This is just my personal story, so this is not to be taken as medical advice by any means, but for anyone that has torn their knee, this might give you some idea of what you may experience. My biggest piece of advice is that if you are trying to decide whether or not to go ahead with the sugery, you have to figure out what activities you will do in the future. If you are planning on doing any lateral activity such as basketball or skiing, have the surgery. If your knee keeps re-spraining or re-buckling, not only will you mess up what is left of your ACL (if it's still there), you can damage other ligaments or meniscus as well. If you are going to only do straight ahead activities such as biking or swimming, you can manage without it. So either change your lifestyle to fit the knee, or the knee to fit your lifestyle. Ah yes, I just jumped off my soapbox.

I tore my Anterior Cruciate Ligament playing Intramural Basketball at UCSB. The initial trauma happened the week before. I planted my left leg while going up for a layup, and some guy on the other team hit the outside of my knee, causing it to buckle in. It hurt a lot, and felt very warm, but after limping around for 10 minutes, I kept playing. If you can't walk or put any weight on your leg for 5 minutes after an injury, take my advice, sit out for a while. Anyways, the next week I played (I am quite the genius...), and while planting my left leg and then pivoting, I went down on my own. At that point I felt a pop. I looked up at the ref and a couple of players who had knee braces on were standing around me, just shaking their heads and wincing. I figured that I had torn my ACL at that point. I felt like Danny Manning (that's an obscure basketball reference, just bear with me). The MRI said I had a probable partial tear and a possible complete tear. Well, that didn't help clear things up very much. Thanks for making me spend hundreds of dollars on something my Spanish teacher could have told me. Anyays, I decided to wait for surgery and try playing until I knew for sure I needed surgery. The ACL helps stabalize the knee, is crucial for lateral movement, and keeps the tibia from moving too far forward. Since I was doing mostly straight ahead activities, it was o.k. to postpone the surgery. However, I aggravated it while doing the LA Marathon, and it bothered me when I did Ironman Florida which I believe was the result of high milage training. I decided to go ahead and have the surgery at the end of May 2001 since I wanted to continue with running long distances in the future and return to cutting activities.

Every surgeon has his preferred method of surgery. (insert bad joke here...)Them being sober is the one I prefer the most. But seriously folks, one of the most popular methods is autograft surgery. This is where they take out the middle third of the patient's patellar tendon and use that graft to replace the torn ACL. The hamstring graft surgery takes some of your hamstring to replace the torn ACL. The method my surgeon preferred was allograft surgery. This method uses donor tissue to replace the torn ACL, therefore you do not take out any of your existing ligaments or tendons. For instance, my surgeon said that the hamstring also helps stabilize the knee, so it isn't the greatest idea to take out something that makes the ACL's job easier. So basically, there's a cadaver ligament in my knee, which I think is very, very cool. Allografts risk for tissue rejection is very low because there's very little protein antigen in the washed grafts (the bone ends are completely cleansed of any marrow elements). The majority of the grafts are primarily made up of collagen, which has very low antigenicity.* I'm glad I used this method. After speaking to friends and others who had the surgery done, they all wished they would've used that method because the recovery time is quicker and you are not taking out some of your own tissue to replace the ACL. You should look for a surgeon that does these surgeries often, at least 3-5 times a week. Obviously, the more experience they have, the better they get. After finishing with my knee, my surgeon did another ACL surgery an hour later on a girl HS basketball player. Tragically, she died. Just kidding, I just wanted to see if you were still paying attention. Below is a picture taken during my surgery:

Before surgery, they gave me an I.V. and put me under general anesthesia. Next thing I knew, I was in the recovery room and felt thirsty and my throat hurt a little bit from the asesthesia. At that point my knee felt no pain. I was given Vicodin which I had to take 3-4 times a day for the 1st 2 weeks. My prescription alloted me 3 refills, but after the 1st 4 days, I started weaning myself off the Vicodin. Oh yeah, and after you go through general anesthesia, you might want to start drinking prune juice, or rejoice! because your saving yourself some money on the toilet paper you won't need...

The first 5 days after surgery was spent mostly in bed. I felt a little nauseated the first 2 days, especially when getting out of bed quickly to use the bathroom, but it was not as bad as some people has described it to me. The pain was not as bad as I had expected either. The only discomfort, again, was rising from bed and taking the first couple steps. I was able to return to work a week later, but since I sit on my butt the whole day, it made it a whole lot easier to return quicker.

A huge difference between current and earlier methods of knee rehabilitation is how aggressive doctors and physical therapists are, and I think my brother can attest to this. He was in a knee immobilizer for months. I was in one for 6 days before my first visit to the physical therapist. I was able to put 50% of my weight on my leg the day of the surgery. My muscle still atrophied, so I can't even imagine what my brother had to go through.

The first goal in physical therapy is to get your range of motion (ROM) back. Later they start working on strength (by later I mean the next visit practically. Like I said, they are aggressive). And the most important thing is to get full knee extension. One of the ways to do this is by rolling up a towel, putting it on your heel, and let gravity do the work of making your knee extend. This is where you might start experiencing some pain and cry like the wussy boy/girl you are. The other part of ROM is knee flexion. The therapists are a little more forgiving about this one, and give you a lot more time to get to 135 degrees. With extension, they want it at 0 degrees at the very least within 2 weeks. My apartment manager had surgery on her knee, and she was not as aggressive in her rehab, and to this day she cannot fully extend her knee.

You can pretty much go at your own pace once you have full ROM and then use PT as you see fit. I really liked going to PT. All the therapists and therapist assistants were great. I went 2-3 times a week for about 2 months. To give you an idea of how long the whole process takes, professional athletes usually get back into their sport at 6 months. Of course, all their day is devoted to getting back into their sport. However, they have the luxury to work out, get proper rest, get paid more money in 2 days than I make in a year, watch Sportcenter all day long, etc. For myself, regaining strength was the hardest part. I managed to stay ahead of schedule by going to PT as often as I did and by doing the excercises at home daily, but my knee did not feel really stable until about 3 weeks after starting PT. For instance, one of the 1st excercises in regaining strength was calf raises on the injured leg. I felt like my knee was going to give out for the 1st 2 weeks when doing this excercise, and then finally I felt dramatic improvement.

Once I graduated from PT, they gave me the ok to do a weight- lifting program. This consists of squats, leg press, and hamstring curls. Many surgeons do not want you to do knee extensions, or any open-circuit excercises. The very basic rule of thumb is that if your legs are not in contact with the ground or some surface, this consists of an open-circuit excercise. Since I took my time with weight-lifting (that's another way of saying I slacked) , I did not start playing basketball again until almost 8 months after surgery.

If you've managed to read all this, good for you, I thought this history was pretty boring myself....But, really, this has been one of my favorite experiences believe it or not. The way God made our body is so amazing! It heals, develops strength again, and it's incredible how you can take tissue from somewhere else and have it become a new ligament. I was blessed with a very good surgeon and Physical Therapist. So blessed, in fact, that if anyone would like to know of a great Physical Therapist office in Santa Barbara to go to, check out the following site: www.hpcsb.com. Anyways, I recommend getting the surgery, although I don't recommend tearing your ACL in order to get the surgery if at all possible.

I looked up many websites before the surgery, I suggest anyone interested in this do the same. Everybody will have a different experience, but hopefully this has given you some idea about what you'll experience. The most important thing is to work hard at rehab, especially at the beginning, because if you slack at first, it will be so much harder to get all the range of motion and strength back later. Also, try and have fun with PT. I remember racing around the PT office with a Physical Therapist Assistant named Loc on a stool chair with wheels (for hamstring strengthening excercises) and it was really a blast, and I looked forward to each visit. I'm easily amused, you say? Possibly, you big jerk.

*This information can be found in the following site: www.orthoassociates.com/ACL_grafts.htm It goes into more detail about the different types of grafts.

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