ACL and LCL Ruptures

[SCHMUCKO]

I'll give you guys a run down, as I'm new to this site.
Im 20 years old, and very active and sporty. I injured my knee in July playing hockey, it twisted under me and I felt a pop and pain/swelling etc. Immediately after I tried to walk, but gave up due to pain. So a first aid person looked at it and said I should really go to the hospital. So someone drove me there, we waited awhile and saw a doctor. She wiggled it around and did other things, sent me for xrays, which came back clear. So they said go and see a private specialist, and gave me crutches and a brace. So a couple of weeks later i visited a specialist and he said it could be various structures injured etc, but he is very busy with his private practice and it would be quicker for me to get things sorted by being admitted to the public hospital(weird?!). So I was admitted and they did an MRI and CT Scan, so I had to wait a couple of days for results, but going on first impressions, they said I had completely ruptured the ACL, MCL and LCL, the LCL was pulled right off the bone. They said they would definately require surgery.
The MRI and CT reports were then received by the doctors, and the surgeon came in and said it confirmed ACL and LCL ruptures, along with tibial rotation on the femur but MCL appeared normal. He said he will come and discuss what the surgery involves etc later on. The surgeon came in and said i would be discharged, as he wasn't going todo surgery. The physio came in again, she was extremely puzzled as to why he refused to reconstruct the ligaments, especially as Im young and active, but also because there was major instability within the knee.

I was discharged, so ended up spending a week in hospital. I was advised to attend physio privately, and was given a follow up appointment to see the surgeon in a month. In the mean time I got off crutches, had a lot of muscle wasting in the thigh, and then visited the surgeon. Nothing much happened and he said we'll see you within the next 6 months.So in December I got a 2nd opinion, this surgeon said the same thing and that I should just continue to see the other surgeon and go easy on it. My physio is amazed they wouldnt fix the ligaments, as its very unstable and my tibia is sliding and rotating on the femur, causing it to give way. He said I pretty much wont be able to play sport until the knees fixed.

So ahh, what could i do? Info, cheers.

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[SCHMUCKO]

Im in Australia, if that helps

[physio.smith]

If they wont fix it at this stage then your only option may be to stick with the physio. My experience of multiple ligament ruptures is that it does not matter how strong you get all the stabilising and mobilising muscles the joint is still unstable when activity levels are increased.

Generally when I have had trouble not being able to access surgery for this type of injury we have just worked hard on reducing swelling, regaining full movement, stabilising as much as we can...working glut, trans abdominals etc as well as major knee muscles. Often functionally a brace is required to prevent collapsing of the joint and further injury.

Using functional markers / outcome measures with your physio will give you a good idea of where you are at now...repeat these maybe monthly and thus when you see the surgeon again you can show them what progress you have (or have not) made. This will give them an idea of how motivated you are, what problems you are still having etc...and thus how much you would benefit from surgery.

Good luck

[SCHMUCKO]

I've started at the gym and it amazes me how much worse my injured knee is compared to the good one, as i didnt think it would be as bad as it is. I dont really trust my knee, even just walking. My physio has said my strength is pretty good at the moment, but hopefully the gym will improve it more. The annoying thing is though, the stronger it gets, the more I seem to notice the instability. How common is conservative management for this type of injury, for active and young people? The original specialist has kind of fobbed me off it seems, havent had any followups with him since, the upcoming appointment is for a 2nd opinion with another surgeon he referred me too, but he basically implied I'll get nowhere. He was quite arrogant, i was under the impression im very low priority on his patient list.

Thanks for the advice

[physio.smith]

I deal mainly with fit young men and they routinely don't get surgery straight away for various reasons. I do not necessarily agree that they should have to wait or that they always need to wait but that is down to surgeons and bigger powers that be!

Often swelling or reduced range at the joint will mean that surgery may need to wait. It may be that the first surgeon you saw was not confident that he could help you, as you may have hoped.

I have treated many ACL repairs and a few ACL / MCL repairs (with or without meniscus repairs), of the ACL most do pretty well and some get back to very high levels of activity...a few don't do as well, for various reasons. ACL with MCL is more complicated, obviously the more unstable your knee is the more complicated the surgery is.

Personally if it was my knee I would probably opt for surgery as if the knee feels unstable with day to day activity then you are increasing the general wear and tear at the joint.

You are right to seek a second opinion, it will do no harm, as I said before let them know what you have been doing. Be careful at the gym, as certain exercises can cause a shearing effect at the joint...ie. knee extension (open chain), which will make it feel more unstable.

When you go for the second opinion be mindful that the 2nd surgeon may be friends with the first! That is not to say that they wont help you...just that they are unlikely to appreciate negative comments about a collegue.

Good luck, don't give up, keep seeing that physio and watch out for joint movt. (shearing / sliding) when you are exercising.

[SCHMUCKO]

Yea the 2nd opinion is with a guy the original surgeon works with. The knee was really swollen, with little ROM and lots of muscle wasting when I saw the surgeon, so this is probably the reason they didnt operate, but it would have been nice if they told me the reason rather than leaving me with no idea. Its been really sore along the joint line since the first time I've been to the gym, especially when I bend it, and hasn't gone.
The physio said LCL ruptures can be a little more serious than MCL ruptures.

If Im given the option of surgery, I will have it but Ive never been given the option. I really want to get back to contact sport, but Im not confident it will be stable and I also dont want to damage the cartilage. My fitness levels are suffering big time, i was so fit before the injury, and now im quite unfit, it really annoys me.

Thanks for your info

[physio.smith]

Swelling a lack of movt. was probably the reason they didn't do the surgery. Because they have to go into the joint to fix ACL there is an increased risk of getting bleeding into the joint...which can restrict movt. if not dealt with. When you injure the knee initially you get bleeding into it due to the nature of the structure you injured. If you do surgery when there is already a lot of swelling (bleeding) it can give you a poorer outcome.

LCL are more tricky...the MCL is closely linked with the ACL and fibers blend together in this area. Commonly people injure ACL/MCL and medial meniscus.

Really take a close look at what you are doing in the gym...analyse the movt., speak to your physio etc... I don't tend to get my patients in the gym doing much initially.

Generally fitness wise you can wear certain braces in the pool and do aqua jogging..keeping legs still and working arms, float between knees and work arms. Nothing where the resistance of the water disrupts the joint too much. Arm ergometers (bikes), rowing just using arms (watch posture)...that sort of thing. If you can't full extend the knee then watch if you are trying to use bikes or cross trainers as you may encourage strengthening of a flexed joint.

Some exercises sitting on a gym ball...feet on floor can help with proprioception (balance receptors in knee)...watch any leg weights, squats etc that you are weight bearing through both legs equally, getting good control of movt., fully extending where need be and not getting excessive joint movt.....speak to therapist about appropriate exercises for where you are in terms of progressing.

Monitor movt. at your knee closely and swelling...any increase in heat, swelling and loss of movt. indicates you are probably overdoing it. I tend to get my patients to use a couple of things to measure it themselves....
*Sitting sliding heel to back side...using tape placed from heel to buttock...so you can see how many centimeters moved.
*Measuring 5cm below knee cap, around middle of joint, 5 & 10 cm above knee cap...can mark these points so you get the same place each time.

Keep going gently and good luck. Let us know how you get on.

[SCHMUCKO]

I dont have any problems with extension, like I can extend it fully to the point where it feels like it will go inside out, its mainly flexion, I have a little trouble getting it flexed fully.

Im getting an ACL brace, so hopefully I can try to play sport, as I would like to wait until the seasons over for surgery, if that would be possible or will it still feel unstable and wear down the cartilage?

Thanks for the info

[SCHMUCKO]

After going to the gym, Im getting quite a sharp pain just inside my knee along the joint line and its worst when the knee is fully extended when walking or twisting.What could this be?

[SCHMUCKO]

Today I went to the sports surgeon. She said next to nothing about the ligaments, and that the pain is bone oedema, but, the oedema isnt where the pain is. She didnt even test the laxity of the knee, no lachman, pivot shift test or anything like that and basically said its all from my brain and muscles that are causing the problems with rotation, even though she read the MRI.

[bajskorv]

hey i had surgurey on my knee 1 month ago, and im just wondering if there is any thing i can do to speed up the recovery process besides going to rehab 3 times a week, anything i can do at home like certain movements or something? any help is appreciated thanks

[alophysio]

Hi Schmucko,

How is you knee??

What city are you in??

I only just read your posts now. That's terrible - we live in Australia - you can get in to see any surgeon you want BTW.

Find another surgeon.

If you don't want to post detials, PM me.

BTW - if there is a good reason why they don't want to do an operation, then they should at least explain it to you.

I only send to doctors who are good communicators as well as excellent surgeons. In my experience, if a patient is to be successfully rehab'd, they need to understand everything that is going on and feel comfy asking questions to clarify the situation.

Cheers

[si1984]

Hi. I've recently had complete ruptures to my ACL and my LCL. I was playing football (soccer to lots of you on here) and as I blocked a shot, my leg was fully extended and my foot was planted, the opponent followed through with his shot and all his weight went onto the inside of my right knee. There was no chance of my being able to stand up, I've never felt pain like it. An ambulance was called and I was taken straight to hospital.
Like Schmucko, there was not a lot they could do on the day due to the swelling and the pain. They took an x-ray, which showed no fractures and then gave me a leg brace to go home in. A few days later, I was back for an appointment with a doctor, who again, said the pain and swelling was to intense, for a proper diagnosis.
To cut a long story short, I saw a couple more people before having surgery this week. 6 weeks on from the injury itself. I thought that was pretty quick but the surgeon said it was a disgrace that I was made to wait that long. Because of the delay, there was loads of scar tissue which meant repairing the LCL was a massive job. For that reason, he didn't get time to work on the ACL and I have another operation booked in for 12 weeks time. Really disappointing as it's almost like going back to the beginning. My leg was in a really bad way though. Complete ruptures to both these ligaments is apparently very rare.
The moral behind my story is I'm shocked that your doctors decided not to operate on your knee. Have you had any luck since you posted?

Simon

[Absolute Sport Therapy]

hi all just to add my little bit about this sort of injury, but two years ago tomorrow (March 17th) i was playing football like a few of the people on here and was tackled, i had complete ruptures of my ACL, PCL, LCL, PLC, tears in both Menisci, one of the hamstring was lifted from its attachment and also suffered a burst knee capsule. Since i have had all ligament and structures repaired and have just started to get back into football training. I feel relatively good however my muscle mass is clearly no where near to what it previously was.

I am relatively hopeful to begin playing football again however it is not clear at how good a standard (was previously step 4 of the pyramid) and ultimately it is possible.

Hope this doesn't contravene the rules of physiobob but sign up to kneeguru forum as it has alot of informative information and good rehab diaries for all sort of knee injuries. Find my rehab blog on the PLC subforum.

I hope you all the best

[Shuardt]

Hi,

I managed to do quite a substantial bit of damage to my knee in rupturing LCL, ACL and having a substantial tear in the PCL. To top this off I also managed to snap the hamstring of the bone and severely bruise the nerve to my foot giving me foot drop. I'm only young too and was given surgery on the lateral parts of the knee and hamstring 12 weeks ago with the ACL surgery in 6 weeks and are ahead of schedule in terms of recovery thus far although still have to be careful. the first doctor only gave me pain killers and crutches so the second opinion was the one that i needed.

hope your knee finally gets fixed
thomas

BTW did mine playig squash