Thread: Knee experts: read my radiologists report, please!

A little background: 37 yo old male, no prior knee injuries, active, skied around 80 days last season, run, bike, climb, crossfit, 6ft tall and weigh 175. I hurt my knee on the 11th of July at work, jumping backwards from about 4 ft high. My lower leg went left and my upper leg went right with some hyper-extension. The ER and the ortho diagnosed a meniscal tear and I got the MRI on 22nd.

Here is the report:
Findings:
Menisci: The medial meniscus demonstrates septate perimeniscal fluid collection at its posterior root attachment. This measures about 16mm in height. There is a small cleft in the meniscus but this is seen st the attachment. No other findings to suggest acute tear. The lateral menicus demonstrates no abnormalities.

Ligaments: The anterior cruciate ligament demonstrates a complete tear no significant edema noted. The posterior cruciate ligament demonstrates no abnormalities.
The superficial portion of the medial collateral ligament is intact.
The femoral fibular ligament is intact.
The iliotibial band demonstrates no abnormalities.

Extensor Mechanism:
Patella demonstrates no abnormalities/
Patellar cartilage demonstrates no abnormalities.
The medial and lateral retinaculum are unremarkable.
The medial patellofemoral ligament is intact.
The quadriceps tendon and infrapatellar tendon demonstrate no abnormalities.

Articular Cartilage:
The articular cartilage of the weight bearing portions of the knee demonstrate no thinning, fissuring, or clefts.

Osseous Structures:
Osseous structures demonstrate no abnormalities.
Bone marrow demonstrates bone marrow edema involving the posterior lip of the tibia and made lateral femoral condyle consistent with the above injury.

Joint and Capsule:
The synovial tissues demonstrate no abnormalities.
Joint space demonstrates a small knee joint effusion.
No poplitel cysts are identified.

Muscles and tendons:
Muscles and tendons around the knee demonstrate no signal changes or evidence of abnormality.

Impression:
1. Non-acute complete tear of the anterior cruciate with some residual bone bruising present consistent with the above injury.
2. Septated fluid collection at the posterior root attachment of the mdial meniscus consistent with a perimeniscal cyst. Findings suggestive of at least a partial tear of the posterior attachment which may account for the above findings.
3. Small knee joint effusion

So my big questions are:
1. non- acute meaning this could be old right? If so, why was I highly functional pre accident and limping with pain post?
2. I've never had any prior injuries/swelling of knee, is the two weeks it took to get the mri enough time to make it 'non-acute'?
3. I had no swelling with this incident and the ortho felt that my knee was stable. Why?
4. If this is old (if non-acute means that in this instance) why the bone bruising?
5. perimeniscal cyst? partial tear of posterior attachment? so is it (acl) torn on both ends?

You are hellbent on the swelling. My acl didn't swell much and my tear of the thumb UCL currently pinned barely swelled.
Hope the doc calls soon to tell you what is really up.

Lemme know man, good luck.

1. non-acute simply implies not at the time of injury, so 2 weeks post could very well be non-acute. Limping with pain is the result of the bone bruising, which can hurt like a MF and last up to 3 months (in my case(s)). Either your ACL gave out when you mis-stepped/ jumped backwards, or was already missing, and it allowed tibia and femur subluxation/pounding into each other.

2. See above, maybe an actual knee doc/or resident tgr MRI specialist JimS can chime in further, but I think the 2 weeks post injury does make it non-acute.

3. The manual test for ACL stability is prone to a degree of false negatives, as high as 25% and dependent on the skill of the doc performing them. Sadly, 3 out of 4 of my ACL injuries failed to show up on a lachman or anterior drawer sign test.

4. If it was a really old injury, your muscles have been compensating for the increased instability of the knee w/o an ACL. Many people can return to near normal functionality without the ACL, depending on age, degree of activity, general health etc. It's possible you jumped back in a way that revealed the knee instability and allowed the bone smack down that is causing your bone bruising, or it could have been your ACL tore at the same time without the classical "pop" people often feel/hear.

5. This pertains to your medial meniscus, not the ACL itself. Possible small tear on the posterior attachment of the medial meniscus that is collecting fluid. This sounds minor, and the good news is small tears on the periphery have a higher chance of healing/repair without needing meniscopy.

Bummer on joining knee club 3Z.

Thanks Mofro, that answered my main questions. I guess I need to start educating my self on surgery options.

Sorry to hear about your injury, Zion. Agreed with the collective that if you've never really injured that knee before, it may be a new ACL tear, especially because you describe a perfect mechanism. I haven't really heard of swelling within the torn ACL itself as a surrogate for how recent the injury was. Realize, however, that the radiologist doesn't have the benefit of context - he/she doesn't know that you've never injured the knee before and just had a recent accident. The bone brusing pattern is consistent with where the bones usually bruise when an ACL tears, so I'd recommend seeing an orthopedic surgeon to start discussing your options.

Best of luck to you.

Bummer ZZZ. I'm on month 4 post-op with similar sounding initial findings.

I went with the hamstring graft and minor meniscus trimming. It all went smooth and quick. The first couple weeks were 'uncomfortable' and I was riding and hiking pretty quick under controlled conditions. Good luck.

Good to hear on the riding and hiking, road bike? The doc just called and wanted to know if I wanted to have surgery tomorrow, I haven't even had a consult yet so I told him I'd wait till next week. I just need to ask him some questions and get some stuff in order before I can lay around for a few days.

Any ideas on when I could return to work (firefighter)? Is next ski season gone? Searches on here seem to have wildly different recovery times.

From slow to let's slice ya NOW. Uggggg, sorry buddy.

You are going to want the ice thing I got, let me know how to get it to ya.

edit: rode my MTN on road, no clips when I did mine. Hiking in brace allowed later.

Mountain biking on dirt roads and certain conditions. Road riding is preferred by Doc. No scree hiking or gnarly hiking, even with my sport brace. Slipping would be a disaster.

I'm told six months to back to normal use....including skiing without a brace if I feel comfortable. Anything short of that you are vulnerable to lateral issues. I would imagine front line firefighting is too demanding for the knee for at least 6 months. Plan a week or two of limited movement and down time. PT started right away for me. Stationary bike spinning felt best and road riding still does.

Which knee? Mine was the left and have a bomber post recovery brace if you need one to save mega brace costs.

Ironically, my surgeon said clipless was fine, while my PT couldn't believe it. I loosened them up a bunch on the mountain and road bike and have flats on the cruiser.

Slow is smooth. Smooth is fast. Baby it and don't rush it. Find other distractions and projects to keep from going nuts not doing your normal activities. The better you heal the better for the long run.

The most vulnerable you may be is in the middle of recovery when it feels great but really the ligament is weak (dead tissue). It takes a few to 4 months for a new blood supply to be established to the ligament. Plus there is a bit of knee remodeling recovery required for the other stuff they had to do to harvest and attach the ligament.

Buzz, I may be heading to Draper on Saturday, you around this weekend?

Alpinord, it's my left knee as well. It's a workers comp thing, do you think they'll cover the brace?

I'm worried about the down time, I'm already stir crazy from the past two weeks. I've been told that I'll be doing light duty office stuff until I can return to full duty. I don't know how I'm going to cope with a 8-5, m-f, office gig.

Actually camping but mom in law will be home. You available for me to call 4:30 ish?

I was hiking and spinning pre-op. I had to wait 5 weeks before surgery. It is what it is and getting up a lot from an office chair to reduce knee stiffness helps. Keep a bike nearby and spin when you can. A large therapy rubber band/cord is also good to have around for movement with low impact resistance.

I have no idea what workman's comp will cover. Regardless, the brace is on a shelf in a closet and could be in Ogden in a couple days. If you want it to use, let me know.

Check your email.

Yes, you will go bat shit crazy but will live.

Thanks Alpinord, I'll let you know! 5 weeks?! Ouch. I hope I didn't blow it by not getting the surgery tomorrow. They felt like he'd get me in pretty quick after the consult Monday.

Buzz, yeah call me.
edit, got it. Thanks!

Ill call ya anyway so you can vent.

ZZZ, find out what graft the doc has in store for you ASAP, get it done and you would stand a good chance of getting back on Snow in some capacity in Feb.

Try to use your own/autograft if at all possible as the real recovery time to full activity is shorter.

Pretty much agree with what mofro said. On the 11th you blew you ACL, and likely tore the medial meniscus. If your ortho wants to cut right away, get a second opinion. Nothing in that report sounds like it needs immediate surgery. A lot of people function just fine without an ACL.

I am two days post-op arthroscopic menicsectomy, from an injury 16 months ago. So no need to rush. Since you are an avid biker, that really helps your knees, but road riding is better at this point in time.

Mofro, he prefers autograft, not sure from which site so I want to find that out.

hutash, the only rush comes from me I guess. I asked him as a personal favor to speed this up. I've known him for years through ski patrol and skiing in general. He has a good reputation, is one of the docs for the US ski team and bases his practice on sports medicine/athletes. If I don't get this fixed now and I return to activity and then hurt it worse/decide to get cut, then I could lose the workers comp deal and I can't really afford to be out of work for 6-8 months.

I had my consult with the Doc today. He recommended hamstring autograft. I should have known that I have to wait for workers comp to authorize the surgery so it could be awhile. WTF is with workers comp? You would think that they want you to get back to work ASAP but everything takes forever to get done.

Doc said if I hit PT hard and had good results I could be back at work in about six months. sigh.

I had a similar experience. Torn my ACL the end of April and it never swelled. I thought it was getting better and started playing basketball 6 weeks later when my leg gave out and found out I tore my ACL. I had surgery last Monday and although I walk with a limp I am weight bearing and only need my crutches as a cane. I hope to be skiing by February.
I went with the Patella replacement because it will grow back and I've always had hamstring issues.
Good luck
RG

Oh yeah. My ACL tore in a similar fashion. I landed on a mogul coming off a cornice and as I fell forward my ski got stuck on the backside of the mogul and all it took was a hyper-extention and a little twist and I heard a pop. Very mild fall but lots of damage.

Go for a second opinion. My doctor does the surgeries for the pro basketball team in Charlotte and he highly recommended the patella.

The way it's been explained to me with workers comp is that if I get a second opinion then I'm tied in to that Doctor. The other issue is I'm sure I would extend this whole process at least a month if I tried to deal with switching.

He'll do a patellar tendon, he says he does both as well but his recommendation for me was hamstring.

Since I know who your doc is I figured he'd say a hammy for you and what you do. I'd take docs recommend from him.