2 Months, 3 Weeks

It was good having the two weeks to settle into a workout schedule and really see what the effects would be. I did gym sessions every three days on average, alternating the focus between squats and deadlifts, with leg press and knee extension added at the end of each session plus the full complement of stretches. As a warm-up, I'd spend 20-30 minutes on the treadmill doing walk-jog-run combinations. In between the gym days I did some home exercises, mainly elastic band work for the gluteus medius and some balance work, but not frequently. These were the results.

The good:

• I improved noticeably at doing squats and deadlifts.
• I improved a little at running.
• I no longer get the feeling of tension and pulling in the area halfway between the kneecap and the incision site - I used to get it while walking at first, and later while running ever since the surgery.

The not so good:

• It takes me time to recover properly from the gym workouts, three to four days at least. In the days between sessions the muscles would feel tight and a little sore and the legs would feel heavy. I wasn't able to push myself on the bicycle and I never really felt like running or doing any exercises other than on gym days.
• The muscles improve faster than the joints. I started feeling some soreness under the kneecaps when crouching or kneeling if I wasn't warmed up. It wasn't a major pain, just a warning that I was starting to work them more than they could recover from.
• The area around where the IT band inserts into the top of the tibia started feeling sensitive under my fingers (I got into the habit to poke and prod the area every morning to see how it's doing, if there's any swelling etc.).

The obvious conclusion was that I should ease off on the gym work and replace it with more exercise for balance, coordination and proper muscle activation. The PT agreed with my conclusions and additionally suggested to decrease the loads on all exercises that strain the knees, so squats, leg press and knee extensions. 

The PT recently started training as an ultrasound technician and he acquired a machine for the office, so we used the opportunity to take a look under the skin during this week's session. Everything looks like it has healed up fine and there seem to be no residual swelling in the tissues. He noticed that the surgery was done very cleanly and neatly without any unnecessary damage. The hard bump looks like normal bone under ultrasound. The PT thinks it's most likely the normal epicondyle being more prominent since it's no longer being hidden by the IT band, but to me it still seems like it's slightly enlarged compared to how it was before the surgery. I still need to make an appointment at the hospital for the ultrasound that my doctor prescribed, so we'll see if they have anything interesting to add.

The bump is definitely smaller than before, but is nevertheless still prominent

The next PT appointment is in three weeks from now, so I'll have plenty of time to develop a new exercise routine. So far I've been a bit lazy this week - I've done just one workout session at home, but I did ride the bike more. I've upped the ride distance to over 20 km and so far all is good. I won't be increasing the distance next week since I've made quite a jump, but I will try to do some running outside. That't the plan at least, we'll see how it goes.

2 Months

It's exactly two months today since the operation. Looking back, I was hoping that by today I would be close to 100% by today, though I was ready to take it as slowly as necessary to make sure the recovery complete and permanent. Yet, when I look back where I was even weeks ago and compare it to where I am now, I really am pleased with how it's going. I think the biggest unexpected thing is the discrepancy with what I can actually do - cycling, running, gym workouts - and the little aches and pains that still happen on the first few steps after I've been sitting for a while, or the way the incision site gets swollen after standing in one place for too long. I guess I wasn't expecting those little things to persist the longest.

In the last few days I've done all the three main activity toes: cycling, running and gym work, and are improving. I've increased the weight for the squats up to 25 kg (I didn't plan to, but the previous weight really felt to easy), I expect to increase the weight of squat to shoulder press from 8 to 9 kg dumbbells next week, and I've done the first few sets of deadlifts. In cycling, I'm pushing harder and harder as well, though I'm keeping the distances low for the moment. I've done the same 7.5 km loop as last weekend, but my average sorted has increased from around 18.5 to around 23.5 km/h.

I've made the least obvious improvements in running, but that's hardly surprising; I was never a runner, so I'd be staying at zero even if it wasn't for the knee surgery. I've done one session of walk/run intervals, purely by feel. The running intervals were around 200 paces each (this is still jogging pace, so I guess 150-200 meters), at which point the muscles in front of my shins would start complaining. If then switch to walking for about as  the same distance as the running part, but I want really trying to be too precise with it. I've no idea how far in total I went, but I was out for maybe 30-40 minutes I guess. I was surprised by the shin pain appearing so quickly, but at yhe same time I was pleased that there were no major complaints from the knee, just a vague feeling of tension from time to time.

I've done only one session of balance and elastic band exercises, but this is according to plan since a lot of the same muscles are now being targeted in the gym. This combination of harder exercises with more rest in-between send to be producing very good results so far, and the lighter exercises are just there to improve balance and coordination further.

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

1 Month, 2 Days

We went for a day trip with friends yesterday, and I spent most of the day on my feet. It was leisurely pace walking, but nevertheless the knee felt sensitive and a little sore by the end of the day. I applied ice and the diclofenac gel, and decided to skip the exercises - today was meant to be a rest day anyway, so I just moved it a day ahead.

Today it's still a little sensitive, but better. I didn't walk as much during the day and I didn't have any problems when doing the exercises this evening. I went harder with the exercises targeting the hip abductors and skipped some of those that involve loading the knee, just in case.

I haven't mentioned it before, but in the last couple of weeks I've really made it a point not to sleep on my left side, to avoid putting pressure on the operated area. It doesn't feel bad when I first lie on the left,  but I've come to the conclusion that most of the time when the knee was swollen in the morning, it was because I'd spent most of the night on the left side. I think I've now come to the point where I avoid that side even in my sleep, and the knee is no longer swollen when I wake up.

Speaking of the swelling, I think the hematoma is really and truly gone and the red bump has disappeared. Left remaining is a general light swelling in the area that's most noticeable after I've spent done time on my feet, and that mostly disappears with rest and icing. But now that the swelling is mostly non-existent, a hard bump has become noticeable under the skin in the same area. I can't tell if it's some sort of deeper swelling, scar tissue, or something else; I'll see the doctor next week for a scheduled follow-up, so I'll ask him about it.

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 18

I had a session with the new physiotherapist today. She started with massage, focusing on stimulating drainage of the hematoma and making sure there is no adhesion of the IT band around the area that was cut.

Next she had me do the following exercises:

1. Knee press: lying on the back, with her closed hand placed between the knee and the mat; push the knee down into the hand as hard as I can, hold for a few seconds, relax, repeat. Maybe fifteen repetitions, didn't count.
2. Heel pulls: still lying on the back, pull the heel back until leg fully flexed while she is providing resistance against the pull. Again didn't count the repetitions, but at least fifteen.
3. Leg raises: same position but with a hard pillow under the knees with an ankle weight. Extend the leg, then raise to 35-40 degrees; hold a few seconds, slowly lower down and relax, then repeat. Around fifteen repetitions.
4. Repeat exercise 2.
5. Repeat exercise 3.
6. Leg abductions with an elastic band: standing next to wall bars, straight leg abductions with an elastic band, around fifteen repetitions in two series.

To finish the session off, more massage focusing again on the swelling and on keeping the IT band free and loose. She told to me do the exercises 1. (against a pillow or a bottle) and 6. (3x10 repetitions) at home at least once during the weekend.

Day 14 (2 Weeks)

Still improving, but still very slowly. It goes up and down during the day, so at times it feels like there hasn't been a change in a few days, and later it feels massively better. I guess it's also easy to forget that a particular move or position used to hurt before, once it no longer does. There are definitely no leaps and bounds though; it still hurts a little to go up stairs for example, and I still do the little hop-skip when descending them. The strange pulling feeling comes and goes too, so sometimes the most sensitive spot is there, while other times it's around the actual incision site.

Speaking of the incision site, the one thing that really hasn't changed much is the swelling/hematoma. It decreases a little with icing, but it comes back if I spend too much time on my feet, whether walking or standing in one place. I'm still icing it daily as it does feel better.

Physiotherapy starts Wednesday. The physiotherapist I planned to go to will be on vacation until the end of August, so I had to make an appointment with another physio I found at the same hospital where I did the surgery. My idea is to work on basic strength and coordination of the muscles around the knee in the following month, and then start the specific cycling and running work with the original physio once he comes back from vacation.

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.

Day 10

The stitches are finally out! That feels a bit better. I can't really tell what the scar looks like yet as I have a new adhesive bandage over it, not to be removed for two more days; luckily, I can shower with this one on.

In other news, the swelling around the incision is actually the hematoma doctor told me to expect - I thought a hematoma would include more visible bruising for some reason. I told the doctor I wasn't really icing it so far since the thick adhesive bandage on it make it really hard for the cold to actually reach the site. He urged me to start using ice regularly now. Other things to look forward to are:

• Start physiotherapy next week to rebuild the quads.
• Free to start swimming next Wednesday.
• Free to start cycling and/or running in six weeks, so beginning of September. I can do very short runs or rides before, but nothing longer than 20 minutes.

Otherwise, the knee is improving slowly. I'm walking up stairs almost normally now, though it still hurts a little. I'm also going down stairs facing forward (no longer sideways), but with a sort of a hop-skip on the left leg to avoid the painful eccentric contraction. Still doing glute and hamstring stretches daily, but I've given up on hip flexors and TFL, it seems to hurt more than it helps at this time.

Day 6

The knee felt sorry of bloated and tight in the morning, and there was a distinctive feeling of pressure all around the incision site when fully flexed. It also gets sore quicker when standing for a while or when having it fully flexed for a period of time. I took a paracetamol to calm it down a little.

The useful range of motion (with some load, not just passive) seems to be improving, and I am becoming able to apply more force with the quads.

The area around the incision started itching in the evening. It stopped when I removed the adhesive bandage - guess it's just the hair growing back and not a sign of an infection.

Day 4

The knee still felt a little inflamed in the morning. I took an ibuprofen with breakfast for a change and it helped. Feels better otherwise: I'm able to do a few steps up stairs before it even starts hurting, and it also hurts less trying to go down stairs. I actually climbed the full three floor to my apartment semi-normally later in the day.

I'm allowed my first full shower today. I removed the adhesive bandage so I could take a look at the actual incision for the first time too. It's not very pretty, but it looks fine. I won't be embedding a picture directly in the post, but here's a link to it for anyone interested.

I took another ibuprofen with dinner after the shower, just in case. That's two ibuprofen for the day, no paracetamol.

I'm other news, the ankle swelling send to be gone, while the one under and around the incision is unchanged, noticeable only when the knee is flexed.

Day 2

I had no pain this night, or at least none that would wake me up - guess the paracetamol did its thing well. There is less pain today, it is now more of a soreness. The swelling around the ankle looks about the same as yesterday.

I removed the outer bandage today, that was a big relief. The first layer or two over the knee were quite snug, they actually caused some light abrasions around the patella. That explains the pain there from the first night. Other than the marks from the bandage, which disappeared during the course of the day, the knee looks pretty good. There is visible localised swelling at the incision site when the knee is flexed, but no hematoma in sight. I took a paracetamol after removing the bandage to prevent swelling and inflammation now that the pressure is off.

The ridges in the middle are marks from the edge of the protective pad under the bandage. The redness to the left is a light abrasion; another one is just about visible to the right.

This right after removal of the bandage; most of the marks disappeared within an hour. The adhesive bandage won't be touched for a couple more days.

As soon as I removed the bandage, max knee flexion went up to 90 degrees (if done carefully, no load). At that point, internal pressure at the incision made it too uncomfortable to go further. Range of motion has kept improving throughout the rest of the day.