Meniscus repair for her knee to eliminate sounds of ‘snap, crackle and pop’

June 8th, 2020
Vickie Revels, an EMT with the Peyton Fire Department, will go in for her meniscus repair soon.
Vickie Revels, an EMT with the Peyton Fire Department, hopes the meniscus repair on her knee will eliminate the “snap, crackle and pop” sound. Photo courtesy of Vickie Revels.

Vickie Revels works by day as a medical assistant in a cardiology clinic and nights and weekends as a volunteer firefighter and EMT for the Peyton Fire Protection District.

Whether on a firetruck or in a clinic, she loves taking care of people. About a year ago, she had a mishap herself. While taking out the trash, she tripped over something in her yard and landed hard on her right knee.

Since then, she jokes that her knee makes the sound of a popular cereal when milk is added.

“I sound like Rice Krispies because it is just snap, crackle and pop,’’ Revels said. “Right now, it’s continuous pain. It’s like someone stabbing a knife into my knee while I am moving.’’
Inclined to tough it out, Revels didn’t see Dr. James Duffey, an orthopedic surgeon at UCHealth Grandview Hospital, until early March, just as the COVID-19 pandemic began to envelop the United States.

A torn meniscus and bursitis

When Dr. Duffey delivered the results from her MRI, it was through a Virtual Visit. Duffey explained that Revels had a torn meniscus and bursitis, inflammation of the fluid-filled sacs in the joints. Duffey said she needed arthroscopic surgery, a minimally invasive procedure to repair damage to the meniscus. With medically-necessary surgeries having resumed at UCHealth locations across Colorado, Revels’ surgery is scheduled for mid-June.

Dr. James Duffey Duffey specializes in both simple and complex sports injuries, arthritis surgery and total joint replacement of the knees, hips and shoulders., including meniscus repair.
Dr. James Duffey, who specializes in both simple and complex sports injuries, arthritis surgery and total joint replacement of the knees, hips and shoulders, including meniscus repair.

Duffey, who has practiced in Colorado Springs since 1995, works primarily at Grandview, which offers total joint replacement surgeries for knees and hips; along with foot and ankle; comprehensive hand, forearm and elbows; and shoulder surgeries. A seasoned pro, Duffey specializes in both simple and complex sports injuries, arthritis surgery and total joint replacement of the knees, hips and shoulders. He has performed hundreds of arthroscopic surgeries like the one he will do for Revels.

Duffey said meniscus tears typically do not heal over time and likely why Revels is having symptoms a year after her injury.

“We assess each tear individually, initially with MRI and later with direct inspection at the time of the arthroscopy,’’ Duffey said. “We repair tears with suture whenever possible. The geometry of the tear and assessment of blood flow to the torn fragment dictate whether we attempt a repair. If not, we remove the torn piece and smooth the remaining contour of the meniscus.

“Fortunately, so long as greater than 50% of the meniscus remains and there is no significant arthritic change, the knee is unlikely to progress to arthritis over the next 10 to 20 years,’’ Duffey said.

The meniscus transmits load from the rounded end of the femur bone to the relatively flattened tibial surface. If a meniscus is completely removed, the knee will absolutely progress to end-stage arthritis within 10 to 20 years.

“Quite a few of our middle-age patients already have some degree of arthritis present at the time of arthroscopy which does affect the long-term prognosis,’’ he said.

What does a meniscus repair look like?

Duffey said the “snap, crackle and pop’’ sounds in Revels’ knee come about as the torn meniscus fragment flips in and out of the joint. The knee arthroscopy he will perform is typically a 30-minute procedure done under light, general anesthetic.

“I use local anesthetic within the small 1 cm incisions so when the patient wakes, there is not much pain. Patients typically leave for home within an hour after surgery,’’ Duffey said.

Patients who have arthroscopy surgery often don’t need crutches and return to normal activities of daily living within a week or two. Recreational activities can usually be resumed within a month, though the presence of arthritic change within the knee may prolong recovery.

Revels is aware of the multiple protocols adopted by UCHealth to keep patients safe during the novel coronavirus outbreak. One visitor is allowed to accompany a patient. Accommodations to allow for physical distancing are in place in waiting areas.

There’s more time between surgeries at Grandview to ensure that professional environmental services teams have adequate time to disinfect surgical suites and pre-operative areas. Staff are wearing sterile Personal Protective Equipment to protect themselves. Since the coronavirus outbreak began in Colorado, no patients with COVID-19 were cared for at Grandview.

“We feel quite confident and comfortable resuming medically-necessary surgeries like Vickie’s. Patient safety is always our first priority, and that’s true now and always,’’ Duffey said.

Revels is eager to have surgery because she believes it will help to alleviate her pain. Since her jobs require her to be on her feet, she anxious to have her knee fixed. As the lead medical assistant for Dr. Sirisha Yarlagadda, a cardiologist at the UCHealth Heart Clinic – Memorial Hospital Central, Revels knows that patient safety is always the No. 1 priority.

“I have a big heart and I enjoy being able to help people,’’ she said. “I love patient care.”

A photo of UCHealth Grandview Hospital, which is an orthopedic-focused hospital that also offers general surgery, including meniscus repair, and an Emergency Room
UCHealth Grandview Hospital is an orthopedic-focused hospital that also offers general surgery, including meniscus repair, and an Emergency Room. Photos by Mark Reis.

As a medical assistant, Revels makes sure that Yarlagadda has everything she needs to take care of patients. She checks a patient’s blood pressure, heart rate, temperature and reviews the list – if there is one – of medications that patients are taking. She reviews vital information and how to reach emergency contacts.

After patients meet with the doctor, Revels spends time with patients afterward to review their After Visit Summary to ensure all questions have been answered. Revels then may get a patient’s consent and schedule a procedure or test ordered by the doctor. She said she empathizes with patients and their families because her husband had a severe cardiac event 6 years ago.

“I chose cardiology because I’ve been in their place,’’ Revels said. “My husband had a heart attack at a young age of 40 and I knew nothing of what was going on. Now that I have learned a lot more, being able to tell the patients and their families that I understand what they are going through –it usually makes them usually feel more at ease.’’

Helping others without the knee pain

On the fire department, Revels responds to structure fires, wildland fires, accidents, domestic violence incidents, medical events and more.

“Even if I can’t save someone, I want them to know that I gave them everything I could. I try to give them the best chance,’’ she said.

She recalled being summoned to a rollover traffic accident on a rural road only a few months ago. She lay on her belly on snow-covered ground, so she could look into the eyes of a 28-year-old man who was pinned under a truck that had rolled on top of him.

Disoriented and scared, the man told Revels that he was going to give up.

“You’re not giving up,’’ she told him. “We’re doing everything we can. I will give you everything that I have. You’re going to stay with me and we’re coming out from under this truck together.’’

Miraculously, the man walked away with bumps and bruises and no serious injuries. A few weeks ago, he visited the Peyton fire station to thank the men and women who helped him that day and announced that he had plans to get married.

Stories like that make all the difference to Revels. In a few weeks, she’ll have outpatient surgery at Grandview Hospital and after recovery, she’ll resume both her jobs with a new skip in her step – minus the snap, crackle and pop.

 

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About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.