Knee Surgery 2020
Orthopedics has, unfortunately, become a hobby of mine this year. I was born with high-riding knee caps. As a result, my knees have always been "risky" with my right knee being worse than my left. Last year, I twisted my right knee skiing, I tore my medial retinaculum, resulting in the opposite tendon pulling my kneecap in the wrong direction. So all year, I've been accumulating cartilage damage around my knee from the kneecap grinding in an area it should not be. I underwent a series of surgeries (there were two) that were aimed to fix the cartilage and also reposition my kneecap. Check out this diagram I drew myself to avoid copyright infringement.
To do this, they performed a Tibial Tubercle Osteotomy (TTO) and an MPFL reconstruction, the latter of which being the more painful one because they had to tunnel into the center of the knee and place a bioabsorbable screw in my kneecap in addition to adding some muscle tissue around the MFPL ligament to strengthen it. Absolutely wild stuff. The TTO sounds even more nuts because they sawed out a section of bone from my tibial tubercle where the patellar tendon meets the bone, pulled it down and shifted to the side, then screwed it back into my tibial tubercle.
Here are a few animated videos of the procedures.
Tibial Tubercle Osteotomy
MPFL Reconstruction
Week 12
Feb 20th
Recovery Phase 2: COMPLETE
We have reached a milestone: week 12. Why is this a milestone? Well, after my discharge, the hospital gave me recovery guidance for 12 weeks. That's it. After that "I am free."
It is true, I am free of crutches. I am also free of my knee brace. No more knee bending machine. No more pain meds, blood thinners, or industrial-strength ibuprofen. But, I still have a long road ahead of me. My knee is still swollen and I cannot bend it fully yet. Plus I still have a bit of pain when I bend it and I am walking with a pretty gnarly limp. Now my primary focus is to build up the lost muscle mass and learn how to walk and use my knee properly again.
I met with my surgeon on Friday. He told me that the crepitation around my knee was soft tissue, which is excellent news because that means it is not the new, precious cartilage. He said that the mechanics were looking good, which I think means that my knee is bending how it should be. I still have a ways to go until I can bend it fully, but it sounds like I am on track.
I did receive some tough news though. Given the amount of cartilage damage that the he saw in there ("gross" was my verbal reaction too), the surgeon said that he can't imagine me returning to a sport like running. That also means triathlons are off the table. Later in the day, my physical therapist noted that even swimming may be difficult or not possible, depending on where the mechanics of the knee end up after everything heals. This all, of course, was devastating to hear. Triathlons are very near and dear to my heart.
I need to get more opinions about the future of my athletic training. It is too soon to tell. The surgeon said that it takes about 6 months for the new cells to finish growing. Most patients who receive this type of surgery get another MRI after a year to check on how the new cartilage cells are healing. Because my knee was so damaged, I will have another MRI in 3 months.
Until then, I will not have many updates. The plan is to continue physical therapy and living my best couch life.
Bis Mai.
Week 11
Feb 11th
Catiously Optimistic
I only use my crutches outside now. This is a picture of my crutches patiently waiting next to my front door. If it wasn't for the series of snow storms and icy conditions outside, I would be walking around outside without them. But while Berlin rests in its deep freeze, I will use the crutches to protect myself from slipping on ice, re-busting my knee, and getting more surgery.
Physio this week was promising. I did squats without holding onto my PT for dear life. I was also told to do squats at home in addition to the other little exercises I have in my toolkit. So far, for those keeping track, are:
- Bridges 3x for 30 sec
- Leg lifts 5-10x for 5-10 sec
- Squats 3 sets of 10 with assistance from furniture
- Roll out the outer side of my quad
My main assignment is to do these exercises about 3 times a week and then monitor how the knee feels during the next 24 hours. I was doing the exercises every day but my PT told me that is not at all what I should be doing. Whoops. He said that after exercising the muscles, I need to rest for a day to let everything recover so muscles can actually rebuild. If my knee is sore, then I need to rest for a few days and scale back the exercises. I'm happy to report that so far this has not been a problem.
They took Angle-a!! My knee machine! I've had it for so almost 3 months and now it is just… gone. Lockdown without the knee machine is strange. What has my life become? But to be fair, the max of the machine was 120 degrees and that was no longer a challenge for me. But I do miss it.
Lastly, the cracking noise hasn't changed. My appointment with the surgeon is next week and I will ask him all about that. I am still worried but there is nothing I can do.
Week 10
Feb 3rd
I got some sobering news from my doctor yesterday…
Just like the noble groundhog, yesterday the knee came outside and saw its shadow. There will be 6 more weeks of recovery.
Actually just 2
I went in for a check up and my doctor asked me about my progress. I said it was going well and that I was eager to get off the crutches. I just needed the ok from him. He said it was fine for me to start experimenting with taking steps without crutches around my flat, but I need to gradually wean off completely over the next two weeks. Week 12 is the finish line. This process is taking longer than I thought.
The real bad news came after my doctor bent my leg a few times and heard the cracking noises similar to that of someone cracking a glow stick. He was not pleased. He said that the noise has not improved since he saw me last (week 6) and it could be more than just fluid or scar tissue build up.
It could be that during the operation, they positioned the patellar tendon such that it got stretched a bit too tight. If the tendon is stretched too tight, it puts pressure on top of the knee cap and pushes it inward, possibly leading to further cartilage damage… not cool. During the procedure, they can't tell with 100% certainty how far to pull the tendon. They, apparently, can move the knee around a little during the surgery (gross) but they can't tell how tight the tendon will be until afterwards.
Unfortunately, I will have to wait until I can talk with my surgeon about all of this. I hope this doesn't mean there will be a third knee surgery.
Week 9
Jan 27th
I am getting bold with my walking! I take steps more often with my crutches hovering over the ground just in case. It has been snowing a lot lately in Berlin, which is amazing. But the ice outside makes me nervous, so I've been limiting my walking distance more than usual. If Covid wasn't enough to keep me inside, the ice will do it.
I am now bending with the machine up to 115 degrees. I just realized that the machine only goes up to 120 degrees. I have no idea what life will be like without the machine. Wow that's sad. The machine has become such a big part of my life. What will I do with an extra 1.5 hours every day??
Physio is going well! My PT gave me a few exercises to do at home to strengthen my pitiful quads and hamstrings. He told me to do elevated bridges using my couch as a platform and isometric leg lifts. My muscles are so weak and they start shaking after no time at all, but it will get easier.
Week 8
Jan 20th
My knee feels really good today. I have been cheating though. I sometimes sneak a limp here and there sans crutch, thereby risking putting more than the designated 30-35kg of weight on my right side. But there is no pain and technically I was told to "listen to my body" by one of my PTs. I also increased my machine angle to 105 because that too felt right. So far nothing bad has happened…
Before the surgery, they said it will take about 2 months to restore mobility in my knee. I had to look up the exact angle but full knee mobility for a normal human means about 135 degrees of knee flexion (bending). I'm in the home stretch!
I DO experience some discomfort when I sit in a chair with my knee bent for an extended period of time. Also, I get lower back pain when I sit with my leg elevated on a stool. This translates to more time laying on the couch. I am very sick of my couch. I've run out of Netflix to watch. Send help.
Want to see what happens when you do not use your quadricep for 8 weeks? My PT measured it yesterday. The left quad is 1cm smaller than the left from the atrophy. Also, my right knee is 1cm larger than the left because of the swelling.
The rest of the year I will need PT to rebuild all of the muscle mass I've lost. The PT will also help rebuild the muscles around the patella.
Week 7
Jan 13th
I got the go ahead from my PT to uhhh not go overboard. I was maybe a little too excited about news from the surgeon last week telling me I can start getting rid of crutches. I was ready to start putting as much body weight as possible on my leg but my PT could not caution me enough against doing that. Instead, he changed my crutching technique so that instead of using both crutches whenever I step on my right side, I alternate crutches with the opposite foot. I'm not sure why, but I feel like an AT-AT from Star Wars when walking like this. The crutches feel like my unstable, slow, mechanical legs. I also don't feel bipedal anymore.
I also got to 100 degrees! But was also told to maybe roll it back to 90 by my PT. I read some testimonials online from other people who have gotten the same surgery and they said that when they added too much weight too soon, they experienced setbacks. So I will try to take it easier. Good news is that with Germany's lockdown measures, I'm really not missing anything out there. I can wait.
Week 6
Jan 6th
We are coming up on week 6 of knee surgery recovery. There are murmurs of beginning the process of weaning off my crutches. I can still only put about 15kg/30lbs of weight on my leg. On the knee bending machine, I am up to 90 degrees. Every day that is getting easier to do. Holy moses when I first got to 90 I was SQUIRMING and hollering. This week is a big knee week with many physio and doctors appointments.
On Friday, I have my 6-week check in with my surgeon. There, I will get the next set of treatment steps.
Week 5
Dec 30th
60 degreeeeeeees!!! It's wild to think I haven't bent my knee to this angle in over a month. Now that I reached 60, I stay at this angle for a week. My knee brace has also been reset so that the reflection is also up to 60.
In addition to “Angle”a 3 times a day, I also have an EMS device to stimulate the muscles in and around the knee. I also use it, on my quad. You can see how small my quad muscle has gotten. Atrophy kicks in within hours after a surgery and there is only so much I can do to combat it given my current condition.
At PT the other day, I was given a scale to check again what 15kg of weight on my leg feels like. I haven't tried that since the day after the surgery. I absolutely forgot and have been erring on the side of caution by offsetting most of my weight while walking. To my surprise, 15kg felt like quite a lot! So I adjusted how I've been crutching around and it has made all the difference. I don't get fatigued as quickly. It's a whole new world.
Week 4
Dec 23rd
The swelling is going down and I am starting to bend up to 60 degrees on the knee bending machine I now call "Angle"a Merkel. Starting as in SLOWLY increasing the angle by 5 degrees every day until I reach 60. Every time I reach a new angle, I feel it! The tendons and muscles are so tight. But after a few bends, it loosens up and then it feels fine.
Something concerning me, however, is a popping sound and kind of a shift that happens with my kneecap when I get to around 50 degrees. My PTs seem to not feel it is a problem, but I was told to ask my doctor about it. That doesn't sound good. I don't want more surgery. One doctor recently told me "meh, sometimes the body just makes noises"
Not sure what to do with that information…
Week 3
Dec 16th
The bruise behind my knee is healing but it still looks awful. The swelling is my main priority these days. Fortunately, I have a prescription from my doctor to receive Lymph Node Drainage from my PT. I have no idea how effective it is, but the science seems sound. Basically, it is a gentle massage around different lymph node sites around my body to encourage fluid movement away from my knee. I get this treatment every time I go to PT, which is about 3 times a week.
PT is going smoothly. Every time I go, I ask when I can stop using crutches. They consistently assure me not any time soon. Honestly, I feel that. I'm very afraid to put too much weight on my leg. But, I am suffering from crutch fatigue. I am more limited by my upper body endurance than I am by the knee pain. One block down the street is about as far as I can get these days without having to stop and take a break.
Week 2
Dec 16th
The pain is under control now. The first week was rough. Getting around was extremely difficult. Taking a step was like gambling with how painful it would be. But by day 7 that pain was virtually gone. I'm still using crutches and offsetting my weight by what feels like 90%. I am getting crutch fatigue but life could be worse. At least I am able to put a bit of weight on my leg. The stitches come out this week and I'll finally be able to get my leg wet. Showering has been an adventure.
My friend, Maria, came over the other night and scared the crap out of me. When I turned around and started walking into another room she screamed! She had looked at the back of my knee and pointed out the worst, most horrible bruise either of us had ever seen.
I never noticed it because I only ever see my leg from the top. There was one night where the back of my knee was tender but I figured that was because the muscle back there was getting tight from inactivity/swelling. Nope. It was all the surgery blood settling at the bottom of my knee.
Week 1
Dec 2nd
I am so very couch-bound. Getting up and moving around is very risky because sometimes the pain is severe. Other times it is bearable. I have yet to figure out what angles or movements trigger the pain. Most of the pain is on the side of my knee where they worked on my MPFL. This is confusing because I figured the site of the TTO would be more tender considering when they described the procedure to me initially they used the words “bone saw” and “screws” with an 's'. I'm on a whole host of medication and I also need to inject myself with a blood thinner every day to avoid thrombosis/blood clots. As long as I'm on crutches I will need to take these shots. I still have not gotten used to them.
The knee exercises are going well though. I use a knee bending machine 3 times a day for 30 min at a time. It slowly bends my knee back and forth from 0 to 30 degrees. Starting week 4 I will need to increase the angle to 60 degrees. I am very much so not looking forward to that.
Knee Bending Machine