2+ Year Knee Update

2 years, 3 months is a long time. Think about it. Ellin had yet to smash Tiger’s Escalade with a 9-iron. LeBron hadn’t taken his talents to South Beach. Obama thought he could “change” the country. And Snookie was a term of endearment, not a pudgy reality star.

I also had 2 holes in my kneecap and a perfectly healthy leg.

Obviously, a lot has changed since then.

So let’s begin with the obvious starting point. If I could do it all over again, would I still choose ACI? I honestly don’t know. Before going under the knife, my knee didn’t hurt THAT badly. I could sense it was about to take a turn for the worst, but it wasn’t there yet. Today, my knee doesn’t hurt at all, which is a good thing, obviously. On the flip side, the lack of pain pre-surgery also meant that I never experienced the unbridled joy of having a pain-free knee, post-surgery. So when I say my knee doesn’t hurt today, I say it with a shoulder shrug, not the fist pump of a guy who just birdied 18 to win the Masters.

Unfortunately, the surgery also produced some unexpected drawbacks, completely unrelated to my knee. I went in with one problem, and woke up with a brand-new one.
The osteotomy didn’t fully heal. My tibia remains “somewhat fractured.” (By the way, somewhat fractured is an actual medical term). While the bone didn’t fuse entirely, however, enough bits and pieces did to hold the leg together. Dr. Champine described my leg as a “poor welding job.”

Now, the screws were inserted to keep the leg intact, and the surgeon had warned me the area surrounding the screws would be sensitive. At the same time, I was assured they could be removed once the tibia fully healed, meaning I spent that first year or so biding my time until the leg healed enough to remove them.

Well, I can stop waiting; the leg never healed. So the million dollar question today for me is: Has the leg healed enough for the screws to be removed?

Champine says, “probably.” He believes – and his partner, Dr. Scheinberg, concurs – that since the leg has held up for 2+ years, it’s “probably” not going to fall apart now. Of course, patients really don’t like when doctors use the word, “probably.” I like to measure risk. Can I catch VD from that Vietnamese “masseuse”? Probably, so I’m not going to ask for the happy ending. Easy decision. So even though my current choice also involves screws, this one is a bit more complicated.

Ok, quick intermission from my knee situation:

Over Spring Break, we road-tripped to Chicago to see family. My parents still live in the same house in which I grew up. After spending the week at my childhood home, I’m not sure what seemed weirder: sleeping in my old bedroom with my wife, or the lack of Michael Jordan or Paulina Porizkova posters on the wall.

By the way, did you know Illinois leads country in vanity license plates? Even minivans have them. I actually saw a guy driving a minivan with “Peters 64” plates. Advertising that you own a minivan? I thought you were supposed to be ashamed of them.

Ok, back to my knee update:

Thus far, I’ve chosen the conservative approach and opted against undergoing the surgery to remove the screws. Maintaining the status quo. By all accounts, this surgery is minor. A few days on crutches. Not a big deal in the grand scheme of knee surgeries, so I don’t fear the recovery. But I don’t want to risk the consequences if it turns out that the screws really were holding my leg together. If so, I would need some sort of bone graft to shore up my shin. And THAT’S a big f*cking deal.

To give you an idea of what’s potentially at stake here, I have no “daily living” issues. I can walk just fine. No issues with stairs. I can bike and use the elliptical machines at the gym. I avoid impact exercises – running, squatting, jumping or explosive plyometrics – but otherwise no functional restrictions. I’m plenty capable of jogging around the soccer field with the kids, even cutting without too much difficulty during scrimmages with 9-year olds. In fairness, I’m a slow, 38-year old dad playing with third graders, and these kids aren’t Brazilian. I actually weigh a bit less than I did pre-surgery, and think I might even regain my 2-pack abs by summer if I keep up my current exercise routine. Overall, I’m pretty content.

On the other hand, the screws in my shin remain sensitive. I mean, really sensitive. A little tap on my shin will drop me to my knees quicker than a hooker looking for a quick $20. Um, not that I have any idea what the going rate is for those types of things….
Until lately, the screws weren’t too big of a deal; I could tolerate them. During recent workouts, however, some of the basic leg strengthening exercises – short arc leg extensions; shuttle leg presses; even hamstring curls – have started to stress the outside of my shin. And guess what? The mere sensation that metal screws might rip through your leg like Mr. Kool Aid bursting through that brick wall is not a good feeling.

Ok, time for the Second Intermission:

Just like a strong jawline or piercing blue eyes define somebody’s face, the random shops dotting the sides of the highways provide a glimpse of state’s personality. On my Spring Break road trip, I discovered that Missouri leads the country in adult video stores and firework stands, which says a lot about the Show Me state. In fact, sometimes there were 2 adult video stores next to each other at the same rest stop -- the porn version of McDonald's and Burger King. That made me wonder -- do truck drivers comparison shop at adult video stores? Do they broadcast over their CBs, “Breaker Breaker. This is Little Bear. The Bobby’s XXX in Joplin has a wider foot fetish selection than Soft Skins.” One of the adult video stores also advertised an adjacent "men's only spa," and even used a picture of a geisha. Why not just throw up a billboard that says, "Happy Endings Available"? And, oh yeah, the local Mizzou gas station is called, Kum and Go. I'm not kidding. And you can find them next to the adult video stores.

Ok, back to the blog:

While the screws have nothing to do with my knee, I can’t truly test my knee for fear of aggravating the screws. Perhaps if the osteotomy had healed, I would have a better appreciation for how well the ACI grafts worked. But the screws prevent me from playing, for example, competitive volleyball or taking jiu-jitsu lessons, which I envisioned as the true measuring stick of a successful surgery. And that’s disappointing. Grumble, grumble.

Here are some other observations:
• My quad remains a bit weak, and I really don’t ever see it gaining full strength. Not only do the screws limit certain exercises, but the osteotomy permanently altered my mechanics, making it difficult to isolate my quad and build up the “teardrop” muscle. You can only do so many straight leg raises.

• I still have a decent amount of crepitus, but no pain associated with any of the crunching. I planned on getting my knee scoped to clean up the crunching at the same time the screws were removed, but obviously that never happened.

• Every so often I experience a twinge of weakness on the inside of my knee. It’s more like a pinch, something that creates the sensation that my knee might give out. But the knee doesn’t. I’m not sure if there’s something slightly defective with my knee, or whether that’s caused by my lack of inner/outer thigh and hip strength.

So here’s where I am 2 years, 3 months after ACI. Part of me wants to tough it out by keeping the screws. I try to convince myself removing the screws just isn’t worth risking a bone graft and the attendant lengthy recovery. But man, my screws can be aggravated as easily as a sleep deprived new parent, and I wonder how much “quality of life” can be gained if they were taken out. I still haven’t made a decision, and probably won’t until my kids’ soccer seasons end next month.

Until then, I’d love to hear from others about their knee experiences, along with updates from other ACI patients who follow my blog. In addition, I welcome any ideas or suggestions on blog topics from my “readers.”

Disney

Well, I figure it’s been long enough since my last blog post. Almost 8 months, in fact. Actually, I started writing this post over the Xmas holidays, but then I got busy lying to my kids that Santa really exists, and, before you know it, two more months slipped by. Wait, do you still believe in Santa? My bad. I guess I should’ve included a “Santa is fake” disclaimer.

I’ve passed a few milestones along the way, including the 2-year mark. I’m not really sure how to describe the past 2 years, other than to note the usual clichés: the recovery is a marathon, not a sprint; the surgery seems like it happened just yesterday; blah, blah. Eventually, I’ll post a 2-year update about my knee. And I promise I won’t wait another 8 months to do so.

But not today.

Instead, I’m going to share my recent Disney adventures. The Florida one, not the SoCal one.

Alright, let me get the usual Disney platitudes out of the way. Every story you hear about how Disney bends over backwards to accommodate visitors – especially kids – is dead-on. All of Disney’s employees were phenomenal – the hotel workers, ride operators, character helpers, the bus drivers. You name it. Even the cleaning people who didn’t speak English. Very friendly. And not fake-friendly. You know the type. The superficial syrupy-sounding people who deserve to be punched in the kidneys. These Disney people were genuine. I don’t know how they remain this friendly, day-in, day-out. After five minutes of kids tugging on my shirt, I’m pretty sure I would start playing Wack-A-Mole with anybody shorter than 3 feet tall. Honestly, I was most impressed with the girl portraying Jasmine. Not only was she smoking hot, but she never broke character, like an old school WWF wrestler. Well, except for the time when the creepy old man started groping her. That freaked out Jasmine, not to mention ruining the Disney experience for some family’s little Princess. Rough memory for a kid, right?

But I assume most Disney travelers know these tips. Therefore, this blog entry shares some observations that, perhaps, are news to you.

First, a random observation.

Disney’s bathrooms never ran out of paper towels. I’m pretty sure I visited every crapper in the park. No, I didn’t have diarrhea, just two little kids needing to piss constantly. Incredibly, there was never an empty paper towel dispenser. Never. I wonder if Disney employs a stable of Sherpas just to fetch paper towels.

Ok, now to my main observation. I’ve never seen so many f*cking fat people in one place in my life. Enough fatties to keep The Biggest Loser busy for 40 years. Holy lard asses, Batman.

Here’s another under-the-radar scoop about Disney – they lead the world in rascal scooters. All those fatties scoot around the park all day rather than trying to walk off the BonBons. Disney was like a giant bumper car park for very large people.

Now here’s the really annoying part. Call me crazy, but I thought rascals were only for non-ambulatory people. You know, the crippled; extreme elderly; or even the morbidly obese people who simply cannot walk on their own. Not at Disney. I lost count how many times some gump of sh*t scooted up to the entrance, parked their rascal, and walked onto the ride. Seriously? At first I thought Disney had some kind of magical healing power, like one of those Sunday morning revivalist churches where worshippers gets blessed, and hallelujah! they rise up and hop onto roller coasters. And get this -- these fat f*cks go straight to the front of the line!

Thankfully Disney’s “Fast Pass” limits the wait time for most rides. But picture this scene: you spend 45 minutes creeping along 2-3 feet every 15 seconds to ride Space Mountain. Like an Oasis in the middle of the Sahara, the final turnstiles appear on the horizon. You can sense Shang-ri-La. You inch closer, squeezing through the final set of gates, reaching the coveted “next rider” status. The moment of truth. Space Mountain, baby!

But as you prepare to board the coaster, you hear a wheezing puttering sound, like a 1970 Pinto desperately in need of a new muffler. “Hold on, folks,” says the ride operator. He’s smiling, of course, because all Disney employees smile more than the Joker. As you struggle to comprehend the last-second delay, the Blob dismounts from his rascal and steals your ride. Sure, it’s just 1 more ride to wait, but those 45 seconds feel more the 45 minutes you just spent in line. You want to enjoy the ride, but you’re kinda ticked about Tubby stealing your turn. And you can’t shake the fear that his 470lbs might’ve stressed Space Mountain’s brakes. Can this car handle those twists and turns? Will I go flying off the track? And why is this seat so God damn warm?

Anyway, the kids had a blast. A definite “must” vacation for families.

A Difference of Opinions

The Summer of Bone Grafts is finally over. Or close to being over. At least I think it is. I might visit one more doctor, and I’ve got one more test to undergo. Anyway, I’ll treat this blog post like Lebron’s “Decision.” I’ll tantalize you with some background and details, string you along for a bit, and then announce my decision at the very end. Of course, unlike Lebron’s shameless hour-long special, you can simply scroll down now to learn my future plans. You won’t hurt my feelings if you do. I promise I won’t stick a shiv in your back like Lebron did to Cleveland fans.

4 doctors, 4 different opinions. Actually, it’s 5 different opinions, though I didn’t have a fully informed visit with Berman back in April. Let’s recap. Back in April, the CT scan revealed that my tibia hadn’t fully healed. Turgeon’s immediate reaction: I need a bone graft, and the bone is borrowed from the iliac crest (ie, my hip). He believed the screws would remain in place, packing the bone graft and putty around them. The next day, I sought Berman’s opinion on Turgeon’s advice. Berman generally concurred with Turgeon’s approach. The only real difference was that he would replace the existing screws with 2 “flat-head” screws so, hopefully, the new screws wouldn’t protrude through my shin like my current ones do.

Over the next 2 months, I educated myself about bone grafts. I also spent a week in Maui, which was much more fun than reading medical journals. Anyway, I learned that 10-20% of patients who donate bone from their iliac crest experience some type of long-term complication. I also learned that a synthetic substance – BMPs – has a success rate almost as high as using your own bone. And, of course, using BMPs means I would avoid having surgery on my hip, too.
Armed with this information, I met again with Turgeon. This visit was as productive as an Israeli-Palestinian peace meeting. By the time I walked out the door, Turgeon had a lower approval rating than George W. Bush did when he left office.

First, I asked Turgeon to explain the exact surgical procedure he would perform. He would borrow some bone from part of my iliac crest (he told me the specific area, but I’ve since forgotten where), mix it with BMPs, then pack it in around the screws. He wasn’t sure how much of the nonunion area would need to be “cleared out.” The nonunion’s not like an empty sack; there’s some bone and fibrous tissue there. He would keep the screws intact. He feared that yanking them out would weaken the existing bone, similar to how removal of a nail might cause a 2x4 to splinter. Turgeon also said he planned to shave down the existing bone wedge inserted to elevate the patella. Despite several follow-up questions, I never fully understood why he would shave down the bone wedge.

I then asked Turgeon about BMPs. He reacted like somebody farted in an elevator. He simply dismissed the use of BMPs out of hand. No response. No discussion. Nada. Zilch. When I mentioned that several medical journals documented that 10-20% of iliac crest patients suffer long-term problems, he got extremely defensive. He scoffed at my information, questioning the legitimacy of the reports. Um, I wasn’t exactly relying on a 1974 study from Zimbabwe. Rather, most of the articles came from various national orthopedic journals, and one of the studies was co-authored by 2 local surgeons, including the dean of the nearby medical school.

My initial thoughts? He didn’t appreciate me – a non-doctor – questioning his surgical advice. At one point, he grew so frustrated that he made the absurd comment that, “Well, none of my iliac crest patients has ever developed any problems.” Really? None of them? Ever? At that moment, I decided I could no longer trust his opinions.

He did note that I wasn’t likely to shatter my tibia performing normal activities, something I was seriously concerned about. But he warned me that if I fired my quads suddenly – like, say, I sprinted to prevent my child from wandering into incoming traffic – I might yank the screws out.

The visit ended, and Turgeon simply told me to let him know what I chose to do.

Because I entrusted this man 18 months ago with a surgery that would – and did – change my life, you can imagine how frustrating and disappointing this experience left me.

I next met with Alan Jones. I read an article Dr. Jones co-authored that compared the use of BMPs to iliac crest bone grafts. Jones specializes in trauma surgery. Most of his patients are car accident victims rushed to the emergency room after their legs got crushed. While he was careful to note that a patient’s own bone is the best source for a bone graft, he believed that BMPs mixed with cadaver bone produce comparable results, with, of course, the added benefit of not needing to cut my hip. Plus, using BMPs also reduces the time spent in surgery, another bonus. Based on his review of the CT scan, Jones was concerned there might have been some slippage with the screws and cautioned that I needed to repair the nonunion. Jones also noted that he was surprised that Turgeon performed a Maquet for the osteotomy. He didn’t go into details, but he said Maquets were rarely done these days. This was news to me. I was not aware he did a Maquet; Turgeon said he was going to perform a Fulkerson.

Next up was Bob Scheinburg at Texas Orthapedic Associates. My sister-n-law works with Dr. Scheinburg (along with the last surgeon I visited, Mike Champine), and spoke highly of him. Scheinburg specializes in microfractures. Bob was pretty laid back. No matter what I decided to do, Bob told me I likely would have long-term issues with my knee. Not surprisingly, as a microfracture guy, he was critical of ACI. He didn’t think the new cartilage formed was any better than that created after a microfracture. That I expected. What I didn’t expect was his criticism of the Maquet. He took great pains not to criticize a fellow surgeon, and I really didn’t want to play Monday Morning QB, so I simply noted that I couldn’t change what was done.

Scheinburg took his own x-rays. He doesn’t think I need to undergo the bone graft. He noted that enough bone and tissue had filled in to keep the tibia intact. He also pointed out that it’s been 18 months since the surgery, and my leg hasn’t suffered any setbacks. His bottom line advice – do nothing. He cautioned that undergoing a bone graft would basically “start the process all over,” and there were no guarantees my quality of life would improve. After all, the bone graft had nothing to do with my knee. He also thought the screws could be removed, and wondered if removing them might improve things.

Finally, I met with Champine, who works in the same practice as Scheinburg. Like his partner, Champine was critical of the Maquet. After prodding my leg, he noted that I was tender around the screws, but not where the nonunion existed. Champine recommended a more cautious approach. First, he didn’t believe I needed a bone graft, again noting to undergo one would re-start the healing and rehab process. He cautioned that I didn’t want to “constantly chase surgeries, undergoing one to fix a new problem, which might lead to further problems and more surgeries.” He also wondered if the screws could be removed. He suggested that perhaps I could have a cortisone shot (or some similar numbing injection) near the screw to see if that eliminated any pain/sensitivity in the leg. If so, then perhaps that would rule out the need to fix the nonunion area. He also suggested I undergo a particular bone scan to determine the amount of bone versus tissue surrounding the screws. If the screws were embedded in enough dense bone, he believed the screws could be removed. He also assured me that I couldn’t damage my leg doing normal activities.

So that brings us to the moment of truth. What will Jim do?

First, I’m getting a bone scan shortly. Unless something unexpected shows up on the bone scan, I’m not going to have a bone graft. I plan on seeing how the leg feels over the next few months. I might try a cortisone shot near the screws. If the cortisone shot suggests the sensitivity relates to the screws and not the union, and if the bone scan reveals enough bone has filled in, I’ll strongly consider having the screws removed.

Keep your fingers crossed. Lebron took his talents to South Beach, and screwed the Cavs in the process. My talents remain here in Dallas, but maybe I’ll remove my screws.

Bone Graft Intermission -- the World Cup

I probably won’t have any updates on my bone graft for a few more weeks. I’m in the middle of meeting with 3 separate surgeons to discuss the pros/cons of using BMPs vs. borrowing bone from my hip. I already met with one, and he confirmed what my research suggested -- BMPs have a similar success rate as using bone from the iliac crest, with, of course, the added benefit of not needing to cut my hip. My new motto: why cut twice when once will do. The doctor also didn’t think there are any obstacles to using BMP on me. I’ll see what the next 2 surgeons have to say. I hope to make a final decision and schedule the surgery by the end of July.

Meanwhile, let me entertain you with my thoughts on soccer and the World Cup.

I love soccer. Growing up, I played competitive soccer. I’m also a big fan. I attended one of Pele’s matches for the Cosmos. I celebrated with the crazy Brazilians and Dutch after their classic ’94 World Cup quarterfinal match. I’ve been to the 200,000-person Maracana Stadium in Rio de Janeiro to catch a club match between heated rivals, Flamengo and Botafogo. And just like the circle of life, I coach my kids’ teams, just like my dad did for me.

Basically, I feel qualified – and comfortable – to say this: Soccer is NOT about to take off in the US.

People who insist otherwise are almost as annoying as those f*cking vuvuzelas. By the way, they’re horns, people! Calling them vuvuzelas doesn’t make them any cooler.

Anyway, I say this even after watching the US’s thrilling win over Algeria to advance to the knockout round. In my opinion, that game was just as exciting as Game 7 of the NBA Finals. After Donovan scored, I screamed so loudly that my dog sprinted around the living room looking for somebody to bite. But even this victory, and perhaps even if Team USA keeps advancing, won’t convert Americans into regular soccer watchers. Just ain’t happening.

And that’s ok. Let’s just embrace soccer as a niche sport, somewhere behind football, hoops, baseball and even hockey. Actually, it’s probably even less popular here than Mixed Martial Arts (the UFC).

Some soccer-lovers question why folks feel the need to point out soccer’s “place” in the American sports hierarchy, which they liken to soccer bashing. Simple. Many people, including soccer fans like me, are sick and tired of all the “American soccer has reached a tipping point” chatter. Dude, let’s just enjoy the current matches. I don’t need some false soccer prophet telling us that Americans are “finally ready” to love “futbol” as much as the rest of the world does. Loosely translated, they’re saying, “Hey hoosier. If these games weren’t exciting enough to keep you interested in soccer after the Cup, you’re an un-cultured caveman.” Yeah, that’s a good way to get people to jump onto the soccer bandwagon long-term. Thanks for ruining the moment, buddy.

Americans simply don’t want to follow this sport on a regular basis; soccer just doesn’t match up with “American sports.” I’m not trying to denigrate the game or the talent of soccer players (though most of them ARE douchebags), just making an observation.

First, the American culture will never accept soccer or soccer players. We’re a macho society. Guys who kick a ball? Pansies. Plus, Americans hate floppers, soccer players who agonize on the ground, insist on a stretcher to cart them off, and then immediately sprint back onto the field. It’s no coincidence a European – Vlade Divac – brought flopping to the NBA. But not even Paul Pierce getting carried off the court in the 2008 Finals compares to the worst soccer flopper. And don’t even get me started with the whining. Imagine Tim Duncan’s bug eyes on steroids for 90 minutes. Anyway, there’s a reason why every American movie features the star QB getting the girl, not the midfielder.

But our ambivalence with soccer goes beyond cultural objections. Soccer’s usually slow-paced; there’s not enough scoring; and the athletes aren’t nearly as spectacular as guys like Kobe or LeBron. Plus, Americans can’t stand sports in which playing for a tie is accepted. I’d rather get season tickets to the WNBA than suffer through some of these 0-0 draws.

And yet every four years during the World Cup, we hear the US is ready to embrace soccer. FINALLY! REALLY! We’re not kidding this time!

Well, guess what? It hasn’t happened. It didn’t happen when Pele played for the Cosmos. It didn’t happen after the US made the 1990 Cup. It didn’t happen after the US hosted the ‘94 Cup and advanced to the 2nd round. It didn’t happen in 2002 when the Yanks made a surprising run to the quarters. It didn’t happen when David Beckham joined the MLS. And it won’t happen after this World Cup, no matter how far the US advances. Please. Stop saying it’s gonna happen. You’re embarrassing yourself. For the past 20 years I’ve heard folks insist America was ready to embrace soccer. The boy didn’t even cry wolf that long.

Here’s my solution. Instead of demanding that we follow and discuss soccer like it’s a major sport, let’s treat it like a special event. That works, right? Let’s treat soccer more like the Olympics. There are lots of similarities, besides the every 4-year thing. Two years ago, I was mesmerized by Usain Bolt, and religiously followed Michael Phelps gunning for 8 gold medals, like I’m sure a lot of folks were. But am I going to follow track & field or swimming on a weekly basis? F*ck no. In fact, I don’t even want to see Michael Phelps hawking Subway right now. America should impose a rule requiring all swimmers to retreat to their aquariums 2 weeks after the Olympics.

Yet Americans dig these sports during the Olympics. The ratings are fantastic, as I expect the World Cup’s will be. Why? Because we watch them only every 4 years, capitalizing on the novelty factor. Combine that with jingoistic pride, and bingo, you’ve got gold.

Same with soccer. Every four years works. It’s infrequent enough to retain the novelty factor, and not often enough that Americans get tired displaying their patriotism. And we get to root against France. Never underestimate the value of booing the Frogs. That never gets old.

Personally, I think soccer’s best chance soccer of catching on here in the US has nothing to do with the actual game but with the changing demographics of the country. Most Americans will never give a sh*t about soccer, unless their kids are involved. But the fastest growing population segment? Hispanics. They’re immigrating here, and once they’re here they multiply like rabbits. And these people really, really like soccer, about as much as Texans love their guns. Of course, this influx of soccer fans won’t necessarily make US soccer more popular. Mexican-Americans – even those born and raised in the US – still tend to favor Mexico over the US. Hey, it’s better than nothing.

Soccer’s next best hope – a longshot, really – is the emergence of an American Pele. Some man-child who decides he doesn’t want to be the next LeBron but the next Pele. If an American somehow became the unquestioned world’s best player – a guy with dribbling skills that make Brazilians look pedestrian –Americans probably would rally around soccer. I call that the Tiger Woods effect. One guy is such a phenom that average folks tune in just to see what the big deal is. However, I can’t imagine a 6’5”, 235lb inner city kid choosing soccer over hoops or football anytime soon.

In the meantime, let’s enjoy the World Cup, and hope the US can make an unlikely run. But when the Cup ends, let me resume my normal sports obsessions (football training camp! Whoo hoo!) without a slew of “soccer is here to stay” articles. Just like the Olympic torch gets extinguished when the Games close, so too will American’s passion for soccer. But don’t worry, soccer lovers. In four years, there will be even more Americans waiting for the next Cup, including me.

Bone Graft Deliberations

I’ve been radio silent for much longer than usual. Earlier this month, my wife and I spent some time in Maui without the kids. Good times. For a short time, at least, my knee/leg issues didn’t hover like a guillotine above my head. It was just blue skies, cocktails and sand between my toes. Now it’s back to the gallows, er, reality. Anyway, while I was bummed to read about some of your setbacks, it was still nice to hear from my “ACI friends.”

Ok, I’ve spent several weeks researching the bone graft options, probably more time than I spent researching the ACI. Yes, there are synthetic alternatives to the iliac crest, and I’m furiously educating myself about them. When my OS first told me I needed a bone graft from my hip, I asked about other options. He acknowledged others existed, but was adamant they didn’t compare. In fact, he seemed pretty dismissive of them. And it’s true – everything I’ve read since my visit described the iliac crest as the “gold standard.” My second opinion OS also said the hip was the best graft site, and I don’t recall him mentioning other bone graft options. Critically, both surgeons downplayed the negative side effects to my hip.

My research, however, suggests a far greater % of patients suffer drawbacks. Anywhere from 10-25% experiences some type of chronic hip pain or serious limitations. I’m not gonna lie. That scared the cr*p out of me. Now, most bone graft recipients are older and generally undergo the bone graft to fix their spine, or repair a leg mangled in some horrific car wreck. It’s fair to say these patients were likely in worst shape. On the other hand, the failure of my leg to heal the first time suggests I’ve got weak bones, meaning my hip’s probably brittle. In any event, I’m steadfastly opposed to borrowing bone from my hip unless absolutely necessary. I’m scared I could create a brand new set of problems if my hip gets cut.

I’ve learned there are 2 less-invasive options than borrowing bone from the iliac crest. The first involves BMP-7, a type of osteogenic putty. Turgeon mentioned mixing this or similar material with the iliac crest bone graft, but nixed the idea of using it alone. BMP can also be mixed with cadaver bone.

The second option appears to be even less invasive. It involves a bone marrow injection from the iliac crest. I still don’t completely understand this procedure, but it appears the surgeon draws the bone marrow from your hip, and then injects it into the area of tibial nonunion. No cutting involved. Obviously, this would be the preferred route, though I have the sneaking suspicion this procedure remains somewhat experimental or won’t be covered by insurance.
I don’t know whether the TTO or ACI eliminates me as a candidate for either option. No clue. And I’m still trying to pin down the success rates for the different options. Some of the medical journals I’ve read suggest success rates for the BMP bone graft – whether alone or combined with cadaver bone – are 5-10 points lower than the iliac crest bone graft. I haven’t located comparable numbers for the bone marrow option.

Assuming these numbers are accurate, a 10-point decreased success rate seems like an acceptable trade-off to avoid getting my hip cut.

While I sort out the bone graft options, I’ve scheduled a PT visit with the guy the 2nd opinion OS uses. My quad remains weak, even after 16+ months. I’m not sure why. Even though the nonunion in my leg probably limits how hard I can push things, I think an updated PT session might be helpful. Plus, I’ll get a third set of eyes to check out my knee. Even as I stare down another surgery, I remain hopeful that my knee might approach something close to normal if I can eventually build up my quad after I fix the tibial nonunion. I’m probably clinging to hope at this point, but still . . .

Two days after my PT session, I meet again with Turgeon. I plan to question him about the non-iliac crest options. Assuming he disfavors the bone marrow injection and the synthetic bone graft and/or lacks experience with these procedures, I’ll seek out another OS. The problem is that I probably need to get my knee scoped, too, though the knee scope can wait. I prefer to schedule both operations at the same time to avoid multiple surgeries and recoveries. But I only feel comfortable getting my knee scoped by guys familiar with ACI, which pretty much is limited to Turgeon and Berman.

I also want to get a sense for what it would take for my bone and screws to shatter inside my leg. A kick? Getting sacked by LT? Just bumping into the corner of the kitchen table? If I learn my tibia is a ticking time bomb waiting to shatter inside my leg, I’ll need to make a decision asap.