MRI RESULTS are in

I don't know if I should be happy or sad. My MRI results are in from a Memorial Day fall injury. Basically, I fell, my left foot came out of its binding, my right foot stayed in, my left leg went left, my right knee and ankle twisted right with the force of the board.

8 weeks later.... This is what my doctor tells me...

Small tears to the ACL and Meniscus (should heal itself if I don't cause further injury)
Knee Bone Bruise between my tibial plateau and knee cap

What is a bone bruise? Has anyone experienced this and/or does anyone know first hand knowledge what this means?

I'm going to a OS but it will be weeks before I can get in. Meanwhile, not a lot on the web... this is what I found!

Bone bruise,
an occult trabecular microfracture of bone typically located close to a bone surface. These fractures may result from compression or impaction forces, and the alterations they produce are similar or identical to those of stress fractures.

Bone bruises are poorly defined and have been visualized only by MR imaging. T1-weighted spin-echo MR images show regions of low signal intensity, whereas T2-weighted spin-echo and short tau inversion recovery (STIR) images show areas of inhomogeneous or high signal intensity (Fig.1).

The finding of bone bruises may be an indicator of the presence of other injuries.


Sagittal T2 weighted and proton density images which reveal complete tear of the ACL with mild increase in marrow signal in the adjacent osseous structures. The bone bruises, as evidenced by increased signal within the marrow, is likely caused by anterior subluxation of the tibia at the time of tear of the ACL accompanied by impaction of the middle portion of the lateral femoral condyle against the posterior portion of the lateral tibial plateau. Signal intensity abnormalities are probably secondary to edema, hemorrhage, and microfracture.

Ouch! Best of luck with your recovery. Definitely wear a brace. Parks does. So does Eisenhauer, Watson, P.J. Marks, and Kyle Schmidt. Charley Patterson, I think, wears braces on both knees.

When I tore my ACL I had a severe bone bruise but mine, I believe, was on the femur above the knee. Either way, it was a real bugger...and took forever to heal.

I hope you are seeking an OS outside of Tracy.
The Bay Area has some of the best in the world.
Get a famous one with a world class reputation.
It's worth the effort and the wait...don't cheat yourself even if it's just for a second opinion.

I, too, had a severe bone bruise, and mine was in a similar location to Gregg's. I also had the meniscus tear. My doc said 12-18 months to heal fully. It hurt pretty bad for a while. I sat out the rest of last season, and I couldn't get up stairs very well for many months. I did hard core PT and then weight training, which helped a lot. Now I'm about 14 months out, and I hardly notice it.
I recommend you put in the time to rehab properly and and then work out. It made a lot of difference for me.

What were your symptoms of pain from the bruise? My pain makes NO sense at all. When I fell, I felt immediate pain in my knee and ankle from the twist. Very little swelling, gone by next day. Then, in the next few weeks, my pain radiated up and down the BACK of my leg. Even up to my right buttock... but mostly in my hamstring and knee area. Now the pain is mostly in my knee and hamstring area. Sometimes it hurts more than other times... But it bothers me most when I am sitting on my butt, or driving a car... rather than moving around....

Thanks so much for the info guys and well wishes. It's not holding me back actually, I'm boarding again, just annoyed by the pain....

Initially, my pain came when I simply put weight on the joint. It felt as though my lower leg was being rammed into my upper knee/lower thigh. As it got better, the pain came with light impact (which seemed to last the longest)... Stairs were brutal. 4 months after the injury it still hurt to jog lightly. It is almost a year later now, (6 months since surgery) and I feel it a little spike with moderate impact (ie: if I case the wake or land a little harder on a w2w)...needless to say...I am not going for big air or the flats just yet.
Again, in my case it was severe bruising.

Stefani- I had a bone bruise in my good knee at the end of last season and it hurt pretty bad. I cased the wake hard on a scarecrow attempt and was done for the rest of the season.

I haven't been resting my sprained knee enough and finally decided to take this week off. I rode 3 times last week, just switch and no jumping but I guess that was too much cause the knee is still hurting.
When you first posted about your injury I told you that I had never had pain down my leg before with a knee injury. Well since I sprained my good knee, I've had pain in my calf and even down into the muscle between my ankle and calf. My dr. said that the swelling in my knee may have put some pressure on some nerves thus causing the pain down my leg.
I know exactly how you feel and it's tough. I hope to be back to normal soon and I'm sure you will be too. Good luck and hang in there. Don't do what I do and push it too soon. Give it time to heal.

Bone bruises suck.I bruised my palm last year.I was playin softball last weekend and caught a wicked line drive and after the game,it started to hurt again.It's weird,like burnin,but it's not gonna stop me from ridin'.Just got back from the lake,hurts a little,but I'll deal with it.
I hope it all works out for you,but don't push it.

Ouch, best of luck to you. Just out of curiousity, what can they see/not see with an xray. I go in for one soon.

Sorry to hear about your injury.
By the way, did you ever get your wakeboard rack repaired?
I am the one that gave you the manufactures phone number.

Bone is covered by a thin membrane called Periosteum.
This is very vascular ( blood supply) and usually whenever you have a blood supply there are some nerves running along side of the vessels.
So when you injure the bones you cause some trauma to the membrane as well.
ACL and Meniscus do not and cannot heal themselves since they do not have a blood supply.
How long ago was the MRI performed?

Very generalized explanation, but I hope this helps some.
Are you still having a lot of pain and swelling?

(Message edited by phantom5815 on July 16, 2003)

What is with No Cali taking so long to get an MRI. My friend came out here in early may, tweaked her knee, took three weeks for an MRI, that it just ridiculous. Glad to hear the injuries were not that severe, my fiancee just had ACL recon last week, it does not look fun whatsoever.

Hey guys:

It took 7 weeks of nursing my knee and PT to get my doctor to ask for a referral for an MRI. My insurance also would not cover it without some lapse time of nursing and PT. And from my conversation with my doctor yesterday, I don't think he thinks my injury is very serious. So I am going to see a OS to be sure I am doing what I am suppposed to be doing. I want an OS to interpret my results, not my family doctor who couldn't even really explain to me what a bone bruise is. And what is this about your Meniscus and ACL not being able to heal itself? Are you serious? Another reason why I need to talk with an expert! By the way, my doctor told me I have "small tears"... so I'm hoping that's good, not bad. I am lucky I didn't tear the whole thing.... right????

By the way, why does the pain come and go? Sometimes I barely notice it. Last weekend I got 3 sets of boarding in on one day, 2 on another day. And I felt fine. But during the week, when I am less active, it hurts more. Makes no sense, I'm telling you. I still think it might be a nerve thing.....

Anyway, from what I have been told, the only way to locate a bone bruise is via MRI. I don't know for sure though. Blabel, we can compare notes next weekend...

Dave: Hi, yes and THANK YOU for the info on the board rack. They were wonderful to work with and extremely fast!!! You really helped us out and I appreciate it very much!!!

On another note, it's so nice to be able to post here and get information and support from fellow wakeboarders. Thanks very much for taking the time.... It's like we have our own little support group.... I love this place!!

Sorry to hear the news Stef.......

I am sure you'll be back and stronger than ever in no time......

However, while you're healing I would be happy to fly down and take your boat out once a week, just so it's not neglected....

Best of luck girl!

Stefani - sorry to hear about your injuries. Luckily they are not any worse. Phantom is correct (obviously), ligaments will not heal themselves. However, from what I know, minor tears don't require surgery a lot of the time since your can strengthen other areas around them to compensate for for the tear.

About 10 years ago, I partially tore my PCL (minor). For several months, they thought I had a deep bone bruise since the symptoms were similar. I finally convinced them to give me an MRI since there was no improvement and that's when they discoved the PCL tear. I did not need surgery, I just had to do a lot of weight training, exercises, wear a knee brace, etc. I really never had a problem with it again. However, my ACL tear in the same knee last September was a different story...

Best of luck with the recovery. The toughest part will be listening to the medical advice when they tell you not wakeboard for X amount of time.

Bone Bruise - nothing you can do medically. Walk it off. Very painful and depending on severity it can take weeks to months to feel %100. Pain is usually a dull agonizing pain that doesn't really let up.

Miniscus - Small tears are seldom repaired however they generally heal faster when repaired surgically - mostly because you are forced to be very careful for a couple weeks. The pain only occurs during use and is sharp at times. Very minor surgury to fix - 3 small incisions around the front and inside of the knee. Minor PT and you'll be as good as new.

ACL tear - uhhh ohhhh. A small ACL tear is somewhat uncommon. Usually all or nothing. I have no idea how this injury is repaired. Probably a few stitches in your ACL, but it sounds like the tear is small enough to not need repair. PT... PT... PT...

I would get a knee brace and start doing some bike riding. Then gradually start jogging. When you get pretty comfortable then start the more rigerious lifiting, sprinting and easy wakeboarding.

By the sounds of it. If you can bear the pain enough to wakeboard three sets in one day then your injury's are probably not serious. Sounds like your doctors diagnosis was probably accurate. If your insurance is not going to cover the cost to see a specialist then I wouldn't go. Time heals. Wakeboarding only breaks things. Good luck

i've had a bone bruise, coming down a front with a locked knee. i couldn't walk for 3 months, and i couldn't run or do anything with impact for about 1.5 years.

i had severe brusing on both those bones you mentioned as well as meniscus damage. i doubt you had the impact i had, so in a couple months it should be fine. If it hurts to stand on, then your bone bruise is still there.

"What is a bone bruise? Has anyone experienced this and/or does anyone know first hand knowledge what this means?" - Great idea .. ask people on a message board for medical advice instead of having the doctor explain. - Annoying.

Okay, guys. I'm not throwing in the towel. I will most likely not have surgery unless I cause further damage. The MRI did not show a complete tear, and my doctor didn't even say a partial tear. He said I had "small tears" in my meniscus and ACL. As far as the bone bruise goes.... that will heal on its own, correct? Can I make that worse by wakeboarding? Maybe I don't want an answer to that..... all I know is that I went out this past two weeks several times and did just fine, even jumped wake 2 wake. I get a little sore after I ride.... But for the most part, the pain is more present when I am sitting in my office chair or driving a car, or bending my knee completely. It actually feels better when I'm standing, walking, working out or riding..... Running doesn't feel too good...

Doesn't make sense.... I know.....

Doesn't make sense. Chris, you couldn't do anything with impact... I feel worse when I am sitting on my butt.

I defintely need to see a specialist!

Stefani,

One thing about tearing your ACL that people don't realize is that you can continue to do whatever you want without an ACL, but you will have little to no support in the front/back movement of your knee. You can really screw up the rest of your leg, ankle, hip if you don't get it taken care of. If you throw one thing out of alignment it can take out the rest of em.

Think of small tears to your ACL like a rope. You can have many small tears in your rope and still use it. It's when you're down to your last few fibers is when you will have the most problems.
There is nothing they will do for "partial tears" to an ACL. It's either completely torn or not.
Almost the same analogy with the meniscus, but with the linoleum lifting from the floor. It's not reall and issue until someone catches their foot on it ,trips and makes a bigger tear.
Conditioning,Coordination, Proprioception and a knee brace that's designed for ACL deficiencies.
Hope any of this makes some sense.

Phantom: Thanks, yes, great analogy. Makes perfect sense... thanks again for the information...

Phantom, great stuff
But just one small correction...for partial tears there is something they can do. "Shrinkage" (woah, all the men just shuttered).

From the innovative Treatment in Sports Medicine website.
http://www.iasm.com/itacl.html
"If the ACL has less than 3-4 mm of laxity compared to the opposite knee and if more than 50% of the ligament fibers are still intact, a shortening or shrinking procedure is performed.

How does it work? The shrinking technique involves the use of a specialized heated probe that provides a measured amount of heat to the stretched ligament fibers and shrinks or shortens them. On a molecular level, the heat causes the microscopic fibers (collagen fibrils) that comprise the ligament to shorten and widen."

I'm not an advocate of Shrinkage but I just wanted to point out that it exists. From what my Dr. said the recovery time is the same as the ACL reconstruct but it is not as permanent a fix.
At first they told me that was the best choice for my injury...but once they got inside they saw that it was worse than the MRI first indicated. So, to my intense satisfaction they did the full reconstruct.

Greg ~ Yes it is the newest innovation to sports....but not without consequences.
The heat shrink has been done with shoulders for a few years now and many Pro Athletes have had this procedure done.
BUT....as I was saying before, there was a case study done and reported about 1 yr ago on the problem.
It appears that 5 people who had the Shoulder shrinking done, all suffered a complete tear in one of the ligaments involved with the rotator cuff within a few months withinn the rehab phase. After review of each person and procedure, findings were that the all the tears occured at the same exact location of each individual involved.
So the conclusion was that the technique and Unit needed more testing.

Cool, and now Stef can know a something about it if her OS mentions it. Thanks for filling in some of the blanks.

Thanks guys...

Phantom & Gregg - I had the shrinkage/tightening procedure done to my ACL in January. I partially tore my ACL and I met the criteria for this procedure. The surgery itself is much easier for the patient than a reconstructive surgery. It is all done arthoscopically. I had 3 small holes in my knee. Also, the initial recovery is relatively painless. I was on crutches for about 10 days (although that was probably too many). Also, there is much less atrophy and I was able to start rehab at the gym afterwards. However, it is still a long recovery period after that since the ACL takes a while to heal. I was recently cleared to start wakeskating. Probably a couple more months before wakeboarding, tennis, basketball, etc. I've been jogging and surfing for several months now. Overall, the knee feel good, although it will occasionally get sore from time to time after strenuous activities.

I think I was around the 50th ACL shrinkage procedure my doctor performed. Like I said earlier, the injury needs to meet certain criteria before they will use this method (I have no real clue what this criteria is). He told me that all but 3 to date have been completely successful. The 3 that had problems basically had to get a full reconstruction afterwards. So, it doesn't seem like a bad risk to me since the worst case scenario is a surgery that I would've had to do in the first place.

Phantom, do you know if the procedure on the ACL has had different results than the shoulder? I'm guessing the procedure is the same. Is the ligament or movement different enough to receive different results? I haven't pushed my knee yet and I'm still scared to think about jumping on a wakeboard again. That mental block is going to be tough to get over when the time comes.

Geoff~ I believe that Thermal shrinking in the knee is still in the "early phases" of long term outcomes. Haven't seen the any recent literature out. The shoulder jt is a multi-axial joint (can move in many different planes), whereas the knee is just a hinge joint( only moves forward and backwards. I think you should just wear an ACL specific knee brace locked out at -5 degrees if you really want to try the jumping just for security sake and peace of mind.
If I find any info I'll send it to ya

"Great idea .. ask people on a message board for medical advice instead of having the doctor explain. - Annoying."
Hey, Mark S...
If you read Steph's post carefully, you'd have noticed that part of her problem was a lack of satisfaction with the information that her PCP (doctor) had been able to provide. If you were paying attention, you also would further realize that there are many doctors, physicians, rehab specialists, and various other health care professionals who regularly read and respond to this message board (example, why don't you check out the profile of "phantom," see what line of work he's in and how much time he spends communicating on this message board). Then there are other types of profiles, which tell us less about the writers (like yours). Not all physicians have excellent communication skills to convey their knowledge, and many just don't have time to provide detailed information or engage in long "question and answer" sessions. The advantage of getting information from people on this board is that we tend to understand the many nuances of wakeboarding, those in health care might better understand the specific medical implications, and there are many, many people who have already suffered and worked through the various injuries. Of course, as with any information/communication medium, there will be some who express whack opinions (do you fall into this category?) or spread misinformation, and we all know to be wary of this.
Anyway, I complement Steph on using the tools available to her to gain knowledge, provide her with a better sense of competence/mastery to predict the future of her injury, treatment, and recovery and reduce the distress that everybody experiences when they do not know what is going to happen or what to expect.
Yay for us!!!

Steph... just to re-iterate, if you are going to continue to ride, (in my humble opinion) you should simultaneously be working hard in the gym (with the guidance of a PT consultant!!). Building up the muscles around the area will provide increased structural support to take strain off the actual injury site as it heals, and it also will increase blood flow to the area, promoting healing.
I would be extremely cautious about riding, find a good brace, and ICE IT after you ride. The ice thing sounds so simple/common that we might tend to underestimate it's importance, but it's really important after working out the injured area.

Doctor Octagon, thanks for the advice and thanks for the compliment. I have been icing since day one. It hurts while doing so, but it feels so much better afterwards. - thanks again!

Doctor Octagon....uhhhhh...but, but I'm a chick
PS .....good pointers

Phantom,
Sorry - my bad!! So much for my ranting diatribe about somebody not paying attention! Instant Karma!

PS... I should have known.... you sounded awfully smart to be a guy!

.........

Good luck with it all Stef. I have had my ACL reconstruction a week ago and the doctor was happy with it. Currently limping around the house super bored. For all you doctors out there I have Ehlers-Danlos Syndrome and I am the first person that the doctor had done a reconstruction on with this condition and the first person that he knows of. (He is a very well known doctor in Australia).

Any way, bring on physiotherapy for all of us.

I am amazed at the audience of this wakeboard forum. I just started reading it a few days ago figuring it would be full of the ah "yo what up dudes, I are a surfer!" but instead we have old folks and young folks with a lot of intelligence. I just orderd my board and supposed to get it thursday (MAN I CANT WAIT) Just seeing this forum has really got me stoked about wakeboarding. I just get a bit concerned when I start seeing all these injuries but from what I can tell every one of em say they cant wait to get back on that board

James What type of EDS do you have?

Thanks James:-) Good luck with your rehab... let us know how it goes!

C.D., Welcome to Wakeworld and wakeboarding! I myself am still fairly new at all of this, been boarding for only 2 years:-) But loving every minute of it!

I hate going to the doctor, so when I go I have a list of Questions for him/her. I have a sports injury book I read and try to understand what might have happened, and what needs to happen (surgery, rest, rehab etc). I try not to let the doc off the hook untill I get all the answers. Take it from me this works much faster! Remember the squeeky wheel gets the grease, or the consult with the OS. I hurt my knee, just meniscus, and two months lator I was done with the surgery and on to rehab and recovery. Good luck.

Wes, good ideas. Another good resource is to purchase the "Human Anatomy Coloring Book." It is available in medical bookstores or online. It's cheap - about 10 bucks, and it has detailed (yet easy to follow) breakdowns of all the skeletal, musculature, and other systems in the body. Every time I get hurt, major or minor, I use it to learn about the bones, ligaments, muscles, and tendons in the area, then I can be more informed when talking to my physician or PT, which makes it easier for us both.

Rene, I have type II EDS. From what I know I am one of the lucky ones with it. My skin tends to break easily and I am pretty flexible in certain spots. Only precautions that I have really taken is not to play football (rugby league or union) or soccer. When I play basketball I wear knee pads (Oops, should have said used to play basketball now).

Just got back from my post op appointment with the doctor. He took out my stitches and seems very pleased with the way it is going. Only thing is he warned me to take rehab slow and not to start trying sport for 9-12months.

Stoked that it went well and I can't wait for physio. Rene, if you know something about EDS, I would love to hear it as I don't have much info and don't know anyone else (apart from my family) who have it.

JamesB ~Here's a site for medical abstracts on EDS.
http://intapp.medscape.com/px/medlineapp/meddirect?searchstring=Ehlers-Danlos+Syndrome&cid=med
You may not be able to get all the articles. but it's a start.
There's also a Sports Medicine page some of you may be interested in as well.

Hey Phantom, that is outstanding! thank you for that info, I will go through it over the weekend. I appreciate it all. Anytime you are in Sydney, I will hook you up with rides, you can crash at my house and I will show how this town rocks. I got the photos of inside my knee during the reconstruction too, I will post them when I get my scanner to work (hope Mr Wakeworld doesn't cut them).

I BROKE MY TIBIAL PLATEAU AND DAMAGED MY ACL playin basketball here is what happend with me. i had surgery on it they sewed my tibial plateau back to what ever it was conected to and repaired my acl. i was in full leg cast for 2 months after i got out of the cast i was in a hinged brace for about 3 weeks which limited the movement then went to rehab for 2 months t oget strength and movement back. after about 7 months after i broke it i was back to full strenght and could do everything on it.

That darn basketball will do it to you Logan!!

Ja was playing basketball last night. He has a torn ACL and partial tear to his MCL. His injury happened over a year ago and since then he has had two episodes where he felt like his leg or knee would give out on him. Both while playing basketball. Well, last night was the second time. He felt a pop so now he is concerned he severed whatever was left of that MCL of his.....

Best of luck on recovery to all of you!