Donovan McNabb Joins the ACL Club

Today, Donovan McNabb, All-Pro quarterback of the Philadelphia Eagles had ACL surgery on his right knee. Feeling his pain.

Two Sundays ago, he tore the ACL on a somewhat freakish play running out of bounds on a QB scramble to his right. It wasn't a force impact type injury .... it seems that a lot of ACLs are injured like this. By happenstance, you catch your knee the wrong way and it pops.

The head trainer for the Eagles is saying 9 months post surgery that he'll be back which I think is very realistic. He did have some meniscus work done but given that he's a professional athlete and will have 100% of his time devoted to rehabilitation, I'm pretty sure Campbell's Chunky Soup spokesman will be back to true form by the 2007 season opener.

Welcome to the Club Donovan and best wishes on a fast recovery.

ACL Update, Week 10: Knee is Coming Back

I am going on week 10 of my ACL recovery. Today was my 2 month checkup since surgery (a bit early) and based on the measurements, the knee and core muscle groups (quad and hamstring) are coming back. The differential in size between the thighs is only 1.5 cm compared to 5 cm after surgery. Strength (measured in centimeters) is the barometer for recovery and I need to continue the 3-4x week exercises to cut down that differential in size.

So the key question I asked Dr. Green was "how does an ACL surgery affect one's speed?" Can you return to your former self and clock that 4.2 forty time? (a la Deion Sanders)

He was emphatic in saying that he's seen athletes achieve their pre-injury forty times on average in 8 months post surgery. That's very good news.

Despite the return of speed, many athletes say the knee is still 'off'. What remains is still physiological. It's the rebuilding of nerves, blood vessels, and bone and the feedback of your knee to brain and back and forth. Having all of that in sync varies per person, ranging from 9-18 months.

ACL Injuries in the NFL & Other Stats

I was curious to know how many notable NFL players have had ACL injuries and recovered. I did a quick Google scan and this is what I found.

It's quite interesting to see that recent medical advancements have certainly improved players' chances of returning to the field and being successful.

I've highlighted the success stories (in bold).

• Edgerrin James - RB
• Jamal Lewis - RB
• Willis McGahee - RB
• Deuce McAllister - RB
• Dominic Rhodes - RB
• Terrell Davis - RB
• Correll Buckhalter - RB
  
• Frank Gore - RB
• Jamal Anderson - RB
• Kijana Carter - RB
• Greg Jones - RB
• Jerry Rice - WR
• Brian Finneran - WR
• Lee Evans - WR
• Tyrone Calico - WR
• Braylon Edwards - WR
  
• Daunte Culpepper - QB
• Brian Griese - QB
• Carson Palmer - QB
• Antonio Cromartie - CB
• Roman Harper - S
• Kailee Wong - LB
• Will Demps - S
  

I asked my physical therapist about how an ACL injury might affect your speed. Theoretically, it shouldn't because it's your quad, hamstring, and calf muscle fibers which determine speed but she does think it may marginally affect the natural knee joint motion. I'll have to bring up this point with my surgeon Dr. Green next week.

Other Stats:

• Grass and turf had equal rates of ACL injuries
• ACL injuries accounted for 2% of all injuries
• 66% of injuries occurred in games
• RBs have the highest risk of injury
• 81% of team physicians said the ideal return to play time is 6-9 months post surgery
• Nearly 100% of NFL athletes were able to return to competition after surgery

Source: Bradley, Sekiya, Kaplan. A Summary of ACL Injuries in the NFL, 2001.

ACL, Week 6

Major jump this week.... hit 148 degrees of flexion.

I can now start going to physical therapy once a week since I can do all my exercises at the gym. It consists mostly of leg presses, leg curls on the machine and ball, step ups, lateral side-to-side with rubber band, bike, and elliptical.

Since I'm only 2 degrees from my other leg, I'm feeling confident I'll be back on the court and field way ahead of schedule.

By end of 2006?

ACL Rehab, Week 4, #7 and #8

This week, some big gains were made:

• Increased flexion from 136 - 142; 150 is max on healthy knee
• Started doing the elliptical machine
• Can walk up and down stairs with no issue
• Increased muscle mass in quad

In two weeks, I'll start going to physical therapy only 1x week. A lot of the exercises I can now do on my own at my gym.

Next week, I see Dr. Green for my one month check up. Will want to get the news on when I can start jogging/running again.

ACL Rehab, #6

Today a small break through was made ... the 130 degrees barrier was broken.

With a lot of hard stretching and this blunt metal tool (sounds a bit ... yeah I know 'funny'), Sara helped me reach 136 degrees. I'm not too far off from the normal flexion of 140-150 degrees.

Log: 127 to 136.

ACL Rehab, Week 3, #5

Each week, the knee has been making nice increases in flexion, about 10-12 degrees. Now, we are getting into the smaller and harder gains. I started the day at 125 degrees and ended it at 129 degrees.

I must say that physical therapy hasn't been a walk through the park. In order for me to get increased flexion, Sara my PT has to physically 'stretch' the knee and force the knee to bend. As she's doing it, she's basically tearing scar tissue. Yah, it kinda' hurts and isn't much fun as your eyes well up a bit.

At this point, I am able to walk normally (regular gait, no noticeable limp) but the leg does swell up if I am on it for too long. The left quad is noticeably smaller than the right but have been doing extra leg lifts to strengthen it.

I can see why these ACL injuries take a good 6-9 months before you are back to playing sports. Lots of rebuilding and relearning to do.

ACL Rehab #1

Today was my first day of physical therapy for the new knee.

Very excited to get this going!

Sara, my physical therapist, began the session by loosening up the fluid around the knee cap and then stretching/pushing my knee towards my hamstring. This is to break up all the scar tissue around the knee joint.

Each session my progress will be measured in degrees (i.e. how much flexion can I get each time).

I started at 80 degrees and the goal was to get to 100 degrees. This part was quite painful, the joint was very tight. I ended up getting to 98 degrees (Nick Lachey), just shy of 100.

Sara made me get on the bike to warm up the joint and she challenged me to see how far I could rotate around. Couldn't get the full 360 degrees; probably closer to 270 degrees.

After the bike, I got a refresher on how to walk properly. Because of the brace, you have to relearn the correct way, really emphasizing the heel-to-toe motion.

The day was wrapped up with 15 minutes of shock treatment on my quad where they place these electrode pads on your quad which send pulsating electricity. This stimulates the regeneration of the muscles. I kind of liked the stim (the medical term), I think I'm part masochist.

Best part of this visit was that she opened up my brace to have full range. No more "Ay, ay Captain!" peg leg.

Day 11, ACL Update

Went in to see Dr. Green for my second post op appointment. Things are on track: the leg is straight (better be damn straight!), swelling has subsided, and muscle strength is improving.

Good news is that I don't have to sleep with the mega brace on. Bad news is a) I still have to wear it during the day even though I don't think I need it and b) I still have to wear the "pantyhose" stocking for another week. Ladies, don't know how you do it.

Day 6, Post Operation ACL

I thought I was a tough guy since I had stopped taking the meds (oxycontin) around Day 3 post op. I was doing fine until the last 24 hours, when my lower leg realized that somebody had drilled a hole into it and attached some foreign object (some other guy's tendon).

Yep, had to go back on the meds to alleviate the pain. I hope this is temporary. Hmm, reminds me of my flag football team's mantra... "Pain is temporary. Pride is Forever."

In this case, pain must be temporary. Pride what, who?

Day 4, Post Operation ACL

Today was a good day. Had my first post op visit with Dr. Green. I was able to see the new knee unveiled (very curious to see what was underneath the stained and bloodied bandages). It wasn't pretty (see below). He made a total of 6 incisions (2 of which were used to drill the graft into the 2 bones and the others were to look inside the knee and smooth out the meniscus in the back of the knee). Yeah I know, probably a little too much info.

All in all, good to get the first visit out of the way and have a plan for rehab. It starts ASAP. I'll be in the brace for the next 4-6 weeks and can walk without crutches as soon as comfortable. Right now, the brace gives me zero flexion (range of motion). I'm basically a pirate with a peg leg attached at the knee and I get to sleep with this bad boy (robo brace).

Cryo/Cuff & Lizzie

Whoever created the Cryo/Cuff Cooler has done a huge service for post op ACL patients. Instead of having to schlep over to the fridge and pack a new cold one every half hour, I attach a blue tube to the air cast around my knee and immediately a rush of coldness soothes the swelling.

Even with the meds, you need this beautiful device to sleep through the night since there's a ton of heat dissipating from the knee.

Lizzie has been quite curious about the knee and crutches (startled by the click clacking around the house). She hasn't quite figured out what's going on.

ACL Replacement, Finally

The day started off with a 5:30 am wake up call (my alarm) and a 6:15 am check-in at the University of Washington Medical Center. The facilities/reception area resembled a new remodeled hotel lobby: clean lines, lots of natural light, open space, and modern furniture.

My surgery was scheduled for 7:20 am. Once I got the call, a tech took me into my 'room', an 8x8 space with a bed and this cool vacuum looking machine called the Bair Hugger. I find out later that it pumps out hot air to keep patients warm.

The next 45 minutes, I met the entire medical team starting with my anesthesiologist, who was a cool cat. Dr. Peter Buckley, a 60-year old+ rugby player with a British accent, and I commiserated about rugby and the reality of aging, mostly laughs. He administered my IV and asked the perfunctory questions: "What's your name? Date of birth? Which knee is getting operated on? When the last time you ate? Health problems?"

I then met the rest of the team, Dr. Buckley's resident with medical student in tow, 3 other murses, my surgeon, Dr. Trey Green, and his assistant (a young orthopedic surgeon, Addison, who also plays flag football at Memorial Stadium). Kind of funny there's a real surgeon at this Seattle hospital called Addison ...

Where was my tending Addison Sheppard from Grey's Anatomy? I prefer this spicy, redhead to the whiny, banal Meredith Grey.

Around 7:20 am, it was time to "get it on!"

Surrounded by my entourage of blue scrubs, I was a rockster rolling at breakneck speed through a series of halls and swinging doors . It was like being in an episode of ER or Grey's where I AM the first person view. Very surreal.

The next thing I know, I bust into this frigid cold operating room that could have been made for a mad scientist. There were a gazillion lamps of all shapes and sizes with tons of medical equipment and supplies on the perimeter of the room. Within a minute of digesting all of the activity (I saw the surgical team as a group of Santa's elite elves on Christmas Eve busily working in the background), I was O-U-T.

Black out. Don't remember a thing.

In the next 2 hours, Dr. Green & Co. do their thing and I wake up back in my 8x8. All in all, it was a smooth operation with very little discomfort. I think the most pain I felt was when Dr. Buckley stuck the IV in the vein on my left wrist. The whole team made me feel comfortable at every stage in the process (nice people), were extremely efficient, and in my view, the medical center deserves to be voted one of America's Top Hospitals, as rated by U.S. News & World Report 2005. Also, props to the UW Sports Medicine Clinic for all of the pre-op work and the forthcoming post-op and rehabilitation.

My resident anesthesiologist was nice enough to take a picture of the operation. The new and improved knee!

ACL Surgery Pre-Op

Had my pre-op today, which consisted of 1) meeting with the surgeon's assistant, Ivory, who happens to be African (the irony) and then 2) getting my knee fitted for the "Robo-brace," (RB) a full-length leg contraption consisting of at least 15 velcro straps and accompanying clips that completely immobilizes any movement of the knee.

After the fitting, my physical therapist, Sara, taught me how to walk on crutches with the RB on which I found to be eerily strange. I mean, it's like preparing to walk injured knowing you're going to break your leg the next day. We then went through an education on isometric exercises for my leg muscles, ones that will help improve strength in my quad post-surgery and minimize atrophy.

So a couple of rules to abide by:

• No eating or drinking day and evening before surgery; right to gorge on my "last supper"
• Bathe with special soap, Chlorhexidine gluconate (CHG), night before and morning of to 'sterilize' my body
• Bring the Cryo Cuff, a cooler-looking device that pumps cold water through an aircast that reduces swelling of the knee, which will be my best-friend post surgery
• Bring the meds; hello Vicodin or Oxycontin
• Make sure to sign the knee to be operated on; yeah, that would be bad if they went in on the wrong knee

T-4 days till the surgery. Getting anxious for this to be over and get on with with rehab. I'm going to do everything I can to accelerate this process. Enough of not having the freedom to run and play sports.

MRI of Ruptured ACL

As suspected, the ACL was confirmed to be totally obliterated. Looking closely at the photo, you'll notice that blobby mess between the femur (thigh bone) and tibia (lower leg bone) where they connect. That sea of blob is what's left of my ACL; it's merely strands of torn collagen. In a healthy knee, you'd have a clear picture of both bones which is connected by a black line, which would represent an intact ACL.

The positive thing about this MRI is that the other major ligaments like the MCL, PCL, and LCL were fine; no damage whatsoever. Pfew!

Road to ACL Surgery

Today was the first of many visits to the University of Washington's ("UW") Sports Medicine Clinic, where they treat both the university's athletes as well as the public. I apparently fall into the latter these days.

After filling out about 20 forms on my family's medical history and my dog's as well, I was taken by a Lisa Loebish assistant with a thick Eastern European accent to measure my height and weight. Pretty normal, a shade under six feet and a girthy 180 pounds. Not my fighting weight but that's what happens when you a) become non-ambulatory and b) continue to feast.

They then took x-rays of both knees. I knew it was a soft tissue injury but apparently, you can determine other issues from the x-rays. My orthopedist, Dr. Green, then walked in the room and I proceeded to give him my play-by-play of the injury. "Nobody was open in the end zone, saw an opening, hit the gap, cut back hard on left leg, and heard a pop. Knew something was wrong when I hobbled around on one leg and felt some pain in knee. I continued to play through the entire game despite this. Was playing on more or less one leg as the left knee would buckle when weight was borne on the leg."

He responded, "That's hardcore" but was thinking, "This guy's got a loose screw in the noggin' and is way too old to be playing flag football. Stick to chess buddy."

Dr. Green asked more questions about other symptoms and conducted a couple of tests on the laxity of the ligaments. Making me extend the leg and bring it in.

Overly optimistic as I usally am, I went into this visit thinking it was an MCL injury, which 98% of the time requires no surgery. This was based on the fact that I had forward stability and incurred no swelling at the time of injury. Two good signs, usually.

Dr. Green quickly dispelled my hypothesis and pretty much concluded that my ACL was blown based on the looseness in left leg compared to the right one.

My immediate response, "So when can I get back on the field?"

"Well, it's typically 6-9 months before you can really doing any rigorous activity."

My heart sank. 6-9 months, you've got to be kidding me. I have NEVER in my life been out of commission for more than a few weeks. I seriously have had the worst luck in the last six weeks: broken clavicle and blown ACL. I might as well lose a testicle while I am at it. Yeah, let's not tempt fate by throwing out such words. Just not worth it.

I could see myself over the next 9 months .... 50 pounds overweight, slothful, pale, and playing Stratego by myself after work.

Yeah, it's going to be a b*tch of a ride post surgery, from the many tales of ACL surgeries I've come across on the net.

Anyhow, I can still pray for a miracle tomorrow when I go to get my MRI, which in reality will only confirm my lack of an ACL.

Shall I dance around on one foot in a circle in a feathered headdress and leather thong and chant for the ACL gods to deliver?

Probably should.

Can't wait for my official invitation to the OR when I return to Dr. Green's den for the good word on Thursday.