The joys of modern technology

My favorite part of post-op appointments has ALWAYS been to get all the awesome pictures that were taken inside my knee. I have a stack of them, somewhere. Probably lost, at this point, but they're always cool. Yesterday I got to see the doc for the post-op from the first surgery, and sure enough, he came bearing great pics. He had shown them to me at the hospital when I was still loopy, but yesterday he talked me through them again and gave me a copy to take home :-)

So you have fair warning, if you don't like pics of inside the body, you should stop here. Otherwise, check this out:

Here's the cause of all my problems, the hole in the cartilage behind the kneecap. The camera went in below my knee (just above the tibia), so this is looking up my leg. The hole is on the inside area of the kneecap:


That flap he's holding with the probe was most likely the cause of my favorite party trick of having to reposition my knee (with a loud crack) at inopportune moments, like when there was an awkward silence in the room (haha). That "hangnail" would get stuck on something and pull the whole kneecap out of place, so I would routinely have to manipulate it back into place. I don't know why it made so much noise when I did so...in a way I kind of miss it, it was kind of funny, haha. I even pretty much got used to the fact that it also hurt like hell when I snapped it back.

The hole itself is about a centimeter and a half in diameter, and you can get a better image of it in the photo on the right, below. The big problem he discovered is that the cartilage around the hole is compromised as well, it's mushy, which you can see in the photo on the left, below. It totally gives way to the probe:


So all in all, he wants to fix about 2 cm diameter's worth of messed up cartilage. To do that, he took the sample for the lab to clone, from the inner edge of my femur (which is apparently not particularly weight-bearing). Here he is scoring the cartilage with the knife:

Then he took the piece out, and you can see what's left now:

I didn't realize that's where he took the cartilage, but that explains a lot. Like why the interior part of my femur feels like I got hit RIGHT THERE, with one of Roy Halladay's fast balls or something. It's just a bad bruise, he said it would feel better shortly.

Anyway, so that's one plan, called an autologous chondrocyte implantation. The other thing he's doing is called an osteotomy, which repositions my tibia to lift up the patellar tendon (which runs over the kneecap). That will mean that the tendon puts less pressure on the kneecap, which will make the kneecap sit higher over the femur when I bend my leg. The reason this is necessary is demonstrated below. He was bending my leg, and you can see that there isn't enough space between the kneecap and the femur, which means that if he does the ACI but not the osteotomy, the new cartilage will probably just wear away again and leave me with the same damn problem all over again.