acl reconstruction

[ages]

10 yrs ago I had an 18 year old mind in a 40 year old body and blew out my knee skiing. I have lived with no acl for many years, and now, before the instability gets much worse and further damage is done, it is time to go to a body shop and get new parts!! ;-0 (I asked the doc to order me a skinny butt too, but he wasn't very cooperative on that point).

So, I have decided to have the patellar tendon bone tendon bone allograft. The recovery time is long It takes a full year for the graft to be complete. But the doctor said maybe in eight to twelve weeks, I can start diving again (but only if I put my gear on in the water, and not hike over rocks etc).

Is there anything I can do pre and post surgery to hasten the healing process? I will be commited to physical therapy, but more than anything, I want to be back in the water.

Have you heard of any bad side effects caused by diving with these types of grafts?

ages

 

[scubadoc]

Knee surgery does not abrogate Boyle's Law and is not a contra-indication to diving. Return to diving is allowed when the diver has been released by his orthopedic surgeon to return to full weight-bearing and regular activities. This depends somewhat on the rapidity of rehabilitation and absence of complications.

Most people have returned to usual activity after major joint surgery by 3 months; this might be lengthened by the graft. Diving imposes significant weight-bearing while donning gear and exiting the boat. Possibly, the diver can accommodate by putting gear on and doffing in the water. Notify your dive master of your problem and ask for help.

DCS is not a major consideration but should be discussed. Decompression Sickness (DCS) results when there is more inert gas (usually nitrogen) absorbed in the body than is able to remain in solution. In other words, “bubbles” form in body tissues and produce various symptoms. Many different factors seem to influence the occurrence of DCS. One unifying element in these various factors is blood supply – anything that alters tissue blood flow (such as age, dehydration, cold temperatures, poor physical conditioning or injury/arthritis) seems to increase the likelihood of DCS. However DCS is quite uncommon, occurring after fewer than 1 in 10,000 dives.

What does this mean for you and your knee? This probably will slightly increase your risk (albeit small) of developing DCS. The fact that your knee problem is post-surgical and chronic and not acute most likely decreases any increased risk to a negligible amount.

In any case, I’d use general common sense in your diving, specifically, don’t “push” the no-decompression limits, make slow ascents, and make a 3 to 5 minute safety stop after every dive. Consider using nitrox with air tables to decrease your risk.

There is one other problem that you might consider. The knee joint is vital for using fins properly for underwater locomotion (although not as important as the ankle joint). This might impose a hardship on your ability to move around in the water or cause some pain or discomfort with the use of your fin with the involved knee. You might want to practice finning with a swim board to strengthen your leg and knee prior to donning your gear again.

 

[large_diver]

Ages,

Sorry to hear about your knee -- as a veteran of a complete ACL blow-out and patella tendon graft, I can sympathize. I blew my knee out playing basketball in college....the trainer said he could hear an audible "pop" all the way across the gym.....

Anyway, I don't pretend to be an expert on this, especially since my injury and surgery took place 15 years ago (god, it makes me feel old to say that). That being said, I don't think the procedures have changed that much in recent years and I am married to a physical therapist.

My suggestion more than anything else is to hit the physical therapy hard after the surgery. Even if you are in good shape prior to the surgery, it is hard to avoid the inevitable atrophy that will occur with your "bad" leg during the recovery process. They measured the diameter of both my legs during my recovery, and at one point the diameter of my bad leg was about 1 inch less than that of my good leg. I was playing college basketball prior to my injury (2-3 hours of practice per day) and was in the best shape of my life before my surgery. Not sure how the recovery process from this type of surgery has changed since my operation -- for me, there was a period of about 3+ months where I could not bear any weight on my repaired knee. As a result, my muscle function really deteriorated and required quite a bit of rehab.

So, bottom line, hit the physical therapy hard after your surgery. It is only with consistent, hard work that you will get your knee back to where you want it. And don't let all my gloom and doom above get you down. I actually emerged from this rehab in better shape than before the injury. While I still have some limitation in my overall range of movement (can't get down into a full "catcher's crouch" due to some lingering fluid in my knee), my legs were stronger and I was actually able to jump higher after my rehab due to all of the work I did on my leg muscles. This was not based on actual measurement of jump heights -- I could tell by how well I could dunk a basketball before and after the surgery -- MUCH better after. One activity to consider during your recovery is swimming --- non-weight-bearing and great cardio exercise for diving. Check with your therapist on this. You won't be able to run -- this is a great alternative to keep your cardio fitness up. Even if you aren't allowed to use your legs, you can still swim with arms only.

The other thing to remember with major joint surgery like this is that you need to take care of it for the rest of your life. The problem I notice is that if I am not in shape and then try to do some intense physical activity, my bad knee always causes me trouble. Not a huge deal here -- my main point is that it is important to maintain some level of fitness. Once a joint like this has invasive surgery, it will never be quite the same again and won't hold up to the same abuse your good knee does. TLC in the form of consistent exercise is VERY important.

Regarding diving -- I have't noticed any problems, but I only started diving last year and my surgery was long ago. Not sure if there are more worries when you start diving soon after this surgery -- I would take a close look at scubadoc's post above. The main thing I would be concerned about is the heavy lifting that diving involves, particulary when donning your gear and when emerging from the water. You really need to make sure you knee is ready for this type of intense weight lifting -- again, by hitting the physical therapy hard and staying in shape after you're done with the formal recovery process, there should be no reason your knee can't handle this type of stress.

Sorry for the length on this -- thought the details would be helpful. E-mail me or re-post hear if you have any specific questions.

I wish you the best of luck!

 

[wolfgirl]

hi there- I too had an acl reconstruction- also a patellar tendon bone tendon bone allograft- about 3 yrs ago. I am a soccer player, skier, and now diver.

I don't know if you've already picked out your doctor yet, but I have some tips from my experience to pass along.

- pick someone who comes highly recommended and is sports medicine-focused (my doctor is the team doctor for the San Jose Sharks hockey team and the SF 49ers-- I never had a doubt about his ability)

- Get in the best shape you can pre-surgery. As someone below describes, your muscles atrophy and weaken at an alarming rate after surgery, even if you're in good shape. Having the advantage of planning your surgery, I'd suggest consulting your doc or a PT a couple months beforehand on what exercises to do to strengthen the surrounding muscles- esp your quad and hamstring. Better shape pre-surgery=better shape post-surgery and less recovery time.

-get a PT that has worked with people who play sports and have torn their acl. Unlike every day non-active folks, those of us who play competitive sports have a lot more reasons to have very good PT- they condition you to get back to your sport.

- when your doctor says that it takes 1 year for the acl to be fully complete, that doesn't necessarily mean you can't be active before then. My doc told me I could play soccer in 6 months-- I waited 9 b/c it's a heavy contact sport and I was being very cautious. I was fine, and have been ever since.

- You're right to be very commited to physical therapy. It's a pain in the butt, but very worth it. I had a drill sargent-type PT who really pushed me right after surgery, and I'm very glad of it. They warned me if I did not get full flexion and extension in the initial month or so of PT, I would *never* get it back 100%, so make sure you work out very hard and do everything they say.

Other than that, swimming is always a good exercise for knee problems; I had a little pain once in the pool with my fins from the water resistance, but after that I was fine. Just don't pick up all your gear and fall while your knee is still healing . Good luck!

w.g.

 

[scubadoc]

To Large Diver and Wolfgirl --- These are really great letters!! Your emphasis on Physical Therapy is right on the money.

Choosing the right doctor is very important - but even Michaelangelo had to have good marble and paint with which to work. What I'm saying is that every patient and every injury is different - and the outcomes are not always that great.

Certainly hope that all turns out well for 'ages'!

 

[sea2sea]

One more thing to add, as I am another veteran of an ACL repair, as well as an MD who sees sports injuries daily--

Swimming is one of the BEST exercises for your knee, because there is little to no jolt/impact on your knee while in the water. Once you regain muscle mass in the quadriceps through PT, consider getting a kickboard and using it for 20-30 mins several times a week. This will not only condition your knee, but will improve your finning ability later. Focus on kicking throughout the entire leg, not only at the knee (i.e. start at your hip). Don't neglect your hamstrings, adductor or abductor muscles, because these stabilize the knee along with the anterior (front) quadriceps.

Good luck!

sea2sea

 

[ages]

I am touched by everyones encouragement....you all warm the cockells of my (well...lets not go there)!! Seriously, I do appreciate the advice. It is difficult to make a decision that you know will hurt for a long time!! Often one feels they are facing these things alone. The sliding of my knee in the past has caused all sorts of discomfort, including the breaking of my ankle (while playing raquetball). So, since I am 50 and only have 100 more years to get everything I want to do done, I decided to get it fixed now, while young!! Diving for me is complete and total relaxation. The minute I exhale and begin my descent, I can feel every stress leaving me. It is better than cold beer (well....) and sex (well...maybe not)!! Giving up something that is so important for me, is not an easy thing to do!

Question for sea2sea - when did you start swimming after your repair? I have my old drysuit which is a light one, and I hope to be able to start ocean swimming in 4 to 6 weeks. Did you swim with fins or just regular swimming?

ages

 

[sea2sea]

Ages,
I started swimming approx 4 weeks after the repair. It took that long mostly because I had lost SO MUCH muscle mass that I had to rebuild it in the gym etc. for many weeks before it even approximated the size of the other leg. However, you can theoretically swim as soon as you are able to do land exercises such as stair master or treadmill. I would stick to the pool, though, and reserve ocean swimming until you are certain you have regained enough strength to overcome ocean currents etc.
Regarding swimming with or w/o fins, unfortunately I wasn't a diver at the time of the repair....luckily that has changed!
You can discuss this issue further with your physical therapist...
good luck,
sea2sea

 

[ages]

I'm back (not diving or swimming yet) and surgery went well. Because I have lived and abused my knee for 10 years without an acl, the doc also did some bone abrasions and cartledge repairs. As a result, I have been on crutches for the last month.

I have taken everyones advice and hit the P/T hard. As a result, I am two weeks ahead of schedule and today was given approval to use only one crutch. They still won't let me swim or dive yet As they say that the stress on the acl by kicking with fins on can cause it to stretch too much. It will be eight weeks before I can use my legs to swim.

If anyone needs an acl repair, I would highly recommend this surgery. There has been relatively little pain, and the healing time is quite fast (given the extensiveness of the procedure).

ages

 

[large_diver]

Hey Ages,

Glad to hear everything went well -- sounds like you are well on your way to a full recovery. Hope that the recovery and your physical therapy continue to go well!