Different Opinions on an ACL Injury: What Should I Do?
I’m a 32-year-old male, active and maintaining a healthy body weight. Recently, I experienced an accident while dirt biking, which resulted in my leg being overextended. After undergoing two MRI scans and consulting three orthopedic specialists, I received varying opinions regarding my condition. Now, I am uncertain about the best course of action and seeking additional insights. - **Surgeon 1**: Diagnoses a complete ACL tear and advises immediate surgical intervention. - **Surgeon 2**: Identifies it as a partial tear, suggesting I wait a few months for a follow-up MRI to monitor any changes before possibly considering reconstructions. - **Surgeon 3**: Indicates that the ACL appears to be sprained and somewhat elongated but is on the path to recovery, recommending against surgery at this time.
Answers (1)
8/14/2025, 6:50:59 PM
OpenHealth AI
It sounds like you’re dealing with a complex situation regarding your ACL injury, and it’s understandable to feel uncertain with differing opinions from specialists. Here’s a breakdown of the main points and clear, actionable steps to help navigate your next steps:
Key Points:
- You have received three differing opinions from orthopedic surgeons regarding the status of your ACL injury.
- The surgical options vary significantly, from immediate surgery to a wait-and-see approach.
Explanation:
A complete ACL tear typically requires surgical intervention to restore stability to the knee, especially for individuals who are active in sports or physical activities like dirt biking. A partial tear or sprain, on the other hand, can sometimes heal on its own with conservative management, including physical therapy. Your level of activity and personal goals for recovery should guide your decision-making.
Next Steps:
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Assess Your Goals: Consider what you aim to achieve in terms of recovery. Are you looking to return to dirt biking or other high-impact sports quickly? This may influence whether to pursue surgery or conservative management.
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Seek a Fourth Opinion: Given the conflicting advice, it could be beneficial to consult another orthopedic specialist, preferably one who focuses on sports medicine. Bring in your MRI results and any notes from previous consultations to help provide context.
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Evaluate Non-Surgical Options: If you lean towards conservative management, discuss with a physical therapist about developing a rehabilitation program focused on strengthening the muscles around your knee and improving stability. This can be invaluable regardless of whether or not you choose surgery.
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Monitor Symptoms: Keep track of how your knee feels day-to-day. Note any swelling, pain, or instability that may affect your daily activities. Sharing this information with healthcare providers can help them make more informed recommendations.
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Consider a Follow-Up MRI: If choosing to wait, ensure that a follow-up MRI is scheduled in a few months to reassess your ACL's condition and structural integrity.
It’s crucial to feel confident and aligned with the treatment plan you choose. Take your time in making decisions and ensure that you thoroughly discuss any questions or concerns with your healthcare providers.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). 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Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.