Wednesday, November 21, 2007

Once more into the breach

Before and after photos of my latest project:



The after photo looks a little more gruesome than it is; there is a discernable kneecap under there, just the photo doesn't show it very well because it's on the inside.

Yes, I jacked up my knee playing Ultimate again. This is the other knee, I jacked up my right knee playing Ultimate ten years ago and got it fixed, then played for ten years until this July. Ironically, my mantra for Summer League this year was "it'll grow back." Twisted ankle? Wonky hamstring? It'll grow back, probably before our next game. Well, as it turns out, not everything grows back.

This injury was much more glorious than the last time. This time, I was open in the end zone, and trying to catch a long throw that was coming down at a weird angle. My defender was back at mid field, and one of her teammates peeled off his man to cover me. We both went up for the disc, and we knocked together. And then I screamed like a soprano (this part was not very glorious) and my knee hurt a lot for a minute, and then it didn't hurt any more. I only wish I had caught the disc and scored.

I was a spectator for the last few Summer League games, and limped through Pennsic a week later, but felt pretty good by the end of the week. Then for the next three months, things pretty much stayed the same. I was doing PT exercises every day and I could walk as much as I wanted, but I had trouble going down stairs (or stepping off a bus) and although I got some rail-trail bike riding in, I couldn't do any other sports. My knee was sore every day.

The doctors diagnosed a completely torn ACL and a tear in the meniscal cartilage. I think it might be the miniscal tear that gave me so much trouble - when I messed up my other knee, I didn't do much damage to the meniscus, and I remember my knee being pretty normal after the first few weeks. Not this time.

I was interested to see if the surgical technology had changed in 10 years. Turns out, it hasn't changed very noticeably. I'm sure it's progressed, but the major outline is the same.

There are three main options for replacement ACLs: patellar tendon, hamstring tendon, and cadaver graft (more euphemistically called an allograft). When my first friend had an ACL repair (in the late 80s or early 90s), he had a hamstring tendon, which was the new thing at the time and they thought it would replace patellar tendon. Well, it didn't, and they still use all three. My surgeon said they all have benefits and drawbacks. The patellar tendon leaves a bigger scar (which is almost a benefit to me, since I think I should have something to show for my trouble) and has the risk of persistent front-knee pain. The allograft has a slight risk of disease transmission, but recovery is faster (no graft site to rehab) and they get to choose a graft instead of having to use whatever they find in your leg.

When I had my right knee done in the late 90s, they used a hamstring tendon. It worked pretty well, but the graft site was very painful and to this day, that hamstring muscle is weaker than it should be (it's noticeably weaker than the other, and it occasionally cramps under stress). My surgeon was inclined to use the hamstring again, because it had worked well in my right knee, but I easily talked him into an allograft. An Ultimate player friend of mine recently had a knee re-done with an allograft and said it was the way to go.

Of course, as soon as I decided my mom told me a story about a childhood friend of mine who almost died from a bad allograft...something about a bad donor that made a bunch of people sick. She didn't have any data to back it up, though.

Anyway, I have a plenty big scar now because the meniscus repair is a separate 3" incision. I'm happy to have it, because they weren't sure they would be able to do anything with the meniscus but they ended up repairing it.

I did have something new: the anesthesiologist did a nerve block in my leg before the procedure. It's supposed to help with pain the first day, and it did. Of course, it wore off in the middle of the night, but the anesthesiologist told me to expect that so it wasn't a big deal. I also had a cryo-cuff this time around, which they had 10 years ago but my HMO wouldn't pay for it. It's a nylon thing that goes around your knee and fills with ice water. Pretty spiff. And I have different drugs this time, oxycodone for pain (I hardly took any because it didn't hurt much) plus an antibiotic every six hours for like forever (6 days!), plus they have me taking two tylenol and two ibuprofen together every eight hours - supposedly for inflammation more than pain. I also got an anti-nausea drug before anesthesia, since it tends to make me puke. No puking this time!

So I'm hanging out in my TV room and Jake is bringing me food every few hours. I can't bend my leg (except doing exercises), which is annoying, and I don't get to shower until next week. I don't know why everyone says sponge baths are sexy...I guess I need a hot nurse and less self-respect. I missed one hockey game but plan to go on Saturday (not sure how I'm going to fit in a seat, but we'll figure something out). It take three minutes to go to the bathroom, and hands and armpits are really not suited for locomotion. I probably can't wear normal pants until the brace is off (four weeks or so), but I ordered $50 worth of cool thigh-high socks and legwarmers! I can't even be tempted to go shopping the day after Thanksgiving.

And I'm catching up on blog posts...more later!

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