Q&A: Knee issues

Mike-

I've written you before, but this time I'm nervous and need some advice. I have an MRI scheduled for Monday, and have been told I most likely have a torn meniscus (left knee, medial meniscus) and possibly a partial tear of the ACL.

I know the exact moment I noticed a problem, but there was no trauma or pain to speak of. I was playing a volleyball tournament on 9/28, had played 3 matches and was finishing my dynamic warmup for the 4th match. The only thing I did different was a hamstring stretch with my foot elevated on a wall (slightly above hip height) - kind of dumb and pointless, but in any case...I went to walk onto the court and my left foot was almost being pulled out to the side as I brought it forward in my gait. I was reticent to do hitting lines because I felt like I would collapse after a jump. The feeling subsided and I played the rest of the match, having absolutely no problems. Later that night into the next day, my knee was swollen and stiff.

I finally was able to be seen by the orthopedist last Thursday. He did the test (I forget the name) for the ACL, and found a great deal of laxity in both knees, but the left did not "lock" at the end range of motion. He was surprised that I had never injured or had surgery on my knee - I think he didn't believe me. Of course, I broke my elbow and had a doctor twist it all over the place and tell me it was fine, so I'm not sure what my pain tolerance is.

My questions are two-fold (and I'm going to buy Bulletproof Knees right away, to be sure!!) - any advice on questions to ask the orthopedist about my ACL/meniscus to ensure I'm getting the whole story, and is it possible to forgo ACL surgery (if it's indeed torn) and just work on strengthening the leg? The degree of laxity in both knees (which I think I've had all my life) has opened up the possiblity that my ACL wasn't doing a whole heck of a lot - and the right one still isn't. My main sport is volleyball, playing competitively once a week and a couple tournaments a month, attending nationals and playing beach doubles in the summer.

Any other advice or suggestions you could give me would be much appreciated. If Bulletproof Knees would have most of what I'm looking for, I'll start there.

Thanks for your time - and counsel!

First off, thanks for your question!

When going to your ortho, here are the following questions I would want to know:

- What's the degree of the ACL tear? A full-thickeness tear (Grade 3) would need surgery; anything below (1 or 2) can be treated conservatively in most cases.

- What is the location and size of the meniscus tear? I would then ask you, is there any feeling of locking and/or giving way? Does it cause pain or a decrease in function?

Here are some thoughts, FWIW.

If you don't have a Grade 3 tear, then you'll most likely be able to avoid an ACL reconstruction. That, in and of itself, is good news. I would definitely be taking some time off from volleyball, though, and when you return you may want to wear a brace for a period of time until you're comfortable again with explosive tri-planar movements. As you may remember, this is what Dallas Clark did for the Colts a few years ago - they thought he had torn his ACL, when it fact it wasn't a full-thickness tear. A few weeks of conservative therapy and he was back on the field.

Now I'm all for conservative therapy, but if you DO have a Grade 3 tear surgery is probably your best option. Those that go without a reconstruction are more likely to have rapid onset of osteoarthritis, so even though surgery/rehab would suck, it should give you a better long-term outcome.

What you do with the meniscus tear will then be contigent upon the severity of the ACL tear. If the meniscus tear is asymptomatic and you don't need ACL surgery, you can probably leave it alone - more and more docs are trying to leave these kinds of tears as is. If it is causing you issues though (whether it's pain or mechanical) you may need to get it scoped. I've discussed the difference between partial meniscectomies and meniscus repairs before on the blog, so be sure to check it out here.

I hope that gives you a little ammo when meeting with your ortho this week. Keep in mind that my bias is always to stray away from surgery if at all possible, but in some cases it is warranted and will provide the best outcome.

Good luck and keep me posted!

Stay strong
MR