ON THE BRIGHT SIDE
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It's Sunday afternoon and I am looking at various football games thinking to myself, These guys have knee injuries all the time. So often we hear that a certain football player injured his knee during a game and the next day has arthroscopic surgery and two or three weeks later he is back on the field.
Even though I'm a practicing medical doctor, before I had knee surgery about three months ago that's what I thought. I soon learned that it's not that easy.
My recovery was not exactly that of a football player. Arthroscopic surgery is a common orthopedic procedure that is used to diagnose and treat problems in joints. The word "arthroscopy" comes from two Greek words: arthro, meaning "joint" and scope, meaning look. This procedure is often performed on knees and shoulders. A camera is inserted into the joint through a small incision. The arthroscopic surgery camera is attached to a fiberoptic light source and shows a picture of the inside of the knee and shoulder joint on a television monitor. One or more other incisions are made to insert instruments that can treat the underlying problem.
Arthroscopic surgery is often performed to evaluate arthritis and it is also performed to repair a torn meniscus. This is the procedure that I had. There are two menisci in each knee, they sit between the thigh bone (femur) and shin bone (tibia). They are made of tough cartilage. The surfaces of the leg bones are covered with something called articular cartilage. This allows the bones to smoothly glide against each other without causing damage to the bone. The meniscus sits between the articular cartilage surfaces of the bone to distribute weight and to improve the stability of the joint.
I don't know exactly what caused my injury but when it was apparent that physical therapy was not improving my condition I opted for the arthroscopic surgery. The symptoms associated with a meniscus tear include: swelling of the knee, knee pain, tenderness when pressing on the meniscus , popping or clicking within the knee and limited motion of the knee joint. I had all of these symptoms.
The diagnosis is usually made by X-rays and MRIs. Surgery is not indicated for all torn menisci. Some patients get better with physical therapy alone. I had a "bucket handle" meniscus tear, which means that the torn meniscus was in the knee joint and causing my leg not to extend properly. So, I basically was limping around with a bended knee. If this is not repaired, muscles of the leg, especially the quadriceps and hamstring muscles, weaken further exacerbating problems. The surgeon has the option of either removing the torn meniscus (as in my case) or perform a meniscus repair.
As with any surgery, choosing a doctor is a crucial decision, and, since I am a physician, you might be interested in how I selected my orthopedic surgeon. I basically knew the physician and had worked with him on many orthopedic cases. I think for the lay person what is important is the experience of the surgeon:
* The actual number of these procedures that he or she does in a month/year
* His infection rate or rather the lack thereof
As a patient, you should research these points. Go to the internet or ask your family doctor. Then question the physician that you choose. These are all important factors and importantly one must have trust in his or her surgeon.
My surgery was successful and actually the postoperative period was really not that bad. The actual surgery takes about an hour. I opted for general anesthesia, and this should be discussed with your physician. I remained in the recovery room a few hours and went home that afternoon. It is important to wear support hose for a few weeks post-operatively because of the incidence of blood clots. Infection after arthroscopic surgery is always a risk, even though physicians take every precaution to minimize this possibility. Antibiotics are given just prior to the procedure to prevent infections. I of course was more aware of this since I am an Infectious Disease physician. I suppose what I did not expect was the long recovery process that would really not have been successful without physical therapy. I cannot emphasize strongly enough the importance of physical therapy. I did not require a brace and actually only used crutches for about 4 days. It is very important to follow the instructions of the physician and physical therapist.
Remember, most of us are not professional athletes--we don't have the training facilities or the round-the-clock access to trainers and physical therapists that they have. So, unless you're Terrell Owens or Lindsey Davenport, don't expect to fully return to any demanding physical activity in a few weeks. Patients must be patient. I am certainly older than most football players and certainly not as physically fit as the average athlete.
It is so important also to remember that with every 10 pounds of weight loss, one takes off about 60 pounds of pressure on the knee. This is certainly an incentive to lose weight. It has been about three months since my surgery and next week my physical therapist will be releasing me from intensive therapy. I am able to walk up and down stairs. I can use the treadmill, exercise bike and the elliptical machine. It will certainly be a few more months before I can run but I have certainly come a long way. I have found that slow and steady wins the race.
I think it is important for all physicians to have a frame of reference with what it is like to be on the other side of the fence. We are so use to being active and being in control of situations. This process causes one to pause and realize that we are not supermen or superwomen. I certainly have sympathy for my patients who have osteoarthritis of the knees and those patients who have arthroscopic surgery and who have total knee replacements. During all those weeks of physical therapy, I certainly bonded with all the individuals in therapy with me, and we worked toward the same goal, learning to walk again after surgery. For all of those patients who are going through a similar situation remember that there is a light at the end of the tunnel. I will be writing articles in the coming weeks on articles in medicine and surgery and newer management and treatment issues.
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