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I am 39 and am fast approaching knee replacement. My original injury was a ruptured patella tendon, dislocated and fractured kneecap, and torn cartilage. About 8 years ago I had a second surgery to remove scar tissue, and ended up having a microfracture procedure done. Holes were bored into my patella in hopes that the marrow that "bled out" would become similar to cartilage.
Last year I was in such severe pain that I could not bear any weight, so I had an MRI. Much to the surprise of both my doctor and I, it was not a torn meniscus. However, all of my "new" cartilage was gone...with reffing basketball and umpiring baseball over 200 nights a year, he was surprised I lasted as long as I did before coming back to him. What the MRI revealed, the doctor told me, was that "it looks like somebody has been beating on your knee joint with a hammer." My options at this point were the following:
1. Stop officiating basketball forever.
2. Knee replacement, and stop officiating forever. My doctor said that if I had my knee replaced at 39 years of age, he wouldn't release me to officiate anymore because the wear and tear would sufficiently damage the artificial knee and surrounding live tissues so that future knee replacements wouldn't fare as well.
3. Get an unloader brace that would shift weight bearing to lesser affected areas of my knee. My brace was about $2000; insurance covered 90% of that.
Obviously I chose option 3. After another couple of additional months of rest, I wore it for the first time in a D2 exhibition game in October 2012. It took a bit of getting used to, but it seems to work for me. I'll never be able to avoid the arthritis and stiffness that occurs, but I made it through the entire 2012-2013 season without issue because of the unloader brace. Depending on if you wear short tights or leggings, you may get some chafing from the brace. It's big and bulky and it sucks to wear but to me, it's worth it to be able to continue officiating.
FWIW, the doctor advised me that doing a lot of stretching, keeping my weight down, and doing some leg strengthening exercises for my quad in my bad leg would do nothing but help.
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