Caught tips on a tree when putting on brakes.Torn meniscus symptoms, VA worthless

[KyleLanTheman]

Last season around gaper day I was going through the runout near the bottom of Pali and had to slam on the brakes unexpectedly, caught my tips on a tree, double ejected and tweaked my left knee pretty good. I got up, skied another run, took it easy, and called it a day. I figured it was a simple sprain and i'd be back up to livin' life as usual.

After a couple months, knee still hurts. ANY impact (going down stairs, jumping, pressing in a clutch etc) sucks and after a light workout (stationary bike) the first few steps I lose major stability in the knee. Stability returns, but the painful impact sensation is still there. Can't run, mountain bike, ski, etc. Shit sucks.

My VA doc said it was sprained. Then went to PT, they said its likely meniscus. I got an MRI and xrays and went to the ortho and he is saying the MRI shows my meniscus is fine. Ortho is sending me back to PT and I am very upset. I don't think this is something I can just 'pt' out of, as I tried very hard at the beginning of the injury to maintain and establish strength around the joint. I am convinced the VA doc doesn't want to perform surgery to save the VA money.

Next semester I will be on CSU's student health insurance, which I am excited about. Can anyone recommend a good knee doc in the northern CO area? I'd be willing to travel also. Any tips on questions to ask to make sure I get the care I need? Anyone have similar experiences they'd care to shed some light about?

I am 25 and since last spring I haven't been able to do what I enjoy and manual labor jobs are hell. I've gained weight and am losing optimism about what the future holds. Any help would be greatly appreciated.

[old goat]

The ortho doc may be missing what is wrong with your knee--I assume he also checked your ACL--but I highly doubt he is lying to you to save the VA money. I highly doubt he gives a shit about the VA's finances. Surgeons like to operate; that's why they're surgeons. Have you asked for a second opinion? That's the first thing to do. There are a lot of good docs working in VAs. Especially in an in-demand field like orthopedics they are at the VA because they like to practice surgery without the business considerations or the need to publish. There are exceptions of course.

The questions to ask--start by describing the injury and what's going on with your knee as carefully as possible. Skip your self-diagnosis. After you've been examined and had any ordered tests you should expect the doctor to tell you what they think is wrong with your knee. If they don't, ask of course. If there's a test you think you should have had ask why it wasn't ordered. If the diagnosis doesn't agree with your own assessment ask them why they think it isn't what you think it is. If a plan of treatment--surgery or otherwise== is proposed ask if there are alternatives. If surgery is proposed ask if there are different surgical options and why the one proposed is the best. Because it's the one the doctor is most experienced with is an acceptable answer if the surgical options are otherwise equivalent. Ask how long the doctor expects it to take to improve after surgical or nonsurgical treatment--if surgery how much time off work, sports, etc.

Most surgeons are capable of doing an operation competently. What matters most is selecting the right treatment for a particular patient and communicating well with the patient. AVoid doctors who don't listen or are defensive when you ask questions or ask for a second opinion.

Re PT--there are different plans of treatment for different problems. It's worth going back to PT but if the treatment is the same as what hasn't worked for months it's not likely to work now. OTOH if the exercises prescribed are different it's worth a try.

[KyleLanTheman]

The ortho doc may be missing what is wrong with your knee--I assume he also checked your ACL--but I highly doubt he is lying to you to save the VA money. I highly doubt he gives a shit about the VA's finances. Surgeons like to operate; that's why they're surgeons. Have you asked for a second opinion? That's the first thing to do. There are a lot of good docs working in VAs. Especially in an in-demand field like orthopedics they are at the VA because they like to practice surgery without the business considerations or the need to publish. There are exceptions of course.

The questions to ask--start by describing the injury and what's going on with your knee as carefully as possible. Skip your self-diagnosis. After you've been examined and had any ordered tests you should expect the doctor to tell you what they think is wrong with your knee. If they don't, ask of course. If there's a test you think you should have had ask why it wasn't ordered. If the diagnosis doesn't agree with your own assessment ask them why they think it isn't what you think it is. If a plan of treatment--surgery or otherwise== is proposed ask if there are alternatives. If surgery is proposed ask if there are different surgical options and why the one proposed is the best. Because it's the one the doctor is most experienced with is an acceptable answer if the surgical options are otherwise equivalent. Ask how long the doctor expects it to take to improve after surgical or nonsurgical treatment--if surgery how much time off work, sports, etc.

Most surgeons are capable of doing an operation competently. What matters most is selecting the right treatment for a particular patient and communicating well with the patient. AVoid doctors who don't listen or are defensive when you ask questions or ask for a second opinion.

Re PT--there are different plans of treatment for different problems. It's worth going back to PT but if the treatment is the same as what hasn't worked for months it's not likely to work now. OTOH if the exercises prescribed are different it's worth a try.

I really appreciate you taking the time to reply. I have an appointment Wednesday at a civilian ortho to get a second opinion, but it'll be out of pocket. Gotta pay to play I suppose. The doc did seem to get defensive when I tried to dig. I felt I was polite and courteous but I also put my foot down because I feel I've been strung along for months now. He stated something along the lines of if there were to be an arthroscopy done, he'd have to remove a section of bone and recovery time would be in the months. I'm no doc, but that is very inconsistent with the research I've done for a knee scope.

I think as far as the VA is concerned, theres many, many more people with more severe injuries than mine so I can't help but to think I'm getting pushed aside for other matters.

The doc suggested PT because he believed it to be some sort of ambiguous degenerative knee cap issue. He admitted he doesn't know how that would be related to a ski injury. My pain is not at, above, or around the knee cap, it is at the top of my fibia. I point directly to the location of the pain and asked what part of the knee it was, he stated fat layer and meniscus.

The doc was not interested in the mechanics of how the accident happened and how my leg twisted, this seems to me a major red flag. I am a nuts and bolts kinda guy, it is hard for me to imagine how the pain I feel in the location it is can be caused from some other area completely. I am curious if anybody else has experienced something like this.

[old goat]

Depending on what the second appointment shows it might be worth getting another opinion within the VA, especially if you're looking at paying for surgery out of pocket. VA medical care (as opposed to the VA system) has a good reputation, and I know a lot of very good VA docs. As far as your injury being ignored because of vets with more serious problems I think that's unlikely. More likely you just got a dud of a doc.

( I could be wrong though; when I was a med student 40 years ago the chief of medicine at the local VA told a medical intern that his dictated history and physical was too long; the VA could only afford one page per patient.)

Good luck

[Kinnikinnick]

Sounds like meniscus to me.

I don’t believe they can know either way until in there with the scope


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[gnargnarshredski]

Sounds like meniscus to me.

I don’t believe they can know either way until in there with the scope


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It depends on the tear - I've had two meniscus injuries, one minor and one quite bad (both occurred along with ACL tears). Both were diagnosed with an MRI - the worse of the two they operated 4 days after the injury in an effort to save the meniscus as it had folded over meaning blood flow was reduced or cut off - they told me they didn't know if it could be saved or not until they were in there. Ultimately, I lost 75% of my medial meniscus in my right knee. On the second (operation was just two weeks ago on my left knee), I lost less than 10% of my lateral meniscus and they told me up front it was so minor it was too small to stitch/save, but a trim was required.

If there is meniscus damage causing that level of discomfort and pain, I would expect it could be determined via MRI, although I am no expert, only speaking from my experience. Will be curious to hear what the other ortho sees in the MRI/xrays.

I have now had 3 acl repairs with the 2 meniscus repairs as described above using Dr. Joel Gonzales of Denver Orthopedics for all of them. Definitely a PITA from Ft Collins and I'm sure there's solid orthos up there, but if you're still looking for recs and don't mind traveling to Denver, I would strongly recommend Dr. Gonzales.

[KyleLanTheman]

Thanks for the recommendations! Visited a random civilian ortho that could get me in before the holiday last week. He confirmed what the VA doc had said in that he doesn't find any reason to scope the knee based on the mri. He had noted that there was meniscus damage however not in the area of the pain complaint, and he broke the news that it does indeed seem like nothing needs operating on, so he too recommended PT

This was great news because he noted that being active won't necessarily cause more damage - something I was very concerned of since the injury.

Ffwd to the PT apt, and the doc there did some taping and provided insoles. He reassured me again that physical activity shouldn't harm it and we worked on exercises that stabilize the knee along with hip flexors/glutes. The tape seems to work, however I still feel impact pain, clicking when walking, and a locking-up sensation after long periods on my feet that I can 'pop' out of when I flex my knee.

It is scary how much I've let my left leg atrophy since the injury. I'm optimistic in that I can strengthen the knee and return to what I enjoy even if pain is involved. I'm less optimistic that the issue will just 'go away' after time.

[Finsternis]

This does sound really similar mechanically to what I did, caught the tip of my ski and ended up with a tibial plateau fracture. I also had the joint instability which I guess you would expect from depressing the articular surface of the bone. I would have thought that would have been picked up on the MRI though - but perhaps they weren't looking for a fracture that had already substantially healed.

[KyleLanTheman]

Update. Lower tib/fib rotates forward akin to what an ACL tear may do. VA is finally getting me to a specialist after seeing the new-found slop. They still say it isn't acl tear, but some other ligament is torn. Something about how rare it is for it to tear without taking the ACL with it.

Psyched that the instability I felt this entire time (since march 2018) wasn't a figment of my imagination. I'm psyched something may finally get done. Not psyched that I was right how fucked it is. Ski'd 40 days on it. Ran on it. Did squats, bands, etc. Sheeesh. All probably did much more harm than good. Been a long year. I just want to be cut open and mended.