Doctor I am back to see if you can answer some


Q: Doctor

I am back to see if you can answer some question on my knee injury

This is follow question following my knee contusion injury of 4 May

I finally had a MRI done but the Doctor says he sees not just a knee contusion but problems with tendons about the knee in my thigh and he has ordered another MRI to look specifically at the Thigh area and then once he has that he could, most likely, send me to a surgeon to see if I might need surgery.

The problem I have is that I can not get the next MRI until 2 July and this will be two months since my injury.

Is this too long a time period to have successful surgery, if It is required?

What could the MRI show--what would be the most positive result and what would be the most problematic result?

At the moment I still have pain but mostly at night when I try to go to sleep and on a scale of 1 to 10 I would say it is a 7.

My leg during the day is a little bit more flexible but I still can not straighten it fully and I notice deep muscle tightness and swelling in the muscle right above the knee cap in the thigh area.

I also have a small indentation in the knee cap. And when walking with a bit of a limp, it will give out. But the walking does seem to be improving.

Well, I guess that is it. Could you just give me some ideas of what I might encounter with the upcoming 2 July MRI and what to expect.

My hope is that I am now on to Recovery and what the Doctor saw with the first MRI is just some minor tearing and swelling that would recover on its own in time, with some strengthening and flexing exercises

Thank you Tom


A:   Hi.
Your posting the MRI report would have helped me in addition to the history you have described.
Well there are bulky muscles converging to become tendons above any joint as in knee too.
MRI on July 2 will definitely be late. Upon recovery from any injury, the fibrosis starts and since your trauma dates back to May 4, it is already a long time and the fibrosis must have already set-in well.
Next MRI would be after almost 15 days.
My Suggestions:
You may try to consult the Orthopedic Surgeon at the earliest for a clinical evaluation, examination and it is possible that the splay we get in MRI might show something to the Orthopedic Surgeon to decide faster.
Your inability to straighten the knee fully indicates that the muscles above are either week or have more than expected tear with fibrosis.
I would expect edema of part of the muscle with fibrosis and may be tear.

Yes, I do agree with you. The healing is done by the body. We as Doctors just assist in the process. I think you need a good Physiotherapist to give you the right direction.
Please keep posted the progress.

Comments / Follow Ups

Patient: Doctor

I have tried for a quicker MRI date but I am on the waiting list. The sports medicine doctor will review the new MRI and then decide to send me to an Orthopedic Surgeon.

What is the worst case scenario since fibrosis must already have set in well and since I can not fully strengthen my knee because the muscles are weak and have more have more than expected tear with fibrosis and now expect edema of part of the muscle.

Must I have surgery and if so what can I expect given the presence already of the above conditions. Just your best guesstimate please. Worst case do you think I have done permanent damage.
Doctor: Hi.
There is likely to have great results now also, provided you get proper treatment as explained above. All the problems are well treatable.
Just follow the advice of your consultants stringently.
Do not worry . Knee recovers well.

Patient: Doctor

Based on the likelihood of above conditions what would you expect to be the worst case. Would you expect the Orthopedic Surgeon to decide on surgery and what would be the likely and worst case outcomes.

I realize you can only give a best guesstimate but what would you expect with the listing of conditions above which you describe as weak or more than expected tear with fibrosis and edema of part of the muscle with fibrosis.

Thank you Tom
Patient: Will I be receiving answers to my follow up questions?
Doctor: Your questions are specific.
The worst case scenario:
Based on the information you have provided, the fibrosis remains and will keep the muscular actions weak if not taken care of.
It is really difficult to comment upon, what your Orthopedic Surgeon will decide as His decisions will be solely dependent upon the clinical evaluation, examination and fresh and old MRI reports, decided on case-to-case basis.

Medical science is all based on the facts, hence it is better to comment upon depending on the facts. For the guess I need your MRI report at least.

Please provide the report.
Thanking you.
Thank you, Doctor for your help
Doctor: You are most welcome .
Patient: Doctor I am back to ask a new question.

My MRI is back and news is not good. I have a torn patella quadriceps tendon. According to the Sports Medicine Doctor it is a pretty severe tear.

I am to see a Orthopedic Surgeon this Friday, June 26 to see if he thinks he will operate.
My questions is on the timing of a potential operation.

It has already been 8 weeks since the accident and my reading says it should be done within 3-6 weeks. Am I too late for a satisfactory outcome?

And must I have surgery? It seems I do as all I read states that the tendon will not improve with time and exercise.

Thanks you Tom
Patient: Doctor

The MRI is in and the news is not too good. According to the Sports medicine doctor I have a severely torn Pattettal quadriceps tendon. He is sending me to a Orthopedic Surgeon to see if he needs to operate.

Everything I read says I will need this true, based on what I said above?

My concern is that it is already 8 weeks since my injury on 4 May and only on this Monday, was it determined I had the torn tendon.

Everything I read says that the operation should occur between 3-6 weeks for probable success? What do you think/

Is it true that a tendon can not heal on its own with strengthening exercises?

Thank you Tom
Doctor: This is what I was trying to tell you repeatedly in spite of your different sort of queries. We are here to help you dear friend and if you still believe in me, please stop reading anything on the internet as these things will confuse more than enlightening you.
I hope you would agree with me.
Since it is quite a long time, consult your Orthopedic Surgeon, discuss with him face-to-face. This is the only proper way.

This is your 4 th follow-up (more than allowed), yet I want you to have the best results in the given circumstances.

Please discuss with your Surgeon. And take the decisions pretty fast, in fact now follow strictly what your Orthopedic Surgeon says; waste no time.

You may continue the further discussion if you want by posting another query and give reference query ID as 264466, so that we can discuss further.

Wishing you all the best in the given circumstances.

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