When I first started reading the blogs of other ACL ‘survivors’, I found myself focusing on the entries about the surgery itself. I was struck by the variations on the theme. Inpatient vs. oupatient. Autograft vs. allograft. General vs. block. So, rather than delve into a narrative of my day at the clinic, I thought a simple list with some comments might be enough for others who are probably mostly curious about how these things might go.
Symptoms: Torn ACL in left knee and torn lateral meniscus as determined by physical exam and MRI. (During operation, the meniscus tear turned out to be minor and some free-floating material was found and removed.)
Surgery: Outpatient on April 11. Arrived at the clinic at noon and was back home (and monstrously hungry) by 6:30 p.m. About 2 hours of this was actual surgery.
Anesthesia: Femoral and sciatic nerve blocks just prior to the operation and general for the procedure itself. My experience with the blocks was very good. The tough part was getting in the house with a numb limb, but it dealt with the pain well. And the timing was pretty good, too. The afternoon surgery meant that the femoral block didn’t wear off until the middle of the night, so I slept well for a few hours.
To Hack Shaft who got a spinal block and watched his procedure: better you than me.
Replacement tissue: Autograft from the hamstring. This was my surgeon’s preference, and mine too. Patellar grafts seem to be less favored these days and probably not as desirable for us kneeling martial artists. An allograft from a cadaver, which Hack Shaft got, was never really mentioned as an option by the surgeon, and I didn’t really pursue it. Not sure why because the results are known to be very good.
Incision pattern: Three small arthroscopic incisions around the knee and a longer incision a little off center just below the knee for the replacement tissue harvest.
Pain and pain meds: When it comes to pain, I think I got lucky. It hasn’t been that bad. The worst, for me, was the burning sensation around the incisions when I first started with the crutches. I think the nerve blocks blunted most of the early pain. I did get a little fentanyl post-op, which was probably the nicest thing that happened to me that day.
When I got home I immediately started taking Percocet in order to be ready for when the femoral nerve block stopped working. Percocet’s a nice little wonder. But usually, after I’ve taken it for a few days, it starts to destroy my sleep, filling it with disturbing dreams in which I’m often being hunted (seriously!). So by the second morning I decided to just go with Rapid Release Extra-Strength Tylenol and take a Vicodin just before my PT sessions.
Surgical team: My lead surgeon is a star. He’s got a great reputation. One of my friends, who is himself a surgeon, asked around on my behalf and got only good reports. Plus, a few days before surgery I was on my way up to the surgeon’s office to pick up some paperwork, when who should get on the elevator with me but a former, All-Pro, NFL Hall-of-Fame defensive lineman who now lives in my area. He was obviously on very familiar terms with the staff in the office and announced he had a 9:15 appointment with my surgeon. Now there’s an endorsement.
More to the point, my surgeon and his team do a lot of knee and shoulder work. They are old hands at it. There’s a great section in the book Complications by Atul Gawande where he profiles a surgical center that does only hernia surgeries. Sounds like a factory, but the results are clear: an extremely high success rate and less pain for the patient. If you haven’t read the book, I highly recommend it. You’ll come away with a more sobered, yet all the more respectful view of the medical profession.
If someone reading this thinks I’ve left out some important aspect, let me know and I’ll amend the post. I’ve also got pictures from inside my knee, so if anyone is curious I can post them separately. Otherswise, I won’t force them on the unwilling.