Diving After Arthroscopic Knee Surgery

I am 24 years old and injured my knee playing soccer. The knee became so painful I had difficulty running. I began to have episodes where my knee would “lock up,” so I saw an orthopedic surgeon and underwent arthroscopy of the knee with subsequent partial resection of my medial meniscus. Several months later I am now running regularly. In addition, I am pain free and my knee no longer locks up, though I have a small area of decreased sensation near one of my scars. I would like to dive later this summer. Can I return to diving, and should I take any specific precautions?

It is good to hear the surgical procedure went well and that you have regained full function and range of motion for your knee. You mentioned that the pain has resolved also. I assume you are pain free at rest as well as during exercise and able to bear weight without any problems. This is especially important as your knee will be stressed when you are geared up and standing on a pitching boat deck or walking on soft sand.

Residual pain that worsens or new pain that results from such stress could be confused with DCS following a dive. If there is residual pain at rest or with exercise or any neurologic deficits, these would need to be considered separately as they would affect your fitness to dive. The small area of decreased sensation around your well-healed surgical wound should not be an issue as long as you are aware of that abnormality and document it. It is important that you relay to your surgeon your intent to return to diving, complete your rehabilitation and be permitted to resume full, unrestricted activity.

When you discuss with the surgeon your desire to dive, describe in detail the stresses you will be putting on the repair associated with finning/swimming and wearing and carrying your gear. There is a theoretical consideration of altered nitrogen uptake and elimination to an area after surgery, but no definitive research has shown any detrimental effects. After successful arthroscopic knee surgery the most important thing is allowing an adequate period to heal and completing rehabilitation before returning to diving.

— James M. Chimiak, M.D.

I was diagnosed with leukemia and underwent treatment. I am in remission and was recently cleared by my doctors for exercise without restriction. I feel well and need only scheduled follow-up. I have always wanted to scuba dive but am unsure given my condition and subsequent treatment. Can I dive, and are there any restrictions or precautions I should be aware of?

Symptoms associated with leukemia include dizziness, fatigue, fever, weakness, weight loss, anemia, easy bruising and bleeding, shortness of breath and infections. Clearly, these all have the potential to affect one’s well-being while diving. You and your doctor should consider two important criteria. First, diving should be considered only for patients who are in remission — as you are. It’s important that all divers be free from any distracting or disabling symptoms. Second, it is important that you and your physician confirm that you are not only in good health but also have good exercise tolerance. As you may know, many dive accidents result from challenges posed by the diving environment such as currents, surface swims, and weather and sea conditions. All divers must be prepared to face such challenges before returning to the water.

— Dan Nord, EMT-P, CHT

I lost one of my eyes in an accident. I have an opportunity to learn how to scuba dive, but I have heard that I would not be allowed to do so because I have an orbital implant. Is that true?

It’s important to understand that people who have undergone enucleation and have been fitted with a hollow orbital implant are generally advised not to dive due to the risk of a pressure-induced collapse. These are known to occur mainly in hollow silicone orbital implants and can happen as shallow as 10 feet deep.

Diving with vision in only one eye can be considered in the absence of associated problems that may affect dive safely and provided that visual acuity is sufficient.

— Dan Nord, EMT-P, CHT

During a recent dive in the British Virgin Islands, I went to 94 feet. The dive shop could not hook up our computers to our regulators, so we dived according to the divemaster’s computer. I have no record of the dive besides written notes. Approximately 12 hours later the second joint of my little finger has swollen slightly. Could this be decompression illness? I have a flight scheduled in two days.

Diagnosis via email is impossible; your best bet is an evaluation by a physician. The following are possibilities based on your account and the physiology of decompression sickness (DCS).

A close-up photo of yellow fuzzy corals

The list of likely explanations for swelling in a finger includes mechanical injury and contact with marine life. In the absence of other neurological symptoms, DCS does not typically present with isolated swelling in a small joint such as a finger or toe. As in above-water activities, fingers are susceptible to a wide range of mechanical injuries in diving. Actions while diving include holding onto a boat for support, getting rope burns, carrying gear, climbing boat ladders and maneuvering a bulky camera or other equipment. Any of these actions can involve twisting or jamming forces.

Another possible explanation for the inflammation would be contact with marine organisms. Dive operations frequently use permanently established mooring lines to avoid dragging anchors across fragile reefs. While this helps protect the reef, that mooring line also becomes a site for colonization by marine animals such as hydroids, which, like their jellyfish relatives, have stinging cells (nematocysts). A diver who uses a mooring line to control descent or ascent may unintentionally brush his or her fingers across the nematocysts, causing swelling, redness and possibly blisters to the affected hand.

Treatment for contact with nematocysts includes applying vinegar shortly after exiting the water and thoroughly rinsing with seawater to remove any remaining stinging cells. Subsequent care includes using topical steroids (cortisone) or analgesics (ibuprofen) if needed and soaking in hot water.

Treatment for a dive-related mechanical injury would be no different than for an above-water injury. Support, wrap or splint the joint as necessary to protect it. Analgesics such as acetaminophen or ibuprofen may provide relief. Applying ice to a joint may relieve swelling.

If the finger is protected from further harm from actions such as carrying luggage, flying is not a concern. As with any injury, medical evaluation is always appropriate and recommended, especially if function is impaired in the hand. The physician does not need to be familiar with dive medicine. Appropriate injury evaluation and care is within the capabilities of any physician.

— Frances Smith, EMT-P, DMT

I am the physician of a patient who was treated for decompression sickness (DCS) in a hyperbaric chamber one year ago. The diver had complete resolution of his original symptom (shoulder pain) but is now complaining of persistent arthritis in his hands, wrists and back. Is there a causal relationship between rheumatologic symptoms and DCS? The patient’s current symptoms were not part of the original presentation, and he had no such symptoms prior to the DCS diagnosis. 

I am not aware of any serious attempt to link specific rheumatologic conditions and DCS. It is possible that residual sensitivity arising from the decompression insult is responsible for the subsequent symptoms. In this case the symptom development could diminish over time. It is also possible that the DCS increased inflammatory sensitivities that may remain in the future. But again no research to date supports this.

Distinguishing between these possibilities is probably not feasible, but it will be of value to follow the symptom evolution, if there is any, over time. If the diver continues to dive and alternates between cold and warmer exposures, I would be interested to learn if thermal status influences the response. It is most likely that these new complaints are coincidental given the interval of more than a year. Finally, an underlying condition such as osteoarthritis may have manifest in this patient; this warrants investigation during future follow-up evaluations.

— Neal W. Pollock, Ph.D., and James M. Chimiak M.D.

© Alert Diver — Q2 2017