going back under the kni– arthroscope

It’s almost been a full 2 months since I last posted something literary, and that post also happened to be a couple of days before I reinjured my knee. Since I’m going to be bedridden in a little more than 12 hours, I figured I’d get the creative juices flowing in anticipation of doing stuff to keep my mind occupied while recovering from my second knee surgery in as many years.

On July 22nd this year, exactly a year and 10 days after I had my first ACL reconstruction surgery and meniscus repair, I re-tore my ACL graft and meniscus while contemplating a game of volleyball. The entire injury was probably manifested over the last few months of my rehab where I had tweaked my knee a few times while running but was cleared to return to activities by the physical therapist.

Day 0 (7/22/2013)

On this fateful Monday, I was waiting in the rotation for a sand volleyball game when someone served the ball long. I retrieved the ball, turned around, took a skip step and threw the ball. Apparently my knee got stuck in the ground while the rest of the body pivoted and whatever was left of the graft shredded and took my meniscus with it.

The pain was not as extreme as I remember it being following my first ACL injury but still bad enough that I took a day off to ice it and got an appointment with North Austin Sports Medicine, the practice that handled my first surgery, as soon as I could. They sent me off to get an MRI and I spent the next three days or so icing my knee and staying off my feet. I then went to a bachelor party in New Orleans where I played phone tag with the surgeon’s assistant but couldn’t get through to find out what the diagnosis was. I did manage to reschedule my follow-up appointment to Monday from Wednesday through a series of voicemails. After doing extensive research on WebMD as well as the tests performed by both my primary care physician and the orthopedist surgeon, I was fairly confident that I had a medial meniscus tear. While this wasn’t ideal, the recovery schedule for this injury was about 3-6 months, a far cry from the 12 months I had just spent from my prior surgery.

Day 14 (8/5/2013)

I got to the orthopedist surgeon and after a 10-minute or so wait outside, I was ushered into a room and given my MRI results in paper form. I was then left to stew in what they said for the next 30 minutes or so, in the normal waiting game that NASM likes to play. This summary was pretty straightforward:

Impression:

  1. Complete tear of the anterior cruciate ligament graft.
  2. Displaced bucket-handle tear of the medial meniscus.
  3. Moderate knee joint effusion.
  4. Status post resection of the medial synovial plica.
  5. Mild bone marrow edema of the proximal tibia.

That first line was the killer blow. The world didn’t spin around and I didn’t throw up in the doctor’s office, but I did spend the next 30 minutes gathering my thoughts and preparing for the spiel.

The surgeon came in and seemed genuinely disappointed and surprised and went ahead and recommended surgery as soon as possible but definitely within the next 1-2 months before scar tissue began to develop that prevented my knee from straightening, or before the cartilage tear got any worse. Unlike last time, I asked for a copy of my MRI with an intention to get a second opinion and an even stronger intention of going with the second opinion’s expertise for the repair surgery. While I have few problems with Dr. Brotzman, unfortunately his practice is not very well-managed, at least as evidenced by how long a trip to see him usually takes.

Day 16 (8/7/2013)

I scheduled a second opinion for this date with Dr. Carey Windler of Austin Sports Medicine. A few people I know have been to this practice and had nothing but good words for them. I even know two people who’ve had ACL reconstruction surgery there and have been recovering well. I took a copy of my MRI and they were able to access my last x-ray.

The verdict was pretty much the same: surgery. However, Dr. Windler suggested a different process, which was to fix my medial meniscus tear first (as well as undo the stuff from the failed ACL surgery) first and get that healed up completely and then follow by getting the ACL reconstructed next year. While this would be more expensive and increase my rehab time by a few months, it also made a little bit of sense for me because I could see how life was without an ACL (but a good meniscus). If I choose to go without an ACL long-term, I’ll have to cut out most all sports and running, and start swimming and biking. It’s a decision I haven’t thought about extensively and won’t really until my rehab from the first surgery is winding down.

In the weeks following this meeting I contacted NASM to attempt to talk to Dr. Brotzman about Dr. Windler’s opinion but I was never able to get him on the phone. Since they didn’t seem to want my business, I decided to go with Dr. Windler for my procedure.

Day 52 (9/12/2013)

Over the last month or so my knee has felt better and gained strength but I still cannot extend it completely apart from, of course, being unable to run, cut, etc. At this point I’m probably back to the lowest physical form of my life (sadness). However, I did give up a little bit since it didn’t make sense for me to go hard with my workouts when I knew I would probably be spending about 3 weeks without any exercise anyway. I know, it’s rationalization at its finest, but I was okay with it.

My first surgery–to repair the meniscus and undo the work done in my previous surgery–is scheduled for tomorrow at 8.15am, which means that I will need to reach the surgery center at 6.45am, which means I will be having a very, very early day. My uncle has flown over from Las Vegas to help me out and that coupled with the fact that I’ve been through this once before has me feeling cautiously optimistic about the surgery and recovery. Hopefully it will all go as planned.

I’ll be using my bed-ridden state to blog ferociously and perhaps even work on some Windows Phone apps that I’ve been putting off, in between spurts of pain medicine and naps. We’ll see how it goes. Onwards to surgery!

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