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Author Topic: MD said crunchy sounds = soft tissue injuries??  (Read 2275 times)

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Offline ilovemycat1

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MD said crunchy sounds = soft tissue injuries??
« on: February 19, 2004, 05:47:23 PM »
I fractured my patella 2 years ago, had the original surgery to repair, had the surgery to remove the hardware 8 months later and basically have been back to normal, except for occasional  buckling, some inherent weakness, and the crunchy sounds upon extension.  Anyway, I'm involved in a lawsuit and my atty. sent me to an orthopedist yesterday to address an issue that my original orthopedist didn't cover.  This MD, as soon as hearing the crunchy sounds, said "you really pulverized the knee" and I think you should have an MRI to see if there is soft tissue injuries.  I said "the knee wasn't pulverized, it was a clean break across and I don't see why I need an MRI.  (I felt that he was just trying to milk the lawsuit for more fees).  We sparred about the MRI a few more times and then he said he will have my atty. fight with me about it.  Then during his narration into his dictophone, I heard him talk about TKR and asked him why he brought that up.  He said those crunchy sounds are bone against bone and that eventually it will get to the point of TKR.  I came home pretty upset last night and have no idea what the future will bring, or if this guy was telling the truth.  Any thoughts?

Offline ozzybug

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #1 on: February 19, 2004, 05:54:17 PM »
The best advice that I could possibly give you is to absolutely go for the MRI.  Many times, trauma to the knee can cause the process of degenerative changes to the articular cartilage which can be detected with the MRI.  Sounds like the OS is headed in the right direction to get you the answers you need about what's going on in your knee.

I speak from experience because I'm having the same symptoms in my knee caused be trauma followed by multiple arthroscopies to repair torn meniscus, plica removal and some debridement of chondro of the patella.  I may be facing another surgery if we can't get this clicking & grinding to stop.

Please- it seems that it would be worth the piece of mind to know what's going on in there because this very well could be a result of the original injury.

Best of luck with your situation!
Lezlee
Rt knee:Meniscal repair 8/03: Repair prev. meniscus repair 10/03;Chondro shave, scar tissue removal 12/03;LR,debridement chondro & scar tissue 04/02/04;TTT done 09/14/04;VMO advancement 04/2005- Does it ever end?

Offline scottrayden

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #2 on: February 19, 2004, 08:29:28 PM »
I've had 3 knee surgeries in the past 5 years and my knee has the same problem. CLicking and crunching sounds when I bend it.
My OS is thinking about doing another surgery just to clean up the scare tissue a bit but not sure I want to go through the process again.
Let me know how it goes though

Scott

Offline Linds

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #3 on: February 19, 2004, 09:24:35 PM »
The fact that you have been doing relatively okay would seem kind of strange to be thinking TKR.  Now of course none of us know what the future will hold ! I am 23 years old and my OS has suggested that TKR on both knees is most likely where I am headed, but obviously tha'ts a long way off for me. I would get another opinion as not having seen MRI's and such on your knee, how could he tell for sure.  DId he see xrays?? Did he see anything other than your knee sitting infront of him???
Hang in there...
HUGS and hope
Linds
1997 Scope RK
2002 LR RK
2002 Scope and hematoma evac RK
2004 LR LK
May 06 Fall from Horse, partial ACL tear and meniscus injury, Tibial plateau injury
2007 Scope, Plica Excision and Debride LK
2009/2010- Possibly Ankylosing Spondylitis?

Offline ilovemycat1

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #4 on: February 19, 2004, 11:06:43 PM »
I don't really see the crunchy sounds as a problem at all and was quite dismayed that he was making it out as a problem.  I know that two of your doctors suggested surgery to get rid of it, but I would not contemplate that for sure.  I think the surgery is what brings it on in the first place.  When he said that I might need TKR because of the bone against bone problem, I replied "that maybe I'll be dead by then".  I don't mean to be morbid, but I guess I was reacting to his emphasis on the worst case scenario, which kind of threw me for a loop.  Thanks for your input and support. Jessica

Offline 2soreknees

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #5 on: February 20, 2004, 02:21:45 AM »
Personally I would go the MRI.  If it is damage related to the original surgery don't you want to know?   I understand your reluctance however the crunching and popping means something is wrong.  I don't know how your doc could even talk about a TKR without an MRI - he doesn't even have an accurate idea of what is wrong!
In my case the knee that had the TTT no longer makes any noise even though I have bone on bone (big time!).  If you have bone on bone you would hurt.

Now my other knee that I have had arthro, meniscus repair, microfractures etc. still pops, crunches, locks up and drives me crazy but that is because I have a genetic problem with my patella femoral tendon.

Good luck, I hope you get things worked out.

Tery
2/02 (R)arthro. meniscus tear, microfractures, grade 4 chondro. under patella.
TTT/LR on (L) 3/03. 
11/04 Arthro (R) MF
4/06 (L) clean up and trim back scar tissue from LR
11/06 (R) HTO
8/08 (R) Hardware removalMFR
8/09 L microfactures
12/09 LTKR
11/11 R TKR and last knee surgery!

Offline Heather M.

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #6 on: February 20, 2004, 02:46:46 AM »
Actually, it sounds like your doctor is trying to protect you.  Often, when there is a serious fracture around the knee the lines of the break don't heal perfectly, leaving behind articular cartilage defects.  This is the beginning of the trip that ends with a TKR.  Your doctor was being a bit alarmist in that all cartilage damage doesn't necessarily mean TKR...but it is a covering the bases and very logical and cautious approach to take.  If I ended up on the TKR watch list because of an accident, I'd want that to be well documented for litigation purposes before it ever got to the surgery stage.

And I have to say, a good doctor shouldn't need an MRI.  I've not had great experiences with them--they quite often don't show what the true extent of the damage is when you are dealing with articular cartilage defects--especially on the patella.  I had a recent MRI done on my bad knee (five surgeries) and the test results came back "Mild chondromalacia and articular cartilage thinning."  Okay, that's fine, except during my last surgery it was documented (with pictures) that I have two severe osteochondral lesions--this is much worse than 'mild chondromalacia' and if my doctor were going just on the MRI he'd say my knee was in pretty good shape.  But he's seen the surgery photos and did a hands-on exam to feel the crunching and grinding, so he knows it's more than 'mild.'

It is quite possible to have deep lesions in the articular cartilage--and even have crunchy noises--without pain.  If you fall in that category, count yourself lucky but understand your knee could well be living on borrowed time.  It could be that it will feel great forever, in which case you will have dodged the bullet and congratulations.  But if your knee ever begins to hurt, the first thing they will blame will be the old fracture and probable resulting damage to the articular cartilage.

Don't let the doctor put you off with talk of the TKR express...but do let him help you protect yourself during your litigation.  He's on your side.  I hope you resolve this without any further problems and your knee continues to be pain free--that would really be the best news of all!

Heather
« Last Edit: February 20, 2004, 02:49:28 AM by hmaxwell »
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
http://www.flickr.com/photos/hmaxwell

Offline lizl

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #7 on: February 22, 2004, 02:52:26 AM »
Jessica,

Welcome back!

I think Heather summarized everything extremely well, though I can certainly sympathize with your reluctance to accept an iffy prognosis.

I've been told repeatedly that some degree of crepitus is pretty normal following patella fracture. I haven't really gotten a clear answer, however, about the implications. It makes sense to me that whatever causes the crepitus cannot be good for the knee's mechanical functions, if it is also creating additional friction or if it is due to stuff floating around in there.

I'll be involved in negotiation myself as soon as I reach MMI, so your situation is very interesting to me.  If there is a possibility of TKR down the road for me, I certainly want that to be an issue in the settlement. Here's hoping that it remains only a possibility for you! Your attorney needs the information in order to advocate for you, so it's a good thing that the OS is making it part of the equation.

I want to point out that "occasional buckling" is not a normal thing, and I'm sure your attorney is going to note that. You have nothing to lose by going for the MRI. Look at it this way--whatever they say is speculation. You are still doing fine right now and maybe for the long term, so go ahead and let them speculate.  Good luck and please keep us updated.

LizL
2003: 1/28-29Fell on wet floor,broke kneecap
ORIF(hdwr&immob)
Post-op drug reaction
3/4-5/13 brace
3/21-8/28PT
12/19Hardware removal,scope,partial meniscectomies
2004: More PT
lost job
Settledw/WC Oct
2005: Personal injury lawsuit--reschedulings,failed mediation
2006: settled out of court in March

Offline ilovemycat1

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #8 on: February 22, 2004, 04:39:54 PM »
LizL,
Thanks for  your reply.  I read the history of your injury and it is similiar to mine.  But when you said you will be involved in negotiation when you reach MMI - how do you know that?  I hope you contacted an atty already since there is a time frame issue that is involved.  Also, negotiation implies the other party will settle.  You don't know that unless I misunderstood and the other atty has contacted your atty about a settlement and your atty is putting it off.  
I also fell on something wet in a county hospital and the atty's for both entities (county and hosp) have no interest in settling.  So at this time we seem to be headed to a trial.  
I spoke with my atty Friday and told him what happened with this 2nd OS.  He said that if I now have any concerns (brought on by the OS or what I have learned from this board) I should go back and see my treating OS, who I haven't seen in over a year..  I'm thinking about that.  I think he will probably say what you said- that the future is sort of unknown, that some of this is to be expected, etc. but maybe it is worth a visit. Thanks again for your input.  I just found this board the day I posted and it really is quite supportive.  

Offline lizl

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Re: MD said crunchy sounds = soft tissue injuries?
« Reply #9 on: February 22, 2004, 04:51:38 PM »
Jessica,

Oh, I thought you were a poster from two years ago just now returning--so WELCOME to the board!

Yes, I have an attorney. Workman's Comp has been trying to spin me out of the system for some time now. My lawyer is the one who told me there will be a payout of some sort after I have reached Maximum Medical Improvement. If anything, I am the one who has resisted accepting the MMI designation, because I still wanted to keep trying to improve.

Are you involved in a personal injury situation, rather than a WC case? I may eventually be involved in a personal injury case, as well. My lawyer is keeping track of the timeframe.

LizL

LizL
2003: 1/28-29Fell on wet floor,broke kneecap
ORIF(hdwr&immob)
Post-op drug reaction
3/4-5/13 brace
3/21-8/28PT
12/19Hardware removal,scope,partial meniscectomies
2004: More PT
lost job
Settledw/WC Oct
2005: Personal injury lawsuit--reschedulings,failed mediation
2006: settled out of court in March