Sports Medicine/acl tear
QUESTION: I have PVNS in my right knee. In april of 2010, I had the knee scoped for a suspected lateral meniscus tear. There was no tear, but the surgeon said that I had fat pad impingment and significant synovitis. So he cleaned all of that up and at that point the acl and pcl were perfect. In dec of 2011 I knelt down to the ground and felt a pop and has massive pain for about 5 minutes then about 30 minutes later my knee was the size of a grapefruit and couldnt bear ANY weight on it. My doc was pretty certain it was a torn acl. I had the mri the next day which showed an intact acl...but revealed a tumor in the posterior medial compartment. I had surgery a few weeks later with a oncologist to remove the tumor and to his amazement, the acl was completely ruptured and scarred down to the pcl. He said it looked like it had been torn for years based on how much it was atrophied.....the notch was empty except for the pcl and a bunch of pvns synovium. He did not reconstruct at that time because he didnt have concent. So after recovery, I met with a OS for the acl and had surgery scheduled, but then he backed out because he couldnt get a positive lachman, anterior drawer, or pivot shift test....they were all negative. However the knee will shift or buckle to the lateral side when I stress it hard, like launching toward a loose basket ball. I had it buckle while throwing batting practice for my sons baseball team while trying to dodge a ball hit right back at me. So clinically I am stable, but in real world, uncontrolled situations it will let go. My doc now is reluctant to reconstruct because all of the clinical tests are negative and the post op MRI still shows the acl intact even though he has operative pics showing it missing. I will attach the arthroscopy pics for you to see. So a year and half ago the acl was visualized at arthroscopy..a year goes by with no mechanisms of injury, the knee popped and swelled, found the pvns and the missing acl, but the knee clinically is stable. Can the scarred acl to pcl in combination of really tight hamstrings produce false negative clinic tests? Sorry for the book...buts a little complicated. Any idea's
ANSWER: Hi Nat.
Sorry for all you've been through and you do have an extensive history.
In short, yes, a scarred down ligament can give a clinical representation of a stable ligament, where in real life situations you are unstable.
I think you are smart to persue further evaluation of your knee especially considering your level of activity in order to protect the cartilage and future integrity of your knee. Should you be interested, Dr. Stone provides Outside Consultations for those who live outside of California. You can send your diagnostic images to him to review. You can learn more at stoneclinic.com. Feel free to contact me directly if you have any questions and you could send your information to my attention.
Whatever you decide, I wouldn't settle for the guidance you are getting right now and would seek further care.
Best of luck and warm regards.
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QUESTION: Thanks for the reply and advise. I do appreciate that. I will actually be in California in a few months, I may try to arrange a time to take advantage of that consult.
Do you think there is any reason to worry about reconstruction with the PVNS in there. Have you guys ever seen a acl atrophy as much as this one did in only a month? This PVNS is brutal!
PVNS is brutal and can be very destructive as you note. Dr. Stone has seen and treated people with extensive PVNS. An updated MRI, ideally within 6 months of evaluation with be important to best evaluate the degree of its effects. If you choose to be seen by Dr. Stone, we will need you to bring all recent images on a CD with you to the evaluation.
Keep me posted on what you decide.