Articles from prior issues of The Advocate

March/April 2001

I Kneed Surgery
by Mark Bernskoetter, Missouri DDS


IT WAS ABOUT A YEAR ago that I had arthroscopic surgery on my left knee. Now that the time has passed, I think I can bring myself to talk about it (well. . . at least write about it). Actually, there was nothing too traumatic, and if the truth be told, it was amazing! But, I guess I should start at the beginning of my story.

In October of 1999, I was being the good dad working with a group of 10 year-olds on a soccer team. I like the sport and enjoyed running with the kids and scrimmaging with them or challenging them in practice. The accident happened at a time when I was just standing on the field and turned, pivoting on one leg when I felt a pop and a sudden pain in my knee.

Over the course of the next couple days, it was painful, but seemed to be improving, then I took a sudden turn for the worse and had to start using a cane to get around. I was examined by a knee specialist who pressed around and pulled and pushed on my leg. Of course, he had to press with a knuckle on that little divot on the front, inside portion of the knee. As I jumped, he quickly turned to the side on his little stool so that he was no longer straddling my foot. Then he nodded, saying he thought that would be tender. Well, duh! If he knew it was going to hurt, why did he have to do it? (I guess that’s why they call it practicing medicine.)

They took X-rays just to make sure there was no bony damage, but decided to forgo the MRI that is sometimes done because the method of injury and the symptoms were clearly diagnostic of a meniscus tear. I was given the choice of scheduling surgery or trying physical therapy, with the remark that a small number of these heal themselves with proper treatment. Well, since I am allergic to hospitals (no, it’s not fear, it’s an allergy!) I opted for the therapy approach. The exercises they gave me seemed to make a tremendous difference, but I still could not return to normal activity. Finally, we set up surgery for December 16, 1999. My plan was that I would have the surgery, go home full weight bearing, be off work for about a week or two, then start resuming normal activities. I thought it would be a great excuse to be off during the holidays, yet I figured I would be feeling better and able to enjoy the holidays. Looking back, I think the only one who enjoyed themselves during those days of recovery was our pet Pomeranian, because she did not have to spend her days outside.

What a day that was - surgery scheduled for 1:30 in the afternoon and I could not eat anything after midnight…or what seemed to be sometime the previous week. As they wheeled me in to the holding area, they asked if I had decided whether I wanted to be put under or have the spinal block. I decided that with all the doubts I had just gone through, I could not trust my life in anyone’s hands. I knew I would have to be there to watch out for myself. So, I requested the spinal. They had me sit up and said there would be a little sting. Then they injected something through my IV, saying it would help me relax. (RELAX!? Who needed to relax? Why don’t they have something to read or pictures to look at on the ceilings of these holdingareas?)

A short time later, they wheeled me into the operating room. It was a huge room, nearly the size of our large conference room, filled with almost a dozen people, all kinds of machines, TV sets, wires, tubes, you name it. (How can all those people and all that equipment gather around my knee? And if they can, why does the room have to be so big?) My doctor commented that it seemed I had opted to remain awake for the surgery. As far as I was concerned, if I was going through all of this, I wanted to know what was happening (besides, maybe I could write an article about it for the newsletter - see, always thinking of you all). I decided at this point to check the effectiveness of the spinal block - my legs felt very heavy, but I concentrated real hard to lift one leg off the bed. Feelingagreat sense of victory, I looked down and saw my legs - still flat against the table. As they made final preparations, the doctor asked if I had any requests - I asked that whatever he did, don’t say, “Ooops.” At which time, he turned to his staff and told them, “OK, guys, nobody says, ’Oops,’ this time.” (A comedian and a doctor! I hoped his medical skills were better!)

They lifted my left leg into a brace of some sort, shaved my knee, and made three small incisions. Into each of these incisions, they inserted a tube. One tube pumped fluid into the knee joint expand it, making it easier to work in and carrying away any blood or debris that may be encountered. Another of the tubes had instruments inserted through it to work on the tissue. The doctor had a TV set to watch and I had my own. It was amazing seeing the cartilage of my knee. The doctor used a probe to move around in the joint. I was asking him several questions about what I was seeing - so that I could better report to you, of course – and after a few of my questions, he asked the nurse whether I had been given the sedative yet. She indicated that I had, but then pulled out a syringe and injected some more into the IV.

As the probe found the meniscus (which are two small crescent shaped pieces of cartilage that cushions between your thigh bone and your calf bone) there was a tiny little tear. The doctor commented that he was surprised it was not larger since my symptoms were so bad. (Well, now I was feeling like quite the wimp. Here I had been using a cane, went through PT exercises, was still hurting, but it was just a minor tear!) Then the doctor panned the camera in the knee joint. (It looked like a sharp curve in a tunnel like you see on car chase scenes in the movies or in video games.) He began to prod the cartilage up on the thigh bone and the probe sank all the way into the cartilage. He said that was the problem. Apparently, the cartilage is supposed to be very tough, but mine was ruptured (an epicondyle defect). He indicated that certainly explained why I had been having so much trouble with it. (I certainly felt better!)

He then proceeded to tell me that I would not be weight bearing for a couple of weeks and it would be much longer before I could return to normal activities. (So much for my holiday plans.) He used a metal tool that looked like a spinning cheese grater to strip away this damaged cartilage all the way down to the bone. The meniscus was trimmed using a pinching tool that bit off little bits of the meniscus until the area that was torn had been removed and the crescent shape was apparent again, just much narrower. Recovery was difficult because there is nothing on daytime television, my pain medication for the first week kept me from being able to focus enough to read a book, and I had to keep the leg elevated. I remember my first visit back to the doctor: he pushed on that little divot off to the side of the knee. I about went through the roof! (Of course, he thought that would be pretty uncomfortable.)

Well, it has been about a year now. I still am not able to run, and from time to time it will swell up on me, but a couple courses of anti-inflammatories since then have brought me to the point that from time to time I will have a limp or an ache, but I’m in much better shape than before the surgery. Of course, mine is an unusual case due to the epicondyle defect. Meniscus tears are pretty universally treatableand the patient returns to normal activities within a couple weeks to a month.