Unhappy Triad - How soon should treatment start?

(Toronto, Canada)

Unhappy Triad - How soon should treatment start and how critical is it?

I recently got my MRI results and it said:

-moderate joint effusion
-full thickness tear of the ACL associated with bony edema in the tibial plateua and femoral condyles
-linear high signal within posterior horn of medial meniscus: equivocal between degeneration or tear
-no tear of lateral meniscus
-high signal within MCL representing high grade partial thickness tear

I am a 30 year old male.
I sustained the injury bowling (in Cricket), just before delivery. This translates to a high shearing force: cleats, wet baseball diamond sand - I can see how it happened.

My question is how about quickly the treatment should begin. I was discharged from emergency with a pair of crutches and the assurance I had no broken bones. It has been a month since then. I live in Canada and health care here is poor.

I was lucky there was a cancellation and I didn't have to wait 2 months for the MRI. 2 weeks after the MRI, I got the results. So that's the first month. After 5 days on crutches, I started limping along and am still doing that. I had an appointment with the orthopaedist who recommended an MCL brace and a MRI. I forwent the brace because I would have had to pay out of pocket for that.

Given the waiting times for appointment - I am still trying to schedule one with an ortho - have I sustained even greater damage to the knee because of the waiting and lack of prompt attention?

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Aug 06, 2008
Early treatment for range of motion
by: Bart - SII

Treatment for the unhappy triad can vary depending on physician preference. Immediately after injury, the most important things are limiting and controlling swelling, restoring pain free motion, and reducing pain. The MCL is the most important thing to protect, as it is the one component of the triad that will heal on its own. My patients are put in a hinged knee brace for 3-4 weeks, and they are instructed to only bend the knee or straighten it in a pain free motion.

If you haven't been playing sports or doing strenuous things on your knee since injury, you probably haven't caused any more damage. I would focus your rehab on improving pain free motion, gentle / light quad strengthening, and controlling your pain and swelling.

Get in to see the ortho as quickly as you can, as you will most likely necessitate ACL reconstruction and meniscectomy in order to get a full recovery and return to sports activities.

Sorry to hear about the injury - comment back with other questions.

May 12, 2009
change doctor or look for an doctor in the us that will take your insurance
by: cc

Here are some doctor in the US listed:

Dr. Graham Huckell Pinnacle Orthpedics michigan ave. 716 854-5700
Dr. Carmen Huckell Pinnacle Orthpedics 716 854-5700

Sep 08, 2009
excellent doctor
by: Judy Mark

My problem is very different from yours. I have avn (avascular necrosis), which is bone deterioration due to poor circulation. My area affected is the left hip.

Local orthopedic doctor could not pinpoint problem, but after diagnosis by another doctor he sent me sent me to Dr. Huckell. First appointment was not great due to my arriving early and there being a long waiting time, but, and I stress the but, sensed this was a doctor I would do well with.

He let me know what my options were and let me know the choices were completely up to me.

After one procedure in January 2008 which did not help me (odds going in were 40%), I opted for total hip replacement and had surgery in May 2009.

I have no basis for comparison, but feel he is an excellent surgeon. He answered all questions (many before I asked), and explained everything in a way that was easy for a lay person to understand.

Despite my distaste for traveling (he is 75 miles from my home), I will go to him for any and all future orthopedic problems. He is a doctor I totally have faith in and would recommend with no reservation.

Good luck to you.

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