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Author Topic: Seeking advice on treatment options  (Read 4668 times)

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Offline Hflicker

  • MICROgeek (<20 posts)
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Seeking advice on treatment options
« on: December 18, 2013, 10:46:02 PM »
Here is my story and I would greatly appreciate feedback on what the best approach for treatment.

I am 41 and lead a very active lifestyle.  I training and compete in brazilian jiu jitsu (bjj).  Through high school and college I was a competitive distance runner.  Two weeks ago I sustained an injury while sparring in bjj.  Complete an MRI which found a high grade partial lcl tear, a moderate grade polietus insertion tear, and an osteochondral lesion measuring 2.1cm by 9mm as well as a few other things that I did not really understand.  I will post my radioology report as a reply to this initial post.

My understanding is that since the LCL has blood supply there is a good chance it will heal without surgery. However it is my understanding that the Chondral lesion would not heal on its own without therapy.   I have been researching regenerative therapies to both speed the healing of the ligament and tendon as well as option to potentially repair the lesion.  Those include prolotherpy (with many combinations of substances), PRP, and stem cell injections.  My goal is twofold, first is to get back to my sport ASAP and second is to set myself up for the best long term results in terms of maintaining high activity levels and avoiding the dreaded OA issues

My question:  Given my set is issues what would be an ideal approach?  Prolo and PRP?  Is stem cell overkill or would it be highly beneficial to go that route?

Also, I am in Arizona so a local doctor would be great but I am willing to travel if there is a strong recommendation to do so.  Any feedback that this community has would be GREATLY appreciated.

Offline Hflicker

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Re: Seeking advice on treatment options
« Reply #1 on: December 18, 2013, 10:47:45 PM »
Here is my radiology report:

LATERAL: Fibular collateral ligament high grade partial thickness versus full thickness distal to
the femoral origin with intrasubstance and periligamentous edema. Adjacent moderate grade partial
thickness popliteus insertional tear. Lateral collateral ligament complex is otherwise intact.

Lateral femoral condyle posterior weight-bearing osteochondral lesion measuring 2.1 em AP by 9
mm transverse. There is diffuse irregularity of the subcortical bone plate with a central osseous
ridge adjacent to the posterior horn of the lateral meniscus. Just anterior to the ridge is a small full
thickness 2 x 3 mm chondral defect. There is subcortical sclerosis, microcystic changes and bone
marrow edema, likely acute-on-chronic injury.

Free fraying of the adjacent posterior horn of the lateral meniscus without cleavage tear.


MEDIAL: Changes of prior partial medial meniscectomy with trimming of the inner two-thirds of
the body and inner one-third of the posterior horn. Inferior surface 1-2 mm notch at the posterior
horn remnant over a length of 8 mm. Medial meniscus otherwise intact.

Mild central weight-bearing medial compartment Grade II chondrosis. No subcortical bony
changes.

PATELLOFEMORAL: Elongated inferior pole of the patella with tendinosis along the proximal
segment of the patella tendon. Mild superolateral infrapatellar fat-pad edema which may be
secondary to contusion. No lateral tilting or subluxation of the patella. Smooth chondral wear along the inferior margin of the central trochlear groove over a height of 8 mm.

Changes of prior fat pad trimming. Mild medial fat-pad scaring related to prior arthroscopy portal.

Small knee joint effusion.

Anterior cruciate ligament increased signal intensity without fibrous disruption consistent with
Grade I sprain. Intact posterior cruciate ligament and medial collateral ligament.