Dr. Mark Jammed Knee

[mulisha00]

Dr. Mark,

Yesterday 3/13/08 I had injured my right knee by jamming it into the ground. I am looking for advice on what to do when to do it and how to get back "on my feet". I've had two acl reconstructions on the left knee already and know kinda where I stand and the pain and symptoms are the same as the left knee.

I am 27 years old. Healthy athletic 6'3 190 male and very active in motocross. So far I went to the ER yesterday and got the x ray and I have a chip in the side of my tibia visible in xrays. No other fractures look present. I cannot walk on the knee but have not tried due to the pain. Knee is swollen pretty bad. I have attached pics of the swelling and my current ROM. I have to push my leg back that far.

I am familiar with acl surgury and read some of your techniques and approaches. I went today to ortho doc and he along with the ER doc did a ??lachman's test?? and it appeared to be stable. I've got a gut feeling that I've blown one of the ligaments out. I go for MRI this thursday (by the way check out Travis Pastrana's 199 Lives Movie this thursday at your local movie theater I will be after MRI). I go back for MRI results the following Wednesday to find out what the outcome is. Do I need a MRI to prove ligament damage or will a Dr. know what to look for.

What do I need to do now as far as moving, ice, medication ect for a typical knee jam/hyperextension? Should I be moving leg at all or trying to keep still? What do I need to do to get ready to come down and get the surgury done. Thanks for all you do for the motocross community.

?

And I know not to enter any Mr. Legs Competitions anytime soon!

[DrMark]

The photographs don't look so bad. The Lachman test in the clinic is only accurate 25% of the time in the awake patient.

I surely would start on the stationary bike, one hour per day, everyday, getting yourself up to the target heart rate for you agel

Let me know the result of the MRI.

[mulisha00]

When you have a patient with similar characteristics do you immobilize the knee or do you advise patient to keep knee moving? They have got me wearing a large immobilizer that really sucks. I've had it off the past 12 hours and slept without it and drove to work this morning without it and felt a bunch better than with the immobilizer. I not sure on the time frame how long to stay in that.

On the bike are we talking anything special as is upright or one you sit down on? About how long after injury do you have guys back on the bike? Thanks again.

[DrMark]

I f@#ked up my knee in a bad get off a week ago last Saturday. I started riding the stationary bike on Tuesday. It made a big difference.

This past weekend I completed the MS-150 which is actually a 180 mile bike ride from Houston to Austin. My knee still hurts, but I'm doing a lot better than when it happened.

Throw the immobilizer in the garbage. Throw the crutches in the garbage. Start the stationary bike today. We use the upright bikes because it is closer to riding a motorcycle than the recumbant ones.

Our surgery patients ride the bike on post op day one. The ACL patients can chill until post of day four. Everyone does one hour per day. Its the key to our rehab program.

[mulisha00]

Dr. Mark,

I've been on the bike and doing PT since a week after the injury.

Here is the MRI.

Description: MRI RT LOW EXT JOINT W/O CON

Findings:

The knee is in normal anatomic alignment. There is a sclerotic rounded lesion in the proximal tibia adjacent to the cortex consistent with an ossified fibroxanthoma. There is a slight amount of bone marrow edema invoving the posterolateral margin of the tibial plateau and a prominent chondral patellar sulcus with a slight amount of edema and minimal impaction. The overlying cartilage appears to be intact. Minmal diffuse edema is noted involving the distal lateral femoral condoyle. The posterior cruciate ligament is intact. The anterior cruciate ligament has some mild diffuse increased signal. Proximal fibers are difficult to visualize, but the distal fibers are seen and unremarkable. I believe there is at least a partial tear involving the proximal acl. The medial meniscus is small but otherwise intact. Lateral meniscus shows a free edge or radial-type tear. Radial type tear involves the central and posterior horn ofthe meniscus. Collateral ligaments are intact. Extensor tendon apparatus is unremarkable. Articular cartilage is grossly intact. There is small to moderate joint effusion.

Impression:

1. Bone contusion pattern consistant with previous anterior translation of the tibia on the femur and its midl impaction of the distal femoral condoyle with associated edema.

2. Tear of the ACL.

3. Free edge or radial type tear involving the posterior horn and body of the lateral meniscus.

4. Probable sclerotic lesion involving the proximal tibia consistant with a fibroxanthoma.

This was done on Thursday 5/21 and injury 4/13.

I can decipher alot of this but this is the report. Your thoughts.

Adam

[DrMark]

This is a standard ACL tear.

You need to ride the stationary bike, one hour per day, everyday to make the knee supple again, and have full motion and a normal gait.

Then you need to have the ACL reconstructed with a graft from the opposite patella tendon like all the other racers I have done.

Then functiional rehab so you can return to racing at three months.

[mulisha00]

I've already had two acl reconstructions on the left leg. First was a graft as the bone pulled loose with acl still attached and one was allograft from cadaver achielies?? tendon that is still intact and doing fine. Op was in 2000 on 2nd left ACL.

Would this affect the right injured leg from using the opposite patella tendon?

Ahh this sucks.

Oh yeah I did your survey but for your reference again I was wearing asterisk braces.

[DrMark]

Thanks for participating in the study. This is vital information for us to learn.

Naturallly the graft source is dependant on what tissues are available.

You said that you have had two ACL injuries on the other knee. One was allograft, but you haven't been specific on what the other graft source was.

Please let me know.

[mulisha00]

My first tear was in 98 and the acl was intact with the bone being pulled loose at the tibia plateau. They did I bone graft I believe but nothing has been harvested from anywhere in my body on any of my surgeries.

So just to be clear on everything.

Two L ACL'S. Bone graft first (98), allograft second(99) from cadaver achilies ? tendon.

Now R ACL with no previous damage or surgery.

Can you remove a plate from my collarbone at the same time as acl recon?

[DrMark]

I would take a patella graft from the other knee, and watch you walking like a normal man that same day, advancing back to racing in three months.

Spend a few days with me, at least you won't have to have it done twice.

We will also remove the plate from the collarbone at the same time. Since a guy is never on crutches, he can get his shoulder worked on at the same time.

I don't do vasectomies or reversals though.

[mulisha00]

[DrMark]

That fracture is healed. The hardware could come out.

Email Yvonne at yjumawan@sandersclinic.net

Send her you full name, your points of contact, and your date of birth.

Mark sure you tell her what ACL it is, and also about the clavicle hardware.

[mulisha00]

Will get in touch with her shortly. What exactly do you need to know about the hardware? Material ?

I am trying to schedule for work. How soon can you schedule if everything is okay date wise? I have to rearrange 5 other peoples schedules for this and they all have vacations sceduled.

How much time will I need off work? I am the finance manager at a dealership and sit behind the desk for the majority of the day but I'm walking around on the lot and back and forth a good part of the day.

From what I've read its a week long operation deal. Do I have any options on that with my PT here?

[DrMark]

For that collarbone thing, I allready know I have the right screwdriver, but thats damm good thinking on your part:thumbsup:

Email Yvonne to get the ball rolling. INclude your full name, front and back of your insurance papers, date of birth and which knee, and shoulder it is. Remind her that we are removing hardware from the clavicle.

I a doing surgery next week, but am away the week after. Then I will be in town for at least three weeks. Its hot has he11 in Htown this time of year and its good to get away to somewhere cool now and again.

doc

[mulisha00]

Emailed her. Special request. Can I keep the plate for war stories and bragging rights? Also can I bring my 23 year old GF??

[DrMark]

Its actually against the OSHA rules, but we can try.

[LKN4DRT]

Its actually against the OSHA rules, but we can try.

The gf or the plate? lol

[DrMark]

Sh1t, bring the GF!

I will try to get the plate away from the Nursing Dept.

[abrocks22]

wow looks pretty bad

[mulisha00]

Dr. Mark,

Insurance changed with new employment on 1-7-08 and insurance went into effect on 4-7-08 and according to your Yvvone its a pre-existing condition (collarbone plate) that will not be covered until a year.

What is out of pocket cost on the hardware removal?

Also what if my shoulder has been hurting ever since surgery for plate. Cannot throw a football, bench press ect without pain. I always thought I had a seperated shoulder. 2005 for plate. Your thoughts?

Do you require a cryo cuff or will a Donjoy Iceman work also. I don't know if the Iceman offers compression like the cryo cuff.

Thanks for all you do and spending time with me and the tons of others that worry the piss out of you.

Look forward to meeting you soon.