Post-op Diary, ACL hamstring autograft on NHS. Week 1-18

[vts69]

Hi

I've found other diaries quite useful so here's mine. (Here's a link to my pre/injury post for backstory...

Day 0 Thursday

Nil by mouth since midnight, had to be at the ward for 7.30. Was taken for surgery soon after 9am and next thing I knew it was around 11.30am. Knee heavily bandaged. Spent a couple of hours dozing, then was given a glass of water and a ham sandwich.

Was told the Physio would be round about 4pm so got my parents to set off earlier rather than wait till the all-clear.

Which was a mistake. Joking with the physio it all went well walking on 2 crutches till we got to the bottom of the stairs for the stair test. Started to get really dizzy and gave him notice I was about to pass out. Woke up in the recovery position and was got back to bed. I had low blood oxygen levels and was put on oxygen and given plenty of water to drink. After half and hour it was still low and the physio went home.

So my parents arrived after their 2 hour drive to be told I'd have to stay overnight and went home again.

During the night I didn't sleep well, couldn't find a comforatble position. I got hot so they took a blood and urine sample to check if I had infection.

[Surprised more people don't faint - after all major op plus no/low fluids...]

Day 1

Practised extension exercises in bed - felt I had full extension. Flexion was painful/tight so didn't bother. I saw the physio again at 10.30, apologised for yesterday. He explained how 'cos I'd warned him he'd executed a perfect takedown. Repeated the walking around (followed by a nurse with a wheelchair this time) and successfully moved up and down stairs.

Started on the painkillers - Co-DyDramol. Called my parents to come get me again but they were out shopping. They needed to free the bed so I was wheeled to the Discharge room which wasn't as disgusting as it sounds, watched rubbish daytime TV with some very old people like it was a nursing home till about 3.30pm. During all this time I was seated, I got up to walk to the toilet a couple of times, couldn't move much in the way of heel slides, couldn't do other exercises as I was in a chair.

When the parents came it was a great struggle getting my leg bent enough to get in the door (turn and sit first, then try to push legs in...) . Pain level about 3/10

Went to bed around 9pm and took a couple of CDDs. I then found the pain suddenly come on, truly excruciating. Felt like real deep bone pain 10/10. Obviously the anaesthesia was wearing off but the painkillers ddn't seem to work for about a couple of hours. Wanted to amputate the knee...

Day 2 sat

Task for day 2 was to get off 2 crutches onto 1 crutch. Task achieved. Basically every hour I would get up from the chair and stand (in basic flexed position). Then gradually straighten the legs to max extension. Then gradually flex toward a skiing posture. Flexion not quite 90. Also I did holding onto the back of a chair and going onto tip toes, to stretch calf muscles as well as flexion. And heel slides.

I think today was the last day I noticed any hamstring pain.
Pain level about 2/10

Day 3 Sunday

Took off the big bandage (after 48 hrs) to reveal 2 big plasters with big bloodstains. Had a kind of a shower, sat on the edge of the bath. Left the plasters on but put the tubigrip over the top. Wondered if the fall in the hospital had torn a stitch? Decided I'd go easy on flexion in case I could make it worse.

Pain level about 2/10.

Had to go to a lunch with my parents. Average age about 70, half the people had knee/leg issues. Was odd when people wish you'll get better, but you're not sure the same will happen for them... By the end of being sat normally for a couple of hours I was getting very itchy to move the leg somehow. But when I stood at the end I had to stand and wait for 20 mins while people cleared up and that began to really hurt so back home for rest.

While pottering round later at home I began transferring weight from the crutch to the leg...


Day 4 Monday

Didn't start off too good, went down for breakfast then felt a bit dizzy so had to sit down for a bit. Felt fine after eating though.

Walked round first thing with crutch if need be but not actually using it. I didn't need it so ditched it. Much better to be hobbling than crutches, don't want to be able to walk with crutches, I want to walk!

Later Dad walked me to the postbox on the corner - a round trip of about 70m. Went fine so that's the end of the crutches..

Got a call from the Physio dept, first apt they can do is the 28th - 3.5 weeks after the op! Unimpressed.

In the evening I noticed a mild chest pain and also that my shin/calf were turning yellow from bruising. [During the day I'd only been taking 1 CDD each time, for the evening I upped it to 2]



Day 5 Tuesday

This day didn't go well. Felt a bit dizzy first thing again. Decided I need to eat/drink before exerting...

Generally took it easy but, by the evening, the chest pain was a lot worse, so it was painful to breathe deeply, or rotate torso. Decided I must have bruised a rib when I'd fainted at the hospital and the crutch maybe hit me there... Plus my shin was hurting under pressure now. The front of the shin bone was quite hot and reddish, the rest of the lower leg all bruised yellowy. Also noticed I have a 'dead spot' of skin just below the knee on the outer side where I can't feel anything. Hoping this is temporary...

Pain level up to 8 if standing and breathing heavier, 2 if resting/shallow breathing.

Didn't really do any exercising as my leg and ribs hurt far more than the knee. Was back onto 2 CDDs each time all day.

Day 6 Weds

Still had the rib and shin pain but had worked out ways to manage this so it was less bothersome but still took it very easy. My parents insisted on taking me to their GP anyway. GPs are useless for anything that isn't really basic but he said what I wanted to hear - that everything was fine. Took off the plasters, they don't need replacing. An ugly big gash...

Day 7 Thurs

Rib and shin pain much lower, started doing the exercises again, switched from taking CDDs during the day to normal Ibuprofen. Mostly felt pretty good. Gradually building in a slight swing into my step, need to work on normal gait.

Pain level about 2

Foreleg is still bright yellow bruised. Still have the sensation dead spot. Flexion is now 90 unaided, a little bit more aided. Still keeping full extension.

Beforehand I'd got my parents a Wii Fit. In the afternoon we unpacked it and they both have wii Fit ages 12-13 years younger than they are. I was only 1 year younger, with off-centre balance but then it's only a week since surgery. Anyway that made them happy and hopefully they'll find the balance tasks a fun way to keep in shape.

[queeny]

You'll have the numb patch for a while, probably forever, but at any rate it will be a few years. Normally they tell you that - it's because they cut the nerve that goes to that are. Im neary 4 months post-op and it has got a little better - before if you dug a pen into it I wouldnt have felt a think, now it's just close to the surface that's numb. When it starts "switching" back on you get funny electric shocks. Its very wierd and not comfortable at all.

Be careful with the ribs, that sounds painful. I was taking ibuprofen the whole time as it acts as an anti-inflammatory and arnica is a godsend, both the cream and the tablet thingys. You can take ibuprofen at the same time as CDD. Also, when you finish with the prescription CDD, you can get paramol over the counter which is the same stuff and almost as strong if you need it.

Have a look on the main site, somewhere there there is a list of loads of exercises. In the first two weeks I was doing patella mobilisations, static quads, hamstring curls, side leg raises (top leg and underneath leg), calf stretches, hamstring stretches, calf raises, standing on one leg holding onto a support, bridging, half squats with back against wall, moving onto half squat holding onto the back of a chair, single leg squats. If you can afford it, it might be worth seeing a physio privately until your NHS appointment happens.

At 3.5 weeks I was doing static cycling, step ups, full squats etc. Keep working on your flexion and keep on top of your extension.

Keep us updated on how it goes!

[vts69]

Hi Queeny, thanks for your reply. I do have some little electric shocks now around one of the wound sites so hopefully this has started for me already. I got a whole bunch of exercises from a physio before the op so I have stuff to go on, but I will revisit the stuff on this site to see what else there is. Static cycling sounds the perfect objective for this/next week!

Day 8

For meds this week I've switched to ibuprofen during the day and paracetamol at night, saving my last few CDDs 'just in case'.

Went to a lunch with parents which was pleasingly uneventful i.e. walked from car park to table, then table to car park quite normally if slow.

Started doing 'ski school squats'

Day 9

Walked to the far end of the road and back - about 200m - which was fine, if slow. After I helped my dad pick apples - I just stood and held the basket but standing around is more awkward than walking. Had to stop after 10 mins.

Had a go myself on the Wii fit - balance games. Worked mostly on flexion. Wii age down to -3 years...

Day 10

Started to notice the yellowy bruising on shin/calf is starting to go away. Went for a 20 min walk in the woods, fairly even ground, went very well and had close to normal gait.

On the pain sde the shin pain has now gone, the rib pain is reduced to avoiding twisting torso PLUS laughing/coughing...

[nellsa]

Hi vts 69
thanks for posting up your diary, its so helpful. I am due for my ACL recon OP any day now (the NHS hospital has phoned and asked if I can go in at short notice - aargh!)

Anyway, I have a couple of questions that you might be able to help me with .
I'm really nervous about the anaesthetic - and recovery process. Any tips or things I need to know?
Getting to hospital is fine - but coming back ? How will I get my operated leg into a car when its so difficult to bend? And is front or back seat better?

Walking from car into house - is it really possible to go on crutch and one leg? or should I order in a wheelchair?
How likely is it to be able to go upstairs/downstairs to bed/bathroom facilities? Would you recommend moving bed downstairs for a few days and using downstairs cloakroom?

Sorry about all these questions but it would help to know more about practicalities...
thanks a million and hope your recovery continues well


Nellsa

[queeny]

I'm really nervous about the anaesthetic - and recovery process. Any tips or things I need to know?

anaesthetic is really safe. You're at higher risk if you're very overweight or have a heart condition, but the risk really is tiny. People are always nervous the first time, but honestly, its nothing to worry about.

Getting to hospital is fine - but coming back ? How will I get my operated leg into a car when its so difficult to bend? And is front or back seat better?

It depends on the car. If its a big car then back is best and you can rest your leg between the front seats. Or you can sit in the front with your foot on the dash. The easiest way to get in is to get in the same side as the operated leg and put the operated leg in first.

Walking from car into house - is it really possible to go on crutch and one leg? or should I order in a wheelchair?
How likely is it to be able to go upstairs/downstairs to bed/bathroom facilities? Would you recommend moving bed downstairs for a few days and using downstairs cloakroom?

Stairs were fine. They dont let you leave hospital until you can go up and down stairs with the crutches. The PT comes and sees you and gives you a trial run before you're discharged.

You should be fine keeping your bed upstairs, but you do need to have someone to stay with you, or be staying with someone. The things you cant do are carry drinks or make food. I went and stayed with my mum and she would make me a sandwich in the morning before she went to work, and I had bottles of water.

The way to carry things round is in a rucksack. It's a bit of a pain, but it's the only way to do it.

If you are using ice - get 4 bags of frozen peas. One for the front, one for the back, and two to change over when the others are refreezing. If you know anyone that has done martial arts, old belts are fantastic for tying ice packs to the knee

In preparation, I'd recommend getting lots of DVD box sets of TV series, as they keep you occupied for longer. Also, get some arnica from somewhere, both the cream and the tablet thingys and start taking it asap after the operation.

I found baths good as I'd get in when it was empty then fill it up once I was in there. You have to be careful when getting out as gravity takes over and water starts dripping down the leg. I also tried sitting on a stool in the shower with my leg poking out, but I preferred the bath method personally.

I went to a wedding 4 days post op. I borrowed a wheelchair specifically for the wedding, but in the end I didnt even take it with me. I would recommend that you don't do the same as me though! Up until that point I hadnt had any pain at all - I paid for it with a week of pain after that.

Keep taking the pain medication, even if you dont think you need it. If you dont take it and the pain starts, it's much harder to get back on top of it.

If there is anything else I can think of I'll let you know

[nellsa]

Hi Queeny
many thanks for your quick reply. I just love the people on this board, you are all so helpful and supportive and a great source of information. I've been reading about femoral nerve block given to control pain - do you know much about it? Also, posts from the USA seem to be more specific about the names of their pain meds eg oxycotin.oxycodone/percocet .... what do people in UK have?

thanks again

nellsa

[queeny]

I didnt quite expect the femoral nerve block procedure - laying there naked apart from my hospital gown and paper knickers the anethetist explained that he was going to electrically stimulate the nerve so he knew where to inject the anaethetic. He then promptly reached up to my bikini line and started looking for the nerve. Mine was about 1cm from the crease at the top of my leg. You might be asleep when they do that. He said to me at the time that sometimes they do it when you're asleep.

Anyway, if you wake up with a funny bruise on your bikini line, that's what it is

The nerve block is great, but it doesnt block the back. They told me that too, but I wasnt expecting the pain that I had when I woke up. I guess its not surprising really as they had just hacked away at my hamstrings. It didnt last long though. My temperature was very low when I came round so I slept a lot imbetween having my temperature taken every 15 minutes.

In a way, I wish I had complained more about the pain when I was in hospital, I had tramadol on my chart, but as I hadnt needed any whilst I was in hospital, sadly they didnt issue any on discharge (but I already have a few at home for emergencies ), It's pretty standard to be discharged with co-drydamol. They're not bad, and I also had a 2 week course of diclofenac which I've been told you can now buy over the counter. You can buy a form of co-drydamol over the counter in the form of Paramol. Each Paramol tablet contains 7.46mg of dihydrocodeine, whereas the stuff I was given on discharge contains 10mg per tablet. You take 2 tablets (dont bother with one - swap to paramol if you dont feel you need quite as much pain relief). Paramol is cheapest in packs of 48 (about xc2xa35.50)

I didnt actually have any pain on discharge, although I did start on my home supply of tramadol after I went to the wedding at 4 days post-op. The pain post-op was nothing compared to the pain when it collapsed pre-op.

As far as I know, oxycondone is hardly used at all in the UK, pretty much for palliative care. UK doctors seem much more strict about addictive drugs, plus the NHS wont issue anything that costs much.

[mrdj08]

Hiya

i had an nhs ACL reocnstruction on 2nd oct.....i had the patella tendon used rather than the hamstring.

I'm not in much pain - but am still wearing the brace they gave me - as my leg wasnt fully straight when i went to the physio this week I think it is now - but pulling my leg back i find really hard. i'm not sure where its all measured from but from lying flat - i can probable drag my heel back about 6-8".

I'm just desperate to get out of this brace and walk - even if its crutch enabled.

[nellsa]

Hi mrdj08
good to hear from you. Did you have your OP in the UK... did you get nervous beforehand and how did you feel afterwards?
Sorry to hear brace is driving you bonkers - but does it help at all? If you didn't have it, how would your leg be - ?
nellsa

[mrdj08]

operation was in UK - wasnt nervous before, and after i felt fine.

I was expecting my leg to be in the brace straight when i came around - but it didnt get put into a brace untill the day after. I'm not sure if this has affected my progress because it seems that most other people are back on their feet after two weeks - yet i'm still in brace and on a crutch.

With the brace on - i can walk with crutch fairly comfortable - although my leg is desperatly trying to walk as normal as possible which makes it uncomfortable as it is locked straight. Personally - i just dont feel that my flexion is going very well - i can get it pretty much straight - not quite do Striaght leg raisers due to the fact the i get a pulling sensation across top of shin. I think i may be able to do these in a few more days. Heel sliding back is feeling much harder as its quite tight and painfull when i get about 1/3rd of the way back.

I've tried itr lying on my front but have an awful pain at the very top outside of my knee when i get anywhere and it feels locked no matter how hard i try

[nellsa]

things do sound a bit grim for you - have you looked on the forum archives (under cruciate ligament) for previous posts about braces & pain - maybe others have been through this
good luck
nellsa

[nellsa]

hallo again queeny
many thanks for your speedy reply. very helpful on the pain meds etc... I will take your advice about bikini lines and making sure to complain rather than keeping quiet!
how are you doing?
all best
nellsa

[vts69]

Hi guys,

Anyway, I have a couple of questions that you might be able to help me with .
I'm really nervous about the anaesthetic - and recovery process. Any tips or things I need to know?
Getting to hospital is fine - but coming back ? How will I get my operated leg into a car when its so difficult to bend? And is front or back seat better?

Walking from car into house - is it really possible to go on crutch and one leg? or should I order in a wheelchair?
How likely is it to be able to go upstairs/downstairs to bed/bathroom facilities? Would you recommend moving bed downstairs for a few days and using downstairs cloakroom?

Anaesthetic: nothing really to worry about. They wheel you off to the anaesthetist, he 2xchecks you're the right person (!!!) and then puts a drip in the back of your hand - you're lying down so you don't have to look. you feel a bit of a prick (hah) and then after about half a minute you feel a weird dizziness wash over, you feel the urge to fight it, it's mildly unpleasant that's all. Told him I was going under and if his conversation always had this effect on people...
Then when you wake up very groggy in the recovery ward the nurses check you're awake and OK and then you basically doze/snooze till yr more awake. You aren't allowed to do anything important for 48 hrs after (drive, operate machinery, sign legal documents)

Car back: Depends on car and leg I guess. I am in UK and had right knee done which meant best option in Ford Escort was passenger front seat. Seat fully far back, use upper body strength to lower bad leg into car then sit then bring good leg in after. Exiting, plant good leg outside car, use upper body to extract bad leg. Pivot on good leg to face away and await someone to pass you crutches.
If it was the other leg I'd have gone backseat but imagine it would be pretty uncomfortable.

Walking to house: Recommend using 2 crutches until you are really confident you have good balance etc and can weight-bear. For peace of mind. Sleeping downstairs would be a good idea for the first night if you can.

i had an nhs ACL reocnstruction on 2nd oct.....i had the patella tendon used rather than the hamstring.

I'm not in much pain - but am still wearing the brace they gave me - as my leg wasnt fully straight when i went to the physio this week I think it is now - but pulling my leg back i find really hard. i'm not sure where its all measured from but from lying flat - i can probable drag my heel back about 6-8".

I'm just desperate to get out of this brace and walk - even if its crutch enabled.

.

So we got done on the same day? Really sorry to hear about the brace, maybe it's because it was unstable? It can take a couple of months for ALL the swelling to go, but by now it should be resembling a knee shape... And I have a dead patch on the outside too but I'm now getting tingling sensations which is hopefully the damaged nerves rebuilding. Hope i keeps getting better

[benjinh0]

Hello there! I had right knee ACLr using hamstring and lat and med meniscus removed on the 25th sept so I'm just over 3 weeks now. I'd recommend the op as things are going well. The anesthetic is nothing to worry about, was the best kip I'd had in a while! The first 2 weeks there is a fair bit of pain and I had a problem sleeping, I was given co-codomol and used these with over counter ibuprofen. I have got a brace and used it all the time for first 2 weeks but now only use it when I go out. I am ok to walk around the house, I have full extension and about 90 degree unaided flexion. My knee is still a bit swollen and I think when this goes down I will get more movement.

[mrdj08]

HI - yes same day!

The brace is on becaus emy physio says i need to be able to extend to zero, i think i was about 10 degrees off on wednesday but i'm pretty sure i can extend to zero now (just not first thing in the morning!)

I cant say i can see much of a knee shape yet although i have started to see the yellow colouring subside and a few tiny bits of kneecap are sticking through. i'm still icing regularly - bit worried as i've been to a football match this afternoon and done some walking in the brace on one crutch, not painful but its aching a bit and it took about 5 minutes to get straight again once i'd got home...

Are you now walking unaided?

my only problem seems to be flexation but i'm trying to just excercise and hope it comes eventually. I'm thinking of getting on a static bike but am not sure....