Diary of Patient Physio: An ACL Injury ~ Part 1

In this four part series, Physiotherapist James Pearce discloses his own feelings, concerns and fears as he undertook his own knee reconstructive surgery.

As a physiotherapist who routinely consults and treats many people with ACL injuries, when I ruptured my own ACL, I decided to write this blog and give an insight into the recovery and rehabilitation process from a physiotherapist’s perspective.

The blog will be broken into a four part series: Injury to 2-weeks post-operation; 2-weeks to 3-months; 3-6 months post op and the final stage, return to play.

Day -6 – Tuesday 17^th May: It all began late on a Tuesday evening. I was playing at Seymour Shaw with my Lilli Pilli FC team in a State Cup knock-out match. In the 89^th minute I went to turn to my right-hand side when my right foot (toes) got caught in the turf. As my body continued to rotate and my lower leg stayed still, I felt an almighty crack and pop and my leg crumbled underneath me. My first reaction was that of severe pain. My second thought was that I knew had done my ACL. It was the classic mechanism of injury. No-one near me, a twisting/turning injury and your leg crumpling and giving way. I tried to crawl off but was in too much pain. By the time I had been helped off the field my knee had a massive effusion (swelling).  Jason who also plays for LPFC was able to have a quick look and confirm what I already knew. He was able to drop into clinic to get me a knee ROM brace and some tubigrip (compression stocking). The pain settled a little, becoming more of a numbing throb around my whole knee. I iced a couple of times, took some Panadol and hoped for the best with sleep.

Day -5 – Wednesday 18^th May: I woke up having slept better than expected and having less pain. The knee was still massively swollen and very unstable. I remained in the brace using crutches to help me walk. I was up at the practice early so Kieran could have a look and give me his verdict. He agreed that my ACL was ruptured and both my LCL and MCL looked damaged. We also weren’t sure if there was damage to my meniscus as I could barely bend my knee. Knowing I was still in a fair bit of discomfort I knew it was more than just my ACL. We managed to organise an MRI for 1pm that day (It helps being in the industry).

Having never had an MRI I wasn’t exactly sure what I was in for. I can get a little claustrophobic but I’m happy to report with a knee MRI there is nothing to worry about. It was a lot louder than I expected. The radiologist confirmed what we already knew about my ACL but in addition identified grade 1-2 strains of both my MCL and LCL. The MRI also showed I had ruptured all the ligaments in the postero-lateral corner (back-outside section) of my knee and had very significant bone bruising in both the tibia and femur. It appeared as though I had actually dislocated my tibia from my femur and on relocation my tibia had smashed into my femur leaving a dent. The radiologist thought I was lucky not to have fractured parts of them. I now understood my pain. With the results in hand, Michael did some sweet talking and was able to get me into orthopaedic knee specialist, Dr MacDessi that Friday morning.

After that eventful morning, the rest of my afternoon consisted of sitting on the lounge with my leg elevated on the coffee table icing every 2 hours.

Day -4 -Thursday 19^th May: I woke again with less pain but still plenty of swelling. I was now able to walk without crutches but still using the knee brace. My morning was all about swelling control. I kept it elevated and iced regularly. I was able to work that afternoon but cut my caseload back again. It was quite a funny afternoon to be honest. My first patient was 4-weeks post ACL surgery. He saw the funny side to my injury. My third patient was coming in for her final session before playing her first game of netball post ACL. My final patient was six months post meniscal repair surgery. He proceeded to educate me on all my VMO exercises. All-in-all the afternoon went well. Everyone loved giving me advice on how to fix my knee, with big grins on their faces but people were also disappointed in knowing what I had done.

My knee was a little sore and swollen following work but nothing some rest, ice, elevation and anti-inflammatories couldn’t fix.

Day -3 – Friday 20^th May: We were able to get an appointment with orthopaedic surgeon, Dr MacDessi today. He kindly saw me before he started his afternoon session. The appointment went pretty much as expected. Dr MacDessi physically examined my knee and then observed my MRI. He also thought I had done a ‘good job’ on it but said everything was fixable. He said if I was happy to proceed with surgery he was happy to do it. Mum came with me and when we left she just laughed and said, “I had no idea what you two were just saying in there”. I then had to explain to Mum without all the medical/physio jargon what we had discussed.

Day -2 – Saturday 21^st May & Day -1 – Sunday 22^nd May: With two days until surgery my focus was on controlling the swelling, trying to get my quads working and maintain flexibility. Most the pain had now subsided.

Day 0 – Monday 23^rd May: Dr MacDessi was able to get me in for surgery at 6pm today. Another perk of the industry! I was very lucky to be able to have the surgery done so quickly but also knew I would be in for a tough few days as my knee had barely any time to overcome the initial trauma and damage. My knee was still significantly swollen on the outside and I could only imagine what it looked like internally. I arrived at St George Private at midday and ‘checked-in’ for surgery. And wouldn’t you believe it the nurse who did my pre-screening was a patient of mine.

At 3pm I was taken into pre-op where a nurse shaved my leg then covered it in Betadine. Around 3:30pm, Dr MacDessi and the anaesthetist, Dr Bohm came and had a chat about the procedure. Dr Bohm who I had met when observing surgeries with Dr MacDessi, explained how we was now doing a spinal nerve blocks to completely numb my right leg during surgery, so no general anaesthetic was needed, only sedation. It sounded pretty cool so I was willing to give it a go.

When 6pm finally came around I was slightly anxious but ready to go. Dr Bohm injected the spinal block and what an interesting feeling it was. Within 5-10 minutes my right leg was numb. I remember trying my hardest to lift my leg off the bed but couldn’t do it. I was wheeled into the operating theatre and when Dr MacDessi arrived, I remember asking him to film the surgery for me so I could watch it after and then I was out.

I woke about two and a half hours later feeling a little groggy but otherwise ok. I was absolutely starving. My knee wasn’t too sore but I knew all the medications where still working.

Day 1 – Tuesday 24^th May: I woke with my right leg still mainly numb. I could move my ankle and toes but there was very little, if any sensation in my shin and foot. The hospital’s physiotherapist came to see me around 10am and inform me on how to use crutches, and the early stage exercises I needed to do, then I was discharged. My girlfriend had taken the day off to help me and be my nurse. I felt pretty lethargic all day so didn’t do much but ice my knee and watch TV.

Day 2 – Wednesday 25^th May: My knee was pretty stiff and sore this morning. I was still fairly debilitated so spent most the day on the lounge watching TV and icing. I began to try some of my VMO exercises and as expected found I could barely turn my VMO on. It was quite frustrating initially but I knew I had to be patient and stick with it. I also focussed on gentle bending and straightening of my knee to get my range going. My hamstring felt quite tight and like it would spasm throughout the day. I tried a little bit of self-massage which had some effect but knew I would need someone else to do it properly.

Day 3: Thursday 26^th May: My 1^st physiotherapy session and I couldn’t wait! I knew that I needed to get this knee moving and that some massage around my hamstrings and calf would ease a lot of the muscle spasm. I took two Panadol Osteo before my session as I wanted to have some Endone for after the session and I also wanted to really know how it felt when I was treating my patients. As expected it wasn’t a pleasant experience. Although Kieran was being gentle on me he was able to get fair amount of bend in my knee about 70 degrees. Kieran also got me to lay on my stomach to try and straighten my knee. I couldn’t tolerate this position very long however I knew the importance of getting my knee straight. I did some more of my VMO exercises. Physio finished with some interferential therapy for 20 mins, then home to take some Endone and ice and elevate my leg.

Day 4 – Friday 27^th May: Physio again today which was much the same. A release of my hamstrings and calf and Kieran trying to bend and straighten my knee.

Day 5 – Saturday 28^th May: Not much to report today. Essentially eight 2 hour sessions consisting of exercises for 20 minutes, icing for 20 minutes, resting for 1 hour 20 then repeat. Every 2 hours till I slept again.

Day 6 – Sunday 29^th May: Today was a bad day. Not in terms of pain in my knee but in terms of frustration and boredom. I was well a truly over having to walk with crutches and need to ask for help for simple tasks. I don’t like sitting still at the best of times so I was getting grumpy and my poor girlfriend had to cop the brunt of it.

Day 7 – Monday 30^th May: I woke up and my knee felt significantly better. I tried to take a step or 2 without my crutches but soon found I wasn’t quite ready for that. I had physio first thing with Kieran. I began some gentle hamstring curls on my stomach (with some assistance from the seat-belt) and could almost extend my knee completely over the foam roller (Inner range quads exercise).

Day 8 – Tuesday 31^st May & Day 9 – Wednesday 1^st June: Nothing much to report from today. I was home all day so just stuck with my regular procedure of exercises followed by icing, 5-6 times throughout the day. I was however able to get rid of one crutch and now only use one. My apartment isn’t massive but I certainly covered several metres doing laps up and back practicing on one crutch.

Day 10 – Thursday 2^nd June: Today was a really good day. I had another bad night’s sleep as I just couldn’t get my knee comfortable and it felt heavy all night. I am trying not to take Endone at night as I want to wean off them but I’m not sure it’s working. I had physio again early this morning. I reported to Kieran that I was now walking well with one crutch. He said that the swelling hadn’t increased with the increased load on my leg, which is a very positive sign in the recovery of a knee. Kieran was able to get my knee completely straight and I could get my knee bend to probably 95-100 degrees. At home that day I was able to bend me knee to 90 degrees with the rope tied around my leg on my stomach, another significant milestone.

Day 11 – Friday 3^rd June: My last day before returning to work so I had two main goals. The first being increasing the strength in my knee so I could walk without crutches and secondly to control this swelling. I didn’t feel completely comfortable without crutches but was able to take a few steps.

Day 12 – Saturday 4^th June: I went back to work this morning. I had 5 patients across the morning which isn’t a busy Saturday morning, however I felt I was quite rushed. I wore a knee brace to work for the extra bit of stability and to limit my bend to 60 degrees as Dr Macdessi didn’t want more flexion than this in weight bearing.

Day 13 – Sunday 5^th June: A rest day consisting of exercises and icing.

Day 14 – Monday 6^th June: Physio first thing this morning. Kieran was again happy with my progress. I reported I was feeling tight through my lateral hip, glutes and ITB and asked if he could release them. It wasn’t pleasant but made a difference. Kieran also spent a bit more time working on my flexion today. I was determined to give the bicycle a try today so I put the seat quite high and after a few attempts both forwards and backwards I was able to get a full revolution. I rode the bike backwards for a few minutes as its often easier that way. After feeling more comfortable I started to ride forwards.

Day 15 – Tuesday 7^th June: I had my two-week follow up appointment with Dr MacDessi this morning. I was pretty confident he would be happy with it. I had full extension and 100-110 degrees’ flexion. I was now walking albeit with a limp, comfortably without crutches and I didn’t think the swelling was too bad. Dr MacDessi came and said as I expected. He was happy with the ROM and said he would see me in 6-weeks.

If you have any questions regarding the management of an ACL injury or to discuss prevention strategies specific to your sport, consult with one of the Physiotherapists at Jubilee Sports Physiotherapy. Please contact our Caringbah practice on (02) 9540 9400 or our Kareela practice (02) 9528 2200.