My medical history spans over 20+ years, ~10 surgical procedures, hundreds of x-rays, thousands of pages of medical records and countless hours of physical therapy. I have attempted to make it digestible for the uninitiated while still providing sufficient the depth for the professionals. This page summarizes what I am working with from a high level. For the professionals, after reviewing this page, you can get a more thorough and technical description in my medical records catalog.
in my own words - a brief description
24 years ago, in 1989, I was involved in a dramatic little-kid-on-little-bike vs. semi-truck accident. While the truck hardly seemed bothered by the incident I was unfortunately forever altered. I was caught underneath the truck and drug on my side against the asphalt for a sufficient distance to result in severe skeletal, muscular and nerve damage to the lateral side of my right leg. When discussing my injury colorful words have been used such as "degloving" and "debridement" (I don't recommend googling them), but for the sake of the squeamish i'll attempt to keep my retelling PG and a bit more upbeat. I have a lot to be thankful for, it's not often an individual can go up against a 50 ton tractor trailer and stay alive. I even managed to save my bike from getting smashed :)
CT Scan 3D Reconstruction vs Normal Knee
These pictures give a sense of the bone missing, the unorthodox orientation and the resulting deformities (click to expand)
Between then and now a lot of time has passed and a lot of work has been done. To put it simply, what I am left with is a leg missing lots of important parts. I am missing many significant chunks of bone from my femur and tibia that are generally responsible for keeping one's leg from collapsing in on it's self. My leg is constantly attempting to buckle in ways that turn the stomach. To prevent this from happening I wear a full leg brace most of my waking hours. Four pounds of polypropylene, carbon fiber and hardened steel. Along with the bone, all of the bits of connective tissue and muscle that were at one-time connected to these bones, absconded as well (LCL, IT-band, a couple of my quadriceps, and some other more minor characters). The damage continued deeper. My peroneal nerve, whom was not even connected to those other parts, but just happened to hang around with them, was also cast upon the pavement. Guilty by association. Turning an otherwise unscathed ankle, obstinate. It no longer wants to lift up or out when commanded, which is another reason for needing bracing. The damage also affected my growth plates. Since the accident occurred early in my youth, growth or rather the lack of growth, aggravated the problem as I came of age. I now am the owner of bigger leg, and a smaller leg. My right leg is about an inch and a half shorter, with about 30% less girth. Shoe size on my left 10.5, on my right 6. These complications have made shopping for shoes the bane of my existence and made me a Zappos VIP customer. No, seriously. They have a VIP site and I was invited.
Thankfully though, despite all of the damage, my leg's creative abilities were kept whole. Which has come in handy when it needed to figure out how to bend itself without most of the componentry normally involved in this operation. When my knee is extended it kind of looks like knee in the traditional sense, however once it beings to flex it starts to "do-its-own-thing". The tibia and femur rotate, the ankle twists in the opposite direction, the lateral knee compartment buckles, the MCL stretches like a rubber-band and the knee cap just gives up and rolls over. In the end my knee "bends" about 90 degrees without relying heavily on bending in the traditional sense of the femoral condyle rolling on the tibial plateau. It's pretty impressive. However this makeshift solution is only the best that can be done with a bad situation. As it goes into flexion, a weak and unstable knee, gets even weaker and more unstable. But hey, you can't knock the knee for trying. This is the base from which I start.
MEDICAL ISSUES SUMMARY
Alright, enough with dramatics and on to the nuts-and-bolts of it. Below is a fun slide show of some significant x-ray films, a bullet point summary of major issues (I was a consultant once upon a time) and some demonstrative videos. Want to get even more technical? Even further below are the scanned medical files for my last evaluation by an orthopedic surgeon and physical therapist.
Most Recent X-Rays - 12/08/2011 (click to expand)
Muscular & Tissue Issues
- Massive lateral instability of knee throughout range of motion
- Limited knee flexion (degrees active/passive): 90 / 100. However "flexion" is a relative term here, much of the flexion I experience in a practical sense is actually my knee falling into extreme valgus along with my hip externally rotating ~45 degrees.
- Knee valgus in extension / flexion: 15 / 40
- Growth arrested in lateral side of knee (accident), medial side of knee (surgically arrested). Several years after my accident left knee growth was also surgically arrested to mitigate the forecasted leg length discrepancy.
- Leg length differential: Right 1 5/8" shorter
- Leg circumference differential (thigh / knee / calf): Right smaller by 27% / 20% / 35%
- Shoe size differential (left/right): 10.5 / 6 (w/o brace)
- Limited ankle flexion (active dorsi / plantar): 5 / 40. Plantar flexion is characterized by severe supination and inversion.
- Pain profile: Almost none (I got one thing going for me!)
Real World Functionality
Despite the injury, through orthotic design and physical therapy, I have been able to achieve a relatively high level of function. I have participated in tennis and snowboarding throughout most of my adult life. In the last couple years as I have begun to push the boundaries of my condition I have added Crossfit, cycling, swimming, running and hiking to my list of regular activities. I'm always looking for ways to increase functionality across all activities. A few pictures and videos to demonstrate my capabilities.
Watch me play
IN SOME OTHER PEOPLES WORDS
Most Recent Orthopedic Surgeon Evaluation
12/08/2011 - Stuart B Goodman, MD - Stanford Medical Hospital
Excerpt - "I had the pleasure seeing Mr. Conserva. He is 30 years old and comes in for evaluation of his right knee. The patient has a right knee deformity secondary to an accident in 1989, when he was 8 years old. He was hit by a truck and dragged. Subsequently, he had multiple reconstructions for the mangled deformity including intramedullary nail, done by Dr. Tolo at Children's Hospital Los Angles, along with skin grafting and soft tissue flaps. The patient subsequently went on to have Ilizarov placement and medial femoral epiphysiodesis in 1991, by Dr. Reynolds, down in Children's Hospital Los Angles. He also had a contralateral side epiphysiodesis, too. He had a right posterior tib tendon transfer for a dropfoot in 1997. He really reports no pain in his right leg. He is very active and still engages in many outdoor activities including weight training, snowboard, tennis, and running without any problems. He currently wears a knee/ankle/foot orthosis, when he walks with his activities. Without the brace, he does not complain of any locking or instability..."
Most Recent Physical Therapist Evaluation
07/31/2013 - Leslie Torburn - Stanford Medical Motion & Gait Lab
Excerpt - "Mr. Conserva is a 32 year old male with a history of (R) lower extremity trauma when he was hit by a truck at age 8. He is referred for a gait evaluation to assist with treatment management. Mr. Conserva’s past medical history includes numerous surgeries and skin grafts, including a (R) posterior tibial tendon transfer for foot drop, a (L) epiphysiodesis, and a (R) limb lengthening. He is a community ambulator with the use of a (R) KAFO until 6 months ago, when he started using an AFO for community mobility, and the KAFO only for tennis, snowboarding, and other sports. Mr. Conserva reports pain in the (R) gluteal area when using the AFO for community ambulation compared to no pain with the KAFO, and (R) knee pain with running greater than 5 miles..."