So, after several 'filler' posts, hints and updates, I can finally fill in the gaps and officially announce that I’m six months pregnant. Apologies I couldn’t share the news before but running my own business meant I couldn’t reveal the news at three months like most people do, having to wait instead until my cover was in place and all clients had been informed re cover arrangements, all while maintaining the line that I've just been over indulging over the festive period and this fat belly is not, in fact, home to a new life but a surfeit of mince pies.
That was finally completed this week so at last I can breathe out again! In many ways, the timing has been fortuitous – it's far easier to bluff in winter than in summer, I’m sure – even if I’ve definitely had to work harder to disguise the growing bump this time around.
Anyway, it’s good (if slightly terrifying) news – and something that we’d delayed trying for following my revision ACL surgery in March 2016. Hopefully it explains why I haven’t gone back to physio/consultant to reassess the knee as it has deteriorated over the last few months as a) I’m pretty convinced that being pregnant does impact my knee (personally, if not among the wider population) so would influence any test results, and b) for obvious reasons, there’s very little I’d do about it immediately, even if the answers do lie in further surgery, so why go there?
In terms of how pregnancy impacts on the ACL and my knee in general, it’s a question I asked when the original reconstruction failed as it hadn’t become symptomatic until roughly five months after I had my little girl, although I had finally regained full flexion while I was expecting (which later went on to become slipping out of joint when kneeling down). I was curious as to whether or not the hormones that circulate in your body during pregnancy to relax the ligaments for childbirth could have any impact on ACL ‘performance’ (as I understand it, relaxin isn’t selective as to which joints it works on so everything becomes looser to some extent). Plus, they say you need to understand why a reconstruction has failed before planning any revision surgery and I didn’t want to go through that surgery again only to have a potential second pregnancy scupper the efforts on all sides.
Anyway, my consultant’s answer was ultimately that he didn’t think pregnancy was the cause. It could have a limited role but there’s no weight of evidence to confirm this or otherwise so we put any worries to one side and went ahead with the revision ACL reconstruction plan as usual.
It’s a tricky one as we all know that research generally operates at a population rather than an individual level – providing a range of ‘norms’ as opposed to answers for individuals. As with everything pregnancy related – from what to eat to impact of age, alcohol and exercise – there’s also very little empirical data out there. All advice errs on the side of caution as designing research involving pregnant women a) involves a limited pool of people and b) entails inherent ethical challenges.
Either way, and this is obviously anecdotal following my experiences with this pregnancy and comparing them to my last, I do think pregnancy has an impact on MY knee and the ACL in particular.
Why? I mentioned in an earlier post that I’d finally started gaining more flexion in my knee over recent months. This coincided with the pregnancy and aligns with my experiences last time around. During my first pregnancy I carried on with high impact exercise right until the last month so, aware this could have made matters worse, I’ve deliberately limited my activities to low/no impact exercise this time around (both because the knee hasn’t been up to anything more and also because I don't want to do anything to make it worse - more on that in another post).
Despite this caution, the knee definitely seems looser and is becoming increasingly symptomatic as the pregnancy progresses. Of course, this could be coincidental. We know the replacement ligament isn’t lying exactly as it should be, increasing weight is bound to have some impact, nor am I as fit going into this pregnancy as I was last time, so nothing is directly comparable, but you have to take the information you have and make a judgement call.
Given the lack of hard data out there, what I’d love to have done is to have had an accurate measure of the degree of laxity immediately prior to becoming pregnant this time around and to be able to measure it throughout the pregnancy and until I’ve finished feeding the new baby. I think, from memory, it takes about six months for the relaxin to fully leave your body once you’ve finished feeding and for everything to return to ‘normal’, but I’m guessing we’re already too far down the line for that data to be useful, nor do I have any means of objectively collecting it, even now that the news is out in the open. Nor do I have any plans to go down this path again, and certainly not just for ACL research purposes!!
So, while I can’t provide clinically-useful data, I do plan to track how the knee behaves over the next few months in the hope that, even as anecdotal evidence, it may prove useful to someone going through a similar experience or add to the knowledge base in some other way. With that in mind, if anyone has any suggestions as to what information would be useful, let me know...
In the meantime, there are some links to existing research on the impact of pregnancy on ACL laxity and reconstructions below, which may be of interest to other readers:
A quick google of ‘pregnancy after ACL surgery’ or variants on those search terms also throws up a variety of questions and issues raised by other people who are either considering getting pregnant following ACL surgery or dealing with ACL injuries during pregnancy, which may also give some different perspectives.
I'll continue blogging over this period and hopefully some of it will prove useful. It's inevitable that those blogs will be coloured by current circumstances so apologies to those this phase isn't directly relevant to. In the meantime, fingers crossed everything goes smoothly and I'll post more in due course.