1 Month, 13 Days

I went to my standard physiotherapist yesterday. He put me through a set of exercises and he was quite pleased with my current condition. He suggested to start putting the left knee under more stress - not enough to feel sharp or burning pain, but enough to feel the load - this is something that I avoided so far, preferring to have a slower recovery rather than pushing too hard and causing new injury. Now that the knee is mostly healed, it's time to get it out of the comfort zone, and train it back to full strength.

We will be having one PT session per week, with exercises to do at home or gym in the mean time. He gave me the following set of exercises to begin with (to be done daily unless marked otherwise):

1. Balancing on the balance board or a BOSU with throw and catch. If I don't have anyone at hand, I throw and catch a throw pillow - the size, weight and shape make it more challenging than a ball from the balancing standpoint.
2. Leg abductions/raises laying on the side with an elastic band or ankle weights (we used 2 kg weights in the session).
3. Single legged supermans.
4. Hip bridges with feet on an exercise ball and an elastic band around the thighs.
5. Single legged bridges with the foot on an exercise ball.
6. Squats, five times a week. When possible, do them at the gym with a 20 kg bar, go for around 6 repetitions.
7. Elliptical trainer as often as I have the time to go to the gym. Build up the time, start with 5-10 minutes.
8. Cycling (normal and/or stationary bike) and swimming fit cardio when I have the time.

All exercises are to be done at a level that's challenging, but not all out painful. Along with the exercises, I am to continue the hamstring and glute stretching routine, plus a lighter hip flexor and TFL stretch, about as hard as I can stand for 20 seconds at a time, a few times during the exercise session.

Today I went for the second follow-up with the doctor. Regarding the hard bump around the incision site, he thinks it may be a combination of residual swelling and some scar tissue growth, but he is not sure about. He prescribed ultrasound to be done in about a month, to give it some more time to settle down and stabilise. In any case, he doesn't think it is something to be overly concerned about.

Other than that, he also recommended starting to push the knee harder, looking for that balance between a bad pain and a good strain. This pretty much settles the course for the following month or more, and I can say I'm looking forward to it.

Finally, this is what the operated area looks like now:

This is the hard bump, there is no swelling of the skin in these pictures

The scar is getting thicker and paler; I don't think it will be very noticeable in the long term

Day 30

So, is been a month since the surgery. The state so far:

• All stitches and bandages are off and out.
• The swelling has subsided significantly, but hasn't disappeared completely yet.
• I can walk, go up and down stairs and swim with no or almost no pain. Tried going up two steps at a time today, no pain there either!
• Physiotherapy rehabilitation is in full swing, doing exercises and stretches daily. Rode a bike for the first time today, though just a stationary one. No pain, but I could feel it would start to hurt if I tried to push harder.
• I can't run yet, except for a few wobbly steps in a light jog.

These are the exercises from today's PT session:

1. Stationary bike, 5 minutes at 125 BPM, 85 RPM, 133 W average. Not very comfortable with the wide saddle, wide stance and steep seat tube, but no pain in the IT band.
2. Leg raises, 2 x 15.
3. Squats against an exercise ball, 2 x 15 with an extra squat-and-hold at the end of both series.
4. Balancing on the foam pad.
5. Balancing with opposite leg extensions, 1 x 8.
6. Balancing with shallow squats, 1 x 15.
7. Leg abductions, 2 x 15.
8. Massage to finish (no massage before exercises this time).

No changes to homework, but I will be mixing it up with different exercises hitting the same muscle groups on different days.

Day 28 (4 Weeks)

No physiotherapy in the last couple of days, and I took a rest day today. Well, it was rest from exercising, but I did go for a nice walk, leisurely pace but a good 2-3 km covered. The knee started hurting a little near the end, but I think I managed not to overdo it too much.

I've noticed that I can really feel the left glute medius, TFL and hamstrings working, and even straining a little, when I start walking a little faster. That's interesting, seeing as my left side now feels stronger than the right when doing the exercises targeting those muscles, yet the right side doesn't complain while walking. It could be a combination of many factors, but the top two I can think of is 1. that those muscles on the left side are now waking up and activating more than the on the right side thanks to all the exercises, and/or 2. that the left side is getting better at doing the exercises, but the functional strength in real world conditions is still not up there compared to the right.

Whichever is the case, I think the following course of action will be in order:

• increase work on the right side to bring it up to speed when it comes to exercise proficiency;
• start mixing it up with different exercises still targeting the same muscle groups in order to improve actual functional strength - so for example do leg abductions one day, side steps the next, and so on.

Regarding recovery in general, I have been able to do a few steps of something resembling a jog - the last time I tried, it a few days ago, it was still not at all doable. It still takes focus however, and when I tried to RN the last couple of stops across the street without really thinking about it, I reverted to a hobbling locked-knee gait.

The hematoma/swelling is mostly gone now, with just a pea-sized bump and some redness right around the middle of the scar. The redness doesn't look very good, but it responds well to icing, so I'm not too concerned yet. All in all, it seems to be getting better at an unchanging pace, which is perfectly fine with me.

The bump is between the third and fourth suture marks; picture taken after icing, so it's not very noticeable

Most of the swelling is gone

Day 20

Yesterday morning, a phone call woke me up quite early. I checked the incision scar habitually, and the swelling was the smallest I've seen it yet, it looked almost completely gone. This was not very surprising as I did ice it before bed the night before. I went back to sleep after the phone call, and when I got up later, the swelling was back to full size, about as big as I've ever seen it. Strange.

I realized I haven't taken any photos that show the swelling, so here's a couple that show what it looks like these days:

Leg flexed to around 90 degrees

Leg partially flexed, around 45 degrees from fully extended

The incision is almost completely healed. There is just one spot with a small scab remaining:

It looks bigger than it is - actual length is almost exactly 5 cm

Today it's been mostly business as usual. I'm descending stairs almost normally now, just a little hitch here and there. I had a nice walk, forty minutes at least, and it felt quite good. There weren't any big oscillations in the size of the hematoma during the day - even after the walk there was no noticeable increase in swelling. All in all, feeling better and better, looking forward to more physio exercises tomorrow.

Day 16

I had the first physio session today. This one consisted of an ultrasound treatment, followed by electro-stimulation of the quads and finished off with a massage. Starting from Friday, I will be having more active sessions with exercises, three times a week for nine sessions in total (including the one from today).

In regular news, after the previous somewhat doubt-filled update, I'm now positive that the knee is indeed improving steadily. The strength in the leg is improving and I can apply more power before it starts hurting. A lot of everyday activities still cause some pain, but that's because I naturally push to the limit where it starts to hurt. For example, going down stairs yesterday hurt the same as the days before, except that this time I was able to go straight and with no hop-skip for the first time - yay!

The scar from the incision is also looking better and better. There's still some scabbing, so I won't be going to the swimming pool just yet, but I expect it to be fine by the end of the week.

All in all, I'm happy with where I am at the moment and I'm looking forward to starting active rehabilitation on Friday. I hope I'll get an exercise program to do at home as well, but even if I don't, the three sessions a week will provide a very welcome change indeed.

Day 12

I've removed the final bandage today. The incision hasn't healed completely yet, there's some scabbing and light bruising there. The picture is here for those interested, but I don't think it's presentable enough to be displayed directly in the post just yet.

I've been icing twice a day since the sutures were removed. The swelling/hematoma decreases noticeably after icing. It would probably have been a good idea to use the ice during the time the old thick bandage was off for showers.

There is a new sensation from the knee. I feel a distinctive longitudinal line of tension midway between the lateral epicondyle and the patella, like there is a thin band stretched there that gets tight when I bend the knee under load. Could be that they had cut the IT band away from the fascia along that line during the operation, or it could be some scar tissue. We'll see how it develops.

The functionality is still slowly improving, though maybe not as quickly as in the first week. It's good that I'm about to start physiotherapy soon, it should help to kick start the recovery and keep it on the right track so I don't develop bad patterns of movement.