Monday, June 18, 2007

Partially bad news

I know you've all been waiting with bated breath to find out what happened with my latest stupid knee incident, right?

Right after the injury, the doctor said that he thought it was a partial tear, and that it would heal well in the next couple of weeks. Of course, since I'm posting about it, you know that's not what happened. It continued to buckle on me, not to mention that it still hurts, so I called and asked the nurse to schedule an MRI before my follow-up, which was last Monday.

At the follow-up, Dr. Busybusy the knee surgeon said that the MRI was "just fine". It showed a partial ACL tear, which I've had for 13 years now, and no new meniscal damage, just scarring from the recent knee surgery. Basically, according to the MRI, the knee is just fine, but I don't think that tells the whole story. MRIs aren't dead-on accurate in detecting cartilage damage where there's scarring from pre-existing surgeries, and they can't tell how much of a partially-torn ligament is still intact, or separate out new tearing from the preexisting partial tear. Normal, fine, healthy knees don't routinely buckle and dump their owners on their asses. Normal, healthy knees let their owners squat and kneel, and walk up and downstairs easily, and not limp around all the time. I want to be just fine as much as the next girl, but I do more with my knee than have MRIs taken of it, so being just fine on MRI doesn't really mean too much to me.

Dr. Busybusy said, OK, maybe the buckling is just muscle weakness and incomplete recovery from the previous surgery, and could be treated with some more physical therapy. He sent me for a couple more tests to measure how clinically unstable the knee is, and to measure how much weaker the bad leg is, and I had those done yesterday morning. The very nice physical therapist who did the tests told me that she could tell I'd worked hard in rehab, because my bad leg actually measured as being slightly stronger than the good one. The instability measurement showed that the knee is a lot looser than my "healthy" one, enough that it qualifies as a clinically unstable knee. She said doing more PT wouldn't help the knee, since the looseness is structural rather than a muscle problem, and that Dr. Busybusy would probably consider surgical reconstruction.

So, a followup appointment is being scheduled with Dr. Busbybusy, at which I assume we'll discuss whether to do the surgery. If I want, I could just wait a while, and fix it whenever it tears the rest of the way, or when the looseness and the buckling cause even more cartilage damage. Based on the way it's acting, though, I think it'll tear again sooner rather than later, and I don't have so much knee cartilage left that I can be cavalier about losing much more. Also, it's causing some non-trivial problems with my life already, so it's not like I can just forget about it until something else happens. Just like my last surgery, it's probably a question of fixing it now, or letting it get even worse and fixing it later.

ACL reconstruction is absolutely non-fun. It's not like any knee surgery is a picnic, but I got off pretty easily back in February, with only a few days on crutches, and near-normalcy in a couple weeks. This time, we're talking about weeks on crutches and months of physical therapy, and nearly a year to reach full recovery. And it's not exactly the best time to go having knee surgery, either -- in addition to the nine-month-old twins (who are, I think, going to be walking quite soon), I'm doing a lot of freelancing, still trying to finish up the master's, and we're putting our house on the market and hoping to move.

I may well delay the surgery itself for a few months, and hope my knee doesn't get more damaged during that time. Eventually, though, I think it needs to be done. In retrospect, if I'd had an ACL reconstruction for the original partial tear back in 1994, I might have avoided both the recent surgery and this latest fiasco. More significantly, I'd have avoided doing more cartilage damage, and thus decreased my risk for future arthritis. I don't want to look back in twenty years and wonder if having the ACL reconstruction in 2007 would have spared me the knee replacement.

The whole thing is just impossibly frustrating. Knees may be a good overall design from a functionality standpoint, but they're very fragile -- injure them once, and they're never the same again.

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