A Question For you Orthopods...please help

[jenjas]

Hi guys,

I'm not a regular on the ortho forum. But I need some advice. My wife just injured her knee playing baseball on Tues. We had no insurance, and so we chose not to go to the ER that night. But because there was continued swelling and pain we went to an Orthopedic surgeon today. He said, she had an ACL tear with the possibility of a meniscal tear. He drained about 20-30 cc's of blood from her knee joint. We had an MRI today and are awaiting for the Doctor to call us back. This was all out of pocket of course since she had no insurance (perfect timing...I start residency in about a month, so neither of us is covered). Anyway, he said that if it was just an ACL, it is actually better to wait a few weeks/month to do the surgery. Do you guys agree with that? He said something about patients just seem to do better long term. I was also curious if you guys had any idea if we could wait on this, and have our insurance pay for this when I start. I know this will be considered a pre-existing condition, but I heard there is a waiting period of a few months and then they will pay....you guys know anything about that? And if we do that, is that putting her knee at risk for further injury? She dances (no not that kind......I wish), and wants to get back into teaching real soon. If she waits, how much more damage can she do? Plus if she has a torn meniscus as well, do they have to do the surgery right away.

Just thought I would seek a little advice. I hope some of you residents could help. I don't know too much about orthopedics......I'm starting anesthesia.....so any help would be appreciative.

Thanks.

Dr. J

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[Ifellinapothole]

Hi guys,

I'm not a regular on the ortho forum. But I need some advice. My wife just injured her knee playing baseball on Tues. We had no insurance, and so we chose not to go to the ER that night. But because there was continued swelling and pain we went to an Orthopedic surgeon today. He said, she had an ACL tear with the possibility of a meniscal tear. He drained about 20-30 cc's of blood from her knee joint. We had an MRI today and are awaiting for the Doctor to call us back. This was all out of pocket of course since she had no insurance (perfect timing...I start residency in about a month, so neither of us is covered). Anyway, he said that if it was just an ACL, it is actually better to wait a few weeks/month to do the surgery. Do you guys agree with that? He said something about patients just seem to do better long term. I was also curious if you guys had any idea if we could wait on this, and have our insurance pay for this when I start. I know this will be considered a pre-existing condition, but I heard there is a waiting period of a few months and then they will pay....you guys know anything about that? And if we do that, is that putting her knee at risk for further injury? She dances (no not that kind......I wish), and wants to get back into teaching real soon. If she waits, how much more damage can she do? Plus if she has a torn meniscus as well, do they have to do the surgery right away.

Just thought I would seek a little advice. I hope some of you residents could help. I don't know too much about orthopedics......I'm starting anesthesia.....so any help would be appreciative.

Thanks.

Dr. J

Hi,

I've had three ACL's and meniscus damage and a whole bunch of other crap.

From my experience, the doc is right it is better to wait 6-8 weeks till all swelling has subsided (there are less risks with arthrofibrosis this way).

I also lived without an ACL for 14 years and did very well; so don't think that you need to get it fixed right away. You can take your time.

You want to get it fixed if you are interested in playing cutting sports (soccer, b-ball, skiing, tennis, etc...) With baseball, if you are competitive she will probably want to get it taken care of, but can see how she feels once swelling goes down and may not need it.

Make sure to go to someone who does a lot of them. ANd ask them, how many they do a year. At a minimum you want someone who does 50 preferably more.

You are only at risk of doing further damage to your joint if your knee keeps giving out. But without that, you can live without an ACL so don't feel like it has to be taken care of tomorrow.

 

[DOctorJay]

Yup better to wait. Most important aspect of rehab would be to strengthen the muscles around the joint. Tricky with both a meniscus tear and ACL tear though (closed vs. open chain exercises, depends on how bad the meniscus is). Above poster is correct, ACL is not really necessary unless you're doing a lot of cutting and stop and go activity.

-J

 

[adamdowannabe]

I lived ACL deficient for a while, strengthening obviously helped some, but excessive lateral movement for many years (maintained an active lifestyle) left me with major meniscal damage. By the time I had my ACL reconstructed, meniscal damage was the least of my worries. From the Scope pictures, you could see nice pink spongy condular bone. Articular cartilage was totally gone, and my menisectomy was more like a harvesting of destroyed tissue. (I had my surgery filmed by a friend) it was rough to watch as out through the cannulas came chunk after chunk of my poor meniscus. these were big portions, easily filmed being rolled between two fingers. (I am age 19 at this point) It was nice to hear I will be due for a total knee in 8-10 years, which puts me 1-3 years away from that point. My activity level now cannot involve any impact activity, the post activity inflammation is horrible, plus I keep seing metal image of my nice pink spongy bone of my condyles. So, waiting can be great, especially doing pre-surgical PT , but if major pain persists, and Meniscal symptons keep popping up, remember the damage you might be doing to yourself. (I was also on the heavy side, so gravity was against me)