Day 4

Pain levels toward the end of last night and this morning continued to improve. The swelling does not seem to have decreased but another change of the dressing shows that the stitched wounds – and now that I take closer note I see that there are at least eight of them – are mostly dry under the protective pieces of first-aid tape. With the reduced pain levels I began today to work on range of motion.

When I woke up this morning I had an approximate range of motion of about 10-25 degrees, or about 15 degrees total. I iced around 10am and again at 1pm and at 2pm I took my scheduled dose of Toradol and added a Percocet, the latter of which I have been skipping on at least half of the available 6 hour doses. At that point I started sliding my foot back and forth on a ramped piece of melamine. I can push my foot up toward the top of the board and toward full extension and then I use a piece of rope looped around the bottom of my heel to gently coax my foot back down the ramp towards flexion. I did this for a couple of hours and eventually worked my way to nearly full extension and about 60 degrees in flexion. I was quite pleased with the progress.

Afterwards, to minimize any resultant swelling, I iced again, this time for nearly an hour. During that time the heel of my foot was resting toward the top of the ramp, my butt on the bed, and my knee, unbraced for the ice wraps, was just barely off the ramp and therefore essentially unsupported in the middle. As I removed the ice wrap I saw that my knee had settled to about zero degrees. Or was it farther? I suddenly worried if the swelling in my knee was causing it to appear more bent than it really was. My stomach turned and I could sense my lunch beginning to reappear in the back of my throat. I tried desperately to determine if I had fallen into hyperextension. Although I have been told that my knee is “solid” and that I should not worry about re-injury, my own mechanical perspective suggests to me that I do not want to be pulling on the ACL at all at this point. The soft tissue of the graft is strong, I understand, but the bone plugs at the ends of the graft have surely not had time to heal into my bones and so are still relying entirely on the interference screws for their attachment. I sat flat on the floor and fully extended both of my legs. The right leg is tight in extension but it gets there far too easily for my taste. I am now nauseous and disgustingly unnerved.

According to the Stone Clinic guidelines my range of motion goal within the first phase of recovery (1-2 weeks) is as such:

"Passive range of motion should be 0 degrees or hyperextension to 90 degrees flexion, minimal pain and edema, unassisted good quality gait before moving onto Phase II."

Certainly my right leg was not far into hyperextension, if at all, and obviously there was very little downward force on the joint but the fact that I even potentially endangered the new graft (or even just the intended tension of the graft) is absolutely sickening me. It is mentally devastating. What is apparent at this point is that since Christmas this ordeal has generated plenty enough pain and emotional disturbance for me to develop an exceptional level of obsessive paranoia around anything that threatens a successful recovery. I may have a difficult time getting to sleep tonight.