Possibly torn ligament or tendon in knee

June 23, 2005 9:47 PM

Can anyone post about experience with a torn ligament or tendon in a knee?

X-rays, which the ER doc assured me were fallible, show no broken bones (a dog yanked me off a low wall and I landed on my knee). I can put weight on the leg, but any sort of pivoting movement makes me scream in pain. A full leg brace and tons of percodan are helping, but I have no experience with this or the recovery thereof. Thanks!

posted by goofyfoot to health & fitness (14 comments total)

gave my mcl a partial tear a few years back skiing... took every bit of the eight weeks the doc said it would to feel better... used a brace for the first week, maybe... but it itched, so i ditched it and walked gingerly with a bad limp for what seemed forever. they tell me tears, like real broken-ligament-level damage, never really heal, but i'm proof most of the pain goes away after a couple months... i guess, if it's worse than a partial tear, you'll know because it won't really stop hurting. fwiw, despite the fact that this happened a half-dozen years ago, i can still coax a little pain out of the knee, just by moving it in the "right" direction. so i try to fall down less often now.

my sympathy.
posted by RockyChrysler at 10:10 PM on June 23, 2005

When I tore my ACL — and I tore the hell out of it, ripped it clean away — normal movement caused no problems. However, certain motions such as stepping down were problematic. When I stepped down, my knee had a tendency to buckle; it couldn't support my weight. Certain pivoting motions caused me pain. I distinctly remember trying to dig a rhododendron and, when I thrust the blade of the shovel into the ground, realizing, "Well, crap, I really do need surgery."

I had x-rays which showed it was likely that I had torn my ACL. This led to an MRI, which proved this was the case, and revealed torn cartilage to boot — torn cartilage can cause severe pain. The MRI, of course, led to surgery. Now, two years later, the knee is mostly healed. I've never really tested it (with soccer or extended running), but it functions well enough for every day life. Sometimes it aches. Sometimes it "pops". Mostly it does its job.

I spent a great deal of weblog time obsessing over my injury, including entries on diagnosis, MRI, and surgery. Ah, I just found the entry with the surgery photos.

Good luck, goofyfoot. An injury is never fun.
posted by jdroth at 10:20 PM on June 23, 2005

If you are in a position to do so, demand an MRI, it's the only way to really know the damage that may have been done to your knee.
posted by sic at 1:06 AM on June 24, 2005

I don't have health insurance so am not in a position to demand anything. This is frightening.
posted by goofyfoot at 2:01 AM on June 24, 2005

I tore my ACL and a few other bits in my knee when I was in grade school and kept doing athletic activities on it through university. By the time I entered graduate school I could push my knee out of it's socket with my finger tips.

At the time of my injury my family doctor just said "Well, you'll probably need a cane" and that was that. I went without one but I did end up flat on my back a few times when my knee decided it was tired of supporting me. By the time I had my ACL reconstructed it was really bad. The final straw was taking a tumble down a flight of stairs.

I was lucky in that I got the team doctor for a pro football team to accept me as a patient. Football players aren't known for the integrity of their joints but his first words on seeing my MRI was "Holy fuck! How are you even standing?"

The surgery went really well and the surgery was designed to get me back on my feet and active quickly.

The middle third of my hamstring was removed as well as a bone socket on either end. This was then implanted in my knee joint where my ACL normally would be. I don't have any cartilage however but it doesn't seem to slow me down. Normally they'd put artificial cartilage in but by the time I had the surgery I had full blown arthritis in the joint which I guess means that they won't try to put any foreign objects in.

So how did I keep going on busted parts? I had huge quadriceps which helped to stabilize things until they got tired (and eventually until I had done too much damage) and I have a high pain threshold.

I can now do anything I ever did, so in a way I was lucky I waited so long for surgery. I doubt if I'd have had as good a doctor and definitely wouldn't have had the particular procedure when I was a kid.

I was doing physiotherapy within a few days of the operation and was on physio for about 6 months a couple days a week. It started off with range of motion exercises and ice, lots of ice and more ice. Within a couple weeks I was doing bodyweight squats on an incline board and exercise biking. A few weeks after that I was running on a treadmill and working on a trampoline. A couple months after that it was 5 mile runs plus agility drills (crazy legs, rapid directional changes etc) as well as starting towards my normal gym routine.

Physio was only complete after my injured leg was 95% as strong as my good leg.
posted by substrate at 4:44 AM on June 24, 2005

I tore my ACL when I was 13 and had a knee scope 2 years ago for a torn meniscus. After I tore my ACL, I had a gigantic stabilizing bandage and had to rest. Then I did physio. I wasn't athletic, so I just left it at that and never had any problems. I live in Canada, but an MRI to diagnose the damage will cost you about $500US, plus you will need physiotherapy.

If you are not too hard on your knee, you can avoid surgery. (I only needed it because I thought that after 27 years of being a lazy girl, I would take up running. Not so smart.)
posted by girlpublisher at 9:29 AM on June 24, 2005

On a more optimistic note, I had a similar injury--slipped off a tracked vehicle and bashed my knee on some exposed rock--and my knee swelled to about 2x normal size for about a week. I could walk on it but range of motion was minimal and lateral movements hurt like hell. I was in the middle of a field exercise and too hard-core for sick call but IIRC normalcy returned within a month or so. I never immobilzed the joint and was back running PT after the field ex ended a few weeks later. I don't know if this helped or hindered my recovery.

The way you describe the fall it is not clear whether you merely landed on the joint or had twisted/hyper-extended it on impact. If it is the former then I'd wager on a bone bruise/compression fracture. If the latter, well, then all the folks with *CL experiences will probably provide more valuable information.
posted by Fezboy! at 10:02 AM on June 24, 2005

I tore my ACL in a downhill race, and they did scope surgery (I guess this was before the days of routine MRIs to diagnose the tear.
I had reconstructive surgery and it worked very well, went back to racing within a year, and have only had minor problems since then.
Without insurance you're going to be in big trouble. Knee injuries can be pretty messy, from what I understand, with cartilage tears and bone fragments swimming around in the joint. Without proper care you could end up with reduced motion in the joint, which could mean using a cane for life. Sorry to be scary, but if you have any rich relatives, now might be the time to make a phone call.
posted by nprigoda at 10:05 AM on June 24, 2005

I blew my right ACL to shreds nearly ten years ago. I had it fixed and then I partially tore it again. Even though my surgeon was excellent (he takes care of professional athletes and olympians) and even though I'd completed extensive rehabilitiation, sometimes surgery just doesn't work.

Strengthening the muscles in my leg was the best thing that I did to improve my joint stability. This may or may not work for you. Squats and hamstring curls are good for your muscles and your knee but leg extensions (where you sit and extend your leg from 90 degress to 180 degrees) are not. Additionally, your joint will be more stable when bent rather than extended or locked straight.

Working on balance also proved to be very helpful. I practiced balancing on my injured leg frequently and concentrated on joint stability. You want to be aware of the muscle that stabilise the joint and how they act. Once you are good at standing on one foot, you can extend the opposite foot to the back, front, and side to further increase joint stability.

Ligament tears are different than tendon tears. IANAD and my grasp of anatomy is basic but ligaments connect bone to bone while tendons connect musicle to bone. If you've torn a ligament in your knee, it won't heal on its own as it lacks a supply of blood and nutrients. My understanding (and my experience) is that when a ligament tears it is accompanied by a loud popping sound and a terrible terrible feeling (you'd know if this happened).

Given that you landed on your knee, it might just be bruised. Joints and muscles lock up when injured to protect the knee from additional stress or strain - perhaps this is causing the pain as opposed to a tear or strain of some sort. I'd rest the joint as much as possible, try to keep the swelling down, and then work on strength and stability.

Do try to get to a doctor for a proper diagnosis. Although an MRI is the best and most accurate way to determine what's happened to your knee, a doctor should be able to tell if you've torn certain ligaments by pulling on the joint in certain ways and comparing its give to that in your other knee. This can only happen, though, once the swelling has gone down. Once you have a proper diagnosis (and it may not be serious damage), you can then determine how to get back in action.
posted by lumiere at 10:06 AM on June 24, 2005

Another ACL reconstruction here. Blew it 2 years ago playing basketball...just went right down on my own. Lessons learned: stretch more, leg strengthening, wear knee brace(!).

I also had torn medial meniscus (spongy stuff that sits under the kneecap, acting as a cushion), so they trimmed that up in surgery as well.

I agree with lumiere that it sounds like you may not have snapped it (that *pop* sound still haunts me), but it could be a lot of things. Another vote for an MRI.

I you have to have surgery, make sure you do as much leg strengthening as possible before you go under, it'll lessen your recovery time after. Stationary bike, leg presses (not necessarily squats), straight leg raises, lots of lateral movement stuff that's not impact related, etc. You might want to pay a visit to a physical therapist (best case with prescription in hand) to see what's the best exercise when you're ready.

I feel your pain...
Good luck goofyfoot/knee! (sorry)
posted by hellbient at 11:43 AM on June 24, 2005

Grade 1 (least damage) tear of my MCL in the winter of 1996. Had an imobalizing brace for walking for about 6 weeks. Took another 6months - 1 year to be fully back to normal.
posted by ccoryell at 12:42 PM on June 24, 2005

How recent was it? I would wait till the inflamation subsides completely, a few weeks. Take some anti inflamitories in the mean time. Afterwards, you will see if you still have any additional symptoms. If you have none then you are fine, and just want to strengthen the msucles. If you do, you will have to decide if its worth having an operation. Many people do not, and continue living with torn ACLs and menisci, the parts of your knee that do not heal naturally (as opposed to MCLs). For example, many professional skiiers have torn ACLs.

I tore my ACL years ago (partially). I didn't realize it, but every so often my knee would give out. Then one day a couple of years later it just completely went out and my knee locked in an awkward position.. I had no choice but to have an operation for the ACL and meniscus. Recovery was a real pain in the a**.. it took more than 6 months.. but I think nowadays they have you move it almost immediately post operation, which reduces the recovery time considerably.
posted by blueyellow at 12:45 PM on June 24, 2005

not to scare you too much about surgery, but concerning ACL reconstruction:
You have a couple different choices of what to do. I opted for the removal of the middle third of my patellar ligament (or tendon?) removed, which is now my new ACL. It's common surgery, but still a real hack job - they chip out bone and thread it through a hole in the bone, and secure everything with titanium screws. Perhaps someone else can give you more specific details.

But the other popular choice is to get an ACL from a cadaver. When I was in physical therapy post-surgery, I befriended a guy who had just had said surgery. I noticed he was immediately able to do soo much more than I could right out of surgery. The recovery time is significantly shaved, because it's so much less trauma to the knee. If I had to do it again (god forbid), I'd choose this surgery.

Feel free to e-mail me if you have specific questions. I've found that people in the ACL club love talking about it...
posted by hellbient at 10:08 AM on June 25, 2005

I have a lot to think about. Thank you.
posted by goofyfoot at 10:19 PM on June 25, 2005