History before ACL Revision with meniscus repair
I'm going to give a not-so-brief history of my knee injuries leading to
15 years ago (when I was 15 ~1995) , my leg was kicked from beneath me while playing soccer in high school--I couldn't walk, my knee was swollen and ultimately, I was diagnosed with the dreaded ACL tear. Over the next year, I underwent the following interventions: arthroscopic debridement -> PT -> ACL reconstruction (ipsi patellar graft)-> PT (In summary knee surgery x 2; PT x 2).
I graduated from high school with the nickname gimp but entered college with a seemingly high functioning knee. Between then (1998-2010), I maintained a very active lifestyle including triathlons, marathons, skiing, and backcountry hiking. While active, I definitely exposed myself to the occasional trip and fall. My knee only really swelled up once after such an injury. However, I did have some longstanding chronic lateral knee pain that goes back as far as I could remember. I took my fair share of naproxen for this pain that worsened with activity.
In 2010 (and as a third year medical student), I went skiing and after a relatively benign fall (essentially sitting down on the slope), I felt kind of weird in the knee and went home to start my surgery clerkship in medical school. One to two weeks into my surgery clerkship (after my fall), I started to notice that my knee would lock up on me as I was running after the surgical residents with whom I was working. It was incredibly painful beyond the typical pain that medical students experience when working with brusque surgery residents.
I was fairly certain that the relatively benign fall I had when skiing was the culprit and that my symptoms were most consistent with a torn meniscus. I made an appointment to see one of the orthopedic surgeons at the hospital where I trained (top 20 research medical center). My MRI was technically negative for a medial meniscus tear (per radiology read) but I took it upon myself to look up my imaging in our medical records system and there was some fuzziness in the joint space that could suggest a meniscus tear. My orthopedic surgeon agreed with me that the MRI was suspicious especially when correlating it with my symptoms. We proceeded with a diagnostic/therapeutic arthroscopic procedure which demonstrated a teeny-tiny flap tear of my medial meniscus (causing the locking) as well as a large longitudinal tear in my lateral meniscus correlating with my chronic lateral pain.
The concern of my orthopedic surgeon was that she had been seeing an increasing number of patients who had ACL reconstructions during the time frame when I had mine (late 1990s to early 2000s) who were partially ACL deficient (evidenced by recurrent meniscus tears from benign injury). This was essentially due to the fact that the standard technique at the time was to place the ACL as a more vertically oriented anterior-posterior graft rather than a ligament that crosses the joint from anterior-medial to posterior-lateral as the native Anterior Cruciate Ligament does.
During the procedure, while I was under anesthesia, my orthopedic surgeon performed a pivot shift test on my knee and did find that the ACL was not effectively stabilizing the knee. At the time, she performed partial meniscectomy on the flap tear.
Our post-operative discussions became centered around the need for ACL revision given the fact that I had already torn my meniscus twice with the current ACL graft (SIGH....). This would result in a total of 4 operations on my knee before I turned 30 years old.
Given my access to most major medical journals and an obsessive physician-scientist personality, I heavily researched the subject to realize that continuing as an active but ACL deficient adult, would predispose me to arthritis at an even earlier age than I was already predisposed to given the number of times my joint had been accessed surgically up to that point. After 3 months of rehab and 3 more months of completing the more physically demanding clerkships for the fourth year of medical school, I went under the knife for the fourth time for an ACL revision with lateral meniscus repair. I will review my surgical experience in my next blog post.
Summary of this post:
--ACL reconstruction in 1997 as teenager
--Relatively active in subsequent 10 years with occasional falls on left knee
--Chronic lateral knee pain and new onset joint locking 12 years after initial ACL reconstruction
--2 meniscus tears (medial flap and lateral longitudinal) due to incorrect placement of ACL graft that was standard surgical technique at the time.
--ACL revision 13 years after ACL reconstruction
Saturday, February 19, 2011 - 9:02pm