How bad could this be.........

Skiing the trees at Stowe three days ago. Thigh deep powder and I'm on tele skis, but not super wide so skis were under the snow. As I made a 90 deg turn to my left, my left ski caught on a buried fallen branch. I fell forward head first and twisted left around the stuck ski, but the binding released, as did the right binding. Surprisingly, it is my right knee that suffered the trauma, I believe from an over-extension as I fell head first. I do not think there was much twisting of the right leg, and the leg was definitely fully extended, so not the normal position for popping the ACL.

I may have heard two pops as I went head-first, but I'm telling myself that was the bindings releasing! No that I think of it, I didn't feel any sensation when I heard the pops.

I didn't have any pain, but the knee was definitely wobbly when I got up. I skied to the lodge very gingerly; knee was only felt stable with the knees bent . Upright, the knee felt unstable. Got some ice on it and had full mobility, no pain, no swelling, full weight bearing the rest of the day, but it did feel wobbly. Stairs no problem.

Next day, still no swelling. Had a PA look at it and do Lachman test on both legs. She said they felt about the same in terms of looseness. BTW, I had a 100% ACL tear in the left knee 20 years ago. BIG pain and HUGE swelling. This week's injury NOTHING like the left knee.

So, today is Saturday. I gave it a lot of RICE Thursday and Friday along with ibuprofen. Today I had to drive home to CT, so no Ice and no Elevation. Symptoms today:
- no noticeable swelling
- MCL sore if I press on it, or perhaps it is soreness due to meniscus tear
- slight soreness on the LCL side with pressure, also perhaps it is soreness due to meniscus tear
- no bruising around the knee
- no locking, popping, clicking, etc.
- no pain or soreness walking
- knee is stiff
- perhaps some instability - I am fearful of over-extension. I may just be having some reflexive twitching rather than instability
- I have not had any falls, even walked on rain soaked wet ice and slush all day yesterday for various reasons, no prob.

I'm walking almost normally, but being very careful not to twist or over-extend (I'm pretty clumsy).

I'm hoping I have a bad sprain due to the over-extension - stretched out the MCL and perhaps a meniscus tear. Praying it is not ACL/PCL.

Thoughts?

MCL's almost never require surgery. Ligaments by themselves do not have a lot of nerve endings so without other damage you may not have pain. Blood in the joint capsule causes a lot of pain so without it, gets hard to tell. Bruising sometimes takes a few days for the black and blue or yellow to show up. I tore my ACL with no pain / no swelling, slow backwards fall. Rehabed and have done well without it for 15 years, wear DonJoy ACL brace for skiing. Three weeks ago did the MCL same knee, similar fall as you describe, soft pow, felt it pop. Pain for maybe 30 seconds, skied down, felt funny but when I took my boots off I could swing by leg side to side and the lower leg swung way too far, pretty yucky. With no ACL I could self diagnose complete tear which was confirmed, Grade 3. The test can be hard to be sure unless you can completely relax and not provide any resistance to the movements they are doing. Also, well developed quads can provide some pretty good support that makes it hard.

Not quite three weeks and I feel pretty good, plan on skiing next weekend. swelling gone, range of motion back and strength good. Get after your quad asap, knee injuries shut that down right away. In a week even though I was doing rehab the difference between my two legs was amazing, injured leg quad was mushy.

If your insurance will cover a good Rx brace get it. The brace provides support that allows for rehab that I would not have been able to do so soon without it. Two days after I was riding a stationary bike, started weights the second week, went to elliptical and am doing leg presses with quite a bit of weight.

good luck

Thanks for the response. It is day 4 now, and I have soreness on both inner / outer sides of the knee at the joint, and a little soreness in the MCL. I'm walking, climbing stairs, no pain. Even kneeling on it, no pain. But I do have some minor swelling and stiffness and about 80% normal ROM.

I'm not feeling wobbly, but being very careful. I would think that is the ACL were gone, I would feel some instability, even with the swelling (I certainly did the 1st time I blew an ACL).

So, staying optimistic that it is a bad sprain.

I see the orthopedist on March 4.

I strained one MCL once teleing in heavy wet Sierra Cement at Heavenly. It was fine in a week or two.

I tore both more seriously when I did my tib-fib and malleolus on my left leg (Hammerheads didn't release or pullout of Explosivs in like 50-60MPH cartwheel). No surgery that time either, but I was on crutches for four months for the fractures and taking it easy for months after that. They were sore for almost a year, but are totally fine now. I would lie on my side at night, and if my legs weren't perfectly aligned and supporting the upper knee, the weight of the leg statically hanging on the knee would make it sore. I don't know what grade the tears were because they ortho never told me, but they were pretty fucked up.

My understanding with MCLs is that surgery is rare outside of pro athlete situations when they need a quicker turnaround or very rare/random extenuating circumstances.

MCLs rarely require surgery because the ligaments are extra-capsular, meaning outside the knee joint itself. Therefore, they almost always heal. ACLs are inside the joint and bathed in synovial fluid, which may partly account for their poor healing (and why we reconstruct them rather than just repair them because they don't heal if just sewn back together).

While ACL tears classically have immediately swelling (the artery to the ligament bleeds) and difficulty bearing weight, this is not invariable. Unfortunately, a fall with a feeling of "pop" and some degree of wobbly sensation is concerning for an ACL tear until proven otherwise. That being said, we're all rooting for you.

^^^ Great info. I always wondered why.

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Originally Posted by meatball66

Thanks for the response. It is day 4 now, and I have soreness on both inner / outer sides of the knee at the joint, and a little soreness in the MCL. I'm walking, climbing stairs, no pain. Even kneeling on it, no pain. But I do have some minor swelling and stiffness and about 80% normal ROM.

I'm not feeling wobbly, but being very careful. I would think that is the ACL were gone, I would feel some instability, even with the swelling (I certainly did the 1st time I blew an ACL).

So, staying optimistic that it is a bad sprain.

I see the orthopedist on March 4.

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Ice it as much as you can, every two hours for 15 minutes if you have the time. ROM can be helped by placing your heel on for example a coffee table and have the rest of the leg back to your butt unsupported, letting the knee kind of "sag from gravity". Be careful about not having instability, I tore my ACL and never had any instability. Avid runner so quads were uber strong and I did a lot of single leg balancing to train the muscles around the knee to take over in the event of loss of balance. As I said I have worn the big brace since then, too bad it didn't prevent the MCL tear. Also for rehab see if you can do straight leg raises laying on your back with no additional weight on the leg. If yes add some low weight and see what happens, be conservative. Is the Orthopedist a Surgeon? I go to a Sports Medicine MD, they tend to NOT recommend surgery if there is any alternative.

We'll, I've been trying to stay very optimistic because things continue to feel better.

I should note that I was doing moderate aerobic training 4-6 day/week leading up to the injury, so the quads are pretty strong (running, bike-trainer, XC skiing, and tele-skiing weekly). I am hoping that protected the knee rather than it giving me the current false sense of security that everything is A-OK.

I have 100% ROM on the extension side "sag from gravity", 80% on the squatting, if you know what I mean.

The Ortho is a surgeon, sports med specialist, knees and shoulders.


I'll keep you posted

Day 7, feeling pretty good, still stiffness, still some swelling. Walking without any compression on the knee. Taking Ibuprofin 2x / day

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Originally Posted by meatball66

Day 7, feeling pretty good, still stiffness, still some swelling. Walking without any compression on the knee. Taking Ibuprofin 2x / day

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I would limit the ibuprofen. Latest research indicates that inflammation may aid healing and avoiding the drugs may shorten the time required.

I always felt that the inflammation is the body's way of protecting the joint. So by reducing inflammation, you are able to use the joint more than the body's natural expectation. So perhaps longer inflammation results in more Rest, hense quicker recovery. I'll buy that.

So I'm off the ibuprofen. Inner side of the knee is sore in the morning when I wake up, and I have to be careful fully straightening and stretching. ONce out of bed, moving around fine. It's lunchtime now, I only notice the knee when I am up walking around, not due to soreness, just not back to normal walking gait.

I see the Otho on Tuesday 3/4. I'm still telling myself that I had a bad strain, no permenant damage......just did a 90deg squat with my back against the wall. No pain, felt normal.

I feel like I could ride my bike trainer and do stairmaster workouts today, but I do not want to risk increased swelling before the Ortho. I want him to be able to easily manipulate the joint.

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Originally Posted by bigdude2468

I would limit the ibuprofen. Latest research indicates that inflammation may aid healing and avoiding the drugs may shorten the time required.

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Quote:

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Originally Posted by meatball66

I always felt that the inflammation is the body's way of protecting the joint. So by reducing inflammation, you are able to use the joint more than the body's natural expectation. So perhaps longer inflammation results in more Rest, hense quicker recovery. I'll buy that.

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Recent research seems to indicate that NSAID's can counteract some of the benefits of working out (eg. taking IBU for soreness). That information SHOULD NOT be transferred to acute injury situations when the body will benefit from a reduction in inflammation - at least during the first few days.

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Originally Posted by Swine

Recent research seems to indicate that NSAID's can counteract some of the benefits of working out (eg. taking IBU for soreness). That information SHOULD NOT be transferred to acute injury situations when the body will benefit from a reduction in inflammation - at least during the first few days.

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Here is a recent article from the New York Times. Some previous research had shown that NSAIDs (ibuprofren, aleve, etc) slowed bone healing, this included soft tissue.


In laboratory experiments on animal tissues, NSAIDs actually slowed the healing of injured muscles, tendons, ligament, and bones. “NSAIDs work by inhibiting the production of prostaglandins,”substances that are involved in pain and also in the creation of collagen, Warden says. Collagen is the building block of most tissues. So fewer prostaglandins mean less collagen, “which inhibits the healing of tissue and bone injuries,” Warden says, including the micro-tears and other trauma to muscles and tissues that can occur after any strenuous workout or race.

The painkillers also blunt the body’s response to exercise at a deeper level. Normally, the stresses of exercise activate a particular molecular pathway that increases collagen, and leads, eventually, to creating denser bones and stronger tissues. If “you’re taking ibuprofen before every workout, you lessen this training response,” Warden says. Your bones don’t thicken and your tissues don’t strengthen as they should. They may be less able to withstand the next workout. In essence, the pills athletes take to reduce the chances that they’ll feel sore may increase the odds that they’ll wind up injured — and sore.

^^ Correct, and the conclusion of the article states:

" When, then, are ibuprofen and other anti-inflammatory painkillers justified? “When you have inflammation and pain from an acute injury,” Warden says. “In that situation, NSAIDs are very effective.” But to take them “before every workout or match is a mistake.” "

I'd say the first couple days after an MCL/ACL is an acute injury situation. At this point however, probably a good idea to limit or completely forego the IBU.

Knee feeling better but still very sore in the AM when I wake, but walking almost normal now.

Went to Ortho today. Took XRays (why??), normal.

Tugged on both legs, kind of a modified Lachmann, said both sides were equally loose. Checked out MCL, said is was intact and "springy" as it should be.

Said that the ACL is like a firehose, if I had blown it, would have expected serious swelling, which I never had. I know that from experience on my Left knee.

I have an MRI Thursday and a follow up next Tuesday. In the meantime I can start training again, whatever doesn't hurt, just no cutting moves.

Starting to think I dodged a bullet!

Its all over but for the crying, full ACL rupture. Surgery in two weeks :-(

So, I had the surgery on 4/14 so I am T+17days. I did the allograft. Twenty years sure makes a difference because I was miserable with pain the first 14 days, I don't remember being sucha wimp when I had the patellar autograft procedure 20 years back. Getting much better now. I can actually concentrate and get work done. PT going well, riding the bike on day 15.