Joe A Shaw PA-C - 2/2/2008

Question
QUESTION: I am pretty desperate right now for some information or impressions as it seems it will  be quite a while till I can get into an OS.
some history:
I injured my knee and now have a torn MCL. I have always had knee pain and have been seeing a Rheumatologist  for years for a possible Auto Immune decease.  Maternal side of family all have degenerative arthritis.

Well when I received the results for my recent MRI (due to the injury to my MCL) it noted some scary things for me. I am not even sure what it means to be honest.

But it says:

a. Fluid and suggested Partial Tear to my Medial Collateral Ligament
b.Small Knee Joint Effusion
c.Irregularity noted about the Cartilage of the Patellar Facet.
d. Mild Tricompartmental Degenerative Spurring is present.

Impression:
Degenerative changes of the knee with irregularity about the cartilage involving the lateral Patellar facet suggesting Patellar Chondromalacia. Fluid surrounds the MCL suggesting partial tear.

So, I'm now laid up, can barely walk, my knee subluxates ALL the time, and I am only 26.  The radiologist also told me it looked like I had degenerative arthritis of some kind already. Is it normal to have degenerative arthritis this young?? what do they do for this kind of thing? I'm miserable. :(

Thanks
Christina

ANSWER: Christina,
For a MCL tear,all those MRI findings are to be expected. You have a tear of a ligament this causes swelling/effusion/fluid in the joint.
Patellar irregularities are not that uncommon and probably has nothing to do with your pain.  
Yes you have some MILD early degen.stages with the spurring and all.
Some people do develop it earlier than others..could be a family thing in your line as you suggested. The biggest thing you can do is keep your weight appropriate...this can make a HUGE difference as you get older!! The more weight the more your bones will compress onto each other causing a grinding effect which causes wearing away of cartilage,which causes terrible pain.
Get your MCL repaired/rehab. and in about 9 mos or so you will be about as good as it's going to get and as time goes on you may need to have that knee scoped to clean up those spurs etc..

---------- FOLLOW-UP ----------

QUESTION: Couple of quick q's if you don't mind, my General physician said they do not repair MCL tears unless they are complete or full thickness as mine is not. Is this true? How long til I can walk and not get stabbing pains and the feeling of instability?

Also, what is the usual course of action for early and mild Degenerative changes and bone spurs? Am I looking at this progressing?
Sorry to overwhelm you with questions! I really appreciate your help!

Answer
Yes they may elect not to surgically repair your MCL, which is appropriate..thats why I said "repair/rehab"...it just depends on where the tear is w/i the MCL and how severe it is..if you were a pro athelete where knee function and stability and million dollar contracts were on the line etc..you would expect more aggressive treatment perhaps.
No one will be able to tell you when you can walk w/o stabbing pains and feelings of instability,(sorry)...like I said it may take several months of slow progression..but at 9 months or so I would say that is about as good as it will get, hopefully that will be 100%.
Again the BEST course of action for knee DJD is to keep your wt appropriate,keep active..walk etc..If it progresses and conservative treatment is no longer helping then you will need to have them scoped and cleaned up.
And I wouldn't invest in shark cartilage, glucosomine etc..double blind studies for the most part have shown that they are not effective...and it cost about $40-50 month if you take it like they want you to. Stick with advil or RX NSAID if you can take them per you Dr's orders.