Examination by Dr. Lars Petersen

Today was a “special treat.” Well, a special treat in the world of knee surgeries. Dr. Lars Petersen, the Swedish pioneer of ACI knee surgery, examined my knee. It was like the hand of God touched my knee.

Lars was in Dallas for a major knee surgery conference. I suggested he grab some Tex-Mex. (By the way, I can only imagine how exciting knee conferences are; hopefully more stimulating than law seminars). Anyway, Lars stopped by my surgeon’s office to check out my knee, as well as the knee of another ACI patient. According to Lars (and my surgeon), my knee seems to be healing ok. It’s tracking well and my flexion’s good. I’m still a few degrees short of full active extension, but neither doctor was concerned.

I pointed out the “clicking” noises my knee makes during the extension process, typically around the 45 degree mark. Lars nodded expectantly, as if my question was #1 on the list of FAQs. After manipulating my knee several times, Petersen explained that the cloned cells are still hardening. Because the graft site is pliable at this juncture, the cartilage has not yet formed a smooth surface. He used the analogy of something crashing over a step. I understood what he meant, but think I’ve got a better analogy.

Imagine a tire rolling slowly over a pothole. The tire dips into the hole, rolls across the crevasse, before smacking into the back edge of the hole. The tire then climbs up and out of the pothole, emerging back on the smooth paved surface. Well, when the bone/cartilage inside my knee passes over the site, it creates a slight indentation on the graft site, producing a clicking noise as it dips down and smacks against the existing, hardened cartilage. The clicking is supposed to end once the cloned cells mature to create a smooth surface area.

I also asked Lars about the knuckle-cracking sounds coming from the back of my knee. Typically, these sounds happen while walking, after my knee is fully extended or locked. Again, Lars manipulated my knee several ways. This time, he also squeezed certain spots along the top of my calf and the bottom of my hamstring. I don’t recall his precise explanation, but he concluded the patella tendon underneath my knee needed to be loosened up. Not only was the tightness causing the popping, that was probably a primary reason why I can't reach full active extension. I realize I’m not the knee expert, but this explanation didn’t seem as convincing as the one for the clicking sounds. Regardless, Lars said the popping noises were normal and nothing to be alarmed about. Easy for him to say.

Of course, I now want to know when (and how) we’ll determine whether the cloned cells are hardening. Turgeon says he’ll probably take an MRI of the knee in early July. That’s the 6-month mark. By that time, he should be able to gauge the cloning process. In other words, he'll be able to see if the cloned cells have filled the lesion. In the meantime, both surgeons gave me the obvious advice of staying away of rehab exercises that caused the clicking noises. They also suggested I rest my heel on a table and contract my quads to loosen up my patella tendon.

Both think I’m on the right path. Hopefully their intuition is correct.