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Should I get a third opinion?

post #1 of 6
Thread Starter 

Hi all,

 

I tore my ACL and MCL and got a small but painful tibial plateau fracture on March 3rd. I've been doing rehab since then. The first doctor I saw was right at the ski area (does not take insurance, either - what a scam and a gold mine) and he correctly diagnosed the two ligament tears based on clinical exam, missed the fracture which was not visible on x-ray, put me on crutches and in a brace, and told me to follow up with an orthopedist. He said that many people do not require repair of the ACL and the MCL should heal on its own, that he has been skiing for 30 years with no ACL. I was supposed to be back on my feet in five weeks.

 

OK, that sounded good. Then I saw a local orthopedist (one of two recommended by my PT based upon her observations of surgical outcomes, and the one who had treated my son for a broken arm over ten years ago). He put me in a stronger brace, read the MRI which showed the fracture (I'd had one by then) and put me back on crutches for a total of eight weeks (I was trying to work through the pain, apparently the wrong thing to do), with the prediction that I would not require surgery and that anyway they don't usually operate on people 50 and older (I turned 50 six weeks prior to the injury - had been skiing all winter before and after my birthday injury-free).

 

That made two guys saying I would not require surgery. Meanwhile, I literally cannot take a step without my knee sliding laterally-medially and/or anteriorly-posteriorly. My leg is like Pinocchio's - held together by a couple of strings (and some skin). I can't get out of my chair without putting my hands and my weight on the desk. If I get up to go to the bathroom in the middle of the night, my leg slides - I have to be fully awake and concentrating on mobilizing my quads and hamstrings simultaneously to prevent the sliding. I kept telling my PT who kept telling me that I was progressing well but that she really thought I would need surgery because my knee is too unstable. I returned to the surgeon who told me, "Just strap your brace on when you get up to go to the bathroom."

 

At that point I decided I needed a second opinion. I went to another local doctor (but a bit further away!) and he immediately showed me the give in my knee (which I was well aware of) and said I needed both my ACL and MCL reconstructed. He wanted to see more flexion in the knee first, and sent me back to two more weeks of PT, but my age, my presumed activity level based upon what he thinks women my age of my profession do, the fact that I like to ski easy trails - none of that even came up. He did not tell me to sit around and wait for grandchildren, or to just live with being one of those women who sits in the ski lodge with her laptop all day, waiting for her family to "finish" skiing. He just told us stories of other ski injuries and bragged how he could move my knee medially or laterally 15 mm (He is still an orthopedist, LOL, not necessarily Mr. Kindness and Personality). He also put me in an even bigger and stronger brace, which does work better than the previous one - but I can't wear it forever or I will lose my mind.

 

That is my long sad tale to this point. Now my question is, do I get a tie-breaker opinion? A third orthopedist? Is there anyone here who wants to put in their $0.02? It has been almost ten weeks. The swelling is gone, the pain is mostly gone, but I still wobble like Pinocchio (when he is a puppet, not a real boy!)

 

Thank you!

post #2 of 6

need more clinical information but as a general response both docs are correct. MCL does heal on its own, provided that it's not a complete tear, and surgery on a pt. >50 yo is usually not performed. Now if you are active (athlete) your knee needs an ACL, for recreational purposes you can live without one but you'll be wearing a custom brace. Not knowing your fitness level, health, physical activity, etc. it's hard to say.
Although, if the ACL is done with the gracilis and not the patella tendon it might be easier on you in terms of rehab/recovery.

post #3 of 6

I know nothing but for peace of mind, get an opinion from someone who fixes the likes of  the US ski team or someone that their people can recommend.

post #4 of 6
Quote:
Originally Posted by jzamp View Post

need more clinical information but as a general response both docs are correct. MCL does heal on its own, provided that it's not a complete tear, and surgery on a pt. >50 yo is usually not performed. Now if you are active (athlete) your knee needs an ACL, for recreational purposes you can live without one but you'll be wearing a custom brace. Not knowing your fitness level, health, physical activity, etc. it's hard to say.
Although, if the ACL is done with the gracilis and not the patella tendon it might be easier on you in terms of rehab/recovery.

 

The 50 year old cutoff is just a rule of thumb.  I am 56 years old and my surgeon recommended (and performed) ACL reconstruction based on what I wanted to be able to do - high level skiing.  (I had the auto hamstring graft.)

 

Based on how unstable VTCS's knee is, I (as a layman, not a doctor) think she needs reconstruction unless there is some specific reason to think it would be unsuccessful.

 

Recovering at our age does require a serious committment and a lot of work. 

post #5 of 6
Thread Starter 

Thanks mdf - at this point I want to be able to go for a walk and push my chair around on the wheels without my knee giving out! How long did your recovery take?

post #6 of 6
Quote:
Originally Posted by VTCS View Post

Thanks mdf - at this point I want to be able to go for a walk and push my chair around on the wheels without my knee giving out! How long did your recovery take?

I had surgery the last day of January, so it is still going on.  I plan on taking a year, give or take a month.  I am exercising more now than I ever have in my life.

 

I feel normal for everyday life already, and have for awhile.  The memory is already starting to blur, but I think the early, feeling really disabled stages were about 6 weeks.

 

(If you type ACL in the search box, you get a whole lot of threads and articles, by the way.  Worth reading.)

.

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