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Author Topic: 2nd MRI...what's up with this?  (Read 1433 times)

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Offline alwaysbelieve

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2nd MRI...what's up with this?
« on: March 08, 2014, 04:20:11 AM »
~Fall onto concrete September 8. ER X-Ray-negative.
~F/U with OS 3 days later-possible mcl/meniscus tears. Given authorization to work with standing/walking limited to 15min/hour. MRI ordered
~Worked 8-14 hours/day, 6-7 days/week without ability to limit standing/walking times. Did utilize crutches for lengthy surface coverage
~MRI done 1 month after initial fall. DX: Patellar fracture. No work. No weight bearing. Breg t-scope 24/7 at 0
~Unable to tolerate t-scope without increased intense pain...remained in bed keeping leg straight and non-weight bearing (OS gave okay for touchdown weight bearing for bathroom only)
~Physio started 8 weeks after bracing ordered. Brace was kept at 0 for additional 3 weeks after starting physio
~Brace at 15 10 weeks after bracing began
~Brace at 90 2 weeks later
~No brace 2 weeks later (except as needed)

It has now been 6 months since I fell. I am still in considerable pain and quite limited. Still not back to work. OS FINALLY orders another MRI after repeatedly informing him/staff of pain/swelling/popping/locking/instability (I also had asked about any other findings on initial MRI when results were first obtained back in October-I was told there was nothing else except fracture). Didn't order MRI until after I told him PT said I had a positive sag sign.

~Second MRI done last Friday.
~MRI f/u with OS Wednesday. DX: meniscus tear, "old" ACL tear. Recommended "injection". Asked about my pain, I told him, he then said "Could do surgery on the meniscus but I'm not sure how much it will reduce the pain as it seems more arthritis"

Okay. I realize I am 47 years old but I do not have one single problem with the function/pain in my uninjured knee (which happens to be on my dominant side). After my previous meniscus tear, I had pain but not enough to prevent me from working.

~Why were the meniscus tear and ACL tear not identified on the first MRI? (Especially if the ACL tear is "old"? )
~I had an MRI & artho/meniscectomy 3 years ago, wouldn't the ACL tear have been mentioned then if it was present?
~Nothing regarding PCL injury even though that is what most symptoms (and sag sign) point to?
~What will an injection do for either tear?
~If the ACL tear is so "old" is it beyond time-frame for revision or is that based on symptoms?

I know I seem to have a lot of questions but I am in the process of obtaining films/reports/records for a second opinion and I want to make sure I am with the right OS this time.

Thank you!
L knee MCL tear- 8/2010
L knee Meniscectomy-3/2011
L knee Patellar Fx-9/2013

Offline Sheiabah

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Re: 2nd MRI...what's up with this?
« Reply #1 on: March 10, 2014, 03:19:13 PM »
My meniscal tear was missed on MRI as well - it was found to be a grade 3 tear during the surgery and actually quite bad, the MRI noted just softening and fluid, I was given the option of PT or surgery and opted for surgery as the pain was just too bad and I didnt feel PT would work.  6 weeks on I am still in pain so opted for Duralane Injection (I am going to assume that is the same as the "injection" you were offered) I am only 3 days post injection however for me it is currently worse not better, I am hopeful that this is just a time thing and that it will get better and I am just impatient.

No advice to offer you except to say it seems MRI is not infallible and if you are given the option of the injection bear in mind it can get a lot worse before it gets better.

Offline Clarkey

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Re: 2nd MRI...what's up with this?
« Reply #2 on: March 10, 2014, 06:12:10 PM »
Hi There,

I have had 3 MRI scans over a period of 11 years and all the 1st two did not show up too many problems. Last week my MRI scan results did show up cause for concern and was hard for my OS to know what exactly is going on inside my right knee.

I have swelling, fluid and bone bruising inside my right knee and some scar tissue from my 1st scope in 2009. This somewhat hinders the true results of the MRI of my right knee. The only option left now is for me to have an exploratory in July; I have had it done previously in 2009 back then I had my medial plica removed and fat pad trimmed. The MRI scan back then came up fairly normal until I had my right knee scoped.

MRI scans are not 100% accurate as one cannot entirely go by the MRI scans. If you are in pain on a daily basis and have swelling then there is something not right. Can have no swelling of the kneecap and can still have problems inside the knee mechanically.

I have had PT and Injections without success and happy to gamble and have a 2nd exploratory scope done. I am too young to hang up my runner trainers at the age of just 35; I am unable to run at the moment due to right knee problems.

Surgery can go 50/50 improve or make the knee worse; this depends on each individual and the type of knee injury and problem, no two knees are alike. Every patient knee problems are different to the next patient.

Also soft tissue injuries like an inflamed fat pad and plica do not show up on an MRI scan but will do while your OS does an exploratory scope. I can confirm this from personal experience after having my fat pad trimmed and medial plica removed in November 2009. Back then my MRI only showed up fluid around the fat pad and missed out the inflamed medial plica.

Good Luck, decide wisely what you want to do next.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Vickster

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Re: 2nd MRI...what's up with this?
« Reply #3 on: March 10, 2014, 06:55:28 PM »
My meniscal tear was missed on MRI as well - it was found to be a grade 3 tear during the surgery and actually quite bad, the MRI noted just softening and fluid, I was given the option of PT or surgery and opted for surgery as the pain was just too bad and I didnt feel PT would work.  6 weeks on I am still in pain so opted for Duralane Injection (I am going to assume that is the same as the "injection" you were offered) I am only 3 days post injection however for me it is currently worse not better, I am hopeful that this is just a time thing and that it will get better and I am just impatient.

No advice to offer you except to say it seems MRI is not infallible and if you are given the option of the injection bear in mind it can get a lot worse before it gets better.

Hyaluronic acid injections like Durolane typically take 2-4 weeks to show any improvement and when they work (50/50 it seems), they should be effective for a long while (my OS says 1-2 years). 

Also, recovery from any surgery can be slow, expect months (at least 3, probably more like 6) to even feel back to where you were pre op let alone better, so hang in there :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline alwaysbelieve

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**Updated**3/24/13 Re: 2nd MRI...what's up with this?
« Reply #4 on: March 25, 2014, 12:47:51 AM »
So, clearly not happy with my OS, I received copies of my medical records (including images) and sought another opinion.

First, the REAL 2nd MRI findings: healed patellar fracture; chondromalacia patella; posterior flap tear medial meniscus; mild ACL tear; mild/moderate knee effusion with cyst formation; edema of patellar marrow.

Second, my appt. with second OS today: Not too concerned with ACL tear as there "is a stopping point" so he does not think that will be a long term problem. Definitely need to repair the meniscus and the cartilage. However, he is quite concerned with the continued/increased pain/swelling along with some anterior shin-ankle-top of foot paresthesia(tingling) as well as decreased lower leg/ankle/foot muscle function. I am scheduled for an EMG tomorrow.
L knee MCL tear- 8/2010
L knee Meniscectomy-3/2011
L knee Patellar Fx-9/2013

Offline Clarkey

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Re: 2nd MRI...what's up with this?
« Reply #5 on: March 25, 2014, 05:32:56 PM »
Hi There,

It always good to seek a 2nd opinion and you do need to have your knee scoped to clean it up inside. An MRI scan can often miss out vital knee injuries inside the knee that can only be spotted by a well experienced and trained OS. once he is inside the knee with the camera, can do a full assessment of all the parts of the inside of the knee.

All OS are highly trained with many years experience, so are good at spotting problems missed out on an MRI scan.

Good luck with your treatment.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline alwaysbelieve

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Re: 2nd MRI...what's up with this?
« Reply #6 on: March 25, 2014, 08:32:57 PM »
Hi Clarkey,

Thank you, I feel much more comfortable with this new OS. Said while he is confident the meniscus and cartilage can be fixed, he wanted to make sure there wasn't something else going on that may be "above his pay grade" before going into the knee.

Can't say how the EMG went today. Started with NCS that sent me nearly off the table. I can't believe I actually hollered out in pain and cried. Of course, that was on the left leg...uncomfortable on the right, but tolerable. Focused on the knee down, more points on the left than the right (I believe they were performing on the right as more of a baseline). Neurologist came in to do the EMG. Asked if I was put in a cast. I told him it was a brace. He asked specifically where the straps came on my leg. Said it may have "pressed then". Only one place on my back was tested and he only did EMG points on my left leg, not my right. I do not have experience with either of these tests, but I would have thought it would have less pain on the leg that is having numbness/tingling. I have an appt for follow up next Monday.4

Right now I am in terrible pain. Am hoping Monday comes with answers and more direction.
L knee MCL tear- 8/2010
L knee Meniscectomy-3/2011
L knee Patellar Fx-9/2013