Tuesday, February 3, 2009

Chronicles of a Knee (Right now, the Grossest Shit that you will see)


This shit is hard for me to look at, really. Poor Tom Brady (not really) getting his knee taken out by a low tackle. I am at a weird point in life where I like football more than ever, but watching it makes me cringe for these players. I can feel the violence of every hit in my bones. They get hurt a lot. I don't know why they don't get hurt more. Like I said, this is hard for me to look at. I hope the rest of this post is really hard for you to look at. Puke your brains out. This is the story of a knee.
If you are not a radiologist, that's okay. See here, a magnetic resonance image of the center of a left knee. The black slug looking thing running down to up, left to right is the ACL. While it should be solid black all the way up, this one is not. A gray or white area indicates a tear, as the ligament fibers are of a different density in that area and show a different magnetic signature under bombardment. NOT COOL. Because the anterior cruciate ligament is the most important mechanism for stability of the knee, holding the joint together and specifically holding the shin bone underneath the femur, it must be operated on for future activity. What the MRI doesn't show, is a tear of the meniscus, the cartilage horseshoes on either side of your knee that cushion the bones from one another and help maintain stability. If this isn't fixed, it can lead to degenerative arthritis. Initially I believed my circumstances were like this. We were playing the skilled team Ramrod in intramural floor hockey. As usual most of our team didn't show up. Me being the competitor that I am, was playing at 110%. I had just finished talking shit to one of their players that I pushed to the ground when I chased the ball into the corner along with an opposing player. I believe my exact words after he objected from the ground were, "whats the matter? can't you stay on your feet?" As I planted my foot I began to fall, I looked down, and my knee was bent sideways. FUCK. My knee was dislocated, and the damage was done. I lay there with the wind knocked out of me from the devastion of the accident. It does not hurt to tear your ACL, it just feels weird and will weaken your entire body immediately as it knows something is wrong. Someone suggested I pulled my hamstring and told me to straighten my leg. I did and it relocated with a pop. Good, I walked away looking for ice. I thought that, as Peter later put it, I had a "bitch ass knee," that merely gave out. I learned some months later that I hate planted my foot on an opposing stick, it slid, and my weight was shifting down onto a knee while my foot was moving out.
Now, to the meat of it. There are several options when it comes to ACL reconstruction. 1. Bone patellar tendon bone autograft. 2. Hamstring autograft. 3. Donor ACL allograft. I opted for the first option. The third option grossed me out. The mission is to take the center third of the patellar tendon that runs over your kneecap and cut it out, along with the pieces of bone it attaches to on the knee cap and upper shin. It is measured and marked to become a new ACL. Then the torn ACL is removed. Holes are drilled from the front of the shin up into the knee and down from the back of the femur into the knee. The new ACL graft is threaded into those holes, tensioned to match the other knee, and screws are put in bone on bone to hold them in place while they fuse. Staples are put in place to tie down any slack. By doing this, the tendon now is exactly where the ACL used to be. Over several months revascularization will lead the tendon, which is naturally more stretchy than a ligament, to set and become more static. The meniscus is repaired with stitches and must be protected from use for six weeks as it heals very slowly. Then that shit is closed up.
Labeling the images top to bottom. 1. Tom Brady getting his bitch ass knee fucked up. 2. MRI of ACL tear. 3. Stump of torn ACL. 4. Torn meniscus. For reference, that metal poker is has the point the size of a ball point pen. 5. Graft set in place, making an X with the PCL behind it. 6. All stiched up and swolen. Those are the doctor's initials on my knee indicating which knee to operate on. They asked me at least 20 times which knee it would be over the course of an hour just to be sure. Now I've recovered and I look like this guy. Except with bigger balls? I know you all would have been better off having not read this, but you keep writing about yourselfs and I felt the need to self-indulge as well. Also I wanted to gross you out. Also I think I will get more surgery because I did something bad to it after Christmas. Anyways, Merry Christmas!

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