Knee questions

[leorl]

So I've damaged my knee playing rugby, a rotational injury when some fatso tackled me funny...gone for MRI and stuff, and what showed up was a partial ACL tear/damage and lateral meniscus damage.

1) Initial damage was on the medial side, and to the medial ligament - there was quite a bit of swelling and effusion, extension block for a period of time. I know that usually medial damage would cause secondary damage to the lateral ligament, but how does the lateral meniscus get damaged? (since the ligament is attached to the meniscus only on the medial side?)

2) As it stands now, I can't do any sports involving rotation or stop-starting (rugby, basketball, soccer, etc.) unless I have a cruciate reconstruction, which will take months to heal...especially if I have to have an arthroscopy to fix the meniscus as well... is this worth it? I know it's a personal decision, but it's not like I'm a top class rugby player or anything...it does mean things like I wouldn't be able (or shouldn't) just play frisbee or soccer with friends and stuff. Is this a worthwhile procedure to get done?

3) would the meniscus heal itself? I'm not sure of the extent of the damage done to it, but given time, does it regenerate? I know the ACL doesn't.

4) I thought partial ACL tears were really rare, I thought usually the whole thing just tears. What kinds of partial tears are there?

If anyone knows the answers to any of these, I'd be most appreciative! thanks!

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[hale-bopp]

I don't know about the ACL questions, but I have a lot of experience with lateral meniscus tears (3 surgeries on my left lateral meniscus, two before I graduated from high school).
Cartilege does not heal itself.
For me, the surgery was worth it, because I care about being active without worrying about my knee locking or buckling. To fix the tears I've had, they cut out the damaged cartilege, which means I am at greater risk for osteoarthritis, but the damge I did to tear it in the first place might cause that anyway.
Good luck making this decision.

 

[Polar girl]

Is an ACL brace not an option for some reason?

I hurt my knee playing soccer in high school. Partially tore the ACL and tore meniscus cartilage. Had to have arthroscopic surgery for the cartilage, because it was out of place and blocked full knee extension.

But I didn't have to have reconstruction surgery. My ortho doctor said that reconstructing wouldn't necessarily give more stability than I would have with a partial ACL and the fitted brace I got. Building up the thigh muscles also helps stabilize the knee.

The brace is annoying at first, but you get used to it. And I played two years of basketball, softball, and soccer without rehurting it. Then I became a deadbeat in college, and stopped doing athletic things, but that's besides the point.

You might have torn yours most of the way (mine was like 60% torn), or have some other damage that would make the brace not very effective. But it might be worth asking about. Cause reconstruction's a bitch.

 

[pallhaco doce]

I had something similar to what you described -- partial ACL tear, meniscus tear, cartilage tear in high school. I wore a knee brace that made me look like RoboCop while I played football. Ended up thrashing it really badly and had both a scope and later an ACL resconstruction done.

I was against the surgery at first but discovered that my knee was seriously unstable and would 'pop' out with little or no warning even while performing mundane activities. Rehab was a major duty pain -- really quite painful and difficult. In the end, though, everything worked out very nicely b/c it has been almost 15 yr and I have never had a problem with it since reconstruction.

Then again, I was very, very tentative with it, mostly out of habit. I dropped most running-type sports (football, basketball, baseball) and picked up milder activities (swimming, cycling, golf). Recently I have been playing hoops once a week or so, and outside of major soreness, the knee itself is very stable. Of course, sports involving lots of knee impact and running are not
recommended to avoid prematurely developing knee pathology.

In retrospect, I am glad that I did it, but it might be a tougher decision for me now. You could really work on strengthening the muscles around the knee to stabilize the joint and see how that works for you, if you don't want to deal with the cost/rehab of reconstruct. But then you don't get the cool scar. Oh, I forgot that they can do it practically scar-free now.

Anyhow, good luck with your decision.

PD

 

[Skialta]

You can damage the lateral meniscus when you receive a valgus stress to your knee, not only do you damage your MCL and many times tear the medial meniscus, but the compression of the joint on the lateral side will sometimes tear the lateral meniscus.

Some tears in menisci will scar down with time, depends on the kind of tear and you wouldn't really know unless you had it scoped.

Deciding on surgery is a harder choice. I am PT as well as a med student. I usually tell my patients that they can return to normal activities (provided they are symptom free), but if they start having problems with their knee "giving way", usually during planting and rotating or cutting while running then they should opt for surgery. That is if you want to stay active. The risk you run with an unstable knee joint is damaging the articular cartilage and ending up with OA and an eary TKA.

Your rehab time because of the meniscus tear is not much of a big concern because you will be restricted from returning to full sports for about 8-12 months because of the time for the ACL to heal. A lot of the time the meniscus tear can't be repaired and the tear is excised and it doesn't add to rehab time.

Hope it helps

 

[deleted29780]

wow, that is really some deep anatomy,

 

[leorl]

Thanks tons, folks! I can't really wear the brace because in playing sports like rugby, you can't wear anything that has hard metal parts in it - it all has to be soft material so a hinge brace wouldn't work.

But after talking to some sports doctors (my Anatomy dept. profs are awesome!) they said I could try to avoid the whole surgery bit and really really build up the hamstrings and quads to stabilize the joint enough to be able to stand rotational strain. They and the physiotherapists in the department said that some people even play rugby without an ACL (!) . So i've met the physio for a gym session and she showed me exercises to do with a swiss ball and a resistance band, and I'll meet another physio this week some time I think. At the moment, my knee isn't popping out and sometimes it feels like it might give way but it hasn't yet.

They reviewed the MRI and although it's pretty hard to tell, it looks like there is ACL damage, although at least one of the bundles making up the ACL seems fully intact. The meniscus damage seems rather minimal.

So it probably isn't wise, but I'm going to really try to build up these muscles, do the rehab running drills starting with straight line running, and see how it goes. If it feels unstable then I know what to do, or if I return to playing and it goes again even with all this rehab work, then I know I definitely have to get surgery done and will get it scoped.

Thanks for all your advice! And yeah, it is a good review of anatomy . I took my MRI into lab for the people in the year below me cuz they're doing limbs and joints right now and gave them a good review.

 

[::Seabass::]

Something you might want to remember is later on down the road you may not have the time to keep up the rehad. I had nonunion of my patella which meant part of it had to come out. If I'm good and keep on my exercises, it doesn't give me too much pain.

What about if you want to be a mom later? Fitting in all that stuff will be hard on top of being a doc and I'm sure with you being athletic that you will want to run around with the kiddos. I think it is important to think about things like this down the line and how active and what kind of activities you see yourself still participating in 10-20 years from now. Keeping that ham and quad strong takes a ton of work.

Good luck!

 

[CathyR63]

I play womens football and last season we had 3 of my teammates tear their ACL's. All three had surgery but each one had it done a slightly different way.

A few weeks ago I twisted my knee during practice, so I took it easy the following week I didn't practice. Saturday I felt better and practiced but I hurt it again because the field was very muddy and sloppy. I changed direction and slipped turning my knee. It hurts on the outside. I read that the LCL doesn't usually get injured but I am wondering if it is the meniscus and if I should have it looked at. I can bear weight on it but I am gimping when I walk. The pain goes down into my calf and to the back of my knee.
Its a little swollen on the later side. I have been icing it and elevating it along with ibuprofin.