Surgery or No?
Two and a half months ago I injured my knee playing soccer. It was a non-contact injury. My left knee caught in the turf, buckled and popped. I went down and then limped off the field. I though it was the medial collateral ligament (MCL) and that it would take some time to heal without surgery. So, I set about trying to reduce the inflammation.
To help with the inflammation, I began icing it 20 minutes at a time, 2-3 times per day. I used several ice packs wrapped around my knee and held tight by straps. In addition, I was going into my hyperbaric chamber several times a week, doing cryotherapy at US Cryotherapy here in Roseville, getting it adjusted and doing cold laser treatments. After two months, the swelling was still really bad and the flexibility had only increased a little.
As far as pain is concerned, I haven’t had that much. When it first happened it hurt but I could still limp off the field, drive myself home, limp into the drug store and buy a brace. The lack of pain concerned me a bit because I have been taught that a complete tear of the anterior cruciate ligament (ACL) is not as painful. I tend to have a pretty high pain threshold so I just figured that was the reason. It would get achy and tender, in general, and certain motions would give me a sharp pain but everything was bearable. I wore a brace while working for a few weeks then switched to kinesio tape. After a while both of those things were really irritating me and I went without either without much trouble. Through it all I maintained a pretty rigorous schedule adjusting around 300 patients per week.
A few weeks ago I finally decided that there was something more serious going on and I decided to get an MRI. The results caught me like an upper cut. According to the report, I have a completely torn ACL and tears in both menisci. The tears in the menisci are likely to heal on their own. They are in what is known as the “red zone” which means it has a good blood supply and should heal. Plus they are vertical tears which don’t usually cause much trouble. The torn ACL is another matter.
So, here is my dilemma. I am a researcher by nature. I want to know options. I am not opposed to doing what is conventional but I still want to hear the arguments on both sides. So far, here is what I know. By far, the overwhelming recommendation is surgery. This entails using a piece of the patient’s tendon from a number of sources or using a cadaver tendon. The recovery mostly requires time. No one who has had the surgery that I have talked to feels like they can perform at the same level as before but plenty have said that they can still do a lot of things they love.
On the flip side, there are a lot of people out there who, for one reason or another never reconstructed their ACL. My best friend, who is an ER medical doctor, is one of them. I have read studies where the outcomes for doing surgery vs. not doing surgery are pretty similar save for a moderately increased risk of doing damage to the menisci. I can make a really strong case for not doing surgery just on the fact that anytime you have surgery you are introducing another traumatic event. Combine that with the general risks of going under anesthesia, the risks of infections, and complications with recovery and I am pretty convinced that I could live without and ACL. I have been walking around for several weeks without an ACL, anyway. I am not going back to playing soccer any time soon with or without surgery. And, I have really good muscle strength around my knee. The argument is valid.
That saying, I am scheduled for surgery on the 7th of June. The argument to have it reconstructed won out despite my firm belief that I could definitely live without my ACL. My surgeon, Dr. Kevin Hanson of Roseville Orthopedics handled it perfectly. When I spoke with him he gave me options but made it known that in his opinion I would be much happier in the long run with a more stable knee. He also said something that changed my whole attitude. Before I spoke to him, I was assuming weeks to months off of work. Not only would that have really hurt financially but I think I would go crazy. I am not one who is accustomed to sitting around. Dr. Hanson informed me that I could bear weight whenever I felt I could based on pain. Ergo, I could feasibly go back to work within a week without risking damage to the knee. For me, this was huge!
The other conversation that really pushed me over the edge was with my best friend who has been walking around without an ACL since tearing it in medical school 12 years ago. He told me that every time he tries to play any sport his knee gives out and swells and he is laid up for 3 days. At first I was looking to him as an example for not getting the surgery. After speaking with him, I was pretty convinced to have the procedure done. Now the question is how long do I need off?