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Author Topic: MRI translation help needed  (Read 779 times)

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Offline mommy0000

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MRI translation help needed
« on: April 19, 2006, 06:02:36 PM »
I was wondering if any of this would be causing the kind of knee pain I am having? The MRI showed widening of the tibial drill tunnel, bony lysis and granulation tissue at the proximal aspect of the drill tunnel. Scarring and mild thickening of the infrapatellar tendon and bony contour change (at several different places) and small joint effusion. My history is an ACL reconstruction with patellar graft (my own) and a knee fracture (from the patellar graft during surgery) in 1997. Any suggestion on what to do for my pain now. I have a few titanium screws left in my leg, could those need to be removed? My orthopedic doc didn't seem concerned and sent me on my way with some anti-inflammatory drugs that haven't worked and I am feeling like a whiner if I call back complaining about the pain unless I have a reason. I was ok for several years with just the normal aches of a less than perfect knee, but now it is not ok. Thanks for any info.

Offline Heather M.

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Re: MRI translation help needed
« Reply #1 on: April 20, 2006, 01:40:05 AM »
Head on down to the soft tissue healing problems section.  It seems that you have both excess scar tissue in the joint (thickening of the infrapatellar tendon) and supreme irritation in the whole area (the bony changes, granulation of tissue, bony lysis, etc.).  So your knee is one unhappy camper.  And likely the scar tissue is at the heart of the problems, because it can cause changes in the knee mechanics that lead to bone grinding on bone--very painful and irritating.  I'm sure the fracture may have had a part in this as well, because fractures don't necessarily heal smoothly and can lead to roughed up cartilage...end result, bone on bone contact is possible here, too.

Unfortunately, as you have discovered, many OS's don't take adhesions (scar tissue--the official name is arthrofibrosis) very seriously.  And they sometimes even 'there, there' the patients and are quite dismissive of their pain.  They say there's nothing to be done, the scar tissue would just come back, blah, blah, blah.  Not true.  There are a handful of surgeons in the US that we have identified (through trial and error and their publishing history) who have a special interest in treating arthrofibrosis cases.  These patients are notoriously tough to treat, as their knees often don't respond like 'normal' knees.  So this sub-group of surgeons can literally be a lifesaver for a patient who has been dismissed and written off by other highly regarded orthopedists.  Seems impossible, I know, but it is indeed true.  I have found in my personal experience that many, many surgeons out there simply don't know enough about arthrofibrosis to adequately treat the patients who have this condition.  They say things like "get used to pain, your knee will never be normal again, there's nothing that can be done for you, I have no idea why you have so much pain, and it's all in your head."  Seriously.  It's not in your head!  You have chronic and debilitating knee pain, and you need it treated.  Many doctors don't know how to do this.  So it is strongly recommended to see one who does!  I have to travel to do this--I go over 800 miles by car and/or plane to see my surgeon in Colorado, because no one else in Arizona would touch me.

In short, there are options out there for you.  The most important first step would be to find the source of your pain.  Since a thickened patellar tendon was noted, that would be a major potential culprit.  When the patellar tendon gets scarred and thickens/shortens, it actually pulls the kneecap out of place.  This is a condition called patella baja or patella infera.  It is very serious in that it can lead to chronic pain and bone on bone contact in the joint, and ultimately this can end up causing serious irritation in the entire joint--complete with swelling, redness/heat, severe pain, and bony changes.  These may be what was noted on your MRI, or they may not be--you'd need a specialist to make that call.  I know I have patella baja (it was dramatically improved by surgical intervention, before which it was one inch lower than my other kneecap, but I continue to have mild to moderate baja and the resulting pain and swelling and cartilage damage/osteoarthritis) and it is likely the source of most of my pain.  So that would certainly be a place to start looking for the knee boogeyman.  Also, getting ot the bottom of the bony changes noted in your MRI would also be a priority--did the fracture heal properly?  Is there chronic low-grade infection creating issues?  Do you have clinical signs of osteoarthritis?  Loose bodies from that OA?  Bone spurs can shred soft tissue, meniscus, and tendons which come in contact--do you have any signs of this?  All of these are questions you will lilkely want to discuss with a specialist.

If your OS is dismissive of your pain and symptoms and sends you away with Celebrex, it may be time to get another opinion.  It's critical to select a second opinion doctor who has the right background--if you get a guy who has the same training and philosophy as your current OS, then you'll likely hear the same stuff.  And that can lead you to think there's nothing left to do; but if you see another surgeon who has experience with severe arthrofibrosis and knee trauma/articular cartilage damage/ligament reconstruction, then hopefully they will provide you with treatment options they've developed to deal with these unique complications.  So it's really critical to get a second opinion from a doctor with the right background and one who has a philosophy that meshes with your goals and plans for the future.

One more thing...yu're not a whiner!  Based on the MRI report, it sounds like you have a VERY unhappy knee.  Any one of those can cause significant pain, and you've got more than a few!  It's important to listen to your instincts, which seem to be telling you that something serious is wrong, and that you aren't getting any satisfaction from your OS sending you off with a script for anti-inflammatories.  That's like squirting a brushfire with a water bottle...and your body knows it.  You'll see lots of discussion--often quite, um, impassioned--about this concept in the threads of the soft tissue healing problems section.  Many of us with arthrofibrosis have been blown off by our original surgeons, told we're imagining things or obsessed with our knees, told to give it time, told to just deal with physical disabilities, told there's nothing to be done anyway...or in my case, I was told at age 32 to "get a cane, get used to pain, find a really good physical therapist, and return to the doctor in 10-15 years for a knee replacement."  So unhelpful.  But when I finally saw a specialist who has lots of experience with my particular problem, the difference was night and day.  I had hope for the first time in a long time.  I have had two surgeries and have seen significant improvement--though I still have substantial problems as well.  But after seeing my specialist, for the first time in 18 months I was able to walk without crutches, be on my feet for a few hours at a time, reduce my pain medications, and take my dogs for a walk every day.  What a change that was.  My knee will never be normal again, but I feel like I got it to a level that was much more bearable.  And I got a lot of my life back.  Even though I know I won't ever climbe Mt. Everest on this knee, I can do other things that I want to, and that's what's important.

Check out the soft tissue healing problems section.  Keywords to look up are:  patella baja, patella infera, infrapatellar contracture syndrome, arthrofibrosis, scar tissue, patellar tendon contracture, chondral damage or lesions, osteoarthritis, bone spurs, effusion.

You might also want to consider seeing a pain management doctor, preferrably one who is a Physical Medicine and Rehabilitation (PM&R) specialist--also called a physiatrist.  They often specialize in pain management for folks with chronic orthopedic conditions.  And they use lots of different modalities or treatment methods to bring pain relief and restore quality of life, like acupuncture, PT, massage therapy and myo-fascial release, medication, home e-stim units, cyrotherapy, trigger point injections, etc.

Keep us posted.

Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja

Offline mommy0000

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Re: MRI translation help needed
« Reply #2 on: April 21, 2006, 03:41:30 AM »
I can't believe your detailed response. It must have taken you forever to write all that out for me. Thank You! It will be extremely helpful when I head out to war on this issue. I'm not giving up thanks to your response, it gives me another path to go down so Thank You!