What are the other issues in your knee? Is your knee stable?
Yes, the knee is stable. I also had/have the following
- Compression fracture of femur
- Lateral meniscus tear
- Medial meniscus tear
- Cartilage fissuring / tear (patella)
The knee just...hurts. Not a lot, not all the time...but it fellsbadman (tm). It could be the meniscus, it could be a patellar tracking issue, it could be the cartilage....who the fuck knows
I've studied the MRI (I can read em, to some limited extent), read the literature, talked to the ortho (three times: I'm clearly paying off his boat). It was the ortho that said to me "Well, the knee isn't unstable and the MRI is clear....going in now risks making it worse".
(FWIW, the 'gold standard' for confirming extent of partial acl tear is arthroscopy + MRI. There are other, more exotic / non surgical ways to confirm too...but outside of a uni lab, you're shit out of luck getting access to a KT-1000 with real time US or fluoroscopy)
Playing 'doctor shopping' is an expensive game (plus, the guy I went to see did the first ACL repair on that knee anyway: I was happy with the results so went back to him), so at present am playing 'wait and see'. I can still do a fair bit (grappling wise) but there's no way I even want to risk hard stand up randori and definitely not comp....so bear that in mind as part of your "meh, it'll heal" strategy. I'm 7 months out (did it 25.01.17) and it's still not 100%
Re: PRP study I mentioned
The problem with PRP is that the synovial fluid in the knee tends to dissolve any scar / clot that forms a scaffold, forming the basis of healing (main knee joint is synovial joint). They need to include a squirt of collagen into the PRP mix so that it doesn't dissolve...and preferably inject it into a scaffold and/or partially torn ACL. There's no reason why this *shouldn't* work but it's experimental...and without it, the PRP gets 'washed out'
Here are a couple of articles for your consideration
Spontaneous healing of torn ACL: MRI study
(not the best level of evidence, but something to consider)
Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series
ACL injuries and stem cell therapy
Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors
Factors Related to the Need for Surgical Reconstruction After Anterior Cruciate Ligament
Rupture: A Systematic Review of the Literature
(if you need the fulltext of these, try plugging them into
https://sci-hub.cc/)
TL;DR: while ACLr is still the gold standard for this sort of thing, it's *much* less clear with partial ACL tears. From one of the articles above
http://sci-hub.cc/http://www.jospt.org/doi/abs/10.2519/jospt.2015.5183
TL;DR - it's very, very grey.
Some highlights from the SR cited above
- "...For example, a recently published randomized controlled trial by Frobell and colleagues indicated that clinical outcomes 5 years post injury for patients successfully treated non-operatively were comparable to outcomes for those patients treated with surgical reconstruction.
- there was no increased risk of osteoarthritis or meniscal surgery based on the ACL tear being treated surgically or not. There was also no significant difference in patients’ function, activity level, quality of life, pain, symptoms, or general health based on the treatment approach"
- Unfortunately, ACL reconstruction is also not always successful as indicated by Ardern et al who based on their review of the literature, reported that only 63% of individuals return to sports after ACL reconstruction.
- The clinical decision whether or not to opt for non-operative management is usually based on the pre-injury activity level, patient’s fear of not being able to return to a previous level of sport ability, clinical instability tests, age, and preference of the patient
- However, the predictive value of these factors on selecting the most appropriate management strategy post ACL rupture is unclear.
- Conflicting evidence was found for the influence of the pre-injury activity level on the likelihood of requiring surgical ACL reconstruction. The study of Eitzen et al determined that there was significantly more high level athletes in the group of patients requiring an eventual ACL reconstruction.
- On the other hand, Kostogiannis et al did not find a difference in pre-injury activity level between patients who eventually went through to surgery and those who did not
- based on the current evidence, we are not able to predict at an individual level whether a patient will require reconstruction surgery after non-operative treatment. Therefore, rehabilitation should be considered the primary treatment after ACL rupture
Finally, I'll copy and paste this from reddit for you also
X-ray (outside of CT arthrogram ; that's a contrast dye injected into your knee X-ray) is not going to show much. Yes, there are certain indicators of ACL/meniscus damage that can be inferred from X-ray (brusing pattern for example) but MRI is better.
Back of knee thing sounds like popliteus muscle pulling double duty trying to stabilise the knee. It's sort of like the "fifth ligament" in what it does for knee motion.
Yeah - get thee to an Ortho. If MRI is too expensive, request CT athrogram ; some places might also do Ultrasound imaging of knee that can be indicative.
...
No problem. The arthrogram is almost as good as MRI (in fact is used when patient can't have MRI due to pacemaker etc) but it significantly cheaper. Depending on where you are, maybe on par or cheaper than ultrasound. Think hundreds not thousands.
It's does kinda suck getting a dye injected directly into the joint space via needle...but c'est la vie.
FWIW, you can get some idea if the ACL is implicated using the Lelli test. It's simple to do. Get a buddy to put a cup or roller under your calf then perform (gently) the following. Remember to do the good side first as benchmark.
Be warned: you still need an in person expert. Just wanted to give you someplace to start!
None of this constitutes medical advice / is provided to you for educational purposes only / see a frikken doctor in person and discuss your options!
