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Sorry to hear about her injury and the rough 2 months both her and you have had as she rehabs.
when was she diagnosed with Ehlers-Danlos? After the knee and leg injury or before?
MRIs are very good at looking for tears of ligaments, tendons and muscles. They can also pick up inflammation as I'm sure your Ortho has pointed out. However, since an MRI is done with the leg in one position, its not a great test for looking at function of the joint, etc. Usually we depend on physical exam and a careful history to determine functional deficits.With any musculoskeletal injury, there is a "retraining" of the brain-nerve-muscle complex that needs to happen (which physical therapists are quite adept at), but it does take time for the patient to unlearn some of the compensation patterns they have picked up post-injury and retrain the original movement patterns.Additionally, her ED diagnosis (assuming she was diagnosed with the hyper mobility type of ED) means that her body will have a more difficult and challenging time with the rehab as well.I would think of it as the difference of learning to walk again on sand versus learning to walk again on a sheet of ice. Its not impossible and she'll slowly make progress.She is only 8 weeks out from the initial injury, and if we say that the first two weeks were impacted by the significant swelling and bruising, she has really only had 6 weeks to allow those ligaments to heal. Realistically, she may need 12 weeks or more to fully heal the ligaments.
And then followed by restarting physical therapy after she is out of the brace or cast.
And obviously, if the new brace doesn't fit properly and keeps slipping down, she is not getting much benefit out of it.
I can understand that dealing with her diagnosis and now knee injury can be frustrating and draining.I think I would have you look at potential casting as hopefully a quicker way to get her healed up, especially with the brace problems she currently has.
Short term casting should not cause any significant bone issues. The stiffening of the knee and muscle atrophy would be biggest issues. What's interesting is that in patients that are immobilized or casted, if they exercise the opposite limb, they do not lose as much muscle mass in the immobilized leg as patients that don't do any exercise in the unaffected limb. So that would be something to talk to the PT about if Ortho does decide to cast her.
depends on the Ortho, but in general, would at least immobilize for 6 weeks and then 8+ weeks of focused PT before any discussion of surgery. Surgery also difficult due to her EDS, so would want that as last resort. But I think you're still at the beginning of her healing process, and she may do very well with the longer term bracing/immobilization.
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