Post Op Week 5: An ACL Recovery Primer

Between my careers as a teacher, banker, personal trainer, and wellness coach, I should know better than to use acronyms and jargon when I'm writing.

But, in a haze of painkillers, I forgot.

I forgot that just because the locked brace, the CPM, and the quad sets are so familiar to me after four months that they are just second nature by this point.

So... a quick primer on all things ACL recovery.  

ACL - the anterior cruciate ligament is found in your knee.  It forms an X on your knee with the posterior cruciate ligament.  It's responsible for side to side and turning motions.  It's why so many people who tear their ACLs do it with "cutting" sports like volleyball, skiing, and tennis.  

Rupture - an ACL rupture is a grade 3 sprain - meaning that the entire ligament has been torn in two.  I've learned that this is not the worst grade you can get - evidently it can separate from the bone as well in a grade 4 sprain.  Most ruptures are repaired surgically with a replacement graft from your own hamstring, quad, or from a donor.  Mine was from a donor graft.  We hear so much about organ transplants that it never occurred to me that I would receive anything like this from an organ donor.  That's one thank you note that I'll happily write.

A rupture is a full tear.

Flexion vs. Extension - two sides of the same angle measurement.  Flexion measures the angle that your knee makes when it's bent... and extension measures the angle that your knee makes when it's straight. 

The goal for extension since I got hurt in January has been zero.   Most people can hyperextend into negative degrees.  I have yet to be measured at zero but I've gotten REALLY close.

The goal for flexion began at 90 degrees and is currently 125.  My last measurement was at 107.

 

Locked Brace - the brace that I have worn practically 24/7 since my surgery has a hinge at the knee.  The hinge can be locked so that my leg is permanently straight or unlocked so that it can bend.  For the first two weeks post op, that brace was LOCKED.  Which means my leg was straight ALL THE TIME.  At rest, while crutching around, while watching the eclipse... it's why (along with the pain) that I couldn't manage stairs at all. Even bumping myself up on my butt was impossible because my leg would just stick straight out.

Unlocked Brace - at two weeks post op, I was able to unlock the brace so that it could bend at the knee.  Mind you, I was only allowed to unlock it while I was resting.  Anytime I was "on my feet," that brace was locked so that my leg was mostly completely straight.  At four weeks post op, I was finally allowed to unlock it permanently.  So, for the last week, I've been able to bend my knee at all times.

That large "button" in the middle is where it locks.

Functional Brace - I haven't used this one yet.  It's the purple one that I posted a few weeks ago.  Once I'm out of the hinged brace (hopefully at my next appointment), I'll use this one for activity.  I'm not sure about it yet but I'm excited.  It's custom-fitted and hopefully will stay up on my leg where it's supposed to!

Better pics when I learn how to actually USE it.

CPM - Continuous Passive Motion Machine - one of my favorite toys.  It's a huge device that my leg sits in and it bends and straightens my leg for me.  I started at 40 degrees of flexion.  The goal was to increase it by 2 degrees each time I used it - eventually capping out at 120 degrees.  I've been at 120 degrees for a couple of weeks now and it's STILL painful when I get started.  I sit in this machine twice a day for two hours each.  It's how I've gone through the entire series of the O.C. since I had surgery.

Mine is more comfy than this but you get the idea.

E-Stim - a device that wraps around my thigh and sends electrical stimulation into my leg.  Yes, it's as torturous as it sounds.  I call it the electrocution device.  I mainly used this at the beginning to help my quad muscle relearn how to activate.  I would attempt to activate my quad every single time it sent the electricity into my muscle.

I wish you could see the torture that is this device.

Activating Your Quad - we use our quad muscles every single day without giving it much thought.  To walk, to go up stairs, to stand, to turn over in bed.  Pretty much every single time you use your leg, your quad muscle is being activated.  This muscle atrophies really quickly after surgery and one of the very first goals post op is to regain the mind-muscle connection between the quad and the brain.  Try this out.  Sit on a surface with your legs out in front of you. Push the back of your knee into whatever surface you're on and watch your foot pop up.  THAT'S quad activation.  For me, that was impossible for the first two weeks.  Many many tears were shed over not being able to do that.

Hopefully this gives you a better idea of alllllll the new terminology that I've been using!  If you're ever like "Bree, you're totally using jargon again!!!" let me know in the comments and I'll clarify!