I have been dealing with knee problems since I was a teenager, and guess what? They haven't gone away! Articular cartilage injuries tend to be a chronic problem. I just recently had a Distal Femoral Osteotomoy and may be a candidate for an Osteochondral Allograft. More about that, and links to online resources to learn more, in the Recent History and Solutions section below.
The purpose of this page is to share my experience and knowledge with others who are dealing with similar problems. Hopefully this information can help others make better decisions and take better care of themselves. Included here is some background on my injury, links to knee-related resource sites, and tips for getting through surgery.
During 2002 a combination of events occured that have prompted me to take a more active role in managing my knees. First, I had some exploratory knee surgery in January and they found that I had serious arthritis in my left knee. Second, I got a copy of Lance Armstrong's book "It's Not About the Bike," in which he describes his battle with cancer. One of the very clear messages in this book is that you must take responsibility for your health. This means learning about your problem, researching solutions, reading journal articles, finding the best doctors you can, etc. Third, I spoke with a doctor that I respect and he gave me some powerful advice: at some point you've got to really deal with your knees so that you can exercise, walk, and otherwise lead a healthy life, because this is what will help you live longer. I had never thought of it that way before. As a new father, this advice hit me especially hard.
As a teenager I suffered from osteochondritis dissecans (OCD), a condition that affects the bone and articular cartilage of the femoral (thigh) condyles, usually the medial (inner) condyle. In my case, it was the lateral (outer) condyle of both knees. The condyle is the part of the knee at the end of the thigh bone. Articular cartilage is the smooth teflon-like surface that covers the condyles (like the white stuff on the end of a chicken leg). Click here to see a picture of the knee and the condyles.
"Osteo" means bone, "chondr" means cartilage, and "itis" means disease. "Dessicans" means that the diseased piece of bone/cartilage broke off. So osteochondritis dessicans means that I had pieces of bone and cartilage that got weak and broke off. We're talking small chunks of bone and cartilage, perhaps a few centimeters in diameter. But in the weight-bearing parts of the knee this is a big deal. When I had the problem initially they went back in and pinned back in place the pieces of broken bone and cartilage. They also drilled a bunch of wholes up into the knee to help encourage blood flow. Over some time my knees healed themselves to a certain extent. I was able to ride bicycles competitively, backpack throughout Europe, and do many other activities (some of which I regret since they contributed to this chronic injury).
Complication: I broke my right ankle when I was about 12. Unfortunately, it never healed properly. This wasn't a factor for a long time but beginning in the mid-90s I started having arthritis symptons in the ankle. In 1997 they fused the damaged joint but now I'm having problems again. This has not helped me in dealing with my knees, especially my left knee. What's better, carrying weight on my left side or my right side? Well, it depends upon whether my right ankle or my left knee is hurting more. You can see the problem.
Gradual destruction: In the early 80s, after my knees were fixed the first time, I got into running and skate boarding. That only lasted a couple of years. Ouch! In the mid 80s I got into cycling as therapy for my knees but then go a little too serious about it. I rode 10,000 miles during the 1986-1987 season and by the spring of 1997 it was clear that I had to stop riding bicycles so much. So I stopped completely. In the late 80s I spent a year in Europe, carrying a 40 pound pack around with me much of the time.
For the first few years of the 90s I drove a clutch car. Again, ouch! The continuous pumping of the clutch was murder on my left knee. Generally speaking, throughout the 90s my knees held up pretty well but slowly but surely the pain was getting more pronounced, particularly in my left knee. To make matters worse, I worked full time throughout this period, got my MBA through an evening program (1994-1998), got married, and had a baby. I was very busy, wore dress shoes a lot, stopped exercising, and gained 35 pounds. Not a recipe for success when it comes to knee maintenance.
I'm the kind of person who can come off major chopping of bones, etc., very (acutely) painful stuff, and be taking nothing but tylenol after just a couple of days of recovery. But with arthritic pain, I want to stay medicated all the time and sometimes feel like crying. Here's the kicker: if you stay medicated then you don't feel the joint as much, which then allows you to overuse it further, which then makes the pain worse, which then requires more medication, etc., etc. It's a downward spiral. Bottom line: when it comes to arthritic pain, you've got to deal with it. You can't run from it and you can't avoid it.
In late 2001 I started having increased chronic pain in my left knee, which was getting worse as our baby got heavier. In January 2002 I had exploratory surgery on my left knee where they discovered Grade 4 arthritis on the lateral femoral condyle. In other words, the repair to my OCD problem had worn out. Grade 4 arthritis is the worst you can have. It means you have exposed bone.
By March I had started doing my homework about potential solutions and learned about a technique called osteochondral allografting. "Allo" means from someone else (as opposed to "auto," which means from yourself) and "graft" means, well, graft. I'm not a candidate for an autograft because my cartilage defect is too large and therefore they would do major damage if they took it from me. It has to come from a cadaver.
Through some connections I made with other arthritis sufferers over the Internet (see the link to KneeGuru below), I found one of the the best doctors in the world when it comes to osteochondral allografting. William Bugbee, MD is an Assistant Professor of Orthopaedic Surgery and Chief of the Adult Joint Reconstruction Service at the University of California, San Diego. He is also Director of the UCSD Cartilage Transplantation Program and Medical Director of the UCSD Tissue Bank. After graduating from UCLA, Dr. Bugbee received his medical degree and completed his residency in orthopaedics at UCSD. Subsequently, due to his research and the clinical application of his techniques in osteochondral allografting, UCSD has become world-renowned as an important research center in the field of cartilage transplantation.
Here are links to information about Dr. Bugbee and osteochondral allografting:
If you're interested in learning even more, email me at mail@atempleton.com and let me know. I've got photocopies of 30-40 medical journal articles on the topic and maybe we can work something out where I get copies made for you, etc. This won't replace you going out and doing your own research, but it can save you a lot of time and effort.
Like many other people, I had a tough time with my surgeries. Once you have a bad surgery experience, it is very difficult to have good experiences in the future. However, I found a number of things that made a big difference for me in my more recent surgeries. First, the medications are better and have fewer side effects. Second, I went to a counselor and got help with meditation and even hypnosis before the surgery. Third, I learned everything I could about the procedure, down to the type of brackets they would use. And four, I got an "iPod" and loaded it with music so that I could always just close my eyes and drift away. All four of these things made a huge difference in getting through the surgery and the recovery.
The bottom line is this: Figure out what things comfort you and use them during this process. It's important and let's you focus on what's most important -- healing.