Anterior cruciate ligament injuries

Left knee 2002: Left knee ACL again, snapped when dancing in a Christmas party 22.11.2002. Operated 7.4.2003, reconstruction using hamstring tendon.

Left knee 1996:

Go to right knee 1997

My left knee injured on January 12th 1996, when I tried to make a piruett-jump in circuit training. When the foot touched the floor, the knee was rotated and I felt a snap followed by flash-like pain. Afterwards walking was more or less painful, and the knee was liable to give away.

The knee was operated in Diakonissalaitos hospital, Helsinki, on March 13th using arthroscopy. The delay was due to inadequate diagnosis in health center, but actually the surgeon said the best time for operation is about 8 weeks after the injury, when the tissues have calmed down, and so the timing was quite perfect. Reconstruction operation was made by doctor Syvähuoko while I was deeply asleep. The anterior crucial ligament (ACL) was completely torn, and the waste system of my body had eaten it away. There was also a small rupture in the knee disk (meniscus).
 


A 8 cm long and 9 mm thick strip of my own patella tendon with small pieces of bone in both ends was installed to replace the broken ligament. In the coloured X-ray pictures you can see the screws made of titanium mixture which are used to fasten the new ligament. I will carry those screws in my knee the rest of my life. They do not beep in airports etc. The patella tendon, which lost about one third of its thickness, will gradually grow to about 90 % of it's original thickness. The rupture in the knee disc was also smoothened. The X-ray picture and photo show also the metal stitches closing the incisions.

When I woke up in the recovery room my leg was installed to a machine, which straightened and bent the knee slowly back and forth. You were not allowed to leave the hospital before the bending angle reached 90 degrees without making you grimace. Only in the recovery room I felt some pain, but it disappeared after additional medication, and did not come back. In spend one night in hospital.
I was on crutches for 7 days, and did not use any immobilizer. From the first day I was told to do series of exercises to mobilize the knee and maintain muscle strength. Two weeks after operation I stopped eating pain medication and started training supervised by physiotherapist. Sick leave lasted one month.
 
 


 

During first months training included water jogging and gym six days a week, a little more than one hour per day. The knee did not like immobility, in the mornings it took time to start it up before I was able to walk normally. While sitting , it was better take a walk every 20 minutes to avoid stiffness.

After three months the training consisted mainly of biking 45-90 minutes a day, plus gym and water jogging twice a week. The full flexion of the knee was achieved about 3.5 months after the operation. Climbing stairs down required extra concentration for months, going up was much easier. Slippery roads postponed the starting of running until March. About a year after the operation I was able to run normally.


Right knee 1997:

Go to left knee 1996

The coloured picture with aroows are magnetic resonance images of my right knee taken by Medimagneetti Ltd. The red arrows show the places where a dark, continuous ACL (like in black and white reference image) should be. The green arrow points to my undamaged posterior crucial ligament, which is seen as a dark band.

I started orienteering on 11th of April and successfully run through six competitions and training routes. On May 8th I was taking part into a competition at Lohja.  It had been raining in the morning, and there were slippery branches on the ground in one downhill. I stepped on one of those branches with my right leg, slipped, maybe unconsciously tried to save the operate left knee, fell and heard the familiar snap again. Immediately I realized that something quite nasty has happened. I managed to get out of the forest to the first aid although the knee was unstable and in pain. X-ray pictures were taken at health center the same day to ensure that no bones were broken.

The day after I visited doctor Syvähuoko who suspected damages in ACL and medial collateral ligament (MCL). The magnetic resonance images confirmed that ACL was almost completely torn and there may also be a rupture in MCL and joint capsule. Due to suspected MCL and capsule problems the operation was scheduled for May 14th. If MCL and capsule would have be badly damaged, the ACL reconstruction wouldhave occurred only in second operation after some months. The arthroscopy however showed that other injuries were minor, and ACL was reconstructed immediately.

This time I used an immobilizer for a month due to pain in strained MCL. Rehabilitation started right after the stitches were taken away on May 26th.

The X-ray pictures show this time besides the stitches and the screws, the pipe by which liquid is drained away from the operated knee for about 24 hours after the operation.

About a year after the  second operation I was able to run properly. The knee suffered quite a while from slight extension problems,  which were  somewhat painful in the beginning of the rehab.
This was due to  the fact that the operation was made straight after the injury,
 and the pulled MCL.
Two  years after the  second operation  occasional over extension when running
on  an uneven surface like forest give me a weird feeling around the patella of the right knee.
 Kneeling on hard surfaces  causes some discomfort.
These problems are  minor, in general both of  my knees work perfectly well.

This picture shows how my knees look like about 2 years after the second operation: the scars are quite unnoticeable from normal viewing distances.

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