The Declarer (Floyd McWilliams' Blog)

Thursday, September 09, 2010

Knee Surgery: Background

I am currently recovering from ACL reconstruction and meniscus repair and thought I would blog a bit about my experiences.

When people ask "how did you hurt your knee" I don't have a good story to tell. The original incident was in July of 2005. I was on a stepladder outside my house in Sky Honda, cleaning the windows of my office. The ladder was anchored in a few inches of wood chips that covered the ground around my house at that time. It shifted, I tilted, and I fell -- only a couple of feet, but my right knee took all the weight.

Something horrible happened -- it buckled and twisted and there was a sharp pain. I lay on the ground, screaming, not because it hurt but because I was convinced I had shredded my knee. Then I stopped screaming. It didn't really hurt too bad. The knee swelled up a bit and was sore for a week or two. Then it was functional, though sore. I bought a brace for it. After a couple of months the knee was more or less normal.

After that I had occasional incidents where the knee would "shiver" under me, when I was on a slippery shower floor or when catching fly balls on a muddy outfield. But these were brief instances that didn't overly trouble me. In late 2007 I had an MRI done and was told there was no ligament damage.

Last summer I began taking MMA classes (mostly to get in shape, not because I wished to pummel people). In January we did a drill which consisted of running in a W pattern, forward and back around a series of cones. While running forward my knee buckled in the same brief, horribly indescribable way. I limped back to Google and made an appointment with an on-site doctor.

He diagnosed a strained LCL (lateral collateral ligament) and referred me to physical therapist. The therapist gave me various exercises to perform. The idea was to strengthen the muscles around the knee, to give it additional support. I did leg lifts, I squatted, I thrusted, I did a funny side-to-side dance with an elastic band around my ankles.

By March I was playing softball again. I went a few months with no problems. In June I was pitching in a softball game. The batter hit a very soft ground ball right back to me. "Even I can handle this," I thought as I stepped forward to field it. When I did so my knee came unglued. It felt as though my knee suddenly stretched to become longer, and popped out. Once again I was sidelined with a sore knee.

At this point I had had enough. I hadn't done anything violent; I was wearing my knee brace and walking forward. I could have been walking at the office or in my home. A few days later I saw a general practitioner at the local hospital. She was an Asian woman in her 30s (you know you are getting old when doctors are younger than you). I was probably more determined to have surgery than the average patient. She told me to ice my knee and take ibuprofen, and I was this close to hissing "Dammit! Fix my knee! Take your pocketknife out and operate on me now!"

She referred me to an orthopedist.

So I saw the specialist, and had an X-ray and an MRI. There was little left of my ACL. Apparently torn ligaments lose their blood supply and are reabsorbed by the body. (I also found out that the 3-year-old MRI was misread; the ACL had been stretched at that point. So I probably loosened it 5 years ago and tore it for good in January.)

I had one final appointment to meet my surgeon. His waiting room had two trophy cases full of sports memorabilia; he has done work with several local pro sports teams. (The office questionnaire asked what sports I play, and whether I was an amateur or professional.) He met me, examined the knee and the MRI, and recommended surgery. We discussed whether to use donor tissue for the graft (allograft) or my own hamstring (autograft). The allograft is stronger (the achilles tendon is used) and doesn't hack up one's knee; the autograft has no possibility of infection. My sense was that infection was an occasional problem in the past but has been stamped out now. I didn't feel particularly funny about accepting a donation from a cadaver. It's just a bit of tissue, after all.

(Curiously, "Tommy John" surgery -- replacement of the elbow's UCL, an operation often undergone by major league pitchers -- uses autografts from the hamstring. Perhaps the UCL is small enough that the autograft is not especially damaging.)

I scheduled the surgery for late August, after a vacation back East. I could have pushed it back further but my knee was giving me a lot of trouble. One day I walked from my office to a tiny conference room to conduct a phone screen. There were agonizing jabs of pain below my kneecap. I sank into the chair, sweating, and called the candidate. When he answered, I drew a blank; I could not remember what I was going to ask him! I had to call him back after calming myself down.

So, enough of that. I asked the surgeon how soon I could drive and he said after a week to 10 days. I would have the surgery on Wednesday, August 18, and return to work a week later -- I could catch a ride with my wife or take a shuttle bus that stops a mile from my house.




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