I understand you have had a couple of knee injuries (without bringing back too many repressed memories) could you briefly describe each event and the path to diagnosis?
Both knees have had ACL reconstructions.
RIGHT KNEE ACL (1997)
In 1997 during my the last game I played in for the Trojans (the Pirates’ junior affiliate), while scrambling around, there was confusion whether to block or act as a receiver from our running back. At the last second he spun off his block to look to catch a pass from me, I saw this while running but at the same time the defender he was blocking went low to tackle me. I was hit in the right knee as my right foot hit the ground, all my weight on it coming forward. I flipped over and instantly had an immense amount of pain. There was an injury timeout.
The pain subsided after what felt like a year but was probably only 30 seconds. I was able to walk off the field. One of our coaches, said “It’s not as bad as you first thought huh?” I agreed at the time, but we both were proved wrong.
On the ensuing possession I went back out (!) only to find when I pushed off with my right foot my knee gave way. It was a weird sensation. I expected force when pushing off but instead it felt like my leg had disappeared; like I was on ice. Strangest feeling ever. Proprioception: it is a wonderful thing and one we don’t fully appreciate until it is gone.
This was on a Saturday. The knee blew up like nothing else. I had never seen a physiotherapist before. I booked in to see a local physio. S—- was her name. She measured the circumference of both thighs and I had lost 1cm of circumference on my right thigh due to 48 hours of immobility. She diagnosed it has an MCL tear and said I will be right in 6 weeks. She said “I don’t think there is any ACL damage.” I don’t think I saw her again, or at least not constantly like I would expect to see a physio these days with such an injury.
6 weeks later I was playing basketball with some friends. I came down on my knee a bit off centre and wham! The pain. All back again. Rolling around on the cement around like a baby, with my mates all feeling helpless. It flared up again. I don’t think I even saw a physio after that flare up. Young and inexperienced, 19 years old and not appreciating the severity of my injury.
2 weeks later, I felt good and joined in at football training (Outlaws). I lasted a fair way into the training, but going through an agility drill, stepping off the right foot, whacko! Down again, not as much pain as before, but a new pain. A sharp pain where I now know is where the lateral meniscus lives. This pain lingered on. During this time I had a partial scholarship lined up for Lakeland College.
I saw a different physio at this point. I found Tony Cosgrove in the yellow pages (pre-internet days). I had a visit to check me out before I flew out a week or two later. He said that it was hard to diagnose with all the swelling. He said there was hope that I could be alright but to have it checked out once I get there. I was impressed at his thorough examination.
To cut this part of the story short, I got to Lakeland College, had the tour, got my room, met my room mates, attended all the meetings and training sessions for a week and then had the team Dr check me out. He bluntly said, “You need surgery, you won’t be playing this season.” I was broken and was being returned to the manufacturer.
Dr Jim Sullivan did the surgery. They even used the video of it for conferences and promised me a copy but then lost the video. All went well. He said the ACL was hanging by a thread, the MCL was torn and I had lateral meniscus damage he had to repair. (I bet I did that on that Outlaws training night). The meniscus damage as gone on being the biggest long term issue out of this whole event.
Following the surgery, I was back up on my feet and crutches in the next day or two and even attended an Outlaws game in Canberra. Then, suddenly, I was hit with immense pain, throbbing with my heart beat. Worse when I stood up. My Mother thought I had done too much up on my feet. Underneath the clear plastic coverage I had on the area, right at the surgery point, it looked like there was a discolouration, a yellow colour. The suspicion was an infection. Went back to Dr Jim Sullivan. A painful ride over to Parramatta. He looked at it and said it was fine.
I started my rehab with Tony. He impressed me last time, much more than S—- did. I was there 3 times a week. That was amazing to me at the time, 3 times a week. After about 1-2 weeks of rehab when we got into the increasing of range of motion phase (Tony explained how important it is to attack that at this point of the rehab). The incision point burst out like a a water fountain with a yellow gunk, Tony said “Yep, that was an infection you had previously.” This set us back two weeks as we had to stop some of the rehab. So I was warned that I might lose a few degrees of range of motion, but then we’ll hit in hard as soon as we can to try and minimise the range loss.
The rest of the rehab went well and I was back and playing 18 months later in the 1998 senior season for the Outlaws.
LEFT KNEE ACL (2011)
This is simpler case. I did this in the 2011 World Cup against Mexico trying to block a charging linebacker. I was running in the same direction as he was and turned to block him. Put me left leg out to stop both of our momentum and snap went the ACL. I put this down to the fact I had ITB friction syndrome and didn’t realise it. I thought I just had painful knees. The pain from the ITB friction syndrome had me moving not as smoothly as I would normally and thus a bit awkward in my movements. I feel it was this that had me putting my legs in the wrong position to make this block. I since know much more about ITB friction syndrome as I am fighting it off regularly.
The pain was nothing compared to when I did my right ACL. Sure there was immense pain right at the time but it only lasted 2-3 seconds and then I was fine. I totally ruptured it this time rather than partial which spared me most of the pain. I was totally shocked when they did the MRI to find it was an ACL rupture. I thought I had paid my dues to the football Gods and was not due another major injury at this point of my career.
Got some anti-inflammatory medication, blood thinning injections for the flight home and other miscellaneous medical items. I was reduced to hobbling around for the rest of the World Cup and our stay on after in Vienna. Upon arrival home, arranged with Dr Sam Sorrenti to have my reconstruction. Dr Sam Sorrenti had done all 4 knee scopes on my right knee since the initial reconstruction on the right knee and had become my go to surgeon. Surgery went smoothly, he did his famous lateral loop as an extra bonus. He said I had ruptured the ACL, did lateral meniscus and also lateral tibia bone cartilage damage. Saw Tony for the rehab. This time no infection. All went according to plan and I was back playing by the 2012 season, about 14 months later.
Can you give some insight into your thoughts in the initial days following the injuries? (perceived impact on life, work and sport)
RIGHT KNEE (1997)
Depression. Having loved playing for the Trojans, to see us bow out of the playoffs when we were minor premiers and only having to play the 4th ranked team in the final was so so so disappointing. To add to that I was done playing for my beloved Trojans (due to age restrictions), I was not a happy guy. I sat in my room in the dark for the coming nights after that. Finding work was a problem but having just left school and living at home, I didn’t have any major life pressures to rush into earning.
LEFT KNEE (2011)
Having done it all before by now, I knew what to expect. So the impact here was minimal. Having a desk job, it had very little impact on work. I choose to drive to work for the coming 1-2 months to help protect my knee more (a train would not be too risky, plus over 1 km “walk” on crutches between work and the train station).
I knew I was going to miss the entire 2011 season. This was very disappointing, but not to the same level as the 1997 knee reconstruction was with leaving the Trojans on such a painful note.
Was the treatment proposed to you initially the same as the treatment that you ended up going with?
RIGHT KNEE (1997)
S—-, the initial physiotherapist, to put it bluntly, was terrible at diagnosing and treating my knee. In hinsight I now know that. Tony was much more on the ball with it. Showed he had done it all before and knew each milestone we needed to aim for and how it all fell together. He was such a wealth of information that I felt I could have guided someone else’s rehab after having gone through it with Tony the first time. So to answer, very different from initial to ultimate treatment here.
LEFT KNEE (2011)
This was stock standard, nothing deviated. The reason was the MRI nailed it right from the start while I was still in Austria so there was no uncertainty about what we were dealing with and we hit the ground running.
Was the recovery following the surgery as it was described to you by the doctor or did you experience any strange side effects?
RIGHT KNEE (1997)
As above: I had an infection that reared it’s ugly head a few days later which delayed rehab a little.
LEFT KNEE (2011)
I had so much more pain with this one in the first 3-5 days. Constant pain that pain killers didn’t solve. This didn’t happen with the first surgery, besides the infection. I put it down to the bone cartilage damage as that was the only big difference from the first to the second reco surgery.
What would you say was the best and worst parts of the rehab process?
Best would be time off work, woohoo! But seriously, completing it is the best. A positive side effect with my first reco was that I was recommended to get into the gym to work on leg press. As I was 19 and had never lifted weights but wanted to, so I joined a gym and started out on a full body workout plan as prescribed by the gym owner. Hit that pretty hard and ended up the strongest I have ever been in my life (adding 10kg of muscle mass) 12 months later.
In hindsight, can you outline the progression of your mental state during your rehab? Do you think the physical progression and mental were tied together?
I think, for me, pain had a big impact. After my first reco and while in the recovery, in pain, I thought to myself “I am never playing football again.” But that rapidly changed. Both times I found there was a depression stage. A feeling stemming from being unable to play sport and worried if I will ever get back to where I was. I think being unable to do much, so sitting with your own thoughts is not healthy. Something that is impossible to avoid unless technology can speed up the rehab 200 fold.
How long did it take you to return to competitive sport?
Both times the timing of the next season allowed me ample time to recover.
For my right knee, I had just completed Trojans, so it was around May 1997 and I was supposed to be playing in seniors competition next which started September. There was no way I was ready for September 1997, but I was well ready come September 1998 season.
For my left knee, I did that well before the 2011 season, so I had over 12 months to be ready for the 2012 season, which was a season I knocked out of the park, I must say
What was the most difficult part of returning to competition?
Right Knee (1997)
After the right knee reconstruction, I found I had an unexpected confidence issue. The last time I was on the field my knee didn’t respond well when pushing off. Also I had several incidents of the knee feeling fine and then milliseconds later it felt like it dropped out from under me. So there was hesitation that it would happen again. Getting into a game helps to take the mind off it and then confidence starts to build back quickly.
Left Knee (2011)
The left knee I had a bit of that confidence issue but having been through it before it wasn’t nearly as big a mental issue as it was the first time around. I used my logic and told my mind to shut the f— up, I’ll be right. And I was, much to the surprise of the little voices in my head.
Does the injury continue to impact any phase of your life or have you returned to feeling the same as you did pre injury?
Initially the right knee was super. In fact, as a result of the rehab I was far superior physically – so much stronger. Over time though, the meniscus damage came back to bite me and I have had a scope every 6 years since to clean out the bits of junk (meniscus) in the knee. Tony said 5-7 years is about normal. I am expecting this to be an issue for the left too in coming years.
I now have issues with the lower quad on the right. It feels like it is catching right where the button was placed. X-rays have shown no structural issue but Tony has said there could well be calcification in the muscle that I am feeling.
ITB has been issue. My knees sound like rice bubbles when squatting down. Sitting with my legs bent for too long starts to cause aching and I need to straighten them. Flights can be a problem, I need to get up as often as possible. I have terrible range of motion on my right knee now. I have large deposits behind the knee that may need to be removed again (I had a 1.5 hour scope in 2011 to remove lots of loose bodies behind the right knee which was causing locking issues.). My right knee has a large lump on the inside of it that is getting bigger over the years. X-ray doesn’t show it, so it’s build up of something not bone, but feels as hard as bone. No one knows what that is. I only have about 30% of my right meniscus left, so it will be bone on bone soon. Not looking forward to that.
We thank David for the detailed insights into his injury history. I’m sure it wasn’t the easiest to recall all the painful memories. Some of the conclusions that we can draw from David’s case:
- Get your injury properly diagnosed – the MRI saved David much time during the second reconstruction
- Find good rehabilitation specialists – the first person you visit might not be the best person for you. Every practitioner is different so ensure you find someone knowledgeable that you can rely on to get you right
- Investigate your surgeon – ask questions, become comfortable with the entire process especially the follow up procedures that may be required. Doing your research can save you time and energy.
- Take care of your mind – rehabilitation is not just a physical recovery. We need to recover our minds as well to return to full capacity. This step is often ignored by the practitioner, often self management is required. Seeking professional help from a sports psychologist may also benefit in returning to the field.