Messed Up Knee

KneeI messed up my knee playing indoor soccer.  By ‘messed up’, I mean that something popped/twisted when I was cutting from one direction to the other, such that it felt like it separated or came out of joint momentarily.  Icing/rehabing/taking it easy for a few weeks before increasing activity didn’t do the trick; I re-injured it more recently.  So now it got to the point where it made sense to get an MRI and see where to go from there.

Last week I had the MRI done and got the results yesterday.  In explaining the brokenness and treatment options, I found it helpful to have a model, or an illustration like this one that shows and labels all the parts – you can click on the image to view it full-size.  Thanks to Ginger for snagging this and labeling the applicable parts!

3 things are “wrong” in there:

  • Mild sprain of the MCL.  Will probably heal by taking it easy for a while.
  • Torn meniscus.  This will almost for sure not EVER heal.
  • Torn ACL.  Again, this will almost for sure not EVER heal.

The meniscus, and more so the ACL, have little or no blood flow, so unlike skin tissue, they don’t ever truly heal.  If the ACL regenerates any new tissue, it will be scar tissue which apparently just isn’t the right stuff for a stable knee.

So the treatment breaks down like this:

  • Repairing the meniscus is relatively routine as these things go; basically a surgeon goes in and trims the torn parts off (the doctor likened it to a hangnail) and smooths it out so as to prevent more tearing.  The difference between a hangnail and a meniscus, though, is that fingernails grow back, but meniscus does not.
  • There’s no such thing as repairing an ACL.  The only way to fix the problem is to “reconstruct” the knee by removing the ACL and replacing it with something else.  I was given three options:
    • Steal about 1/3 of the patellar tendon which connects the patella (knee cap) to the tibia (shin bone).
    • Steal something from the hamstring area.  Don’t know if this means hamstring, or a ligament or tendon connecting the hamstring, or what.  I think I stopped listening when I heard the word “hamstring”.
    • Use tissue donated by a cadaver.  Well, arranged to be donated by a person before his body became a cadaver.
  • In each of the 3 options for the tissue, what happens is this:  the ACL is removed completely, holes are drilled in the top of the tibia and bottom of the femur (thigh bone), then the replacement tissue is weaved through the holes and secured with screws.  It stays like that for life.

For old people who won’t be very active for the rest of their lives, the reconstructive surgery doesn’t make much sense because there are enough ligaments that keep everything stable enough to walk around just fine.

In my case, though, I plan to stay active for decades to come, so the surgery makes the most sense to me.  If my soccer career is over, so be it, but the scope of my activity is far beyond just that.  I’ve been going on mission trips/service project trips once a year since high school, and plan to continue that – this involves construction and other activity that will certainly stress my joints more than normal walking around.  And The Mighty Throckmorton has a good 5 years of activity left in him – he needs someone to run with!

So right now I’m leaning heavily toward having the full reconstruction done with the cadaver tissue.  I don’t have a problem with other peoples’ body parts being in mine — hey, I had cadaver substance fused into my teeth in a periodontal surgical operation a few years ago.  Besides, using tissue that’s not my own reduces the amount of trauma that would be inflicted upon other pars of my body by cutting it away, thereby injuring yet another part that would need to heal.

What about the schedule?  Ginger and I are visiting Florida in October, so it’s probably going to be right after that.  The doctor said the healing process takes about 8 months to be complete – that’s 2 weeks of hobbling around and mostly staying off it; then the PT starts; non-impact exercises like swimming and biking start after a couple months; then after 4 months jogging is allowed.  That messes up end-of-year plans for me: I’m signed up to go on a house building trip to Mexico with a group from church at right after Christmas, but right now I’m leaning toward putting that off till “next time”, which is the Spring.  If it’s late March, that will be 5 full months of recovery, which should be enough time to get it back to almost normal, which would be necessary since the trip involves construction and other strenuous physical activity.

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