A Spill at Parsenn Bowl Pt 2 (2)

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Roosevelt University *

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Feb 20, 2024

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Group 2: Lindsey, Brooke, Emily A Spill at Parsenn Bowl: Knee Injury and Recovery Modified from: Elaine S. Chapman Department of Biology, Illinois College Part 2 –Seeing the Orthopedic Surgeon #1 The day after she arrived home, Elaine saw Dr. Scott. Dr. Scott ordered an MRI, which confirmed the injury. She suggested that she consider reconstructive surgery on her knee. While some patients elect to avoid surgery, they are at much higher risk of developing osteoarthritis earlier, and the instability of their knee makes them more likely to fall again. Because Elaine was a fairly active individual prior to the accident, Dr. Scott encouraged her to have reconstruction of the anterior cruciate ligament, and she referred her to another orthopedic surgeon who did that surgery on a routine basis. 1. Why did Dr. Scott order an MRI? - An MRI can show more inside the knee like damage that is on the ligaments and cartilage around the knee. Doctors usually order an MRI when a patient is complaining about knee pain. 2. What is osteoarthritis? Why might not getting surgery increase the risk? - Osteoarthritis is when the cartilage that lines our joints is damaged or worn out or changes in structure. Not getting the surgery can increase the risk of osteoarthritis because the cartilage will deteriorate due to bone rubbing on bone. After viewing the MRI and talking with Elaine, Dr. Ramirez strongly advised her to have reconstructive surgery on the ACL and to use conservative therapy on the partially torn medial collateral ligament. First, though, he wanted her to “pre-hab”—that is, take physical therapy for several weeks—in order to have the knee and leg in the best possible shape before the surgery. She was also instructed to use a more substantial brace. Dr. Ramirez described the procedure: either a cadaver tendon OR the middle third of her patellar tendon would be removed and used to replace the ACL, which would be removed. Elaine opted to use her own tendon. Five weeks later, Elaine went in for surgery. She was given a drug used for conscious sedation as well as a general anesthetic. Through the arthroscope the surgeon noted significant injury to both the medial and lateral menisci, which he repaired with sutures and screws. The pieces of the torn ACL were removed. A superficial incision was made in the midline of her right knee and a piece of patellar tendon was removed, along with the attaching small pieces of bone to use for the grafting procedure. Unfortunately, when the piece of patellar bone was chiseled out, the patella itself fractured. The fracture was

repaired with metal screws, the incision was closed, and Elaine was discharged from the hospital. Questions 3. What are the primary movements of the knee joint? The knee joint is a hinge joint, and the primary movements of the knee joint are flexion and extension. 4. Of the structures injured (patella, MCL, ACL, menisci), which will heal the fastest? What about the slowest? Why? - The MCL will heal the fastest. The MCL has a good supply of blood which will help it heal faster. The MCL will typically heal in 3-12 weeks. The ACL consisting of ligaments has less blood supply, which will make the healing process slower. The ACL will heal in 6-9 months. The patella tendon that was removed will gradually be filled in with tendon-like tissue and this process heals over 2-3 years. These tendons also have less of a blood supply making the healing process slow. The fracture of patella bone itself will heal quicker due to access to a blood supply. The meniscus will take the longest to heal due to its cartilaginous structure and lack of blood supply. 5. Why could a tendon be used to replace a ligament? Hint: think histology. - Tendons and ligaments are mostly like dense connective tissues. Tendons can remodel themselves into ligament-like structures. These tendons are most adaptable to change and can transform structurally to create strength and structure for the repair.

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