Knee Surgery 2015: Injury, Pre-Surgery Decisions, Prep

  • Updated: October 28, 2015
  • Post By: Matthew Hengst

This is the first in a series of entries I'm planning to write about my experience (hopefully) recovering from a knee injury I sustained back in 2011.  Since I'm going to be recovering from surgery any new trip reports will just be from the backlog I haven't had time to finish (of which there are unfortunately a large number)

The Injury and Years of Pain (Basically This....)

Yes, I'm inside that bag

The fall that caused my injury can be read about here.  The short version is that I took a significant fall while scrambling back down into 9 Lake Basin after climbing Triple Divide Peak and injured my knee and ribs.

The fall happened on August 25th, 2011 a few hours before sunset.  I was there alone for 3 hours as Jen Blackie went running for help and it was a total of 15 hours before a helicopter arrived to pick me up on the 26th. I was airlifted to Ash Meadows and brought via ambulance to the Kaweah Delta Hospital where I received somewhat unsatisfactory care before being discharged and spending the night in a Marriott.  The following day the rest of my party came out and drove me home to Orange County.

On September 16th I was back in the mountains backpacking Starr King with much assistance and not insignificant pain.  The following weekend I was in a kayak exploring sea caves off Anacapa.  Before either of these I'd had to resume my weekly flights to a client site in Boise Idaho where I parked on the 3rd floor and worked in the basement.

Initially the ribs were the major source of pain.  I could hardly get out of bed in the morning and had to be rather careful how I moved.  That slowly improved and as it did I became more and more aware of just how bad my knee was.

I realized I could feel a grinding in my knee when flexing it and it sometimes felt like something was squishing in and out of the joint.  I could occasionally locate the object and move it around with my finger which was an...interesting sensation.

The doctors I saw at the time weren't overly concerned attributing most of the symptoms to just inflammation.  The object they said was probably a cyst or some piece of bone or cartilage floating around the knee and that any attempts to remove it would do more harm than good as long as it wasn't interfering with the motion of the joint.

I took some inflammation medication, did some PT, and tried to keep on getting out.

Which I did.  I absolutely love being outdoors and I'm a firm believer in strategically maneuvering the rest of my life to accomplish that.  The summer of 2013 I had a work situation which allowed me to run amok and I spent 17 weekends in the Sierra including an 8 day fastpack of the JMT while spending most weeks in Boise working.

The grinding was always there if I paid attention.  The knee was sometimes swollen but usually just hurt pretty much every step.  Low angles I could manage with minimal pain most of the time but when the trails got steep or it was time to scramble over a boulder I was usually doing it with a grimace and a muttered curse.  Several trips including the aforementioned JMT trip were almost canceled due to concerns over my knee.  And pretty much all of the enjoyment I had from the pure exercise component of climbing was gone.

But I was climbing and that was all that mattered.  If I had to back off rock climbing that gave me an opportunity to hike, backpack, and peak bag more.  And time passed

Finally Fed Up

This continued for several years with multiple ups and downs.  Then in 2014 it got bad enough that I was struggling to walk around in Jtree while I was there for AMGA training.  Rock climbing was extremely limited for me and now I was starting to drop out of hikes and struggling with certain types of moves when scrambling up summit blocks.

On the advice of a friend I went in to Orthopaedic Specialty Institute and saw Dr Fischer and was then referred to Dr Grumet.  For the first time it felt like someone was actually taking the time to really look into my injury and symptoms.

One MRI later I found out I had an impact scar on the back of my kneecap.  So the grinding I was feeling was bone on bone where there was no longer any cartilage.  (It feels about as unpleasant as it sounds.)

I was given the option of surgery but recommended to at least try a synvisc injection first since it was minimally invasive.

I can't tell to this day if the synvisc did anything.  It happened at the same time I finally got an accurate diagnosis and felt like I had a handle on what was going on with my knee.  It's possible the injections helped somewhat and it's also possible just knowing what was going on and that I had options led to me feeling better.  So I went from contemplating surgery to limping along with manageable pain.

Back To The Doctor, 2015

Flash forward to summer 2015.  After struggling through the usual amount of knee pain during trips there was a sudden change following a WTC centric backpack to Cirque.  I didn't have any issues (beyond the usual pain) during the trip but when getting ready for the next one after two weeks of sitting around in town my knee started swelling up.

Initially I was half convinced it was an infection and in desperation not wanting to cancel one of my trips I went to a GP Urgent Care.  This was a mistake.

The doctor didn't even want to examine me knee, told me flat out I wouldn't be backpacking in 10 years, gave me medication for inflammation, and sent me off for x-rays basically saying my major need was to go on a diet   and find a new hobby.

I got the x-rays, never got a promised response from the Urgent Care, never was able to get a copy of the x-rays from the imaging office, and got overbilled for the whole mess to cap it all off.

I ended up dropping out of that trip and the remaining 2 summer trips.  I made an appointment back with Orthopedic Specialty Institute and was sent for another MRI.

The MRI 

This time the MRI was with fluid since my knee wasn't swollen enough that particular day to get a good picture.

So before the usual 30 minute session with my leg in a loud banging machine I was swabbed clean and injected with what feels like an awful lot of fluid.

It's sooooo squishy!
It wasn't exactly pleasant but knee swelling never is.  It always just feels like something is very wrong and something might give our on you at any moment.  Worse I seemed to have a low grade reaction to dye and spent the rest of the day and following night feeling all around awful and in a different sort of pain.

The follow up appointment with Grumet showed improvement in the bone behind the impact site.  That meant I was a better candidate for microfracture than I had been a year ago.  In addition he was able to point out several pieces of cartilage that had migrated around the back of my knee (which is rather disturbing somehow.)

It appeared the cartilage at the edge of the impact site was still ragged and the best theory for my current woes was a flap of cartilage causing inflammation.

At that point Grumet explained I could wait it out and hope, try another synvisc injection, or go the surgical route.  As far as surgery his recommendation was for a debridement and if possible a microfracture.  That would involve drilling holes in the back of the kneecap which causes some additional cartilage to be formed.  The downside is I'd be looking at a 6 month recovery if that happened.  There were other options (ACI, OATS) but they all had significantly longer recovery time.

I talked it over with Jen and Kristen and opted for the surgical option.  6 months would cause me to miss some activities during the 2016 WTC class but I'd hopefully be back in time for snow camp.  And the hope was this would finally put an end to the constant pain that had been holding me back for the last few years.

Next Steps 

On November 5th I'll be going in for what is hopefully a microfracture procedure on my right knee with a possible debridement.   Unfortunately as I mentioned above they won't know if the microfracture is possible until they're in there so there's the possibility I may be looking at a less effective surgery with only 6 weeks of downtime instead of 6 months.  Currently that's my biggest fear  because I'm just sick and tired of the pain.

I plan to do periodic updates during the recovery period since reading ones others have done (this being the best I found) has been a huge help getting prepared.

My updates can be found via the tag here.

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