The Knee – Second Opinion

You go for a second opinion for a bunch of different reasons. Maybe you don’t trust that you got full information from the first person. Maybe you want a different explanation of something complicated that you don’t really understand. Or maybe because what’s recommended is big or expensive or complex and you just want to hear if someone else agrees with it. I got mine for all of those reasons.

My problem is a torn Medial Collateral Ligament (MCL) on the right knee, which already had a total knee replacement. The MCL on the inside of the knee and its partner the Lateral Collateral Ligament (LCL) on the outside act together like hinges to keep the knee stable and not wobbly. Tearing one makes the knee unstable and left me prone to falls. I’ve learned not to straighten my knee completely when I walk or stand which helps a lot, but at night it straightens as I sleep – and the movement wakes me up with pain. And I’m afraid of falling.

I tore the MCL in May 2020 and saw my primary care doctor a few days later. I got x-rays and not much else, but at the time we thought it was a sprain. But it didn’t go away and I got very fall-prone. In August I saw an orthopedist who did more x-rays and confirmed I had a complete MCL tear, which is only corrected by surgery. Since I already had a knee replacement, we were talking about a revision surgery, which meant replacing the replacement. It’s a big surgery and not something to jump into without a lot of thought. Plus he also told me that I couldn’t have it anyway until my BMI was lower than 40. He also sent me to get a custom brace which I didn’t actually have in hand until just after Thanksgiving. It’s large, cumbersome, and the velcro on the thigh portion rubs the inside of my other thigh too much for me to want to wear it. So I’m not.

Then I fell a month ago. You remember that, right? It was fun. I sprained my foot and twisted the knee, and decided it might be a good idea to get a second opinion about what was actually wrong with it. That appointment happened this morning with a knee and hip surgeon at Azalea Orthopedics. They took more x-rays, then talked to me about what’s happening.

Yes, I have an MCL tear. And you fix it with surgery. But having already had a knee replacement, what I would need is not just revision surgery. It would involve a very long and complex surgery to take out everything there and installing a new joint with a hinge. Part of the femur would be cut down. It’s not a long-term solution and if it failed in a few years, it would mean amputation. So it’s not something he recommends for someone young and healthy. He said I should take the idea of it off the table. He had me at “amputation.” He also showed me on the x-rays why he suspected that the MCL was already compromised, possibly even from the original surgery. While we couldn’t prove it, he was concerned that a second surgery might not be successful.

What he DID recommend was a knee nerve block for the pain and physical therapy. I had asked the first doctor for a PT recommendation back in August but never heard back. I left the second doctor’s office with a PT prescription for 6 weeks of 3-4 times a week of therapy. I also got the name of the specific nerve block he said should solve the problem of nighttime pain. It might only work for 6 months but hey, 6 months is 6 months. I see my pain doctor soon for a follow up so I’ll ask him about it. If it’s not a procedure he does, the folks at Azalea do.

My biggest fear going into the appointment was that my weight would be a factor. Turns out the doctor doesn’t think surgery is the right choice for me no matter what my weight is. He explained that larger people have greater risk of infection following surgery because they have more surface area to infect, and therefore a greater possibility of implant failure. Orthopds use BMI as a cut-off because they want surgery to be successful and infection is to be avoided at all costs.

This second opinion visit was definitely worth the trip. I understand what’s going on in the knee far better than I did after seeing the first doctor. I didn’t want surgery anyway but man, I really don’t want it now. And I know why.

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