Disrupted ACL and Gr.II tear in the posterior horn of medical meniscus

[lata2009]

I am 32 years female and 15 days back my knee twisted during stair climb.

MRI Left Knee Report-
MULTIPLANAR MR IMAGING OF LEFT KNEE WAS DONE ON 1.5T MAGNET USING DEDICATED COIL.
SE, TSE AND IR SEQUENCES WERE USED TO OBTAIN TI W, T2W AND STIR IMAGES.
FINDINGS:
The scan findings reveal partially disrupted fibers of anterior cruciate ligament at its distal attachment as is suggested by fluid signal intensity tracking along its course and intrasubstance hyperintense signal intensity, along with Gr. II-tear meniscal signal intensity in the posterior horn of medical meniscus.
Linear hyperintense marrow signal intensities in the proximal tibia on STIR sequence and appearing hypointense on TIWI could represent bone contusions.
There is evidence of mild increase in the joint fluid in the supra patellar fossa, bilateral para- condylar regions and within the intra meniscal surfaces.
The distal femur and patella appear normal in MR morphology.
Patellofemoral and femorotibial joint spaces are well maintained.
Lateral meniscus is normal.
The posterior cruciate ligament appears normal in caliber and attachments.
Medical and lateral collateral ligaments are normal.
Patellar ligament and quadriceps tendon are normally visualized.
IMPRESSION: MR findings are suggestive of:
• Partial ACL tear at its proximal attachment.
• Gr.II tear in the posterior horn of medical meniscus.
• Bone contusions in the proximal tibia.
Doctor has advsied that after 1 week will examine my knee and exercise.  Depends on how my knee respond and I feel further action can be taken.  If it is successful then ok otherwise it is certain that ACL or Meniscus or both are teared (as per MRI scan) which will be treated with arthroscopy.
My queries-
1) Can above injury is cured with the help of medicines and exercise.
2) Is arthroscopy is the only solution for meniscus and ACL tear.
3) How safe is hroscopy and what information we should know to make sure that we are going right way.

[Michael L Gross, MD]

A grade II signal in the meniscus on MRI indicates an internal abnormality in the meniscus, but no definite evidence of a frank tear is seen on the images.  Therefore, the definitive diagnosis must be made on the basis of all the clinical information and the MRI combined.  The further information your doctor will use are the history: did you fall or twist your knee, or did it just started hurting after you got off the stepper?  was, or is, your knee swollen?  what makes it hurt?  what makes it feel better? does it awaken you from sleep? does it lock, buckle, or give way?  On physical examination the doctor will look for specific findings such as joint line tenderness, swelling, and clicking or popping.

As far as the ACL, it sounds as if this is a mild sprain, and not a complete tear.  Again, the clinical finding are very important.  The history issues remain the same.  On examination, the most important findings are those of instability.  Your doctors will perform various maneuvers to determine the "functional" status of your ligament.  The three most important factors in determining the need for surgery or conservative measures are:  age, activity level, and degree of instability.

In a young, active personwith an unstable knee, I would recommend surgery as the most reliable form of treatment for a torn ACL.  Arthroscopy is very safe, with an overall complication rate of something around 1:10,000.  One factor I always recommend checking when choosing a surgeon for this procedure is: how many does the doctor perform a year?  Somewhere between 75-100 is a reasonable amount.

[lata2009]

Hi Michael,

Thanx for your reply.  Injury occured when i was about to climb stair.  Immediately in next hour knee was swelled.  I took anti-inflamatory medicines prescribed by doctor and kept the knee straight till 3 weeks and started applying ice pack(on 2nd week), also worn knee brace for entire 3rd week.  i also avoided putting weight on my left leg till 3rd week.  

After 3 weeks, doctor again examined my knee and said that there is not ACL tear.  And have asked to walk slowly (putting 50% weight) and do exercise regularly.  I feel ok while walking.  Swelling is still there and according to doctor it is due to raw space created when blood was taken to check fat level after 1 week of injury.  It is my personal opinion that may be due to swelling on upper part of knee am not able to bend knee completely.  Doc. has also advised that this swelling will go when at raw space blood start flowing swiftly and this will happen with pace of time.  I can perform exercise without pain to the level knee bends.  
  
Can you advise upto what level of activity i can do and how much time it generally takes to get to normal.  What precautions should I take so it heals properly.  I am thinking to rejoin office by next week as i would be able to do my job with compromising on mobility till the injury heals completely.

Lastly, when we took second opinion of another doctor (after 1 week of injury) who advised arthroscopy, said if you don't go for arthroscopy at this point of time , the torn meniscus will give you pain at later stage of life and your leg will become thin. Is this really happens?

I am bit confused whether meniscus is really torn or not as am able to walk and bend knee more than 50 degree.  I have never came across stituations of knee bukling or lock.  In sleep I awake as I feel very much akward and tired in straight sleeping poster to keep left leg striaght.