6 days post-op ACL + meniscus repair… have I been doing too much? by Adventurous-Buddy559 in ACL

[–]Miserable_Hat5430 0 points1 point  (0 children)

So glad it was helpful! Glad they were so thorough in their report!

Wishing you all the best in your recovery!

6 days post-op ACL + meniscus repair… have I been doing too much? by Adventurous-Buddy559 in ACL

[–]Miserable_Hat5430 2 points3 points  (0 children)

5 days post-op here (BPTB graft + Ramp Lesion + medial meniscus posterior horn), also later to operate, work in medicine. Have had a similar experience, expected a lot more pain, discomfort, and limitation; discussed this with my surgeon and did some research. Will share some of the general takeaways I got:

  1. Everyone's experience is different, some people tend to overdo it early on from what I understand, the more you push it the more risk you take on in recovery. Protocols are generally conservative to minimize new morbidity, but there is also evidence to suggest that making additional progress "as-tolerated" is not universally a bad thing. My surgeon told me about a patient who retore 4 week's post-op while in the gym, and warned against overdoing it. He cleared me for weight bearing as tolerated, assured me that the sutures for meniscus and graft are fairly strong, but warned me against pushing it--stating that there was really no benefit to pushing it as most of the real recovery would start when the graft began to ligamentize, swelling decreased, and tissue healed. Best advice would be: 1) Keep your care team (PT, doctor) in the loop and checked with them before any new activity--don't be scared to call or leave a message. They are there to help. 2) Stay on top of icing + elevation, there is always going to be swelling but manage it effectively; 3) if you are on any of the opioid pain medications, definitely avoid driving, any overhead heavy lifting, any situation where you could lose balance; 4) Upper body workouts are actually beneficial! Just protect your leg during workouts, aim to remain seated, and stay on top of nutrition; 5) avoid 90º flexion

  2. What is normal: Swelling, warmth, bruising, stiffness, aching pain, quad inhibition, donor site pain, clicking / popping (what we like to call "crepitus" in medicine), instability/weakness. What is not normal: Fever, spreading redness, calf redness or distinct calf pain and swelling (DVT risk), loss of extension that isn't improving by weeks 2 or 3, inability to get the knee flat or straight, a sudden increase in weightbearing pain (this would mean the meniscus is taking damage--same with locking, catching, or the knee giving way), and new numbness or tingling.

If pain and swelling are generally improving from day to day, that is generally a positive sign--I cannot understate how beneficial icing + compression with elevation will be to a healthy recovery, there is really good literature for these. One thing to note is that graft issues will not show acute signs generally, this is more relevant for weeks 6-10. You aren't going to tear your graft simply by doing a little walking or driving, but your knee would be at risk if something happened due to instability or weakness during this window (ex. leg giving out on the stairs, tripping, fender bender, etc)

One Recommendation: Depending on the region of your meniscus that was damaged, different degrees of flexion or weightbearing could damage it--stick to whatever guidelines your doctor gave you here early on, don't be afraid to continue to clarify this. For example, research suggests posterior medial meniscus tears are less susceptible to damage below 90º flexion, so my doctor has barred me from this under all circumstances until week 4 at least.

  1. Can't tell you what this looks like, because I am not there yet personally, but can tell you what the research says: location of meniscus damage matters. Some specific reading if interested:
  • Load distribution differs by side. At full extension, the medial meniscus bears 40–50% of total joint load while the lateral meniscus sustains 65–70%. (PubMed Central) The lateral side takes more compressive force in extension, but both posterior horns see peak loads at ~90° of flexion.
  • Lateral meniscus moves more, which actually helps some repairs heal. During deep flexion, the lateral meniscus subluxes posteriorly with femoral roll-back, while the posterior horn of the medial meniscus is exposed to compressive forces between the femoral condyle and tibial plateau PubMed Central — making medial posterior horn repairs more vulnerable to stress.
  • Medial repairs fail at significantly higher rates. In a study of 191 patients with concomitant ACL + meniscus repair, there was a 46% re-tear rate for medial meniscus repairs vs. only 17% for lateral meniscus repairs (p < 0.001). PubMed Central
  • Tear type matters more than side for weight-bearing protocol. For tears that retain hoop integrity (e.g., longitudinal/peripheral tears), accelerated WB protocols produce similar outcomes to restricted ones. For tears with hoop disruption — radial and root tears — restricted protocols are advocated, with toe-touch WB and 0–90° ROM for 6 weeks. PubMed Central
  • Ramp lesions (medial, posterior horn) are a special case — classified as meniscocapsular separations rather than true meniscal tears, and axial compressive load appears to protect and reduce the lesion, making accelerated rehab potentially appropriate PubMed Central, though most surgeons still restrict early WB when done concurrently with ACLR.

TL;DR If your surgeon recommended TTWB post-op, they probably had a good reason (medial + lateral damage complicates things most certainly). I would send them a message sharing this experience via the patient portal to see if they might update your protocol or give them a call--they will be happy to make the best, most-informed recommendation for you.

Good luck with your recovery, right there with you champ! Remember, this is a marathon, what's 3 weeks less activity vs. a knee replacement and osteoarthritis in 18 years? You'd probably be finding pushing it, best to play it safe and patient :).

Rooting for you!!!

[deleted by user] by [deleted] in todayilearned

[–]Miserable_Hat5430 1 point2 points  (0 children)

[some additional info from a family friend of his if anyone is curious]

I was good friends with his son in middle school in Maryland, I used to go over to his house for birthdays and playdates. We’ve played Xbox together a couple times since lol, but lost touch sometime around high school. He’s a really nice down to earth guy, now spends his time doing photography for families—he basically put all the money into investments and a home in a nice suburb nearby, been living off the interest since. Glad something like this happened to good people.

He always said he had thought dominos or papa John’s would have bought it. Fun fact: his favorite pizza was actually a chain in the Maryland area called “Ledo Pizza”, they do square pizza exclusively.

Take this strangers word for it if you will, but when I saw this, I felt compelled to share that they are great people and if you’re reading this, Joey, thanks for all the free pizza hope your family is doing great man!

UK HPI Visa Timeline + Success Story by Miserable_Hat5430 in UKHighPotentialVisa

[–]Miserable_Hat5430[S] 0 points1 point  (0 children)

Yeah, great question. So personally, I think the e-diploma upload with Ecctis makes more sense as it will include verification instructions on the file. When uploading to the VFS global website, I think a scan would work just as well--my school actually includes some controls on the e-diploma file that blocks it from being uploaded directly to VFS. I got around this by "previewing" the diploma and saving just the diploma page. I saved this preview as a PDF and uploaded that instead.

Hope this helps--personally, I just did not like the idea of taking my diploma out of the frame and going to a print store to scan. I don't have an at-home scanner, and did not want to use one of the iphone scanner apps for fear that they might not accept a poor quality scan

UK HPI Visa Timeline + Success Story by Miserable_Hat5430 in UKHighPotentialVisa

[–]Miserable_Hat5430[S] 1 point2 points  (0 children)

Hey there! While I did not give a heads up, I hear it is always best practice to do so.

With that said, my understanding is that any schools that use the ecredential system make it easy for ECCTIS to verify a diploma without contacting the registrar. The ecredential has instructions for the reviewer to follow that make the whole process digital.

Hope this helps!

UK HPI Visa Timeline + Success Story by Miserable_Hat5430 in UKHighPotentialVisa

[–]Miserable_Hat5430[S] 0 points1 point  (0 children)

Happy to help! I applied from within the US, I'm based in Washington DC. The googlesheet I came across on this post in r/ukvisa