Cruciate ligaments :

New here w/ MRI results. Can anyone help? - - Posted by Keegan102 (Keegan102), 14 September 2004

Hi everyone. I posted on the "dont know where to post" section and was told that my issue may get a better response here on this board. Unfortunately, I can't get in to see my OS for about 2 weeks unless there is a cancellation.  I tried to reach him today to no avail. I'm concerned with these results and if I should brace back up. He originally had me immobilize for 2 weeks while the MRI, results, and next appt were pending. My 2 weeks are up with the brace and I got these results today. Any insight that anyone can offer is greatly appreciated!

My injury was a slip on a wet floor. I twisted my knee and became NWB for a few days. The pain continously got worse and worse.

Results:

There is evidence of bone marrow edema identified involving the distal aspect of the lateral femoral condyle as well as involving posterior aspect of the tibia prominently laterally.

Significant loss of substance seen in the anterior cruciate ligament with edema surrounding the region of the anterior curciate ligament consistent with anterior cruciate ligament tear.

There is abnormal signal identified in the posterior horn of the medial meniscus extending to its inferior articular surface consistent with a medial meniscal tear.  

The later meniscus appears intact.

Some mild increased T2 signal seen surrounding the region of the medial collateral ligament may be reflective of medial collateral ligament strain.

There is moderate joint effusion seen.

Impression:  

Bone Brusing involving the later femoral condyle and posterior tibia.

Tear of posterior horn of the medial meniscus.

Findings consistent with ACL tear.

There may be a few fibers of the ACL visualized.

Finidngs suspicious for MCL strain.

Moderate joint effusion.  

My thoughts were that I have torn the ACL and the medial meniscus. Does that mean definite surgery? Or for the short term, does that mean get my brace on because it could be unstable? I'm very scared as I'm new to the knee injury department. Thanks!
Posted by andrewc (AndrewC), 14 September 2004

Hi there...

you dont say how old you are but....I'm also assuming your healthy apart  from this injury..

What should you do??
Well, how stable / unstable is your knee? Does it feel like it will collapse from under you at any minute or does it feel fairly stable?and just hurt....

If it is stable enough just be careful and you should be ok without the brace until you see your OS.....but if it feels unstable and the brace gives you some sort of comfort then you might be wise to wear it....

Tears to the meniscus do not usually repair and ususally degenerate over time...so would probably need an arthrospopy ..but ACL injuries do not always have to have surgery.
It really depends on the size or amount of the tear (although yours sounds possibly ruptured), the age of the patient (eg over 65 may not have it repaired unless very active), how active or sporty teh patient is and what activity they wish to return too....
Some people try and get by without an ACL and just strengthen their leg but this is normally either not possible or not advisable......

Hang in there till you see your OS and dont worry if you do need surgery...its not that bad!!
Read some other posts from people who have ACL injuries for more info on this...

All the best
Posted by Keegan102 (Keegan102), 14 September 2004

I wanted to thank everyone for replying. I appreciate all the advice so much  

My OS had a cancellation this morning and I got in. What a relief that was!

I didn't mention anything about myself in the first post and that plays a role in the OS's course of treatment so here goes:

I am 58 years old. I have RA in both my knees which flares up from time to time. I am not as active as a 20 year old (naturally). My activity of choice is walking or doing circuit training at a gym called curves (if anyone is familiar with the routine they do there). So as you can see I'm not an avid participant in sports or anything extreme or vigorous.

As far as my visit today, here is what my OS told me:

Completely ruptured ACL. Torn MCL. Torn meniscus. I also have a cyst on the back of the knee from all the fluid that's been accumulating. He gave me a cortisone shot today.  

His recommendation is to try PT for a month and see if I'm still in pain, then we will go from there. We both wanted to give it a little time to calm down before moving to a more aggressive means. I've never had a knee surgery and I admit, I am a bit overwhelmed by all this.

My OS stated that since I'm not a mountain climber or track star that I could manage with my ACL as is. He said it most likely would not cause issues if all I'm doing is walking. He is optimistic that the MCL will heal on its own and wants to wait to see what the meniscus does as far as symptoms go. If it is still bothersome than I will have no choice but to have surgery, but as far as I've understood the ACL would not be a part of that surgery at that time.

I guess this is semi-good news. I didn't like the confirmation that my knee was so injured, but I'm glad he didn't want to jump right into surgery. The ACL surgery is very much involved and just something that if I can live without, I'm going to.

I did forget to ask the OS if I should be braced while we wait for the MCL to heal and if I did take another spill would ACL being ruptured cause something else in the knee to take the brunt of the fall and possibly become injured. I will be calling him back to ask these things, however, if anyone has an opinion please feel free to post it.

Does anyone know of anyone on the board that did not have their ACL repaired so I could do a search on their posts and gain some insight to see how it affected them and in what ways.

Thanks again for the support! If anyone has anything to add, feel free!  
 
Posted by Shoeball (Shoeball), 17 September 2004

Well I'm not a doctor, nor do I have much experience with knee problems (other than my own acl reconstruction...I'm 25 by the way). In fact I'm a new poster here.

But

Although simple walking will be fine, and even weight training,  If you ever find the need to put on a little jog or hustle to catch a bus....Or you find the need to hustle down a set of stairs or downhill terrain, or need to tackle a steep and numerous set of uphill stairs or terrain....Then you might find yourself in trouble.  That's why I would suggest the surgery....But again I'm not a doctor and I have very limited knowledge or experience in these matters....

Anyway, usually a solid and rigorous regimen of leg weight training (for the rest of your days...it must be maintained) to really tighten up your leg muscles is sufficient to support your knee if you are not "too active".

Still though, I'd ask your doctor specifically about all the points i've just raised...Even push him on it...I suspect he may be trying to save you the agony of this type of surgery in favour of pushing you into a more sedentary or cautious lifestyle than you are currently enjoying.

Then again, maybe wearing a functional brace for most of the day is the better choice for you. (read the brace thread) and

Ask your doctor.

This old Forum was so valuable that we have kept it as an archive. It is just for reference. If you want to ask questions or offer advice, there is also a current Bulletin Board which you can access from our home page.

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