Years ago, an article, probably in Sports Illustrated, caught my attention. It must have been an overview of common athletic injuries and a discussion of the advanced, new treatments. I clearly remember the article stating that the most devastating athletic injury, both physically and emotionally, was a knee injury. Maybe it’s because knee injuries are so common. A recent study reported that nearly 50 percent of all high school athletic injuries are to knees. The high level of anxiety might also be related to the fact that until quite recently, the prognosis for a serious knee injury was not encouraging. A decade ago, a torn ACL (anterior cruciate ligament) could end a professional football or basketball player’s multimillion-dollar career. How quickly things are changing in medicine!
These days, total knee-joint replacements are relatively commonplace, and they are not just for elderly folks who want to push their grandchildren through the mall in strollers. Just over a year ago, our friend and outdoor enthusiast, Will Lange, invited my wife, Kay, and me to join him on an overnight hike up Tuckerman Ravine on New Hampshire’s Mount Washington. Will was filming a segment for his popular New Hampshire Public Television show, Windows on the Wild. We spent a beautiful, late summer day ascending one of the steepest trails in the White Mountains, keeping pace with a film crew, and a former Outward Bound instructor with two replacement knees!
In fact, that hike might have been a catalyst for Kay, who had been suffering increasing pain for decades from a high school knee injury. She had been a multisport athlete, participating in field hockey, softball, and Alpine skiing in addition to cheerleading for the boy’s basketball team. A fall in a slalom course resulted in a torn meniscus in her right knee, and ultimately an operation to remove the damaged cartilage. She remembers being hospitalized for 10 days following the surgery, and an impressive 8-inch, vertical scar beside her kneecap.
A visit to an orthopedic surgeon (who is also a close family friend) revealed significant deterioration of Kay’s knee joint where the damaged cartilage had been removed decades earlier, making her a promising candidate for the relatively new, partial knee replacement, or unicompartmental knee arthroplasty. After several preliminary evaluations, Kay decided in favor of the procedure rather than face probable restricted activity and an increasingly painful knee.
Bright and early on the morning of the operation, our friend the surgeon got our attention by reminding us that if the condition of Kay’s knee was worse than he expected, he would do a total knee replacement. Several hours later, I was relieved when he found me in the waiting room and reported that the partial replacement was the correct decision, the operation went smoothly and that Kay was doing well. Soon thereafter, I visited her in the recovery room, and by late afternoon the physical therapy folks were showing her how to use her crutches!
Within 24 hours of the operation, Kay was experiencing her second PT session, learning how to climb and descend stars with the crutches. I couldn’t help thinking what a change in recovery philosophy this represented from the 10 days of bed rest she had endured following her original knee surgery. It was comforting to learn that some recovery advice remained unchanged. During my coaching days, I advised scores of limping athletes to ICE: apply Ice or ice packs to the injury, Compress the site of the injury with an Ace bandage to minimize swelling, and Elevate the injury. The physical therapist at the hospital added the letter R, forming the word RICE, representing a reminder to Rest. Although I totally agree with him, in practice, his advice seemed comically hypocritical since Kay rarely had more than five minutes in the hospital between nurses’ visits to check her vital signs, administer medication, check the bandages, take her meal order, etc.
Another somewhat comical (in retrospect) situation related to the several prescribed medications Kay was supposed to take following the operation. Once released from the hospital, I drove Kay home and helped her get situated before I headed to the pharmacy to fill the several prescriptions. By the time I returned, the hospital-administered pain medications were wearing off, and for the first time, Kay was aware of the trauma her knee had endured. As I scrambled to sort out the several containers of pills and the accompanying booklets of instructions and disclaimers, I was befuddled by prescription names that were totally foreign to me. It took a few anxious moments for me, and increasingly painful moments for Kay, before I discovered that the pharmacy had filled the prescriptions with generic brands.
Her recovery has progressed smoothly since then. Her goal is to cross-country ski, pain-free before the winter is out. I wouldn’t bet against her.