BillsFanM.D. Posted February 9, 2007 Posted February 9, 2007 The problem is that this injury occurred 5 months ago.....at what point do I say "this is not working" As I said in the prior post, it may be time to reimage his knee. An additional MRI at this point is reasonable if the original was done at the time of his injury. Getting a third opinion is also appropriate if it's been five months and he's not improving. As far as getting a scope done, it can reveal findings not seen on MRI but you don't want to introduce more trauma (which is what surgery is) to an area unless you've exhausted every other means of diagnosis. An MRI might not be normal now even if it was months ago. He may have caused additional injury etc. lastly, it hurts to write it ...but sometimes after a knee injury things never completely return to normal. Your best bet is to get a third opinion and evaluate whether anything can or should be done. If you came to me with above story and his MRI was five months old, I'd re-image him. I'd also get a new ortho opinion; even if I completely trusted the first. That's my opinion. If his MRI is abnormal now, you know what is happening and what to do. If it is "normal" you need to decide whether a scope to have a "look see" is worth the risks of the procedure. P.S. To all those who are concerned that John is "seeking advice on a football board:" I was simply trying to give him basic info and answer his questions. I'm not suggesting he rely on info from someone his son has never seen and I never recommended treatment of any kind. Lighten up. It's no different than the 3000 questions a week I get from my personal friends, family, coworkers etc. I don't mind it then and I don't mind it now. It's just conversation. Not a medical evaluation and treatment. John, you can PM me if you have any other questions and I'd be happy to help you understand what results etc mean or if you don't understand what the docs told you.
BUFFALOTONE Posted February 9, 2007 Posted February 9, 2007 As I said in the prior post, it may be time to reimage his knee. An additional MRI at this point is reasonable if the original was done at the time of his injury. Getting a third opinion is also appropriate if it's been five months and he's not improving. As far as getting a scope done, it can reveal findings not seen on MRI but you don't want to introduce more trauma (which is what surgery is) to an area unless you've exhausted every other means of diagnosis. An MRI might not be normal now even if it was months ago. He may have caused additional injury etc. lastly, it hurts to write it ...but sometimes after a knee injury things never completely return to normal. Your best bet is to get a third opinion and evaluate whether anything can or should be done. If you came to me with above story and his MRI was five months old, I'd re-image him. I'd also get a new ortho opinion; even if I completely trusted the first. That's my opinion. If his MRI is abnormal now, you know what is happening and what to do. If it is "normal" you need to decide whether a scope to have a "look see" is worth the risks of the procedure. P.S. To all those who are concerned that John is "seeking advice on a football board:" I was simply trying to give him basic info and answer his questions. I'm not suggesting he rely on info from someone his son has never seen and I never recommended treatment of any kind. Lighten up. It's no different than the 3000 questions a week I get from my personal friends, family, coworkers etc. I don't mind it then and I don't mind it now. It's just conversation. Not a medical evaluation and treatment. John, you can PM me if you have any other questions and I'd be happy to help you understand what results etc mean or if you don't understand what the docs told you. You are a good man Doc. Don't listen to the people who like to maintain the doom and gloom. god forbid someone askes for personal advice.
cale Posted February 9, 2007 Posted February 9, 2007 Well, for the record, I am a doctor. Not ortho...not even surgery;so I would not consider myself an expert on an MD level. I practice in general adult medicine but I'll give you my best info. I'm a little confused as to what his diagnosis is. The knee has four basic ligaments... ACL, PCL, MCL and LCL. If his injury is an MCL sprain (no tear), this is rarely treated with anything other than rest. Even with tears, it is usually treated quite conservatively. The big concern with that type of injury in an athlete is additional cartilage tears that can occur with it. The MCL is on the inner side of the knee and is attatched to the medial meniscus. Imagine a support strap on the inner side of the knee (mcl) attatched to a cushion (medial meniscus) that fits between the "thigh bone and leg bone." The meniscus is the cartilage in the knee and consists of both medial and lateral parts. Just wanted to clarify as some have mentioned these as different terms. Cartilage and meniscus are the same. When the mcl is strained the medial meniscus is often injured as well. The last concern you mentioned is the growth plate. If that portion of the bone is injured he may have some concerns re: further growth. That's a huge if...and hard to predict. I'll leave that to the ortho. From what I can guess (and i stress the word guess) he should have healed an mcl strain by now if he has been faithful with rest. That's always a tough one for a kid who is athletic. make sure he's been honest with you. that's not a knock on your son as I sure as heck would have lied to my parents/coach etc to "get in the game." If he has a cartilage tear this generally has symptoms of the knee locking or significant pain with resistance such as lifting or running. If he has symptoms of instability (knee giving way) that generally points towards a ligament tear. An MRI answers these questions almost all the time. The only question then is whether it is treated surgically or conservatively. In some cases, however, they will go in arthroscopically to "look around" when the patient's symptoms are not explained by the MRI findings (or lack of). This also is the time to remove any loose particles of cartilage that may be present. As far as cartilage healing....that's not very likely. Cartilage has poor blood supply and it's ability to heal is very controversial. When you hear about athletes getting "microfracture surgery" the principle is to make small holes in the cartilage to promote blood flow. Some are firm believers; most are skeptical. In general, if the cartilage is severly torn, the offensive piece is removed. This obviously accelerates the development of arthritis over one's life but can often greatly improve symptoms in the short term. If the piece is a flap and not shredded it can be "tacked down" in it's original position. He may be have suffered direct trauma to the cartilage and bruised the underlying bone. This is called a bone bruise (aptly named). This can be a lingering injury with no real structural damage but hurts like heck. A bone bruise typically is visible on an MRI. You also mentioned pain directly under his kneecap. A lot of young athletes have significant patellar laxity (loose kneecap). This means his kneecap moves left and right more than average. Everyone's can be slid a bit in the relaxed position. Some moreso than others. Often those individuals will develop wear and tear changes under the kneecap because of the increased trauma that occurs in someone with this "loose" kneecap. This "disorder" is called patellofemoral syndrome. Usually this occurs as a chronic worsening problem rather than a sudden onset of pain so it is much less likely in your son's scenario. If it's been months since his last MRI, I might suggest you repeat it. He may have had a small cartilage tear that failed to show initially and his repeated attempts to start sports may have exacerbated it. Just a thought. Lastly, get a second opinion. Any doctor who is worth their salt would certainly encourage it. sometimes a fresh set of eyes is helpful and your son may be reassured by hearing some confirmation. Don't get too frustrated. Sometimes these things just linger and caution is the best way to proceed. Hope this helps. House? That was a great user friendly analysis and explanation...
BillsFanM.D. Posted February 9, 2007 Posted February 9, 2007 House? That was a great user friendly analysis and explanation... Best show on TV but I'd never have the guts to say/do the stuff he does. He's pathologic....but hilarious.
BillsFanM.D. Posted February 9, 2007 Posted February 9, 2007 You are a good man Doc. Don't listen to the people who like to maintain the doom and gloom. god forbid someone askes for personal advice. I agree and thanks.
cale Posted February 9, 2007 Posted February 9, 2007 John, I'm not a med professional. My wife is a PA but not ortho. I think BillsFanMD has given you some great advice. I think you're doing everything reasonably possible. So don't take this the wrong way. Not every doctor is created equal. Your son's injury doesn't sound unusual. Your doctor's experience dealing with the issue may be. I would talk to your social or sports network and see who has a good reputation and take your son there. Don't you live in the San Diego area? I would call UCSD's Sports Medicine Dept. and ask if they know of anyone in your area who could give you an informed second opinion. There might be other college/university medical centers in your area. I would research their faculty and call or email for references or advice. Faculty like to talk.;-) I work in a Med Ctr. For some health issues I wouldn't go anywhere else. For others, I would go to the competitor across town. We had our baby delivered at the cross town hospital. It's just a matter of institutional experience and focus. Plus, you don't take a thoroughbred to the local pet clinic... Good luck. Charles
cale Posted February 9, 2007 Posted February 9, 2007 Best show on TV but I'd never have the guts to say/do the stuff he does. He's pathologic....but hilarious. I don't care if Armageddon is scheduled for Tuesday. If there's a brand new House MD episode on, my wife and I Tivo it and watch. It's writing and acting is phenomenal. Beats the crap out of Grey's. Though the music on Grey's is cool. My wife is addicted to that too....
John from Riverside Posted February 9, 2007 Author Posted February 9, 2007 To MD...thank you for all your help and I wlll PM you when I get more info next week. To Cale.....thank you as well....I am going to take him to Loma Linda medical center next week.....not quite as far as San Diego from Hemet. They have sports medicine doctors in their ortho dept.
cale Posted February 9, 2007 Posted February 9, 2007 To MD...thank you for all your help and I wlll PM you when I get more info next week. To Cale.....thank you as well....I am going to take him to Loma Linda medical center next week.....not quite as far as San Diego from Hemet. They have sports medicine doctors in their ortho dept. Hey John, You're welcome. I would still try to find somebody who has a reliable recommendation for whom to see at Loma. Unless you already have a reference. C
Rubes Posted February 9, 2007 Posted February 9, 2007 John...I'm no ortho specialist, but I'd have to basically agree with BFM.D. above. I think a repeat MRI is reasonable if it has been this long and he's still having problems, although I wouldn't be surprised if it didn't show anything new. But he's right, if it does show something, then you've got a target. If not, then I also agree that there still might be something that can show up on a scope, and you would need another opinion to see if a scope is indicated. And then you'd have to decide if the risk of the procedure is worth it. I'm also available by PM if you want.
Bob in Mich Posted February 9, 2007 Posted February 9, 2007 John, You may want to look at Bob's ACL board. Folks discuss all sorts of knee issues, not just ACL problems. Bob's ACL Board
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