Tuesday, July 01, 2008

Divergent Path Exploration

Trying to help the layman. Look up the anatomical terms via Wikipedia (in another Firefox Tab) if you haven't been reading along up until now.

Yesterday's post was before I saw TGC's GC broadcast. (My posts are always timed UTC)

News: 3 weeks on crutches non-weight-bearing, no range of motion for 3+ weeks, "some cartilage stuff". "Told to stay off planes". "Leg swelled a lot on the flight home". "I've been in pain 10-12 years (loosely)". It'll be nice for it to be normal again (more or less)". Sorry, I didn't take notes, but these are close enough.

Malarkey. No simple ACL, not even close.

Normal again? No.

We're supposed to be awed that he did what he did on an abnormal knee and he's going to be better on his "better than new knee".


What are the surgeries? What happened in there?

1 - All the pivot shifting required a complicated lateral meniscal (LM) repair. No good LM, no good knee. Period. Very likely, perhaps most likely reason for altered post op course. This post op course suggests this as most statistically likely possibility. The delayed range of motion (ROM) really brings into play the need for another procedure to mobilise knee as it is more likely to get stiff. Earlier intervention (day 9) than ideal (14-21, in my opinion) suggests this repair was needed. These do work, but better on the medial side because the blood supply is better.

2 - All that pivot shifting and a lateral meniscus transplant was needed. Not good. Not at all good. Worse than #1 rehab wise, timeframe wise, however ..... potentially better outcome if it works and they had a good match of an Allograft.

3 - OCD was bad enough to require osteo-chondral graft. Really bad. Borderline awful. Not so likely, but still possible. No confirmed evidence of OCD.

4 - (Reconstruction Comments) Contralateral (opposite leg) hamstring for graft - not such a great choice in my opinion. Surgeons do what they are comfortable with, though and they could have done a multi-bundle recon. Nothing ominous. Or is it? Ipsilateral (same leg) hamstring is not at all my favorite and certainly you don't want to add further damage to that knee (One that already swelled a lot, etc., etc.). Patellar autograft not used. An already significantly damaged kneecap-thighbone (patello-femoral) joint could be cause and also not so good. Risk of patellar baja (lowered kneecap) with this option. (It happened to me; I can't squat all the way on that knee I had done). Autograft middle third of patellar tendon is still most surgeon's "Gold Standard".

Special note: Tiger clearly chose not to have an Allograft - probably would have been best option for early return, he may have not wanted someone else's tissue. Small chance of added complications.

5 - Significant swelling on the plane - worry about cumulative damages. Now's as good of a time as any to suggest strongly that the knee will not be "better than new", if you get my drift. "Told to stay off planes" - increased swelling - increased risk of DVT and PE (Deep vein thrombosis (blood clots) and Pulmonary Embolism (clots going to lungs)) - just like Hogan. Those are bad things.

Tiger's a billion dollar baby and the economy is already in the shitter.
Don't shoot me, I'm just the guy with an education giving additional informational possibilities. Press releases can be rubbish.

Sounds like he's got an interesting road to travel.

Fortune Cookie says: May you live in interesting times. One never knows if that is a blessing or curse until after the times are over.

And just as Chairman Mao once said when asked about the long-term effects of the French Revolution:

"Too early to tell".

It is indeed too early to tell. Good Luck Mr. Woods.

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