Breaking Down

I guess it was bound to happen. Shit, I’ve lasted longer than many of my peers. But, at some point in many athletes’ lives, real injury happens and the consequences have to be navigated. This is my injury story.

Sometime in June my left knee started being funky. At first I thought it was a pes anserine (hamstring tendon) bursitis. I’ve seen it before in the clinic and the location was right. It seemed to bug me with the appropriate motions. It was worse after longer runs and downhills. It got worse around Mount Marathon and I was glad I wasn’t racing this year. I could ride a bike without much pain so that was good. And then it calmed down. With a ski trip to Argentina looming I decided to get an MRI of my knee just to make sure I didn’t have something that could cause me real problems down there.

Medial meniscus tear. The black triangle is supposed to be solid black

The MRI showed that I had a small medial meniscus tear. It also showed that my articular cartilage was healthy. Nothing too major so I headed off to Las Leñas. My knee improved further there with no running and just skinning. I had very few issues skiing hard downhill. When I returned, I was able to do short runs with nearly no symptoms. All good. But then I did a big beat down day with 9K of vert and about 8 hours of travel. My knee was unhappy after that. I followed this with a trip to Washington where I did a 15-mile run and, again, my knee was sore. I was limping and my knee was swollen.

I sensed that the tear was getting worse so I got another MRI. The tear was, indeed, bigger. Knowing what I know about knees, I knew that leaving this could lead to other problems. Meniscus tears can beat up articular cartilage if they displace enough. I certainly didn’t want that. With the ski season approaching, I decided the time was right to have it treated. The rub was that I could bike without pain and skiing wasn’t a problem either. But I knew that come spring, I’d want to be back in the mountains and the thing would likely be a problem.

So, I consulted with our sports doc and scheduled a left knee arthroscopy with partial medial menisectomy. For those of you who don’t know about this stuff, the menisci are C-shaped cushions that sit on top of your tibia and provide additional impact absorption with each step. They aren’t completely attached in places, giving them some dynamic quality under load. But this feature also makes them susceptible to shearing and tearing. Also, as we age, our collagen loses elasticity making tearing more likely. The problem is that a meniscus doesn’t have a very good blood supply so, except for a few types of tears, their potential to heal is limited. Instead of “fixing” the tear, most of them are simply trimmed back to stable tissue. The human knee seems to tolerate the absence of a certain amount of meniscus tissue without breaking down further. However, take too much of it and the articular cartilage takes a hit, osteo or degenerative arthritis ensues, and you’re on your way to a knee replacement years later. Not good.

So, I didn’t approach my knee scope with carefree abandon. On the other hand, it’s a very common procedure and I know hundreds of patients that have recovered fully and have gone back to full activity.

My job is pretty demanding as far as time on my feet goes. I’m also not in a position to take a bunch of time off to recover. My boss and I form a team that provides surgical care for hundreds of patients each month. We don’t have the extra manpower in our practice to let me not work. So, I knew this wasn’t going to be ideal as far as my recovery goes.

Gotta mark the surgical site

That's me down for the count

Cal Heald, PA-C, putting on the finishing touches The surgery went well. The case was as advertised and he was able to spare most of my medial meniscus. He confirmed that I had no arthritis aside from some scuffing of the cartilage around the tear. Pretty good news. He injected my knee with local anesthetic after the case so I had very little pain for the first 24 hours.

Houston, we have a problemI had my surgery on a Thursday and by Friday night things started to go sideways. My knee blew up a like a balloon. The few errands I did on Friday were blamed for my new predicament. I spent Saturday on my back in hopes of getting some relief. No dice. By Sunday, my gait was so impaired that I called my surgeon asking him to drain the knee. I was having nightmares about my knee being infected and other such craziness. Relief

Ahhh, that's better.He agreed I’d do better with it deflated so his PA met me at the clinic and we got 30cc’s of bloody joint fluid out. I thought there’d be more but things were better. The funniest thing was that after he drained my knee he said I should avoid all athletic activity for 4 weeks. Riiight. He doesn’t know me very well, does he?

Agatha Kitty helping me behaveI stayed flat Sunday and kept the knee wrapped tightly. I got some crutches and decided that I would use them to be as nice as possible while things calmed down. Of course, I still had to work in the operating room for 10 hours Monday, Wednesday and Friday. Not ideal. I still had no pain to speak of as long as I behaved myself. I never took any of the narcotic pain meds I was given but had some ibuprofen on board. Typically, I don’t use that stuff as I feel that the inflammatory process is generally a good thing that mobilizes all the healing goodies that help us get better. But I wanted to keep that joint effusion from coming back so I relented.

Things have gotten quite a bit better now that I’m 2 weeks out. I’m able to ride my bike and do air squats in an attempt to stave off the significant detraining effect this experience is providing. It might get better faster if I did nothing but the road back would be brutal. My inspiration is following the recovery of great skiers like Herman Maier and Lindsey Vonn. Both of them were on the bike nearly right away after career ending injuries and major reconstruction surgery and both came back to win World Cup races again.

I can’t say my knee feels better than it did preop. It’s still too soon. I tell my patients that it can take 6 weeks to fully recover and I seem to be following that trend. We’ll see. I’ll keep you posted.

Comments

[Karol]

Glad your knee is feeling better!

[Marek]

How's your knee now? Next month I scheduled a left knee arthroscopy, I'm a bit worried about the recovery process now...

[Brian]

Hey Marek,

Great question. Reminds me to do a follow up post.

The knee is pretty good. No real pain or swelling. I'm back to doing everything. But at 6 months post op, I can still tell I had a scope. I ended up with a bit of scar tissue around one of the portals that would catch on my patella randomly when I was standing still. It would hurt for a moment and then let go. No biggie. Also, I still have difficulty fully flexing my knee as in sitting on my heels when kneeling. I continue to work on this and it is slowly getting near normal. I'm back to doing everything I want to do without symptoms. From a pure activity standpoint, I'd say that I could do everything except the deep flexion thing at 6 weeks post op.

Hope that helps. One thing I would add is that your recovery will depend partly on any other issues you might have or that are found at surgery. My knee was clean except for the tear. If you have some thicker articular cartilage wear then you might experience something different.

Good luck!

[Derek]

Going into Juneau Bone and Joint November 20 for same procedure at age 47. Tried to not have it done for five months, but I'm too gimped. I looked at your blog for advice, knowing your profession and athleticism.

Seems like you over did it post op. I'm pretty neurotic and hope to avoid going overboard.

Hope your knee is still good.

[Brian]

Hey Derek,
Thanks for reading. I guess it all depends on which episode with my left knee you refer. This post was my first rodeo followed by 2 other surgeries for my ACL rupture a couple of years later. If you read my blog then you probably know this.

As for your upcoming partial menisectomy, it typically goes well as long as you don't have a bunch of arthritis in the knee as well. You should have a good idea of that from your MRI and will have an even better idea after the scope.

I think hanging on the couch while getting your range of motion back should be your focus for a few days. Wouldn't hurt to use crutches during that time, too. I was acting pretty normal after my scope. Maybe that's why my knee filled with blood. Maybe not. But it won't hurt you to chill more than I did. I was still hiking within 4 weeks. Good luck.