Saturday, October 13, 2007

Knee injury: Chapter 2

Mid Spring, 2007: So, off to the doc I go. I went to a local sports/Ortho clinic and saw the same doc that tended to my shoulder issues a year or so back. He poked and prodded, asked some questions and then did a test to see if the knee showed any sings of looseness due to an ACL tear. Nope, not really. "Your knee feels pretty tight", he said. Still, to see what happened he took xrays and scheduled an MRI. The xray showed no fractures, but some bone bruising. So far so good.

The MRI happened and the follow up was scheduled.

Back at the docs, imagine my surprise when the words out of his mouth were "You have a full section ACL tear". Whaaaaat!!? "See here", he said, pointing to the MRI (which just looked like some photography experiment gone wrong), "We really don't see any attachment here and here".

I was stunned and depressed. No way had I thought this was headed there. I got back up on the table for another push me/pull you exam. This time he said, "Well your knee is looser than the other one". Now this was the one that 4 days ago was tight. What is up with that? SO what are my options, doc? Hard to say. I would have limitations, certainly, but how much was unclear. When will I be able to play hard again? Martial arts? Cycling? Heck, I was wondering about a simple hike, if I would live wondering when my knee was going to give way or begin to be unstable, etc. So basically, take no risks. Great. We discussed the surgical options as well.

I ended up with a knee brace, some suggestions on what NOT to do (extreme sports, etc), and a prescription for vitamin I and physical therapy. I walked out with more questions than answers and the answers I had were not the ones I wanted. Bummer.

The PT person gave me a slightly more thorough exam, range of motion, etc. She reiterated that my knee felt very tight and was surprised at the MRI results. She did not feel the knee showed any sings of classic ACL damage. No signs of meniscal damage either. A few exercises later and I was on my way.

I hit the Google again and did a lot of reading on ACL surgeries. Autograph, allograph, patellar tendon graft, etc. Also, the success rates, dangers, typical results, etc. What an education. Did you know that the one of the highest percentages of ACL injuries happen to early teen age girls? Especially soccer players? Me neither. I also spent time on knee injury forums, I read about alternative medicine approaches, etc.

See, the deal was this. if I had blown my knee out so badly that it swelled up and laid me out, or it was giving out as I went down stairs or lived life, or it was obviously REALLY screwed up, I would have scheduled the surgery cause it would never get better beyond what the operation would provide. I would always have serious compromises with a missing ACL. One thing for sure, no matter what, I would never be the same again. One bright light was that cycling is not ACL dependant, but life is way more than bikes. I was too young and fit to be this limited....too much was uncertain.

But, I was not that bad. I had no instability, some pain but not a great deal, no swelling, clicking, popping, catching, etc. I knew I was a bit screwed up, but I dreaded the thought of rushing into surgery to "fix" a knee that was not as bad as the results of the operation might make it. Would I heal enough to live a more careful but reasonable sports life if I just left it alone? A loose knee can lead to arthritus and joint damage later in life. And, if I did the surgery, should it be Autograph (using my own body tissue as the 'fix agent' of Allograph where cadaver tissue is used? The allograph is becoming more popular since it does not involve cutting parts of a 'good' section of your body, typically a section of patellar tendon or hamstring tendon, to make the repair. The recovery is shorter that way, but there are no guarantees of the quality of the cadaver donor. Even if the tissue is not diseased or compromised, it may be not be as strong and fit as your own body would provide.

Well, 2 weeks and I see the doc again, with more questions that I know what to do with. Either way, life feels a bit darker right now. God is good, but he doesn't always tell me everything I would like to know.

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