Uncertainty can be happiness

"Security is a false god," or running around the world as an FSO

Final US follow up

Posted by quirksalight on February 7, 2008

And the story continues…
On Monday, I met with the Orthopedic Surgeon I’ve been seeing in VA to go over the MRI results from last Wednesday, and the scans from NY (which just arrived in the mail). This is the last time I’ll be seeing the OS before heading to Korea, barring any unusual circumstances, so I wanted to get a full accounting, etc.
One thing that’s pretty cool is that you get a cd with the MRI scans burned in to it. So of course I was perusing my knee prior to my appointment. And… well… it looks like the defect decreased in the inferior-superior direction and grew in the medial-lateral direction.
However, the MRI images are in 2-D. So if the scan isn’t in the middle of the chondral defect, then there can be interpretation issues. For example:

Here are two possible scans in figure 1. The circle is representing the focal defect, and the lines the plane of scan.
top view
Figure 1: Lines A & B represents the plane that the MRI took a cross sectional scan of the focal defect (which is the circle)

Scan A is directly in the center, it’ll give an accurate read. Scan B is off center, giving a false reading of the defect, indicating it is smaller than it actually is.
side view
Figure 2 A,B: Cross sectional view of how the chondral defect changes depending on scan location

Figure 2 illustrates this, as the image of the defect in the plane of scan would look like 2a for scan A and 2b for scan B.
Basically, since the damn thing is still there and b/c my knee still hurts, the Baker’s cyst is there, I still have a problem. The OS recommends surgery, to realign the patella. And I can understand the reasoning, but I really don’t want to do a pretty invasive procedure if I can avoid it. Right now, the knee pain is not a severe detriment to my quality of life, it just forces me to be more careful of my physical activities than I had in the past. Yes, pain and swelling is there. But hopefully it’ll continue to be manageable via NSAIDs, ice, PT, and exercise.

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5 Responses to “Final US follow up”

  1. Jim said

    I have been dealing with this problem since 1989 while in the Army. I got out in 1995, still had the knee pain & going to the VA. Finally a surgery in 2004 (Lt knee) and in 2006 (Rt knee). At 40 years of age I was told I was to young for knee replacements. Now I’m 48, I have two major surgeries behind me and I’m seeing all these “younger” people getting partial knee replacements. Surely the VA will reconsider me now for partial or total knee replacements. Ice, NSAIDS, and PT really haven’t helped for almost 20 years. What has the VA been telling you about replacements? Just curious..good luck!–Jim

  2. Er…I meant Virginia by “VA”…
    I haven’t really looked into partial knee replacements; my knee isn’t bad enough to warrant that.

  3. Melissa said

    Jim & All,
    I can understand the pain and overall discomfort you are experiencing. Since 1993 at the age of 18 I suffered a dislocation of my right knee and when it relocated my knee broke in two areas as well a chunk off the tip of my tibia. I had to under go immediate surgery where they scoped my knee and performed a lateral release. Knowing that something was not right I suffered severe pain for several years until 1997 when I had to undergo a Fulkerson Osteotomy. Things were well for a couple of years until 2002 had to scope again for clean-up and removal of hardware. My knee has since detoriated and I went in on 8/22/08 for another scope for a final diagnoses before proceeding into a major surgery. At the age of 33 I am scheduled for a partial knee replace on 6/16/09 and can’t wait. Within the past couple of years I have not been able to maintain the physical activity level that I am used to. The OS that I am seeing used a very conservative approach due to my age but see’s this is a necessary surgery at this time. I wish you all luck and hope you are able to seek the care you need.

  4. Isabel said

    Hello Melissa, I hope all is well with you and your knee. My daughter is 15 years old and 2 years ago she had a patella reconstructive surgery to secure her kneecap. Today we went to see the same surgeon, since she can’t walk without dislocating and pain. The orthopedic said because of her anatomy in her leg, her kneecap had shifted again and she may need to go for Fulkerson Osteotomy.
    I read your coment about this and that you were going for it in 6/09. Did you get this done and how are you feeling after. Was it dificult and did you recuperated from it? Please answer my questions. I will apreciated so much?. We are going for 2nd and 3er opinions. Thanks again and hope you are better and without pain.

    • Hi Isabel:

      Melissa posted once on my blog and I haven’t heard from her again. It may be better to post your questions on a forum.

      However, there were two ladies who posted their post- fulkerson osteotomy updates for several months after their surgeries on this post of mine: https://quirksalight.wordpress.com/2007/12/16/revisiting-my-gremlin/. I don’t know if it’ll help, but it’s an ongoing dialogue of what they went through post-surgery. They are both quite detailed about their experience.

      Cheers, Beney

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