John from Riverside Posted February 8, 2007 Share Posted February 8, 2007 A little background.... My son (just turned 15 in Jan) is a aspiring football/basketball player and a pretty good one at that......but 5 months ago towards the end of his freshman HS season took a blow to the side of the knee covering a special teams play..... - The original diagnosis was a sprained MCL......while it looked bad to begin with actually ended up healing in a couple of weeks...... - He went out and played one fore game (with 2 to go) and it took us that long to get an MRI down here and since it was scheduled we went ahead and took him.....the MRI revieled that not only did he have the sprained MCL but a fracture of the growth plate in his knee. He was done for the season right then and there (caused a HUGE problem in our house as he wanted to finish his season) but anyway he was done...... - The fracture was supposed to take about a month to heal......right about the month time frame....basketball begins and he tries out.....has pain immediately in his knee at tryouts and so he skips the basketball season and we take him back to the doctor - The doctor says he still has menisus? injury and smashed cartilage which will heal. He he recommends swimming pool exercises for the next month no liftfing and then it should be fine - Brett waits TWO months before he starts lifting again along with continuing with pool work.....but there is this one small problem....the sharp pain in his knee is not going away.....he lifts pain free but cannot run..... - It has now been 5 total months from the time of the injury......and he STILL cannot push off of it......the pain is coming from underneath his kneecap and he says it almost feels like a piece of cartalage is broken off and he feels it when he tries to run.... - The ortho who examined the MRI mentioned nothing of any broken off cartilage I dont know what to do......does this sound like a orthoscopic surgury thing? How long to heal from something like that for an athlete. Link to comment Share on other sites More sharing options...
Dwight Drane Posted February 8, 2007 Share Posted February 8, 2007 I'm not a doctor, but it sounds like you've nailed it by saying it's a floating chip. The original fracture and miniscus problem could have sent a chip into the joint that has only now gotten in there pretty good. If that's the case, they probably scope it out and he takes it easy another 6 weeks. Like I said I'm not a doctor, but I have done this with racehorses. Does the boy like carrots? Link to comment Share on other sites More sharing options...
John from Riverside Posted February 8, 2007 Author Share Posted February 8, 2007 I dont know...he LOOKS like a racehorse and eats everything in site.... That is my feeling as well....the problem I have with all this is if this was the case the scope should have been done MONTHS ago.....he is just now starting to be able to do things like squat and the scope will take him down for another 6 weeks..... The other thing is the medical machine moves REALLY slow around here....I have to go to my doctor and get a referral...then wait for the doctor to look at him again....then wait for whatever comes next.....and on and on..... As much as I would like my son to be able to play his sophmore year (we are getting into the time frame when he needs to be able to show somthing and participate in combines etc) I really would just like to see him healthy again..... Link to comment Share on other sites More sharing options...
Dwight Drane Posted February 8, 2007 Share Posted February 8, 2007 If it is a chip, it may have just come off recently. It sounds like he got nailed pretty good, and sometimes it takes a while for a fragment to break off. Almost like a dead leaf falling off of a plant...you can see it coming sometimes, but you just have to wait for it to happen. If they re-do an Xray, they can compare it to the old one where there was damage and I bet it was probably part of the original area. All this being said, I am used to horses....but the vets have digital Xrays and can take 20 angles of the same joint at 50x zoom on the computer. When 5 years ago we wouldn't know what was bugging a runner, today you can almost anticipate if one is going to develop problems and where. Good luck...hopefully he doesn't miss much time. Link to comment Share on other sites More sharing options...
Stussy109 Posted February 8, 2007 Share Posted February 8, 2007 One thing i would recommend.... Most doctors will never tell you this, but go to your local drug store, cvs, rite aid etc... and pick up a couple bottles of glucosamine chondroitinin. Take it EVERYDAY for a few months, then get back to me on how he feels. I had severe tendonitis/pain in both my right elbow (used to pitch in baseball) and my left wrist (lifting heavy weights too much). WIthin a few months, my years of agony had all been overcome. It was a miracle supplement for me, it is known to help repair and regenerate joints back to a healthy state. Highly recommended! Link to comment Share on other sites More sharing options...
Zona Posted February 8, 2007 Share Posted February 8, 2007 I have had 2 knee surgeries, and wife has had 4. It sounds to me like it very well could be a Miniscus tear. It is right under the Patella, and would allow him to lift without pain, but not run. I had a Broken kneecap with pieces loose in the joint, and you couldn't do any lifting or running if there was a piece of bone loose in the joint. Just my two cents. Oh and sometimes a miniscus tear wont show on MRI's or X-rays. My wife's didnt. The Ortho thought it was cartilage when he went in, and found out it was a Miniscus.... Link to comment Share on other sites More sharing options...
tennesseeboy Posted February 8, 2007 Share Posted February 8, 2007 I'm not a doctor, but it sounds like you've nailed it by saying it's a floating chip. The original fracture and miniscus problem could have sent a chip into the joint that has only now gotten in there pretty good. If that's the case, they probably scope it out and he takes it easy another 6 weeks. Like I said I'm not a doctor, but I have done this with racehorses. Does the boy like carrots? Racehorses? Don't be relying too much on Dwight or he'll end up putting the kid down! Seriously...get a second opinion from another competent (or very competent) specialist and then do what they tell you. Good luck enforcing the rest part with a 15 year old! That's how I got my gray hairs! Best of luck to both of you and hope the young man has a terrific season next year. Link to comment Share on other sites More sharing options...
BUFFALOTONE Posted February 8, 2007 Share Posted February 8, 2007 I agree with Zona, I have had 2 myself. First thing is to have him STOP SQUATING IMMEDIATELY.! If it is cartilage or anything else he will continue to due damage to the knee. I have less than 50% of my cartilage and I can play anything with no pain, but he will in all likely hood have to get it scoped. He will be laid up for a few days but then he can begin physical therapy and really strengthen it the right way. I know its frustrating not being able to play but if he does this the right way now in the long run he will be much better off. He is still young and you do not want him messing with his knees. Trust me. But NO MORE LIFTING ON THAT KNEE! Link to comment Share on other sites More sharing options...
RayFinkle Posted February 8, 2007 Share Posted February 8, 2007 I'm no doctor, but has be tried rubbing some dirt on it and taking a lap? Link to comment Share on other sites More sharing options...
tennesseeboy Posted February 8, 2007 Share Posted February 8, 2007 I'm no doctor, but has be tried rubbing some dirt on it and taking a lap? You ever coach football at South Park High School? Link to comment Share on other sites More sharing options...
Captain Hindsight Posted February 8, 2007 Share Posted February 8, 2007 I have a knee injury similar to this, they still don't know what i did. I was running and i changed direction and my knee didnt turn. they thought it was miniscus but nothinhg showed up on the mri so i kept playing and now it really bothers me. ive been wearing a knee brace and that minimizes pain but its not healed at all still. (injury occured in August) i did have protein shakes all season and that seemed to help a little bit, but i really dont know Link to comment Share on other sites More sharing options...
John from Riverside Posted February 8, 2007 Author Share Posted February 8, 2007 Hey Stussy....thanks for the advice.... For pretty much the whole last 5 months I have had him on both GNC Triflex Chews (has the supplements you are talking about) and Lglutimine (also helps healing) I def do my internet research....I am just starting to think that this is going to require more then anything I can do or buy from a store to fix this problem. I cannot prove it....but I really think he has a cartilage piece in there somewhere that has broken off and is hitting a nerve when he uses burst and accelleration. Link to comment Share on other sites More sharing options...
BillsFanM.D. Posted February 9, 2007 Share Posted February 9, 2007 A little background.... My son (just turned 15 in Jan) is a aspiring football/basketball player and a pretty good one at that......but 5 months ago towards the end of his freshman HS season took a blow to the side of the knee covering a special teams play..... - The original diagnosis was a sprained MCL......while it looked bad to begin with actually ended up healing in a couple of weeks...... the MRI revieled that not only did he have the sprained MCL but a fracture of the growth plate in his knee. The doctor says he still has menisus? injury and smashed cartilage which will heal. - The ortho who examined the MRI mentioned nothing of any broken off cartilage I dont know what to do......does this sound like a orthoscopic surgury thing? How long to heal from something like that for an athlete. Well, for the record, I am a doctor. Not ortho...not even surgery;so I would not consider myself an expert on an MD level. I practice in general adult medicine but I'll give you my best info. I'm a little confused as to what his diagnosis is. The knee has four basic ligaments... ACL, PCL, MCL and LCL. If his injury is an MCL sprain (no tear), this is rarely treated with anything other than rest. Even with tears, it is usually treated quite conservatively. The big concern with that type of injury in an athlete is additional cartilage tears that can occur with it. The MCL is on the inner side of the knee and is attatched to the medial meniscus. Imagine a support strap on the inner side of the knee (mcl) attatched to a cushion (medial meniscus) that fits between the "thigh bone and leg bone." The meniscus is the cartilage in the knee and consists of both medial and lateral parts. Just wanted to clarify as some have mentioned these as different terms. Cartilage and meniscus are the same. When the mcl is strained the medial meniscus is often injured as well. The last concern you mentioned is the growth plate. If that portion of the bone is injured he may have some concerns re: further growth. That's a huge if...and hard to predict. I'll leave that to the ortho. From what I can guess (and i stress the word guess) he should have healed an mcl strain by now if he has been faithful with rest. That's always a tough one for a kid who is athletic. make sure he's been honest with you. that's not a knock on your son as I sure as heck would have lied to my parents/coach etc to "get in the game." If he has a cartilage tear this generally has symptoms of the knee locking or significant pain with resistance such as lifting or running. If he has symptoms of instability (knee giving way) that generally points towards a ligament tear. An MRI answers these questions almost all the time. The only question then is whether it is treated surgically or conservatively. In some cases, however, they will go in arthroscopically to "look around" when the patient's symptoms are not explained by the MRI findings (or lack of). This also is the time to remove any loose particles of cartilage that may be present. As far as cartilage healing....that's not very likely. Cartilage has poor blood supply and it's ability to heal is very controversial. When you hear about athletes getting "microfracture surgery" the principle is to make small holes in the cartilage to promote blood flow. Some are firm believers; most are skeptical. In general, if the cartilage is severly torn, the offensive piece is removed. This obviously accelerates the development of arthritis over one's life but can often greatly improve symptoms in the short term. If the piece is a flap and not shredded it can be "tacked down" in it's original position. He may be have suffered direct trauma to the cartilage and bruised the underlying bone. This is called a bone bruise (aptly named). This can be a lingering injury with no real structural damage but hurts like heck. A bone bruise typically is visible on an MRI. You also mentioned pain directly under his kneecap. A lot of young athletes have significant patellar laxity (loose kneecap). This means his kneecap moves left and right more than average. Everyone's can be slid a bit in the relaxed position. Some moreso than others. Often those individuals will develop wear and tear changes under the kneecap because of the increased trauma that occurs in someone with this "loose" kneecap. This "disorder" is called patellofemoral syndrome. Usually this occurs as a chronic worsening problem rather than a sudden onset of pain so it is much less likely in your son's scenario. If it's been months since his last MRI, I might suggest you repeat it. He may have had a small cartilage tear that failed to show initially and his repeated attempts to start sports may have exacerbated it. Just a thought. Lastly, get a second opinion. Any doctor who is worth their salt would certainly encourage it. sometimes a fresh set of eyes is helpful and your son may be reassured by hearing some confirmation. Don't get too frustrated. Sometimes these things just linger and caution is the best way to proceed. Hope this helps. Link to comment Share on other sites More sharing options...
John from Riverside Posted February 9, 2007 Author Share Posted February 9, 2007 Well, for the record, I am a doctor. Not ortho...not even surgery;so I would not consider myself an expert on an MD level. I practice in general adult medicine but I'll give you my best info. I'm a little confused as to what his diagnosis is. The knee has four basic ligaments... ACL, PCL, MCL and LCL. If his injury is an MCL sprain (no tear), this is rarely treated with anything other than rest. Even with tears, it is usually treated quite conservatively. The big concern with that type of injury in an athlete is additional cartilage tears that can occur with it. The MCL is on the inner side of the knee and is attatched to the medial meniscus. Imagine a support strap on the inner side of the knee (mcl) attatched to a cushion (medial meniscus) that fits between the "thigh bone and leg bone." The meniscus is the cartilage in the knee and consists of both medial and lateral parts. Just wanted to clarify as some have mentioned these as different terms. Cartilage and meniscus are the same. When the mcl is strained the medial meniscus is often injured as well. The last concern you mentioned is the growth plate. If that portion of the bone is injured he may have some concerns re: further growth. That's a huge if...and hard to predict. I'll leave that to the ortho. From what I can guess (and i stress the word guess) he should have healed an mcl strain by now if he has been faithful with rest. That's always a tough one for a kid who is athletic. make sure he's been honest with you. that's not a knock on your son as I sure as heck would have lied to my parents/coach etc to "get in the game." If he has a cartilage tear this generally has symptoms of the knee locking or significant pain with resistance such as lifting or running. If he has symptoms of instability (knee giving way) that generally points towards a ligament tear. An MRI answers these questions almost all the time. The only question then is whether it is treated surgically or conservatively. In some cases, however, they will go in arthroscopically to "look around" when the patient's symptoms are not explained by the MRI findings (or lack of). This also is the time to remove any loose particles of cartilage that may be present. As far as cartilage healing....that's not very likely. Cartilage has poor blood supply and it's ability to heal is very controversial. When you hear about athletes getting "microfracture surgery" the principle is to make small holes in the cartilage to promote blood flow. Some are firm believers; most are skeptical. In general, if the cartilage is severly torn, the offensive piece is removed. This obviously accelerates the development of arthritis over one's life but can often greatly improve symptoms in the short term. If the piece is a flap and not shredded it can be "tacked down" in it's original position. He may be have suffered direct trauma to the cartilage and bruised the underlying bone. This is called a bone bruise (aptly named). This can be a lingering injury with no real structural damage but hurts like heck. A bone bruise typically is visible on an MRI. You also mentioned pain directly under his kneecap. A lot of young athletes have significant patellar laxity (loose kneecap). This means his kneecap moves left and right more than average. Everyone's can be slid a bit in the relaxed position. Some moreso than others. Often those individuals will develop wear and tear changes under the kneecap because of the increased trauma that occurs in someone with this "loose" kneecap. This "disorder" is called patellofemoral syndrome. Usually this occurs as a chronic worsening problem rather than a sudden onset of pain so it is much less likely in your son's scenario. If it's been months since his last MRI, I might suggest you repeat it. He may have had a small cartilage tear that failed to show initially and his repeated attempts to start sports may have exacerbated it. Just a thought. Lastly, get a second opinion. Any doctor who is worth their salt would certainly encourage it. sometimes a fresh set of eyes is helpful and your son may be reassured by hearing some confirmation. Don't get too frustrated. Sometimes these things just linger and caution is the best way to proceed. Hope this helps. MD....thank you very much for responding....I will give all the info I know in hopes of shedding additional light: - The injury occurred on a special teams play where he took a blow to the side of the knee.....the injury swellled badlly immediately. Taken straight to emergency where the X rays said there was no broken bones - Immediately went to RICE method and a MRI was ordered (unfortunatley we couldn't get it for like a month) the following week he went to both a sports medicine docter AND a ortho within a span of 2 days....they both diagnose the injury as a sprained not torn MCL.....he sat out 2 weeks and went back to practice. It is totally my fault that I let him go back before the MRI and he went through a full week of practice and a game with no problems.....wasn't even limping. - Took MRI appt when it came up and the MRI tech said he should be on crutches and def not playing any sports....I didn't understand that at the time as he wasn't showing any ill signs...took the MRI results back to the ORTHO who said he had a slight growth plate frature and some miniscous injury but that it was already healing so no need to cast it....but his season was over - No type of sport activities for about a month....went out for basketball tryouts and had sharp pain in his knee when he tried to run..... - Went back to the Ortho who said it was not healed yet.....it was at that time that he diagnosed him with the "loose kneecap" symtom you are prescribing.....but he said that he always had it and it had a lot to do with that he was growing rapidly......said NO lifting and said he should be doing swimming pool work to PT the injury and to take work on the loose kneecap situation....said give it a month - He gave it 2 of no lifting and just upper body lifting and swimming pool work......by the end of that time he was able to do olympic lifts with no pain...ex deadlift, powerclean, bench, squat......BUT he STILL has pain when he attemps to accellerate or burst..... - My son says it feels like there is something "under his kneecap" that feels out of place that keeps causing the sharp pain when he attempts to accellerate or burst. 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BillsFanM.D. Posted February 9, 2007 Share Posted February 9, 2007 MD....thank you very much for responding....I will give all the info I know in hopes of shedding additional light: - My son says it feels like there is something "under his kneecap" that feels out of place that keeps causing the sharp pain when he attempts to accellerate or burst. Well it's certainly reassuring that two docs gave the same opinion. Being one, I can tell you that's not always the case. It really sounds like his MCL sprain has healed. If it weren't he'd still be having a lot of discomfort on the inner portion of the knee and not so much "under the kneecap." It may be that his injury coincided with him starting to have problems with the patellofemoral syndrome and now that's become the primary problem. As suggested, that's usually treated with PT/water therapy and strengthing the thigh muscles using a particular type of exercise for the knee. Rarely, they will do surgery to "fix" the kneecap so there is not so much room to slide around. I would be very resistant to letting a growing 15 yo do any kind of surgery on his knee unless there is a clear indication and it doesn't sound like you have it. Kids don't always "grow" symmetrically either. (think back when we all had big feet as growing kids) It may be that he's going through some changes that, with time, will correct themselves. Like I said, be patient. Reinforce with your son what a good thing it is that he didn't "blow out his knee" and need major surgery. That would have been a disaster for him. Lots of kids with blows to the side of the knee knock out the acl, mcl and tear the medial meniscus. I know that won't make him feel better but, honestly, it could be a lot worse. Don't blame yourself either. Like I said, kids "don't rest." He may have practiced with your permission but when you weren't looking he was goofing off with friends (horseplay etc) and doing the things that all 15 yo guys do. Lastly, ask the doctor a pointed question next visit....find out what exactly is causing his current pain and how best to fix it? The doc already has him in a treatment program but it sounds like your son needs more understanding of what's happening. Keep us updated and good luck. Link to comment Share on other sites More sharing options...
BUFFALOTONE Posted February 9, 2007 Share Posted February 9, 2007 Sorry John but having gone through this already and hearing your sons symptoms it sounds like he did some damage to the meniscus. The menscus injury will give you the feeling of confidence but at a certain point the strain is too much and the knee gives out causing more damage to the meniscus. The only way to combat a meniscus tear would be to have his knee scoped, its really not a bad procedure and that is the best way to really check what the problem is. As for the Gluclosamine I would stay away from it at his age. It is really meant for older patients whom have had surgery or arthritis/tendonitis. It helps to try and re-grow cartilage but if his is not torn it will only cause the glucosamine to back up in his system. I am not a doctor, but have had my share of pain and surgeries. Link to comment Share on other sites More sharing options...
Ctown Posted February 9, 2007 Share Posted February 9, 2007 A little background.... My son (just turned 15 in Jan) is a aspiring football/basketball player and a pretty good one at that......but 5 months ago towards the end of his freshman HS season took a blow to the side of the knee covering a special teams play..... - The original diagnosis was a sprained MCL......while it looked bad to begin with actually ended up healing in a couple of weeks...... - He went out and played one fore game (with 2 to go) and it took us that long to get an MRI down here and since it was scheduled we went ahead and took him.....the MRI revieled that not only did he have the sprained MCL but a fracture of the growth plate in his knee. He was done for the season right then and there (caused a HUGE problem in our house as he wanted to finish his season) but anyway he was done...... - The fracture was supposed to take about a month to heal......right about the month time frame....basketball begins and he tries out.....has pain immediately in his knee at tryouts and so he skips the basketball season and we take him back to the doctor - The doctor says he still has menisus? injury and smashed cartilage which will heal. He he recommends swimming pool exercises for the next month no liftfing and then it should be fine - Brett waits TWO months before he starts lifting again along with continuing with pool work.....but there is this one small problem....the sharp pain in his knee is not going away.....he lifts pain free but cannot run..... - It has now been 5 total months from the time of the injury......and he STILL cannot push off of it......the pain is coming from underneath his kneecap and he says it almost feels like a piece of cartalage is broken off and he feels it when he tries to run.... - The ortho who examined the MRI mentioned nothing of any broken off cartilage I dont know what to do......does this sound like a orthoscopic surgury thing? How long to heal from something like that for an athlete. I can't believe your on the buffalo bills message boards looking for advice. How about getting a second opinion from a sports doc ortho? For the record I just had ACL surgery and the MRI showed no torn cartlige, but when the doc went in he found cartlige torn in 4 places. Three on my meniscus. Link to comment Share on other sites More sharing options...
JB_55 Posted February 9, 2007 Share Posted February 9, 2007 go here... he did my rotator cuff. excellent doctor, excellent work. and you get to talk about your favorite bills players and their injuries. http://www.ubsportsmed.buffalo.edu/marzobio.html Link to comment Share on other sites More sharing options...
John from Riverside Posted February 9, 2007 Author Share Posted February 9, 2007 I can't believe your on the buffalo bills message boards looking for advice. How about getting a second opinion from a sports doc ortho? For the record I just had ACL surgery and the MRI showed no torn cartlige, but when the doc went in he found cartlige torn in 4 places. Three on my meniscus. I am definately not relying on just here for advice...I have him lined to go to to sports medicine doctors next week..... Link to comment Share on other sites More sharing options...
John from Riverside Posted February 9, 2007 Author Share Posted February 9, 2007 Well it's certainly reassuring that two docs gave the same opinion. Being one, I can tell you that's not always the case. It really sounds like his MCL sprain has healed. If it weren't he'd still be having a lot of discomfort on the inner portion of the knee and not so much "under the kneecap." It may be that his injury coincided with him starting to have problems with the patellofemoral syndrome and now that's become the primary problem. As suggested, that's usually treated with PT/water therapy and strengthing the thigh muscles using a particular type of exercise for the knee. Rarely, they will do surgery to "fix" the kneecap so there is not so much room to slide around. I would be very resistant to letting a growing 15 yo do any kind of surgery on his knee unless there is a clear indication and it doesn't sound like you have it. Kids don't always "grow" symmetrically either. (think back when we all had big feet as growing kids) It may be that he's going through some changes that, with time, will correct themselves. Like I said, be patient. Reinforce with your son what a good thing it is that he didn't "blow out his knee" and need major surgery. That would have been a disaster for him. Lots of kids with blows to the side of the knee knock out the acl, mcl and tear the medial meniscus. I know that won't make him feel better but, honestly, it could be a lot worse. Don't blame yourself either. Like I said, kids "don't rest." He may have practiced with your permission but when you weren't looking he was goofing off with friends (horseplay etc) and doing the things that all 15 yo guys do. Lastly, ask the doctor a pointed question next visit....find out what exactly is causing his current pain and how best to fix it? The doc already has him in a treatment program but it sounds like your son needs more understanding of what's happening. Keep us updated and good luck. The problem is that this injury occurred 5 months ago.....at what point do I say "this is not working" Link to comment Share on other sites More sharing options...
BillsFanM.D. Posted February 9, 2007 Share Posted February 9, 2007 The problem is that this injury occurred 5 months ago.....at what point do I say "this is not working" As I said in the prior post, it may be time to reimage his knee. An additional MRI at this point is reasonable if the original was done at the time of his injury. Getting a third opinion is also appropriate if it's been five months and he's not improving. As far as getting a scope done, it can reveal findings not seen on MRI but you don't want to introduce more trauma (which is what surgery is) to an area unless you've exhausted every other means of diagnosis. An MRI might not be normal now even if it was months ago. He may have caused additional injury etc. lastly, it hurts to write it ...but sometimes after a knee injury things never completely return to normal. Your best bet is to get a third opinion and evaluate whether anything can or should be done. If you came to me with above story and his MRI was five months old, I'd re-image him. I'd also get a new ortho opinion; even if I completely trusted the first. That's my opinion. If his MRI is abnormal now, you know what is happening and what to do. If it is "normal" you need to decide whether a scope to have a "look see" is worth the risks of the procedure. P.S. To all those who are concerned that John is "seeking advice on a football board:" I was simply trying to give him basic info and answer his questions. I'm not suggesting he rely on info from someone his son has never seen and I never recommended treatment of any kind. Lighten up. It's no different than the 3000 questions a week I get from my personal friends, family, coworkers etc. I don't mind it then and I don't mind it now. It's just conversation. Not a medical evaluation and treatment. John, you can PM me if you have any other questions and I'd be happy to help you understand what results etc mean or if you don't understand what the docs told you. Link to comment Share on other sites More sharing options...
BUFFALOTONE Posted February 9, 2007 Share Posted February 9, 2007 As I said in the prior post, it may be time to reimage his knee. An additional MRI at this point is reasonable if the original was done at the time of his injury. Getting a third opinion is also appropriate if it's been five months and he's not improving. As far as getting a scope done, it can reveal findings not seen on MRI but you don't want to introduce more trauma (which is what surgery is) to an area unless you've exhausted every other means of diagnosis. An MRI might not be normal now even if it was months ago. He may have caused additional injury etc. lastly, it hurts to write it ...but sometimes after a knee injury things never completely return to normal. Your best bet is to get a third opinion and evaluate whether anything can or should be done. If you came to me with above story and his MRI was five months old, I'd re-image him. I'd also get a new ortho opinion; even if I completely trusted the first. That's my opinion. If his MRI is abnormal now, you know what is happening and what to do. If it is "normal" you need to decide whether a scope to have a "look see" is worth the risks of the procedure. P.S. To all those who are concerned that John is "seeking advice on a football board:" I was simply trying to give him basic info and answer his questions. I'm not suggesting he rely on info from someone his son has never seen and I never recommended treatment of any kind. Lighten up. It's no different than the 3000 questions a week I get from my personal friends, family, coworkers etc. I don't mind it then and I don't mind it now. It's just conversation. Not a medical evaluation and treatment. John, you can PM me if you have any other questions and I'd be happy to help you understand what results etc mean or if you don't understand what the docs told you. You are a good man Doc. Don't listen to the people who like to maintain the doom and gloom. god forbid someone askes for personal advice. Link to comment Share on other sites More sharing options...
cale Posted February 9, 2007 Share Posted February 9, 2007 Well, for the record, I am a doctor. Not ortho...not even surgery;so I would not consider myself an expert on an MD level. I practice in general adult medicine but I'll give you my best info. I'm a little confused as to what his diagnosis is. The knee has four basic ligaments... ACL, PCL, MCL and LCL. If his injury is an MCL sprain (no tear), this is rarely treated with anything other than rest. Even with tears, it is usually treated quite conservatively. The big concern with that type of injury in an athlete is additional cartilage tears that can occur with it. The MCL is on the inner side of the knee and is attatched to the medial meniscus. Imagine a support strap on the inner side of the knee (mcl) attatched to a cushion (medial meniscus) that fits between the "thigh bone and leg bone." The meniscus is the cartilage in the knee and consists of both medial and lateral parts. Just wanted to clarify as some have mentioned these as different terms. Cartilage and meniscus are the same. When the mcl is strained the medial meniscus is often injured as well. The last concern you mentioned is the growth plate. If that portion of the bone is injured he may have some concerns re: further growth. That's a huge if...and hard to predict. I'll leave that to the ortho. From what I can guess (and i stress the word guess) he should have healed an mcl strain by now if he has been faithful with rest. That's always a tough one for a kid who is athletic. make sure he's been honest with you. that's not a knock on your son as I sure as heck would have lied to my parents/coach etc to "get in the game." If he has a cartilage tear this generally has symptoms of the knee locking or significant pain with resistance such as lifting or running. If he has symptoms of instability (knee giving way) that generally points towards a ligament tear. An MRI answers these questions almost all the time. The only question then is whether it is treated surgically or conservatively. In some cases, however, they will go in arthroscopically to "look around" when the patient's symptoms are not explained by the MRI findings (or lack of). This also is the time to remove any loose particles of cartilage that may be present. As far as cartilage healing....that's not very likely. Cartilage has poor blood supply and it's ability to heal is very controversial. When you hear about athletes getting "microfracture surgery" the principle is to make small holes in the cartilage to promote blood flow. Some are firm believers; most are skeptical. In general, if the cartilage is severly torn, the offensive piece is removed. This obviously accelerates the development of arthritis over one's life but can often greatly improve symptoms in the short term. If the piece is a flap and not shredded it can be "tacked down" in it's original position. He may be have suffered direct trauma to the cartilage and bruised the underlying bone. This is called a bone bruise (aptly named). This can be a lingering injury with no real structural damage but hurts like heck. A bone bruise typically is visible on an MRI. You also mentioned pain directly under his kneecap. A lot of young athletes have significant patellar laxity (loose kneecap). This means his kneecap moves left and right more than average. Everyone's can be slid a bit in the relaxed position. Some moreso than others. Often those individuals will develop wear and tear changes under the kneecap because of the increased trauma that occurs in someone with this "loose" kneecap. This "disorder" is called patellofemoral syndrome. Usually this occurs as a chronic worsening problem rather than a sudden onset of pain so it is much less likely in your son's scenario. If it's been months since his last MRI, I might suggest you repeat it. He may have had a small cartilage tear that failed to show initially and his repeated attempts to start sports may have exacerbated it. Just a thought. Lastly, get a second opinion. Any doctor who is worth their salt would certainly encourage it. sometimes a fresh set of eyes is helpful and your son may be reassured by hearing some confirmation. Don't get too frustrated. Sometimes these things just linger and caution is the best way to proceed. Hope this helps. House? That was a great user friendly analysis and explanation... Link to comment Share on other sites More sharing options...
BillsFanM.D. Posted February 9, 2007 Share Posted February 9, 2007 House? That was a great user friendly analysis and explanation... Best show on TV but I'd never have the guts to say/do the stuff he does. He's pathologic....but hilarious. Link to comment Share on other sites More sharing options...
BillsFanM.D. Posted February 9, 2007 Share Posted February 9, 2007 You are a good man Doc. Don't listen to the people who like to maintain the doom and gloom. god forbid someone askes for personal advice. I agree and thanks. Link to comment Share on other sites More sharing options...
cale Posted February 9, 2007 Share Posted February 9, 2007 John, I'm not a med professional. My wife is a PA but not ortho. I think BillsFanMD has given you some great advice. I think you're doing everything reasonably possible. So don't take this the wrong way. Not every doctor is created equal. Your son's injury doesn't sound unusual. Your doctor's experience dealing with the issue may be. I would talk to your social or sports network and see who has a good reputation and take your son there. Don't you live in the San Diego area? I would call UCSD's Sports Medicine Dept. and ask if they know of anyone in your area who could give you an informed second opinion. There might be other college/university medical centers in your area. I would research their faculty and call or email for references or advice. Faculty like to talk.;-) I work in a Med Ctr. For some health issues I wouldn't go anywhere else. For others, I would go to the competitor across town. We had our baby delivered at the cross town hospital. It's just a matter of institutional experience and focus. Plus, you don't take a thoroughbred to the local pet clinic... Good luck. Charles Link to comment Share on other sites More sharing options...
cale Posted February 9, 2007 Share Posted February 9, 2007 Best show on TV but I'd never have the guts to say/do the stuff he does. He's pathologic....but hilarious. I don't care if Armageddon is scheduled for Tuesday. If there's a brand new House MD episode on, my wife and I Tivo it and watch. It's writing and acting is phenomenal. Beats the crap out of Grey's. Though the music on Grey's is cool. My wife is addicted to that too.... Link to comment Share on other sites More sharing options...
John from Riverside Posted February 9, 2007 Author Share Posted February 9, 2007 To MD...thank you for all your help and I wlll PM you when I get more info next week. To Cale.....thank you as well....I am going to take him to Loma Linda medical center next week.....not quite as far as San Diego from Hemet. They have sports medicine doctors in their ortho dept. Link to comment Share on other sites More sharing options...
cale Posted February 9, 2007 Share Posted February 9, 2007 To MD...thank you for all your help and I wlll PM you when I get more info next week. To Cale.....thank you as well....I am going to take him to Loma Linda medical center next week.....not quite as far as San Diego from Hemet. They have sports medicine doctors in their ortho dept. Hey John, You're welcome. I would still try to find somebody who has a reliable recommendation for whom to see at Loma. Unless you already have a reference. C Link to comment Share on other sites More sharing options...
Rubes Posted February 9, 2007 Share Posted February 9, 2007 John...I'm no ortho specialist, but I'd have to basically agree with BFM.D. above. I think a repeat MRI is reasonable if it has been this long and he's still having problems, although I wouldn't be surprised if it didn't show anything new. But he's right, if it does show something, then you've got a target. If not, then I also agree that there still might be something that can show up on a scope, and you would need another opinion to see if a scope is indicated. And then you'd have to decide if the risk of the procedure is worth it. I'm also available by PM if you want. Link to comment Share on other sites More sharing options...
Bob in Mich Posted February 9, 2007 Share Posted February 9, 2007 John, You may want to look at Bob's ACL board. Folks discuss all sorts of knee issues, not just ACL problems. Bob's ACL Board Link to comment Share on other sites More sharing options...
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