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.