going back under the kni– arthroscope

It’s almost been a full 2 months since I last posted something literary, and that post also happened to be a couple of days before I reinjured my knee. Since I’m going to be bedridden in a little more than 12 hours, I figured I’d get the creative juices flowing in anticipation of doing stuff to keep my mind occupied while recovering from my second knee surgery in as many years.

On July 22nd this year, exactly a year and 10 days after I had my first ACL reconstruction surgery and meniscus repair, I re-tore my ACL graft and meniscus while contemplating a game of volleyball. The entire injury was probably manifested over the last few months of my rehab where I had tweaked my knee a few times while running but was cleared to return to activities by the physical therapist.

Day 0 (7/22/2013)

On this fateful Monday, I was waiting in the rotation for a sand volleyball game when someone served the ball long. I retrieved the ball, turned around, took a skip step and threw the ball. Apparently my knee got stuck in the ground while the rest of the body pivoted and whatever was left of the graft shredded and took my meniscus with it.

The pain was not as extreme as I remember it being following my first ACL injury but still bad enough that I took a day off to ice it and got an appointment with North Austin Sports Medicine, the practice that handled my first surgery, as soon as I could. They sent me off to get an MRI and I spent the next three days or so icing my knee and staying off my feet. I then went to a bachelor party in New Orleans where I played phone tag with the surgeon’s assistant but couldn’t get through to find out what the diagnosis was. I did manage to reschedule my follow-up appointment to Monday from Wednesday through a series of voicemails. After doing extensive research on WebMD as well as the tests performed by both my primary care physician and the orthopedist surgeon, I was fairly confident that I had a medial meniscus tear. While this wasn’t ideal, the recovery schedule for this injury was about 3-6 months, a far cry from the 12 months I had just spent from my prior surgery.

Day 14 (8/5/2013)

I got to the orthopedist surgeon and after a 10-minute or so wait outside, I was ushered into a room and given my MRI results in paper form. I was then left to stew in what they said for the next 30 minutes or so, in the normal waiting game that NASM likes to play. This summary was pretty straightforward:


  1. Complete tear of the anterior cruciate ligament graft.
  2. Displaced bucket-handle tear of the medial meniscus.
  3. Moderate knee joint effusion.
  4. Status post resection of the medial synovial plica.
  5. Mild bone marrow edema of the proximal tibia.

That first line was the killer blow. The world didn’t spin around and I didn’t throw up in the doctor’s office, but I did spend the next 30 minutes gathering my thoughts and preparing for the spiel.

The surgeon came in and seemed genuinely disappointed and surprised and went ahead and recommended surgery as soon as possible but definitely within the next 1-2 months before scar tissue began to develop that prevented my knee from straightening, or before the cartilage tear got any worse. Unlike last time, I asked for a copy of my MRI with an intention to get a second opinion and an even stronger intention of going with the second opinion’s expertise for the repair surgery. While I have few problems with Dr. Brotzman, unfortunately his practice is not very well-managed, at least as evidenced by how long a trip to see him usually takes.

Day 16 (8/7/2013)

I scheduled a second opinion for this date with Dr. Carey Windler of Austin Sports Medicine. A few people I know have been to this practice and had nothing but good words for them. I even know two people who’ve had ACL reconstruction surgery there and have been recovering well. I took a copy of my MRI and they were able to access my last x-ray.

The verdict was pretty much the same: surgery. However, Dr. Windler suggested a different process, which was to fix my medial meniscus tear first (as well as undo the stuff from the failed ACL surgery) first and get that healed up completely and then follow by getting the ACL reconstructed next year. While this would be more expensive and increase my rehab time by a few months, it also made a little bit of sense for me because I could see how life was without an ACL (but a good meniscus). If I choose to go without an ACL long-term, I’ll have to cut out most all sports and running, and start swimming and biking. It’s a decision I haven’t thought about extensively and won’t really until my rehab from the first surgery is winding down.

In the weeks following this meeting I contacted NASM to attempt to talk to Dr. Brotzman about Dr. Windler’s opinion but I was never able to get him on the phone. Since they didn’t seem to want my business, I decided to go with Dr. Windler for my procedure.

Day 52 (9/12/2013)

Over the last month or so my knee has felt better and gained strength but I still cannot extend it completely apart from, of course, being unable to run, cut, etc. At this point I’m probably back to the lowest physical form of my life (sadness). However, I did give up a little bit since it didn’t make sense for me to go hard with my workouts when I knew I would probably be spending about 3 weeks without any exercise anyway. I know, it’s rationalization at its finest, but I was okay with it.

My first surgery–to repair the meniscus and undo the work done in my previous surgery–is scheduled for tomorrow at 8.15am, which means that I will need to reach the surgery center at 6.45am, which means I will be having a very, very early day. My uncle has flown over from Las Vegas to help me out and that coupled with the fact that I’ve been through this once before has me feeling cautiously optimistic about the surgery and recovery. Hopefully it will all go as planned.

I’ll be using my bed-ridden state to blog ferociously and perhaps even work on some Windows Phone apps that I’ve been putting off, in between spurts of pain medicine and naps. We’ll see how it goes. Onwards to surgery!

of acl surgeries and more

I’ve decided to go ahead and include a few tidbits about my ACL surgery so that I can (a) come back and look at it when I have made a full recovery and (b) answers questions/doubts for people who are looking at ACL reconstruction surgery as a possible solution for a torn ACL issue. Feel free to add questions and I will do my best to answer them.

Day 0 (5/21): Injury

I injured myself playing basketball at work. Concrete courts are probably not the best location to be playing basketball regularly. I don’t clearly remember what happened except that I was going up for an offensive rebound and while I was jumping, I felt like I was pushed from behind (while leaving the ground). I bobbled the ball and jumped once again before crumpling to the floor. Both times I felt like someone had knocked knees from behind me. I’m not sure if they had or hadn’t, but that’s the sensation I got. I may have heard something pop, but I feel like that is just something I feel like happened because it is one of the common symptoms.

I wasn’t sure how bad the injury was since I’ve never had significant knee issues before, so I sprayed some Icy Hot on and waited around for about 10 minutes for the pain to subside. When it felt good (or, I guess, numb) I grabbed a ball and attempted a jump shot from three-point range. This time, it felt like one of my bones had knocked against my knee cap, or something. Yup. Definitely something serious. I knew I was done so I packed up my things as I debated whether to go to the ER or not. I was also depressed since I was going to be missing my team’s playoff game the next day.

After I went home and showered, my knee started developing more pain as it stiffened up and the Icy Hot wore off. I decided that going to the ER would be in my best interests and found that the North Austin Medical Center was the closest option so I drove over there. The wait was horrendously long but I was at least grateful that I wasn’t in as much pain as some of the other patients there, who were at various degrees of crying (from sobbing to wailing) presumably from physical pain. At this point my knee was getting pretty locked up and I had to hobble around.

It took probably about 2 hours at the ER before I was finally seen and the doctor ordered an x-ray to check for bone issues. The x-ray didn’t show any bone issues and going by the ligament tests they do (by pushing the knee in various directions to check for pain/range of motion) the ER doc diagnosed it as a strain in my lateral ligament and applied a brace to prevent motion. She indicated that I should be back in action in about 10 days and that I should see a specialist if the pain/swelling got worse.

Day 1 (5/22): First day after injury

I took the day off the next day since I was in a considerable amount of pain and because I didn’t trust the ER doctor, I scheduled an appointment with North Austin Sports Medicine, which had a pretty reputable knee surgeon. It helped that a couple of my friends from work had been going there for leg issues and were happy with the experience. I got an appointment for the next day itself. I spent most of this day on pain meds and hobbling around my apartment. I was still optimistic that the injury was not a serious one.

Day 2 (5/23): Diagnoses and drainage at NASM

I had my first appointment at NASM with an assistant doctor (or some weird title like that) about 36 hours after injury. She pulled the x-ray from NAMC and noticed the extreme amount of swelling and noted that this happened either with an ACL tear or a tibia fracture, which is kind of hard to diagnose from an x-ray unless you are specifically looking for it. She conducted the same range-of-motion tests that the ER had done and concluded that my ACL appeared intact. She also ordered an MRI for that day so that she could get a conclusive idea of what the issue actually was. She also went ahead and drained the fluid from my knee joint, which apparently contained a high percentage of blood, which confirmed her suspicion that it was either an ACL tear or tibia fracture.

I left the office with a prescription for crutches, an MRI appointment and two possible diagnoses. A tibia fracture would have resulted in a walking boot of some sort to prevent further pressure on that bone while the bone healed naturally, and possibly pain medications and regular draining to keep the pain away from the knee. An ACL tear would require… well, the rest of the content of this blog. 🙂

I returned to work for a couple of hours (after picking up a pair of $3 crutches from a medical prescription equipment store) and then left for my MRI. Apparently they had a machine specifically to look at the knee so I just got strapped in there with plenty of pillows and a bunch of magazines to read. Apparently I was relatively still since the MRI only took about 35-40 minutes. I went back to work with a 24-hour waiting window to find out what was actually wrong with my knee. Thrilling stuff.

Day 3 (5/24): The real diagnosis

In the middle of work on this Thursday, I called into NASM to figure out the severity of my injury. In classic mystery-style, the assistant for the surgeon was not available to take my call. He did eventually call me back and told me the results of the MRI: a complete acute/sub-acute tear of the ACL and damage to the medial meniscus to boot. Apparently the acute/sub-acute implied that they were not sure whether this tear had happened during this last incident or whether it had happened earlier. I forgot to mention earlier that I had been having pain in my left knee for a few months but a couple of visits to the health center at work had yielded no diagnoses. I now believe that I may have possibly had a partial tear well in advance but this incident may have pushed me over the top (or injured the meniscus which created the pain here, I guess).

The assistant asked me to come in and get fitted for an ACL brace and then schedule a meeting to meet with the surgeon and figure out the details of scheduling surgery and rehab and all that jazz. I begrudgingly did so. I was also told that I didn’t really have to use the crutches any more since the brace was weight-bearing.

The next few days were not all that exciting. I eventually met with the surgeon and he said that given my age and lifestyle and the fact that the meniscus was also torn, surgery was the best option so that I could get back to sports and so that I didn’t end up getting early arthritis in that knee. I scheduled the procedure for June 26th to begin with and then pushed it back 2 weeks so that I would have a chance to spend the July 4th vacation with a few friends before getting operated on and kicking off (pun intended) the arduous rehabilitation process. This was a good decision, in retrospect, because it also allowed my parents to fly over for my surgery which has been invaluable.

I’m going to end this post now and dedicate the next post to the actual surgery and the ongoing rehab process.