Suggestions on Next Step

[skcher]

HISTORY:
Fell on a mountain skiing in March — immediate pain not too much swelling. After a couple of weeks went in for what I thought was a sprain from it. MRI showed microfracture of the femoral condyle, grade 2 meniscal tear among some other small things. I was put in a brace. Came back in two weeks, doc put me on crutches for 7 weeks.

Started PT in May — made great improvement, but still limping and having pain. When I finally was able to straighten my leg fully, a nice little clicking sound that I can reproduce easily. Doc said pain was pes anserinis, adjusted pt.

Another MRI scheduled after the pain increased. Improvement shown, but the bone is still fractured. Went back a couple of weeks later with small improvement. Still pain — clicking was low and dull with some high pitch clicks. Doc said it is plica. Received a cortisone shot in the knee. Didn't feel my knee for 4 days, but clicking is still there.

Was supposed to meet with him a couple of weeks ago — he had to cancel the appt. Ended up spilling my frustration out on nurse who then said, why don't we just get you referred to an OS. Appt is in 2 weeks.

17 weeks after the accident, still limping. Can straighten my leg but with pain and high pitch clicking. Can't make it through a usual day of work, shopping  — anything without pain at the end of the day. Go to bend back in and it is tight at the right inside of the knee.

QUESTIONS:
Is it reasonable to assume that when I go in to the os that he is going to tell me to just be patient it will go away after 20 weeks?

Since I have already done all the non surgical treatments does it mean automatically they will likely suggest arthroscopy?

Is it normal for the fracture to still be fractured after 18 weeks? And if not, what are some of the potential treatments for my condition.


Sorry to babble, just highly anxious and feeling out of control. Honestly, I don;t know what normal is anymore and maybe I'm there.

[Michael L Gross, MD]

SO far your treatment has been all over the map, without positive results.  It sounds like you may need and benefit form arthroscopic surgery.  Not only to adress your meniscal injury, but also to evaluate and treat the articular cartilage and subchondral bone of the medial femoral condyle.
A third MRI before any surgical procedure would certainly add information and can only be usefull.

[skcher]

I have to say you were right on. Apparently I bonked up the articular cartiledge and yep, the bone is still broken. Given the choice of a surgery called Carticel — which is a ton of recovery and Microfracture. Not looking forward to the recovery for microfracture, BUT the other is not much better as far as recovery issues. Thank you for your diagnosis. Just wanted you to know how close you were.

[skcher]

As far as the articular cartilage goes — is this something that would have shown up on the original mri's? And could some things have been missed by the radiologist?

What concerns me is that besides the fracture and the small tear, they are saying the mri is relatively normal. My PT has even mentioned something about a "bucket handle" tear or a loose body which is as far I understand a little hard to find. So, my biggest fear is the treatment of "just let it be" and I end up damaging myself for the future.

I know I won't know anything really until I get in there BUT I want to have the most information/questions about my knee so I can be sure they don't dismiss me as some crazy lunatic but rather an informed patient.