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Trevonte Citizen injury considered serious [Sep 23 - *may* return this year]

Rellyrell said:
Not to butt in, but it appears @SWFLHurricane makes a compelling case. I’m only butting in b/c one of my homies was diagnosed w/ an ACL tear when the swelling was at its optimal level, & it turns out, he had a severe knee sprain upon a second look.

Came across a Q&A w/ an orthopedic surgeon via docpanel.com & this is what she stated:

[DocPanel] What are some common pitfalls in reading a knee MRI and diagnosing ACL injuries?

[Dr. Mehta]

“Common pitfalls in diagnosing ACL tears can be related to suboptimal positioning of your knee during your exam due to considerable swelling and pain, or technical issues with the MRI scanner. Typically, a 1.5 or 3.0 Tesla scanner is preferred.

Additional factors that make it difficult to diagnose an ACL tear are:

scarring of the ligament if the MRI is performed too long after an injury
blood surrounding the ACL
pre-existing degeneration of the ligament
These circumstances make it challenging to accurately interpret a knee MRI. It’s where experience really comes into play. Because general radiologists aren’t getting exposure to different presentations of musculoskeletal injuries and conditions - they do not have the familiarity required to identify these factors, which can lead to an inaccurate reading.”

So it appears that all of u guys r right, but I can definitely see the benefits of a second examination after the swelling has gone down to confirm the first reading. Now, it makes sense why these athletes are constantly getting a 2nd opinion a few days later.
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When I get to work tomorrow I'll post some images of a torn ACL to show you how easily a complete tear is to see, swelling or not. It's a silly thing to be arguing about but it's what I do and have been for a long time. The important thing here is it sucks that we have to RBs out, and probably for a while. Oh, and probably 60 percent of my patient load is from the Andrews Institute. Most of you have probably heard of Dr James Andrews. So I've seen a ****load of torn ACLs unfortunately
 
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K.O.M.A. said:
When I get to work tomorrow I'll post some images of a torn ACL to show you how easily a complete tear is to see, swelling or not. It's a silly thing to be arguing about but it's what I do and have been for a long time. The important thing here is it sucks that we have to RBs out, and probably for a while. Oh, and probably 60 percent of my patient load is from the Andrews Institute. Most of you have probably heard of Dr James Andrews. So I've seen a ****load of torn ACLs unfortunately
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Bro, I’m not disagreeing w/ u at all; hence, why I said u all are right. First off, Dr James Andrews is a GOAT. Lol. He didn’t get his rep by being some shoddy surgeon; he’s a legend.

All I was pointing out is that in some cases, ACLs “have” been misdiagnosed due to swelling, inflammation, & a second opinions are typically prescribed, as well. I posted an orthopedic surgeon’s response on the subject matter. That wasn’t to discredit u or anyone else. It was to highlight that @SWFLHurricane deceased ex wasn’t giving bat chit procedure either.

Question; have seen modifications & adjustments made to MRI machines that have made them more succinct & accurate in their readings over the past 32 yrs in ur profession?
 
Rellyrell said:
Bro, I’m not disagreeing w/ u at all; hence, why I said u all are right. First off, Dr James Andrews is a GOAT. Lol. He didn’t get his rep by being some shoddy surgeon; he’s a legend.

All I was pointing out is that in some cases, ACLs “have” been misdiagnosed due to swelling, inflammation, & a second opinions are typically prescribed, as well. I posted an orthopedic surgeon’s response on the subject matter. That wasn’t to discredit u or anyone else. It was to highlight that @SWFLHurricane deceased ex wasn’t giving bat chit procedure either.

Question; have seen modifications & adjustments made to MRI machines that have made them more succinct & accurate in their readings over the past 32 yrs in ur profession?
Click to expand...
No disagreement here, with anyone. My friend you wouldn't believe the technological advances I've seen over my career in MRI. When I first started, the old school ortho docs didn't even want MRI's done, they felt that a manual exam and x-rays were enough to start cutting. It was insurance companies that insisted on getting an MRI done. I've had them impatiently sitting next to me waiting on the scan to be done so they could take them to the OR, without waiting on the MRI report. They knew what the problem was. Newer ortho guys won't touch you without a scan, although most of them still don't care about the radiologist's report. The biggest advances are field strength of the magnet and speed of the scans. I operate a 3 Tesla scanner and do mostly ortho work. 1.5 Tesla use to be the gold standard but most ortho docs won't send their patients to a 1.5 scanner anymore. Right now, an average knee scan takes about 15 to 20 minutes or so. We're getting an upgraded scanner soon and it will do a knee in about 8 minutes. That's ******* fast. And the images will blow you away. What's getting better is seeing meniscal tears. Some of them can be very subtle and hard to see. Anyway, apologies to anyone if it seemed like I was being a **** or know-it-all but like I said, it's what I do. SWFLHurricane, condolences on your late ex. If she worked in Destin I probably knew her. I worked there in 1997 to 2004 or so. She must have worked at Dolphin Imaging, that's the only imaging center in Destin besides the one I worked at (Emerald Coast Radiology)

​

 
Rellyrell said:
Not to butt in, but it appears @SWFLHurricane makes a compelling case. I’m only butting in b/c one of my homies was diagnosed w/ an ACL tear when the swelling was at its optimal level, & it turns out, he had a severe knee sprain upon a second look.

Came across a Q&A w/ an orthopedic surgeon via docpanel.com & this is what she stated:

[DocPanel] What are some common pitfalls in reading a knee MRI and diagnosing ACL injuries?

[Dr. Mehta]

“Common pitfalls in diagnosing ACL tears can be related to suboptimal positioning of your knee during your exam due to considerable swelling and pain, or technical issues with the MRI scanner. Typically, a 1.5 or 3.0 Tesla scanner is preferred.

Additional factors that make it difficult to diagnose an ACL tear are:

scarring of the ligament if the MRI is performed too long after an injury
blood surrounding the ACL
pre-existing degeneration of the ligament
These circumstances make it challenging to accurately interpret a knee MRI. It’s where experience really comes into play. Because general radiologists aren’t getting exposure to different presentations of musculoskeletal injuries and conditions - they do not have the familiarity required to identify these factors, which can lead to an inaccurate reading.”

So it appears that all of u guys r right, but I can definitely see the benefits of a second examination after the swelling has gone down to confirm the first reading. Now, it makes sense why these athletes are constantly getting a 2nd opinion a few days later.
Click to expand...
In medicine there are no absolutes. But from my experience it is extremely difficult to miss an acl tear or diagnose a tear when it isn’t.
There are of course instances when it happens but it’s become extremely rare now a days.
The machines are too good, the software is very advanced and the operators are very well trained
Here’s a video of what it looks like.
 
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K.O.M.A. said:
No disagreement here, with anyone. My friend you wouldn't believe the technological advances I've seen over my career in MRI. When I first started, the old school ortho docs didn't even want MRI's done, they felt that a manual exam and x-rays were enough to start cutting. It was insurance companies that insisted on getting an MRI done. I've had them impatiently sitting next to me waiting on the scan to be done so they could take them to the OR, without waiting on the MRI report. They knew what the problem was. Newer ortho guys won't touch you without a scan, although most of them still don't care about the radiologist's report. The biggest advances are field strength of the magnet and speed of the scans. I operate a 3 Tesla scanner and do mostly ortho work. 1.5 Tesla use to be the gold standard but most ortho docs won't send their patients to a 1.5 scanner anymore. Right now, an average knee scan takes about 15 to 20 minutes or so. We're getting an upgraded scanner soon and it will do a knee in about 8 minutes. That's ******* fast. And the images will blow you away. What's getting better is seeing meniscal tears. Some of them can be very subtle and hard to see. Anyway, apologies to anyone if it seemed like I was being a **** or know-it-all but like I said, it's what I do. SWFLHurricane, condolences on your late ex. If she worked in Destin I probably knew her. I worked there in 1997 to 2004 or so. She must have worked at Dolphin Imaging, that's the only imaging center in Destin besides the one I worked at (Emerald Coast Radiology)

​

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Bro, that was awesome to read. I’m in insurance, more so transitioning to the underwriting side since I became tired of the actuary dept. lol. But u’re spot on 100% of the insurance companies pushing MRIs.

I knew there was great advancements in imaging, especially in regards to accuracy + length of time, but holy chit did u just confirm that. That’s amazing. 8 minutes??! Sheeesh!
 
pacusmc said:
In medicine there are no absolutes. But from my experience it is extremely difficult to miss an acl tear or diagnose a tear when it isn’t.
There are of course instances when it happens but it’s become extremely rare now a days.
The machines are too good, the software is very advanced and the operators are very well trained
Here’s a video of what it looks like.
Click to expand...


Right; I agree. That’s y I asked that question regarding advancements. Tech is way too good now vs. yesterday.
 
pacusmc said:
In medicine there are no absolutes. But from my experience it is extremely difficult to miss an acl tear or diagnose a tear when it isn’t.
There are of course instances when it happens but it’s become extremely rare now a days.
The machines are too good, the software is very advanced and the operators are very well trained
Here’s a video of what it looks like.
Click to expand...

The funny thing is that's not even that good of a scan quality wise, but all of those issues were clear as a bell and very obvious.
 
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K.O.M.A. said:
No disagreement here, with anyone. My friend you wouldn't believe the technological advances I've seen over my career in MRI. When I first started, the old school ortho docs didn't even want MRI's done, they felt that a manual exam and x-rays were enough to start cutting. It was insurance companies that insisted on getting an MRI done. I've had them impatiently sitting next to me waiting on the scan to be done so they could take them to the OR, without waiting on the MRI report. They knew what the problem was. Newer ortho guys won't touch you without a scan, although most of them still don't care about the radiologist's report. The biggest advances are field strength of the magnet and speed of the scans. I operate a 3 Tesla scanner and do mostly ortho work. 1.5 Tesla use to be the gold standard but most ortho docs won't send their patients to a 1.5 scanner anymore. Right now, an average knee scan takes about 15 to 20 minutes or so. We're getting an upgraded scanner soon and it will do a knee in about 8 minutes. That's ******* fast. And the images will blow you away. What's getting better is seeing meniscal tears. Some of them can be very subtle and hard to see. Anyway, apologies to anyone if it seemed like I was being a **** or know-it-all but like I said, it's what I do. SWFLHurricane, condolences on your late ex. If she worked in Destin I probably knew her. I worked there in 1997 to 2004 or so. She must have worked at Dolphin Imaging, that's the only imaging center in Destin besides the one I worked at (Emerald Coast Radiology)

​

Click to expand...

incredible that people who who have had no education or work experience opine with such certainty on this matter only because they've had an ACL or they work with someone etc.
 
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itsacanething said:
Terminatorx saying Cheney 2 weeks.
Click to expand...
terminator GIF
 
Rellyrell said:
Bro, I’m not disagreeing w/ u at all; hence, why I said u all are right. First off, Dr James Andrews is a GOAT. Lol. He didn’t get his rep by being some shoddy surgeon; he’s a legend.

All I was pointing out is that in some cases, ACLs “have” been misdiagnosed due to swelling, inflammation, & a second opinions are typically prescribed, as well. I posted an orthopedic surgeon’s response on the subject matter. That wasn’t to discredit u or anyone else. It was to highlight that @SWFLHurricane deceased ex wasn’t giving bat chit procedure either.

Question; have seen modifications & adjustments made to MRI machines that have made them more succinct & accurate in their readings over the past 32 yrs in ur profession?
Click to expand...

That Dr. Andrews: On any given day, you'll see some of the most famous athletes and other famous folks in his facility. From everywhere. You just gotta keep it cool, nod only, and never mention they were there.

Could mess up a pending athletic contract, contract extension, or draft number. It operates similar to a safe house - no one sees anyone, no one recognizes anyone, no one knows * * * *.

Andrews definitely knows his bidness. And got skills!
 
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K.O.M.A. said:
No disagreement here, with anyone. My friend you wouldn't believe the technological advances I've seen over my career in MRI. When I first started, the old school ortho docs didn't even want MRI's done, they felt that a manual exam and x-rays were enough to start cutting. It was insurance companies that insisted on getting an MRI done. I've had them impatiently sitting next to me waiting on the scan to be done so they could take them to the OR, without waiting on the MRI report. They knew what the problem was. Newer ortho guys won't touch you without a scan, although most of them still don't care about the radiologist's report. The biggest advances are field strength of the magnet and speed of the scans. I operate a 3 Tesla scanner and do mostly ortho work. 1.5 Tesla use to be the gold standard but most ortho docs won't send their patients to a 1.5 scanner anymore. Right now, an average knee scan takes about 15 to 20 minutes or so. We're getting an upgraded scanner soon and it will do a knee in about 8 minutes. That's ******* fast. And the images will blow you away. What's getting better is seeing meniscal tears. Some of them can be very subtle and hard to see. Anyway, apologies to anyone if it seemed like I was being a **** or know-it-all but like I said, it's what I do. SWFLHurricane, condolences on your late ex. If she worked in Destin I probably knew her. I worked there in 1997 to 2004 or so. She must have worked at Dolphin Imaging, that's the only imaging center in Destin besides the one I worked at (Emerald Coast Radiology)

​

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How is this one? They have come a long way.
 

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Rellyrell said:
Bro, I’m not disagreeing w/ u at all; hence, why I said u all are right. First off, Dr James Andrews is a GOAT. Lol. He didn’t get his rep by being some shoddy surgeon; he’s a legend.

All I was pointing out is that in some cases, ACLs “have” been misdiagnosed due to swelling, inflammation, & a second opinions are typically prescribed, as well. I posted an orthopedic surgeon’s response on the subject matter. That wasn’t to discredit u or anyone else. It was to highlight that @SWFLHurricane deceased ex wasn’t giving bat chit procedure either.

Question; have seen modifications & adjustments made to MRI machines that have made them more succinct & accurate in their readings over the past 32 yrs in ur profession?
Click to expand...
I'm an orthopedic radiologist. A full tear is very difficult to miss and swelling/inflammation has nothing to do with it. But unfortunately there is no perfection in anything, let alone medicine. If an ACL is getting missed, it's probably in some rural town with a general radiologist, but that's not happening with D1 athletes/facilities. The practice comes in looking at partial tears which the decision for surgery comes down to the orthopedist physical exam.

It's the pain and swelling that make it hard for the surgeon to make the physical diagnosis. But that doc is right that pain can limit how the athlete is positioned in the scanner and lead to them moving which hurts the images.

The vast majority of times we get the patient already knowing the ACL is torn and it's just for confirmation (so the surgeon can charge for the knife) and to look for associated injuries (menisci, LCL, MCL) that can complicate surgery and recovery.

I've met Andrews a couple times. Nice guy. He also did my Tommy John.
 
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