleasant strengthening exercises. By month 3 I was able to run and in months 4 and 5, I progressed to some plyometric exercises. I went through periodic strength testing to measure the degree of strength difference between my right leg and left leg. The goal was to have equal strength in both legs and by the end of month 5, my strength was 100% and I was cleared to play. Getting back into game-ready shape was the final challenge and by the start of the next season, I was ready.
I did wear a brace initially, but ditched it the summer following my surgery. I played a full 4 years of collegiate eligibility and didn’t have any hiccups in my recovery or after my recovery, for that matter. I do have a scar on my left knee and some residual numbness in the skin on the outside of that leg starting at my scar in a 4 inch by 4 inch area. The numbness has never really bothered me, though I prefer not to touch it because it’s a weird sensation.
Make sure you come back next week to read about ACL injuries from the medical side of things.
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