Knee To This Point - Book 1 Of The Novel

The Recap:
Things seemed to be "normal" until October 15th...then my knee swelled up and didn't get better. By the following Wed, it was still swollen and had some general pain (a new symptom) so I called my ortho friend and was able to get an appointment that Friday, with an MRI.
I continued to run a little, logging a 6 miler the following day and put in 15 miles the following week (a light week) and 27 the next. Then, we had to shut it down.
Other than walking on the TM (at an incline) and stationary biking, i wasn't really alllowed to do much else.
I had the knee aspirated (drained) on 11/3 to have the fluid tested for gout, rheumatoid condidtions and Lyme disease - thankfully they all came back negative.
Next, it was time to schedule the diagnostic arthoscopy as no other causes of the swelling had been found (other than some suspected arthritis behind the kneecap).

So, 12/2 I was schedule for and had the diagnostic arthroscopy of the right knee. The procedurel was quick and the doc gave me the news after the procedure but the general made me feel like a drunken freshman. I couldn't remember a thing other than he said that he saw a lot of bone and did the synovectomy (removed the fluid lining in the knee). Physical therapy started the next day and I was still in a fog from the general and the codeine...and I drove myself to the appointment (doh!).

Physical therapy continued to progress and I had my post-op appointment with my doc on 12/15 and then the really bad news hit. The good news is that my knee is in really good condition - all ligaments, the meniscus and other connective tissues are excellent. Other good news was that the synovectomy seemed successful and he was able to remove much of the floating gunk in my knee that was causing some of the pain and swelling. The bad news was the condral defect on the back side of my kneecap, called a lesion of the patellar articular cartilage. Basically, this is a hole in my cartilage likely caused by some form of traumatic injury (like running into a chain link fence column full speed while catching in a baseball game) and instead of healing it progresses over time like a speed bump. Well, it must have reached (close to) critical mass for it to swell and be painful. Typically a condral defect is a direct line to osteoarthritis and because my defect was already abraded down to the bone, I am well on my way. The pictures of the defect (I'm trying to get copies so I can share) were pretty nasty - it looked like an explosion with jagged edges sticking straight up.
I was dumbfounded. Scared. Bummed. Confused. Aimless.
I still am.

So, since then I have been reading on condral defects and their remedy, speaking and exhanging information with Genzyme on their Carticel process and considering how I want to or should progress.

My thoughts moving forward....

1) No running for the foreseeable future. Since part of the diagnostic arthroscopy was to perform a debridement around the rough edges of the defect, I don't want to cause any further damage from pounding or excessive strain. Any further damage means more intrusion (operations) to make a clean site for implantation if I choose the options I am considering.

2) Pursue autologous condrocyte implantation (ACI) as the option for my knee. In speaking with my doc the last time I was there, he didn't sound too optimistic in general, but mostly for microfracturing the surrounding bone (a common, seemingly short-term, fix for chondral defects - it causes the marrow to leak into the defect forming fibrocartilage - sort of like a cartilage scab. This is a different structure and type of cartilage than the hyaline (hard, glossy cartilage) that exists in the joint. Over time, the fibrocartilage can loosens and break free - it's not as durable as the hyaline cartilage), mosaicplasty (age limited - typically patients under 40 size="3">or use of a synthetic patch (implanting a durable substance {sometimes a smooth metallic surface} in the chondral defect to protect the bone. This has a limited lifespan and will require that I restrict my activities for the rest of my life). So other options don't provide a very good outlook.

3) Since I have a patellar chondral defect, and not a "kissing" defect, my chances that this is likely to be covered by insurance are not as good. If I had a kissing defect, it would be more likely covered by insurance as ACI used for femoral defects is FDA approved.
(A "kissing defect refers to a defect on both sides of the condyle surfaces - the patellar and femoral condyle - luckily, I don't have this). I have an uphill battle with this one but during my coversation with Genzyme (the owner of the Carticel process) they seemed to be more confident as long as other invasive/uninvasive options have been pursued or would prove useless or are infeasible. I'm hoping that my doc will go on record that a temporary fix isn't worth it - it does nothing for my quality of life.

4) I'm curious if the insurance company will deem ACI a non-critical procedure - I can still bike and swim, I just can't run. This would be ruinous. Not only from a selfish perspective (running marathons, etc) but from a quality of life perspective in enjoying life with my family, etc and always having to worry that I am fast tracking to osteoarthritis and whatever I do could further accelerate that process.

So, in a nutshell, that's where I stand. I have an appointment on 1/12 with my ortho to discuss moving forward, his thoughts and hesitations on my prognosis and potential for fixing my knee. I have no plans on toeing the line any time soon so you'll all have to pound out the miles for me. I'm jealous, that's for sure as I wish I were out there enjoying the cold air up my nose and in my face. In the mean time, I have to keep my BMI down so I'm still elligible for the surgery.
Seriously.

Yikes!

...more to come. sorry it has been so long.