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William "Bill" Nauseef, a 57-year-old infectious disease specialist for University of Iowa Health Care, sized up the daunting challenge.
Ahead lay 200 miles of hot, dry desert known as Death Valley.
His challenge: cover the distance quickly on a bicycle, competing stroke for stroke against other athletes who, like him, had trained passionately for the race.
Nauseef didn't win the 2007 event. His strong finish, however, signaled a remarkable comeback over knee pain so severe it threatened to end his ultra-active lifestyle.
Nauseef was no stranger to grueling challenges. Between 1973 and 2003, he had logged 78,000 miles as a competitive runner, completing three dozen marathons and many ultra running events, running across the Grand Canyon and back, finishing the Pike's Peak Marathon twice, and running up (and back down) Japan's Mt. Fuji
Along the way he weathered the usual aches and pains but little more. Then, after one particular 100-mile race in 2003, he could run no more.
"It hurt to walk; it hurt to move," he says, "I had limited mobility."
Nauseef visited the UI Sports Medicine Center at University of Iowa Hospitals and Clinics, where he was seen by orthopaedic specialist Ned Amendola, MD. The Center's doctors and therapists treat competitive and professional athletes at every level.
Nauseef was hoping for a quick fix …perhaps a routine scope procedure to repair a simple meniscus tear. Unfortunately, the problem was more serious.
In fact, the root cause—a biomechanical defect—was so subtle it didn't even show up on an MRI scan. Nauseef's tibia (the larger of the two bones below the knee) was misaligned in such a way that the knee joint was "overloaded" with each stride.
Too much stress was being placed on the medial (inside) portion of the tibia. This angular deformity, while small, wore out the meniscus and caused painful osteoarthritis (inflammation of the bone).
Amendola proposed a complex surgical procedure called a "high tibial osteotomy." In his opinion, this approach offered Nauseef the best chance to remain active.
The procedure—performed Nov. 2, 2005—involved the realignment and straightening of the tibia. Amendola fractured Nauseef's tibia and used tiny bone fragments to fill a small space that had been created by the deformity.
Amendola then covered the newly placed fragments with a temporary metal plate. This permitted Nauseef's knee to function normally while it healed.
On Christmas Eve, Nauseef began weight-bearing and was ready for an intense period of rehabilitation. Under the direction of UI physical therapists Katie Bewyer and Joel Lee, Nauseef worked extremely hard to recover quickly.
Nauseef's comeback has been nothing short of dramatic. While his competitive running days are over, he has instead become an ultra-cycling enthusiast, logging over 6,000 miles and completing the race in Death Valley, California, in 2007 alone.
"I've had no trouble with the knee, and no pain," he says. "I'm extremely happy with the care I received."
Nauseef adds that as more is learned about the complex biology of the knee, orthopedic surgeons are getting more creative in thinking "beyond the blade" to avoid knee injuries or to recover from them when they occur.
"In a small way," he says, "my recovery personifies what is possible for members of my and future generations, for whom ultra active lifestyles will be the rule, not the exception."
In assessing the outcome Amendola says, "Performing the surgery is one thing, but having the discipline and desire to rehabilitate is what allowed Bill to regain a high level of function. Katie and Joel's work demonstrates the team approach we employ and the reason for our success."
For more information about UI Sports Medicine, patients and family members should:
Physicians should call UI Consult.
—Michael Sondergard |
