The Anterior Cruciate Ligament (ACL) is one of two ligaments that cross at the knee and attach the tibia to the femur that provide stability to the joint.
Ten years ago I fell victim to a nasty sweep in a BJJ exhibition match and my ACL sheared at the femur. Incidentally, this means that more than 1492 Newtons of force were applied laterally. This left my knee unstable and hypermobile, which led to frequent sprainings and other light injuries during activities such as push hands, or stepping down off a stepstool to change a light bulb. It also had the effect of chewing up a little bit of my meniscus, the cartilaginous cushion between the two bones, over time.
Four weeks ago I had surgery to reconstruct my ACL and remove damaged portions of my meniscus, and frankly I feel fantastic.
I've got almost full range of motion in the affected leg. I can bend and extend fully, but if I were to put the ankle on the opposite knee and then push down on the bent knee, that still hurts, but I can do it with the natural knee just fine. I can kick with it at chin height with power.
This is a little bit amazing to me because I didn't expect to be off of crutches this early, much less kicking and bending and walking without a limp.
And this success comes with not even having started the formal Physical Therapy I've been prescribed, just a tiny bit of taijiquan and walking the dog for exercise.
I can't take all the credit, though, the procedure itself used the latest technology, and we're a far cry away from the days where such a surgery required flaying open the knee to the bone and then keeping it immobilized in a cast for six months, with another six months of grueling physical therapy to wind up with permanently reduced function.
Here's what they did.
To replace this ligament, the usual method is to harvest a length of hamstring from the patient. This results in a bit more pain during a necessarily longer recovery, and a year before "most" of the tendon grows back.
We opted for an allograft. This uses donor tissue from a cadaver. When requesting the tendons from the body bank, my surgeon asked for tendons from someone under 30 who died due to trauma. There's no need for blood typing or other genetic matching. Any old tendon will work.
He harvested two tendons, a bit longer than twice as long as needed, these are then bent double together to produce a bundle about 9mm thick and pulled through a corresponding hole drilled in my tibia and femur with a wire.
Before insertion, the tendons are soaked in stem cells. Once they are in place, a syringe is used to saturate them with Platelet Rich Plasma processed from my own blood. This activates the stem cells and gets them to work growing blood vessels, etc.
The tendons are fixed to the tibia on bottom with a screw that clamps the ends against the sides of the hole, and the opposite side is held in place with a "suture button" that catches the bent middle of the tendons in a loop.
This is all done arthroscopically, so I have five tiny incisions around my knee, a total of ten stitches worth of cuts. Tubes were inserted into the incisions, the surgeon works the camera through one tube and his instruments through another, and to me that's the most impressive part of the whole thing. It's like working on a car engine through the tailpipe. Nuts.
I haven't yet gotten back to daily taijiquan practice, but that's sheer laziness on my part. It'll be at least another two months before the DR clears me for push hands, but I plan to be back in full on obsessive weapons and empty hand form practice by then.
Thanks for coming to my TED talk.