MRI Translation? Post-op ACL.

[JHearn911@yahoo.com]

I had an ACL reconstruction 11 months ago using Patellar Tendon Graft. I am still experiencing pain, mild swelling, and occasional instability. My symptoms seem to get worse the further I get from surgery. In September I had another MRI done and the results were as follows:

SURGICAL CHANGES INDICATIVE OF ACL RECONSTRUCTION. NO DEMONSTRATED GRAFT DISRUPTION, ALTHOUGH MILD INCREASE IN SIGNAL AT THE INFERIOR ASPECT OF GRAFT IS NOTED WHICH MAY REPRESENT A MILD STRAIN. POSTERIOR CRCUATE LIGAMENT AND COLLATERAL LIGAMENT IS UNREMARKABLE IN APPEARANCE. NO DEMONSTRATED MENISCAL TEAR.

FINDINGS CONSISTENT WITH MILD PROXIMAL PATELLAR TENDINOPATHY. NONSPECIFIC HYPERINTENSE SIGNAL CHANGE WITHIN THE INFRAPATELLAR FAT. THIS MAY REPRESENT EDEMA FROM MECHANICAL INJURY VERSUS SOMEWHAT PROMINENT POSTOPERATIVE GRANULATION TISSUE.

NO DEMONSTRATED OSTEOCHONDRAL LESION OF INTRA-ARTICULAR LOOSE BODY.

I am not sure what all of that means, but I am concerned that it mentions a possible strain of the graft. My doctor read those results and told me that the MRI report said that nothing was wrong and that I did not need to come back to see him. I am awaiting a second opinion. Could you please tell me what that MRI conclusion means? Also, is there a possibility that I may need a revision surgery or that I have re-injured the ACL? The pain that I experience is directly behind the knee cap, a sharp/burning pain that varies throughout the day with no seeming relevance to activity. Thank you in advance.

[Heidi]

Hi

I am no expert at reading MRI's, but here is what I would take from it:

Possible mild strain (tear) of acl near lower attachment
Mild patella tendinopathy: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/indexjumpersknee.html
Prominent post-operative granulation tissue - scar tissue (possibly?!)

What kind and extent of rehab did you get following injury? Have you continued with this?

[JHearn911@yahoo.com]

That's what I gathered from the MRI. Tendenitis and a mild tear on the ACL graft. My concern is that the doc told me "nothing is wrong" with my knee after he read that MRI. This is a work-related injury, so there are a lot of hoops to jump though. I can't help but wonder if something was done wrong during the surgery and the doc doesn't want to admit fault and that's why he gave me the brush off. He said that he would help in any way that he could with getting me in for a second opinion.

I had PT 3 times a week (one hour duration) for 5 months, then twice a week for another month. I then had "Work Conditioning" which consisted of 1.5-2 hours of therapy at each session. That I did 3 times a week for two weeks. No more PT has been or will be approved, unless I get in for a second opinion and the other doc some how convinces the insurance company that it is, indeed, necessary. After completing the 6.5 months of therapy I still had at least 2cm of atrophy to the quad. From my perspective, the injured leg is still atrophied now 10 months after surgery. I have not continued with much of a home exercise program, just walking, swimming, etc. I do have a TENS unit that it set up for electrical stimulation, but my doc hasn't told me whether or not I should continue to use that this far out, and I am in a period of paperwork shuffeling where I have no doctor to turn to and no private insurance.

Walking, sitting with my knees bent, kneeling, crouching, and stairs all aggravate the pain. I took my daughter out for Halloween and we walked for about two hours (in flat shoes, I can't even attempt to wear heels) and since then I have experienced even more pain and swelling, although the swelling is minimal, I think it feels more swollen that it looks). I think that if there was a mild tear evident on the MRI that is has gotten worse in the last two months.

I must also mention that this injury occurred July 2006 and the MRI taken at the time of injury siad "mild strain or sprain." Nothing was done for 2.5 years, until another MRI in December also said "mild strain or sprain of the ACL." Surgery was scheduled for the beginning of January this year, and at time of surgery there was only 25% of the ACL intact, so it wasn't a complete rupture, but it did not show up on the MRI as bad as it was. I don't know if I have so many post-op problems because it took 2.5 years to diagnose and get treatment? So I walked on the torn ACL for a long period of time, and all of the "tests" were negative, so I am not surprised that they continue to be negative. This pain is the same pain that I had pre-op.

[Heidi]

I think that given the extent of the rehab plan you followed you should not be having the kind of trouble you are now, if everything was ok.
I think a second opinion on the MRI results is definately the way to go.
If I were you I would try to resume some of the rehab exercises you were gievn before to maintain the range of motion and strength in the knee as much as possible. Always start off lightly and stop if any exercise is painful. Gradually increase the amount you are doing. You might find some useful exercises here:

http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm