My Posterior Cruciate Ligament (PCL) Surgery

I went against all my rugby principles when the fateful injury occurred on 23rd Feb 2006. I was not fit, it was only my second time playing rugby in 6 months and my body was not conditioned for the rigorous rugby activities. I was at the side line chatting with a friend when they called me to join the “shadow run” (non-contact but full speed “game simulation” training) against the Navy Orca team. Not in good physical condition, and not properly warmed up.....it was all a perfect recipe for disaster.

It happened when I first touched the ball while attempting my trademark “side step” against the much younger and fitter opponents. There was no contact but the heavy load on the knee as I tried to shift the direction of my run was enough to do the damage. Suddenly I heard a “pop” and I fell onto the ground with my left knee in excruciating pain. I tried to get up but the pain was so severe that I fell down again. That was enough to trigger immediate response from the guys to send me to the Emergency at the Armed Forces Hospital 96 (HAT 96) nearby. To my dismay, they only did minimal checks on my knee, not even an x-ray. I was prescribed with pain killers and was given an appointment with the orthopedic specialist in two weeks. By then my knee was already swollen and I needed crutches to move around.

I was determined to fight it off and I truly believed that I would eventually recover. So, I did what the HAT 96 orthopedic doctor told me to do; regular trips to the physiotherapy department and continuous intake of the “magic” supplement, Glucosamine (the brand I was prescribed with is known as Viatril-S). I did recover to the extent that I did not need the crutches and I could bend my knee fully (so no more praying while sitting on a chair anymore), but I was frequently troubled by my knee “locking” and I always ended up in terrible pain after a mere 20 minute walk. Jogging and other activities involving running were out of the question as well. It was a big and drastic change in my life style obviously. I tried numerous people who provided massage therapy, but still not much improvement in my condition.

The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability

Almost two years later I decided to tell the orthopedic doctor, Dr Musa, who by then has become a friend of mine due to my regular visits to his clinic, that I was ready for a surgery. He said it was a wise decision but he cautioned me not to expect full recovery. A good PCL recovery of 70-80% should be considered a success. I did some reading on my own as well and I was convinced that a surgery was really necessary and it was worth the risk.

My surgery was scheduled on 25th Feb 2008. I reported to the hospital the day before, slightly troubled by flu. After a regular check, I was told to shave my knee and they put a huge red “X” on my left foot (I sure hope the doctor did not miss that during the surgery : =)). I woke up very early for the surgery the next day and by 7.15am I was already wheeled on a stretcher to the preparation room. Everything seemed fast and organised, and before I knew it I was on the OT table, ready for the surgery. I was given Epidural which was injected into my spine and a few seconds later everything waist down felt numb. Folks, I was not delivering a baby via caesarean, the similarity was only from the same method of anesthesia using Epidural. At least now I know how it was done when my wife delivered the twins. Two doctors, Dr Amir and Dr Musa, gave me a quick insight into what was about to take place. “Basically, we are going to take one of your hamstring muscles and replace the damaged PCL ligament”. Sounded simple enough. For the next two hours I experienced a PCL surgery which resembled more of a household DIY project with lots of pulling, tearing, drilling, cutting, sawing and knocking. I was awake obviously and it did not feel like an OT at all apart from the caption of the inside of my knee projected on the TV screen. The doctor discovered that the PCL ligament was completely severed so the surgery was absolutely necessary. I was also shown the damages occurred to my meniscus and the repair they did to it. I was also told that a PCL surgery normally required two doctors as it was more complex than an ACL surgery. I was also shown the hamstring that was “bolted” in to replace the PCL. As it was bigger than a PCL ligament so technically, my knee should be stronger after the surgery. Good to know, good to know. I was also told much later by Dr Musa that there were 3 screws placed somewhere in my knee to keep the hamstring cum new ligament intact. One of them is protruding out from under the skin and my daughters love to check it out.

My family was always on my side

The surgery was completed within 2 hours. I was sent to the recovery room and when the nurse removed a tight band around my thigh all of a sudden I felt the whole room spinning and as a result I threw up whatever was left in my stomach. I didn’t even know they put the band there. I was told it was to restrict the flow of blood during the surgery, hence reducing bleeding in the area.  The sudden flow of blood once the band was released resulted in the spinning I felt....that was quite a ride.

The 5 areas where my knee was cut

(No. 1 & 4 are the points where the new PCL/hamstring was bolted.  The protruding bolt is at No. 4. No. 2, 3 & 5 are the insertions made for camera & tools...it was a DIY alright)

When I was finally sent back to the ward, the anesthesia was still in full effect. I was told to remain on my back till 7pm to avoid further complication. So I was actually lying flat on my back for at least 12 hours….it was longer actually as I couldn’t remember when I actually first got up after the surgery but it was definitely long after 7pm. I was fed with IV till the next day, and I was given lot of antibiotics and pain killers in the next few days. It was only a few hours later that I could urinate which was a sign that some of the anesthesia was wearing out. I was cautioned about the great pain I would feel when the Epidural effect was completely gone. By the nurse’s estimation that would be around 10pm that night. She gave me a “special” painkiller which I should consume when the pain became unbearable. Just as she said, right at 10 pm the pain started to become stronger (placebo effect maybe) and I decided it was the right time for me to consume the special pain killer. It didn’t help much to ease away the pain, and at the same time I felt itchiness around my eyes. Just my luck, it was an allergy reaction to the pain killer as my eyes were also slightly swollen. As it turned out, this was a true blessing in disguise as I slept like a baby till morning after the nurse injected me with the medication for my allergy.

A get well soon fruit basket from a friend

There were 2 other patients who underwent ACL surgeries on the same day with me. When I met them at the physiotherapy, I could see that they were not happy campers. They told me that they couldn’t sleep as they were in great pain the whole night when the anesthesia wore out. Suddenly the allergy I experienced felt like a “gift” from God as I was fully rested and the pain was not that bad when I woke up in the morning. The physiotherapist then took us through some simple exercises to do as a part of our long journey to recovery. This was going to be my second home for at least 9 months and I progressively went through multiple regimes of exercises to help strengthen and develop my newly constructed knee.

I spent a lot of time with this remote

The loyal Mickey Mouse pillow helping to elevate my foot

Walking gingerly on crutches while the two "spotters" look on in case I fall down

My thigh was put on a cast on Friday and I was released from the hospital right after that. I was touched seeing what Lin had prepared at home. A single bed was placed for me in the children playroom, and as a welcome home gift, she gave me a Mickey Mouse pillow to put under my ankle. For the next two weeks she diligently cleaned and bathed me until my cast was removed. I had to use crutches to move for the next two months. I knew I wasn’t going to recover fully but I was hoping that I could at least be able to run again. So for the next 9 months I followed the prescribed exercises religiously. Dr Musa was happy with my progress and said I was doing extremely well.

A very useful gift from Lin

(she said I can give it to the kids once I'm done with it...now I understand why Mickey Mouse)

Now, it’s almost 2 years after the surgery. I still feel constant pain in my left knee, but it is mild most of the time. The scars and the protruding screw are still there as blunt reminders of what I had experienced. My right knee is beginning to trouble me, and sometimes I feel more pain in this knee than the one that had the surgery. Dr Musa told me that this is almost an inevitable long term effect as I subconsciously tend to put more weight on the right knee since the surgery. Despite all these constraints, I’m still counting my blessing and I am glad that I had the surgery. I can do a little jogging now at my own slow pace. I have jogged up to 5km so far. The funniest thing is that I feel my left knee had to be told to move, hence there is this slight feeling of a few nanoseconds delay in its response. It’s really funny when your left and right legs are not fully synchronized. Dr Musa has a simple explanation for that. He said hamstring is a straight muscle as opposed to the PCL which is subjected to bending and twisting. Therefore, it takes a a lot of coaxing to get it to move and “think/response” like a ligament, hence the tiny little delay in its reaction time. Made enough sense to me. The best part is that now I could lift up and carry my twins. Farzana is 22kg now and I could carry her up the stairs without much trouble. I can enjoy golf again and have been out on the course for the past two months. I can also enjoy rugby coaching a whole lot more as I can participate in some of the drills and exercises. My ultimate dream is to one day climb Mount Kinabalu and I believe my triumph to conquer the peak of South East Asia’s tallest mountain will signify my journey to overcome this little challenge in my life. InsyaAllah.

I was at the rugby field two weeks after the surgery (once the cast was removed)

Be careful with the knee....winning the President Cup

At home 5 months after the surgery

(no contact happen during this game...the guys were kind enough never to tackle me)

Mount Kinabalu.....hope the knee will hold when the time comes