Opinion completed 10/12/14

Adam Allister
24 years old, Male
Left knee grade 3 anterior cruciate ligament (ACL) sprain
Initial diagnosis Left knee grade 3 anterior cruciate ligament (ACL) sprain.
Diagnosis made by physical exam, MRI, CT
Proposed treatment Left ACL reconstruction with autograft vs. allograft.
Goal of consultation The patient seeks a second opinion to define the optimal course of treatment. Specifically, he seeks to gain the following information:
  1. In your opinion, how severe is the injury to my knee?
  2. Do you believe surgery is required? If so, what is the optimal procedure, and what are the associated risks?
  3. If reconstruction is recommended, do you recommend autograft or allograft?
  4. Do you recommend any alternatives to surgery? If yes, what are the risks and benefits of these treatments?
  5. Will avoiding surgical treatment result in permanent damage to the knee?
  6. Would there be any activity restrictions with and without surgery?
  7. Would you recommend physical therapy before or after surgery? If so, what is the recommended intensity and duration of physical therapy?
  8. What can I do to prevent recurrence of this or similar injuries?
Chief complaint I am a active individual. About a third of the time I play, my knee will buckle, causing severe pain. Within minutes, the pain lapses and I am then able to continue playing. I can run, walk, and cycle with no pain at all. I even trail run for about 20 miles a week in the mountains. I would prefer to avoid surgery, but am worried about causing permanent damage to my knee.
HPI Mr. Miller is a 35 year-old male with a history of left knee pain and instability for the last 2 months secondary to left ACL tear diagnosed by MRI. He

The pain has been persistent since January. He describes moderate pain, looseness, and instability around the left knee. The pain increases with activity. On 9/24/13, the patient’s treating physician noted the presence of a grade 3 ACL sprain, mild left knee effusion, and pain at the end of flexion. MRI of the left knee revealed an ACL tear. He recommended range of motion and strengthening exercises, and surgical ACL reconstruction.

ROS Pain localized diffusely around the left knee
Medications None
Allergies NKDA
Family history No relevant history
Social history Software developer. Enjoys running, tennis, travel, and time with family.

Tobacco: none

Alcohol: moderate use

Notable physical exam findings

6’1”, 190 lbs

No pain on patellofemoral compression, no atrophy or crepitus. Mild effusion is present.

Imaging reports Please see included.
For the Patient

Briefly Summarize the patients chief complaint, history of present illness and relevant past medical/surgical history. Our staff physicians got you started, feel free to edit as you see fit.

Answer these questions from the patient.

Indicate 2-3 actionable next steps for the patient based on this opinion.

When appropriate provide any links links that you would reference for your own patients. We got you started. Feel free to edit as necessary.

For the Treating Physician
Patients share these opinions with their treating physician. This section is for you to provide some guidance to the treating physician.

If you have something that may be helpful, here is a space to include citations for published articles, information about new clinical studies or web links that would benefit for the treating physician.

Note from the Patient
Thank you Dr. Spinelli for all of your help! Lorem ipsum dolor sit amet, consectetur adipiscing elit. Maecenas laoreet erat sit amet ligula lobortis, ac euismod quam convallis. Sed cursus quam nec ex accumsan maximus. Praesent et ullamcorper orci. Ut malesuada ligula vel nisi varius tincidunt. Etiam commodo tellus quis lectus fringilla mollis. Maecenas egestas sodales gravida. Quisque laoreet et velit eget convallis. Vestibulum ante ipsum primis in faucibus orci luctus et ultrices posuere cubilia Curae; Praesent et consequat ante. Curabitur non ante nibh. Nulla egestas neque ac convallis tempor. In quis urna sed ipsum placerat consectetur. Donec facilisis, turpis id cursus ornare, tellus nulla sodales sapien, ut commodo mi ex vitae erat.

Note from the Staff Physician
Thank you for completing this case in such a timely fashion. We look forward to working with you again in the future.