Knee Pain

Yes, it is possible to function normally (and even at athletic levels) without at ACL. But, I've heard this same story numerous times. Strange, but true.

CW

 

Wrong. Depends on the type and location of the tear and cycling doesnt load the knee very much unless you are standing on the pedals and grinding it out.

Straight flex/ext of the knee with an acute MCL sprain is usually painful no matter how perfect the plane is. Plus the OP stated pain as inside front which is not where the MCL is located.

You should be very careful about advising people not to see an MD. Kinda puts your butt on the line if it turns out otherwise. I'm sure nothing would come of it, but CYA!

I have never heard of anyone injuring themself when they slept! You might get your leg in a painful position but extremely unlikely to cause further injury. And there are many braces on the market that serve different purposes and do so admirably. You are speaking from a single study on skiers and spreading it across the board, which is basically making assumptions and you know what they say when you assume!

 

I can vouch for this fact myself. I myself had severely sprained my knee required that I wear a knee splint for 10 days because I did not untuck the sheets at the foot of the bed one night. My size 15 foot was trapped under the covers and when I rolled over the pain was so extreme that I yelled out loud waking up half the hotel I was in. On top of that I ended up missing 3 races due to the injury. I have since always slept under loose sheets. It pisses off my girlfriend but I can walk in the morning.

 

I'm gonna need a little more info on that severe sprain. Not doubting that it happened just hard to believe that rolling over with your foot caught in the sheets could cause that much damage. Seems like the sheets would give well before tearing a ligament. You must be one fitful sleeper.

 

You may wish to re-read my comments --- more carefully this time. The "cycling" I refer to is not the act of pedaling a bicycle or piece of exercise equipment --- rather, it is the motion of cycling the knee joint through its flex-ext ROM.

When a patient says, "my knee hurts in the front and the inside", prudence suggests that may not be a perfectly precise description. I also suggest you bone up on your anatomy --- paying specific attention to the nerve network in that area of the knee.

I've seen many patients with complete ruptures of the ACL, MCL, or LCL who claim to experience no pain whatsoever --- until we put them through guided over-ROM and stress testing. I've also seen a few whose partial tears were entirely unpresented through physical exam, but suggested, and not actually revealed until MRI or scope study.

That is not what I said --- again, read it more carefully.

No it doesn't --- "cover my a**" from what? Obviously, you are not a lawyer either.....

You've obviously never spent any significant amount of time in a hospital setting (at least not from the attending perspective) --- post-surgical and post-injury / trauma patients hurt themselves ALL THE TIME during sleep. For example, pulling sutures is so common that many patients require sedation during sleep for prevention. It doesn't take hardly any "stress" to exacerbate a partial tear to a full tear of a joint ligament --- easy to do when you are asleep and completely unmindful of your prior injury (the OP has already injured the knee, remember? Now, it is more vulnerable than a healthy knee) as you would not be when you are fully awake and paying attention.

I get the impression there may be many things you have never seen nor heard of before... Besides, "sleeping" is not why that recommendation gets made (from most Physicians, btw) for knee injuries. Many people get up in the middle of the night ---- half asleep, stumbling in the dark, and non vigilant to protecting (or even being fully aware of) themselves --- to get a drink of water, use the bathroom, answer the phone, put the cat out, etc. People get injured rather frequently getting out of bed under such situations. Ever stub your toe in the middle of the night?? --- think you can't "stub" your knee?? How about being half asleep, falling down the stairs in the dark, and breaking your neck?? --- Yes, it has happened. Increase the breadth of your thinking a bit.

 

Well this thread proves one thing. Guys here can argue about anything with passion.

Phil, did you go to the doc yet? Just wondering what HE or SHE might have said about the extent of your injury.

DM

 

Pain in the location described by the OP (with the assumption the OP does not have a medical/anatomical background) could refer to many derangements including, but not limited to, meniscal tear, MCL sprain, pes anserine bursitis, patellar tendonitis, loose bodies, and/or onset of medial compartment osteoarthritis. The bottom line is nobody can give a proper diagnosis over the internet. We can only provide possibilities. A physical examination, and if required, imaging and or scoping, is the only manner in which to receive a proper diagnosis and appropriately recommended treatment.

Most meniscal injuries will be more painful with increased weight bearing and/or within certain ranges of the full ROM arc. What has not been described by the OP is the mechanism of injury (MOI). He stated it had been "tender" for the past few weeks. Does that mean it is tender to palpation, tender to weight bear? Does he recall a specific event where he injured the knee, was there swelling, instability, stiffness? Without knowing all of the facts, and even if we did, we are all speculating.

In regards to braces/compression sleeves and more specifically ACL braces. Neoprene type sleeves provide compression to assist in the reduction and possible increase in edema. They also provide proprioceptive feedback which is lacking after an injury. So they do provide some benefit. Braces are another story. The most common problem with braces of any kind are the improper fitting of a brace by the patient outside of the clinical setting. Know matter how "good" a brace is if it is not properly donned/fitted it will not work.

John Elway played NFL football without an ACL. An ACL is not necessary but provides increased stability of the knee joint and decreases anterior translation of the tibia. Even after an ACL reconstruction there is still anterior translation of the tibia greater than what is desired. The manner to combat this is specific hamstring strengthening activities and closed chain quadricep (VMO) strengthening as open chain extension activities of the knee are an absolute no no during rehabilitation of a post ACL reconstruction. Plus closed chain activities are more functional. In addition many post ACL reconstruction patients will never see full knee extension secondary to the anterior translation of the tibia. When the body notes excessive anterior tibial translation it shuts off the quads not allowing full extension. The only brace I found, when I used to practice, that decreased anterior translation was the Bledsoe dynamic ACL brace. In my opinion, certain braces can be effective if fitted and donned correctly.

In regards to sleeping; we never know what we are doing when we are sleeping. Bracing/splints can be effective in decreasing unwanted movements post injury while sleeping. I am sure it is possible to injure oneself when sleeping as noted by another poster. It doesn't appear that it was a significant injury as he only wore a brace for 10 days and his symptoms appeared to have resolved.

Finnerty, I have a slight problem with your advising the OP to take ibuprofen as you are not aware of his full medical history and ibuprofen may be contraindicated. Although I am sure the OP would/should know that already. You also stated that is his injury doesn't heal or pain resolve within 2-3 weeks he should see a doctor. Soft tissue injuries typically take six weeks to fully heal and that is if the healing process is not disturbed. You also stated he could go see his MD if he chooses and I feel that is appropriate so that he can obtain a correct, non-internet diagnosis. You also stated that his injury is unlikely to be one that would warrant surgical intervention. Again speculation which in my opinion is improper. When providing any information on this forum regarding musculoskeletal issues I always try and advise the poster to see their physician (see threads on the bicep tendon rupture, knee popping,). You never know when your internet thoughts may be incorrect and it is always a good idea to error on the side of caution.

I don't want to get into a pissing match with anyone but want to provide insight if I can and make sure the poster of any injury gets the appropriate medical diagnosis/treatment through the proper channels. I know we are all trying to help but we all need to be careful as to not provide advice that may lead to a greater injury.

 

Which the OP did after his knee began to hurt. On a bicycle.

Oh please educate me good doctor!!!! You know nothing of my background. What exactly is your specialty?

Me too! Can we be friends now!!!!! I've even seen them happen with absolutely no sign or symptoms other than a positive drawer. Wow!

CYA from offering poorly based advice on the internet w/o even putting hands on the OP. And no, I am not a lawyer but I did stay at a Holiday Inn Express last night!

Never claimed to be an attending but the last 20 years in the medical field may have given me a little perspective that you are lacking. And is popping a suture really considered an injury. Not to me or the surgeons I have worked with. More of just annoying complication that is easily corrected.

Really. So when was the last time that you performed a drawer on someone and completely tore what was left of their ACL. After all, "It doesn't take hardly any "stress" to exacerbate a partial tear to a full tear of a joint ligament". Hasn't been my experience but maybe yours.

Please enlighten me O Great One! And I get the impression that you don't know as much as you think you know. What is that line about... baffle them with your BS.

Right. So to protect the inury/surgery from further harm or from moving into an very uncomfortable position that may exacerbate the injury/surgery. And no, I have never heard of anyone stubbing their knee. Please explain that to little ole me! No big words though! Increase your breath, so your brain gets more oxygen! You also might try pulling your head out of your a##!

 

Well said PT 328. Point taken on my part.

 

Thank you. I think we all mean well.

I feel the ideal scenario for people coming and asking questions on F-chat in regards to health related issues is to get an idea of what their injury/illness might be but not to obtain a definitive diagnosis. Using our thoughts they can perform some internet searches to read about the possible injuries/illnesses the individuals on this board have suggested. Having an increased knowledge base prior to a MD appointment can never be a bad thing. It may also allow them to ask more appropriate questions of their provider(s).

 

Agreed. What do you think Finn?

 

Assuming it is a meniscal tear, it really depends on the type and severity of the tear and if it can be repaired or removed. Repair requires usually 8 weeks on cruthces to allow the meniscus to heal. Menisectomy, or removal of a portion of the meniscus, will usually require a few days to a week on crutches and a few weeks of rehab to get things going. In my experience, the portal holes are sore much longer the the actual meniscal pain. That could be 2-3 months of increased sensitivity with the portals. Young athletes can be back in a week. But no need to push things unless you are getting paid to play! Kind of a catch 22 in that you really want to keep the meniscus intact to prevent arthritis down the road, but that recovery is a longer road. I wish you the best. Let us know how things progress!

 

Had this done 3X, twice over 45 yrs old.

they took out a little of the meniscus and cleaned up some messes in there. I was on an exercise bike in about 3 days, waling pretty normally. Pain was minimal, used ice, got some PT,was pretty much back to 100% in 4-6 weeks.

NOTE, pretty much normal for me meant getting back into my workout schedule at the gym, not skiing, which I suspect is much tougher on knees than elliptical trainers and some weight lifting.

Follow the instructions of your PT guy after surgery and you'll be fine. Push too hard and the setback will be a great lesson in how it's important to follow directions.

DM

 

But, the good news is that you, too, can be 100% again!

If it's a meniscus, it's common, and it's fixable. An annoyance, to be sure, but do it right, take the rehab seriously, don't rush it and you'll be as good as new.

CW

 

Both of these responses are dead on but I will add a few more thoughts. For a meniscal repair to be effective it has to be in whats called the red zone. The red zone is the area of the mensicus that has a good blood supply, this is on the outer third or so of the meniscus. Inside that area is called the white zone and has very poor blood supply so a repair in this area is not a good idea. Most of the time, or at least when I was in the field years ago, they used barbed dart to hold the tear together for healing.

Phil, good luck as you move toward diagnosis, treatment and recovery.

 

Yup, good luck.

CW

 

You will not be able to have surgery and be ready to walk long distances in less than 20 days. I would also avoid surgery that close to flying, especially if they are long flights, secondary to an increased risk of blood clots. Throwing a clot on a plane causing a pulmonary embolism at 30K feet is not the ideal location for medical assistance. I, myself would avoid surgery until I returned from my trip if at all possible.

In regards to your "make sense" question. How I look at any orthopedic surgery is if you can do all of the activities you have and want to do with the assistance of post activity icing and/or proper OTC medication for pain then I wouldn't have surgery. If you cannot perform those activities then it is time for surgical intervention.

Your mensicus will more than likely not repair (scar) on it's own that won't cause you future problems. The question is can you deal with those problems. That, my friend, is the million dollar question that is your call to make.

 

Not sure if I would do that with my knee since I have seen too many athletes try it to finish a season and end up with early arthritic changes in very young knees. Of course they are also pounding the crap out of them and you don't have to do that. I would focus my cardio on less weightbearing exercises like bike and elliptical to protect it as much as possible.

Hopefully you won't have any problems with it and can make it through ski season at least! Wish you the best.

 

PnH,

How's the knee going? I'm beginning my dryland workouts late this year, due to a death in my family. Stuff's sore, but I'll be good to go by mid-Dec. Will miss Vail's opening day, but it's getting hammered. If this is any indication, it will be a good snow year. Crossing fingers...

CW