Knee Surgery . . . Finally

After whining about a deteriorating knee that has slowly eroded my capability to ride my bike over the last few years, I finally found a sports medicine physician who diagnosed my problem and performed surgery to fix it. I had the surgery yesterday and start my too long recovery period today. Officially, the diagnoses was Chondromaliacia Patellae caused by Patellar Tilt (see diagram at right).

It turns out that amount of cycling I was doing caused the patella (kneecap) to be pulled laterally towards the outside of the knee. Basically, my lone focus on cycling caused certain muscles to develop while others remained weak, pulling things in one direction only. Since the patella was pulled outside the groove it normally sits in, it rubbed the cartilage between the kneecap and femur where it’s not designed to – over the sharper part of the femur. After about 10 million cycles, it rubbed right through so that there is no longer any cushion between the kneecap and femur. Bone rubs on bone. Ouch.

Funny, though, I had no trouble walking. The hole was low on the knee so it only affected me when I bent it by over about 30 degrees. Stairs were hard, ladders were almost impossible and cycling . . . well I had to stop riding last August.

The surgery is arthroscopic and isn’t major, relatively speaking. The surgeon cleans up the crappy hole in the cartilage and does a lateral release – cutting part of the connective tissue that holds the kneecap in place (the lateral retinaculum) allowing it to slide into its normal resting place. Finally, and this is the gross part, the surgeon drills or digs a small hole in the femur (a process called microfracturing) to release cells that help the cartilage heal more completely.

About four weeks after surgery, I’ll be getting four weekly injections of Orthovisc, which is made from naturally occurring lubricants found in joints. Apparently, this is injected with a needle the size of an oil well drill bit, but it’s worth manning up because it helps the cartilage heal, adds some lubrication to the beaten up joint and speeds up all-around recovery a good deal.

The prognosis is that it will take me about 4 months to recover enough to get back on my bike for any serious riding – why didn’t I do this in September? One of the advantages in working with a sports medicine specialist is that they are very sensitive to their patient’s addiction to their activities and work to get them back in action faster. Given that, I’m hoping my doc works with me to cut some time off the textbook recovery period.

Update(s): when I searched the web for information about this surgery and, more importantly, the recovery from it, there was very little to be found. So, for those of you have stumbled across this as a result of a search for information, I’m going to keep a brief digest of what my recovery was like. As usual, your mileage may vary.

• One day after surgery – Ouch! Anesthesia and anesthetic are all gone and being very much missed. Like an idiot, I didn’t take the pain medicine (percocet, in my case) soon enough or frequently enough. This is the only day I had to take any though. 24 hours after surgery, the pain was manageable. I’m a wimp, too.
• Two days after surgery – Still a lot of swelling and very stiff. Moving around on crutches a bit. Started using a CPM machine to exercise the knee. Doesn’t seem like it would help, but it does. Start doing basic exercises with short range of motion. Painful.
• One week after surgery – I still can’t bend my leg much. After using crutches for about 4 days, I moved onto a cane. Doctor says I don’t need it, nurse and physical therapist insist I do. So, I compromise. I overuse it and the knee remains really swollen. Sleeping is hard, every move causes me to wake up.
• Ten days after surgery – See the surgeon. Have the stitches removed (no bleeding at any time – the holes are very small). He says my knee is abnormally swollen. I probably used it too much. Gave me a few more exercises and tells me that I can do the PT work myself if I like, which I do. He tells me “full” recovery will take 4-6 months. Longer than his original estimate. I start walking without any support (cane/crutches) all the time. I crank the CPM machine to 80-degrees of motion.
• Two weeks after surgery – Still discouragingly stiff and swollen. Doing loads of basic leg lifts and such and spending >2hrs/day in the CPM machine.  I’m getting around better and can even climb (not descend) stairs a little. Interesting how the basic act of releasing my leg in the backswing of a stride is stiff and painful. I can walk, but with a stiff leg. Sleeping remains difficult since I toss and turn, waking up each time.
• Three weeks after surgery – Remains stiff and swollen. The swelling is certainly less severe than right after surgery, although it’s hard to tell if it’s better than a week ago. Spending >2hrs/day in the CPM machine and another hour/day “exercising” and icing. Also, added a 20 minute session/day on the elliptical – almost no resistance. Like last week, releasing my leg on the backswing of my stride is stiff and painful. Getting little sleep because every toss and turn wakes me up with some pain.
• Four weeks after surgery – I could feel enough improvement that I abused it. I ended up standing and walking a lot this week. At times, I could walk with almost no limp, but ended up paying for that in the last couple of days. No real pain, just a bit stiff on the backswing of the leg, I can go up small flights of stairs with almost no pain, but can only go down stairs one at a time – always leading with my bad leg. Still using the CPM machine, now at 100-degrees and I’ve turned up the resistance on the elliptical, although not the time. Sleeping is no longer a huge problem, although I still end up waking up because I bump or twist something during the night.
• Five weeks after surgery – I still have a lump on the outside of my knee that is completely numb to the touch, but doesn’t disturb me otherwise. I think this is swelling around where the muscle holding the patella was cut. That’s also where I feel the tightness in the backswing of my leg, which continues. Once I get loose, I can walk without much of a limp. Climbing stairs has gotten a bot easier and I can even gingerly descend stairs with both legs. I’ve increased both my time and resistance on the elliptical and have even gone for a couple of mile walk. The knee makes a lot of crunchy noises, though, which is freaking me out a bit.
• Nine weeks after surgery – Fast forward . . . another appointment with the surgeon, only my second one since the surgery. He’s pretty casual. I called a couple of weeks ago because of the crunching sounds coming from my knee when I bent it. He said, “nothing to worry about.” That didn’t help. They did, however, mostly go away over the following weeks. I still have the tightness where the band was cut, although it’s not as bad. I stopped using the CPM machine at the 6-week mark, per doctor’s orders. I don’t think it was doing too much for me anyway. Going up many stairs brings about a little pain. If I hadn’t had surgery, it might not even register too much. Going downstairs is quite a bit different, although I can do it much better and with less pain than just a couple of weeks ago. At this visit to the doctor, he told me to start physical therapy, which I will this week. He told me it will be another four weeks until I should even sit on a bike. I’ve upped both time and resistance on the elliptical and am on it five times per week. I’ve also restarted weight training – upper body only, of course. Things are getting better, although much more slowly than forecasted by me or the surgeon. My biggest concern is that there is no indication yet that the surgery actually fixed the original problem. There are other pains and stiffness that mask the pain from the injury.
• Sixteen weeks after surgery – well, I’ve officially blown off the cycling season, there’s no way I can ride a bike . . . at all. Things are better, I guess, but they’re not very good. Stairs remain a problem, especially down. I’ve been doing physical therapy now for almost 6 full weeks. I’m stronger, for sure, but not in much less pain. The pain is different most of the time and I still feel a lot of numbness on the outside of my knee – the other side from the injury. I have to think it’s surgically related. Probably from the band that was cut holding down the patella. Stretching like a maniac helps, but disappointingly little. I can’t squat down and if I do work my way to the floor, I can’t get up. While supporting my weight, even half of it, I can’t bend my knee more than about 50-degrees. Without weight, I can bend it all the way. Very discouraging.