Sunday, 15 May 2016

KNEE RECONSTRUCTION (part 1) two weeks post surgery

I haven't done any cycling in four months. Now before you start calling me a lazy sod, let me explain...

Last summer I made the decision to go back to university in my hometown, Nottingham, to take a masters degree in Applied Linguistics. It's also the city where I grew up skateboarding and the majority of my friends are still rolling. The skate scene here is pretty amazing. There are some great spots now that didn't exist when I used to live here and the new generation of skateboarders are killing it. I haven't skated regularly for several years now. When living in Korea I lost the desire to skate because it has always been a social activity for me and none of my friends out there were skateboarders, so whenever I come back to the UK I dust my board off and catch up with my friends. Usually all the old tricks come back quite quickly and last summer was proving to be a lot of fun. Then one day at the local DIY concrete skatepark, built on a wasteland at never you mind, it all went tits up. When trying to do a frontside bluntside on a teeny tiny rail on the flat, I kicked my board away and tried to bail. My right leg stepped on to the top of the rail, hyperextended, and my knee bent out to the side. felt the joint pop and fell down in the least dramatic way. It really looked laughably pathetic! Obviously I started swearing like crazy!

This was the first incident with my knee; let's call it the September incident. I thought I had just sprained my knee. I managed to hobble around a bit. I didn't do any exercise for a month, before I started cycling again. I went to see a doctor and a physio who both seemed to think I hadn't done any serious damage. I wasn't in too much pain, so I thought nothing more of it. There were occasions where I felt like my knee was going to give way, but by Christmas time it seemed to be fine.

Then in mid January, shortly after having handed in all of my assignments for the autumn semester, I decided to get back on my board. I really felt like skating a bowl, so I cycled down to "Flo", my local indoor skatepark, with my skateboard strapped to my bicycle. The session started slowly but I managed to get a few nice lines in, landing a couple of backside smith grinds and 5-0s. I then had a shot at a combo trick, a backside smith to 50-50, not the prettiest of tricks,  but a fun one to do. That was the last trick I ever attempted to do on a skateboard. Needless to say, I didn't land it! Haha. As I stepped down the transition of the ramp my knee just gave way and once again I felt that dreaded pop. Fuck! Fuck! Fuck! I picked myself up off the floor, hobbled around a bit and somehow managed to get out of the bowl. We'll call this the January incident. It felt more or less like the previous injury I had. After about 20 mins of sitting around rubbing my knee I figured the session was over, so I made my way home. Somehow I managed to cycle back to my house. Little did I know how completely fucked my knee was.

Weapon of mass destruction
(Death trap for sale! 4 months on and my skateboard is still strapped to my bicycle)

The next morning I couldn't walk. My leg just simply could bear any weight. To cut a long story short, I had royally fucked my knee up. I wouldn't realise the full extent of the injury for another four months, shortly before I underwent surgery on my knee. Here's a breakdown of what happened:

  1. The cartilage (meniscus) in my knee had torn on both the left and right hand side of the knee. 
  2. I fractured my tibia.
  3. My anterior cruciate ligament had completely ruptured - snapped in two.
  4. I ruptured my posterolateral corner (PLC) 
Four injuries at once, although I didn't realise it at the time.

Fooked knee. Totally busted
(my totally swollen knee the day after the January incident)

The day after the injury I headed to the walk-in health centre as I didn't think the injury was too serious. An x-ray revealed that I had a fracture at the rear side of my tibial plateau. They sent me to accident and emergency where they put my leg into a "Richard brace" (see photo below), a fixed brace that doesn't allow your knee to bend. Somehow I managed to get an MRI scan within a week, which is pretty miraculous! The scan revealed that I had completely severed my ACL. I didn't find out that I had damaged my PLC until the day of the surgery.

Richard brace
(This is a Richard brace)

I spent about 10 days on crutches in the Richard brace, non-weight bearing of course. Wearing it for so long gave me really bad lower back pain. The muscles in my right leg atrophied. My VMO (the tear drop shaped muscle above your knee on the inside of your leg) completely disappeared. Subsequently I was given a hinged brace and started a course of physio. My memory is not so good, the first two weeks in the brace was at 45º, then the next four weeks was at 90º.

After about 6 weeks I went to see the knee specialist for a consultation. He gave me the option of having reconstructive surgery or opting for non-operative rehab. Because I'm an active fellow, he advised that having surgery would give me the best chance of a full recovery. The thought of my knee giving way underneath me while hiking somewhere remote, or having fallen off my bike in the middle of nowhere did not sound appealing. "Yes sir, please I'd love some surgery".

Even prior to my surgery, my knee made a pretty amazing recovery in a short period of time through physio alone. I was able to do some light hiking in the Peak District, and was even even capable of making a careful dash for the bus! It was starting to to feel quite strong already.

Mam Tor
(Taking a stroll on Mam Tor in the Peak District a couple of weeks before the surgery. My recovery from the January incident was fast. Stick to your physio and you'll make good progress)

On the afternoon of Thursday 28th April I went under the knife. That morning they informed me that they would be performing three procedures, rather than two. Up until then I was unaware that I had damaged my PLC, but nonetheless that wouldn't affect my decision about the surgery. Get it done, boss! I was under anaesthetic for about two hours before I woke up post surgery.

knee - 1

The ACL and PLC procedures involved taking a graft from my my hamstring tendons, one from either leg, which were then used to create new ligaments. I stayed in the hospital overnight and was discharged the following afternoon. Physio began immediately. My knee was kept in a fixed Richard brace for 5 days.

If it had just been the ACL, my recovery time would have been about 9 months to get back to full sporting function. However, because I have multi-ligament damage, the recovery will take about a year, the first two months being particularly slow. My first 6 weeks on crutches are non-weight bearing. The PLC is the real bastard here. It's a complex series of soft tissues which I couldn't possibly being to explain. Here are a few articles for you to read about the PLC:

"The dark side of the knee" 

"Posterior corner injury of the knee"

Posterolateral Corner Injury

Unfortunately due to the PLC injury it's unlikely that I'll reach high level function again. I should be able to do all the things I enjoy, such as cycling, swimming, hiking and running, although I have been told that contact sports will not be a possibility. I couldn't care less about contact sports, so I'm not too worried about that. I have been advised that I shouldn't skateboard again. I will almost certainly follow this advice!

The irony of this injury is that although it occurred during skateboarding, the real cause of it is cycling. Over twenty years of skateboarding I never injured my knee. Cycling is considered good for the knee because it is low impact and it is a recommended exercise for knee rehab. However, when cycling is your main exercise and you do it as much as I do, you neglect lots of stabilising muscles that support your knee because it involves no lateral movement. In short, this injury could have been avoided had I been doing exercises that strengthen these supporting muscles. I will post more about this in the future.

The other irony is that everybody keeps telling me that it's no surprise I injured myself skateboarding because it's so dangerous and involves a lot of high impact. This is a misconception. Both of the incidents that led to my knee surgery were low impact. In fact most of the skateboarders I know who have suffered serious leg injuries did them doing virtually nothing. Arthur Tubb shattered his leg doing a kickturn on a quarter pipe. Ian Rees also buggered his knee doing a kickturn down at the Nottingham DIY spot.

knee - 2
(Morphine and tea up to the eyeballs!)

knee - 4
(When I need motivation, I just pretend to be Freddie Mercury)

After 5 days I went to the occupational therapist to get my my dressings changed and a "genurange" brace fitted with a range of 90º.
knee - 5

knee - 8

knee - 7

knee - 9
My lovely new brace

knee - 11
The first exercises I was given weren't too taxing. They were mostly static exercises for my quads, glutes, etc and stretches for my calves and hamstrings.

knee - 13
After two weeks they gave me some more advanced exercises. Initially I couldn't do this leg raise as it was painful and my knee felt too weak. Within three days these were easy to do. It's amazing how quickly your body strengthens and regenerates.

knee - 14
Two weeks post surgery and I know have a range of about 85º. Pretty good progress.

Anyway, that's enough about my knee for now. I'm pretty optimistic and looking forward to the rehab process. There's something strangely enjoyable about it. I should have this brace on for about 9 weeks in total. I'll post some more once I get this brace taken off.