MCL tear or Meniscus Tear?

[Tomski]

Hi guys! I'm new to the forum and was wondering if you could help me.

Well, my story starts back in June. While playing in goal during football, I had a bit of an accident. As I came running out to an opposing player with the ball, I stopped and brought my knees together so he could not shoot the ball between my legs. As I did this, I must have put all my weight on one leg and my knee bent inwards. I felt something pop out but immediately go back in again. I was in a lot of pain but I was able to limp off on it.

The next day I went to my local treatment centre. I had a sharp pain on the inside of my knee and could not bare much weight on it, however there was no swelling. I was told by a Nurse that it was probably just a sprain and that I just need to rest it and give it time to heal. I wasn't too convinced that it was "just a sprain", but I decided to follow her advice as I wasn't a medical professional.

After a couple of weeks, I was back to walking normally again. However the aching on the inside of my knee did not completely go away for a couple of months.

In about late August, my knee was feeling OK and I decided to try and strengthen up my knee. I went for some light runs every couple of days without any bother.

I play field hockey for a local club and I was ready to start playing again when the season started mid-September. I was able to play several games without my knee giving me any bother. "Excellent!", I thought. I wasn't expecting it to be giving me any trouble anytime soon.

However, on Tuesday at hockey training, my knee went again. This time I was practising hitting the ball on the turn. I got the turn all wrong, but too much weight on my knee and twisted it and fell to the floor. I experienced the same "dislocation" feeling as I did the first time. But this time, I was not able to weight bear on the leg at all, and slight swelling appeared on the inside of the of the knee within 5 minutes.

The following Thursday, I went to A&E. I was still not able to weight-bear and there was significant swelling on both sides of the knee (more so on the medial-side). I was told that it seemed to be a soft-tissue injury and that I will be referred to a Physio. I was given a leg brace and some crutches to get me by.

Today, my symptoms are as followed:

- Significant swelling on both sides of the knee (however has gone down slightly since Thursday).
- Inability to fully straighten leg.
- Cannot bend knee more than 90°
- Slight pain on inside of the knee when grinding and contracting quad.
- Sharp pain under knee-cap when leg locks straight when standing up.
- Knee cap is very wobbly
- Knee feels very unstable and feels as though it's about to give way when weight bearing.
- Knee cap grinds against top of the tibia.

I originally thought I had torn my MCL, but after doing some research it seems that I could have torn my meniscus cartilage. Just wondering what you guys think it is. Do you also have any suggestions that could show signs of it being one of the other?

Thanks a lot for your help!

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[pudding_bowl]

Hey buddy,

Sounds like a Meniscal pain - initially not too bad but worsened when you reinjured. When you do your mensicus it's quite hard not to do your MCL as well so I'm gonna say you'v likely done both. Doesn't sound soft tissue - i'd get a second opinion if I were you. We have something we call the terrible triad - where you manage to do MCL ACL and meniscus. Here is hoping you haven't done all 3. But your description of the turn for the ball and your inablity to weight bear following those would indicate you certainly could have. Best to get yourself sorted - go private if need be.

Over the next wee while, locking and giving way are classic signs of meniscus, so pay attention to those symptoms and let the physio/doctor/orthopaedic specialis know that they are happening.

Pudding

[Tomski]

Hi mate, thanks for the reply.

Is it possible that the poor ROM is down to the swelling? Or do you think that even if that swelling was non-apparant, I would still not be able to fully straighten my leg?

[pudding_bowl]

either or. Yea swelling will reduce your ROM. But don't know if that is going to stay reduced until the swelling comes down. The increased swelling is more indicative of a ACL - if you remember it didn't swell that much on your initial injury which was quite likely a meniscal.

[Tomski]

Do you know what could be causing a grinding between the bottom of my knee-cap and my tibia?

[pudding_bowl]

I wondered if you'd managed to dislocate your kneecap without realising it... but it's hard not to realise it so it's unlikely. It could be the swelling is making it so the knee cap doesn't move normally and your getting a grinding with that.

[Tomski]

Ok cool. Thanks for your help!

[Tomski]

Sorry to double post, but just have a couple more questions.

If this is a meniscus problem, can it be treated without surgery? And also, how long would you expect before A; I am able to walk normally again? And B; I'm able to continue playing hockey?

[pudding_bowl]

No problem buddy. Meniscals depend on the severity, the "bucket handle" tear very commonly will require surgery, but there are other types of tears that may reduce with conservative treatment - So you'll have to undergo physio and play a waiting game to find out - but you shouldn't be bored as you'll have exercises. I'm thinking you should be having a MRI to confirm what kind of meniscal tear and if you have a ACL rupture. If the ACL is busted then you'll require surgery to return to sport really.
Lets say your just in a acute flair up of a conservatively treateable meniscal injury - With appropriate exercises you'd be looking at a couple months. But lets be fair you already had a couple of months didn't you? and it hasnt resolved. Your current symptoms would indicate it is likely to go down the surgical route.

For your sake I hope that it is able to have conservative treatement but you won't really know without a MRI scan. You need to be pushy - go to your GP and say your symptoms and say it's been since June and it ain't better and then don't leave until you have an orthopaedic consult referral - or until your mind is at ease that you don't need one.

Don't hesitate if you have further questions.

[Tomski]

Yeah, I think I'm going to have to be patient to find out exactly what's up.

Reading on a few websites, if you have a meniscus tear you will experience a 'click' when squatting. When I squat, there is pain and a lot of restriction, but I don't feel a click or pop. Is it possible to have a meniscus tear without experiencing these signs?

[pudding_bowl]

Symptoms always vary, you don't have to have the clicking

[Tomski]

Ok. Well I need to phone up the Physio today to make an appointment. God knows when that will be for as I'm going on the NHS.

It's incredibly annoying not knowing exactly what's up with my knee. I guess I'll just have to be extremely patient and like you say, play the waiting game.

[pudding_bowl]

I'm sure you'll keep us posted

[Tomski]

I certainly will. Infact, I've just phoned up to make an appointment now and I have one for next Tuesday, which isn't too bad considering it's on the NHS.

[Tomski]

Sorry for double posting again, just thought I'd post another update.

A minute ago, I was feeling along the inside of my knee where some of the pain is coming from. I felt a lump just floating about in my knee. It felt rough and gristle-like. As I was trying to feel it, it moved and now I cannot feel it again. Is it possible this is a bit of loose cartilage?

Also, I've noticed that, as well as my knee cap grinding against my tibia, if I tab the knee-cap towards the back of the knee, it knocks against something. I'm slightly concerned about the 'looseness' of my knee cap.

[pudding_bowl]

Yea maybe you dislocated it during the injury?
You've got a week till physio, Play it safe till then. Use your PRICE prinicipals - protect, rest, ice, compression, elevation.
When you turn corners make sure you aren't trying to pivot on the bad leg - just do small steps to turn.

[Tomski]

OK, I have had quite a lot of developments on this over the past few days. I thought I'd just fill you in.

Well, after feeling the lump in my knee, I decided to go back to A&E to get it checked out. So on Wednesday, I after sitting for 90 minutes, I had another knee examination. The doctor said it seemed as though I had ruptured one of my knee ligaments, and the lump I could feel was part of the torn ligament. However, she sent me to have some X-Rays done anyway.

When the results came back shortly, she explained that there was an extra bit of bone around my knee cap. She said it could possibly be a fractured piece of bone, however she suspected it to be an extra bit which is suppose to fuse with the knee-cap during early teens. I asked whether this was related to the pain I was feeling. She said it was unlikely and still suspected I had ruptured a ligament. Anyway, I got booked in to see an Orthopedic doctor the following day.

So the next day I saw the Orthopedic. He also did a knee examination on me, but said that I didn't seem to have any problems with my ligaments. He said it was likely that I dislocated my knee-cap, but in the process fractured it. He showed us the x-ray on his computer and explained that the lump that was floating around my knee was a the fractured bit of bone. The strange thing was, is that it was at the back of the patella that the bone broke off. How that happened is beyond me. Anyway, he said that I'll need surgery to remove the fragment which was causing the majority of the pain.

Expecting the surgery to be performed in at least a week, he got me fitted in for the following day.

So on Friday, I was put under general anesthetic and they fished the fragment out (which they kindly saved for me to take home and show off ). I know need to rest my leg in a splint for 3 weeks, then go back and see my surgeon for a check-up. Hopefully everything will be OK and I will be able to undergo physio.

So as you can see, things have developed quite quickly over the past few days. Seems that it was neither a meniscus tear nor a MCL tear. There doesn't seem to any serious damage to my ligaments. The only problem is that because the cartilage from the back of my knee-cap has been removed, it is inevitable that I will end up with arthritis in that knee.

[pudding_bowl]

Very Interesting Champ, Just goes to show how we really can't know what has happened without seeing the patient. And as much as we can offer advice over the internet the best thing to do is to get that objective examination done from a professional and get those scans that are needed to diagnose.

Don't think about the arthritis aspect mate, just have fun for as long as you can... Knee replacements are common nowadays so just imaging in 40 years when you'll need one how good they'll be.

Have a good one

[Tomski]

It's been 5 days now since my surgery. Knee is still very sore and quite swollen. My knee-cap is also still quite wobbly and still knocks back against my femur. Still, I'm not getting overly concerned just yet.

Can you give me any ideas on how to keep the weight off with me being unable to use my knee. Obviously, the main one would be to eat healthily, but that's easier said then done at the moment with all the Christmas snacks lying about the house.

[pudding_bowl]

Eat healthy. Use the upper arms for some cardio.
An arm ergometer for example. Like the people on the yacht that wind really fast. you know what i'm talking about?
Once your wounds have healed then get into a pool to do aqua jogging. no frog kick (breaststroke). and very light kicking with freestyle/front crawl.

Have a good xmas

[Tomski]

Well, it's nearly been 6 weeks since my knee surgery and I'm still having problems. Although I can weight bare now, I have this lump on the inside of my knee which grinds against the bone, and I can feel a click on the outside of my knee when I walk or bend my leg.

I have a check-up with my surgeon this Wednesday to see how things are. I wouldn't be surprised if I'm sent for some scans...as it's gone on for long enough now!

[enggrajshukla]

Hey buddy,

It seems you do not follow the doctors advice.As you are saying that the pain is still there,And even you cannot bend your knees,That is the time factor dear.so please take some time it will surely be ok.

[Josephine]

A few thoughts on your story, Tomski.

First of all the swelling on your knee was probably a joint effusion - knees readily over produce joint fluid in the presence of injury or inflammation. This not only restricts movement but is also very painful, as you have discovered!

Second, it's possible that the ligament that ruptured was the medial patello-femoral ligament. It can come away from your knee cap with a piece of bone attached and could well be connected with a displacement of the kneecap. Just removing the bone fragment doesn't seem to be an altogether good way of treating it.




So thirdly, please check that the surgeon you are seeing is a knee surgeon and preferably one who specialises in sports injuries. Mostly you can check his name on a Google search and see his CV. If he's not, find out which orthopaedic surgeon at your local hospital is in this field and ask your GP to refer you to him instead. You'll be the better for it in the long run.