Doctor becomes Patient: Part 1

It started as a usual Friday morning. It was May 27, 2011. I got to the gym at 6:15 a.m., warmed up as the other guys came in.  Morning basketball…I love basketball. Not because I’m great at it, but it’s something that agrees with me.  It makes exercise fun.  Especially when you play with a group of guys who share a similar passion, who all feel, as you do, that starting the work day with two hours of pick-up basketball is a great time.

I think it was the second game -- it had just begun -- when going up for a rebound there was a collision and as I came down, my trapped leg twisted underneath me. The combined weight of myself and the other player came crashing down on the lateral side of my right knee.  I felt a pop, but it was more than that; it felt as if the sensation was one of grinding, and it seemed to resonate through my bones, up my spine and into my brain which was wide awake by then.

If I could have done it all over again, maybe I should have let the opponent have the ball, was probably the first thought that crossed my mind (although that isn’t realistic, I am too competitive).  The second was that I think I dislocated my knee. Third thought was that the ACL was definitely torn, who knows what else.

Sometimes things happen and we want to look for someone to blame.  Was it the person who collided with me?  Was it my own fault?  The floor, etc? In a case like this, the reality is there is no one to blame. Unexpected things happen and often times that’s just what it is.

The guys helped me to a bench, I tested my own knee and sure enough there was dramatic laxity in anterior drawer testing.  We iced it, slipped a neoprene brace over it and I drove myself to the office where I wrote myself a script for an MRI of the Right knee without contrast.  I went to the local MRI facility.  MRIs are very loud machines. Even with the earplugs in place, the repeated blasts of noise were impressive.

An couple hours later I got the  call from the radiologist. His first words: “Doesn’t look good”.  He confirmed my clinical judgment; I knew it was a severe injury.  Full thickness tear of the ACL, essentially full thickness MCL tear, meniscal body tear, impaction fracture of the tibial plateau, extensive bony contusion tibial plateau, partial tear soleus muscle origin. I thought I was even prepared for the news.  But it was hard to describe it.  A feeling of regret, perhaps, knowing my best basketball days may be behind me.

A few days later, I went to my first consultation with an orthopedic surgeon.  I think I've been pretty lucky in my life, never having had to see a surgeon prior to this event.

"You say you did this playing basketball?  In all my career I have never seen such a severe basketball knee injury. "

Shortly after his medical assistant came in, prepped the tray and the surgeon came back to anesthetize the skin over the superolateral corner of my right knee.  Then with a pink tray nearby, he proceeded to aspirate about six to seven syringes of blood out of the knee.  Those tiny globules of fat floating on top of the blood signified that there was indeed impaction fractures in the knee.  Then came the bad news: "Your injury is too severe to treat with a traditional surgery.  I recommend you go to U Penn or Temple to have it done."

I'll take a step back and go over some background information on anatomy of the knee:

Anterior Cruciate Ligament

Let's break it down into its parts.

• Ligament: A ligament is a strong fibrous, dense connective tissue that connects a bone to another bone across a joint.  A ligament can be stretched, partially torn or fully torn.  An example of this would be a typical sprained ankle, where the ligaments on the outer portion of the ankle are stretched or torn after inversion injury.  Four main ligaments in the knee include ACL, MCL, PCL, LCL.
• Cruciate: Inside the knee joint are two major ligaments that keep the knee stable.  One is the anterior cruciate ligament.  The other is the posterior cruciate ligament.  These two ligaments cross over each other, which is where the term cruciate comes from.
• Anterior:  The ACL prevents the tibia from sliding forward/anteriorly on the femur.  It is also involved in stabilizing rotational motion.

Absence of an ACL may not be necessarily noticed with walking or even running in a straight line. However cutting or pivoting motions would be problematic, and repeated maneuvers where the pivoting motion causes buckling of the knee will likely lead to early osteoarthritis of the joint.

Medial Collateral Ligament

The MCL is a ligament that is located on the medial (inner) aspect of the knee, and has a superficial band and a deep band.  A tear of the MCL often occurs with an impact from the outer aspect of the knee, such as a collision coming from the lateral (outer) side of the knee.

I was faced with a decision, do I have both ACL and MCL operated upon?  Or should I leave the MCL and only have the ACL reconstructed? 

Stay tuned for my next blog post to find out what happened!