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Author Topic: 2nd opinion's? What to do next?  (Read 1166 times)

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Offline Stasha83

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2nd opinion's? What to do next?
« on: November 16, 2010, 10:15:35 AM »
Hi

I am just wondering how many of you have had to seek 2nd/3rd/4th etc opinions? Or do you have complete trust in your OS? I am currently at a loss about what to do next and am beginning to wonder if it is time to give up and just accept what my OS is telling me?

My current situation is as follows:

Right knee
MRI scan in June: MCL sprain, partial tear of ACL, contused meniscus and bone bruising to Tibia.
Surgery in June: removal of impinging Hoffa pad, 6 weeks in full length brace as leg ‘not straight’
Consultation in October: ‘Spectacular’ Patella Alta (patella out by 30 degrees)
MRI arthrogram in November: More bone bruising
Current situation: Cannot walk without limping, cannot run, squat, kneel, ROM less than half of other leg and getting worse. Knee is hot every evening and swells periodically without reason. Daily pain which increases as the day progresses. Knee feels very tight when I try to bend it and it simply won’t go past a certain point. Inhibited quads, cannot lift leg when straightened. I’m suspicious that I may have a scar tissue problem (Arthrofibrosis perhaps?) but when I asked my OS if this could be a possibility he advised that my original injury was not traumatic enough (I’m still not convinced though!).

Left knee
MRI scan in August – horizontal abnormal signal in the posterior third of the medial meniscus reaching the inferior surface consistent with a tear.
Second opinion on MRI results – the same
MRI arthrogram in November: High signal in same area but dye did not enter the cartilage
Current Situation: ROM almost normal, but painful when at full flexion/extension. Have a catching/pinching sensation when walking and knee makes noises when moved from straight to bent. Pain at back of knee.

I saw my OS yesterday and he has advised that there is nothing ‘mechanically wrong’ with either of my knees. He has referred me to a pain specialist and I am then to continue with physio for 2 months. If I have not improved at that stage he said he will manipulate the right knee under anesthesia but is confident that under anesthesia my knee will bend.

I do not know where to go from here. I have been trying to rehab the knees throughout but cannot make any progress, to the extent that the physio referred me back to the surgeon as he felt there was an underlying problem with both knees.

I am now back to square one and don’t know what to do. I am not convinced that seeing a pain specialist is going to provide me with a miracle cure (only a £200 bill!) and so far 5 months of physio hasn’t either. Should I get another opinion? Or just accept that this is my life now? My OS has a very good reputation and was personally recommended to me through acquaintances that have been treated by him. I am seriously beginning to wonder if I am looking for answers that simply don’t exist but I am only 26 years old and want my life back.

Sorry for the long rambling post, I just don’t know what to do next . Any advice or suggestions would be very much appreciated.

Thanks in advance
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Snowy

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Re: 2nd opinion's? What to do next?
« Reply #1 on: November 16, 2010, 03:43:14 PM »
Definitely seek a second opinion. Your left knee certainly sounds as though it may have a damaged meniscus from the symptoms and initial MRI results. For the right knee, what have they done to treat the patella alta? If the goal was conservative PT and the physiotherapist wants to send you back to the OS, that suggests that conservative treatment may not be the right (or only) option. Additionally, arthrofibrosis could just as easily be a consequence of the surgery you had as the original injury.

Don't give up. You have every right to want enough knee function back to lead a normal life, and the most important thing you can do is to be your own advocate if you feel the advice you're getting isn't right or isn't helping the knee.

Best of luck.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline Stasha83

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Re: 2nd opinion's? What to do next?
« Reply #2 on: November 16, 2010, 04:22:34 PM »
Hi Snowy

Thank you so much for your reply, I really am so grateful for the help and advice this site provides.

I have had no treatment for the patella alta nor has any treatment been suggested.

The plan given to me in September was to rehab with a new physio for 6 weeks and then if no improvement, the left knee was to be scoped and the right knee injected with a steroid (cortizone I think?). Both knees flared up dramatically during rehab, to the extent that my physio advised me to stay off work attached to an ice machine until an emergency appointment with the OS had been made. Now I have been sent back to the physio and am no further forward, it is just so frustrating. I have an appointment with the physio next week so can discuss the situation with him then to see if he has any insight about what to do next.There is no plan to scope/operate on either knee at present.

Time to research a new OS I guess. I am based in the UK and am fortunate enough to have private healthcare so have a large number to choose from, I just hope that I make the right choice!
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Snowy

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Re: 2nd opinion's? What to do next?
« Reply #3 on: November 16, 2010, 07:23:14 PM »
I'm not an expert on knee conditions, but the folk on this board who've been through meniscus repair have generally found it pretty straightforward - if that is the source of your problems, it might be a relatively easy fix (though still requiring surgery, which is never fun). Your symptoms do match the initial MRI results, and even a very small tear can be enough to cause problems.

The right knee sounds a lot more complicated, but it surprises me that the OS didn't try and figure out the source of the patellar alta. It's a symptom rather than a condition, so treatment would rely on getting to the underlying cause. This in itself is reason enough to look for a second opinion, and more diagnostics.

If you head over to the information hub, you'll find a pretty comprehensive list of knee specialists in the UK - hopefully there will be one in your area. It may also be worth posting a new thread asking if anyone has personal recommendations for knee specialists (or patellar specialists) in your area. Good luck!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA















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