How did you hurt your knee? That sounds like a simple question, but in my case, it really isn’t. It was a common question when I was on crutches in High School, and now again, while I am wearing a big knee brace while traveling around the world. Unlike most people in those situations, I didn’t hurt my knee. I don’t really remember a time when my knees didn’t hurt, but there was never any traumatic event that caused the problems or the pain.
Patellar Subluxation, Dislocation, and Osteoarthritis
As an adult, I know the problem is from the knee caps partially or fully dislocating. Recurrent subluxation or dislocations over a long time cause the loss of cartilage in the knee area from osteoarthritis. Osteoarthritis is the “wear and tear” type of arthritis more usually caused by injuries or age. By the time I was 15, I had stage 4 osteoarthritis – the last stage, commonly called “bone-on-bone.” At that time, the only solution for stage 4 osteoarthritis was a total knee replacement. The problem was no one made artificial knees sized for young girls, so that wasn’t an option.
First Signs and “Growing Pains”
 |
| First Grade |
My parents first took me to a doctor about my knee pain when I was in Kindergarten. It was diagnosed as “growing pains.” By first grade, I was falling down from subluxation and the occasional full dislocation of either knee cap during physical education class. Since children fall down frequently, no adult really noticed what was going on. I would just wait until the knee cap moved back to where it belonged, or if that took too long, I just hit it back into place. Naturally, the big words of “subluxation.” and “dislocation” were not in my vocabulary, so telling the doctor “my knees hurt” and “I fall down” did not change the diagnosis away from “growing pains.” I imagine my description of hitting my knee cap into place was beyond comprehension.
I don’t remember how old I was when I told my Mom I didn’t want to go to the doctor anymore because all he would say is that I would grow out of the pain, even though it got worse every year. The only way I could think of to stay away from the doctor was to stop talking about the pain and the falling down. So I guess I just stopped talking about it.
In second grade, my Mom signed me up for the local swim team. Swimming was a pretty good sport for my problem – I only had issues with dives and climbing out of the pool. A few years later, Mom signed me up for alpine ski lessons. Usually, the first lesson in skiing is how to fall down and get back up.
So my falling down didn’t seem any different than anyone else. The cold did make the knees hurt worse. When I was 13, my parents decided to put me on a children’s ski racing team. Naturally, I fell down during the races and rarely completed a race. But “fear of winning” was a big thing in popular psychology at the time, and my parents had me nearly convinced that was the reason I fell down in the ski races. It didn’t explain the falling down just walking, but I guess I still didn’t talk about that.
So my falling down didn’t seem any different than anyone else. The cold did make the knees hurt worse. When I was 13, my parents decided to put me on a children’s ski racing team. Naturally, I fell down during the races and rarely completed a race. But “fear of winning” was a big thing in popular psychology at the time, and my parents had me nearly convinced that was the reason I fell down in the ski races. It didn’t explain the falling down just walking, but I guess I still didn’t talk about that.
I went from ski racing to becoming a ski instructor while I was in High School. I worked as an Associate Ski Instructor for a couple of years but by the time I had enough experience to apply to become a Certified Ski Instructor, the knees wouldn’t cooperate. There was no way I could pass the demonstration portion of the test.
 |
| Skiing at Stevens Pass |
When I was 15 or 16, one knee swelled up so much I couldn’t walk on it. I was still refusing to go to the pediatrician. My parents decided I had to go, but they picked a different pediatrician as part of our negotiations. The new pediatrician put me on crutches and told my parents that they needed to take me to a specialist. There was a new field of orthopedics called “sports medicine” that was just coming into being, and I went to the first sports medicine clinic in Seattle, which was under the University of Washington football stadium and part of the College of Medicine. Dr. James G. Garrick headed the clinic and all the research.
Diagnosis and Treatment
Within minutes, Dr. Garrick diagnosed what had caused all the years of pain. A combination of a slight case of scoliosis, a slight difference in length between right leg and left leg, underdeveloped medial quadricep muscles, and tendons, which pulled the knee caps to the outside and dislocation. A combination of things that just didn’t “grow right”. Nearly all the damage that could have been done by the subluxation and dislocations had been done already.
The only known solution for the resulting osteoarthritis was total knee replacements for both knees, but that wasn’t a viable solution for my age. I hadn’t yet hit my full height of 5’4” and weighed around 105 pounds. All Dr. Garrick could do was to try to alleviate the pain by putting me a few clinical trials and experimental physical therapy. He also put me on a regimen that included taking 8 aspirin a day to reduce the swelling in my knees. Eventually, he got me into the last stage of clinical trials for a surgical procedure he invented called “lateral release”. It is now the most common surgical procedure to treat patellar subluxation.
He wanted me to drop out of high school during my senior year to do the surgery. I was not willing, so he scheduled the surgery for the last day of the final stage of the clinical trial – the morning after my high school graduation. Because I decided to graduate instead of taking the year off, I spent much of my senior year in a blur of pain. But I was still teaching skiing. I couldn’t demonstrate much, so I had a junior instructor helping me with all my classes. A few of my high school classmates were aware of what was going on and helped me keep up with my classes. One friend somehow figured out how to tell when my knees were going to give way, and he would catch me before they buckled. He would hold me up until the knee cap popped back into place, and then I would head off to my next class.
First Knee Surgery
The morning of surgery, Dr. Garrick came in and asked me to pick which knee he would operate on. They were in equally bad health, so it didn’t really matter which one and I chose the left. After surgery, I woke up with no pain – something I was not wholly comfortable with. As the surgical anesthetics wore off, I started feeling more “normal”. Even after it all wore off, the surgical pain from the left knee was less than the usual pain (which I still had from the right knee). The nurses kept trying to get me to take some kind of pain killer, but I refused. Eventually, they put morphine into my IV when I wasn’t watching, and we all discovered that morphine made me very ill.
Dr. Garrick moved out of state into private practice a few days after my surgery. His remaining associates were uncomfortable in dealing with the rehab of Dr. Garrick’s last surgical patients, and they kept me on crutches for 3 months, which caused a lot of issues with the knee that hadn’t had any surgery yet. I had to wait for Dr. Garrick’s protégé, Dr. Steven Bramwell, to graduate from residency before I could get the right knee treated.
Second and Third Knee Surgeries
I started having stomach problems and asthma from the aspirin regimen, so Dr. Bramwell switched me to coated aspirin and later to naproxen. The bursa on the right knee became extraordinarily swollen, and nothing Dr. Bramwell tried would reduce it down to standard size. Eventually, he decided that the bursa had to be removed. During the surgery, he discovered that several nerves were damaged from being stretched across the swollen bursa. After surgery, I lost all feeling between my knee and my ankle. A couple of years later, these nerves came back to life. Fortunately, all the nerves in and around my knee were still working.
About six months after Dr. Bramwell removed the bursa, he scheduled the left knee for surgery again – this time, the lateral release. The lateral release was successful, and for several years I managed to stay upright. I was still taking naproxen to control the swelling.
