The Graphic Details - Chapter 2 continued

So what really scared the crap out of me and really made the condition known were the photographs from inside my knee. Sure, having the doctor tell me what was wrong was pretty effective, but actually seeing the difference and conditions inside my knee really made an impression.
First, this is what a healthy knee is supposed to look like. This is the medial facet of the patella and the trochlea (knee cap and inside of the femur):



See how the surfaces are smooth, unfettered and there is no discoloration? Nice, huh?
Now let’s move to the lateral portion of my knee (the outside – where the illiotibial band connects into the knee joint.) This is the back side of the patella – called the lateral facet.











And so is this.




This is more towards the ridge (middle) on the backside of the patella. See how it’s right down to the bone – the white stuff is the hyaline cartilage and is supposed to have a continuous and smooth appearance and not look like it was just hit with napalm.

And now the kissing part of the lesion. This is the “base” of the femur where it meets the knee joint, called the trochlea.



The top of the image inside the circle is the trochlea and you can see how it’s not worn down to the bone, as is the patella on the bottom (bottom left inside the circle you can see the exposed bone). This is a Grade 3 lesion – blistered and damaged but not gone.

So these pictures pretty much stopped me in my tracks and has me second guessing pretty much everything I do. The unfortunate thing is that the conclusion is inevitable but the path I take to get there is what I’m trying to affect. More impact = a faster path to osteoarthritis. Hopefully the lower impact options will prove effective...both in knee longevity and weight management.

The really shitty part is that I’m really just not looking forward to spending a few thousand dollars on a new bike. Crap, that’s a lot of pairs of running shoes! I’m not going to buy used as I don’t really know anyone who is selling a bike and I have enough problems of my own. I don’t need to buy someone else’s problem(s).

I can't wait to get outside though.

Knee - No Progress, Chapter 2

(I have actually had this written for quite a while but never got around to posting it. So here it is, finally, with some recent modifications.)

I spent the 4 weeks between my (12/2) surgery and first post-operative meeting and my meeting in early January (1/10) researching options for treatment or repairing my knee. Whether it was reading what wikipedia had to offer, soliciting articles from various medical journals, digging into other online resources (www.cartilagecare.com), investigating advertisements seeking candidates for knee pain studies or contacting pharmaceutical companies for information on their latest technologies…I was on it.

Not that I wasted my time but unfortunately none of it is applicable to my situation. I guess any knowledge gained is good knowledge, but it sure as hell is frustrating.

After meeting with my doctor in January, in the middle of a 20” snowstorm nonetheless, it turns out that I have a kissing lesion, so it not only affects the patellar articular cartilage (Grade 4 defect), but my femoral condyte (lateral troclea) is also damaged to some extent (Grade 3 defect). That means that I have damage to the cartilage on the backside of my kneecap AND to the tip of my femur – the two surfaces touch when the knee is cycled, therefore it’s called a kissing lesion. And, to boot, neither lesion is contained...meaning, there is no definite edge to the outer edges of damaged cartilage. The edges of the damage is still frayed somewhat and it was left that way intentionally. Because the cartilage is in such limited supply, it’s better to be left in place even if it is damaged. Only the fragmented and floating pieces were removed as a conservative measure. (as part of the synovectomy – removal of the synovail sac in the knee (the sac full of fluid that increases the lubricity of the knee).

Makes sense, I guess.

My orthopedic surgeon is the top dog in the area and I trust him implicitly as he is a conservative physician, he really knows his shit and is an athlete himself. He spent a good portion of my January visit explaining his philosophy and talking me off of the cliff of taking any drastic actions while "my head was in it". He emphasized patience and that I can and will return to some activities if I want, but everything comes with a risk. This knee issue is going to be a process – a long process. Right now, we start with the most non-invasive and easy to implement options to see if we can work with what I still have and keep some level of activity to keep the knee strong and stable.

So what does this really mean?
Obviously anything I do is my own choice. I could start running anytime if I really wanted. I could also seek a second opinion or give the cartilage replacement technologies a try (like autologous condrocyte implantation). In the end, the pictures say it all and the conclusion is likely to be the same. Long distance running is out of the question…for now. He even frowned on 10K's (this little bit of advice or specificity is something that I actually had to pry out of him). So, again, I am not running now or anytime in the near future…but I haven’t ruled it out entirely. Stationary biking has at times been quite uncomfortable as has, believe it or not, swimming. Sure swimming is uncomfortable because I totally suck at it but some of the kicking motions at times tweak my knee. The indoor stationary exercise just hasn’t been cutting it for an equivalent caloric burn or from a motivational (or fun) perspective. I am heavier than I have been in about 8 years (*) and I don’t really look forward to any of my workouts…they’re just flat out boring!

(* - some of this is admittedly muscle. I have been lifting 1-4 times per week on average. There is an obvious and ever increasing layer of fluff though that’s pretty nasty.)

It’s time to go road bike shopping…or better put, bike buying.
I’ll include some pictures from my post-op report in a separate post. The pictures really tell the story.