Day 2 to 4

Day 4

Four days since the surgery and all seems to be going well. Yesterday I only took painkillers in the morning and before bed - slept from 11 till 6 then dozed till 8. Today I'm avoiding them altogether but I'll put some by my bed in case I can't sleep. Swelling doesn't seem too bad, but it's under about 4 layers of bandage, so hard to tell! I really hope BBC Radio 6 doesn' get axed as it's definitely helping to keep me sane! Cutting 10% of the wages of the top DJs would pay for it...

Posterolateral Corner

As I've said before, I tore both my Posterior Cruciate Ligament (PCL) and my one of the ligaments in the Posterolateral Corner (I tore the often missed Popliteofibular Ligament - PFL).

Surprisingly, the tiny, insignificant looking PFL is anatomically more important than the PCL. The PCL stops the shin bone translating rearwards under the knee and anyone with reasonably strong Quadriceps can live a normal life without one. Many sports can be played with a knee that has no PCL.

The PFL on the other hand stops the lower leg moving outwards (varus translation, or more commonly "bowlegged") and it stops the lower leg rotating in a toe-out direction. For me, the most important aspect of this repair is the varus translation, as I was finding that my knee was giving way in this manner, especially when outside edging in my climbing shoes.

For anyone who's interested, and not squeamish, here's a video of the procedure of reconstructing the PFL:

http://www.youtube.com/watch?v=Zz_U2CWES3s

My PFL was replaced with a tendon graft harvested form my hamstring and my PCL was replaced with a ligament from a donor, called an Allograft. The allografts are usually taken from the Achilles. I recently read a decent article on the various aspects to think about if you are considering a PCL Allograft:

http://www.kneeguru.co.uk/KNEEnotes/node/2125

Four more days till I get my staples and stitches out. Then I can get into my locked, but releasable, knee brace and out of this monstrosity: 

Happy days!

The Surgery

Surgery

They never tell you about the pain. They tell you about everything else: the rehab, the risks, the outlook, but they never tell you about the pain. Morphine, Co-Codamol and Voltarol don't make a dent on sliced skin and drilled bones. OUCH!

In the end my surgeon replaced my posterior cruciate ligement with a donor achillies tendon and replaced my popliteo-fubular ligament (shown as PFL below) with a hamstring graft.

My knee is apparently in good shape with no signs of wear or cartiledge damage. My LCL is a little slack but he wasn't too worried about that. It's pretty amazing what they can do these days.

REHAB

Today is the first day of long period of rehab. Best estimates are 12 months before I'll be back climbing and I'm stuck in a fixed knee brace for 6 weeks or so during which time I can only do passive exercises. A long road ahead, I'm hoping for a good outcome...

Motivation Boost

Today is a good day. Well, it started bad - bit hungover because of the one too many three too many beers last night. But my flatmate was heading down to Dumby for a spot of bouldering and since the weather was stunning, I thought I'd tag along. Brought my shoes to do some very easy climbing.

Like I said in my last post, I've been struggling a bit for motivation recently. The thought of a year out from climbing and various other things have been playing on my mind. Losing all the hard fought fitness and finger strength was a worry. My copy of Dave MacLeod's 9 out of 10 climbers dropped through the door today.

A few things today have really lifted my mood and taken a weight of my mind:

1. Ross Henighen doing Silverback, a Font 7C at Dumby and the first hard problem he's done since his return from 2 years out of climbing.
2. Speaking to Mark McGowan who, after a 15 year lay-off is back in the game and already getting near to doing some hard routes.
3. Top roping a Fr7b route I did last year and finding the crux easier! Also nearly getting Slap Happy, a benchmark 7A boulder problem. This is all after 3 months of not climbing, in fact, not doing very much at all.
4. A quote from Dave's book about reversibility maintenance:

"It turns out much less training stimulus is needed to maintain a given level of fitness than to increase it ... in the region of one session a week"

These events and ideas have really upped my psyche. If I can manage a reasonable fingerboard session once or twice a week for the next year, I should come back to climbing without having lost too much.

Today also gave me a reminder as to why I'm getting the surgery. Quite often it feels like my knee is fine -day to day it doesn't bother me and I was seriously starting to question if I need the surgery or not. If I had onyll torn my PCL, I think I would maybe get by without it, as many people do but it's the pesky wee PLC (posterolater corner) that's causing me the most grief. If I'm outside edging, doing drop knees and eqyptions my knee just gives way. I quite positive about the surgery. If my knee is this good now, a bit of improvement should really make a difference to my sporting life.

Only one more day until the operation!

Summoning Motivation

This week has been a bit weird. Went sailing on the west coast on the weekend, but due to other people's commitments, we had to be back on Monday. Got lucky(ish) with the weather and had a blast.

I'm off work this week, using up holidays as I'll be struggling to use all mine this year - never said that before. Just been pottering around the flat, trying to summon the motivation to do something. Anything. I've been doing a lot of cooking, just making stuff for the freezer so life's a bit simpler once I'm out of the operation. Beef Rendang yesterday, Venison Casserole today. Rick Stein's Beef Rendang might be one of my favourite dishes, I urge you to try it, or gimme a shout and I'll make it for you.

Get Strong

Lots of folk have said I should spend the next year getting super strong on the fingerboard. Good in theory, difficult in practise. I bought a pull-up bar and have been doing pull-ups every couple of days, seem to be getting a bit stronger at them...might break the 15 rep barrier soon, pretty gash for a climber...

Today I managed to get on the fingerboard (beastmaker) and man, have I got weak. I used to be able to hang the small monos and the 45s, but now, 30s are a struggle. Still, feels nice to be able to put some effort in. Need to get in to a rhythm and hopefully once I'm back to climbing I'll not have lost too much. It'll be a miracle if I come back stronger, but who knows!

Check the size of them weedy forearms, and the new HTC Desire/stopwatch in the background. Repeaters are much harder when you actually time the 7/3 second cycle. Stop that cheating!

I'll need to start posting some aims and achievements - that might help the motivation and track the +/- progress.

The Diagnosis

It's a strange feeling to regain consciousness in the middle of this mess:

Next stop, Perth Royal Infirmary for a neck-check, pee test and seven x-rays. At one point I had to sit up for the chest x-ray and was on the verge of passing out again. Got some stitches for me knee and glass removed from everywhere it had got stuck, which was just about everywhere.

I wish my Mum had taken photos of me leaving the hospital. No shoes, jeans and t-shirt cut to shreds and hanging off me and I nearly passed out again, twice. Down jacket all covered in blood, fortunately in one piece as I'd made sure the paramedics didn't cut it off!! Rank.

Woke up the next day, well, to wake up you need sleep, so, waking up may be a loose term for what happened the next day. Anyway, pain was the order of the day, no, sorry, I mean PAIN was the order of the day. Knees, wrists, neck, stomach, ribs, calf muscles, ankles, and left shoulder. Getting out a chair was verging on comical, rock back and forth until momentum is on your side and brace for the pain.

Anyway, enough winging about the pain. The A&E doctors thought I had done no permanent damage to anything, but my right knee felt very unstable. After a quick google, everything was pointing to a torn Posterior Cruciate Ligament, so I went back to A&E to get a second, and third opinion. Verdict: Nothing Wrong, any persistent issues, go to your doc in 6 weeks.

To cut a long, and frankly quite boring story short, lots of doctors got it wrong but I finally got seen by a specialist orthopaedic knee surgeon and had an MRI:

Now, this doesn't mean a lot to me, but apparently there should be a PCL in the circled region, and mine is missing. Not good.

Here is the full report from the MRI specialist:

Complex picture.
1.  High grade PCL tear confirmed.  ACL intact.
2.  Areas of bone bruising as described.
3. With reference to posterolateral corner: definite
posterolateral corner injury involving biceps femoris, LCL,
popliteus tendon and popliteofibular ligament. However most
of these structures appear to have partial tears rather than
complete disruption. Posterolateral corner capsular rupture
with soft tissue oedema.

The outcome of all of this is I need my Posterior Cruciate Ligament and some of the ligaments in the Posterolateral Corner replaced. More on this in the next post.

The Cause

I've been meaning to start this thing for a while, well, since the accident really. Unfortunately, and maybe unsurprisingly, motivation has been low. I suppose I should start at the start.

On 31st of January this year, on the way home from a couple of awesome day's climbing, I was in a car crash. Pretty bad one too.

Me and Neil had gone gone up to the Lost Valley in Glencoe to have a look at Neanderthal, classic steep mixed route that we'd wanted to do far a while - no luck on this occasion, too black was the verdict, so we did Barbarian instead. Nice route.

After quickly nipping up Minor Issue, we started back down to the car, on the way we came across a gaggle of folk around a female casualty. She must have slipped on the icy snowpack and looked like she had a few injuries. Since there were plenty of people on the scene, it was decided that we'd be more useful as runners, so run we did. Well, run Neil did, as I gave up about half way as my knee was packing in. Again.

So, Neil got in touch with the mountain rescue to make sure they new about the accident, which they did and that was that. After some food in the Clachaig Neil headed home and I went to Fort William to catch up with Andy.

On Sunday we went up to Creag Meagaidh as there were rumours of classic routes in good condition. We guessed it would be busy so headed up the hill early, second team on the hill. As we practically had pick of the routes, we went for Smith's Gully, apparently one of the hardest of the Scottish gullies. It all went well and we got off the hill pretty early, just after lunch. Maybe not one of the hardest in the condition we found it, but certainly one of the finest.

Three routes in the bag and the season is only looking better and better, until it gets worse. A lot worse.

On the way home I was involved in a pretty brutal crash. Some of you know what happened, unfortunately, I can't post any details at the moment but all will become clear in time.

Next post, the (mis?) diagnosis.