Life in the surgical lane

Injuries: Adult athletes know they will face, inevitably, a time when their bodies compromise their ability to compete. A Columbia writer offers a snapshot of one such moment.

November 25, 2001|By M.K. Livengood | M.K. Livengood,SUN STAFF

I really wish there were a warranty for what has been my biggest investment of the past 13 years - my right knee.

I underwent my fifth knee surgery last month. I am, for the record, neither an exceptional athlete nor an exceptional klutz. And no, I don't get a frequent orthopedic customer discount.

Operation No. 1 was required after I accidentally tripled in a 1988 co-ed softball game. Egged on by my teammates, I tried to make it to home plate, which was guarded by a 6-foot-2 bearded monster with a cast on his right arm. I jammed on the brakes. My right knee stopped, but my body didn't.

The obvious problem - torn cartilage and strained ligaments - was minor in the scheme of things. The real problem was that I bought into the prevailing notion that I'd be back on the field in two weeks, just like the pros. A lack of physical therapy (I swear the doctor never said a word about rehab) plus continually reinjuring the knee in basketball and more softball led to surgery twice more during the next 2 1/2 years.

Three years of orthopedic normality followed, until a basketball game one afternoon. As I turned to shield the ball from my brother, I felt and heard that pop! - I had ruptured the anterior cruciate ligament, the injury that often derails the careers of pro athletes. In Operation No. 4, a tendon from my shin was transformed into a new ACL, but there was good news.

First, I could forever blame my brother.

Second, I came to a genuine appreciation of pain, limits and frustration. Three surgeries and assorted bumps and bruises through the age of 27 hadn't really enlightened me. I still took for granted daily tasks - walking up stairs, lifting my dogs into the car - as well as the ability to heal quickly and then do what I wanted without a second thought.

It wasn't until I couldn't do even the routine tasks that it all sank in. This epiphany wasn't produced by the surgery itself, but by the extensive - and excruciating - rehabilitation afterward. It took 18 months to recover.

I returned to sports with wise, not reckless, abandon. New knowledge and heightened fitness - brought on by extensive physical therapy - made me appreciate the body's abilities and limits. I also was able to accomplish more difficult and varied activities, enjoying a second childhood that included things I wouldn't have tried before surgery: 10-mile road races, 100-mile bike rides, countless soccer leagues.

Friends think I would be a far greater athlete if I hadn't injured my knee so badly; it is because I've injured my knee so badly that I am as active I am.

Taking the fifth

You know how you take your car into the shop for an oil change, thinking 30 minutes, $19.99, then you're out of there? But then the mechanic produces a mile-long list of all that's wrong? That's how I describe this fifth and, I hope, final knee operation.

I severely twisted my knee playing soccer during the summer. A few weeks later, I aggravated it in a charity tennis tournament.

My doctor's remedy was simple enough: "clean it out." The initial problem, a large cartilage tear (medial meniscus), was easily corrected. In addition, he found a small tear in the other cartilage (lateral meniscus, no big deal), bone spurs (arthritis, no surprise) and, much to my despair, evidence that my surgically reconstructed ACL was near its end.

One more episode, my doctor told me, and the ligament would rupture. Again. Uh, thank you, no.

`It hurts when I do this'

Quitting sports seems a simple enough solution. But giving in to another injury is about more than cartilage or ligaments. It's defeat. It's being forced to accept limits. And, yes, it's about age.

The follow-up visits to my orthopedist were sobering. Another reconstruction was one option. Dr. Robert Viener, who works out of Ellicott City and Laurel, said that medical advances have made it so that a reconstructed ACL should last forever - if it's not reinjured. He estimates that 10 percent of reconstructed ligaments, if ruptured, will need to be redone. The most common injury he sees among adult recreational athletes is to soft tissue - cartilage, ligaments, tendons - usually because of overuse and under-conditioning.

The 30- to 40-year-old weekend warriors that Ellicott City physical therapist Mary Jane Ward treats suffer various ailments. Their sports might differ, but the root of their injuries is generally the same.

"The most common cause, I think, is that these people forget they are no longer 18," Ward said. "They try to do things they did when they were younger and their body cannot handle it. I frequently recommend to someone who is prone to reinjury to change sports. Ultimately, it's their decision."

For me, it's really not just deciding for or against more surgery, for or against more soccer. It's time to really consider long-term ramifications. The first time a doctor warned me about arthritis and a full knee replacement, I did what all 23-year-olds do: I figured that I was 23, so he didn't really mean me.

It's different now. It's not just modifying my present but guarding my future. I need to remain active to stay happy and healthy, but being too active might mean more damage or more pain that won't appear until years later.

Still, I'm only 35 and just not ready to switch to golf full time.

But ACL surgery really, really hurts, and I just don't want to do that again.

After slipping into a short-lived funk, though, I've regrouped. I've got a plan to get back to the basics - leg strength, muscle stability, general fitness. Soccer is out, tennis is a maybe. Grudgingly, I'll find less stressful, lower-impact substitutes that keep me competitive without the lateral, quick and potentially damaging demands on my knee.

You know, it's only 118 days until the inaugural D.C. Marathon.

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