1 Month Later....

Jas started his twice a week sessions with the recommended Physiotherapist on 27 Sept 2011 and will eventually scale down to once a week.

He was still using crutches.

Prior to his soccer accident, we have made arrangement to fly back to Penang to visit his grandparents who were not well.

The Dr approved his travel plan and also gave us a letter to certify that he just had an ACL Reconstruction Surgery in case the metal detector goes off though it was not expected to ( there is 1 screw placed to hold the replacement ligament ).

Luckily, Jas was in good shape and mood to travel with his crutches and we also brought along the ice gel for his knee swelling.

We got him a wheelchair to minimize his walking on the crutches in the airport.

Jas and his grandfather in our Penang house.

Well, this is how his knees were after 1 month of recovery.....

You can see that the swelling on the right knee has gone down and you can see the shape of the knee cap now.

Jas started to use only one crutch on 8 Oct  and totally walked without any crutches on 11 Oct 2011.

We bought him a knee guard to help stabilise his knee joint as he has to walk up a slope to get to his classes in his school, which started classes on 24 Oct 2011.

It was most unfortunate that he has to spend the last month of his school holidays recovering from his knee surgery but then, it also meant that he did not missed any classes.....

Recovery at Home

Jas was discharged on Tue 20 Sep 2011 and went home with a pair of crutches.

He was taught how to use the crutches to go up and down the stairs since we live in a 2 storey house.

We also rented a CPM machine for a week to stretch his knee joint daily.

The Dr gave us a pair of ice gel to wrap around his knee so as to continue to keep the swelling down.

1st Week of Recovery

The ACL Reconstruction Surgery was successfully done on a Saturday afternoon on 17 Sept 2011.

Jas has to wear a tube bandage on his right leg and constantly hooked up to an ice machine to keep the swelling down.

During his 2 days' stay at the hospital, he has to use a CPM machine to move his knee joint.

He was taking 3 types of painkillers during the stay at the hospital.

His right leg especially the knee area is quite swollen and looked rounded in comparison to the other knee.

Keyhole surgery so there are 4 cuts made to the knee area only.

Here is an actual video of the keyhole surgery done on Jas's knee :

Search For Another Orthopaedic

As I was not happy to wait until end of the month or about 2 weeks' time to have the knee surgery done, I started to look for alternatives.

I thought of my own orthopaedic who I have consulted on my problem left knee ( having osteoarthritis or OA ). I decided to give him a call and told him of my son's situation.

I was glad that he was enthusiastic to help me and we managed to get an appointment to see him the following day.

We took the MRI along for the appointment.

Dr Lim did not look at the MRI but took some time to explain to us the muscles around the knee joint and how they work. Then he examined Jason's both knee; starting with the good knee and then the injured knee. In short, he was able to confirm that Jason has a torn ACL as his knee joint is slipping forward.  ( I think the test that he did is called the Lachman's test. )

Dr then look at the MRI and confirmed that it was indeed a torn ACL and surprisingly, the meniscus seems to be in order.

Dr briefed us on the pros and cons of having a allograft versus autograft. He can do both and we could still proceed with the allograft as he has stock now ( also from a reputable supplier from US ). However, he recommended that we re-consider to do an autograft instead.

His reasons were :

- taking Jason's own hamstring ligament would not affect his hamstring much; maybe only 1% of the strength

- taking a dead man ligament; no 100% guarantee of disease free like Aids and these are dead people who were above 60 years old

- though an additional cut is required to extract the hamstring, and potentially some soreness around the hamstring area, recovery is almost the same

- most of his patients choose autograft and if there is a need to replaced the ACL again, then to opt for allograft ( that's what happened to a young patient of his, a school ruby player )

Dr shared more information and statistics on the ACL surgery and recovery processes. We saw some of his patients photos on his office walls and we asked about them especially those in their teens like Jason.

After some discussion, we decided to do an autograft instead of allograft and we felt confident about it too after hearing so much from the Dr who was very willing to share his knowledge with us; eg he even took us through what he would be doing during the operation like the holes he has to drill and how the hamstring ligaments are introduced into the knee.

Importantly, Dr is able to operate on Jason's knee the coming Saturday afternoon, 17 Sep 2011.

So we agreed on it and I cancelled the early surgery that was to be scheduled in 2 weeks' time.

Review of MRI Scan Results

The MRI scan results showed that there was a tear at one of his knee ligaments, anterior cruciate ligaments or ACL.

It could have been worse if there was any damage to the meniscus too but none.

The Dr explained that we need to replace his torn ACL as it will not grow back or heal by itself, and gave us 2 options:

- used a ligament from a dead person ( also known as allograft )

- extract own hamstring ligament to replace the damaged ACL ( also known as autograft )

The ligament from a dead person, comes from US and as such, it is more expensive but recovery is faster.

Using his own hamstring has a slower recovery as an additional cut would be made.

We were thinking that a speedy recovery is more important and not to take another ligament from his leg and make his leg worse.

This Dr was not very articulate and he seems more in favour of an allograft so when we feel the same, he did not give us more info on pro and con of allograft versus autograft. Also, when I queried him further for more clarification, I sensed that he was not very comfortable about it ( I am not saying that he is not a good Dr but I think he is from the older generation where they do not share information openly and not used to being queried....? )

He was prepared to do the surgery the following Thu or Sat depending on the availability of the surgery facility.

BUT he was also going away the following week so another surgeon would also be present during the surgery and would follow-up on his absence.

I was not too comfortable with this arrangement but then we were so keen to get it fixed during his semester break that we just went along with it.

So after signing the necessary forms, the receptionist would call me to re-confirm the surgery date.

Later that day, the receptionist called me to inform me that there is no stock for the allograft and we need to wait for the stock to come in and since the Dr is also going away the following week, it was best to schedule the surgery at the end of the month; ie about 2 weeks' time!

I was shocked and asked if we could get the stock in early and schedule for another surgeon to do the surgery but it seems that it was not possible ( I do not understand why? ).

I agreed to it as I was not given any choice then!

BTW, I was surfing the Internet and looking for information on allograft and autograft.

Again, too much information and mainly from US and I think they favour allograft and these cases were from people involved in mainly extremely sports. A few have even torn his ACL twice!

Honestly, I was very confused and not sure whether I made the right choice though I discussed it with Jason and my wife. I was also not in the proper state of mind too..... while I expected an operation but still it scared me and what could be the right choice...?

Jason actually said to me that he trusted my decision and would go with what I have decided for him, this added more pressure on me!

Appointment with Specialist

The specialist is an Orthopaedic Surgeon, a Dr who specialised in bones, joints and muscles system.

This Dr examined Jason's knee and suspected that he has a ligament tear so he recommended a MRI scan to confirm his findings before he proposed the action plan.

Unfortunately, the earliest available MRI that can be done would be the late afternoon that day!

And the follow-up consultation with this Dr the following morning.

No choice but to accept these timings.

I was complaining to the receptionist that even in a private hospital, we have to wait so long for the MRI scan.

So even got money, it does not help unless you are dying....... sigh

No choice but to go home and then come back to the hospital at the end of the day for the MRI scan.

Very frustrating indeed!

Though it is not life threatening, but as parents, we were definitely worry about the knee problem and wanted some answers.

Visit to GP

As agreed, I took Jason to our regular GP to seek his advice on his injured knee.

The GP did some simple check on his knee joint and then prescribed some painkiller and anti-inflammation medication for him. He also referred him to their specialist in the hospital but the earliest appointment was Tue morning.

Luckily, Jason was not in pain and no obvious swelling in the injured knee so we have no choice but to wait for Tue.

Also, he was having his semester break too.

He continue to wear the knee guard and use the walking stick so as not to aggravate the knee.

But in my thoughts, I was still troubled by the 'pop' sound that he heard when he injured the knee.

I started to searched the Internet for such knee injury but too much information and just not sure what to accept!

It was very frustrating knowing that something is not right but we have to wait for Tue appointment to know the real problem.

Friendly Street Soccer Match

About 2 months ago, Jason joined his friends for a friendly street soccer match organised by a church.

Sometime in the afternoon, I received a sms from Jason that he has hurt his knee and heard a 'pop' sound. I think my heart missed a beat as it is no good to hear a 'pop' sound but when I replied to him if he needed me to fetch him home and see a Dr, he said that he is ok and did not feel any pain and had applied ice on his knee. The good thing was that he has stopped playing immediately. He would find his way home.

Based on his reply, I was comforted a bit.

Jason came home after dinner with his knee bandaged and not in pain and no swelling, surprisingly.

He could walk but he said that he felt his knee wanting to glide or slip forward, a funny feeling.

I got him to wear one of my knee guards and also my old walking stick to help him walk.

We decided to see our GP to get an opinion and a referral to have a look too, if necessary.

It did not seem so bad but still, something did not seem right and the 'pop' sound still bothered me.
We have a friend who was walking and then heard a 'pop' sound and her knee was painful and swelled. Eventually, she had an operation to fix her knee.