Dear Michael,
Thanks for your response. The Dr. I saw today is an Orthopod, specializing in sports med. I've seen him for a couple of years now. I have to say, that sometimes I am just not so sure I agree with his decisions sometimes. They don't always seem to be right or workout. I have seen some of the notes that he sends to the ins. company too and they sometimes contradict what I tell him. BC doesn't seem to care though and they pay the bill.
The "shot" I got in ER was Demerol, in my hip. It took about 5 days before I could walk at all and a full week before I could walk without crutches. It is still swollen a lot and painful but the pain is usually tolerable to some degree. I still take a pain pill sometimes though.
Dr. G. performed the reg. tests while I was sitting in a chair and said they were neg. However, since I am a gymnast, I think the probability of muscles masking the results is at hand, and I'm not so sure that these tests should have been done while sitting a chair.
As for the hist. of this knee. Orig. acl inj is very old. as was evidenced by some old mri's. They always said it was intact though stretching was evident even 6 years ago. The last time an mri was taken before yesterday was over a year and a half ago. It also showed acl damage but said that it was intact and edematous. About 5 or 6 months ago, I landed strait on the floor on both knees and blacked out from the pain. I came to and was able to walk immediately but had some trouble ever since. Orthopod keeps checking and saying it is just arthritis, until now. But he says that arthritis is still a major factor here. I have had a menesectomy X2, last was just about a year ago. The knee was great after that until I fell on the floor. It's been 3 weeks now, but I did get a cortisone shot in the joint.
I really do appreciate your advice. It will give me direction. I guess I'm just not really happy with my Dr's. help, or the lack of it.
Sincerely
Ruby
> Dear Ruby,
> A few questions and comments for you:
> 1. Is the doctor you consulted today a knee-experienced
> orthopedist, or just a family doctor (general practitioner)
> or emergency-room physician? In posting 364874, you noted
> that your knee is painful and unsteady. In posting 364862,
> you noted that you will be seeing an orthopedist this week,
> but it is unclear whether this is the doctor you saw today.
> 2. The fact that your ACL sheath is inflamed is cause for
> serious concern, because it immediately raises the question
> of why this sheath would have such an inflammation. The
> most logical explanation for this is that the entire ACL
> (or at least, a large part of it) is injured in some way.
> This is strongly corroborated by the knee being painful and
> unsteady.
> 3. Please note that, with an ACL tear, it is extremely
> common for the swelling and pain to decline quite soon
> after the initial injury event. It is most common in cases
> where the ACL has been fully torn, or so badly stretched
> out that it is biomechanically useless anyway. It is very
> plausible that your ACL falls into the latter category.
> 4. Please note that MRI scans are not always accurate in
> ascertaining the severity of an ACL tear. What appears as a
> "slight disruption" on an MRI scan could in fact
> be a microscale tearing (i.e. stretching-out) so severe
> that the ACL might as well be fully torn anyway. What is
> needed here is for the knee to be tested via the standard
> suite of manual-manipulation tests (Lachmann drawer test,
> anterior drawer test, dial test, pivot-shift test,
> Macintosh test, etc.). Ideally, these tests should be done
> under anesthesia, in order to guarantee that residual
> muscle tenseness is not masking any ligamentous
> deficiencies. (The fact that you were able to walk into a
> doctor's office and receive an MRI on the spot shows that
> expensive, high-tech imaging is readily available. This is
> good, but it is no substitute for rigorously done low-tech
> manual-manipulation testing.)
> 5. What is the injury history of your knee? Was there any
> memorable incident that triggered the recent spate of
> problems? Was there any event in which the knee was forced
> sideways, twisted, or forced backwards? If so, in what type
> of activity did it occur? Did you fall to the ground? The
> more details you can provide about the injury event (or
> events) and any subsequent history, the more insight can be
> provided.
> 6. In posting 364874, you noted that your doctor gave you
> "a shot". Was this a cortisone shot directly into
> the joint space? These injections can sometimes relieve
> pain, but they can cause serious long-term problems,
> particularly if repeated.
> 7. The instability in your knee is extremely unlikely to go
> away on its own, particularly given that it is almost
> certainly ACL-related. ACL tears are notorious for not
> healing in a meaningful way. Because your ACL is (according
> to the MRI) not completely severed, some rudimentary
> scarring-over might occur, but the result would be a
> stretched-out bundle of scar tissue that would not properly
> fulfill its biomechanical roles anyway. However, if you
> avoid abrupt twisting-type movements, you might be able to
> prevent most of the giving-way incidents. But given how the
> human knee is so essential to a wide variety of everyday
> activities, the inherent instability of your knee will make
> itself apparent, at least occasionally. Please remember
> that each and every giving-way incident brings cumulative
> and permanent damage to the knee's remaining intact
> structures (e.g. the menisci). The more such damage you
> accumulate, the sooner your knee will become painfully
> arthritic.
> 8. If your orthopedist suggests you just leave the knee
> alone and see how it responds, I recommend consulting two
> additional knee-experienced orthopedists. As I noted above,
> experimenting with an intrinsically unstable knee is risky.
> 9. At the very least, some sort of physiotherapy program
> should be prescribed for your knee, in order to build up
> the knee-surrounding musculature. Such strength might help
> avoid certain giving-way episodes, but it would also be
> valuable in terms of facilitating rehabilitation from any
> type of surgery (given that any knee surgery results in a
> certain degree of muscular atrophy).
> Yours truly,
> Michael Frind.
> Knee Library http://factotem.org/library
