Sonia's Knee Surgeries of 2004 and 2005

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Fair Warning: This is not a happy fun page. It contains unpleasant images and a somewhat depressing back story. Read at your own risk.

See update at the end of the page for how things are as of end of August 2005 & July 2006.

When Sonia was about 16, her mother badly injured her right knee, cracking it hard against a corner while beating her. Typical behavior in the household at the time. It was a bad injury, and (somewhat uncharacteristically) her parents took her to a doctor.

The doctor evidently decided that there was no bone damage and the injury was not serious. Sonia had to ask him for crutches specifically, so at the least, he was unaware of the extent of the pain. Very likely, her parents talked to him and made him believe that she was exagerating. Meanwhile, the pain was bad enough that she could not walk at all.

It isn't clear whether the doctor's inaction was due to incompetence, or interference from Sonia's parents, or whether the doctor planned a follow-up if there was no improvement. Quite likely the latter, since that's fairly standard procedure. Either way, she got no further medical treatment at the time.

That doctor didn't find out about the fragments of bone (the biggest over a centimeter in diameter) that had broken off her femoral condyle. She had a hole in the bone in the knee joint where the femur (the big thigh bone) presses against the tibia (the big lower-leg bone), and had free-floating bone debris in the joint.

Her household did not take the injury seriously. Her father mocked her attempts to cope - since he had a problem with his knee, he claimed (and maybe even believed) that she was just imitating him. Her mother did the same, and dismissed the concerns of other relatives, laughing at how silly Sonia was, claiming her mother hurt her, when her mother didn't do anything.

The pain, caused mostly by the free-floating pieces of bone, came and went. At school, her fellow students claimed she was faking, because sometimes she was able to walk with almost no trouble, and at other times, she was on crutches, trying to deal with the pain. Some adults and students noticed the recurring injuries throughout Sonia's childhood, but her father managed to play the system to keep any action from being taken. Sonia herself assumed all of this was normal, so did nothing, and told counselors everything was fine.

Eventually, she just sort of learned to live with it. She couldn't move around as well as she used to, and she wasn't nearly as active, but when you grow up with constant pain as part of life, and get hurt more if you complain, you stop noticing it consciously. And it's not like it was the only long-term injury her parents gave her. It's hard for most people to understand this part - how she ignored it, and was able to live with it - and why she started noticing again so many years later. Ask her sometime, if you're curious. There's a lot more to it than I can easily go into.

So things were until the end of 2003. At this point, she was 24, and leading a gradually more active life. Her knee increasingly began to bother her, particularly during martial arts as she was getting to a higher rank and being pushed harder. At the same time, she was beginning to set aside the old habits of ignoring pain. The knee got overworked and inflamed for no obvious reason (no injury had occurred since all those years ago), and stubbornly refused to get better. So we went to see a doctor.

An x-ray showed almost nothing. It had a ghost image that looked like a bone spur in one place, but that was subsequently taken to be a sensor ghost. Most likely, it was one of the bone fragments showing up.

Sonia's doctor had her get an MRI. Seeing the results, he referred her to a surgeon. The MRI had showed an area of darkness at the tip of the femur, suggesting a cartilage defect in the area.

The surgeon to whom we were referred was pretty vague and useless. He talked in generalizations and did not explain what any of the procedures he suggested were. He also implied that the situation was pretty hopeless. We asked some friends for suggestions, and went to another surgeon for a second opinion.

The second surgeon was a little more clear, despite numerous mentions of the perfect way in which (glancing up) we had been engineered. After elaborating on the possible injuries, he told us there was someone better qualified to handle this complex a problem, and referred us to an expert in the city. (Not that we live out in the boonies...)

This last surgeon (Jeffrey Halbrecht in SF) was helpful. He explained that MRIs were far from perfect, so it was hard to tell what was wrong based on the scan. The only way to tell was to go in and take a look. Depending on the cause, there were different things that could be done: microfracture to try to regrow cartilageous tissue, or transplants (osteochondral graft), either from other places on the bone, or from a cadaver, or from cloned tissue. But since there was no way to know from the outside exactly what the severity and type of problem was, the surgeon would have to go in prepared for any of the above and do what the situation dictated.

At this point, Sonia could not walk much, and the knee hurt even at rest. Not a lot of choice to it, so we went ahead with the surgery. It was arthoscopic - they make two point incisions in the knee and insert video cameras and instruments, doing all the work through those portals, minimizing the invasiveness of the procedure.

This (first) surgery was on March 22nd, 2004.

When the surgeon went in, he found pieces of bone floating around the joint, worn smooth by the years, like pebbles on the beach. The biggest was about 1cm in diameter.

The area of the femur from which the bone broke off was the weight-bearing part of the condyle (that rounded thing at the end of bones), so every time she stepped, she put pressure on raw bone unprotected by cartilage. The gap had partly healed, but about a 1.5cm x 1.2cm area of patchy surface remained. Doesn't seem like a lot, but imagine it inside you, where one leg bone meets the other, with fragments floating around, in and out of the joint. And Sonia is not a big girl.

The surgeon removed the fragments and did microfracture on the area of the femur from which the shards had broken free. Microfracture is a process where tiny holes are punctured in the bone to increase blood flow to the area in the hope that scar tissue forms over the raw bone. Not as good as the original cartilage, but a lot better than nothing. The microfracture has about an 85% success rate.

Sonia fell in the remaining 15%, but we would not know this for another year.

A long recovery followed. Months of not being able to place any weight on the leg, having to lie in the CPM (continuous passive motion) machine for six hours a day, then months of therapy made especially long because the therapy was tailored for gradual recovery alongside a successful microfracture.

This is the CPM machine: it goes back and forth, back and forth, slowly, for hours at a time, keeping her knee joint in motion without putting strain on it.

Six months later or so, she was able to walk again.

The knee no longer bothered her when she was resting - after all, there were no more bone fragments there. But when she walked, or was active at all, it would start to hurt again.

We gave it every chance to heal, but in January 2005, we went to same surgeon again. A new MRI showed the same darkness in the bone.

Again, the surgeon said there was no way to know exactly what was wrong without going in. Almost certainly, however, the microfracture had failed, and the area of unprotected bone was what was causing the pain. This time, it would be a bigger operation - at the very least, there would have to be a transplant, and the surgeon might have to cut the knee open all the way, leaving big scars. Again, the success rate was uncertain.

On February 11th, 2005, she went under the knife again.

When she was coming around from the anesthetic, Sonia freaked out the doctors and nurses when she panicked, trying to warn them that her mother was coming to hurt her again. Something like "no, she's coming, she's coming... she's going to beat me", over and over. They managed to calm her down, but there were some extremely concerned nurses asking her about the cause of the injury when she finally woke up.

The surgery went all right, as far as we know, as these things go. The surgeon found the area of patchy cartilage, just as hypothesized. Some of the area had filled in from the microfracture, but a 1.2cm area of damage remained.

The surgeon removed this bad tissue, leaving a hole 1.2 cm in diameter, and almost as deep, into the bone.

Then the surgeon did a transplant from another, non weight-bearing, area of the femur. The maximum graft size is 1cm, so he made a plug that size and filled the rest in with bone paste.

The aftermath of the second surgery was a lot worse than that of the first. She spent a week on heavy painkillers, trying to deal with the extremely unpleasant aftereffects of the anesthetic. She fell less than a week after the surgery, landing on the bad leg, screaming horribly at the pain. The meds made her throw up continuously, her chest hurt, her stomach ached, yet she had to dump more into her system because of the pain. She had never had to take that much medicine, and is still having to take (a slightly smaller dose) weeks later. Now it hurts a little less, she's out of the knee splint, back in the CPM machine.

As of writing this, it's the 23rd of February. She has months of recovery before we know if the surgery succeeded. There's no way to tell from the outside, except to wait and see if the knee still hurts. Meanwhile, she has to miss the wedding of a close relative, a milestone birthday of another, a trip to visit her relatives and friends in Canada, another California spring and summer (we're not planning on settling down here, so chances are limited), months of martial arts classes (and presumably getting to rank with me), and it looks like we may have to put off our move back to Boston and her going off birth control because of this.

Hopefully, this time, the knee will heal all the way, and she can move on with her life.

Sonia doubts that most of her relatives will understand. When told of incidents like this one, most still say "family is family", choosing ignore the reality of what has happened.

Sonia had tried to stay in communication with her mother, trying to take care of her, even though she had not forgiven her mother at all. Now that Sonia has realized more of the extent of what happened during her childhood, she has forgiven her mother some, but wants nothing to do with her, or her father, or her brother. It's weird, but... well, look at the photos above - this is only one of the physical injuries.

That is not family. Family would have cared enough to act differently, to change after such terrible things happened. But for all that Sonia's mother (years later) realized how badly Sonia was injured, and may be sad over it, she'd do the same thing again if the situation repeated. When a pattern happens enough times, eventually, you just have to accept it and move on.

So we're moving on.

If you'd like to talk to Sonia, send her an email or call. If you don't know our contact info, send something through the contact page, and it'll get to her.

Update Aug 30 2005:
Sonia is doing a lot better. She has not yet started to be able to run, but she can walk okay, can handle stairs, and has pretty good endurance. The second surgery has definitely been more successful than the first, although it is too early to tell whether the knee is fully recovered. Most likely, it will never be as good as it was before the injury, but at least Sonia can now do most of the things she wants to be able to do.

Update Jul 12 2006:
Well, a lot of time has passed. Her knee was hurting today again - it still does that fairly often. She can't do full martial arts classes, but she can do some, and run and jump some, though not for long. She is in Kung Fu, she went to AX 2006, and was able to walk around normally for most of that. So things are looking good so far.