OnePhatMan

“What seems to be the problem?” the orthopedic surgeon, Dr. M, said as he walked through the door carrying the x-rays of my knee that had just been made. He looked at me more closely. “Have I seen you before?”

“Back in June,” I said. I grinned ruefully. “I got run over by a raft on the Ocoee River and my doctor sent me to you. You determined I had a torn labrum and sent me to Dr. F. He repaired it in August.”

“How’s that working out?”

“Pretty good. It still hurts some, and it’s not as good as it used to be, but it seems better than before the surgery.”

He looped his right arm in a big circle. “He did my shoulder, too,” he said. “They get better after the surgery, but never as good as they once were. What’s going on with your knee?”

I explained my problems—the pain on the stairs (especially down), the ache that sets in when I do the elliptical on a high resistance, and the severe flares of pain when I flex my knee just the right way with a little applied weight. While I prattled on about the various things that make my knee hurt, Dr. M hung the x-rays up on the holder and studied them. I rambled for an eternity, much like Bubba Blue listing the plethora of ways one can prepare shrimp.

“The pain’s always right here,” I said, pointing to the bottom front of my knee. “Only inside, like it’s behind my kneecap. Sometimes when the achy part is bad my whole knee hurts, but mostly it feels like it’s under my kneecap.”

Dr. M sat on his stool and starting messing around with the computer.

“How long has it been bothering you?” he asked.

“For several years, but it seems to be getting worse.”

“Does it ever swell up?”

“No, it just hurts. Sometimes it’s achy.”

“Any sort of clicking or grinding noise when you bend it or straighten it?”

I raised my left leg and straightened it. His eyebrows shot up when he heard the cacophany of sounds it produced.

“Any slipping of the patella when you move it?”

“Not that I can tell.”

“Did you ever injure it, maybe in an accident?”

I thought for a second. “I had a pretty bad bike wreck when I was a kid. See that?”—pointing—”That’s gravel, still in there.”

“One of the perils of childhood,” he said. “Ever injure it in a car accident? Anything with a blunt force?”

“Nothing I can—”

Then I remembered the spring day back in 1999 or 2000, when I went to Lowe’s for some topsoil and had to climb up on the pallet to get the bag. Turning around, holding a 40 pound bag, my heel slipped between two slats of the pallet and hung my foot. I pitched forward, off the pallet and fell onto the concrete, my entire 370+ pounds (and 40 pounds of topsoil) crunching down from close to two feet onto a single point: my left kneecap.

I hooked my chin on my shopping cart as my tumble continued. The cart popped a wheelie. The wheels crashing back to the pavement caused everyone in the vicinity to turn and stare at me as I knelt there still holding my bag of topsoil, tears in my eyes from the pain.

It’s a good thing, too, because falling like that might have been embarrassing otherwise.

“I fell once,” I said. “When I weighed a lot more than I do now. A big fall, right on the kneecap.”

He nodded, and had me flex my leg several times while he held my knee and pressed in various places. Each time, he asked if it hurt, and each time it didn’t. Next, he had me lie on the exam table so he could move my leg all around. Still no pain, which I expected. The things that make it hurt are pretty specific weight-bearing movements. Finally, he had me sit up.

“You have two joints in your knee,” he said. “The main joint between your femur and your tibia, and the joint between the patella and the femur. The main joint in your knee looks perfectly healthy in the x-ray, which is good. The problem isn’t actually in your knee, it’s with your kneecap. If we were to open your knee up and flip your kneecap back—”

Makes your balls crawl up in you to think about that, doesn’t it?

“—what we’d see is that the bottom surface of your kneecap would be cracked and fissured. It would look furry, instead of smooth like it’s supposed to be. That’s what you’re hearing when you bend and straighten your leg. It could have been from when you fell—pressure accidents cause the problem a lot, because they force all the fluid out of the joint—or it could be the beginnings of some spurs. That uneven surface is rubbing on the cartilage and making it inflamed. It’s softening and damaging it, and will eventually destroy it. The condition is called chondromalacia, and unfortunately technology hasn’t progressed far enough to give us a lot of options.”

He put me on a series of exercises to strengthen a specific part of my quadriceps (right above the kneecap) and forbade me from doing squats, leg extensions, step ups, and pretty much every other quad exercise in my normal leg routine. I’m to take mild anti-inflammatories (Aleve or Advil) for the pain (though I’ve taken those on days when my shoulder is bothering me and I don’t recall them having any effect on my knee pain).

I asked about glucosamine and chondroitin and he said lots of people get relief from those similar to taking anti-inflammatories. He gave me a brochure from the Arthritis Foundation (dammit, I’m too young to be getting handouts from that place) about the supplements, which I haven’t read yet.

If the exercises don’t help, the next step is to look at possibly injecting new fluid into my knee. That gives a lot of people relief, and works for several months. If that doesn’t work, then way on down the road it’s time to look at surgical options: resurfacing of the patella, mechanical replacements, or, in the absolute worst case, removing my kneecap. Like, just opening up my knee, cutting a couple of strings, and popping that bad boy right out.

I apologize to your balls for that, but I couldn’t resist.

The weight you’re carrying around today will affect your life for years, even after it’s gone. Is there a better reason to start doing something right now to get rid of it?