MRI or Arthroscopy

[ChrisF]

Whatever it takes.

 

As Baz Luhrman says, "Be kind to your knees, you'll miss them when they're gone"

 

remember your sunscreen ....

[Mailman7412]

HI

 

Just looking for some advice. Was knocked of my bike quite badly approx 8 weeks ago.

Two fingers broken etc. Anyway only lingering issue is my knee. SO I have two options it seams. One is to have the arthroscopy done and at the same time have fixed whatever is the problem. and two do the MRI 2.5 k co payment, but know exactly beforehand what awaits. I have major anxiety around the fact that i may not be able to drive for six weeks.

 

My other major gripe at the moment is I cannot stand and pedal. At the moment, physio suggested i lower my saddle on my trainer to increase knee range of motion.

 

Basically very confused at the moment .

 

Dr Graig Solomon at Gape gate medi clinic is the surgeon.

 

Any Advice welcome.

 

Regards

Paul

medial meniscus tear  and A tibial plateau fracture

[V12man]

medial meniscus tear  and A tibial plateau fracture

So you did the MRI? don't think you would have seen the fracture during an arthroscope normally.

 

Personally I would leave that tear for a while after the fracture is healed - they do quite well with rest and physio - jury is out on arthroscopic repair being better than rest at the moment - Talus probably has a better view of the state of thinking on this than I do at the moment.

[TALUS]

So you did the MRI? don't think you would have seen the fracture during an arthroscope normally.

 

Personally I would leave that tear for a while after the fracture is healed - they do quite well with rest and physio - jury is out on arthroscopic repair being better than rest at the moment - Talus probably has a better view of the state of thinking on this than I do at the moment.

Concur 100%

[Mailman7412]

maybe this means more to you guys.

 

 

[V12man]

mri.gifmaybe this means more to you guys.

What it mean is 1 thing - what it looks like is another - pictures would help a lot.

 

 

Looks like to some extent you got lucky - could have been worse for sure - torn posterior cruciate ligaments are not fun - and looks to me like you dodged a bullet on that one - I will defer to Talus on the route forward on the fracture treatment - but for sure you should be taking it easy - you do not want it to displace - feet up and off weightbearing till your orthopod has seen the mri would be my recommendation to be on the conservative side.

[ChrisF]

What it mean is 1 thing - what it looks like is another - pictures would help a lot.

 

 

Looks like to some extent you got lucky - could have been worse for sure - torn posterior cruciate ligaments are not fun - and looks to me like you dodged a bullet on that one - I will defer to Talus on the route forward on the fracture treatment - but for sure you should be taking it easy - you do not want it to displace - feet up and off weightbearing till your orthopod has seen the mri would be my recommendation to be on the conservative side.

 

problem being that Mailman had his accident exactly two months ago ....

 

 

Primary treatment concentrated on the broken fingers.  The knee issues were only diagnosed now .... after walking, and some riding, on the knees ....

 

 

HOPE the late diagnoses did not result in further damage.  Also wonder how this impacts on the treatment and recovery options, two months after the accident.

[Marcv]

Hey

 

I did my knee 20 years ago wakeboarding, multiple times. I'm no medical person just someone whos had the surgery twice and once on my ankle.

 

So here are some points or questions i would ask:

1) How good is your physio, for knees you have to have a great physio. I learnt this the hard way. Your physio should have done all the tests when you first went in and should be giving you good advice with regards to whether the injury is Ligaments or Cartilage. 

2) How good is your doctor? are they well known for knees? are they a Knee only specialist? who else have they worked on? Again learned this one the hard way. I realized that I didn't have to rush so I chose the best doctor I could find who worked on alot of MX injuries and he had a waiting list of 12 weeks which i was ok with. In the end I went to a Doctor called Ponky Firer who was a knee only doctor, had pictures of all the springbok rugby players he had worked on and lectured on micro surgery.

3) How well do you react to anesthetic? the complications I had on my knee op were all from my reaction to pain and the anesthetic. this is my major fear.

 

this is what I would do. At first when I read your post I thought surgery all the way given you have points 1 and 2 covered. my thinking was just get it out the way and if the MRI shows anything there is a chance you need the surgery anyway.

 

but then I remembered my experience with point number 3 and I would personally go with the MRI because there may be a chance i don't need anesthetic which I find to be a bit unpredictable.

 

like I said just my experience

 

Marc

 

Ps, talk to the hospital, i've heard that sometimes during quiet times they give discounts for MRI and CAT scans, you just have to be flexible in your timing.

 

 

 

 

[V12man]

problem being that Mailman had his accident exactly two months ago ....

 

 

Primary treatment concentrated on the broken fingers.  The knee issues were only diagnosed now .... after walking, and some riding, on the knees ....

 

 

HOPE the late diagnoses did not result in further damage.  Also wonder how this impacts on the treatment and recovery options, two months after the accident.

It shouldn't have much impact on treatment - I say that with some caution having once (together with some colleagues) told someone with a stress fracture in his femur that he had been walking on for 6 weeks that it should be ok and to just take it easy..... heard it break about 50m after he walked out the consultation....

[Craai]

Concur 100%

Wait a minute.... I've seen this movie before 

[Mailman7412]

It shouldn't have much impact on treatment - I say that with some caution having once (together with some colleagues) told someone with a stress fracture in his femur that he had been walking on for 6 weeks that it should be ok and to just take it easy..... heard it break about 50m after he walked out the consultation....

thanx guys I am kakking myself already. tomorrow he will clean up inside the knee plus a straight brace for 6 weeks. explain this to an employer where you are working for 12 weeks now. and probably off in some capacity for 3 weeks. luckily at this stage  i can do my work and meeting from home, who knows how long they will be happy for it.

[Schmorglebot]

thanx guys I am kakking myself already. tomorrow he will clean up inside the knee plus a straight brace for 6 weeks. explain this to an employer where you are working for 12 weeks now. and probably off in some capacity for 3 weeks. luckily at this stage  i can do my work and meeting from home, who knows how long they will be happy for it.

 

Sterkte ou maat!

 

I've been through a similar situation though perhaps not as brutal. I went the MRI path rather than the arthroscopic route. Turns out is was fibrilation of the cartilage most likely due to overtraining and muscle imbalance. Long story short I went to a biokineticist, got the exercises, did the EMS therapy, stuck to the program, and I was back on the bike in about 4 months. It was dark days psychologically but luckily it was during winter and I could tell myself that I wouldn't be riding much anyway. Now I'm back and stronger than before the injury.

 

My point is, stay strong, find something to occupy the time that would be spent cycling, spend more time with your family, and if you're like me, don't find your worth in your ability to pedal a bike. There is light at the end of the tunnel, sometimes the tunnel is curved but you'll see it eventually and it'll be a wonderful feeling.

 

That's my 2c, stay strong, stay focused, listen to your doc, and you'll be smashing it in no time flat

[ChrisF]

Mailman is out of theatre.     Looking good, groggy, and still worried about the time out of the saddle ... 

 

NO "visible fractures".

 

NO torn ligaments

 

Damages to the "kraak been", with some splintering requiring a "clean up and scraping" of the knee.

 

 

Hoping our resident experts can confirm, but this sounds like some very good news.

[Captain Fastbastard Mayhem]

Mailman is out of theatre. Looking good, groggy, and still worried about the time out of the saddle ...

 

NO "visible fractures".

 

NO torn ligaments

 

Damages to the "kraak been", with some splintering requiring a "clean up and scraping" of the knee.

 

 

Hoping our resident experts can confirm, but this sounds like some very good news.

I see u got the vid as well ????. Will wait for him to confirm all that was there.

[Mailman7412]

Just a quick update, Did the MRI and it looked like the cango caves inside. cartilage in spikes everywhere.

 

1. So arthroscopy done, Brace on zero degrees for 6 weeks. Crutches.

2. After six weeks , Range of movement increased on the brace, Still one crutch.

3. Friday still the brace on, but no crutches .

4. All this time physio, Still pain from time to time.

5, Getting up in the morning is an absolute bitch

6. Allowed 30 minutes on the trainer, but cheats once in a while and goes out on the road.

 

So yes hopefully by 18 September we have the full go ahead. And a Mangaung cycle tour by 5 November but thats optimistic.

 

Cheers 

Paul

[Ryan physio]

Hey All - 

 

I work in a clinic with a knee surgeon and frequently discuss this type of thing with the doc. I also attempt to cycle myself now and then

 

1. MRI first and always.

• Preferably you want a diagnosis BEFORE you go for an op. MRI is the best investigation we have. That being said it is NOT full proof, but serious damage to the soft cartilage (meniscus) and ligaments will be noted. 
• You are giving consent with a scope. If you go for a diagnostic arthroscopy, you are giving the doc consent to fix what he finds. This means he may find and fix something that you would have preferred another treatment for. Thats important to note
• There is hard and soft cartilage. Sort cartilage tears respond very well to surgery. Why have the op? It has very poor blood supply and does not heal well, so often the piece that is torn must be removed. Hard cartilage is another animal. If you have hard cartilage wear (called articular cartilage), your joint is headed downhill no matter what you do. Honest surgeons will tell you that you are just buying time before a replacement. That being said, many people have horrid findings when the scope is done but do well for many many years after.
• The MRI is a guide to the surgeon as to what to expect. Sometimes the damage is worse (as noted by someone) and sometimes its not as bad. Remember that an MRI can only take 2-4mm slices of the knee. Only show much that it can show.

Just some other comments people have made

 

• Arthroscopy is a sham treatment when done in a study. There is an element of truth that some docs are knife happy. The flip side is this. If you have a stone in your shoe, no matter what you do, your foot will be irritated until you remove the stone. Its a similar analogy with a scope. You are removing the debris that is inflaming the knee.
• Physio : I am biased being a physio, but I get excellent results with MOST of my patients (no1 has a 100% success rate). HAVE YOUR CLEATS CHECKED. I use a special mould that your cleats fit into that allows me to check 100% they are straight or slightly turned in. NEVER have your cleats set turned out. EVER. Rehabilitation is what fixed people, not so much the hands on physio. Cyclist's will happily ride for 3-5 hours Sat and Sunday but refuse to do 15min of rehabilitative exercise. Many of these issues are cause by imbalances in the lower limb that can be corrected with some simple exercises. ELECTROTHERAPY is a sham! If your physio is not using their hands and their brain to treat you, go somewhere else! The reality is rehab is boring. Either knuckle down and get it done or join a pilates class under the guidance of a physio.
• Not all doctors and physio are equal. Just like any other business. Some are good, some are average and some are crap. Make sure you are seeing a medical person who has good post grad experience and a special interest in the knee. There is not ONE good doc or physio. There are several and we all know each other so we can refer people to the right person depending on where they stay.

 

Rather long post. Hope it sheds some light

 

R