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 Tibial spine fracture and torn MCL
Rich B    7:17pm Mar 17 2019

Hello,

I was wondering if any of you might be able to give me your thoughts. Coming up on twp years ago now I slipped and broke my leg and tore ligaments in my knee. I had a non-displaced tibial spine fracture, high grade two torn MCL, and a torn MPFL (this may have been existing since I have dislocated my patella before on several occasions). Per my doctor there was no damage to my meniscus or cartilage and since the tibial spine fracture as non displaced it would heal without surgery and and the MCL would also heal without surgery. I was non-weight bearing for 6 weeks while the fracture healed and another 4 weeks on crutches while I built the strength back up in my leg.

As I said previously I am now almost two years in and I still feel instability on the front medial side of my knee. the best way to describe the location of this is just above where the Pes Anserine Bursa is. This is especially true when twisting to turn a corner where my foot would be twisting inward even with no weight on it. I also have a very hard time standing for extended periods of time.

I've been to my Dr. multiple times and he insists that structurally everything in OK but my knee tells me differently. There has only been one MRI done when I initially injured it. Any thought would be appreciated. I'm extremely frustrated. the full text of my original MRI is below...

--------------------------------

Narrative

CLINICAL HISTORY:

Sprain of medial collateral ligament of right knee, initial encounter. Patient is a 36-year-old male with right knee pain worse with walking and weightbearing, knee swelling and limited range of motion following slipping injury 1 week ago with patellar dislocation. Evaluate for medial collateral ligament injury. Evaluate for patellar subluxation.

COMPARISON:

No relevant prior examinations.


TECHNIQUE:

Axial T1, T2 fat-sat and proton density fat-sat, sagittal proton density T2 fat-sat, coronal T1, T1 fat-sat and T2 fat-sat weighted series of patient's right knee were acquired.


FINDINGS:

Medial meniscus: The medial meniscus is normal in morphology without a surfacing tear.

Lateral meniscus: The lateral meniscus is normal in morphology without a surfacing tear.

Ligamentous structures: Mild edema of the anterior cruciate ligaments suggesting ACL sprain without definite tear. There is diffuse edema along the medial collateral ligament with indistinct appearance suggesting grade 2 to grade 3 MCL injury with partial thickness versus complete tear observed. Intact appearance of the posterior cruciate ligament and lateral collateral ligament complex. Popliteofibular ligament is thought to be maintained.


Articular cartilage:

Medial femorotibial compartment: The articular cartilage is normal in thickness without focal chondral defects.

Lateral femorotibial compartment: Grade 4 chondral fissure along the weightbearing portion lateral tibial plateau extending into tibial spine fracture.

Patellofemoral compartment: Grade 2-3 chondrosis along the central eminence and medial facet of patella thought secondary to known lateral patellar dislocation injury.

Osseous structures: Bone bruise involving the anterolateral aspect of lateral femoral condyle in a pattern suggesting lateral patellar dislocation. There is bone bruise and lucency seen extending through the posterior tibial spine just posterior to the ACL tibial attachment site thought to represent nondisplaced tibial spine fracture through the level of the ACL attachment. No additional fracture is observed.

Extensor structures: Diffuse edema along the medial patellar retinaculum and patellofemoral ligament with complete medial patellofemoral ligament tear along its posterior 1/3 fibers. Lateral patellofemoral ligament and patellar retinaculum appear maintained. Intact appearance of distal quadriceps tendon and patellar tendons. Mild lateral shift of the patella is observed.

Fluid and synovium: Large knee joint effusion. No knee joint synovitis. No popliteal cyst or definite joint body suggested as seen.



Diffuse infrapatellar fat pad edema is identified along with superficial infrapatellar fat pad edema without underlying bursitis. There is mild intramuscular edema along the myotendinous junctions of the vastus medialis and vastus lateralis muscles incidentally identified. Definite tear is not suggested. Soft tissue edema is also seen overlying the pes anserine region with definite pes anserine tendon tear not observed.



Impression

1. Complete tear of the posterior 1/3 medial patellofemoral ligament with diffuse soft tissue edema along the medial patellar retinaculum. 2. Grade 2-3 MCL injury with concern for high grade partial-thickness versus complete tear. 3. Nondisplaced tibial spine fracture extending to the posterior aspect tibial spine from level just posterior to the ACL attachment site extending through PCL attachment site. 4. ACL sprain without definite tear seen. 5. Lateral shift of the patella corresponding with history of lateral patellar dislocation. Chondrosis along the central eminence and medial facet of patella and bone bruise along the anterolateral lateral femoral condyle corresponding with lateral patellar dislocation. 6. Large knee joint effusion. 7. Diffuse infrapatellar fat pad edema. 8. Mild soft tissue edema along the myotendinous junction of vastus lateralis and vastus medialis muscle seen distally. 9. Soft tissue edema along the subcutaneous infrapatellar region and overlying the pes anserine region.

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 Tibial spine fracture and torn MCL  new
Rich B  7:17pm Mar 17 2019


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www.MyBrokenLeg.com
17 August 2019