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Unhappy Triad

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Hey Dr. Mark,

first off can I just say thanks for all the time you have devoted to this forum, it has been so helpful to me of late! :lol:

I recently found out thanks to an MRI scan that I have torn my medial ligament, my ACL and my lateral meniscus. :cry::applause: I've read all the threads here from guys who have torn they're ACL and none of them seemed to be on crutches before their opperation. My GP didn't know a whole lot about the pre and post surgery practices of surgeons dealing with this kind of injury so she recommended the crutches until my meeting with the surgeon. The earliest appointment I could get with an orthopaedic surgeon is 2 months from now so I was just wondering in the meantime if my medial ligament heals would it be ok to abandon the crutches or because of the damage to my meniscus would I be better off staying with them?

Thanks Dr. Mark and if anyone else has any insight into my whole dilemna feel free to add your 2 cents :applause:

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We treat the medial ligament in a 20 degree bent knee cast for two weeks. You can walk on that without crutches. After two weeks the cast is removed, and we start people on rehab to get range of motion and strength. At about two to three months after full motion is achieved and good strength, we reconstruct the ACL. Guy will be riding two and one half months after that.

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The classic "Unhappy tiriad" was the medial meniscus, medial ligament, and ACL. This was described by O'Donogue in 1949 (J.B.J.S.)

The actual Unhappy Triad, is the lateral meniscus, medial ligament, and ACL. It was revised by Shelbourne in the mid 90 (Am. J. of Sp. Med.)

It is really no more unhappy than a straight up ACL injury.

The medial ligament heals while ambulating without crutches in a cylinder cast for two weeks.

Then rehab starts on the stationary bike, and other exercises to get full motion and normal strength. Total time since injury two months.

Then, an ACL witht the PT graft from the oposite knee. Never take out the lateral meniscus. A torn one quickly becomes asymptomatic after the knee is stabilized and a removed one leads to certain arthritis. And return to rehab the afternoon of surgery.

In 2006, TT guys taught me that most MX racers are back, not at 3 months like I said, but at an average of 2.5 months.

I could think of far more unhappy things than can go wrong in MX than the above.

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The most common associated injury is a Lat. meniscal tear on an acute ACL with or without the MCL. On a chronic ACL, its the medial meniscus.

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Thats a relief to know I won't have to lose the meniscus, arthritis was my biggest worry! :applause: I'm having trouble achieving full extension of my knee and read somewhere that a torn meniscus can oftentimes be the root of this problem. Have you come across many instances like this Dr. Mark?

Would I be right in assuming that by putting pressure on the knee once the medial ligament has healed, the only way I can cause any further damage to the meniscus is due to a hyper-extension of some kind?

Thanks again for all the insight! :applause:

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A locked knee form a torn meniscus is pretty uncommon at youthful age with a fresh injury.

Many of our patients have difficulty getting full extension. Usually it takes some sessions with a physiotherapist. All our patients are weight bearing at all times.

If would be good if you could get to see a surgeon sometime soon. Socialized medicine isn't so good.

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Haha ye I would have to agree with you there! Problem is that I'm dealing with the Irish health system here :applause::lol:

Thanks for the help Dr. Mark, I'll update the thread when I have the surgery done and let you know how it went! :applause:

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The most common associated injury is a Lat. meniscal tear on an acute ACL with or without the MCL. On a chronic ACL, its the medial meniscus.

Doc...what's a medial meniscus? Oh yeah, it's that thing that I am sorely lacking. Anyone got one they wanna give me?

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Hey folks, well i had the surgery done last week thanks to my physio pushing the date forward! im off the crutches a few days now and my knee feels fine. it swells a bit if im sitting down for long periods and there are some nasty blood blisters forming under the bandages

Just a quick question for anyone who had the surgery, did any of you guys have a badly bruised calf on the affected leg after the surgery?

Mine is swollen and pretty discoloured.......:thumbsup:

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thats par for the course.

+1 here.... I'm at (3) weeks post-op and still just a bit sore and swollen.

andy t.

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Just a quick question for anyone who had the surgery, did any of you guys have a badly bruised calf on the affected leg after the surgery?

Mine is swollen and pretty discoloured.......:thumbsup:

I'm 8 weeks post-op.

My ankle was actually more swollen than my knee!!! I bled quite a bit into my calf. It took about 4 weeks for all the swelling to go down.

Good luck.

SusanE

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