Dr. Timothy K. Durnin - 10/31/2011

Question
When I was 18 (in 2004), I tore my ACL and menisci.  A just over a year later, I re-tore my ACL and had it fixed at the end of 2005.  In 2009, I had another surgery to remove debris from my knee and a lateral release.  My doctor said that I had Grade 3 damage on my lateral meniscus and my knee cap.  In May of 2011, I fell and tore my hamstring and it healed on its own.  I am now 25 and have started to have knee pain and swelling after routine activities.  It has only been 2 ?years since my last surgery.  I ended up seeing my regular ortho and he claims that my knee cap is not aligned with my knee and this is the source for my problems.  He immediately suggested surgery and only ordered x-rays.  Because I felt like there may be more to the story, I sought out a 2nd opinion.  This 2nd ortho went over my x-rays and said that I do have some bone spurs and arthritis starting to form in my knee, which is no surprise considering my history.  When he examined my knee, he seemed very concerned with my ACL.  He tested all of the ligaments in my knee and watched my knee cap.  He claims that my knee cap tracks normally, but wanted an MRI to see what was going on with my ACL.  My knee does not feel like I have torn my ACL, but it does seem to give out at times.  After tearing 2 previous ACL抯, I know how it feels to have my knee give out because there is nothing there to prevent my tibia from moving forward.  At this point, the last thing I want is to have another surgery.  Having 3 scopes in less than 5 years is enough!  If I do have to have another surgery, I want a more long-term solution.  I am a very active person and all I want is to live my life normally, which is a bit challenging right now.  What would your protocol be for a 3rd ACL reconstruction?  I know you have never seen my history, x-rays, or MRI抯, but are there any new long-term treatments available that I could potentially discuss with my doctor or creditable articles that would point me in the right direction?  Do you have any theories on what could be wrong with my knee?  All I want to know is what is wrong with my knee?br> Thanks for your time!
Heather

Answer
Hi Heather,

Don't let anyone touch you before you get an MRI, this or exploratory surgery is the only definitive way to determine the amount of injury and/or degeneration. I can only speculate that a good autograph ACL repair would be the most durable option. This harvests your patellar ligament as your new ACL and takes much longer to rehab. I don't know what kind of ACL repairs you previously had, this matters since the other option called an "allograft" is transplanted cadaver tissue and doesn't hold up nearly as well but rehabs much faster. None the less, you need an MRI and "if", and it's a big "if", you need ACL repair, autograft would be the best choice for reasons above. Another big tip is take 3 grams of glucosamine sulfate a day to preserve and possibly reverse some of the degenerative condition showing on x-ray. This is imperative if you want to avoid knee replacement surgery in 10 years.

Wish you the Best,

Dr. Timothy K. Durnin