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knee damage and treatment

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3 weeks ago (Jan 23) I landed from a jump with my left leg out. The MRI and xrays show two cracks (nondisplaced) on the tibial plateau, both medial and lateral sides, a small femur compression fracture in the middle, plus medial meniscus/MCL/ACL damage. My ortho put me in a custom KAFO brace, no restrictions on ROM, and NWB. He said we'll need to wait until the fractures heal and I can be weight bearing before we decide the next steps on the soft tissue damage. My next appt is March 9, and the fracture healing will be reviewed.

Does this sound about right for his treatment so far? Can I do nNWB rebab exercises? I dont have any pain, and my ROM is about 80% (then I get pressure from the swelling which is still around the knee).

Thanks!

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Naturally, you need to listen to your doctor.

I treat the little cracks only if they are seen on an X-ray. Bone edema seen on the MRI, I ignore. Torn MCLs are treated in a tight brace without ROM, but without weight bearing for four weeks. The nonweightbearing is for the fracture, and the MCL heals best without motion initially Then I start aggressive "prehab" and when the rider has full motion and good strength (usually three to four weeks, motion comes back really fast when no one has been mucking around in there with a knife) I do the ACLR only as the other stuff has healed. Post surgery, I use neither a brace, cast, or crutches. After three months rehab, they are back racing.

http://www.sandersclinic.net/aclrehab.html

http://www.sandersclinic.net/terrible-triad.html

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Thanks DrM

Couple more questions:

- won't the good knee have future issues due to using it for the PL?

- other Dr's say the ACL bone grafts need 6-9+ months to heal... why do you say 3 months is good?

- if I came to Houston, how long would I need to stay there before coming back home?

- how long off work would I require (I have an office "desk job")?

Thanks again

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Answers:

- won't the good knee have future issues due to using it for the PL?

NO, IF YOU DO THE EXERCISES, YOU WILL NEVER HAVE ANY ISSUES WITH IT AT ALL

- other Dr's say the ACL bone grafts need 6-9+ months to heal... why do you say 3 months is good?

THE SCIENCE BEHIND THIS HAS SHOWN THAT THE BONE GRAFTS HEAL IN FOUR WEEKS. IT TAKES ANOTHER TWO MONTHS TO REHAB THE KNEE BEFORE SPORTS. IF DOC USES OUTDATED SURGICAL OR REHAB TECHNIQUES, THEN IT COULD EASILY TAKE THAT LONG. THE THING TO REMEMBER IS THAT 80% OF ACLRS IN THE USA ARE DONE BY DOCS WHO DO LESS THAN TEN PER YEAR. BY CONSTRAST, I USUALLY DO TEN PER MONTH.

- if I came to Houston, how long would I need to stay there before coming back home? FOUR TO FIVE DAYS, DEPENDING ON WHAT DAY WE DO IT. USUALLY IF YOU COME TO HOUSTON, ITS FROM WEDNESDAY TO MONDAY, IF YOU GO TO THE NORTH TEXAS CLINIC, IS FROM TUESDAY, THROUGH SATURDAY

- how long off work would I require (I have an office "desk job")?YOU WILL BE BACK WALKING INTO THE OFFICE LIKE A NORMAL MAN ON THE SEVENTH DAY AFTER SURGERY

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Ok, a couple more questions Dr Mark. It's now been 5 weeks, and I'm still on crutches and NWB with a KAFO brace (full ROM). Next apt with OS is next week. My MRI (from 2/2/11) findings: "Medial tibial plateau fracture involving the posterior and medial apsects with small region comminution that is depressed 3mm associated with bone marrow edema. Complex tear of the medial meniscus with folded flap tear component of the posterior horn and inferior surface tear of the medial meniscus body at the red-white zone junction. Complete tear of the ACL at the junction of the middle and proximal third with adjacent edema. 6mm depressed fracture involving the posterior aspect lateral tibial plateau. Inner margin radial tear of the lateral meniscal body. Tear at the meniscocapsular junction of the posterior horn lateral meniscus."

Whew! At leat no MCL/PCL/LCL damage... SO my question(s).

After 5 weeks I can straighten my leg almost fully, and bend to almost the same as my good leg, no pain just some pressure at either end of this ROM and odd little click here and there; no locking. There is some swelling still around the knee. Is this "normal"? Can I get on a stationary bike yet? How long until I would be ready for ACLR?

Thx

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The MRI reports fractures. First I have heard of that. I would need to see the ordinary real world X-rays. MRIs over read call fractures all the time.

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Interesting... what about the remaining swelling after 5 weeks?

I'll be having xrays next week, so hopefully I can get off these crutches.

Also - how long typically until ACLR would be scheduled (ie. how long of pre-hab is needed)?

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How much is necessary depends on the person. I dont operate until the guy has nearly full motion, normal gait, and good leg control. In most riders that a few days to a week or so. In couch potatoes is is like forever.

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I'm now at 6 weeks and saw the OS today. Don't need the KAFO brace anymore, but he wants me NWB for 4 more weeks to "be sure" the tibial plateau fracture is healed.

Question for Dr Mark - what exercises can I safely do to work my quads and calf? I have an OTS CTi brace now, but still not supposed to use it as I'm not supposed to walk for 4 weeks more. Can I ride a stationary bike? Or?

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This whole treatment plan is beyond me. You need to either listen to your doctor ofr get a second opinon. I would choose the second.

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