That pain in my knee, part 2

EXACTLY two weeks ago, I underwent knee surgery. In my previous column, I ended by saying I was still mulling over going for physiotherapy or meniscus root repair. I thought I would take my time deciding but in the end, I quickly opted for the latter after consulting my doctor.

After my initial meetings with her, I sought a second opinion from another orthopaedic surgeon who more or less said the same thing.

So, back I went to Dr Teo. This time I raised my concerns and fears with her. According to what I found on the Internet, meniscus root repair is supposed to be better for people under 40, which was concerning since I am 65. A lot would also depend on the condition of my meniscus and the surrounding cartilage.

So just how good was my meniscus and cartilage? From my MRI scans, Dr Teo said my condition was quite good for surgery. To briefly recap my problem: the posterior horn of my medial meniscus where it is supposed to be rooted to the tibia had become detached due to degenerative wear and tear.

What was also in my favour was that the meniscus was not sticking out, or extruding, beyond the tibia, making it ideal for surgery. But left untreated, it would extrude and lead to chronic pain and, worse, hasten the development of osteoarthritis.

According to studies, the success rate was 80%-85%, going up to 90% when the surgery is performed by an experienced surgeon. That is Dr Teo indeed. She has an impressive list of qualifications specialising in shoulder, knee and sports injuries, is a sought-after speaker at many international seminars and conferences, and has authored several papers.

At her young age, she is already an associate professor who loves to teach – which is why she has not joined a private hospital, earning buckets of money.

To fix my problem, root repair surgery is recommended. This involves using permanent sutures to reattach the torn meniscus to the bone.

This is done via arthroscopy, or keyhole surgery, a minimally invasive procedure whereby small incisions are made to allow a small camera (arthroscope) to be inserted for the surgeon to see the inside of the knee and repair the damage with tiny surgical instruments. Such a method generally results in less pain, faster recovery and minimal scarring.

I saw Dr Teo on Tuesday, was admitted on Wednesday morning and my surgery was done at noon that same day under general anaesthesia.

When I woke up, my left leg was bandaged up and wrapped up in a hinged brace that stretched from my lower thigh to my upper calf.

I had a pleasant two-night stay in the University Malaya Specialist Centre, the private wing of University Malaya Medical Centre.

The day after the surgery, a physiotherapist came to teach me the exercises I needed to do to prevent deep vein thrombosis and muscle atrophy. My discharge was also quite smooth with my medications delivered to my room.

But once home, the challenge began. The healing process for meniscus root repair is the most taxing and restrictive of all knee surgeries.

Patients have to wear the brace, which weighs about 1kg but feels like a tonne for six weeks. It is to provide protection and stability by limiting the range of motion, like excessive bending or straightening, to avoid putting undue stress on the repair when the meniscus is most vulnerable.

The brace’s hinged design provides an adjustable range of motion settings to support the knee. For the first two weeks, my brace is set at 30 degrees, allowing me to flex my knee that much. Tomorrow, I can increase it to 90 degrees for more flexion. I have to wear the brace for a full six weeks and I can only remove it to shower and for my leg exercises.

Heavy and uncomfortable as it is, the brace is not the most difficult part of the post-surgery protocol. It’s the stern injunction from Dr Teo not to put any weight on my left leg. I was provided with a complimentary set of crutches, but I found them painful on the armpits, unwieldy and didn’t give the confidence of stability. I bought a walking frame instead.

Still, it is not easy to hobble on my right leg while keeping the left suspended. It tires me out as it is strenuous on my arms. I am encouraged to ambulate, but I am honestly terrified of putting too much stress on my right knee that has held up so far. After all, surely both legs must be subjected to the same degenerative wear and tear. The left gave out first, but surely the right is also at risk and goodness knows what shape the menisci are in. So I try not to hop too much on my still good leg and try to protect it by wearing a knee guard.

How well I heal will depend a lot on me. That means not just sticking to my doctor’s orders but also how disciplined I am in doing the physiotherapy (PT), which would not just prevent muscle shrinkage but strengthen them as well.

These are the quadriceps, hamstrings and glutes that I have now become very familiar with. These muscles are crucial to my recovery and the future well-being of both knees.

I need them to be strong and powerful to stabilise the knee joints and reduce the pressure on my menisci so that the repaired one can heal properly and my right one can be hopefully preserved.

But boy, those series of exercises are tough to do. I need to do at least 30 repetitions for each one for both legs and at least three times a day.

It’s exhausting and I have to grit through the pain. The good thing is they are getting a little easier to do as the days go by, and I take it that my muscles are getting stronger. Whenever I feel like reducing the repetitions, I tell myself if I do that, I am only cheating myself. That actually works!

All said and done, I would rather suffer the pain of screaming muscles instead of pain from the wounds from the surgery. Many patients have experienced severe pain and discomfort. I have none, touch wood. I could stop my painkillers within a week of my discharge. There is also very little swelling and bruising.

I now have an inkling of what it is to be somewhat disabled and needing help to do some of the simplest tasks like carrying a cup of coffee. I am using my late father’s old but still sturdy wheelchair for my doctor’s and PT appointments, and his bathing chair to shower. Thank goodness I didn’t get rid of them when I moved house. Regretfully, I did give away Mum’s walking frame as I never thought I would need it so soon.

I have another four weeks before I can put weight on my left leg and slowly start walking again. It will be several months before I can regain full mobility.

Even if the surgery and healing are completely successful, I will have to be careful with how I move my legs for the rest of my life. For one thing, the so-called deep Asian squat is out. I used to think preserving my teeth was the most important thing in old age. Now it’s my knees.

The views expressed here are the writer’s own.