Left ACL ligament...

[Kandra]

I am sitting here captured by the couch...and have been for 3 hours at least. I can't get up! When I try, my left lower leg hangs uselessly...and exquisite pain occurs when I attempt to put weight on the leg...:eek:

I have had these episodes before but they didn't last nearly this long (30 min.) Had a MRI last month and it showed a tear in the ACL and a mod. joint effusion etc. The radiologist even questioned in the body of the report if I had a functioning ACL at all.

The orthopod just looked at me and said I was too old for a ligament transplant/repair..that "we don't do them once folks reach their 40's"! He offered to do a steroid injection but retracted that once he found out how high my INR was...

I know I should have pressed him more on WHY anyone over 40 isn't a candidate; after all it doesn't take THAT long to grow a new ligament for a transplant/repair...however I was in a state of shock over the MRI results of my back so...the knee kind of was in 2nd place at that time but now it isn't...:(:(

Soo...sitting here and trying to manipulate and massage the knee back into place, sigh...trying not to take my Dilaudid...and it's sooo late!! Sheesh :(

[lobelsteve]

Second opinion needed.
Our clinic repairs almost anyone with an active lifestyle.

Press him, it isn't the age that is keeping you from getting anatomically corrected.

[Kandra]

Second opinion needed.
Our clinic repairs almost anyone with an active lifestyle.

Press him, it isn't the age that is keeping you from getting anatomically corrected.

Well, since I have to see someone else about my back as he doesn't do back surgery anymore (his neck would hurt from the heavy micro glasses) I will definitely make this knee part of the consult. I was going to go to a NS for my back but will try another orthopod.

Thank you :)

[mrsdoubtfyre]

There are stretches you can do when you feel that your knee is going out.

The chiropractor gave me those stretches. When the knee is bent in a chair and then you get up, you can slip and slightly dislocate. I had my right knee go out that way, years ago. I finally had an MRI showing synovitis, and had a marcaine/celestone injection, for it. That was only a temp fix.

One other thing that helped was improving quad functions. Balance between the muscles in the back of the leg and front, changes with age. I had a CE once that said up to 70% of knee stresses, injuries are due to this imbalance.
So excercises that strengthen the quads in front, often help the knee.
(these are done carefully, when you have no swelling or severe pain).

I found a flexible brace very helpful when going to the gym or walking long distances. Over time I rebuilt the knee with SAMe...which took down the swelling and improved tendon tone. I didn't have a torn ligament however.

I wonder if you are bleeding into the knee (since you have that Coumadin)?
Bleeding into the knee is common in patients with hemophilia who tend to bleed alot. Causes alot of joint pain!

[Kandra]

The chiropractor gave me those stretches. When the knee is bent in a chair and then you get up, you can slip and slightly dislocate. I had my right knee go out that way, years ago. I finally had an MRI showing synovitis, and had a marcaine/celestone injection, for it. That was only a temp fix.

Yep, I think too that when I get up from this particular couch that sometimes I have it slightly rotated laterally rather than straight up and down
since the table is a little too close. Of course, lateral movement is the last thing you want to do with an ACL problem...

One other thing that helped was improving quad functions. Balance between the muscles in the back of the leg and front, changes with age. I had a CE once that said up to 70% of knee stresses, injuries are due to this imbalance.
So excercises that strengthen the quads in front, often help the knee.
(these are done carefully, when you have no swelling or severe pain).

This is true...those can be very helpful. Many years ago I actually pulled the left patella briefly off and required a cast. I then threw a huge PE, off came the cast and nasty sequelae developed. My point is that at the end of that 6 month nightmare that I was given lots of knee exercises to do and strengthening the quads was only one of many :)

I found a flexible brace very helpful when going to the gym or walking long distances. Over time I rebuilt the knee with SAMe...which took down the swelling and improved tendon tone. I didn't have a torn ligament however.

I wonder if you are bleeding into the knee (since you have that Coumadin)?
Bleeding into the knee is common in patients with hemophilia who tend to bleed alot. Causes alot of joint pain!

I'm going to ask about a brace..he won't be in the office until Tuesday because I do go to the Healthplex for exercising. My concern is that I MIGHT be bleeding slowly into the knee because part of that six month nightmare was my doing just that. My H/H dropped to 8/23 requiring a blood transfusion and the IV heparin was stopped and I was placed on SQ (this was in the 80's).
As I type, the lateral side of my knee is exquistely painful and I'm going to take the Dilaudid...so I hopefully can get some relief and at least nap. If I do that maybe the muscles around it will relax enough for me to be able to adjust it. I can put only a very small amount of weight on the toes/ball of my foot. Anyway, I want to then be able to get to the fridge to be able to ice it down...not to mention the call of the bathroom is becoming an issue! :eek:

Thank you, mrsD!

[mrsdoubtfyre]

lateral knee?

When I went to the Ortho...when he examined the knee, which was swollen etc,
he pressed on the lateral edge between the femur and tibia...right in the center there. And bingo...big surprise pain! At the time he thought I had a cyst or tumor in that knee (which may have made it slip), because the swelling was not
symmetrical. When he pushed that spot, and got a positive reaction (a BIG reaction) he said that was the meniscal trigger point.

But the MRI did not show any tumor or cyst.

It took years to heal up. It was very slow going. I think the SAMe did the work, since I used it for 10 yrs. I am now trialing a super absorbable curcumin product to see if I can maintain my status with less money. Curcumin has anti-inflammatory actions in studies and looks good so far. I've been off the SAMe now 2 months (the longest I've tried to stop) and only had a brief flare before a storm for 2 days.

That meniscal trigger point means the nerve is being affected by swelling or whatever inflammation is there. That is what my Ortho told me.

If you have any Lidoderms, they may help too. I used them on the back of the thigh just above the knee crease...they are very effective for knee pain
for me.

[painfree3]

I am sitting here captured by the couch...and have been for 3 hours at least. I can't get up! When I try, my left lower leg hangs uselessly...and exquisite pain occurs when I attempt to put weight on the leg...:eek:

I have had these episodes before but they didn't last nearly this long (30 min.) Had a MRI last month and it showed a tear in the ACL and a mod. joint effusion etc. The radiologist even questioned in the body of the report if I had a functioning ACL at all.

The orthopod just looked at me and said I was too old for a ligament transplant/repair..that "we don't do them once folks reach their 40's"! He offered to do a steroid injection but retracted that once he found out how high my INR was...

I know I should have pressed him more on WHY anyone over 40 isn't a candidate; after all it doesn't take THAT long to grow a new ligament for a transplant/repair...however I was in a state of shock over the MRI results of my back so...the knee kind of was in 2nd place at that time but now it isn't...:(:(

Soo...sitting here and trying to manipulate and massage the knee back into place, sigh...trying not to take my Dilaudid...and it's sooo late!! Sheesh :(

I would get a second opinion. One newer option may be worth your review.
Hines Ward recently underwent Platelet Rich Plasma (PRP) treatment.
Read the story at this link:
http://www.waitingfornextyear.com/?p=7532

Also knee pain often is the result of muscle inbalance between the quads and hamstrings. Trigger points in the muscle and fascial can referr pain to the knee. These trigger points can be treated with hands on techniques.
Good luck

[Kandra]

lateral knee?

When I went to the Ortho...when he examined the knee, which was swollen etc,
he pressed on the lateral edge between the femur and tibia...right in the center there. And bingo...big surprise pain! At the time he thought I had a cyst or tumor in that knee (which may have made it slip), because the swelling was not
symmetrical. When he pushed that spot, and got a positive reaction (a BIG reaction) he said that was the meniscal trigger point.

But the MRI did not show any tumor or cyst.

Hmm, didn't show up on the MRI?? Wow. Actually, my appt. went like this:
1) review of MRIs (also had one of LS) 2) no physical exam of either but did get names of 3 other docs for the LS.

The only one who DID do a physical exam was my pain doc who I wanted to smack because that's how much it hurt...that exam was only palpation

I've felt there's more to it other than a torn ACL only because when I finally do get it back in I feel lots of "crunching". Sigh..

I'm sooo sorry you had have surgery...and am amazed that a MRI didn't pick it up.

It took years to heal up. It was very slow going. I think the SAMe did the work, since I used it for 10 yrs. I am now trialing a super absorbable curcumin product to see if I can maintain my status with less money. Curcumin has anti-inflammatory actions in studies and looks good so far. I've been off the SAMe now 2 months (the longest I've tried to stop) and only had a brief flare before a storm for 2 days.

As long as it doesn't involve NSAIDS (for me) I'm all for anything that will help. Geez, why did it take YEARS for it to heal?? :(

That meniscal trigger point means the nerve is being affected by swelling or whatever inflammation is there. That is what my Ortho told me.

If you have any Lidoderms, they may help too. I used them on the back of the thigh just above the knee crease...they are very effective for knee pain
for me.

Don't have any Lidoderms....but thank you soo much for the info!!

[Kandra]

I would get a second opinion. One newer option may be worth your review.
Hines Ward recently underwent Platelet Rich Plasma (PRP) treatment.
Read the story at this link:
http://www.waitingfornextyear.com/?p=7532

Also knee pain often is the result of muscle inbalance between the quads and hamstrings. Trigger points in the muscle and fascial can referr pain to the knee. These trigger points can be treated with hands on techniques.
Good luck

Hmm, the PRP they're talking about was used for a sprain and not an actual tear. I don't see how, at this time anyway, that PRP would help a tear...but who knows, I could bring it up but since it's not (yet anyway) a standard of care, I don't think anyone around here would consider it.

Thanks so much...when I was finally able to get it back in at 0600 my quads were absolutely angry with me for not getting things to work earlier! :)

[Bahamaroot]

The orthopod just looked at me and said I was too old for a ligament transplant/repair..that "we don't do them once folks reach their 40's"! He offered to do a steroid injection but retracted that once he found out how high my INR was...
That is just crazy. It sounds like that "he" doesn't do it for what ever reason. I tore my ACL in my 30's and the first ortho I saw said I would be crazy to have it replaced. The second ortho I saw said I would be crazy not to, it would just cause more problems later if I didn't(arthritis and meniscus tears). I had it replaced and it was the best decision I made. I think the first ortho just wasn't comfortable in his skills. I would get a second opinion. I had a friend tear his ACL and the ortho talked him out of having it replaced and he is now facing knee replacement surgery in his 40's because of the damage it kept causing.

[Peter B]

Kandra,
If an ACL reconstruction is in your future you should know that the replacement ligament either comes from a cadaver ( called an Allograft ) or harvested from a different part of YOUR body (called an Autograft ). It isn't grown in the stricter sense of the word, but it IS grown. So I guess you ARE right, Kandra.

Good luck whatever you decide,
Pete

[Kandra]

That is just crazy. It sounds like that "he" doesn't do it for what ever reason. I tore my ACL in my 30's and the first ortho I saw said I would be crazy to have it replaced. The second ortho I saw said I would be crazy not to, it would just cause more problems later if I didn't(arthritis and meniscus tears). I had it replaced and it was the best decision I made. I think the first ortho just wasn't comfortable in his skills. I would get a second opinion. I had a friend tear his ACL and the ortho talked him out of having it replaced and he is now facing knee replacement surgery in his 40's because of the damage it kept causing.

It's kinda odd because this orthopod is "known "for doing knee surgeries. I know he's uncomfortable because I'm on Coumadin but there's always bridging. I HAVE to get another opinion because while meeting someone at Starbucks this afternoon I went to get up and yep...dislocated again. I couldn't believe it...I was embarassed. Finally get it back in and left...went to MVD and my RIGHT knee just "gave out". I do have a torn meniscus there but it doesn't normally do that. Anyway, my left lateral is really hurting extending up into my quads :( I agree you made a very wise decision!

The reason the orthopod DID tell me to get a 2nd opinion was because of my back...he told me the stenosis at L3-L4 was severe and it would only get worse...and I also have a herniated disk at L5-S1 with all the other lumbar disks bulging with less problematic stenosis.

Take care! :)

[Kandra]

Kandra,
If an ACL reconstruction is in your future you should know that the replacement ligament either comes from a cadaver ( called an Allograft ) or harvested from a different part of YOUR body (called an Autograft ). It isn't grown in the stricter sense of the word, but it IS grown. So I guess you ARE right, Kandra.

Hi Pete,

Thanks! I was aware of the difference but really didn't know for a knee they'd use an Allograft. A friend's son recently had a torn ACL replacement and she said it took 8 weeks for him to "grow" one that they'd use hence my thinking. However, it doesn't really make sense that they'd go in and take a ligament, put it in another area to "grow" and then go back to take it to use it for the replacement. Humm.

Take care!!! Thanks again :)

[Bahamaroot]

In my surgery they used a piece of the muscle tendon that covers the knee cap to replace the ACL. Supposedly a muscle tendon is much more durable than the original ligament, does not increase the likelyhood of injury to the kneecap and decreases the chance that it will tear again. Using a tendon from your own body is suppose to lesson the risk of infection and improve the speed of healing. At least that is what I was told. I have had no issues with that knee since surgery in Jan of 2001. :)

[Mark N]

Kandra, is there a sports medicine clinic near you? Sports orthos deal with many knee problems and would be much better treating your knee. I know of a football player that used a brace to play most of the season with his ACL torn. You should have a brace until you get the treatment you need. I hope you find an Ortho that does ACL surgeries as the one you saw is not the norm.

[Kandra]

Jeff,

Using a tendon makes sense as you're right...much stronger. I'm so glad for you that you've had no problems since! :)

Mark,

Hmm, I'd have to look in the phone book for a sports clinic per se, but there's 2 huge orthopedic practices in town (the orthopod I saw is in solo practice) and I'm sure there's at least 2 or 3 that do sports medicine.

I totally agree with having at least a brace! This is just about intolerable as it's happening on a daily basis now and the ache/pain in my quads and lateral knee pain
isn't fun.

Thanks!