Figuring out The Knee Injury, Part II - Road to Resolution

So, here's where we are

Here's part 1 in case you missed it. A quick recap - I rotated my knee, heard a snap. Consulted various doctors and was advised to rest. I realized my knee condition was deteriorating, rather than improving. Eventually, I started some mobility work by myself, and started to feel better. Surgery was the recommended option, but I was not gonna even think about it while my knee was in terrible shape. So, I found a physio on the same wavelength as me, and started to work on my range of motion. ### Walking with a limp

My knee was swollen, and I had the narrowest range of motion. If I tried to straighten my leg out, I was lagging behind my about 20 degrees. And when I tried to bend my knee and try and kick my butt, I was off - by a lot! I was obviously walking with a limp. I had spoken with a bunch of folks with ACL injuries but none of them suffered from a lack of range of motion around the knee joint. The most common issue when you tear your ACL is buckling - your knee is pretty unstable. And if it buckles, you risk damaging your meniscus (a shock-absorber of sorts). My knee was pretty stable though. Just as I was looking for a good physio to go to with this, I ran into a friend of mine after ages who had torn his ACL too. And he was working with a physio who he absolutely swore by. He got me an appointment the very next day, and I went to see him. It had already been 5 weeks and some. The physio's first response was "You should've seen me earlier".  I had a long conversation with him, and with no leading at all from me, he said his primary goal was to restore my knee functionality, and then see what needs to be done. Music to my ears. And so I began some intense physiotherapy. For folks who haven't had to go through physiotherapy, it is definitely not easy. Mine was a slow and arduous process but slowly my knee started to improve. I could almost sit down on my heel, and forcibly touch my heel to my butt. Flexion (bending) was fine, but extension (straightening) was not, as you can see from the image below. [caption id="" align="alignnone" width="640"] Couldn't straighten the knee out beyond a point[/caption] Beyond a point, I stopped seeing improvement. The surgical team maintained that it was not possible to extend my knee fully because of a possible impingement by a torn piece of tissue (from my ligament or the meniscus). My physio on the other hand was reasonably sure that it was capsule tightness, and we tried some dry needling. This basically involves sticking a small needle into the knee area, trying to rupture the capsule and attempting to get it to re-heal but in the right fashion. [caption id="" align="aligncenter" width="500"] Sticking needles into the knee[/caption] But it never did happen, unfortunately. I had a restricted knee capsule, due to adhesion inside which couldn't be released at all. In addition, I had a meniscus tear (horizontal tear in the posterior horn) and a ACL tear. I had improved my knee range of motion as much as I could, and it was time for surgery. ### Finding a surgeon

Meanwhile, I had settled on a surgeon, in case I had to go down that route. Again, the surgical team's analysis of my lack of joint mobility was that my ACL could be caught between the shin bone and thigh bone, thus not able to 'close' properly. While my physio disagreed with that diagnosis, we agreed that surgery was the best route forward as we had hit a dead-end. On Dec 15, I went in for surgery. The surgeon was expecting to clean up the meniscus, repair it if possible. And graft my knee tendon to replace the torn ACL. And also to clear up the fibrous tissue buildup. I had spoken with a friend of mine who had his ACL reconstructed just a few months back and he gave me valuable advice. And that I should absolutely watch the surgery on the monitor inside the operation room. Fortunately, I was not given any such option while in surgery. I was wheeled in, a bit nervous to be honest. The operation theatre had a lot more conversation going in it than I thought there'd be. But then, regular day at the office for them, right. The bit I was dreading was anesthesia, given spinally. It felt kinda weird but after I lost sensation of my lower body, it felt kinda fun. I floated in and out, heard snatches of conversation, and was too zonked out to know much. In fact, it took me quite a while to realize that the surgeons had made the incision and were probing around my knee. I lay there for quite a bit thinking, "Hmm, when is this thing gonna start?". [caption id="" align="aligncenter" width="384"] Uhh, why did they have to shave so much of my leg again?[/caption] Once I was out of surgery, a member of the surgical team demonstrated to my wife and mum (who were keeping me company in the hospital) that I could extend my leg - and proceeded to snap my leg into extension. Thankfully, I was still under the effect of the anesthetic. And now, on to the interesting bit. The surgeon had probed around for quite a bit but could not find any indication of meniscus damage. And the ACL that was supposed to be torn fully, was actually torn under 20%. He spent most of his time clearing the adhesive build-up and sealed me up. Didn't touch the meniscus or ACL, as it was still rather strong. Pretty cool huh! ### How did that happen?

First up, as I mentioned earlier, the MRI is just one part of the diagnostic process. But is it so far off that a >90% tear was actually a <20% tear? Apparently. What about the other tests done to determine if the ACL was torn, which everyone I saw did? Did they all get it wrong? What happened was I tore my ACL very minimally when I rotated my knee, but the jump that preceded it was also rather poor and that led to the bone contusion. Doc 1 (who got it right, said there was no ligament damage) examined me within a couple of hours. Am guessing that enabled him to make the right call as well. But by the time I went to the other doctors, my knee had locked up a little and I had also had the MRI taken. Am guessing that these variables might've thrown them off. But hey, why am I finding excuses for them? Anyhoo, I am glad my surgeon cleared up the problem and left me untouched otherwise, and that my physio was clued in all along. ### Where am I at now?

Back to physiotherapy. But would my research about prehab hold true? Well, it has been two weeks and some. For the first 10 days, I was on crutches and minimal physiotherapy. The last 10 days, I've been rather aggressive (with my physio, obviously), and am at where I was before surgery. Perfect! Coz that was exactly what I was hoping for, and that's why I put in all the work diligently before surgery as well. ### (Do You Wanna) Get Fit With Me

I am in terrible shape. I cannot walk properly, let alone run. I need crutches when I go out. Climbing up or down a floor takes me forever! I cannot even get into a plank position. And even when I am able to walk properly, I wont have the lungs to run a mile. It will be ages before I can think of squatting. Hold up! Am not setting all this up for the love and pity to rush in. Here's the deal. I know there's a bunch of you out there who have been waiting for something to kick-start your fitness adventure. Maybe you've let yourself go so much that you hate it, maybe you didn't have the time, maybe you got injured and then let it go, or you've just been a lazy ass - it doesn't matter. Guess what? You now have company. This time of year, a whole lot of us make fitness resolutions and fail to keep them. Here's your chance to ride along with someone who isn't (that would be me) gonna fail to keep them. Stay tuned for more on this. I am going to give the community (that's you!) a couple of days to share any ideas. You can use the comments column below to talk to me. And do share this post if you think it might be useful to folks who've been injured/lazy/unfit/busy/"waiting for tomorrow".

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