oooh, that's gotta hurt

July 15, 2006 12:02 PM

Is it possible to seriously hyperextend your knee without doing any permanent damage? Nauseating details inside.

So while hiking last night, my wife took a good fall, landed funny, and bent her left knee backwards. After rolling around in blinding pain a bit, she stood up, and put a little weight on it, at which point it made a creepy popping sound and bent backwards a little again.

As of this morning, there was no swelling, but lots of pain. We went to her HMO's urgent care place, where they basically gave her a pair of crutches and told her to buck up. They took x-rays, which showed no bone damage. But ligaments don't appear in the images, and she's worried she may have torn one. Her insistence was met with "call us in a couple weeks it it still hurts."

So she'd like to know, is it possible to injure one's knee in such a way that it pops and hurts and makes gross noises for a while, but without any permanent injury? Could that be normal for just a sprain? Would the pain or swelling be worse if something was really ripped? She's an avid runner, and is very worried about all this, and I'm hoping to offer her some reassurance that her doctor apparently didn't have time to.

posted by M.C. Lo-Carb! to health (9 comments total)

I've torn my ACL in both knees, and my PCL in one knee. I only needed surgery in one knee.
It is possible for it to pop and ache without there being a tear, but It's also possible to have ligament damage that, while permanent, isn't bad enough to require opening her knee up.
Also, if something is torn, moving on it is not going to make it worse. I would heed the doctor's advice and wait it out for a couple weeks. If after a couple weeks she is still having issues with her knee bending where it's not supposed to, then she should consider going back.
Meanwhile, surgery is the only option to repair ligaments (they won't heal back together on their own), but you can often get by without fixing it and without any change to your lifestyle or activities. And, if there was enough damage to absolutely require ligament reconstruction, she would not be able to put any weight on that leg without her knee collapsing.
posted by gally99 at 12:19 PM on July 15, 2006

I've torn my ACL and my cartilage in my left knee -- it's no matter to mess around with.

That's not to say it's impossible to hyperextend without doing this, but please do understand that if the damage was done, you do not want to be agitating it more by not taking great care of it and doing physical therapy and possibly surgery.

I did not have much swelling from my injury - just a gut-wrenchingly nasty noise and a boatload of pain.

I differ from gally99 here, and would recommend that since she's insured, she see an orthopedist if possible. If the doctor didn't seem to examine the possibility of ligament or cartilage damage, she should go to one who will. The worst case scenario is that you waste a co-pay and some time to talk to a doctor who specializes in sports injuries and find out she's fine.

If I'm misinterpreting, and the urgent care doctor said the ligament/cartilage are probably fine but you just could'nt see them on the x-ray, then I wouldn't try to discredit his/her advice of wait-and-see.
posted by twiggy at 12:48 PM on July 15, 2006

I have hyperextended my knees several times skateboarding. A couple of the times were pretty bad, had me laid up for a couple of weeks. I have not torn any cartilage so I can't speak from that point of view. However, I think age has a lot to do with the severity/longevity of the injury. The older you get the longer the recovery. Most of my injuries were in my early twenties. I am now 30 and I am still very active (snowboard, skateboard, bike, and kickbox) and I have little to no problems with my knees....now my back, that is a different story :/
posted by birdlips at 2:10 PM on July 15, 2006

I've torn my right ACL (twice!) and, if I recall correctly, it's not possible to tell if a ligament is torn until the swelling/tightness around the joint has gone down. This normally takes about a week, so it sounds like your urgent care centre wasn't totally out of line, even if overly brusque. People react to torn ligaments differently - I tore mine playing basketball, rolled around on the court in tremendous pain, and then was able to get up and walk off unassisted. Others I know were unable to walk for days.

In order to see if a ligament is torn, your doctor will pull on your knee in certain ways and then compare its movement to that in your uninjured joint. Immediately following an injury, it isn't possible to accurately ascertain the joint's movement as your leg muscles are acting to immobilise/protect the joint.

For peace of mind, I'd suggest making a doctor's appointment in about a week's time. Even though it's probably nothing, it's not wise to mess about with knees! In the meantime, swimming, aquajogging, and cycling are excellent activities that are easy on knees and great for keeping fitness up. I'd wait for the pain to go down before running again, though running on relatively smooth surfaces shouldn't be a problem (I run lots and lots and lots with a torn ACL).
posted by lumiere at 3:45 PM on July 15, 2006

Did they do the anterior or posterior drawer tests? (Pushing/pulling on the tibia/lower limb with the knee flexed.) This usually gives some information about ACL/PCL tears. The "hearing a pop" is also concerning for a tear. The test of choice would be an MRI of the knee. (I'm not your doctor nor *a* doctor; this ain't medical advice.)
posted by gramcracker at 4:33 PM on July 15, 2006

My reason for not rushing in to get a second opinion is that it's never such an important issue that they're going to rush you into surgery. And just walking and regular activity will not cause any more damage, if there's any damage already.
They'll make you wait until they're sure there's no more swelling, and they're going to get you into surgery as soon as it's convenient.
She should definately lay off the running for a couple weeks, as well as anything else that can put any kind of strain on the knee at all, but getting into the doctor sooner is not going to make much difference, and doctors, waiting rooms, MRIs and waiting for test results will put more stress on the both of you than just relaxing and taking it easy for a week or two will do.
posted by gally99 at 5:21 PM on July 15, 2006

The anterior and posterior drawer tests are not terrifically sensitive, but they are fairly specific. Meaning that, if you test positive, you've got a tear, but if you don't test positive, you could have a tear then too.
posted by jennyjenny at 5:58 PM on July 15, 2006

Thanks, all. She's feeling better today (Sunday), but still can't put much weight on it.

I think what it boiled down to is we wanted to make sure we were taking any risks by just waiting for a few days or weeks to find out what actually happened in there. The general consensus here seems to indicate the doctors weren't being negligent or anything. Of course, she's still worried about being able to run again, etc. We'll see.

They didn't do posterior or anterior drawer tests.
posted by M.C. Lo-Carb! at 11:10 AM on July 16, 2006

I crashed a motorcycle and hyperextended my knee. At the time, the only thing that could be said was that it wasn't a fracture or a meniscus injury, so they sent me home with crutches and a prescription for pain meds.

It turned out to be stretched (not even torn!) ligaments. and two different doctors agreed that surgery wouldn't help much, and to basically just suck it up. Three years later, it makes the occasional cracking noise, but no other ill effects.

It took a long time to heal fully though (several months), during which time I could not run. I was able to ride an exercise bike at first, and worked my way up to walking, and then running eventually.

The first few weeks may be the worst, as the internal inflammation works it way down. She may not even know the extent of the injury until that inflammation goes away, unfortunately.

Also - those posterior or anterior drawer tests won't work well on an inflammed (possibly swollen?) knee anyway, so they're not much help until the swelling or internal inflmmation or muscle spasming around the joint reduces. (At least, that's what my doctor told me.)
posted by SuperSquirrel at 7:20 PM on July 16, 2006