The Tale of the Knee

On Friday 25 July I had a stupid fall in the garden which cost me a weekend in hospital, surgery to re-attach my quadriceps tendon to my kneecap (I heard them drilling holes in the bone to stitch into!) and five weeks with my left leg in a thing called a cricket splint.

I was discharged by the hospital and told to make my own decisions about when to wear the splint (prematurely, I suspect), and I probably overdid it. In particular I went upstairs without it on the way to bed and the knee sort of ’gave way’ halfway up. This had obviously done some damage (though not apparently to the tendon repair, and I couldn’t face going back to the hospital - very stupid, as it turned out. I wore the splint all the time for a week and then decided it was okay to take it off. A couple of days later I walked to the paper shop with one crutch and no splint, and halfway back the knee ’gave way’ again, this time re-rupturing the tendon. This necessitated a second and more complicated operation followed by six weeks a full-length cast, no weight-bearing at all on the leg and really scary ’walking’ on elbow-crutches or more secure but tiring travel using a zimmer frame. If you’ve never experienced having one leg completely unusable but stuck rigidly out just waiting for an accident, you have no idea how disabling and exhausting this is!

After six weeks my fourth cast (three resin and one plaster - they all quickly became loose and uncomfortable) was replaced with a ’dial-a-knee’ brace, and I saw the consultant, expecting to start weightbearing and knee-bending, and therefore becoming far more mobile. However, without even looking at the knee he ordered another two weeks non-weightbearing with the brace locked before starting rehab. In fact, he said that if the brace hadn’t already been fitted (it was supposed to be done after I’d seen him, but this got brought forward because half the orthotists were off sick) he would have put me back in a cast.

When Patricia asked what I wanted for dinner that night, I said ’ Mr P*****i’s liver, with some fava beans and a big Amarone.’ (Not a Hannibal fan? Read The Silence of the Lambs. The ’Billy Rubin’ joke alone is worth the time. Better still, read Red Dragon, then Silence, then Hannibal and finally Hannibal Rising - I did recently, while chairbound, all of them for about the fourth time. Brilliant!)

In fairness, I know he was genuinely anxious about the possibility of the tendon rupturing for a third time. He had warned me repeatedly that if this happened I probably wouldn’t recover full knee function. Given that the joint wasn’t too brilliant to begin with, that was a pretty bleak prospect.

At the end of the fortnight, I saw a different doctor and then the physio, and I was finally allowed to use the leg, though with only one-third of body-weight on it (no - I couldn’t be sure: just had to use my judgment!), and with the brace set to allow 45 degrees of bending. What a difference! I could finally move around without constantly worrying about damaging the knee - and with about a tenth of the effort. Prior to this I had actually stopped having second cups of tea because that would mean more trips to the loo.

After two more weeks, the leg felt really strong, and I could finally get in and out of both front and back doors with the crutches (previously I could only do the front door - reversing out with the zimmer!).

After three more weeks I was doing well with a 60-degree limit and by the 12 December I could bend the knee freely to 90 degrees and put my full weight on the leg. I still had to use the crutches for balance and protection, but got out and about round Worksop, did several laps of our favourite farm shops and by Christmas I was able to spend several hours cooking without the crutches. In fact, when I needed one to go out to the garage I often had to go round the house looking for it!

On the 2 January I had a physio assessment in the hospital gym, and on the 16th I got the surgeon’s okay to wean myself off the brace, which I’ve now (26 January)largely done. I had my first proper gym session on the 23 January, at which the physio doubled the exercises I got at the assessment. I was able to bend the knee 120 degrees - almost as much as the ’good’ one. Today I risked going up and down our spiral staircase without it for the first time, which was scary but worked okay. For the past week I’ve finally also been able to get in and out of our shower cubicle instead of showing sitting down in our corner bath. Yesterday I even managed to get each leg bent enough to wash the soles of my feet properly - and that meant standing one-legged on both the good leg and the bad one (though I made sure I was securely wedged in the corner of the cubicle)!

Up to the point at which I could walk on the leg, the whole experience was a nightmare. Since then, though, there’s been a new step forward every few days - things like those mentioned in a last paragraph, and being able to put my foot on a chair to lace and unlace my shoes and put on my socks.

But it’s been six months so far since the accident, and I’m still not fully fit. I use one crutch outside, and the brace too when I go ’off the premises’. The knee is uncomfortable rather than painful, and I can’t kneel on it yet. I suspect that I did damage other than rupturing the tendon in the accident, the incident on the stairs and the second re-rupture incident.

Update 6 March 2009

I had four sessions in the gym, with a doubling of the number of repeats on all my exercises and the addition of five minutes on the exercise bike, some leg-thrusts on the multi-gym, fun and games with an upsized marble-maze in a balance board and one-leg stands on a firm foam mat. At the end of four, I was discharged with a six-week open appointment (meaning I can phone for more sessions if I feel I need them). That was two and a half weeks ago. A week later I saw the consultant: he was very happy with the range of knee movement (now the same as the ’good’ leg) and the strength of the quads, and discharged me.

I haven’t worn the brace for about four weeks now. What finally convinced me was a really silly episode...

I got up early one Sunday morning to go for the papers. I had recently stopped wearing the brace even for our crazy spiral staircase but not for walking outside, and had actually left it downstairs when I went up to bed. So I dressed, went downstairs and just dropped my tracksuit trousers to put it on. For some reason it felt rather strange, but I strapped up and went off, with one crutch, to the shop about 300 metres up the road. The brace still felt a bit peculiar, but it wasn’t until I came out of the shop with the combined weight of The Observer, The Sunday Times and a four-pint bottle of milk that I realised why. I had actually put the thing on the wrong leg!

That was the last time I used the brace, though it still lives in the boot of the car with one crutch for emergencies. By the time I saw the consultant I had completely stopped using the one crutch, too.

I have become much more active around the place. I can kneel on the floor without too much discomfort to do odd low-level DiY jobs, and can even get up again provided I can use a chair or something similar for support (the tendon that joins my kneecap to my shinbone is still swollen, and that’s what takes the strain). I can go up and down stairs using both legs normally with some support from my hands and a little discomfort, though not carrying a tea tray yet. I have very little pain, and I feel I’m well on the way to what passed for normal before the accident, given my ski-damaged and arthritic knees.

Update 12 April 2011

There’s a good reason for the lack of updates since March 2009: the knee has been great. I have got back to doing the ’old farts’ Christmas 7-mile hike, and since being diagnosed as borderline for Type 2 Diabetes have been walking hard most mornings. The knee has simply ceased to be an issue - in fact I get more pain from the other one!