But Renee was 15 and an avid, year-round athlete. Although the prospect was a drag, it was clear she'd need to have her knee surgically fixed — and soon. Recovery can take six months to a year.
In June, Renee started the longest and most costly phase of recovery: physical therapy to get her left leg back to where it was, so she could return to the volleyball court for her next varsity and club seasons. And — athletics aside — it would be nice if she could have the best left leg possible to help walk her through the next seven decades of her life.
Progress was slow. Her knee was scarred with several holes and a 2-inch incision, and underneath her flesh she was wounded in two places — first, where the surgeon harvested a piece of tendon attached to her knee bone to fashion a new ligament, and second, where that ligament went in to replace the one that had ripped.
The weak link
The ligament giving my daughter such trouble is a short band of tissue running inside the knee between the thighbone and the shinbone. It's crucial for knee stability: It stops the shinbone from sliding too far forward, and prevents the two bones from twisting relative to each other. Land from a jump with a too-straight knee, or twist the leg as you abruptly swivel, and the stress can rip or stretch it. Once damaged, it cannot be restitched.
A year ago, I'd never heard of the ACL. Now I'm running into ACL tears everywhere. My pal Patti. A close colleague. The buddy of a buddy. Even my mom, who ripped hers 20 years ago when she wandered into an auto shop and fell into a grease pit. If there's a weak link in the human musculoskeletal system, the ACL appears to be it.
Surgical procedures
A month after Renee's injury, we sat in the office of orthopedic surgeon Dr. Marc Samson, idly studying a colorful chart of sundry tendons and bones, an athlete tumbling to the ground and a disaster area of a knee described as the "unhappy triad" for its three torn structures: knee cartilage; ACL; and another ligament, the MCL.
Samson delivered the expected but still-depressing news. The MRI showed there was a high likelihood Renee's ACL was trashed, and that she'd probably also damaged her knee cartilage — the meniscus. He'd stitch that meniscus if he could. But often the mends don't take, which can mean arthritis down the road.
There were surgical options to consider. Renee could receive a tendon from an organ donor or one from her own body — a sliver of tendon from her hamstring muscle, or a tendon linking her kneecap, the patella, to the shinbone.
Samson recommended the patellar tendon graft; he said it provides the most reliable results. But it takes longer to heal than a cadaver graft, for obvious reasons: A new injury is created even as the original one mends.
March 25, she was under the knife. We arrived at the crack of dawn and waited our turn for the surgery, which would take about two hours.
When it was over, Renee's father and I met Samson in the waiting room. The ACL had been torn right through. Surgery went great. No damage to the meniscus after all.
Right back to work
No lolling about in a cast eating bonbons for Renee. Barely had she revived from the general anesthetic when she was walking the hospital floor on crutches flanked by two physical therapists, a long black brace around her bandage-swathed leg to keep it straight. They even had her climb and descend the stairs.
Once home, a swift six hours after surgery's start, the mollycoddling also was brief. A nice man had delivered a hulking surgical device with the look of an instrument of torture — a continuous passive motion machine. It would bend and flex Renee's leg to help her regain a full range of motion, and we were to crank up the angle of bending by 10 degrees each day. Renee was to put her leg in it for as many hours as she could. When she wasn't doing that, she was to start — right away — doing leg drills to begin the long climb back to her original strength.
In the days that followed, we went through prodigious quantities of party ice to keep the injury cool, and spent lots of time wrestling her in and out of the brace that would keep her leg straight when she walked and bendable when she was in the machine. Three days after surgery, a pain pump delivering medicine to the surgical site was removed.
Renee was lucky: The post-surgery pain can be considerable, but she experienced little of it. The Vicodin she'd been prescribed went untouched.
Slightly more than a week after the surgery, she was off to school on her crutches.
Not long after, I watched as she went through her drills at Professional Orthopedic & Sports Care in Pasadena, Calif.
"It's flabby, it's dormant," physical therapist Maureen Regan said, touching Renee's quadriceps muscle as she manipulated Renee's knee. "It comes back, but she's just not been walking, she's not been getting the impulses."
The sleepiness of those muscles was evident as Renee walked gingerly to the parallel bars and began a drill of raising her left foot over a ball, lunging forward then stepping back again — with deliberate motions so that her leg could clearly relearn things she'd never had to think about before.
New discoveries
Several things struck us as the weeks rolled by. One is the disconnect between what surgeons said she needed — physical therapy fast, and plenty of it — and what her insurance gives her.
We experienced waits for appointments, a canceled appointment and limits on how many sessions she'd get. Six weeks post-surgery, Renee finally had the first physical-therapy session paid for through her plan. We are lucky we could pay for extra sessions.
We've also noticed a lack of doctor awareness. Initially, Renee's then-pediatrician sent her off with instructions simply to rest up for a couple of weeks. A 16-year-old student who works out with Renee said the same thing happened to him. His doctor said it wasn't an ACL tear, and the teen went back onto the soccer field — popping his knee a second time. Either that time or the first, he damaged his meniscus as well.
This might have happened to us, but an orthopedic-surgeon acquaintance offered to look at Renee's knee on a Sunday and made a quick provisional diagnosis.
It's been a busy and not-fun experience filled with faxing, phone calls, waits for MRI approvals and knee-brace approvals, figuring out how to get her the surgeon we wanted, endlessly scribbling instructions on bits of paper and wondering whether there was some crucial thing we were forgetting that would raise the risk of knee pain or disability down the road.
The main thing now is the future — not just rehab, but figuring out how to lower the risk of another ACL tear, either to the grafted or the still-uninjured knee.
As awareness of this common injury increases, sports physicians and surgeons have been trying to devise preventive training, through learning better landing and pivoting skills or building muscle strength. Several programs have demonstrated success — and we plan to investigate.
For Renee, giving up year-round volleyball is not an option.
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