Update on knee

I met with the doctor Monday to go over MRI results, and would you believe I made it through the appointment without crying!?!  Tears stayed at bay probably because there was some good news mixed in among the not-so-great news.  Here's what the doc didn't say:  "Your knee is beyond all hope and you'll never use it again!"  So, a little "yay!" right?  :)

So you know already that the Xrays from Friday showed that there is a piece of bone that had broken off from somewhere, likely many many years ago, in my knee. (A good guess would be 2004 when I began having significant knee pain and the regular "flare ups" began.)  

Well, the MRI shows that this piece of bone came from the top of the calf bone.  And it's been lodged in the space between where the top of the calf bone meets the bottom of the knee socket.  And that piece of bone has nearly worn away all of the cartilage in that space.  And because there's little or no cartilage in much of that knee joint, the top of the calf bone is jagged and rough.  And that surface area rubbing up against the smooth bottom of my knee cap has caused the arthritis he referenced.  

So, what to do from here...  Piece of bone must come out.  And the best shot at fixing the rough joint area where knee bone is rubbing up against calf bone without cartilage to cushion it (a few spaces in there have a narrow lining of cartilage, but most of the joint area is without any cartilage) is a surgery called "micro fracture."  In terms that I understand, here's the jist of the surgery.  Holes would be drilled into the rough area at the top of the calf bone.  (Holes drilled in bone, how pleasant...) The bone would bleed, and the blood would fill those holes.  That blod would clot and harden, and serve as the new "cartilage-like" material that would provide some cushioning between the bones.  It's orthroscopic surgery and I would be put under during.  :(

Recovery from the surgery would entail 6 weeks of being on crutches with absolutely NO weight bearing on the knee.  I could drive, however, which is huge, right?  Physical therapy would be super important because, although I would not be able to bear weight, range of motion would help shape the joint as it repairs itself.  Think about how when you extend your knee in and out, that motion would help smooth and form the new cartilage as it forms.  If my knee were braced in a cast, never extending or moving, then the clot would actually form something like a "hill" doc said.  And then, you can imagine moving the joint after that wouldn't work so well :)

Of course I asked the doctor what he'd expect to happen if I didn't choose to have the microfracture surgery to repair the joint?  He said that he'd anticipate in another six months, I'd reach a new level of pain, and that being 32 right now, it's such a young age to have arthritis and that it would only worsen from here on out.  That rough part of bone at the top of the calf will only roughen the smooth area of the knee joint.  "Rough will always make smooth, rough.  Smooth never makes rough, smooth," he said.  Makes sense...

I asked about the arthritis and would surgery stop that.  He said it would and that the arthritis would theoritically cease.  That's good.

Another piece of good news was that after I did the physical therapy for 6 weeks/remained on crutches, I could expect to slowly begin to build up my strength again.  And because, after having surgery, I wouldn't be exercising and teaching all these classes with a piece of bone in my knee, I should enjoy being active a helluva lot more.  

The doctor did say that the solution to my knee issue would be a lot more of a "sure thing" if this rough joint was the bottom of the thigh bone and top of the knee instead of the top of the calf bone and bottom of knee.  If that were the case a bone or cartilage graft could be done, which is generally very successful.  Doc said that cartilage grafting at the top of the calf bone just isn't that reliable, it's a tougher area to do surgery at, and that I'm just not a good candidate for that.  So, that was a bit of bad news.  Too bad this isn't happening just a few inches higher in my leg.  :(

I'm going to another doctor on Friday morning to find out how a second opinion compares to what I've learned so far.  

Several of you have reached out in concern to see how I'm doing.  Thanks so much for your support and concern!  I have some amazingly fantastic friends and family!  Will keep you posted...