My road to recovery after a DeNovo NT cartilage graft and tibial tubercle osteotomy took a hard right turn last week. A hard right turn in the wrong direction.
I have no explanation for what happened–no specific accident, incident or episode to speak of. I had no mishap, misadventure or misfortune. No calamity, catastrophe or collision. In other words, I have no clue why my knee suddenly began to hurt so badly I could hardly walk without cursing.
Last Tuesday was the first that I noticed things weren’t “normal.” I woke up in pain, and that never happens. Mornings are when my knee feels best because I’ve had it up all night, and I usually ice right before I go to bed. Tuesday was training day at work, so I sat for quite a bit, and every time I’d get up, I noticed that my knee was really stiff. That night, I held off doing a full set of PT exercises to give my leg a rest. But Wednesday morning, I woke up in pain for the second time. I did even fewer exercises Wednesday, but I woke up in pain on Thursday, and I knew something was wrong. Things were getting worse with less exercise. Friday morning, I called PT. He said to stop my exercises, elevate as much as possible and ice, ice, ice. I was kind of irritated by his response–what did he think I’d been doing all week?! I don’t think he appreciated just how badly my knee had to hurt for me to call him between appointments. But, for lack of better ideas, I followed his instruction.
The weekend was an awful three days. I was completely frustrated that I couldn’t do anything. We had another beautiful Saturday, and I was irate that I couldn’t go for a bike ride. Monday morning came, and I decided enough was enough; I called the surgeon and asked to be seen that day (I had an appointment scheduled in one week, but I couldn’t bear to wait that long). Thankfully, they fit me in.
My surgeon asked what was going on, I explained; he asked how long it had been since surgery, and I said, “Eighteen weeks tomorrow.”
“There’s definitely something wrong.”
He asked me to lay down on the table so that he could do an exam of my knee–he turned it every which way, poking and prodding every inch. Then he had me sit on the edge of the table and extend my leg. I couldn’t do it. He indicated that I should use my left foot (attached to my good leg) to assist in the extension. I was able to fully extend with the assist. My surgeon then turned his back to me so that he could look at my scans on the computer screen. “What am I going to do with you?”
Excuse me? That’s not exactly confidence inspiring. I need to believe you know what you’re doing and you know how to fix me.
My surgeon told me there are a few different things that might be going on in my knee.
- The graft may have delaminated. This would mean, basically, the graft didn’t work and peeled off the bone. Luckily, my surgeon does not think this is the case.
- The graft may not have fully filled the entire defect on my patella. This would cause a rough spot on my patella that catches during range of motion (ROM). If this is the case, I still have hope because the defect might continue to fill.
- The graft may have caused too robust of a response. This would mean that the tissue graft overgrew the defect site and caused a lump that could catch during ROM. I think it’s this one. I’m a chronic overachiever, so it makes sense that I’d unknowingly be too awesome at recovery. Plus, they can fix this one, too.
So with those thoughts laid out, my surgeon went on to tell me that he doesn’t think an MRI would show us anything at this point (research indicates that he’s right) and the only way to tell for sure what’s going on is to go back in with a scope and check it out. Hells no. We both agreed that’s not what I need right now. So, he said to continue physical therapy for 6 more weeks and then come back to see him. More on that later.
As I was leaving the appointment, I said, “You know, I knew going into this that I had a long road ahead of me. I was prepared to do the work. But I thought that by four months, I’d at least be walking pain-free.”
“I thought you’d be walking pain-free by now, too, but unfortunately, you’re not following the textbook on this one. But then you don’t follow the textbook on a lot of things.”
He’s not the first person to tell me I don’t follow the book, not even the first doctor. But that’s not what I want to hear when I’m in pain and desperate to know what’s causing it and how to fix it. I was dangerously close to making a scene, and I just wanted to shout, “Write a new freaking textbook!” But I didn’t. I saved that for the next PT session.