National Service (NS) in Singapore Air Force (SAF)

Jason is now into his 2nd year of his National Service (NS) but was given a PES C after reviewing his medical records ( esp after his knees surgery ).

PES C  programme  include light physical training and vocational training to prepare them for combat service support vocations, such as service medic, and those related to logistics and administration.

He is trained as an Aviation Material Specialist (AMS).

But after office hours, he is still actively involve in social soccer at least once a week with his friends.

He sometimes complained that his right leg hamstring is not as strong before, though.

Also, he needs to watch over his other non-operated knee as it could have been stressed too much as he could be over conscious of his operated right knee and relies on the good knee too much.

Otherwise, he is living a normal life after his ACL operations a few years ago.

NAPFA Test - GOLD

Jas just went for his NAPFA test and scored 30 out of 30 and got GOLD for it.

This is a preliminary physical test before he goes for his formal medical check-up in Dec and then to be enlisted into National Service (NS) for 2 years.

NAPFA test involves running 2.4KM, shuttle run, standing broad jump, sit-ups and chin-up, sit and reach.

Glad that both his knees are in good shape...!!!

1 Year Later .....

Jas has been going for his physiotherapy sessions regularly for the past 12 months, starting with 2 sessions a week and then scaled down to once a week but he has to do some of the exercises on his own at home, including some jogging and kicking the soccer ball casually at the later stage.

Jas did not participated in any soccer games or active sports during this period as we have decided to wait until the 1st anniversary of his surgery.

Otherwise, he is doing well in daily activities and he even went on a Tree Top hike in MacRitchie Reservoir with some of his friends during the June 2012 school holidays.

Jas is on the extreme left of the photo, taking a drink from his water bottle during the Tree Top hike.

Jas went to Hong Kong and Shenzhen in Sep 2012 as part of the school trip overseas to visit some companies. Above is a photo of him in Disneyland, HK.

On 1 Oct 2012, Jas went for his progress review by his Dr and was discharged from further orthopedic review.

The Dr also wrote a letter to inform SAF about his surgery that he will need to be permanently downgraded and classify his PES status accordingly.
( Jas has been called up for his medical examination in Dec 2012 and to be enlisted in 2013 for his National Service. )

Jas will slowly resume his soccer and other sports with immediate effect. He needs not wear a sport knee brace and a normal knee guard will be sufficient.

I hope the information shared here would have benefited someone who could have been in a similar situation.

This episode will be considered closed and there will be no further update.

Thank you for visiting this blog.

3 Months Later .....

Jas is recovering well and has started doing some light jogging and skipping during his physiotherapy sessions.

Dr reviewed his progress and advised the physiotherapist to introduce some functional progressions and side-to-side agility exercises.

Dr also spoke to us about the biology of graft healing and how it takes between 6-9 months for the biology to catch up with his recovery. We were reminded that there is a very small risk of repeat injury particularly in the first 1-2 years after surgery.

As such, I told Jas not to start playing street soccer or any active sports until 1 year later, to be on the safer side.

Better to be safe than sorry even though the risk may be very small.

So Jas ended up spending more time playing FIFA 12 on his xBox 360 instead .....

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.