knee fall, maniscal damage?

[sarahkelly]

I fell on my knees while out jogging (fallign flat on both knees and wrists) 48 hours ago and when i fell my left knee instantly swelled up A LOT. Right now its very bruised and swollen (although the regular icing I have been doing has taken the swellign down alot. the main area where there is pain and swelling is the anterior medial lower "quarter", there is pain along the joint line for the last 1.5 inches before it hits the patella. I have ruled out ACL rupture, is there any chance that this is NOT a meniscal tear and that it will all just go away in a few days (its just that everywhere i read it points in that direction whihc is very worrying for me as someone I know had that and it was painful for months.
The nurse also suggested I go for an x-ray but I am weight bearing (though it is painful to do so and have been from teh start, so you think I should skip the x-ray? also other thatn icing restign and static quads every now and then is there anythign that I shoudl be doing right now? The pain is also decreasing as time passes.
Thank you so very much for your invaluable openions
Thank you

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[Emanuele]

Meniscal damage doesn't tend to swell up immediately but usually it tends to swell later on hours to days after the injury, the mechanism of injury is not clear, how did you exactly injury yourself? How come you are so sure that ACL is not involved?

all the best

[sarahkelly]

I did an anterior drawer test on myself and the doctor in the A&E did also did one this morning, both acl and pcl are intact. The x-ray done in A&E also came back normal, I also have a high pain tolerance (the kind to fall asleep at the dentist..) but this is a bad pain. The medial portion feel unsteady (not sure if actually 'unsteady, may be poor proprioception-i havent' fallen over or there's not giving way or anything like that) also the mcl is fine, I'm a bit confused by it all atm. Right now what I think it may be:
1. meniscal tear (due to the position of the pain, but I can full flex the knee no problems)
2. damaged plica
3. cartilage damage to the femur
4. Just a case of bad bruising (but as its now been a week it seems a long time for it to be going on if its just a bit of bruising I would have thought, then again my wrists are pretty cut up as well and if they are not yet healed then maybe the knee is not yet healed, if the soft tissues underneath are ripped-up.
Mechanism of injury : a fall while running, wet surface, slipped and fell onto knees and wrists (only superficial damage to the other structures thou)

(still taking anti-inflammatories trice daily and mobilising a little)

Meniscal damage doesn't tend to swell up immediately but usually it tends to swell later on hours to days after the injury, the mechanism of injury is not clear, how did you exactly injury yourself? How come you are so sure that ACL is not involved?


all the best

[sarahkelly]

also when I do static quads, the entire patella feels creeky as hell if I hold my hand over it

[Emanuele]

Anterior draw is not reliable as a test in acute events, however considering the mechanism of injury you had, it seems unluckily you injuried your cruciate, unless if in falling down you didn't awkwardly twist your knee, then that would change the scenario. Possible post traumatic sinovitis could be taken in account but the fact that your knee has swollen so rapidly doesn't convince me too much

Did you have a big cut over your knee?
Have you got fever?

however you said you can fully flex the knee so I guess the swelling is subsiding otherwise you would have struggled.
Damage to the cartilage would have possibly given you "joint mice" and you would have had some problem on flexing or extending (not always though)
Plica tends to be quite pinpointed as a problem, mostly just medially to the patella and anyway not easy to diagnose (usually by exclusion or with arthroscopy)

More than an X-ray, MRI is indicated.

Let us know how you are proceeding!

All the best!

[sarahkelly]

I will keep you posted! (I hope and pray that it is not the cruciates!)
Why do you ask about fever?
As I'm going to bed now the pain is bad just like it was last night, the knee's on fire ouch.
The usually want an x-ray done before they do an MRI so that, gettign elbow crutches and the extreme pain I had in the night the night before were my raesons for getting the x-ray.

[Emanuele]

Just in the remote possibility that you have an infection due to an open cut following the injury.

Wish you all the best

[sarahkelly]

My knee feels alot better today (day 9 post injury) I wonder if the fact that I have SLE made me have some kind of massive inflamatory response? I've never had an injury before. Either way I'm booked-in for physio next week to get it checked out, by then the brusing may have gone down and they can check it out

Just in the remote possibility that you have an infection due to an open cut following the injury.

Wish you all the best

[sarahkelly]

Two physios just assessed my knee and are now referring me for an urgent MRI for a suspected acl tear, my knee is actuallly very sore after all their puling and yanking, i'm guessing thats not a good sign?
My life is over.

[sarahkelly]

But I need to ask, when I went to teh physio today I practically jogged there, no pain no problems, but after they tested my ACL, two of them, (the first was unsure) they really pulled wil everythign they had, well I've not been righ tsince, I'm in a hell of a lot of pain, teh joint feels very unstable, all since earlier today, is it normal for them to be so aggressive? I know they probably have to justify an MRI, but really.....I'm in agony!!!!
I mean I don't even know if I can go out for a walk on it or not now its so painful!!

[sarahkelly]

I'm actually really worried about the possible damage done at yesterday's physio appointment, I was doing really well, practically skipped in and litearlly limped out, i'e in absolute agony since they assessed my knee they were quite aggressive with the ACL tests I know that they had to justify ordering an MRI but seriously, my knee feel incrediblly unstable, very painful and with every move its as if I'm going in one direction and my leg is going in the other. Did the physio assessment bring-on what I had coming anyways or could it have made my acl tear worse? Should I not allow others to carry out such tests in future?

[bikelet]

Sorry to hear about your knee pain. The physio appointment may have aggravated your pain but I doubt that it would have made your tear worse.

If you think about it, the ACL's role is to stop two bones from moving in separate directions- particularly when there is sudden acceleration or decceleration such as when running and changing directions. If the (normal) ACL can handle that amount of force, I doubt that there is much a physio can do to make it worse by tugging on it with the arms, the forces really don't compare. With an injured ACL, it might be more vulnerable but it is still a strong ligament. The other thing to consider is that your muscles will be guarding your knee (even subconsciously) so I don't think that a physio could damage your ACL while you are awake and conscious of them trying to move your leg. ACL injuries tend to occur when there is unanticipated high loading movement which the muscles weren't prepared for.

So at this point in time, I think you could try some gentle range of movement exercises in an attempt to ease your pain. Also try gentle static muscle holds of the quadriceps and hamstrings to help increase feelings of stability and to help with the pain. If you go for the MRI then hopefully you won't have to go through this experience again. You could tell other people about this experience so that they won't be so brutal if they need to do the test again- which they shouldn't really if the physios have made up their mind and referred you off.

[sarahkelly]

Thanks! Logic tells me that this is the case, but if it it was me, I'd rather just refer someone if all the indications were there rather than tugging it like they did. No-one else will ever do any kind of drawer test on me!!! In the meantime I have began ACL Rehab as it we know definitely that it is torn. My MRI is scheduled for the 8th Jan. I asked the physio briefly about surgery earlier and she said that as long as it's not giving way, surgery is not indicated.