The following are just odds and ends, random thoughts, and some opinion. Feel free to ignore or challenge. If you have anything to add or if you're interested in more detail or any of this, please drop me a line K. Allen Comer.

• Rehabilitation, The Most Important Factor - I see many debates over which surgeon one should choose, what supplements one should take, what type of graft one should use in ACL reconstructions, etc. It's my opinion that, given a minimum level of competency with your surgeon, the most important factor in determining the success of knee surgery is, by far, the patient's commitment to rehabilitation. One must be absolutely diligent with regards to physical therapy and be willing to sacrifice the time necessary to rehabilitate the knee. Keep in mind that the rehabilitation period often extends beyond the period during which you are in formal physical therapy.
  
  
• Pre-Surgery "Rehabilitation" - This is a sister item to the issue listed above but, try to get yourself in the best shape possible before the surgery. Time spent conditioning and strengthening the leg before your operation will be well-rewarded with a less-painful and, likely, quicker rehabilitation. If your leg is in perfect condition before your operation, the subsequent physical therapy will nonetheless be demanding simply as a consequence of surgical trauma. The better shape you are in beforehand, the more support your surrounding muscles will be able to provide for the recovering joint.
  
  
• Know Your Surgery and Medical Terminology - If you don't know the terminology, acquaint yourself. There are numerous resources available on the web (educational sites, discussion groups, etc.); I've included a few good ones in the Web References portion of the site. The better you understand your surgery, the better you'll be able to communicate with your surgeon and therapist. Understanding this material is also necessary if you are going to have any hope of following your post-op surgical reports. My surgeon teaches, so maybe I have an exaggerated sense of how important this all is. Regardless, it doesn't take that long to have a basic medical understanding of your surgery. Surgeons and therapists see many patients each day and it's unreasonable to expect them to understand and remember all of the details of each individual situation.
  
  
• Obtain and Read Operative Reports - I think this becomes increasingly important as you have additional surgeries and even moreso if you switch surgeons. It also gives you insight into your therapy that you wouldn't have otherwise. Again, surgeons and therapists see too many patients each day to maintain knowledge of individual details that may be important.
  
  
• Prepare for Your Recovery Before Surgery - For most of my surgeries I've been primarily alone during the recovery. A little preparation beforehand goes a long way. Some excellent tips can be found at The Center for Orthopaedics and Sports Medicine (Marietta, GA) web site, in the Life After Surgery: Suggestions From Patients section.
  
  
• Glucosamine Sulfate & Chondroitin Sulfate - After my second ACL reconstruction and chondroplasty, I began taking these supplements. One year later, my cartilage situation had worsened. I don't know what this says about these supplements as there may be situations in which they do work; there are plenty of testimonies by people claiming good things from glucosamine sulfate and chondroitin sulfate. I may try it again, I've recently read that the two supplements should not be taken together as chondroitin may interfere with the absorption of glucosamine in this situation. There are article abstracts and a brief discussion of these supplements at the The Stone Clinic Web Site.
  
  
• S-Adenosyl-Methionine (SAM-e) - SAM-e ("sammy") has been used in Europe for 20 years or so, primarily to treat depression. Recent claims suggest that the compound also promotes healthy joints by stimulating cartilage growth and aiding in the repair of injured ligaments. I took this for some time and didn't notice any significant improvement but that's just my situation.
  
  
• Home Rehabilitation (Mobility Exercises and Stretching) - Therapy isn't limited to the time you spend with your physical therapist. I think it's every bit as important to do the basic mobility (heel slides, straight leg raises, etc.) movements at home as it is to attend therapy regularly. I've seen more than a few patients that slacked on the at-home exercises and had great difficulty obtaining full flexion and extension. Following my last four surgeries, I performed these basic exercises several times per day in the first few weeks of my recovery. Even with five total surgeries, I've been able to gain full extension and flexion early or on schedule.
  
  
• Massage Therapy - I'm now trying this out in an effort to accelerate swelling reduction. I do feel better, particularly noticeable in going up-and-down stairs, after each session. I think massage would have been valuable for my foot since I was non weight-bearing for so long after this procedure. The tingling sensation and weak foot muscles could have maybe been avoided altogether with a little massage.