Doctor Russel,
While discretion is a mandatory component of our job, I am seeking your advice in particular because I know you to be a trustworthy man. If you haven’t heard already, Philadelphia Eagles’ star receiver Derrick Cowl was recently injured in a game against the Chicago Bears. After assessment by the team’s trainer and an orthopedic in Philadelphia, a tear of the right ACL and damage to the right medial collateral ligament and medial meniscus was confirmed. About 2 years ago I treated a similar injury sustained by a prospect receiver, Jamie Nelson, at Ohio State, which is why I assume I was referred for this case. However, Cowl is significantly older than Nelson and I’m worried I cannot produce the same results. This is why I am asking for your help. You are far more specialized in knee injuries than I am, and I feel like an outside perspective could aid me in choosing the pathway that could most guarantee Cowl’s return to football. The odds don’t look promising, but I’m going to try everything I can to fix him. Before you make a decision, I’ve attached my case study outline. You can read this over, and even if you decide you don’t want to take on this case with me, any advice or critique on my plan would be most appreciated. Doctor Lantz Patient: Derrick Cowl, age 38 Diagnosis: ACL tear, damage to medial collateral ligament and medial meniscus As a quick recap, the knee is composed of the femur, patella, tibia, and fibula. …show more content…
Holding these bones together and providing movement and stability are the lateral collateral ligament (LCL), the medial collateral ligament (MCL), the anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL) (“Knee Anatomy”). The top of the tibia is also covered by menisci acting mainly as shock absorbers (“Knee Anatomy”). As Cowl turned sharply to avoid being tackled, he felt a pop in his right knee. Following Cowl’s injury, an anterior drawer test, a Lachman test, and a pivot shift test were all performed. Through these tests, the trainer confirmed his suspicion of an ACL tear to the right knee. ACL tears are fairly common in football and upon replay of the injury you can clearly see Cowl turn his body without turning his foot, resulting in the injury. The pop he felt was in fact a tear of the ACL, which could not withstand the stretch from his pivot and very much “popped off”. While these tests can easily detect injuries to the ACL, other tears or strains could be present without detection (Sexton). After an x-ray of his knee, it also became apparent that the MCL and medial meniscus were damaged as well. Following the diagnosis, Cowl was referred to me for treatment. Here lies the predicament, choosing the best course of action for recovery. In a less active individual I would recommend rest and physical therapy with the aid of an anti-inflammatory to help with the pain. While the ligament might not completely heal, there is hardly any risk for infection and the recovery time is shorter. However, Cowl has expressed a desire to return to football, and although I have told him this is unlikely he still wants to pursue a more promising option. Against my better judgment I recommended surgery. Given his age this would involve an allograft from an organ donor instead of using one of his own tendons from his quadriceps or hamstrings (Warren and Rodeo). Older patients seem to respond better to allografts and have a more successful recovery rate. The surgery itself is not at all invasive and only requires a few small incisions along the knee (“Knee Ligament Repair”). While in surgery the meniscus will also be sutured together (“Torn Meniscus”). While the MCL was also injured, the damage itself was very minimal and surgery is not usually recommended (“Knee Ligament Repair”). Immediately after the surgery Cowl will be observed for a short period of time, but after he is deemed fully awake and functional he can be sent home. He will most likely need the help of crutches to get around for the first few weeks of recovery. This is when the real work for him will begin. After about 2 days, rehab
While discretion is a mandatory component of our job, I am seeking your advice in particular because I know you to be a trustworthy man. If you haven’t heard already, Philadelphia Eagles’ star receiver Derrick Cowl was recently injured in a game against the Chicago Bears. After assessment by the team’s trainer and an orthopedic in Philadelphia, a tear of the right ACL and damage to the right medial collateral ligament and medial meniscus was confirmed. About 2 years ago I treated a similar injury sustained by a prospect receiver, Jamie Nelson, at Ohio State, which is why I assume I was referred for this case. However, Cowl is significantly older than Nelson and I’m worried I cannot produce the same results. This is why I am asking for your help. You are far more specialized in knee injuries than I am, and I feel like an outside perspective could aid me in choosing the pathway that could most guarantee Cowl’s return to football. The odds don’t look promising, but I’m going to try everything I can to fix him. Before you make a decision, I’ve attached my case study outline. You can read this over, and even if you decide you don’t want to take on this case with me, any advice or critique on my plan would be most appreciated. Doctor Lantz Patient: Derrick Cowl, age 38 Diagnosis: ACL tear, damage to medial collateral ligament and medial meniscus As a quick recap, the knee is composed of the femur, patella, tibia, and fibula. …show more content…
Holding these bones together and providing movement and stability are the lateral collateral ligament (LCL), the medial collateral ligament (MCL), the anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL) (“Knee Anatomy”). The top of the tibia is also covered by menisci acting mainly as shock absorbers (“Knee Anatomy”). As Cowl turned sharply to avoid being tackled, he felt a pop in his right knee. Following Cowl’s injury, an anterior drawer test, a Lachman test, and a pivot shift test were all performed. Through these tests, the trainer confirmed his suspicion of an ACL tear to the right knee. ACL tears are fairly common in football and upon replay of the injury you can clearly see Cowl turn his body without turning his foot, resulting in the injury. The pop he felt was in fact a tear of the ACL, which could not withstand the stretch from his pivot and very much “popped off”. While these tests can easily detect injuries to the ACL, other tears or strains could be present without detection (Sexton). After an x-ray of his knee, it also became apparent that the MCL and medial meniscus were damaged as well. Following the diagnosis, Cowl was referred to me for treatment. Here lies the predicament, choosing the best course of action for recovery. In a less active individual I would recommend rest and physical therapy with the aid of an anti-inflammatory to help with the pain. While the ligament might not completely heal, there is hardly any risk for infection and the recovery time is shorter. However, Cowl has expressed a desire to return to football, and although I have told him this is unlikely he still wants to pursue a more promising option. Against my better judgment I recommended surgery. Given his age this would involve an allograft from an organ donor instead of using one of his own tendons from his quadriceps or hamstrings (Warren and Rodeo). Older patients seem to respond better to allografts and have a more successful recovery rate. The surgery itself is not at all invasive and only requires a few small incisions along the knee (“Knee Ligament Repair”). While in surgery the meniscus will also be sutured together (“Torn Meniscus”). While the MCL was also injured, the damage itself was very minimal and surgery is not usually recommended (“Knee Ligament Repair”). Immediately after the surgery Cowl will be observed for a short period of time, but after he is deemed fully awake and functional he can be sent home. He will most likely need the help of crutches to get around for the first few weeks of recovery. This is when the real work for him will begin. After about 2 days, rehab