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Quick help on knee decision needed

post #1 of 16
Thread Starter 
Hello my friends,

Many of you know I have a daughter who plays college basketball. Last year she had a traumatic knee injury of the "unhappy triad" type -- completely torn ACL, partially torn LCL, and partially torn lateral meniscus. She had a hamstring graft repair of the ACL, a trim of the lateral meniscus and the LCL was left to heal on its own. Ten months post-op and athlete-quality PT she experienced some swelling during practice so visited her orthopedist and had a MRI last week. The MRI was suspicious for a torn medial meniscus, but not definite, and the doc wants to scope her knee this week. He says she could be out two weeks if the findings are negative for a tear and could be out the entire season if the findings show a significant tear and he needs to do major cleanup.

She was told not to practice or play during the investigation of the cause of her swelling. She ignored the doc, has been practicing and playing a lot of minutes in two exhibition games, and now claims to have very minimal swelling that she is controlling with RICE.

Here's our dilemma: should she have the arthroscopy, knowing she risks losing her sophomore year of play, which is essential to move up to a larger program next year (she still has 4 years of eligibility). The doctor says he will support whatever decision she makes--to scope and maybe not play or not to scope and play in the hope that her medial meniscus is not torn. The doctor is the team physician for a top-25 mid major Div I basketball team.

This kid lives to play basketball. If it was taken away from her, I worry that she would sink into a deep depression.

What would you do if she was your daughter?
post #2 of 16

The risk of losing sophomore play is not from the procedure but from the injury.

Risk = likelihood * cost.

Cost of procedure: 2 weeks play.

Cost of treated injury: sophomore play.

Cost of untreated injury: missing from the reckoning above.
post #3 of 16
Darn! This is a really tough judgement call! I mentioned in another thread that I am currently working with a girl on the freestyle circuit who probably would have been an olympic qualifier had it not been for the multiple surgeries she ahs had throughout the years. She is willing to admit that some of her injuries were the result of ignoring minor injuries, which in turn became major injuries.

On the other hand, from my own experience, the medial meniscus was infintely more painful than the ACL tear. How much pain is she in? That might give you a clue as to whether or not the meniscus is torn.

Is there some kind of radical PT she can do without having an operation? Can she play with a brace? The depression is a real issue. Believe me, I know. However, the depression over never being able to play again can be devastating.

Sorry I can't offer a more definite opinion.
post #4 of 16
Have you thought of doing another MRI?
post #5 of 16
Thread Starter 
The doc says that the tear could be on the inferior aspect and thus not clearly seen even on MRI.

Lisa, she claims to have no pain just a sense of "tightness" and slight swelling after practice and games. I say "claims" because she has not been completely forthcoming with me about the whole deal. That's why I called the doctor.

The doc's chief concern is a reinjury of what is now a very strong ACL graft. He claims that swelling can reduce the strength of the joint by up to 40% which makes the new ACL vulnerable to injury. He said she would need to really dedicate herself to strenthening all the surrounding muscles and controlling the swelling to manage the risk. And he would want to see her in a month for a status check.
post #6 of 16
Is this a scholarship issue? I.e., she may either lose an existing scholarship or a chance at one if she sits out and/or it gets known she has a resurfacing knee issue? Sad to say, but that can be one thing to take into account.

Also, I am not a doc ro a PT, so take it fwiw, but she has swelling but no locking/clicking or other "bad" cartilage symptoms, at least as she has reported to you. So, why does the doc say he wants to scope her? If this is major swelling, then this makes sense, if it's minor swelling, I don't know that I question the doc per se, but I do think there is another set of facts out there (in addition to the MRI) that may illuminate why he wants to scope. He (as many docs do) may not have communicated this clearly.

A fully rehabbed ACL should actually be stronger than the ACL in the other knee, minor swelling or no. I would aslo ask if she's practiced jumping drills, similar to www.girlscanjump.com , to help minimize likelihood of future knee issues.

Basically, if she were my daughter I would quiz the doc to the limits of human decency first, then weigh the scholarship and other playing issues versus long term knee health. If the knee is currently stable and muscles are not being turned off by major swelling, gutting it out may make sense. If the muscles are at risk of shutting down due to major swelling, losing the season may be the best lesson she could have at this stage of life. We lose, in addition to win, all through our lives, it's a process.
post #7 of 16
Thread Starter 
It is a scholarship issue as far as having a position. She had to redshirt last season with the knee and is starting this year. She feels she's playing better than ever and says the knee doesn't really bother her that much, but in an unconvincing voice, if you know what I mean.

The bottom line is it is her decision. I was all worried about what advice I would give her, but my advice is biased because I'm her mom. In the end I told her that she already knows the answer--only she knows what symptoms she's having, i.e. pain and swelling, only she knows if it's okay to play. She's going to call the doc and confer about that today. I'll let y'all know what they decide. Thanks for helping me work through this.
post #8 of 16
I am so sorry, Nolo. This is very tough. If there is a tear, it will likely continue to get worse and hurt more. I waited too long for surgery and ended up with worse problems. I wish I had not. It's a tough decision and both have advantages and disadvantages. It is tough to not want to be able to continue playing right now. I hope everything works out!
post #9 of 16
At best, she should probably get it scoped. At least, if we know what is, it will be easier to figure out what to do about it.
post #10 of 16
Thread Starter 
That's what she's decided to do. I think she's growing up!
post #11 of 16
post #12 of 16
I hope that it's a quick and easy fix, and that she makes the best decision for her. It would be sad if she had to sit out a season, but then again, is the risk of permanent damage a possibility?

Life is long. Plan for the future.:
post #13 of 16
Thread Starter 
I just read SMJ's story about his MRI which has given me hope that the doc finds nothing when he scopes her next week. It would be great if she could play by mid December. I told her your story, Bonni. All the good stuff helps.
post #14 of 16
Thread Starter 
Update: arthroscopic surgery went well yesterday. There was no torn medial meniscus after all. The problem was more insidious: early arthritis. So she ended up with a mixed blessing: she can play basketball but she is looking at more reconstructive work down the line.

Lucky for her, she plays golf well, if she needs to give up the bigger round ball and re-route her competitive juices elsewhere. But for this season, she's a starter, and she's going for it.

Did any of the others who had this done get a parting gift of a video of the procedure? Fascinating!

Thanks for those in this thread who helped us make the decision, though my daughter now wishes she had chosen not to have it done.
post #15 of 16
Interesting. They warn that arthritis is a possible outcome of ACL surgery, but it is supposed to happen eventually.

Nonetheless, it is not a death sentence. She might play with pain, but given that she is active, it is possible that it will be tolerable.

Arthritis is often congenital. Does anyone else in your family suffer from it?
post #16 of 16


Nolo: I would play it safe and go in with the scope for a long term fix instead of playing on an injured knee, which may have a good chance to be really damaged if no intervention occurs now. Just my view, but playing now could ruin the next three years instead of a short term out of comp now with a long term career. It's still a roll of the dice. Best of luck. Hope your daughter does well either way.

whtmt & Mackenzie 911
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