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Author Topic: MRI vs Scoping - what to ask OS...  (Read 1615 times)

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Offline eguie921

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MRI vs Scoping - what to ask OS...
« on: July 20, 2006, 07:16:05 PM »
First, I'm glad I found this site! It has given me so much insight!!!

Background on injury: While playing softball on May 25th, I twisted my left knee landing on first base. The throw from the SS was off and it hit me on the back side of my left foot as I was coming down on the base. As I landed, I twisted my knee. I heard no "pop" or anything. Just, quick pain along with a little swelling and I couldn't put pressure on it. Went to the emergency room and they gave me crutches and a knee immobilizer and suggested I see a specialist.

Saw an OS in a week and he sent me to get an MRI which I took the following week (15 days from the injury). I had my follow up with the OS with the MRI and he stated that I had the following: 1. bruised bone (top back side of Tibia), 2. Tear of the meniscus, and 3. Partial tear of my ACL. However, he did some of the normal tests on my leg (pulling, bending, etc. ) and stated that I had more mobility and stability than someone who has an ACL tear. He stated that he didn't want to rush into surgery and wanted to re-evaluate me in 2 weeks. He wanted the blood to subside from the bone bruise. However, he scheduled me for surgery on August 9th due to his schedule with notes that it will be arthroscopy with a possible ACL recon. The reevaluation was rescheduled to the 28th of June due to schedule conflicts.

Now, since the injury, I've progressed well each week to the point that now I walk w/o a brace, can go up the stairs w/o assistance and can go down the stairs will less assistance. Haven't tried jogging or running but I think that will come with time. So, I'm sitting sweating the fact that I mya have to start the healling all over again. (I miss playing sports.† >:( ) Anyhow, my questions are:

I read here where someone's MRI wasn't accurate and when they conducted a scope is when they found out the truth. I like to hear other's experience on this? In my case, it looks like I'm going in for a scope either way. Do DRs normally look around while scoping and then fix something they find IE> if my ACL is in fact in need of repair? I guess it depends on the DR? Also, if he's re-evaluating me how is he going to know for sure? Won't I need to do another MRI to see if things have gotten better? I'm going to ask the DR on the 28th but are there other questions I should be asking as well?

I'm 36 and this is my first knee injury and in fact my first surgery period. (I've been fortunate that the most I've had were sprains of ankles and wrists. Never broken a bone either) So, I'm a tad bit concerned about ACL recon† ;)

Reading the forum has soothe me a bit so thanks for any insight you can provide from similiar experiences. Hey, if I have to do an ACL recon then so be it. However, I want to make sure I need it. ;D

Offline Janet

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Re: MRI vs Scoping - what to ask OS...
« Reply #1 on: July 20, 2006, 11:08:02 PM »
Remember that a MRI is just a tool the doctor uses to evaluate your problem. There is no way to know for sure what is going on inside the knee except for them to "look" via surgery. As far as wanting to re-evaluate you, your OS will check to see how you are progressing and decide whether the surgery is really necessary. And yes, he will probably plan to fix whatever he finds during surgery. But that is definitely something you will want to ask.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline eguie921

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Re: MRI vs Scoping - what to ask OS...
« Reply #2 on: July 20, 2006, 11:37:23 PM »
THX for the reply Janet. That's what I was thinking. He will know when he looks in there. Excuse my nerviousness. This is my first time.

As I read more around the forum. it's amazing all of the proceedures people have had!

knee deep in Goo

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Re: MRI vs Scoping - what to ask OS...
« Reply #3 on: July 21, 2006, 03:05:13 AM »
my suggestion for you is to speak with your os and ask him .. If he finds this.  Will he fix it or will you have a second operation ? Frankly its best to have everything done in one shot if you can.

However, I have seen people have two seperate surgery's

Offline emphatic

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Re: MRI vs Scoping - what to ask OS...
« Reply #4 on: July 21, 2006, 06:59:35 AM »
I read here where someone's MRI wasn't accurate and when they conducted a scope is when they found out the truth. I like to hear other's experience on this?

It's not that MRI's aren't accurate. They just don't see inside the knee as well as a surgeon can with an arthroscope. There is also a range of interpretations of what the MRI is showing, so one doctor might think something is torn and another doctor would disagree. That's why the MRI should only be considered along with a history and exam, so the doctor has the most information possible before proceeding.

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In my case, it looks like I'm going in for a scope either way.

Well, regardless of what the doctor decides to do about the ACL, you apparently still have a meniscus tear, as well. That does need to be taken care of -- whether by cutting the tear out or repairing it. You should talk to your doctor aobut that. You might want to ask if he intends to try to repair it, if possible, or if he will just cut it out. Also ask about his post-op rehab protocol if he's considering a repair -- it is usually a lot longer and more involved than the rehab following a menisectomy (cutting the meniscus tear out).

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Do DRs normally look around while scoping and then fix something they find IE> if my ACL is in fact in need of repair? I guess it depends on the DR?

The vast majority of the time, the surgeon will fix what he sees during the scope. Typically, the only reasons for doing an exploratory scope only, are a problem with the patient and they need to end the surgery, or the type of problem found is outside that surgeon's capabilities. I think you can probably be quite certain he'll fix what he sees. If you're really worried about this, just ask him what he intends to do.

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Also, if he's re-evaluating me how is he going to know for sure? Won't I need to do another MRI to see if things have gotten better?

Partial ACL tears are hard to diagnose immediately following the injury. Fluid collects in the joint and muscles contract due to the pain and make the joint feel more stable than it really is. So, the doctor usually wants the patient to wait a bit for the knee to settle down so they can feel just how loose the joint is. You don't need another MRI because he already has the information it would give him. Your ACL won't have healed itself -- he just has to decide whether he thinks it's really torn and how significant the tear is. However, given your meniscus tear, he pretty much has to go in anyway (unless he believes the MRI is wrong there, too!), so whether the ACL is torn is moot. If it is, he'll fix it. If it's not, he'll leave it alone and that's good for you. Given your age and activity level, you really shouldn't ignore the possibility of an ACL tear -- it really does need to be looked at and fixed, if necessary.

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I'm going to ask the DR on the 28th but are there other questions I should be asking as well?

You could ask:
-- What are the possible procedures you would do during the scope? (menisectomy, ACL reconstruction, etc??)
-- What are the rehab and healing times for each possible procedure?
-- What is your rehab protocol for each procedure? (this is important stuff to know -- how long are you on crutches, weightbearing status (yes/no), when you start PT and how long/often do you go, what are the big milestones along the way (off crutches, full weightbearing, first return to light activity, return to full activity, etc)
-- Will I have to stay overnight in the hospital?

Good luck with your appointment. Please do come back and tell us how it went and what's going to happen for you.

Meg

Offline drparent

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Re: MRI vs Scoping - what to ask OS...
« Reply #5 on: July 21, 2006, 03:32:37 PM »
Re: menisectomy vs meniscus repair:

This is what I found out from my Physical Therapist: You can either repair the meniscus or do a removal (known as a menisectomy).

A repair is a better option b/c you get to keep what you have, though the risk of complications are higher due to the vascular status. With the menisectomy you are left without a part of your cartilage which may lead to increased stress at the joint line later on as you age.

It depends on how much cartilage and where the tear is to whether you will have future complications. The orthopaedic should be able to shead some light on the specifics.
Tore my ACL & meniscus playing soccer in May of 2005.† I had surgery on Aug 24th 2005.† Two weeks post surgery developed blood clot. I've seen 2 different SOs & 2 different PTs - all MRIs come back normal - however I'm still having probs w/ recovery.

Offline emphatic

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Re: MRI vs Scoping - what to ask OS...
« Reply #6 on: July 21, 2006, 06:45:05 PM »
There is only one qualifying criteria for a meniscus repair -- its location. If the entire tear is not within the very small vascularized region of the meniscus, it can't be repaired. Some surgeons will try to do a repair on a tear which is partly in the vascular region and partly outside of it, but the failure rate is high because the part that isn't vascularized never heals.

The whole area of repair vs. menisectomy is fascinating me recently. In my 20+ years experience with meniscus tears, I have never seen an incidence rate of repairs as high as I've seen recently on this board. Granted, the pool of patients is much different, but I can't tell if there's a resurgence in repair attempts (given the considerable body of research indicating the incredibly high incidence of OA following menisectomy) or if there's a regional/country preference for repairs over menisectomies. At any rate, I'm interested in understanding what I'm noticing.

Meg

Offline eguie921

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Re: MRI vs Scoping - what to ask OS...
« Reply #7 on: July 21, 2006, 09:27:21 PM »
THANKS A BUNCH FOR THE REPLIES!!! I really really appreciate it. I will definitly come back and let you guys know what happens.

At this point, depending on what the OS say I may ask to push the surgery out to begining of OCT due to family/work issues and I like to have time to strenghen up my leg a bit to help my recovery time. I'm not in pain and can walk around. So, unless the doc advises me otherwise, I like to pospone it because it will make life easier for me. But, if the Doc says we should, then I'll deal with it.

Meg: thanks for the assist. Your reply was specially helpful. The more I read here the more informed I get. I truly appreciate it! I will definitly have those questions with me when I visit on the 28th.

Offline eguie921

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Re: MRI vs Scoping - what to ask OS...
« Reply #8 on: July 28, 2006, 04:04:56 PM »
I had my follow up today and things went well. ;D The OS reviewed my file, asked me a few questions, and examined my knee by bending my leg here and there a few times and looking at the knee area.

(He's a funny guy. ;D) He then proceeded to tell me what he thought by starting out with explaining some history saying that 10+ years ago when docs didn't have MRIs, they were more "clinical-ists" who had to go by feel more but that now they have MRIs and other tools to assist in the diagnosis.

Anyhow, he said based on his experience and what he can see, he feels that my ACL is ok and that I donít need an ACL recon based on my progress and his analysis. He stated that he can't be 100% sure about the ACL but a scope will confirm it further. However, he feels pretty confident.† He stated again that the MRI report says I have a tear in my lateral meniscus but when he exams me I don't feel pain there but when I do feel pain it's on the medial side. ??? He said he's seen that before. So, there are two things he doesn't totally agree with the MRI. When I told him I like to push out my surgery, he stated that's ok because he doesn't see the need to rush in there right now. He feels only a scope is needed to repair the meniscus and verify things. As a matter of fact, that is what he had me scheduled for on Aug 9th. He said it would have been a scope and if the recon was needed I would come back for that.† After all what he said, I was leaning on going ahead with the scope on the 9th but I told him I had to travel two days afterwards on the 11th. With out hesitation, he said then it's best to push it out because you will be on crutches for a max of 2 -3 days and thereís always a chance for blood clots. So, he told me 'let's have another follow up in a month and then we can reschedule the scope to a better time." I was like - cool.† 8)

It was cool because he pretty much answered most of my questions before I even asked. The only question I didn't get answered was his preferred ACL recon method. Since he thought I didn't need it, I didn't ask and I will tackle that later if it is needed once the scope is done.† For right now, I'm at peace because I was concerned about the timing in Aug. I have family items I have to attend too, this is the busiest time at work for me, its summer time, plus my B-day is in Sept.† †:D

Thanks again for the replies. I will follow up in a month!