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Had knee injury. Done with X-ray . What are the findings?

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Orthopaedic Surgeon
Practicing since : 1998
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Question #1; the medical and x-ray information show an injury to the right knee, disrupted ACL,
Can you state with reasonable certainty based on statements;
“The quadriceps and patellar tendons are intact. The medial collateral ligament appears intact”

That injury did not occur as a result of an articulation or force that would draw the knee or lower leg out away from the body at an acute right or 90 degrees angle?
Posted Sat, 22 Jun 2013 in Bones, Muscles and Joints
 
 
Answered by Dr. Vaibhav Gandhi 1 hour later
Hello,

Thanks for writing to us

I am Dr Vaibhav Gandhi, I am an Orthopaedic surgeon and knee specialist.
I have studied your case.

Yes, your MRI report suggest ACL tear, and he is suspecting bony injury to tibial condyle for which CT scan is suggested.

There is injury to medial menisus leading to a free fragment inside knee joint

You have previously done ACL repair ,so it can be weak, now you may need ACL reconstruction with arthroscopic meniscus repair and rule out fracture in tibial condyle.

This injury can occur due to sudden force to leg from front or side in standing or sitting position, or due to sudden twist of leg with foot on floor.

Take care
Above answer was peer-reviewed by
 
Follow-up: Had knee injury. Done with X-ray . What are the findings? 56 minutes later
Your answer does not match the question.

You said:
This injury can occur due to sudden force to leg from front or side in standing or sitting position, or due to sudden twist of leg with foot on floor.

Based on the fact that the COLLATERAL LIGAMENT IS NOT DISRUPTED BEFORE THE ACL -
is it beyond a reasonable doubt the injury occurred as stated below in the several excerpts from testimony -

The testimony in the case I am working on is;


25     A. He had wrapped my leg -- his leg -- his ankle
1      around me and kicked it out from under me.
2      0. He takes which foot of his, right or left?
3      A.      Right.
4      0. Okay. And-

************************
23     and he wrapped his leg around me and took it out from
24     under me and it went at a right angle this way and I
25     heard it break.
**********************
10     A. He wrapped his ankle around the lower part of
11      my leg and flipped it out at a right angle.

*************************

8      0. (BY MR. BELL) Okay. You testified earlier
9      that he wrapped his leg around you, correct? Your
10      leg-- his leg around your leg, correct?
11      A.      He wrapped his ankle around my ankle.
12      0. And he pulled it out from under you?
13      A.      He kicked it out from under me.

************************

1 1     And as I was leaving the room, he was coming

12     back in and he hooked his leg around my right leg and did kind

13     of a military or a soccer -- he kicked it out from under me and

14      I heard it crack, and I screamed and I fell to the ground.     

*************************

14      0. Okay. Now, thinking back to how we were
15     situated, was he still in front of you at that point?
16     A. Yes.
17     0. And your right leg was the leg away from the
18     banister, correct?
19      A. Correct.
0. Now, you said he kicked you. What leg did he
L,     use?
25     0. Would it help you if you saw me standing in front of you

2     A. Yes.
3     0. Okay. So if I'm standing about where he was,
4     which leg did he kick you with?
5     A. This leg.
6      0. So you're pointing to my right leg?
7     A. Yes.
8     0. Okay. Describe exactly what he did with his
9     right leg that hurt you.
10     A. He wrapped his ankle around the lower part of
11      my leg and flipped it out at a right angle.

So it is a fact the testimony states the leg moved
it is a fact the testimony says it moved away from the body
It is a fact that the testimony says it was the lower part of the leg.
It is a fact The ACL is damaged.
IS IT A FACT IN a grade three injury the ACL damage occurs AFTER MCL - collateral ligament is disrupted when the injury is from an articulation to the side, as in a 90 degree or right angle blow or movement away from the body?



 
 
Answered by Dr. Vaibhav Gandhi 3 hours later
Hello,

It seems like this is a query on academic interest. Sometimes an attempt to decipher the clinical setting along with the actual scenario shall not be accurate without proper clinical correlation.


One plane anterior instability is present when the tibia moves forward on femur due to anterior pull of leg when foot is in neutral position. This include disruption of anterior cruciate ligament, lateral capsular ligament [partial or complete], medial capsular ligament [partial or complete]. This does not include medial collateral ligament.

In rotary knee instability anteromedial instability - when medial platue of tibia rotates anteriorly and externally as joint opens on medial side ,this implies disruption of medial capsular ligament ,medial collateral ligament, posterior oblique ligament and anterior cruciate ligament.

In your MRI, there is bony contusion on medial and lateral tibial condyle - implies traumatic forces have affected bony surface also along with soft tissue.

I hope this helps.
Above answer was peer-reviewed by
 
Follow-up: Had knee injury. Done with X-ray . What are the findings? 36 minutes later
The complaints of the knee are medically documented from an arthritis Doctor since 2002.

The previous ACL repair was 1971.

Does the possibility exist that any of the injury may be preexisting and not related to the rebutted allegation of the leg being wrapped and kicked out?

This outcome is to be able present the doubt if one exist and motion for a hearing to evaluate evidence by subject matter expert testimony.

And by your answer can I assume the ACL injury alone as an isolated symptom is inconsistent with the claim of alleged assault?

The ultimate burden is proof beyond a reasonable doubt.
Truth is the highest consideration.
 
 
Answered by Dr. Vaibhav Gandhi 2 hours later
Hello,

Arthritic changes are bound to happen as ACL repair was done in 1971 ,and considering present age.

Injury to medial meniscus can be old as it is very common presentation in osteoarthritis knee, but ACL injury due to osteoarthritis is rare finding

And by my answer you cant assume the ACL injury alone as an isolated symptom is inconsistent with the claim of alleged assault. you will have to club clinical finding ,history ,present condition,occupation and mobility of patient before assult, radiological finding,

May be arthroscopic evaluation will throw more light in this case, MRI finding like lipoheamarthrosis, joint effusion, bone contusion suggest acute injury .


I hope this helps.
Above answer was peer-reviewed by
 
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