How best to deal with a torn knee ligament?
December 15, 2016 10:27 AM   Subscribe

Rehabilitation and injury care advice wanted.

A relative of mine recently took a spill on some unshovelled, icy ground. He landed mainly on his knee. Overnight the knee swelled up and he called his GP, and was told to go to the emergency room.

The attending physician there diagnosed his injury as a torn ligament, but didn't go into any other details but to say he "hoped it wasn't behind the kneecap." His advice was to take it easy for six to eight weeks and if it's still a problem, see a specialist. He prescribed nothing, saying anti-inflammatories have the potential to cause stomach upset, but added my relative could take an Aleve or and Advil if the pain was too great.

So given that his primary physician is useless (and she mainly is) and there was no real advice from the emergency guy, what should my relative be doing to ensure he heals in the best way possible? If it matters, he's a senior who has had both hips replaced, and while that makes him sound feeble, he's the exact opposite. He's tougher and stronger than people half his age and does more work and physical labour than two average people on a good day.
posted by sardonyx to Health & Fitness (12 answers total) 1 user marked this as a favorite
Is there any reason to not go to a specialist tomorrow?
posted by gregr at 10:45 AM on December 15, 2016 [2 favorites]

My brother tore his quadriceps tendon last week and will have surgery on it this week. The leg will be immobilized for six weeks and then there will be 6 months of PT.

I suggest your relative go to an orthopedist or sports medicine specialist.
posted by suelac at 11:06 AM on December 15, 2016 [2 favorites]

Knees are tricky bits, especially when it comes to healing. Your relative needs to rest his knee, but also needs to keep his strength in his legs. The doctors I saw about a recent knee injury had a lot of advice but weren't really a lot of help:

- No deep squats. No squatting to pick things up off the floor, look in cabinets, that sort of thing.
- Lots of squats! We're talking about the controlled-movement excercise kind. You throw your butt out in the back and balance yourself with your arms out front and squat with your knees pointed exactly the same direction as your toes to about a 90° angle, so the quads are parallel to the ground (but no deeper!). You're allowed to hang onto something at first.
- You have to keep muscle strength up in your legs otherwise you put all the rest of your ligaments and soft tissue at risk from overuse.
- But you have to rest when you feel pain and don't overexert yourself at the same time.
- Pain usually means inflammation, treat with rest and anti-inflammatory medication.
- Knee braces help with stability. I'm usually ok with a compression sleeve, though finding a good fit can be challenging. I'm hoping to start using a more complicated brace today (c'mon UPS!) while cycling. There are websites (e-stores) that can help you choose a brace based on your injury.
- Cycling and swimming are good low-impact exercises, just pay super close attention to form. Keep your knees over your toes!

I spoke to a surgeon about my injury, but he advised against surgery. It's really easy to make things worse when you cut into a knee, apparently, and just as easy to not really improve the situation. It's been a frustrating few months of recovery, but now that the pain has receded and my life is mostly normal again (as much as is possible, natch) I'm glad I put the work in and the rest in to heal properly. I hope your relative heals relatively quickly!
posted by carsonb at 11:36 AM on December 15, 2016

Oh, and for the record that's a summary of advice I received from:

- A family doctor, who sent me to get x-rays and referred me to
- An orthopedic specialist, who arranged a CT scan and had me talk to
- A physical therapist and helped me make an appointment with
- An orthopedic surgeon, who interpreted the CT scan and offered not to perform surgery...
Over the course of a few visits to the medical center.
(A lot of people complain about Kaiser Permanente apparently, but I've always had pretty exemplary experiences.)
posted by carsonb at 11:44 AM on December 15, 2016

Oh I forgot! All of that happened after I waited 3 weeks to see if the pain would recede, which I realize is a very relevant bit of information to your question. Sorry!
posted by carsonb at 11:52 AM on December 15, 2016

Response by poster: Personally, I think he should see a specialist, but that involves getting a referral from the GP who has a very lackadaisical wait-and-see approach to that sort of thing. And when she finally makes a referral it's usually to local quacks who really shouldn't be practising. (I had to find somebody out of town for his hip surgery, after the local idiot "specialist" just kept shooting him up with cortisone. And even then, we had to pass the hip guy's name to the GP so she could make the referral. Oh, and his hip guy doesn't do knees.) So that's where we stand with the specialist, which is why I've turned to the Internet.

Thanks for detailing your experience, carsonb. That gives me some hope and some (modified--for example, no cycling after the hip surgeries) suggestions to pass along.

Still if anybody else wants to chime in, I'm still all ears.
posted by sardonyx at 12:36 PM on December 15, 2016

As someone who just came out of a knee ligament injury, get a different GP ASAP and a referral on insistence to a specialist of your own choosing (with research). I happened to have an injury that, if I had waited a week, would have meant a drastically different outcome in my ability to walk.

This is no joke.
posted by pando11 at 1:21 PM on December 15, 2016

WTF does "tore a ligament, hope it's not behind the kneecap" even mean? He should see an orthopedist and get an MRI to see what happened. If it's a partial tear then yes, surgery may not be needed or advised. But in that case you'd still want a plan of how long to rest, pain control, and probably physical therapy.

Source: I tore my ACL last year in a freak accident, was poorly diagnosed by an urgent care doctor that thought everything was fine because it wasn't that swollen and I could stand on that leg, even though it felt unstable like it would give way or collapse at any time. Had a "90-100%" tear diagnosed via MRI and tried to avoid surgery on my orthopedists advice, with physical therapy for 6 weeks, but ended up having surgery.

It's very true that surgery is a bigger trauma than the initial injury and a bear to recover from. My surgery was Jan 22 of this year and I'm not back to 100% though I am performing all of my usual activities now. My ortho doc told me it was totally up to me, especially because my sports (cycling and running) were all straight-line not really side to side stuff. But you have to know what the actual extent of the injury is - sprain, partial tear, full tear - and *which* ligament before you decide. And even without surgery I really think your family member probably could use some physical therapy, which they'd probably also need a referral for.

I'm sorry your family member does not seem to have a good care team. I hope you can help them get decent advice!
posted by misskaz at 1:23 PM on December 15, 2016

I went to the ER with a hurt knee last year. The doctor there couldn't tell me exactly what I'd torn or how badly I'd torn it, but he referred me to orthopedics and told me to make an appointment to get an MRI. They needed the imaging to tell the difference between a bad sprain and a complete tear. It turned out that I'd torn my ACL and badly sprained my MCL, and even if I hadn't opted for surgery I was going to need to do PT.

It sounds weird to me that your relative's doctors don't want to be more precise than "a torn ligament" and are happy to wait so many weeks to see if things improve. My understanding is that it's easier to tell what's going on once the swelling goes down some, but also that you don't want to wait too long because you'll start losing muscle if you can't use the leg.
posted by Akhu at 2:29 PM on December 15, 2016

It sounds weird to me that your relative's doctors don't want to be more precise than "a torn ligament" and are happy to wait so many weeks to see if things improve. My understanding is that it's easier to tell what's going on once the swelling goes down some, but also that you don't want to wait too long because you'll start losing muscle if you can't use the leg.

I'm guessing the poster is in Canada so the specialists probably won't be able to see them until January anyway because their schedule will be crammed due to doctors taking holidays and patients wanting to avoid treatment over the holidays as well.

I'd go with standard RICE treatment for a week and see what happens.

My guess would be that it is a ligament sprain that got translated into something worse via chinese whispers and it will probably be the PCL which isn't that big of a deal. After the intial swelling goes away he will probably know by the pain and knee stability what he hurt. PCL injuries manifest in pain going up stairs but otherwise are not that bad. Other ligament injuries are often much worse symptom wise.
posted by srboisvert at 3:23 PM on December 15, 2016

Response by poster: You've got it. Southern Ontario, so if anybody in the area knows a good knee specialist (anywhere in the Toronto to London corridor should work), I'd be happy for a recommendation.

I hope that's all it is, srboisvert. I've suggested seeing a specialist but am receiving pushback of the "I'm fine" and "it's better" variety, even though it's extremely obvious that's not the case. I'm sure if it doesn't improve I can convince him to see somebody--eventually.

As for the "diagnosis" I heard the same thing from both people who were in the room, and the vagueness doesn't surprise me. It sounds pretty typical for that hospital and its use of resources (happy to send people x-ray, but never seem to be willing to send the patient a few steps further to the MRI department.)
posted by sardonyx at 4:48 PM on December 15, 2016 [1 favorite]

A lot depends on which ligament. The anterior cruciate ligament (the one behind the kneecap) is the worst one. I tore my medial collateral ligament (the one on the inside, between your knees) earlier this year. Rehab involved a lot of strengthening and stretching the surrounding muscles and being banned from any kind of high impact exercise (though walking and cycling were fine).
posted by intensitymultiply at 7:35 PM on December 16, 2016

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