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My experience with knee problems began in 1976 (age 25) as I was working as a bicycle courier while attending college in Santa Barbara, CA. I was dodging traffic while returning from a delivery and got tangled up in some construction equipment. My right leg was snagged in a temporary water main hose and my knee was extended and twisted. After two weeks in a knee immobilizer, it felt O.K., but after two years of conservative treatment, I was having marked pain, swelling and clicking sensations in my knee. A torn lateral meniscus (the cushioning pad between the upper and lower leg bones) was identified. On July 21st 1978 surgery was performed at Cottage Hospital in Santa Barbara by Dr. David K. Gordin. What should have been a routine, partial lateral meniscectomy using the cross-knee technique was complicated as (unbeknown to the surgeons) my lateral geniculate artery was nicked during the procedure. Following two weeks of repeated, painful hemarthosis (blood in the joint) and seven aspirations (draining of fluid through a needle), another surgery was performed and the artery was identified, stitched and cauterized and massive blood clots were removed.. What followed were months of painful rehabilitation as my knee was severely
traumatized by the back-to-back surgeries. I managed to work my way back
into shape, but the damage done by the botched procedure kept me in pain
and by 1980, I needed more surgery if I was to continue being active in
sports. At that time I sought out renowned orthopedic surgeon and Olympic
Ski Team doctor J. Richard Steadman who practiced in South Lake Tahoe
CA. In January of 1980, Dr. Steadman performed the following procedure:
What that all means in terms of a diagnosis is that at the age of 29, I had degenerative joint disease in the lateral compartment and on the undersurface of the patella. What that meant in terms of continuing to pursue sports such as tennis, running, hiking and skiing was very depressing indeed. While the surgery would restore relatively pain free movement, it could not restore my knee to anything like normal and I was advised to "give-up" impact type sports or I would surely continue to have problems. Being only 29, a very athletic person and enjoying all the activities just mentioned, this was extremely bad news. The only saving grace was that my rehab (after 8 weeks on crutches and endless 'leg lifts') was to consist of "bicycling with low resistance". Bicycling is my favorite way of staying in shape, so I was relieved that I could still do that. In fact, bicycling became a kind of spiritual quest after that.(Click HERE for more on bicycling).
I managed to continue on for two years 'till knee pain and swelling once again had me on the operating table In Dec '82 (#4). That surgery and the next ones in '84 and '88 (#'s 5 & 6) were mainly to remove loose debris and smooth out areas that had re-grown fibrocartilage. These were all arthorscopic procedures performed by Dr. Steadman. Within a few weeks of the procedures, I could gradually perform "normal " (sans hiking, jogging and tennis) activities. I skied exclusively on the monoski during the winter and rode my bicycle in the spring, summer and fall. I accepted the repeated procedures as the price I'd pay to continue participating in my beloved sport. In October of '92, I had surgery again (#7) this time on both knees as my left knee had a torn medial meniscus of undetermined origin(#1 left). These surgeries were done by Dr. Terrence Orr as Dr. Steadman had moved to his new clinic in Vail, Colorado. Procedures included Arthroscopy with chrondroplasty , drilling with an ice pick and debridment of the right knee and arthroscopic medial meniscectomy and patellar chrondroplasty of the left knee. After recovering from those surgeries, I was fitted with an "unloader" brace to take the pressure off of my lateral compartment which was exhibiting increasingly diminished joint space…….in other words, there was little space between the upper and lower leg bones (femur and tibia) and they would occasionally contact one another and cause a short burst of excruciating pain. Interestingly enough, this only happens while walking or standing…never while skiing or cycling. I believe the bent knee position of those sports keeps the "kissing spots" on the bones from contacting each other. Dr. Orr informed me that it was the last debridment procedure that would be helpful. After that, I'd need something more extensive if I was to continue with an active lifestyle.
The ski season of '98/'99 was another great one in Tahoe and I monoskied 2 to 3 times a week, but only in soft snow conditions. Soft snow like; powder, packed powder, windblown and spring "corn" and slush are all very forgiving and are lots of fun on a monoski.. My knee would tolerate this activity fairly well with a minimum of pain as long as I:
The best medical prognosis 20 years ago would not have included skiing as much as I'm still able to so I have to consider myself "lucky" to still be skiing and biking at a high performance level.. None the less, I am currently (April '99) experiencing more pain while walking or standing and my range of motion is diminishing. I'm of the opinion that a relatively new procedure currently available will restore quite a bit of function to my knee and extend it's "useable life". This would entail increasing the joint space by cutting a wedge out of the tibia and then inserting a graft of cartilage (super-sterilized bovine or human cadaver) onto the tibial plateau. I am currently exploring whether this procedure, or some variation thereof, would be advisable. As stated on the home page, I hope to have this and the subsequent rehabilitation completed and back to full (expanded??) physical capability by my 50th birthday on April 13, 2001. UPDATE…….January 2001
With the pain in my knee getting worse, I consulted with head U.S. Alpine
Ski Team surgeon Dr. Terrance Orr at the Tahoe Fracture Clinic (visit
their website at www.tahoefracture.com). After an extensive review of
my history and a frank discussion of my desire to continue with an athletically
active lifestyle, Dr. Orr offered me the following choices: After all the pros and cons of the various options were discussed, we elected to proceed with the osteotomy . This would restore the joint space in my lateral compartment and allow the new microfracture to heal without the bone-on-bone situation I was currently experiencing. I would have a better chance of skiing with this procedure then with the others and still leave myself the option of future replacement. The surgery (#10) was done on 1-04-00 and entailed microfracture as described above and then cutting the femur just above the condyle and taking a wedge out of the bone. The femur is then rejoined with a stainless steel plate and screws. The result is that the alignment of the right leg is changed to open up the space between the femur and tibial plateau in the lateral compartment.
By Fall of 2000, I was able to walk and stand with virtually no pain. I even took a 5 mile hike on uneven terrain with no pain…..something I'd been unable to do for years! There was, however, a persistent "clicking" sensation at the lateral joint line…a sensation I was all to familiar with and felt that it was probably scar tissue that needed to be removed. Dr. Orr agreed and on 11-03-00…10 months after the osteotomy…another surgery (#11) was performed. Scar tissue and adhesions were removed and inspection of the previously drilled area on the lateral tibial plateau showed approximately 85% coverage with new fibrocartilage. This was very encouraging and a few more microfracture holes were placed to extend the coverage of new growth. While there is no absolute "proof" of this, I believe that the Human Growth Hormone (HGH) I've been injecting twice daily since July '99 increased the rate of cartilage growth. (See the supplements page for more on HGH).
Dr. Orr suggested a course of Synvisc injections. Synvisc is a viscous and elastic sterile mixture of hylan A fluid, hylan B gel and salt water. Hyaluronan is a natural chemical found in particularly high concentrations in joint fluid. It acts like a lubricant and shock absorber in the joint. Three doses of Synvisc are injected directly into the joint over the course of 2 weeks. Maximum benefits are not realized until 8 to 12 weeks after treatment. I seemed to notice an improvement with the first injection. At this writing (1-16-01), it's two weeks after my 3rd Synvisc injection and I've been able to bike fairly hard and even monoskied and cross country skied a little with NO PAIN!! The "clicking" sensation at the lateral joint line is virtually gone. With regular, focused stretching, my r.o.m. is up to 135 degrees. If this trend continues…and I fully expect it to…I should meet my goal of skiing and biking at a high performance level with a reconstructed knee by my 50th birthday on 4-13-01. At this time I want to acknowledge a few people who have greatly helped me in my quest to remain athletically active despite my condition. First off, my deepest thanks to Dr. Terry Orr and his staff at the Tahoe Fracture Clinic. Without Dr. Orrs' expertise and dedication to his art, I'd probably be in a wheelchair now. Additionally, his generosity in lowering his fees has made these expensive procedures bearable. His entire staff, especially Lynn, have helped me through my recovery. Tami in the insurance office has been an angel in helping me with the frustrations of getting the insurance pigs to pay up. Thanks also to Dr. Richard Steadman and his staff for keeping me going all these years. Dr. Steadmans' contributions to the art of knee surgery are legendary and orthopedic surgeons worldwide use techniques he's pioneered. Many thanks also to Dr. Larry Foster of the Tahoe Clinic whose advice
on healing and anti-aging strategies has been invaluable to my progress.
His starting me on HGH and monitoring my progress have made a huge difference.
Dr. Foster has sponsored my rehabilitation by supplying me with HGH and
the necessary blood tests at his cost. Visit his anti-aging website from
the 'SPONSORS' page. See you on the slopes Larry!! Please check back
periodically as I will update this web site with information on my progress
and any new products or techniques which may be helpful to those facing
similar challenges!
UPDATE 11-16-02 Hard to believe that it's been almost 2 years since my last update. Thanks to all who have written to share their own stories and to thank me for inspiring those who are facing similar challenges. I celebrated my 50th birthday (4-13-01) monoskiing at Heavenly Valley, CA! Here's my current status: I'm still bicycling although not as strenuously as in the past and I'm looking forward to the up-coming ski season. My knee is doing reasonably well despite having had another surgery (#12) on 6-29-01. That surgery was primarily to do a medial meniscectomy. While my major problem is in the lateral compartment, after the osteotomy, more of my weight was shifted to the medial compartment and in April of '01 I was unloading from a chair lift and upon quickly standing up to move out of the way of the chair, I felt a sharp pinch in the back of the medial compartment. While the pain passed quickly and I was able to ski through the end of the season, I was experiencing intermittent pain in that area. I guessed correctly that the posterior portion of the medial meniscus had been damaged. By June my right knee was locking up due to the torn cartilage in the medial compartment and the surgery on 6 -29 revealed a flap tear of the posterior horn of the medial meniscus which required removal of 50% of the posterior horn. Additionally, the lateral compartment showed good healing across the tibial surface with a small area of near-full-thickness loss involving the posterolateral joint region. The recurring scar tissue in the lateral gutter area was also removed. Summer '01 and the '01/'02 ski season passed without any real problems with my knee. In the summer of '02, I was once again experiencing some intermittent right knee pain and Dr. Orr ordered x-rays. The pictures revealed that my lateral compartment had reverted back to the diminished joint space that resulted in the osteotomy. That was bad news as we had hoped that the osteotomy would last perhaps 5 years. My next option is a total knee replacement which I will put off as long as possible. In the meantime, my knee works reasonably well if somewhat painfully at times. UPDATE 2-2-04
I''ve just monoskied my first 10 days of the '03/'04 season (5 in succession) and my knee is holding up very well with minimal pain and swelling. All the supplementation, bicycling, and Hgh seem to be paying off. I also suffered a severe shoulder injury this past summer necessitating extensive surgical repair on 8-13-03 and that has healed beyond expectations for being less than 6 months post-op. The message stays the same: Your body is a near miraculous healing machine...you just have to give it the proper care and nutrition. Amen UPDATE 8-31-04 After completing the '03 / '04 ski season with no injuries and only transitory and minor knee soreness, I find myself living in Southern California to take care of my 83 year-old mom. After almost 30 years of living in the mountains, this has been a major adjustment. Fortunately, there is access to mountain biking within 10 minutes of my mom's home. However, when the heat of summer hit, I had to find a way to stay cool and still exercise. I dusted off my surfboard and started making regular trips to the coast 30 minutes away. Surfing is an exciting and fulfilling sport but the rotational forces involved are tough on my knee. I'd just bear the pain and apply ice packs when I returned home. I had sometime ago suspended the use of anti-inflammatory drugs in favor of food based Cox II inhibitors (see supplement page) and ice packs after activity. To my delight and amazement, in July of '04 I was introduced to a supplement made from the tropical fruit Garcinia Mangostana (mangosteen). Mangosteen is the richest natural source of a group of substances called xanthones (pronounced zan thones). Medical research confirms what I have personally experienced: Xanthones are extremely potent anti-inflammatory agents. Please visit my links page and click on the links to abstracts of medical studies listed on PubMed. Since I started using mangosteen with it's high concentration of xanthones, I have enjoyed a reduction in pain and inflammation in ALL my injured joints (knee, shoulder, elbow, wrist). Please consider adding this valuable supplement to your inflammation management program.
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That
summer I bicycled like never before and resumed water skiing with little
problem. THANK YOU DR. STEADMAN!!! Now came winter and another snow skiing
season and the prospect of NOT skiing was so depressing that I decided
to go ahead and face the consequences. Hiking, jogging and tennis were
negotiable…..skiing was not. After the first surgeries in '78, I had altered
my skiing technique to accommodate using shorter skis to reduce the chance
of twisting my knee, but that did nothing to reduce impact forces. Early
that season (80/81), two close friends introduced me to the monoski and
after some initial frustration, I got the hang of it and it was certainly
easier on my knee with both feet on one, wide ski. (more info. on 
In
September of '95, I had a microfracture procedure done by Dr. Steadman
in Vail. (#8) This entails 'punching' holes into the surfaces of
the bones. The purpose of this is to get blood to flow to the surface
of the bones so that they can grow fibrocartilage……a rough substitute
for the original, cushioning cartilage that no longer exists there. The
rehab. protocol requires eight weeks on crutches and extensive rehabilitation
before resuming "normal" activities. With that behind me, I had a great
ski season in '96 and '96/'97 and '97/'98. In April of '98 I was
in Colorado for a monoski summit and afterward underwent diagnostic arthroscopy
(#9) at the Steadman/Hawkins Clinic in Vail. The good news was
that 50 to 60% of the previously drilled area was covered with new fibrocartilaginous
tissue (not too bad for a 47 year-old who skis 60 to 75 days a season).
The bad news was that a repeat microfracture with it's long rehab would
be necessary to try and get the rest of the bone surfaces covered. This
done, I endured yet another lengthy rehab…the second one in less than
2 1/2 years.
The
rehab from this procedure was lengthy and painful and my range of motion
(r.o.m.) was noticeably reduced. By late February 2000, I was riding my
bike again and in late April, I even monoskied 2 runs in perfect, groomed
spring conditions with no knee pain!! My r.o.m. gradually improved with
constant stretching and help from Lynn at the Fracture Clinic. My endurance
for bicycling continued to improve and in mid June I tried to ski again
(Mammoth Mountain, California had just gotten a foot of snow….in June!!).
Groomed runs were no problem, but steeper, un-groomed terrain was too
much at that point. I put my monoski away for the season and concentrated
on cycling, stretching and pool work-outs.
With
#11 behind me, my 3 to 4 weeks of using crutches passed quickly. I was
in the pool and using a stationary bike within a week. My efforts to continue
a sports oriented lifestyle were recognized by the folks at Innovation
Sports and they sponsored me with a new brace. The O Asis brace is specially
designed for people like 
me
with osteo arthritis. It's much lighter and easier to wear than my old
brace. You'll see me wearing it while on tour with the first U.S. Monoski
Demo Team during the winter of 2001. Please visit Innovation Sports website.
Also please visit the White Knuckle website for more information on monoskis
and the Demo Tour. My rehab, supported by the HGH injections, progressed
quickly. The only fly in the ointment was the return of the scar tissue
along the lateral joint line. In reviewing all my previous op reports,
a pattern of scar tissue growth in that spot was evident. At 6 weeks post-op,
more surgery to remove it was not an option medically, psychologically
or financially.