Question

ACL 2013  

ACL 2012   Ill try to make this brief, but I have a rather complex knee problem that I dont feel I am getting a straight answer on from my Doc.  In Jan 2012 I had my right knee scoped to remove a presumed PVNS tumor from the posterior medial compartment of my knee. When the doc got into the knee he found the pvns also in the notch along with a clearly seperated ACL from the femor wall. There were no frayed fibers, just a clean seperation from the femor with the end of the ACL cleanly scarred to the PCL. He left it alone because he didnt have my concent to reconstruct. He cleaned up as much pvns as he could but I ended up with a recurrance just a year later. I had another scope 2 weeks ago by a new doc who found that the pvns was now in every compartment with new changes to the articular cartiladge on the medial femoral condyle and the lateral meniscus was beginning to fray. I asked him specifically to pay attention to the ACL because I have an overwhelming distrust with the knee...it constantly feels weak and does shift....but very slightly and it has to be stressed pretty hard. He also did what he could with debulking the synovium but didnt go into the posterior at all so I am looking at another scope at the minimum. As far as the ACL....He left it alone and gave me a picture of its anchor at the tibia which showed the entire ligament which appeared intact on the picture, but he didnt go up into the notch to check the femor attachment. He said that the tension was good so he didnt look any further. Im confused now because I have one doc telling me the ACL is detached and not suitible for an active person like myself, so I have another doc (who is closer to home) go in there and take pictures of the good part of the ligament and leaves it alone because it felt fine to him. If the ACL is not attached to the femor and is getting its tension from being scarred to the PCL, is this acceptable? Is it ok for the PCL to be bearing the load of the ACL? He also we telling me that he wasnt comfortable reconstructing an ACL in an actively diseased PVNS knee. But if my thought process is right, the nature of PVNS is to destruct the soft tissues and can accelerate bone erosion, and a Insufficient ACL or one that is not in its anatomic position will allow the knee geometry to be off which will accelerate wear and tear in the joint?  Does any of this make sence? Should I seek yet another doctor to look into this?Ill attach a pic of the acl in the notch from the first surgery and a pic from this last one that shows the tibial attachement

Answer
Dear Nat,

This Orthopedic Chicago Podiatrist located in West Loop 60661,Roscoe Village 60618, Elmhurst 60126 & Bartlett 60103 says...
I am unable to comment on the attached photos, due to varying state laws.  Pigmented villonodular synovitis PVN is known to have a high recurrence rate and can be difficult to treat. I would seek an expert who has treated it successfully. As far as the ACL- sounds like it's attached. Unable to comment on what could have happened to the ACL. ACLs have been known to repair themselves if there are fibers and a blood supply. The PVN is what needs to be treated for now. I would seek a consult from a neoplasm expert, or an orthopedist who specializes or has extensive experience in PVN treatment.

Hope this helps.
Good Luck!
The podiatrists of AnkleNFootCenters.com are specialists in orthopedics and sports medicine.
We are located in Chicago & Elmhurst

Dr George Tsatsos & Svetlana Zats
Podiatrist Chicago 60618 & Elmhurst 60126 Podiatrists
Board Certified in Foot and Ankle Surgery & Orthopedics
New South Loop Location-Chicago 60661


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