ACL Tear and Meniscus Damage Injury and Diagnosis

October 2, 2009

After fighting the flu this week, Big Country was pretty anxious to be able to play in the varsity football game this evening. He had managed to only miss one practice this week and was feeling better by Friday, raring to go. Just before half time, Big Country went in for a tackle. Seeing that the player was already down with a pile on top, he began to swing his leg to jump over the stack of tangled players. As his right leg came up, he was hit by friendly fire...a team mate going in for the same tackle dove towards the pile mistakenly tagging Big Country on the outside of his left knee with a helmet shot. Pop went the knee and Big Country hit the ground...knowing that something was not right.

As we were sitting on the visitor's stands fairly low, I couldn't see past the line of players to actually see the play. I had been attempting to video tape the game from my poor position and was about to the point of bagging it since it was too hard to see over the sidelines. Casually putting away the camera, I wasn't even aware of the delay of game and finally hearing the mention of who #44 was around me. Suddenly I realized they were talking about a downed player...Big Country. Looking up I could see the field taking a knee and then began to get worried. Camo Queen who was watching the game jumped up in a flash to tear down to the tape around the field to see if it indeed was Big Country. I stayed put with H-Bob and maneuvered myself so I could see what was happening on the field.

The trainer for the team had Big Country stretched out flat and was adjusting his leg, obviously accessing the damage. They finally helped him up, and he hobbled over to the sidelines. Great! An obvious injury. As typical he was taped up with ice and had a seat along the edge of the field. Within minutes, the whistle blew for half time, and he slowly walked off the field with the team.

By the time they returned from half time, Big Country was definitely having trouble walking...lagging way behind the team which began to bother me a bit. It didn't look like just a bad bruise or strain. After the game, which by the way had the most exciting finish a high school team could ask for, I spoke at length with the trainer. She had performed several tests on the field immediately after the hit which are valuable in determining if there had been ligament damage...tests that are more difficult to perform later once swelling starts in. She couldn't come to any conclusions that would positively indicate a torn ligament and had hopes that he would be 100% the following day after some significant icing this evening. With instructions to check in with her after school on Monday, we went home.

October 3, 2009

As the weekend progressed, Big Country elevated and iced his knee continually. The swelling was definitely becoming an issue and his greatest complaint was his inability to straighten his leg. The motion just wasn't there. Forcing it in either direction caused pain, and interestingly enough the only pain he even had associated with the injury. Sunday came and went and there was no improvement. This perhaps was not a simple bruise or strain.

October 5, 2009

As the health of Big Country's knees are the lifeblood of his hopes to some day play Division I or II football as well as a body part you don't want to deteriorate early in "old age", I begged for an immediate appointment with our local orthopedic office, Oregon Orthopedic & Sports Medicine Clinic whom we have gotten to know quite well. An appointment for Tuesday was scheduled. We visited with the high school trainer after a long line of athletes streamed into her office for various tapings and injury evaluations. We are fortunate to have an on-site trainer available after school and present at games to be there to assist the coaches in evaluating injuries and coordinating rehabilitation between the coaches and the athletes’ doctors. Melissa of ProActive Orthopedic and Sports Physical Therapy went through another set of evaluation tests and provided us with a more specific speculation...a damaged meniscus (knee cartilage). She was thankful that he had an appointment already scheduled with the doctor as his situation definitely warranted further investigation.

October 6, 2009

Today I hauled Big Country off to visit with Dr. Feinblatt of Oregon Orthopedic & Sports Medicine Clinic to go over the injury to his knee and hopefully find some answers as to why there had been no lessening of his swelling and to see what his consensus was as to the outlook. As expected, he gave a thorough exam of the leg and sent Big Country down the hall for an x-ray. I've learned to bring plenty of reading material with me on appointments like these as you never know exactly how long you'll be there. Today was no exception. With x-rays in hand, Dr. Feinblatt went over them with us and showed where they did not indicate any bone chips or obvious impediments that would affect Big Country's ability to straighten his knee. His conclusion concurred with Melissa's that there was probably damage to the meniscus, and that perhaps a flap of the torn cartilage was flipped up as often occurs keeping the knee from operating properly on a mechanical level. He gave us the option of scheduling surgery or performing an MRI to get a better look at the soft tissue structures before going in. We chose the MRI as that would most conclusive. He hoped that a MRI could be performed that week and asked us to schedule a return appointment in one week. And the big bomb...the surgeon wanted Big Country on crutches...no weight on the knee at all...in the event pressure could further damage the torn meniscus.

So the phone calls began...to the insurance company, to the MRI facility to determine their insurance participation, back to the insurance company, to my husband who was out of town hunting, to the orthopedic office, and on it went. Finally with a bit of persistence, I had a MRI scheduled for the next day.

October 7, 2009

Neither Big Country nor I had any idea what is involved with an MRI and so went to the appointment after school pretty blind. We were just happy to have it performed soon enough so that the scheduled appointment with the surgeon would not have to be postponed. The timing of the appointment was also critical as Big Country didn't want to miss any school realizing how hard it is to make up missed lectures and notes in his AP classes, and we were able to get one late enough in the day and at a time that DH could also attend once he returned to town. After confirming the Big Country had no metal parts in his body, which we got a big laugh out of, they took him off for his scan. Apparently they needed to straighten his knee in order to strap it into place, but not wanting to tell them how difficult it was to straighten it, Big Country gritted his teeth and endured the pain as it was in the brace for the three or five minutes the scan took hoping he wouldn't pass out. He did admit though that he could move it a little bit further after that. Odd I thought. Perhaps they pushed the torn meniscus out of the way. One could only hope.

October 8, 2009

Getting along on crutches at high school with a 50 pound back pack is not fun for Big Country. Now he complains of terribly sore arm pits. But he did get an elevator key pass so that he can negotiate getting to the second level of the school for classes. Fortunately we have a medical supply source locally, so after dropping him off at football practice...yes, injured players still attend all practices...I purchased a set of fleece arm pads for the crutches. They had belonged to DH after his Achilles tendon surgery about 18 years ago and were pretty deteriorated. Fluffy fleece pads on a football player's crutches? Yes, he had to take a lot of guff for that one.

October 9, 2009

Big Country and I are both tired of these crutches now. Somewhere, somehow the deteriorated foam pads slipped off the crutches without his knowledge, so off to the medical supply store again. Fortunately, they had a single package of replacement parts in stock but in two different sizes. Taking a wild gamble, I purchased the set I thought would fit and headed off to doctor up the crutches. The sales associate did have some good advice about the height of the crutches though and arm pain. The height should never touch the underside of the arm and the hand piece should fall about the wrist area. Big Country's were adjusted all wrong. So here's hoping for a better fit and a little more comfort.

October 10, 2009

With the weekend here, it was time for a little research homework and see what all this meniscus damage could mean. It would appear that a meniscus tear can be fixed pretty simply. Once you start talking about it with people, they have either had the surgery performed on themselves or know of someone personally who has. If the damage is to the front, live tissue of the meniscus, however, it needs repair and that repair takes time. Time to heal, time to rehab, and time away from athletics. Big Country was not liking the sound of that option.

October 12, 2009

The big day. The reading of the MRI. It rather felt like you were about to go before a judge and be handed your sentence hoping it would be a light one. Dr. Feinblatt pulled up the MRI on his computer screen, which is a pretty impressive way to look at an MRI if you ask me. He showed us the meniscus and how there appeared to be no damage at all. Perfectly intact. We all exchanged glances and gave a big sigh of relief. Then there came the BUT word. "But it would appear that his ACL is torn." What! How could that be! I would have loved to have had our expressions video taped. I'm sure they would have been a text book example of a "fallen countenance". Dr. Feinblatt went on to show us in detail where the two stumps of the ACL were and that the ligament was no longer attached. He looked at the two exterior ligaments and found that they were perfectly fine. It was hard to find the right questions to ask. He did a pretty good job of filling in the blanks. Surgery was optional. Rehabilitation and time to get back into athletics could be up to nine or even twelve months. Forty percent of ACL surgeries do not result in 100% pre-injury performance. Not a pretty picture. It was pretty obvious to all of us that surgery would be necessary to reconstruct the ligament. It was obvious that Big Country would miss the remainder of the football season and that he would not be playing varsity basketball this winter either. And that there would be a lot of appointments and physical therapy down the road.

Dr. Feinblatt explained that before the surgery would be performed, he would want Big Country to attend physical therapy sessions three times a week for the next three weeks so that the fluid and blood that had accumulated in the knee at the time of injury could be removed. Full motion of the knee was necessary so that it would not be compromised before the surgery. There was some good news....no more crutches. The more movement the better. Would have been nice to know that a lot sooner! He gave Big Country a knee brace to wear for stability and as a sign for others to be aware of his injury. He must realize that high schoolers don't think twice before doing stupid stuff like chucking a backpack towards someone forgetting about their injury and possibly doing further damage. He set a follow up appointment for three weeks, and off we went feeling pretty glum.