ACL reconstruction: 13 years on

BACKGROUND

September 2008. Kettering rugby club. I am playing in the lock position. I had complained to the coach a few times that my fellow lock kept collapsing - bad technique - and was concerned that someone was going to get injured. I was ignored. She was his daughter.

Don't be under any illusion here - I was very new to this, built like a lock, but not through strength. I was unfit and overweight and this was the first game of my second season trying to play rugby.

As I feared, a scrum formed, my number 4 collapsed pulling me down sideways, all the 8 opponents still pushing, came down on top of us. I heard a loud crack, like a branch snapping. I wondered if it was my leg. I stood up, it seemed OK, I tested it out, it seemed ok. However, when I ran, each time I changed direction I collapsed on the floor, and in the next scrum, I was just completely unable to push. I was forced to retire from the game.



on the left - normal knee with ACL,
on the right, mine... MISSING!

 

That was going to be my last game. 6 months later, an arthroscopy showed I had torn my cruciate ligament that day. No one believed me when I went to A&E saying there was something wrong, because it didn't swell and didn't hurt.

THE RECONSTRUCTION OPERATION

September 1999: I had a full ACL reconstruction operation. Back then it was a major operation that involved 34 staples and a full leg brace for 3 months. Major muscle atrophy, which is why it is no longer managed like that, these days it's a key hole

Operation and the patient is back walking within days. In my operation, they replaced the torn ligament by using a graft from the quad muscle. It was held in place with two aluminium screws.

I remember being disabilitated for weeks and weeks. When they took the brace off, I had to learn how to walk again. The recovery was horrendous. I was told I would never regain the feeling on the right side of the scar, and that the graft would be good for about 15 years before it may be susceptible to stretching. I got on with it, as you do, and became accustomed to my new limitations: for many years that knee was less stable as I tried to re-strengthen the muscles. I have never been able to kneel down since the operation, and sitting in restricted areas with no leg space becomes painful if I am unable to move regularly: i.e. planes. I have never regained the feeling on the right side of that knee, and I have a huge cartoon style scar like you don't see any more.

Fast forward 13 years.

TODAY and the new knee troubles

My life is very different now. I am 4.5 stone lighter, considerably fitter, competing for Great Britain in triathlon, and although I have always struggled with running, on the most part, the knee has behaved itself, till now.

A few months back, I started to have trouble with it. It began aching after running, I noticed that when I sat in certain ways it was sore. I have always been very careful with it, and my physio clinic has looked after me since the operation. I have on several occasions over the years had them check if it was still intact by doing the wibble wobble test.

With my knee bent, foot flat, they sit on my foot and pull the leg forwards, to check the stability. The cruciate ligaments, posterior and anterior, criss-cross in the centre of the knee, and are responsible for holding the lower and upper leg together an keeping the knee stable. Ligaments hold the skeleton together whereas tendons hold muscles together in position.

The physio checked his records, the graft was always a bit loose from the start, but yes, there was more play in the joint than there should be. He did a power test on both legs, and concluded that the damaged leg still had significantly less power than the other leg.

What can I do about it? Back to the gym again to build strength. I feel like I am always playing catch up with this leg, but let's face it, despite surgery; it isn't how it was when I was born, so it will never be quite the same.

When I run, it aches. After I run, it aches. Sometimes if I sit still too long it seizes up and I struggle to straighten it. On every occasion, once I get it moving, it's usually

Ok. Am I frustrated? Yes. Can I do anything about it? Yes, I can do everything in my power to continue to build strength to try and avoid the need to re-operate, something that fills me with fear and dread. I know it will not be the same as it was back then, but the operation and recovery was truly horrific, and I remember thinking at the time, had they told me the truth about it all I would have NOT gone through with it.

It's another really good time to fix my run form, and make the hip flexors do the work like they are meant to so that there's less stress on the joint. Will it stop me? NO! It will just make me more determined! The husband has already started with the Zimmer frame jokes!

What do others say?

I have done some research. In general people seem to say that the graft stays intact for life. I have found evidence though that it's not uncommon to start to have trouble with it about 13 years on, as the graft begins to stretch. It is also not uncommon to develop arthritis in that joint later in life. Brilliant. Some have ruptured theirs, needing another operation however some people do seem to manage life ok without a cruciate ligament at all.

Where does that leave me? Well at least I know the reason for the pain. In part, I know what I can do to try to manage it, and minimise further damage. It is widely reported that strengthening ham strings helps.

I have read that Chondroitin and Glucosamine helps the joints, so I started taking that some years ago. I will continue to do so.

I guess it’s a case of watch this space.