I should start this post by acknowledging that my ACL journey hasn't, in the truest sense of the word, been a calamity. True calamity is being diagnosed with a life-limiting illness or coming back from a war zone minus several limbs and, self-absorbed as I can be, I'm not insensitive enough to think that having a dodgy knee is in any way comparable to either of those scenarios. But the headline is a well-known phase, and it is alliterative. And alliteration is NEVER a bad thing. So I'm going to run with it...
With my consultant's appointment looming this Saturday, I've been mulling over what to say when I see him. And, truth be told, I'm not really sure what to say. The knee is better than it was eight weeks ago but, functionally, it's still pretty rubbish. Walking on predictable surfaces is fine (ish). I have more movement back but not enough for what I want to do (ie kneeling, getting up and down relatively easily - the bar isn't exactly set high there). There is some strength coming back but I can't step down forwards from a low box without pain so I'm a long way back even on where I was in January.
I've been thinking more and more about just accepting that it's shit and living with it - even if that's just for a few years while I get on with other priorities - but then I get annoyed with myself for effectively giving up and that isn't normally my style. So, trying to analyse why I'm feeling this way in the small hours of this morning (always the most effective time for logical thought, I find), it occurred to me that my deeper frustration stems from the fact that this 'revision ACL' issue has been going on for two and a half years. Wow!
Chatting it through with my husband this evening, I realised that if you wanted to make up a story about a bad ACL surgery and rehab, you could think for a long time and you wouldn't come up with the combination of cock up and calamity (there, I used that word again), that have cropped up here. So here's the timeline from the last two and half years.
October 2014 - knee shifts during a walk around the forest with my little girl in her pram. Convince myself I was imagining it or that a little bit of movement is normal..
December 2014 - knee shifting fairly frequently, even just walking round the house, and beginning to shift out of joint when I kneel down (NB - I never managed to kneel down after the initial ACL surgery but seemed to finally reacquire that skill while I was pregnant with my little girl), requiring me to shift it back in manually.
January 2015 - visit GP to check it out. GP convinced there is nothing wrong but refers me to physio under duress, but only 'given the history'
February 2015 - start physio who adminsters weekly painful massages and asks me to score day-to-day pain on scale of 1-10 despite repeatedly being told that pain isn't the issue, stability is. No mention of ACL failure.
April 2015 - back in the gym, all be it less plyometrics etc than previously due to still sore knee.
August 2015 - jump out of camper van to fetch something and knee shifts out of joint good and proper, leaving me swearing and clinging to the door until it calms down. Go and see private physio who takes one look and suggests initial ACL surgery has failed. Faff with insurance as recently changed providers and not sure if this will be covered or not.
September 2015 - confirm knee is still covered on insurance and referred onto consultant.
October 2015 - get appointment with consultant, who orders MRI. MRI inconclusive as shows ACL is still intact but joint is very lax so exploratory surgery booked for December.
December 2015 - exploratory surgery takes place and confirms ACL is present but essentially non-functioning (pivot shift score 3++). Revision surgery booked for March 2016.
March 2016 - revision surgery takes place and referral onto hospital's physio department. Physio commences. Not convinced by quality of treatment, professionalism or attention paid to issues raised but decide to give them benefit of the doubt for now.
April 2016 - brace removed and back in the gym to start proper rehab. Massive flare up after cycling on the bike for 5 minutes. Wait several weeks for swelling to go back down and start again.
June 2016 - after getting full extension back within a week or two of surgery, constant flare ups keep setting this back. Poor physio session before I head off on holiday combined with being told next appointment will be in three months (despite the fact I still can't 1/4 squat on it and, as it turns out, I don't have full extension back) leads to decision to move physio back to provider who diagnosed it in the first place.
July 2016 - Good knee locks getting into car to go to physio. Gets steadily worse during physio session. Two days later, call NHS 111 for advice as still can't stand on it but don't want to waste A&E's time. Told to go to A&E. X-rays come in clear but given crutches and appointment for fracture clinic next day (side note, whoever invented under-arm crutches gave no thought to underwired bras. Almost certainly a bloke. Ow ow ow!) Fracture clinic advise cartilage is likely torn but referred back to private consultant for speed (given wider context)
August 2016 - MRI shows likely cartilage damage. Operation to remove it booked for October. ACL physio limited as good leg not strong enough to support it.
October 2016 - floating articular cartilage removed from good knee. Rehab starts again. Health insurance requests treatment plan from physio to sanction further treatment. Physio office manager passes away unexpectedly. Treatment plan never received.
November 2016 - start swimming as stage one of post cartilage op rehab.
December 2016 - progress to the gym (cycling, cross training and stepping up on box - forwards, backwards and sideways). Signed off by consultant.
January 2017 - progress to jogging (plus activities from December 2016). Take husband out for birthday meal, slip on ice, ACL knee shifts in and out of joint and gives way completely leaving me on my backside in the road.
February 2017 - physio assesses damage and refers back to consultant. Consultant reviews and suggests eight weeks of physio to try to stabilise joint conservatively. Two weeks sticking head in sand and being angry. Contact insurance company to organise new physio. Insurance company will only sanction one session of physio. Will then need treatment plan from physio to sanction further treatment. See physio and start over again.
March 2017 - still waiting for call from insurance company to give go ahead for additional physio. Chase physio who is in middle of renegotiating contract with health insurance company. Receive voicemail asking me to call physio to discuss what we need to do next. Busy work lives mean we keep missing each other over the course of two weeks. End result? Back to see consultant on 1 April and have no real progress to report and just one physio session under my belt since I last saw him.
So, in the absence of formal physio while we try to sort this mess out, I've taken myself back to the gym and I'm doing the basics. Again. Over and over. Walking on the treadmill, cycling, quad sets, straight leg raises and stepping up onto the box (even if stepping down isn't a goer as yet). I guess I know what I'm doing at this point but it would be good to have clear direction from here on in so we can get this right once and for all.
I keep wondering how I find myself two and half years down the line and no further forward? In fact, not just no further forward but actually behind where I was when this whole process started in many respects?
What frustrates me most is that, at every stage bar the two week 'head in sand' at the start of this year when I couldn't face dealing with a damaged ACL again, I've done everything I'm supposed to along the way. I've done the physio. Repeatedly. Yet, here I am again.
Is there an element of cock up? In several respects, I could definitely say yes.
Have there been elements of bad luck? Again, yes, but you make your own luck, don't you? As the only constant throughout this whole palava, I must be at fault in some way or other, even if that's just being complicit in allowing this to drift on as long as it has. Assuming that is so, what can I do to change things now to drive this to a better conclusion?
I don't want to have wasted two and half years of my life on this to be no better off. Equally, I've put other things on hold for two and a half years that I don't want to continue doing. Talking with my husband this evening has helped clarify a few things, and in reality, I need to focus now on what has (or hasn't) happened over the last eight weeks, as opposed to the bigger picture, if I want to start making progress. Maybe Saturday's appointment will be the first step in finally getting this sorted.