Bad News Today....seeking advice

[94PS190]

8 surgeries on my right knee, Choose the options that make the most sence to you, but most importantly, Check out your doctor. Just like everything else, there are good ones and bad ones. I went to a highly recomended practice to later find out my doctor wan not the so highly thought of.

[TxsRiverRat]

Where can he get some deer antler spray?

[JohnnyB]

Originally Posted by TxsRiverRat

Where can he get some deer antler spray?

That crossed my mind. Going to go look for sheds tonight.....

Major predictors for being able to return to high level function without requiring ACL reconstruction include:

normal range of motion - RESTRICTION IS I CAN'T RUN
no or minimal knee swelling - MINIMAL TO MODERATE
good quad strength - NOT AN ISSUE
good static and dynamic balance - DOESN'T SEEM TO BE AN ISSUE
no episodes of the knee giving way - NO ISSUE

Very similar to my Dr.'s and my discussion today. _FNG_ are you a PT??

[kodiak]

My wife just had her ACL FCL, PCL and Posterolateral corner replace by this guy.
http://drrobertlaprademd.com/complex...ament-injuries
They suspect the reason her injury was so bad was her ACL, which was done 20 years ago
was weak. She had surgery 5 weeks ago and still can't walk on it.

[tex]

Originally Posted by TxsRiverRat

Mike ("Tex") made the mistake of trying to come back too early from his ACL and he ended up re-injuring himself and that I believe cost him 2 seasons on the water. Now that he is 'recovered' he skis with a brace all the time.

I know this guy you call Mike("Tex") and no he didn't try to come back too early. He was skiing with a great ortho's advice on what he could and couldn't do and suffered a freak injury the 2nd time riding a sky ski. They have written this Tex guy up in medical journals to try and figure out why this happened! I bet his insight would be trust your doctor! There has been so much advances in the area of operations. I took double cadaver and double hamstring grafts. An ACL is a day at the lake compared to what it used to be! If you want to have some fun, try an ACL/MCL/PCL! Good luck, listen to the doctors(they have a big head for a reason-Unlike others here), and do your PT! Oh yes....Doctor says wear my DonJoy at everything above a jog so I wear it every time I ski and enjoy the heck out of it and I hate braces!

[ahhudgins]

I’m no doctor, but if it’s true that you could be at risk for tearing your meniscus without corrective surgery on the ACL, I would have the surgery and possibly miss a season. I torn my meniscus about 12 years ago and had to have quite a bit of it removed. Since the surgery, I can no longer do any activity that involves impact to the knee. Well I can, but not without several days of pain following the activity. I can ski, barefoot, and wakeboard, but I no longer land in the flats. I can ride a bicycle or use an elliptical but running is not an option. I did a few light squats at the gym last night, stood on concrete for 10 hours today and my knee is killing me. Once cartilage is removed, it doesn’t grow back.


Bottom line: Follow the doctor's advice. And good luck.

[Big Dogg]

Originally Posted by drschemel

You will get all sorts of "advice" so take this for what it's worth. The ACL provides knee stability front to back and without it, you knee has a tendancy to "pivot shift" causing a sudden loss of strength and buckling when you walk. In time, this abnormal motion with damage the articular cartilage and you will develop arthritis. In the short term (like over the Summer) you risk tearing one of the meniscal cartilages if you knee gets torqued. A brace with hinged metal side stays will help protect againt this and would probably take you safely through the Summer. If you decide on this course, you will need to be doing quad exercises to avoid loosing leg stength. Some people are able to compensate well enough with strong quads and don't have the surgical repair done. Most people will go ahead with a surgical repair. Your surgeon can best advise you as to what type. Unfortunately, any repair can fail. A tendon repair with either cadaver or autologous tendon graft will most closely restore the natural knee mechanics and may reduce your risk of arthritis down the road. This is usually done in women or men with smaller muscles as it might not be quite as strong and may fail more often. The patellar tendon reposition is thought to be a stronger repair and more often done for people with larger muscles or people that are going to demand a lot from their knees (like skiers, boarders, etc). It does change the knee mechanics slightly and you will be looking at a knee replacement in 20 or 30 years.
Good luck on your rehab. It's a bummer of an injury.

Doc, your information here is great. I was wondering your thoughts from the rehabilitation position post surgical, about muscular strengthening for reduced knee valgosity and correct patellar tracking. I have seen research that supports that gluteus medius as an external rotator of the femur (inherently inhibited control because of long duration sitting) can be trained through rehabilitative exercises both functionally and proprioceptively to activate better and control the knee from diving into valgosity. Especially in the functional screens of an overhead squat test or one leg squat test (the assumed position that a skier/barefooter takes as they move across the water) To further that stability, increasing VMO activity to provide better patellar tracking. Other clinical approaches have included manipulation of the femur head/acetabular articulation for improved mobility through the hip capsule and manipulation of the ankle mortise and talus/navicular articulation to improve tibial rotation and foot pronation through the gait cycle. All of this combined to reduce torsional and valgus stresses on the ACL/MCL. While it sounds like this case is most definitely a need for surgical intervention to repair the ligaments, I was interested in your thoughts for rehabilitative procedures to get him back on the water faster, more stable, and of course pain free.

~Inquisitive mind of a (near graduation) Chiropractic student who enjoys working with pre/post surgical rehabilitation and chiropractic management cases.

[_fng_]

Originally Posted by JohnnyB

_FNG_ are you a PT??

Yes sir.

[drschemel]

Sorry BigDogg, it's out of my pay grade! I just diagnose and send to the rehab specialist for the rest. Everything you suggest sounds apropriate. There is a lot of science and physics behind the rehab but in general, anything that strengthens the thigh is going to help. Start light, do a lot of repetitions and increase resistance as the knee responds. I alway have people see a therapist or chiropractic doctor that specializes in sports medicine.

[Big Dogg]

Originally Posted by drschemel

Sorry BigDogg, it's out of my pay grade! I just diagnose and send to the rehab specialist for the rest. Everything you suggest sounds apropriate. There is a lot of science and physics behind the rehab but in general, anything that strengthens the thigh is going to help. Start light, do a lot of repetitions and increase resistance as the knee responds. I alway have people see a therapist or chiropractic doctor that specializes in sports medicine.

Doc,
I appreciate your honesty as well as your support of the ideals that I proposed. Its great to see a physicians such as yourself providing patients co-management options to optimize health, performance, and return to play.

Thanks,
Aaron