ACL Reconstruction

Every once in a while, I find out that someone I know requires an ACL reconstruction surgery.  Often, that person ends up asking everyone he/she knows to have had one for advice from their personal experiences. I thought it would be useful to write up a blog of my experience to help some people that perhaps I don't know, and who find themselves in this unfortunate circumstance. I am not offering any medical advice, just a perspective.

I had my surgery about 5 years ago in April and I must admit that my knee doesn't feel completely normal. Additionally, I continue to have minor anxiety when participating in rigorous sports such as ultimate frisbee and soccer.  Recently, this psychological barrier is actually getting a lot less significant, and I feel like I can trust my knee again for strong support. I have heard from friends that they have similar experiences about sports. On the other hand, there are a lot of football and soccer players that get right back into training in about 3 months, so I would encourage you to be dedicated to the recovery process and not to be worried about abusing your newly replaced knee ligament. I am pretty sure that you have a greater chance of injuring the opposite knee than injuring the fixed one.

The planning...

I had my surgery performed by Dev Mishra, who came to me as a reference from someone my mother worked with at UCSD and the VA Hospital.  He was very patient with me and I felt comfortable with him. For an allograft ACL reconstruction, it seems that different doctors each have their own personal preference for the replacement part they use.  Dev preferred the posterior tibial tendon.  There is another doctor at Stanford (Dr. King) who is pretty famous for using the Achilles tendon for allografts. Doctors seem to readily impose their surgical preferences on you. I found it difficult to get them to deviate from what they are most familiar with.  To have a procedure that you are comfortable with, it's probably easier to shop around for a doctor that describes the procedure in a way you can accept.  I checked with 3 different doctors in the area, and in the end, chose an allograft (as opposed to an autograft) because I felt that I didn't want to destroy a part of my body that already worked well.  I have heard that most autografts use either the hamstring or patellar tendon. One of the best advantages of using the patellar tendon is that it is taken out with some bone attached.  This is nice since it will make one point of reattachment very secure because one bone fused to another is very strong.   I was never offered the option of getting a cadaver's patellar tendon, and don't know what the reason is. As far as the Achilles tendon goes, I believe it doesn't come with a bone fragment attached. My replacement tendon didn't include bone, and was made by braiding the posterior tibial tendon. Dr. Mishra said he used bioabsorbable screws on my knee, which were preferred to titanium. It may not make much difference, but having magnetic screws or screws that appear on x-rays are more likely not to let you forget about your surgery.  As far as strength goes, my opinion is that it doesn't matter. Though the Achilles tendon is the strongest tendon in the body, everything that could be used is stronger than the native ACL you once had that ripped.

The surgery...

During the procedure, perhaps of some concern is that the doctor will have to avoid a major nerve which if severed could lead to potential permanent numbness near the knee. In my experience, I felt numbness for a couple of months in one area below and to the inside of my right knee.  Prior to the surgery, I was put under general anesthesia starting with Valium to knock me out. One of my friends had her surgery done with local anesthesia.  There again, I don't think that matters too much.  Also, be sure that you ask about video taping the surgery since it might be an option available to you and could provide a source of entertainment for years to come.

The recovery...

I tore my ACL in January, let my knee heal for 2 weeks, planned for the surgery for about 2 months and scheduled it for April. I didn't think the operation was urgent, but it would have been nice to have the whole recovery take less than 8 months or so. Instead, it took over a year for the bulk of it.

My first week in recovery wasn't too painful because there was a catheter slowly dripping pain killers directly into my knee for about 4 days after the surgery. Then a nurse took that out and it was a bit painful, but really not too bad. I ended up taking a couple of Vicadin pills during my recovery, but since I try to keep myself off that type of medication, I didn't take very many. The worst part of this period of time was not being able to shower and then after that, having to bend my leg to get into the shower. The bending of the leg was excruciating and the physical therapy requires a lot of flexibility maneuvering (not fun). I didn't have anything apparatus for automatically moving my leg while I was sleeping like some people have.  My leg was in a brace for about a week, and then I was on crutches for about 4 more weeks. Physical therapy lasted about 6 weeks. The hardest piece of mobility to get back was leg extension, but I eventually was able to achieve good extension.  During physical therapy, managing pain is extremely important because you'll want to do the most painful exercises as much as possible to fully recover. In this case, I was told that pain is not indicative of something not good for you. The more that you push yourself, the better.

Other notable things were that I had to ice my leg a lot to quell the swelling for a month or so. Sitting with my legs crossed was fine, but I couldn't really sit on the floor with my legs bent under me for a very long time.  Even today, I feel uncomfortable sitting like this. Also, I find that now, when I sit still for a very long time, the knee feels stiff when I get up to walk. I have to walk on it a bit to loosen it up and get the blood flowing.

My friends have had a wide variety of recovery experiences.  Some have had a much quicker recovery than me, and one college friend had a pretty extreme recovery where he had to have the surgery redone.   I think that most people have a 3-4 month recovery to an active lifestyle.  In judging my own, I would say it is average to poor.  Regardless of how long it takes, the most important part is to continue with the physical therapy and get back into sports. You'll definitely be able to do what you did before the surgery, but make sure not to let your fears of reinjury prevent you from doing what you once did.

If you are preparing for a surgery like this, make sure to relax, rent a lot of movies, and have a loved one who is willing take care of you for a few days.  It helps a lot.

Movie Finder Applications on Android

I wanted to evaluate some of the Movie Searching Applications for Android, and this is just a quick intro to some of the ones that I have used in order of my preference.

All of these applications use your location and the internet to give you more information to help you find movies and show times.

1. Movie Finder
   
   • Has a very clean main page, showing newly released movies first . You can sort by title or rating on the main screen. The ratings come from Google movie ratings.
   • Also easily accessible is the theater view and the upcoming movie view. The theater can be sorted by name or distance.
     
   • When you drill down on a movie, you can see the movie posters, links to trailers and the IMDB page, as well as show times in your area.
   • Nice clean application, and my number one. I wish they had rotten tomato ratings because I think this is a better source for movie ratings than Google.
     
2. Flixster Movies
   
   • Gives you information on the main window about box office movies, upcoming movies, theater information and show times, and dvd movies.
     
   • It's a pretty clean page which is visually appealing and gives you ratings that come from flixster users and rotten tomatoes, although at the moment, you have to drill down to see the rotten tomatoes rating. I wish this weren't the case because I think rotten tomatoes is a great source of accurate ratings.
   • Also has a drill down for trailers and show times which is nice and clean.
3. Movies and Showtimes
   
   • This feels more like a browser window than a client application.
   • It provides ratings based on IMDB movie ratings, and really just shows a list view with very little information on the main navigational page.
     
   • You really have to drill down hard to find information about the show times.
     
   • This also seems to be the most popular application in the Android market for finding movies. I don't exactly know why, since I don't think it is that great.
     
4. Where
   
   • Seems to list movies in alphabetical order which is inconvenient since you would probably be searching for movies based on popularity or release date.
   • Has a local theaters and local movies tab and defaults to the local theaters tab when it would be nicer to default to the movies tab.
   • There aren't any pictures, trailers, or visuals to help you with the movie. It is all text based and fairly ugly.
     

Great Bit of Code

Someone at work had this as their signature for their email.  Since I am such a big fan of Christopher Walken and I have the More Cowbell shirt and all, I thought it was terrific:

if ( hasFever() ) {
 return ((Cowbell) Prescription.getInstance())++;
}

War Games

I was on a ski trip with Google to Squaw Valley this past week, and aside from the fact that there was awesome powder, great weather, and that I killed myself doing black diamonds all day, I had a long long bus ride. And you thought I would talk about my snowboarding or shredding the frozen waves of the mountain. Naah. I saw War Games on the bus, which was a terrific old movie. I liked that they documented to some degree what hacking was like in the old days when computers were very unsophisticated. I could really see why all the Googlers are cult fanatics about this movie. It was also had a great message that still is valuable to us in today's world about war. "It's a strange game... The only way to win is not to play"