Tuesday, April 12, 2011

Knee surgery update

“When was your accident?”

I was in my 2-week post-surgical follow-up with my doctor (Dr. Grant)’s ace PA (physician assistant) Vince. He was reviewing pictures from my knee surgery, which was the first time that we had seen real images of my damaged knee.

“Accident? Huh?” I answered.

Vince explained that he was wondering what had happened to so colossally mess-up my knee. I realized what he meant because I had been asked it before. Nobody 40 years old should have this level of cartilage damage without being in some sort of accident.

“Oh, I wasn’t in an accident. But I played catcher for 30 years.”

Vince was startled, but managed to say “Really? That might do it.”

Vince did the 2-week post-op review, and I was lucky to receive rave reviews* – little swelling, good range of motion, and no infections or other complications. There is very little scaring and I’m allowed to resume normal activities “as tolerated,” except I must avoid high impact activities like running.

Though the surgery was a success, the reason for avoiding impact activities can be seen in some of the surgical pictures as seen through the arthroscope during surgery.

Originally, we thought that I had a simple meniscus tear prompting a couple of months of physical therapy to strengthen the surrounding muscles. A few months later, an MRI indicated a slight degradation of my articular cartilage. The pictures, though, showed twice as many areas of cartilage degradation, each many times larger than reported on my MRI.

 A little bit on articular cartilage, or chondyle: it’s the very slippery material on the front of the femur at the knee joint that allows smooth and easy bending of knees. How slippery? Cartilage on cartilage rubbing is 10X more slippery than ice rubbing on ice. The articular cartilage is ~4mm thick, and mine had worn to the bone, resulting in arthritis. Yes, I’m a 40 year old with arthritis, but hopefully not for long.

Knee parts: 
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Side view of a cartilage “divot:" (Click on any picture for a larger view).

 (Each white area is cartilage, each tan area is bone.)

To repair the “divots” in my knee cartilage, I’ll be going in for another knee surgery (autologous cartilage implantation) in a few months to have new cartilage laid into the gaps – like laying sod or filling a pothole. Just like after laying sod, I’m not allowed any movement for 6-7 weeks post-surgery that could rip up the newly laid cartilage.

Because the replacement cartilage will be frozen for shipment to Virginia, I can choose the schedule for the implantation surgery, so as to schedule when 6-7 weeks of downtime might be convenient. My two thoughts here are to either proceed as soon as possible (likely early June implantation, back on my feet by late July) or to delay until next winter, when I wouldn’t mind being couch-bound and unathletic for 2 months. What would you do?

* For the great 2-week review I have to thank my parents for taking care of me post-surgery and Move Better physical therapy for the post-op rehab.

1 comment:

Mike said...

This is great information. I have the exact same situation with my knee (similar pic's and all). I am considering Carticel. My knee biopsy is sitting in the lab. Did you go thru with the surgery yet or are you waiting until the winter? I am undecided far. I'd love to hear how things went (if you had it done). Thanks very much for the detailing of your surgery. There's not much out there (aside from what Carticel says and I'm looking for unbiased opinions).

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