|
Bob's ACL WWWBoard
Re: MRI says ACL sheath inflamed -- Manual tests best redone under anesthesia...
Posted By: Michael Frind
Date: Thursday, 25 February 2010, at 9:39 p.m.
In Response To: Re: MRI says ACL sheath inflamed -- Wonky knee needs thorough manual testing.... (Rubyroo)
Dear Ruby,
First of all, sorry for taking so long to get back to you. (The last fortnight has been difficult for me: my girlfriend passed away. Instead of becoming a fiancé, I became a pallbearer. It's quite a setback for me, given especially that we were planning to get engaged this spring.)
Looking again at your knee's injury history, it is abundantly clear that there is more than osteoarthritis in your knee. Your doctor's decision to inject cortisone into the joint does not strike me as a stroke of genius. How knee-experienced is this doctor? Is this the same doctor as the "Dr. G."?
Injections of cortisone into the joint space often relieves pain, but such simplistic treatments do not solve the root cause of the problem. Moreover, intra-articular cortisone injections can engender a very pernicious weakening of the ligaments as well as a weakening of bone. In return for the short-term pain relief, they bring a lot of long-term worry. Given that your knee already has a significant history of serious ligamentous problems (and the gross instability you reported is already enough to confirm this), I am surprised that cortisone was so liberally dispensed. (As an aside, the intra-articular use of cortisone reminds me of the carefree and careless aerial-spraying dispensing practices of organochlorine insecticides such as DDT, back in the 1950s. While cortisone is not toxic, high concentrations of this stuff injected into joints can cause a lot of problems...and on top of that, there is also the mechanical damage done to the articular cartilage surfaces by the act of jabbing a needle directly into the joint space.)
No doubt about it -- given your knee-injury history (i.e. at least one very bad fall), and also given that the knee is unstable, there is significant ligamentous deficiency. Please keep in mind that MRI scan (e.g. the one taken over 18 months ago), in showing that there is edema (swelling) of the ACL, hints that the ACL is seriously compromised. Remember that what appears as an intact-but-damaged ACL on an MRI is very likely to be seriously damaged. This is especially the case if this is corroborated by direct evidence such as conclusive manual-manipulation testing and/or serious giving-way incidents. The most definitive way to diagnose ACL tearing is via mechanical means (low-tech manual manipulation testing: the only equipment required is a table), not an MRI scanner (million-dollar high-tech machine, the results of which can be severely compromised if interpreted by a radiologist who is unfamiliar with the fundamentals of knee biomechanics).
You noted that your doctor ("Dr. G.") carried out a series of manual-manipulation tests while you were sitting in a chair. You also noted that the results from these tests were negative, but you noted that because you are a gymnast, there is a high likelihood of the leg musculature masking the results of such testing. Since the time this testing was done, have you inquired about having the manual-manipulation testing repeated under anesthesia? A good orthopedist should know that, in cases where the manual-manipulation tests are inconclusive but the knee has a history of gross instability, it is wise to repeat these tests with the patient under anesthesia. And, especially in cases where both the MRI results and the manual-testing results are vague, it would behoove the orthopedist to promptly redo the manual tests under anesthesia.
The fact that you had two menisectomies does indeed mean that osteoarthritis will be more advanced (as compared to what would be the case if the menisectomies had not been done), but this does not mean that a stretched-out (or otherwise compromised) ACL should be ignored. Given the picture of knee instability that you very clearly painted, it is apparent that the major issue is the ligamentous deficiencies. The now-rather-advanced osteoarthritis, irrespective of exactly how widespread within the joint, is really just a consequence of ligamentous deficiencies that have been ignored for far too long.
Also: you noted that, on February 2nd, you saw an orthopedist. Is this the same doctor as the "Dr. G."? Or, is the doctor you saw on February 2nd also the same doctor as the cortisone-injecting one, the "Dr. G." who did the manual-manipulation tests, the one who did the menisectomies, and the one who feels that the major problem is arthritis? (It would be easier to follow the details of your knee situation if it were clear which actions and comments originated from which doctor, and when.)
More questions come to mind: where in your knee (medial tibiofemoral compartment, lateral tibiofemoral compartment, or patellofemoral compartment) is the osteoarthritis now? And, how much of which menisci (i.e. medial or lateral, or both) was lost as a result of the repeated menisectomies?
Yours truly,
Michael Frind.
Knee Library http://factotem.org/library
Messages In This Thread
Bob's ACL WWWBoard is maintained by virtual Bob with WebBBS 5.00.
|
|