5 Year Update on the Knee

Five years! In many ways it is hard to believe that it has been just over 5 years ago that life began to change. It has been just over two years from my last knee surgery. I am so thankful that my knee doesn't look like this any more.

After gaining some weight and being tired of sitting around,  I decided it was time to see what the knee could handle and I signed up to join Orange Theory Fitness. Orange Theory is a high interval training class/routine that pushes you through the paces by filling an hour workout with cardio, rowing, body weight and dumbbell exercises. Now being actively going to OTF for the past year, I have to say that I love it.

The year at OTF has helped me regain balance, muscle tone in my left leg, and helped me get back into shape. It hasn't all been easy. I still have to modify certain exercises knowing that lateral movements, jumping, and running make my knee angry; but I think I have improved my vertical leap from 2 inches to about 4 inches. However, with the aid of the trainers and paying attention to what my body is saying, I get through a rigorous workout 4 and 5 times a week. And in many of those workouts I am now able to perform squats and lunges. Who knew???

Where am I at now? Overall, I feel pretty good. I still deal with some pain from time to time. My knee clicks every time I walk across the room. Which is both physically and audibly annoying, but nothing that concerns me too much at the moment. When straightening the knee from a bent position there is still a fair amount of grinding taking place. The good news is the knee isn't swelling and when there is pain, it is manageable. The goal is to get down the road another two years before we consider doing a total knee replacement. I think...that is doable. But one thing I have learned is that when it comes to knee stuff it can turn in an instant.

Melissa and I really appreciate the support from friends and family we have received over the years. I plan to continue to workout regularly and I am even thinking of doing one more bike race in February of 2018, for old times sake. The goal being to go have a good time and not to compete for the podium. Let's see if the leg will continue to cooperate.

I will continue to update the blog when there is something interesting to write about. Thanks again.

Bringing in the New Year

Well...it happened- another surgery.  Right before the parties got started to usher in the new year, I was hanging out with the medical staff that was getting my leg prepped for another surgery.  Here is the run down of how we got there and what happened.

After the latest diagnosis of having SONK and then finally hearing some positive signs that the SONK was showing signs of reversing, my wife and I decided we needed a break.  So we decided to play the "ignorance is bliss" card for while and just live life the best that we could and not worry about the knee until something happened that caused us to have the necessary conversation.  In plain English, we stopped going to the doctor for a while.

And honestly, that provided a little over a year of fun and manageable activity.  However, this past fall things began to change again.  I flew to India for two weeks and after arriving home, I wanted to spend sometime helping my 4 year old learn to ride her bike.  It only took about two minutes of walking behind her bike holding the seat for my knee to get really angry.  It actually took me out of commission for a couple of days on top of making me very grumpy.  That is when we decided it was time to see the doc again.

During the appointment and routine evaluation it was confirmed that most of my current knee issues are probably a result of my knee cap.  Therefore, it was suggested to perform a chondroplasty to go in and clean up the knee and to see if the knee cap could be helped out at all.  Following the suggestion of our surgeon, we decided to move forward and to schedule surgery for December 31.

What we found is that the ACI surgery took fairly well.  There seemed to be a good amount of new cartilage that had regenerated and still looked healthy.  However, the knee cap was "trashed."  My doctor did his best to clean it up and tried to get it tracking a little better, but honestly time will tell if it is working.  It was mentioned that I might need an artificial knee cap if this surgery doesn't do the trick.  So I have some educating to do when it come to artificial patellas.

As of right now - I am still in recovery mode.  I am walking without assistance but not winning any races. There is still some swelling on the joint along with bruising.  Because of the swelling, it really is too early to tell the final outcome of the surgery.  As the swelling goes down I am hopeful that this will be the last surgery for the near future.  I know there are more surgeries in the future but hopefully further down the road.

I will continue to update the blog with the latest happenings and progress coming out of the this latest procedure.  I appreciate everyone's support and pray for those that are going through similar challenges.

Two Year Update

Hard to believe it, but it has been two years since surgery.  In some ways the recovery process, the long days laying in bed, and even the intensity of the pain seem like distant memories.  The process coming out of ACI surgery is an ultra-marathon...not a sprint.

I am sure you might be wondering what the latest news is concerning the knee...so here are some observations followed by what life is looking like today:

• My quad strength is still limited.  I really don't think the quad will fully come back.  I have gone through several sessions of dry needling to help with pain management and to get the muscles firing correctly.  The goal is that this will help the muscle to continue to heal and strengthen. More on the dry needling in a moment.
• I still have a lot of grinding in the knee.  Every step I take you can actually hear the knee snap, crackle, and pop.  Though I have an orchestra living in my knee, the grinding doesn't seem to be causing any pain.  It just serves as a constant reminder that more surgeries are coming.
• Standing for a long time gets tiring and painful. My knee still doesn't like the times I have to be on my feet for an extended amount of time.  It does help me get out of shopping, so I guess there is a bonus to it.
• Still no running or jumping in my routine.  The best I can do is a slow awkward trot around the yard when playing with my kids.  You know its bad when your three year old daughter can outrun you.  
• The osteonecrosis seems to be a thing of the past.  At least that is how it is feeling.  I haven't had another MRI since the last one in May.  I am playing the "ignorance is bless" card when it comes to the knee and MRI scheduling.
• I continue to ride the road bike a few times a week.  It has helped level out my weight and at least gives me a little relief from the demands of the day.  However, riding on the road has gotten boring.  I finally decided to buy a mountain bike a few weeks ago to vary it up.  My wife and I came to an agreement that I would ride once a week and that it would be a bike with gears. Mountain biking does bring some discomfort to the knee but the rolling over boulders has a way of easing that discomfort.  I know this time is limited, so I wanted to do some riding in the mountains while I still have a little ability to do so.  I don't ride like I used to but at least I am out there doing something.

So...that is where I am at two years after ACI surgery.  I love hearing your feedback and questions and please let me know if there is a certain topic you would like me to cover.  Any suggestions are welcome.

Positive News

Finally...got some better news this week.  After the last MRI, I had the chance to sit down with my doctor on Thursday.  Immediately, he walked in and proclaimed, "I have good news."

The good news we heard is that the bone is now showing signs of vascularization...in other words, blood was beginning to flow back into the areas affected by the osteonecrosis.  This is what we wanted to hear.

What does that mean?  First, I no longer have to walk with a cane.  Secondly, the overall process of healing will take around 6 months.  Thus, we will have another MRI in 6 months to confirm the bone has healed completely.  Until then, I have to continue to use my unloader brace for the next 6 months, but only when I know I am going to be on my feet for an extended amount of time.  The great thing is I can begin introducing some activity back into my life.  I was encouraged to walk around the block and to ride my bike.  YEP, I can ride my bike again but I did have some specific guard rails...no hill climbing and no racing.

I am looking forward to spending time on the bike again.

I am still dealing with some pain in the knee.  I am hoping that some of this is still a symptom of the osteonecrosis and the fact that my muscles and tendons are overloaded.  I started to do some basic physical therapy to help rebuild the muscles and even ordered some orthotics to help with my overall alignement.  Can't wait to see where things go.

I will continue to report any new progress and tell you how the therapy and the orthotics do for my overall progress.

I am Evolving

Just a few days ago I had my follow-up appointment with my doctor.  I wish I had more to say at this point.  The exact wording on the MRI results were that my SONK lesion is "evolving."  Evolving???  What does that mean?

All of a sudden all the jokes of me being the missing link are beginning to make more sense.

Basically, my understanding is that the SONK is changing.  It hasn't gotten progressively worse which is a good thing.  However, before we start dancing through the streets naked...it is still there and by no means hasn't disappeared.  Where do we go from here?  Actually nowhere...yet.  Doc said that he wants me to keep living life as we have for the past 30 days for another six weeks.  At that point he wants to do another MRI to re-evaluate the knee.  I think after the next MRI I will officially be glowing.

Waiting seems to be the word of the moment.  If I am honest, my patience is beginning to wear thin.  I am tired of sitting around, walking with a cane, and living in constant pain.  We are now approaching the two year mark from when things went really bad with the knee.  My wife and I are ready for answers and that seems to be our constant prayer right now.  My doctor really acts like we need to outlast the SONK- so he can move forward with the osteochondral allograft procedure (Bone and Cartilage Transplant).  Which I am not super excited about doing.  I feel like we have looked at and tried the conservative approach and now we are ready to try some "not so conservative" approaches when it comes to the knee...which would be something artificial.

I guess we will know more in 6 weeks.  At least that is what we are hoping for!

MRI #2

Yesterday, I finally made it in to have my second 3T-MRI of the year.  I just wanted to update any progress in moving forward and this is one simple, and yet, big step forward.  My follow-up appointment with the doctor will be in one week.  At that point, I hope to have lots to share.

SONK

Today, I learned a new term related to the knee - SONK.  Before I get to what SONK is and how it relates to me, let me briefly update what has taken place the last few weeks.

Over the past few weeks following the initial MRI results I have visited or have been in touch with five different orthopedic doctors concerning my case.  Which led me to my sixth doctor that I visited yesterday.  Why so many?  It has been hard to get both a solid perspective of what the next step should be and to find someone that seemed ready to dive into my case (or had the expertise to dive in).

The first words that doc #6 had to say when he walked in the room was, "Lee, you have one challenging knee."  After stating what I took as obvious...lol...he began to ask questions about the last year, we talked through the last few surgical reports, and then he did some pushing and moving of the knee.  Coming out of that appointment we decided to schedule a scope of the knee to get eyes on what is really going on inside...with two possible plans of action based on what we found: 1) Osteochondral allograft or 2) Artificial fix.

Melissa and I left feeling like we had a plan of action that both of us were very comfortable in exploring.  Then the phone rang.  Dr. #6 was on the other end of the phone.  He began to explain that he decided to dive into my MRI a little more and so he called his favorite radiologist to give an opinion on my films and together they came to a conclusion that I might have a SONK lesion.  You can click on the link below to read into the detail of what a SONK lesion is.

SONK Lesion or (Spontaneous Osteonecrosis of the Knee)

What does this mean and where do we go from here?  Basically our plan of action at this point is that my doc told me to put the unloader brace back on, walk with a cane, and to take it easy.  There is a small chance that the damage to the knee (what seems to be a SONK lesion) could reverse itself if given to rest (if it is small).  However, to do a scope of my knee could cause my SONK lesion to get worse if indeed that is what it is.

From here the plan is to rest the knee for a month, at that time we will do another 3T-MRI of my knee and compare the images to my January MRI.  If the area they are concerned about doesn't change or worsens...it is a SONK lesion.  We haven't talked in detail at this point what we will do if indeed this turns out to be a SONK lesion...but from my research the only options seem to be a unicompartmental knee replacement or a TKR.

It is hard to explain the emotions of the current journey.  I feel more numb to it all at this point...probably because I feel I have moved into survival mode or I am just tired of facing the emotions of the problem.  At least, at this point, it looks like we will have more answers in a month.  In the meantime, I am rocking my new Walgreens cane.