Last weekend I was still limping a little bit. Then I went to Nice for a hen weekend. I couldn't believe it, but after all the walking and dancing, my knee actually felt better. I had a much better range of motion, and I wasn't limping unless I was tired. I did manage to bump one of my scars while getting up from lunch, and it hurt like hell.

Yesterday I went to see the physiotherapist again, and he said he was really pleased with the way I'm healing. He said that the reason it hurt when I bumped my knee is that I have some really sensitive scar tissue under the incision wounds. He said that's not unusual, and he recommended massaging them with lotion or oil to sort of desensitize the area.

So it all seemed really good until I accidentally ran while I was trying to cross the street. That's probably a good thing, since it means my brain wasn't trying to favor my leg, but I felt a little twang and it definitely did swell a little bit. On top of it all, I accidentally tried to sit cross-legged last night. I didn't feel a twang then, just a lot of pain. My leg is still a little bit swollen, but it hasn't been sore.

The physiotherapist said that if they do a hamstring graft, I probably won't have any more incisions on the top of my knee. Instead, it will be a keyhole operation from the back inside part of my thigh right above my knee, where they will cut out a bit of the hamstring and then go through my knee, I guess from underneath.

Peter was pretty pleased with my range of motion, but he said I need to work on getting it into 5 degrees hyperextension, like the other knee. I think I have about 10 degrees to go. I can bend to about 110 degrees now, so I've got another 30 degrees for the flexion, but apparently that's easier to regain than the extension.

He said I will have little nodes of scar tissue under the wounds where they did the keyhole surgery, and that they shouldn't bother me, but he can teach me self-massage to alleviate any irritation if they do. (I wonder what sort of search engine hits I'm going to get from "self-massage"!)

So today he stretched me out, watched my gait to see where my limp is coming from (I am walking flat-footed, which I knew, but I am also not putting enough weight on my left leg so am landing heavy on my right leg), and gave me exercises to do: in addition to my stretching, I should use an exercise bike and a stair-stepper, swim (urgh), do squats against a wall, and scoot forward and backward on a bench to regain hamstring strength. That last one sounds easier than it actually is. He also wants me to do balance work, where I stand on one foot for as long as possible. I can already do it for pretty much as long as I like, so I guess I'm a little bit ahead of the game on that one!

Getting on the bike was depressing. It was nearly impossible to do one full revolution, when just a few weeks ago I was going to spinning classes. ARGH!!

It's been a pretty uneventful weekend for my knee. Jon and I went house-hunting on Saturday, which meant a lot of walking around and going up and down stairs. My knee didn't really complain at all, though it was tired by the end of the day, so I didn't end up going out for a friend's birthday party. I go back to work tomorrow, and I see my physiotherapist, Pete, again on Wednesday.

I think Pete will be pleased with my range of motion. I can now put my knee straight out, but not into hyperextension, and I can bend it further now too, but still not as far as the other one. I had a scary moment on Saturday when I stood up and it felt like my knee went into hyperextension. There was a tiny popping sound, and it hurt for about a minute, but there was no swelling or pain afterward, so I think it's probably ok. It also started popping by the end of the day, every time I would go down stairs, but it seems to have stopped that now.

The scabs on the little stab wounds are starting to heal now, too.

I saw the physiotherapist today for the first time since the surgery. He stretched me out, and it felt good afterward (though it hurt like hell while he was doing it).

He said I have a decent range of motion right now, and that we need to concentrate mainly on getting the extension to 0 degrees (it's more like 5 or 10 right now), and also to keep working on the flexion. He said I should wear the pressure bandage when I walk around a lot, but that I can leave it off while I'm at home. He of course also recommended ice and elevation.

If I can get back to a decent range of motion and strengthen my muscles as much as possible before the surgery, I will be halfway through the therapy before I even start, he said. I suspected as much--it just makes sense.

He also described the process of harvesting a hamstring and drilling through the knee in order to attach it. Eeeeeeeee.

Quote for the day: "Orthopedic surgery is basically butchery."

Today I took off the steri-strips from my arthroscopy stab wounds. The strips themselves were all bloodied, so I had no idea what to expect. What I found was three tiny little incisions, no stitches or anything. There will probably be three microscopic scars. Since the ACL reconstruction itself will also be a keyhole operation, I probably will escape from this relatively unscathed (on the surface, anyway). I've covered them with bandaids and a little bit of antiseptic ointment. I've also put the pressure bandage back on, because each little wound has a lot of swelling around it.

I already have lots more mobility in my leg than I did before the arthroscopy. I can nearly straighten it, and I can bend it without any real pain. I am still wary of bending and straightening it, probably for more psychological reasons than physical reasons. Then again, my muscles have definitely paid the price for not being moved too much. My calf aches because I'm trying to walk as normally as possible, which means making sure I use a heel-toe action--which of course you don't get when you're on crutches or wearing a brace that limits your mobility.

I called the insurance people (BUPA) yesterday, and all of my surgery and physiotherapy will be covered by my policy. Hurray! When I see the doctor next Monday, I have to ask him some paperwork-type questions, but I can go ahead and set it up for whenever I want.

I want to wait until early June to have the reconstruction, because May is full of weddings, and I don't want to be unnecessarily incapacitated for those. That will also give me time to build back up some muscle tone so that I've got a head-start on the wastage before it starts again.

First things first.

I tore my ACL in my left knee while skiing in the French Alps on March 24th, 2003. It was my first skiing trip, my fourth day out, and I was going too fast (for me, anyway). I lost control and fell over. My skis did not come off, and I twisted my knee farther than it wanted to go. I didn't hear a pop, but I felt a twang, sort of like a guitar string. When I tried to stand up, my knee went right out from under me, so I knew something bad had happened, but I thought it might just be a sprain.

I waited on the top of the mountain for about two and a half hours for someone to take me down, and I kept my knee cold using snow in a plastic bag. When someone did take me down, it was pretty cool: a guy skiied down a red run pulling me in a stretcher behind him. So I can honestly say that on my first skiing trip I went down a red run backwards without falling down!

The doctor in France was absolutely marvellous. He diagnosed me with a torn Anterior Cruciate Ligament (hereafter referred to as ACL) and healthy cartilage, which was, as we shall find out, the correct diagnosis.

He referred me to a specialist in London at Chelsea and Westminster hospital, which takes about an hour and a half for me to get to from North London, where I live. The specialist said that they weren't sure if I had completely torn the ACL. They wanted to do an MRI, and would sort out some physiotherapy for me, and if I could get my knee straight by the time they saw me in a week, they would just recommend physiotherapy to get my knee stable until they could do the MRI.

The physiotherapist (at a hospital about 3 miles from me, thankfully) said he thought the ACL might not be torn because I didn't have any real swelling until the next day, which is apparently rare if the ACL is torn because it has its own blood supply. He said that I might have some serious cartilage damage.

I was still unable to straighten my knee past about 15 degrees or bend it past 90 degrees by the next Monday (March 31st), so the specialist decided to take me in for an arthroscopy on Thursday, April 3rd. They found that the first doctor was right. There was one part of the cartilage that was slightly damaged, but should heal on its own pretty well, so they didn't do anything to it. The ACL, on the other hand, was completely ruptured. The reason I couldn't bend or straighten my leg was that part of the ligament had wrapped itself around in my joint. I have some pictures in my file, so I'll see if I can get them and scan them in. Sounds pretty gross to me.

I went home the evening of my arthroscopy, much to the head nurse's chagrin, but since I was in a room with 3 other people (one of whom was about 300 and decrepit and always fell asleep in really uncomfortable-looking positions, one pretty girl a little younger than I am, who was very nice and talkative but had scary massive bruising because her platelet count was 3 (it should be about 154), and last but not least the woman next to me, who was about 50 and kept muttering "Oh Christ" all day long)--since I was in a room with these three people, I was more than ready to go home, and the specialist had said I could leave that evening, I went, and how's that for a sentence?

Friday was uncomfortable and sore, and I spent Friday and Saturday just sitting around with my leg up, icing it down when I remembered, and eating and generally feeling all of my lovely 10k-running muscle tone fading away. Today was the first day I really felt comfortable with getting up and moving around, so I decided to start this blog to log my experiences. I had some people around today, and we just sat around and talked. My knee complains a little bit when I've been standing for a while, and I don't think there's any way I would make it to work, which is just under a 10-minute walk away.

The doctor has said to take two weeks off work, but there's absolutely no way. I would top myself if I had to do that. Fortunately, my manager has sent me a laptop so I can do some work at home.

I am going to try to use my private health insurance for the reconstruction so I can have it done sooner. The NHS has been surprisingly quick with everything except the MRI, which I didn't actually need anyway, so I've been happy to use it so far. Nevertheless, I think private care will be much more prompt for an ACL reconstruction, since it's not technically something you need in order to be able to live a relatively normal life (that is, if you don't mind your knee giving way any time you turn quickly, or run, or do anything young active people do).