For most city commute I prefer to ride my bicycle. This early March I was in a dilemma to ride my bike to a work meeting at EGL. It was a 4PM meeting, clear day, I rolled in a formal shirt into my laptop bag. At Trinity circle, as if like a premonition, the bungee cord from my pannier snapped and got stuck in my rear wheel. Fortunately, there was no damage done, I thanked my stars and carried on. But just after command hospital, as the road narrows down a bit, I could hear a car blare its horn to an empty stretch of road. In the next minute, the car behind this one brushed past my cycle. For a brief second I crashed into the rear door of the blue car, half cursing, half balancing, half bracing for the impending fall. The next thing - a big thud as the back of head met the tarmac. The familiar ligament pain the left knee was back.
Lying face up on the road, my cycle, bag, phone scattered around, all at the mercy of oncoming traffic, I let out a loud scream (Kantara style ;), - this would change many things in my diurnal life.
A lot changed - Ooty Ultra and Hennur Ultras were the first to go. I was adamant with recovery, hoping (almost sure) that the knee will be good in a few days. The few days turned to a few weeks. I began to use an elbow crutch to walk, but the exertion caused calf strain right up to the back of the knee. It took me 3 days to release a brick-like calf muscle and then a spasmed popliteus muscle.
After about a week, when the mobility did not improve, I started physio sessions with a focus to improve knee extension. These sessions caused excruciating pain, but it had to be done. Eventually after a month of grief, I went in for an MRI, only to confirm the Anterior Cruciate Ligament (ACL) had torn, with some damages to the cartilage.
My first issue with ACL was way back in 2001, a freak football injury. Then my first Arthroscopic surgery in 2006 (read here) and then another bicycle accident in 2015 (photoblog here).
I have mixed opinion of Ortho / radiology experts. The MRI reports are seldom clear and one has to interpret them with a lot of contextual background. One physio suspected bone chipping, MRI second opinion indicated that my previous screws were not in place. Amidst this confusion, I suspended my physio sessions. The knee mobility got back and I started strengthening my knee at the gym.
I eventually visited my Ortho of last resort - Dr. Hemanth Kalyan. He had had conducted my surgery way back in 2006. We discussed the option of a second surgery, but decided to give it 3 months of strengthening to see if we could avoid surgery.
The surgery option that was prescribed was using a Hamstring tendon graft and an arthroscopic procedure using an Endobutton & a bio screw. Dr. H was confident of finding another tunnel without disturbing the previous tunnel or screws.
In the coming weeks, I was able to shuffle jog about 1-2kms with lot of discomfort. I was able to lift weights, deadlift (up to 80kgs), lunges, leg extensions & curls. I used the time off running, to do what I could in the gym. Not too bad, eh.
I decided to get it sorted out - once and for all! My ACL "reconstruction" had to wait till our dream home "construction" could be complete. Within 3 days of Grihapravesh of Tadvanam our new home, on Vijayadashami, I did my hospital-pravesh - same knee, same injury, same hospital, same doctor, separated by thousands of miles of running and 16years!
Revision ACL Surgery
Technically speaking, the surgical / therapeutic procedures performed was:
Revision arthroscopic ACL Reconstruction left knee using 6 stranded ipsilateral semitenidinous and gracilis with microfracture chondral lesion and medial meniscus balancing left knee done by Dr. Hemant Kalyan (HK)
I was wheeled into OT room2, after an overnight fast in hospital overalls (incl. a disposable underwear) at 7:30am. Mine was the first surgery for HK, I spent sometime in the waiting room. By 8, I was wheeled into a super large OT with some massive overhead lights and lots of sophisticated equipment. The anaesthetist and 2 orderlies got working on me. I was seated on the OT bed and felt a few pricks in my lower back - spinal anaesthesia done. Soon the legs felt heavy and then felt nothing. HK came in and started going over my case with another doctor, spoke to my awake "upper half" briefly.
I had seen this video explaining the Endobutton ACL reconstruction technique earlier. I had a sense of what is coming. (It's quite a procedure, check out the video)
Right through the 1.5 - 2hr surgery I didn't sleep. I had a cloth wall at my waistline to prevent me seeing the procedure. I could "feel" the drilling and the hammering of my joint, but no pain, like it was being done to the bed or something.
While I was being sewed up after the surgery, HK walked across to my conscious half and gave a summary. "We got a nice 10mm graft from the hamstring tendon (usually 8mm is sufficient). The earlier screws did not come in the way, so we left it as is. There was some cartilage damage, which we fixed via a procedure called the microfracture which allows for tissue from the bone marrow to form the cartilage naturally. All's well!"
I now have a bioscrew, an endobutton and 2 titanium screws in my left knee!!
I was transferred to the recovery room, where I waited for over 2hours to get some sensation back to my legs. My knee was all strapped up in crepe bandage and the immobilizer brace. Weird sensations, stiffness, dull pain came by during the post op evening, with it discomfort while lying down in the bed all day and disturbed sleep during the night.
On his evening visit, HK mentioned that I it was ok to put all my weight on my operated leg already and should begin my physiotherapy session on Day1 itself.
The IV line was a pain, with constant pain killers, antibiotics, etc. and other injections. The food was good, I was able to get to regular food from the next day. The support of my wife during the hospital stay alleviated the discomfort to a great extent.
I was discharged after 2 days at the hospital. I am now in my 4th week post surgery, the vastus medialis oblique (vmo) muscle needs more tlc but in general I'm recovering well. If I feel inspired enough, I will create another post on the rehab.
Thank you for reading and your good wishes for my recovery!
“Life is not a journey to the grave with the intention of arriving safely in a well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming, “Wow what a ride!” ―
Cheers and have a good day!
Ps: fellow biker and dear friend, Shilpi added a pretty accurate illustration
