T Nation

Good Knee Surgeon in NJ/NYC Area?


#1

I tore my ACL, damaged my meniscus and fucked up the cartilage in my knee during a football injury in September 2009. I found a highly recommended orthopedist who's worked on pro athletes and who's been the surgeon for D1 college teams. He did a full recostruction of my ACL in February 2010 and my knee is still fucked. It pretty much hurts on a daily basis and light jogging isn't even possible.

During all the follow up visit's he said inflammation was causing it but it hasn't improved since mid June. To top it off, he no longer accepts my insurance. I was going to look for another ortho anyway, but it sucks that this guy was so highly acclaimed and my knee is still fucked.

Does anyone know of any good ortho's in the NJ NYC area? Preferably someone with a sports background. There's athletes on TV every day that have come back 100% from this surgery yet here I am 9 months later and can't do shit. It's frustrating as hell.


#2

What type of rehab did you receive? Of course there are multiple factors into how a ACL repair will go, but quality rehab is on the top of the list IMO. The athletes that come back 100% from the surgery generally have athletic trainers/physical therapists dedicated to them/their team who do progressive and appropriate rehab/treatment with them on a daily basis. I'm sure if this doctor was a hack, the pro and collegiate teams would have dropped him.

Also, what type of graft was used? Did you have a meniscal repair or menisectomy? If you did receive rehab, how often was it, why type of therapist was it with, and what was their background?


#3

can you elaborate on the pain? where in the knee? when do you feel it? 9 months you should be feeling a lot better by now. Did he state the full procedure?


#4

I went to physical therarpy 2-3 times a week for about 2-3 months. The had me do stuff like stiff legged raises, ride the bike, hamstring stretches, leg curls among other things. They then put electricity on it for 10 minutes and ice for 5 minutes. I don't believe the physical therapist has a sports background based on the clientele in there. The ortho took me off the physical therapy because it was causing inflammation.

I had a full ACL reconstruction using a cadaver ligament. When I visit the surgeon, he pulls my shin and calf towards him and says everything is properly attached. He took X-Rays and the screws are OK too. The pain was originating from the area of the lower screw. It's a sharp pain when I put weight on it. His last diagnosis was Pes Bursitis so he told me to keep putting tiger balm patches on it.


#5


I found this photo online. The light blue arrows whos where most of the pain is.

If you were facing me, its about 4 inches below the knee cap, right on the inner side, at the bottom most of the scar from surgery. This is why he X-rayed to see if screw was OK. My guess is this where the ligament was screwed to the bone. Looking at anatomy charts, it would be near the pes anserine bursa. The ortho diagnosed pes bursitis the last time I saw him.


#6

After you stopped rehab, did you continue with any therapy/rehab? Did you go through a progressive gait training rehab to re-learn to walk, jog, then run? After stopping, why didn't you look into finding another therapist?

From the sounds of things, it seems more like this is caused by some poor rehab, not necessarily a poor surgery. Also, you still haven't said whether you had a meniscal repair or menisectomy. Was there any other injury associated with the ACL? How did the ACL tear happen; contact or non-contact? Also, why was there such a large gap between injury and surgery (Sept 09 to Feb 2010) and what was done between the date of injury and surgery? Did you continue to try and play/train and push through things before seeing the doc or before surgery?

With a cadaver graft, it generally takes a little longer for the graft to fully heal and be adapted within the body, which may also contribute to the knee pain. From the description of your pain and what the doc did during followups, the ACL is intact, but the bursa around some muscle attachments is inflamed. Without a physical assessment this is pure speculation, but I'd assume that bursitis would be caused by some mobility issues, poor soft tissue quality, and poor movement quality.


#7

I have good dr and physical therapist in NJ
Here is the therapist http://www.infitpt.com/bios.html also he knows lots of good dr that he works with
My dr is Johnathan Archer 201-784-6800 he has offices in englewood, teaneck and closter


#8

Some of the most reputable doc's for knee surgery are at Hospital for Special Surgery.


#9

So the problem area is on the location of the tibial tunnel, it might be a case of arthrofibrosis. Meaning that excessive scar tissue has formed over this area, it may be problematic for various reason since that seems to be restricting your range of motion which will lead to gait problems and a whole host of subsequent problems. My suggestion would be to find a physio therapist who is experienced with rehabilitation for athletes and try and salvage as much as possible in terms of damage and regaining function.

LevelHeaded might be better qualified to elaborate on this although this seems like it is a likely diagnosis for what yo are describing.

I can sympathize and it must be hell to be out that long without knowing knowing when you will be back.


#10

I think it is a good possibility of being some scar tissue built up in the area. It is just really hard to determine exactly what is going on (bursitis vs scar tissue vs ?) without a physical eval, but definitely not out of the question. And just to echo my earlier thoughts and yours as well to the OP, go find an experienced, qualified therapist to get some therapy/rehab.


#11

No , I did not continue because the surgeon wanted me to layoff because of the inflammation it was causing. This post was my attempt at locating another surgeon AND therapist. I was hoping the new surgeon himself would have a good therapist to recommend.

Could be. This surgeon has worked on NFL athletes and an NCAA basketball team. It took me a while to find a surgeon in my area with this many accolades. The therapists I work with seemed OK but to be honest, I wasn't impressed.

I didn't hear either of the 2 terms listed above. They kept saying ACL reconstruction. Based on the MRI , it was complex ACL tear, meniscus tear and cartilage damage. It happened playing football. The cleat got stuck in the ground as my body was twisted by a big lineman. Picture my leg rotating but my foot stuck in the ground. You could her a snap across the field. There was a gap between injury and surgery because the 1st ortho I talked to sucked. He was unprofessional and I didn't trust him with my knee. It took a couple months to find the surgeon who specialized in sports injuries. Between injury and surgery, I did some light physical therapy but no sports. My knee was too fucked to do anything more than walk on it.

This is pretty much what the surgeon said on my last visit. I didn't know it'd be our last visit at the time. So I'm going off this diagnosis currently. But I really need to find a new surgeon to sort this out. His recommendation of tiger balm patches 3 times a day helps, but is not curing anything.

Thanks for the detailed response, much appreciated.


#12

Thanks, he takes my insurance by the looks of things. How do you know him? Did he do surgery on you or any of your friends?


#13

We paid alot of attention to breaking down the scar tissue during therapy. Neither Dr. nor PT mentioned that as culprit to my current knee pain so I don't think that was it. I overexerted myself about 4 months post surgery doing some yardwork so that might have something to do with it. I told my PT and surgeon about this but they said it shouldn't have prolonged my recovery as much as it did.

Thanks for the sympathy. It's killing me because I'm the active type who hike, biked, and played b-ball a few times per week. It's a HUGE change in lifestyle.


#14

Update:

I found a good surgeon through NJ Monthly's top Doctors edition. I met with him 2 weeks ago. I told me the original surgeon was highly respected so that helped me feel a little better about the situation. He said the ACL was intact and that the problem could be the screw since that is where my pain is. I took an X-Ray and he said the screw was a type that fuses with the bone over time.

He explained it may take up to 2 years to mend properly and that could be causing the pain. He sent me for an MRI and I got the report today. It mentioned the screw. Unfortunately, I can't decipher it and he hasn't contacted me yet. If I post the report here, would anyone be able to tell me what the hell it means? lol

Edit: I'll just post the MRI report in case someone can help out. Thanks in advanced:

FINDINGS;
Examination of the medial compartment demonstrates increased intrasubstance signal in the posterior horn compatible with degeneration. There is however a linear component contacting the inferior articular surface posteriorly compatible with a tear. The cartilage of the medial compartment is intact. There is no subchondral bone marrow edema. The posterior cruciate ligament is intact. The anterior cruciate ligament has been repaired with a graph. The femoral tunnel is intact. There is a small amount of fluid within the anterior aspects of the tendon fibers, however, the fibers are largely intact, and there is no significant tear. The patient reports pain at the pes anserine region. The tibial interference screw does contact the cortex in this region and may protrude distal to the cortex. Correlation as to the syrnptomatology is suggested. The tunnel itself remains intact. The lateral meniscus is normal. The cartilage is nonnal in appearance in the lateral compartment.

The quadriceps tendon and patellar tendons are intact. The patellofemoral compartment is normal in appearance. There is no joint effusion. The medial collateral ligament and lateral collateral ligament complex arc norma1 in appearance. There is no acute fracture.

IMPRESSION

1) Status post ACL repair.

  1. The tibial interference screw does contact and probably protrudes through the anterior medial tibial cortex.. Correlation as to symptomatology is suggested. There is no loculated fluid collection in this region.

  2. There is a posterior hom medial meniscal tear.

  3. No evidence of arthrofibrosis.
  4. No joint effusion