To describe Alison Manaker as active is like thinking of a marathon as a walk in the park. She's more like a force of nature. But for the better part of her 56 years, she's also thought she was living on borrowed time.
At 18, Alison had what she describes as a "minor bike accident," though it was severe enough to tear the anterior cruciate ligament (ACL) in her left knee. Her doctors, she says, "decided it was enough to simply have me walk again, so they never reattached my ACL. Over the years, it kept slipping further and further, to the point that my knee was essentially reduced to bone rubbing on bone."
Around 10 years ago, Alison started seeing Brian J. Sennett, MD, Chief of Sports Medicine and Vice Chair of Penn Orthopaedics. Dr. Sennett was able to reduce Alison's pain enough through non-surgical treatment that she could continue hitting the gym five to six times a week. But he cautioned her that, inevitably, there would come a time when she'd need knee-replacement surgery.
She can almost pinpoint the exact moment when she realized that time had finally arrived. "Two years ago, almost overnight, I suddenly couldn't walk. My knee was so painful. Something must have finally given way, that last tiny bit of cartilage," Alison says.
In hindsight, her knee's decline was less abrupt than it seemed. Increasingly, Alison was having trouble cleaning around her home and even climbing and descending steps. "It was depressing," she says. "I wasn't sure if this was the way I was going to be going forward, hobbled and only in my fifties. It was devastating."
Surgery, recovery, repeat
By the time Alison arrived in the office of Craig Israelite, MD, Program Director of the Department of Orthopaedic Surgery at the Penn Musculoskeletal Center and Co-Director of Knee Service, she had severe degenerative arthritis in her left knee, "which," Dr. Israelite says, "essentially means that she had worn out the cartilage on the surface of her knee." Those, like Alison, who damage their ACL when they're young are at a high risk of developing the condition, particularly if they're active.
Because Alison is so active, and relatively young for a knee replacement, Dr. Israelite placed an uncemented prosthesis, "which means," he says, "that the bone actually grows into the prosthesis to hold it in place.
"We think that because of this, there may be a lower likelihood of failure with time and increased activity," Dr. Israelite says. "We know that it's at least as good, if not better, than the cemented fixation devices [which typically have a lifespan of 15 to 20 years], but because it hasn't yet been around for 20 years, we really don't know its longevity. However, we expect it to perform extremely well into the future."
To that end, Alison was hiking in mountainous Armenia six weeks after her surgery. Generally, most are back to their normal activities within two months of their surgery. And in January 2019, seven months after her surgery, she was skiing. But that's where Alison's incredible trajectory came to an abrupt halt. On the day's last run, Alison, a lifelong skier, became entangled in her daughter's skis and … tore the ACL in her right knee.
She returned to Dr. Sennett, but the pain would not abate this time. So, almost exactly a year to the day after her first knee-replacement surgery, in June 2019, Dr. Israelite placed the same prosthesis in her right knee. "I had all the same nurses, too," Alison says. "Everyone thought it was déjà vu."
For Dr. Israelite, it was more of an eventuality. Because it turns out that Alison had degenerative arthritis in her right knee as well. "So, just fixing her ACL, she would still have osteoarthritis, and she would still have pain and limitations," he says. "The only surgery at her stage which could have given her relief of her symptoms was a knee replacement."
To the top of the world
True to form, Alison returned to the gym six weeks after her second knee-replacement surgery. And it was like she hardly missed a rep. "People at the gym have told me they can't believe I've had two knee replacements," she says.
In December of 2019, six months removed from her latest surgery, Alison and her family hiked the Inca Trail and climbed the iconic Machu Picchu, set nearly 8,000 feet up in the Andes Mountains.
"I receive all my care at Penn Orthopaedics, and these experiences with Dr. Sennett and Dr. Israelite were my best," Alison says. "I'm back to doing 100 percent, if not more. Dr. Sennett and Dr. Israelite gave me hope and confidence."