Knee Surgery (Part II) - Pre-Surgery

(Continued…) After my MRI, I was given the names of a couple of specialists to see.  I was able to get in to see the first doctor immediately, as it was through MGH (Mass General Hospital, for those that don’t live in MA!), where my friend worked.  For purposes of this story, I’m not going to mention any of these doctors by name (except the one that actually did my surgery).  I saw the first specialist (“Doctor #1”) in late October (2015), who touted himself as the doctor of the Red Sox and Patriots.  The visit did not go well…and it’s not just because I’m a Philly guy!  I’m sure he’s a great surgeon, but his approach just didn’t work for me.  He just acted like it was no big deal…does it all the time (or, one might say….a little arrogant!)  However, to me, it was a HUGE deal.  He lost me midway through the appointment.  I just felt like he was busy and had better places to be.  Just to be clear, however, his approach to the repair of the knee was spot on.  All of the doctors that I saw told me that I needed a tibial tubercle osteotomy (TTO), which would help the knee track better, and limit further cartilage damage (Where the doctors differed was how to treat the deteriorated cartilage).  If you’re not familiar with a TTO, it’s not pleasant.  Basically, the tibia bone is cut and moved, then screws are inserted to hold it in place. 


After that initial visit, I was pretty down.  Going in, I wasn’t really sure what my prognosis would be.  But, hearing that my bone would likely need to be voluntarily cut and moved scared me to death.  I really wasn’t sure what my athletic future would hold, if any.  At that point, I just wanted to be able to run around with my kids.  To make matters worse, I couldn’t get in to see the second specialist until March, as he was in high demand.   The one thing I did take away from that initial visit with Doctor #1 was that he suggested I try to get back to some physical activity on it….running, biking, etc..  The only issue with that was that the Baker’s Cyst was pretty painful and would swell up, making it hard to even bend the knee.  It was also a wonderful feeling to hear my knee “cracking” as I would walk up the stairs!  But, I did my best to stay in physical shape.  I did some training on the elliptical, the Concept II rowing machine and some cycling.  I barely ran….maybe a couple 20 minute runs on the treadmill. 

In late October, while trick or treating with the kids and neighbors, my neighbor, Mike, started talking to me about a guys’ ski trip to Taos, NM.  I love to ski, and this trip sounded awesome!  However, I honestly wasn’t sure if I should go, as I didn’t know if my knee would hold up.  So, I called my buddy at MGH again.  We had a long talk.  He wasn’t against the trip, but told me that there were risks.  After talking with my wife, I decided to go.  I mean, I wasn’t sure if I’d be able to ski again after the surgery….so I might as well get one last trip in, right???!!!

The ski trip was at the beginning of February, 2016.  I didn’t know any of the guys, other than my neighbor….but everyone was great!  We all met up in Santa Fe, where we flew in, then drove to Taos.  I hooked up with one of the guys to do some skiing the first morning.  After we got our demo ski gear, we were on our way.  Unlike the snow in Utah, where I had skied a few times recently, the snow in Taos is deep….but it’s not light and fluffy.  It’s somewhat heavy.  We skied for about an hour and a half, then headed up to Kachina Peak, which is all double expert. 


I was pretty stoked to ski this.  First run was fine.  Second run, I was about halfway down and BAM…DOWN GOES PAT!  On a turn, I felt something give and down I went….and I couldn’t get up.  It took me 5 minutes to get my leg around and get up.  My buddy was at the bottom looking up, waiting for me.  I gingerly tried to make my way down (still skiing on a double expert mind you!).  When I finally got to him, I told him that I thought I tore something in my left knee.  I told him to keep skiing and I would be fine.  I left him and made my way down the mountain.  My knee felt like it was bending backwards….it’s an awful feeling.  I made it to the lodge at the bottom (which isn’t actually  at the base of the mountain).  It took me a while to get my boot off.  I knew the knee wasn’t good.  But, then I quickly pulled out my phone and Googled “ACL Tear”, which is what I feared I had….and I had pretty much every symptom.  Now, I had to make my way to the mountain first aid.  I had two choices….(a) I could take the lift back up and ski down or (b) I could call ski patrol.  Not knowing where I was, and having already skied on the knee, I opted for (b).  So, I got strapped into a sled and brought over to first aid.


The beauty about Taos is that since it so far removed from civilization, they pretty much have a hospital ON the mountain.  They took some xrays when I got there (they don’t have MRI), which were negative.  But, they assessed it as an ACL tear too.  They strapped a brace on me and sent me on my way.   Skiing turned to solo beer drinking for the next day.  As awesome as Taos was, I decided to cut the trip short and head home.  I couldn’t bear watching everyone head out skiing every day while I was stuck in a full knee brace on the couch. 

In late February, I was able to get my second opinion from Doctor #2 at Brigham & Womens.  However, this time, we were also dealing with an ACL repair (MRI revealed a complete tear).  The visit went well, and I liked the doctor.  We came up with a game plan for the knee.  He wanted to do Autologous Chondrocyte Implantation (ACI).  This is where, through an initial, smaller procedure, a small amount of my cartilage is harvested, then cultured and multiplied, in order to patch the defect in a later (secondary) procedure, which would still include the TTO and ACL repair. 

Brigham & Women’s Hospital Outpatient Care Center at Patriot Place

Brigham & Women’s Hospital Outpatient Care Center at Patriot Place

On April 22, 2016, I had the initial procedure done at Brigham & Woman’s Hospital Outpatient Care Center at Patriot Place in Foxboro.  Although it was minor, I was still given crutches and told to stay off of it for a few days.   Again, as this was a two-step procedure, I had to get insurance approval for both.  This meant a holding pattern until the second procedure was approved….which turn out to be a blessing in disguise!

While waiting for insurance approval, I ran into a friend and Boston Triathlon Team teammate of mine, Ed Galante, who had similar issues with his knee, and had actually gone through the ACI procedure.  He suggested that I speak with a woman on our team (who I didn’t know at the time), Courtney, who was formerly the physician assistant (“PA”) for Doctor #2, and now was the PA for another doctor at the same practice, Dr. Andreas Gomoll.  I had heard of Dr. Gomoll in doing my initial research about the surgery…he’s considered one of the top orthopaedic doctors around and is on the cutting edge of cartilage replacement. So, I reached out to Courtney via email and she was quick to respond.  She asked if she could look at my chart, which I agreed. In doing so, she diplomatically told me that I shouldn’t move forward with the scheduled procedure….that I had other options to consider. What I found out is that Doctor #2 basically pioneered the ACI procedure….so he loves doing it….to the point where he doesn’t consider the other options.  Anyway, Courtney helped me get an expedited appointment with Dr. Gomoll (it pays to know people!). 

My visit with Dr. Gomoll went very well.  He told me that he felt we could avoid the ACI procedure by using a cadaver cartilage to patch the cartilage.  We would still need to do the TTO and ACI, but avoiding the ACI would be HUGE with recovery time.  Here’s what I didn’t know and/or completely understand (shame on me for not knowing)… me, the ACI procedure sounded good because I’d be patching my cartilage defect with my OWN cartilage.  BUT….I didn’t understand the recovery.  With ACI, you can’t do anything on the knee for about one year…so you don’t really know if the surgery was successful for about one year…and there’s a good chance it won’t be successful.  With cadaver cartilage, the recovery is much, much quicker.  It takes about three months to know whether or not it was successful.  I cancelled my scheduled surgery with Doctor #2 (my insurance approval had come through just before my visit with Dr. Gomoll), and scheduled my surgery with Dr. Gomoll for Monday, October 3, 2016…the day before my 13th wedding anniversary (to be continued…).

PART III (The Surgery)


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Patrick Dwyer