By Lindsey Christie, Knee1 Staff
Gretchen Moore thought she was going off for a nice day of skiing with her son. Two years and three surgeries later, Moore has yet to get back on the slopes and is uncertain whether she ever will. However, Moore is back to riding her bike, shoveling snow, and looking after her four active children, thanks to the help of Dr. Jack Farr and the Cartilage Restoration Center.
At a small resort in Southern Michigan, Moore spent an enjoyable morning on parabolic skis. After she and her son finished lunch, they traded skis and Moore found herself on an older pair of long, skinny skis. She noticed that the snow conditions had changed while they were inside but didn’t think much of it. Unfortunately, however, the new conditions, strange skis, and her tired legs were cause for disaster. On her first run of the afternoon, Moore took a nasty tumble and her skis did not release. The fall was so bad that Moore could no longer ski and had to be transported down the slope on the back of a ski-patrol sled. When asked about her fall, Moore says, “I just overdid it.”
Moore was immediately taken into town for X-rays and medical attention. X-rays revealed that Moore had fractured her lateral tibial plateau. The physician who examined Moore told her that she should head home to her local hospital to have her badly damaged knee repaired.
The next day Moore went to the emergency room at her hometown hospital to have her knee “set.” Moore’s orthopaedic surgeon completely removed her torn meniscus and tried to repair the rest of the damage with three internal fixation screws. Moore was discharged with instructions to see a physical therapist. Although she was in pain, Moore was anxious to begin her recovery.
Nine weeks after getting off of crutches, Moore was still unable to walk. It was now May and her injury had occurred in January. Extremely disappointed with her progress and frustrated at the toll the injury was taking on her family, Moore went back to her orthopaedic surgeon. This time, he removed the hardware (or screws) he had put in four months earlier and performed the microfracture technique on her knee to try to stimulate the growth of articular cartilage.
Moore left the care of her doctor with the understanding that she would be healed by mid-summer. However, when summer arrived, Moore was still in significant pain and unable to walk properly, even with a brace. She was taking samples of the arthritis medication Celebrex to help with the pain and swelling she felt in her injured knee.
In October of 1999, almost 10 months after her injury, Moore was desperate for help and decided to contact Dr. Jack Farr, Medical Director of the Cartilage Restoration Center in Indianapolis, Indiana. Moore had heard that Dr. Farr was doing work with meniscal transplants and she wanted to see if he could help her.
Upon examination, Dr. Farr recommended that Moore undergo a surgery that would entail implanting a fresh composite transplant consisting of a small shell of bone, the overly living articular cartilage of the plateau, and a natively attached meniscus to replace her missing meniscus and damaged articular cartilage, as well as repair the deformity to the tibial plateau (a result of the initial fracture). Dr. Farr hoped this procedure would relieve Moore’s pain and restore function to her knee.
Moore was willing to try anything to get back to her normal routine and agreed to the surgery. She then had to wait for a proper tissue match. Unfortunately, however, her insurance company did not approve the surgery and Moore was left in pain once more.
With a recovery within reach, Moore could do nothing but wait and hope. Moore and her husband switched their health insurance carrier and were happily surprised when her surgery was approved. Her physician could then begin the search for precisely sized and matched fresh donor tissue. They found a match for Moore in April of 2000, and she was headed for the operating room on Easter Day.
Moore’s third corrective surgery was long and involved. Dr. David Brokaw, a specialist in trauma reconstruction, assisted Dr. Farr in reestablishing the proper bone height, articular cartilage and mensicus to her knee. The new tibial plateau was stabilized with five screws and the soft tissue of Moore's new meniscus was secured with sutures. Unlike the many outpatient procedures patients experience today, Moore remained in the hospital for four days.
It has been almost 10 months since Moore’s last surgery and although she is not back to her pre-injury level of activity, she is no longer taking pain medication, has no limitations with activities of daily living, and states that she is “75 percent recovered” and suffers no more severe pain. Dr. Farr told Moore that it would take up to one year for the “creeping substitution” to take over the bone portion of her surgical transplant and allow for recovery.
Moore knows she still has some work to do to make a full recovery, but she is an active participant in her therapy. Three to four times a week she swims, bikes, and lifts weights to increase muscle tone, flexibility, and strength in her knee. Moore says she can feel herself recovering as each week passes and she and her husband have high hopes of completing a weeklong bike trip during the summer of 2001.