Torn knee ligament - recovery path?

Family, Education, Health and Pets
1
Hello!

Being we are in Switzerland, it seems like there are enough of us out here who have wrenched the knee skiing (or otherwise...) I tore my MCL on 1 Feb. and am happy to say I am doing pretty well, have had 3 stints at PT, and can bend the knee quite well, but the straightening doesn't seem to be improving since my last PT session, unlike the bending.

I go back on Weds and will be able to ask my therapist, but given that all is done in German, and while my German is quite good, I still sometimes feel like I might not understand everything!

Any of you out there go through the same thing? I try and do mega stretching, am sure I must be making headway in how far I can straighten my leg but in the end, don't really see any improvement. Like I said, I can tell that since my last session on Friday the bending has improved. I thought she said something like it was important to get the leg straight as quickly as possible to avoid permanent damage, so that is freaking me out a bit!

Thanks in advance.

ps-but it does feel good to be brace free at home and home some knee function again! And I know I need to be patient. I am trying

2
Ow! I feel your pain

I had the same or similar injury about 4 years ago and it really hurts! It took ages to heal I tore the miniscus (sp?) and detached one of my crucial ligaments (Kreuzbande) and nearly ripped through another.

The bending part came quite quickly for me too but fully extending my leg to completely straight took many months and lots of painful physio. Thinking about it now brings back that burning feeling and sheer pain.

I wish you a speedy recovery!

3
hello drmom,

I tore my MCL dec 31st 2009. I managed to ski Easter weekend 2010 with no problems. That said, I could clearly 'feel' it for 18 months. But now it's much subsided.

Do the stretching religiously at home.

Also, I noticed a decent improvement after joining a gym and doing plenty of leg strengthening exercises.

Even now though, my vastus medialis is definately smaller on my injured leg.

4
Because of sports, I tore the ligaments of my left ankle 5 times, my right ankle twice and the lower right side of my back twice. I udnerstand that it's not the same thing as a knee, what I can suggest is therapy lots of it and taking it easy, even though you might feel that you're good to go. In my case, I went to a Chinese doctor, which helped me out imensely. Also, in case you'll engage in physical activities later on, remember to warm up very good and focus on stretching.

5
What was the severity of the tear?

I had a grade II tear of my MCL when I was younger right before the soccer season. I was on crutches for a week or so and forbidden from athletic activity for 4 weeks. Light running for a week or two, then I played out the rest of the season with a knee brace. In my case, I didn't feel improvement until I started moving around again and got the leg running again. Hopefully it's the same for you.

Don't really know any good exercises, as my PT consisted of just gradually making the joint more mobile and easing back into my normal activities, which included weight training, so that probably helped. Anyway, do what the physican and PT say, they should know best.

6
It was a complete grade III tear - but luckily no damage to the meniscus or other ligaments. I did tear a muscle in the back of my knee and had a bone bruise as well. All in all the pain hasn't been too bad - but the last time she was really pressing down to straighten my leg and I was being as brave as possible. But there is no way I can self inflict that kind of pain on myself I have a pretty high pain threshold, but I am also not a masochist so I don't do that at home. Not to mention all I need is to do damage rather than good!

My muscles do need strengthening after 5 weeks of immobility so I do my exercises plus am walking as normally as I can at home and some am hopefully passively strengthening things as well.

Thanks for your responses, I hope I won't be in pain for 18 months, though. The Dr. in Serfaus promised I would be good as new in 6 weeks I am sure he sees these injuries many times a week! Now just hoping I get the bills reimbursed from my accident insurance, as we have the 2500 CHF deductible because we never get sick (knock on wood)

ps-the MRI was almost the worst part of this whole thing! I nearly thought I wouldn't make it. I mean, who can stay TOTALLY still for 20 minutes long. Hopefully there won't be a next time, but I think I will need to be drugged

7
Ouch, total tear? I hated being down after my grade II tear, I'm glad I didn't have a full tear 'cause the PT would have been extremely important, and I was a dumb teenager who didn't give a rip for it.

Good luck, hope it gets better for you over time!

I agree about the MRI. I had to force myself into a zen-like state to forget about the itches that were developing during my MRI.

8
Well good luck! I tore my ACL and MCL skiing when I was 27. I am 44 now. Needless to say I don't ski anymore because of the danger. I never had surgery on either. The MCL 'found itself' to heal. The ACL remains detached and I can exercise straight away - cycling, etc. No running, no soccer (which I used to play avidly), no lateral movement. It gives out now and then when I am fatigued.

On the other hand, my sister had the ACL surgery as she was a volleyball player and the knee swelled like a ballon and she never recovered movement. I'll take mine thank you.

You have to take the time to see if the ligaments 'find each other' to grow back together. If not, then you get to consider the surgery option.

9
Ligament injuries are a pain, and vary immensely. The problem is that they're not able to regenerate, or rejoin if broken, as a bone would, so any tearing or stretching is permanent. Completely broken ACLs are often surgically replaced, and the possibilility should not be dismissed without thought. Some people can manage quite well with no ACL, but others can not.

In most cases there will be other tissue damage, and it often this that causes most of the actual pain, and often the associated inflammation can make the pain worse (by displacing and putting pressure on other tissues), which can in turn lead to more swelling, which all the time can work to inhibit healing as the tissues won't mend until they're relaxed and in their proper places, if you see what I mean.

So initially the answer (assuming surgery is not indicated) is drugs. Anti-inflammatory drugs such as diclofenac or ibuprofen are usually the first choice, depending on the severity (diclofenac is 'stronger') and should be viewed not just as a pain reducer, but as an active healing agent, working by reducing the swelling and allowing the natural healing process to take place.

Longer-term, if you've still got pain it can actively inhibit proper reactivation of muscles, and physiotherapy may be needed to address this, as well as for stretching and development of muscles that may have somewhat atrophied through disuse. Don't be afraid to continue taking anti-inflammatories (unless your doctor tells you not to) as they will work with you to allow faster healing, and the faster the healing takes place the less muscle wastage there will be.

But don't expect miracles - you must recognise that joints can take a long long time to heal, and be be a patient patient, whilst of course doing recommended exercises, but not too much too soon, which can again cause more pain and inflammation. And by 'a long time' I mean sometimes it can take years.

Ask your physio to provide leaflets explaining what he/she is doing. These can be quite useful even if they're also in foreign, and they may help you understand why some things are taking longer than others. Or get a knowledgeable friend to go aling with you and help to explain things if you're still not sure of what's going on.

Best of luck with your recovery anyway.

10
That does not happen. Even if the broken ends are surgically reattached they will not knit together, which is why ACL surgery these days is almost always done in the form of a complete replacement using part of the hamstring tendon.

11
in my totally amateur opinion, the ligament "fibers" have found each other and now need to be stretched back out into the correct place, and the knee(cap?) itself has to get back into the right place. At least that is what I understood my therapist to say. I don't feel any weakness in the knee, and I feel very stable.

I am a bit afraid/anxious to ski again, but I can't imagine not doing it! The accident happened in a very weird situation that I can easily avoid in the future - it was a fairly violent collision (for my standards!) which I tried to avoid by sharply turning and that is where the damage came in. I did then ski for about an hour afterwards as I wasn't sure if there was serious damage - needless to say, I skied very safely during that hour! (it was a special early morning skiing session where we were the only group out on the slopes, followed by a fancy breakfast afterwards). I could tell a bit of instability getting in my skis after the gondola lifts, but I guess my ego and pride were hurt and I didn't want to quit. Plus, by the time I did think that I should maybe not do anything, I was too far from the middle station and figured I just needed to get back (and again, my pride took over and there was no way I was being ski-patrolled back to the station). I was hoping I just had a bad bruise or something but, alas, that wasn't the case!

Plus, I already bought a new pair of skis for next season

12
Hello drmom,

I have never injured my knees but I had a somewhat similar injury in late August 2011: while running, I severely sprained my right ankle and I tore some ligaments. When it happened, I heard a loud cracking noise. I was sure I had broken something. Later I read that the noise was the tearing of ligaments. An x-ray confirmed that there was no broken bone. The doctor suggested that I just take it easy for a while. I thought I would start running after 3 or 4 weeks of rest. It took 10 weeks before I could start running! Now I am back to "normal" training, i.e. 5 runs per week for a total of about 50 km per week. But the ankle still hurts a bit. I read that it can take a year or more in some cases before you get to the point where you have to ask yourself "Wait a minute, was it the right ankle or the left ankle that I injured?"

I suppose that physical therapy might have improve my recovery. Also, it would have been nice to have a precise diagnosis. But as with previous injuries, once I can run again, I am happy and nothing else matters.

Best wishes for a complete recovery!

13
Update on my recovery for those of you who might be unfortunate enough to have this injury.

I finished my physical therapy the end of April after about a dozen sessions. My main problem was range of motion and not stability. In the end, lots of pressing and pushing on my leg to try and get it to straighten and bend all the way were done. That was not fun!

Now, then end of May I am working out again and trying to get back in shape. I can do pretty much everything that I want - jog, bike, etc. I still can't sit all the way back on my haunch but it is close. Also, since my knees seem to go a bit further in the negative direction (over-extended normally) the injured knee still can't extend like the non injured one, but I can get better than 0 degrees which is technically full range of motion.

For the most part I am happy with the progress. The injury is thankfully a distant memory. Now my big question is how I will feel when it is time to hit the slopes next year! Hope I won't be scared...that would be dumb! And I bought new skis

14
What a depressing and scary thread.

Makes me glad I chose much safer sports...such as tennis...cycling and motorbike racing.

Oh wait.

15
exactly. I have heard people who have torn ligaments just tripping and falling at home or at work, so I guess I was *lucky* and had a *real* accident...

Is it really depressing? Don't tell me that, I'll have to start feeling blue...

16
Whats depressing is that a torn ligament at my age (40) never really goes away. There will always be days it aches, or perhaps theres permanent range loss (as some have noted). Especially at knees, elbows and ankles.

Thankfully my racing days are long gone, so it's really only cycling these days. Which in itself is a good sport for avoiding injuries (and even recuperating from others), but presents it's own problems, such as imbalance, and lateral weaknesses.

17
OK, I'll be depressed now...I hit that magic number this year too oh, and I broke a tooth (first time ever, and it happens to be a baby tooth and can't be saved) and it will need replacing. And my daughter broke her arm. 2012 not being good to me Woe is me. And I have a 2500 CHF franchise...although time to consult my excel spread sheet to prove over the whole year it is still cheaper for our family of 5!

18
i did mcl skiing three years ago, because I d not have enough physio to start with, ended up with bad tendonitis in lower leg. Had physio int he end for about 5 months, still occ get pain at that side of the leg, but basically ok. Unfortunately i am now 8 weeks into recovery of surgery after tear of ACL on the other leg - injured last year but delayed surgery adn had physio first but ultimately still had an unstable knee even when walking. DOing well, still stiif, but got very good movement back, able to use a static bike, doing squats and lunges, no splints needed etc. Just need to build my leg back up now. My opinion is always get physio straight after these accidents!

19
Oh completely bust his interior cruciate ligaments in a ski accident in his mid 40s, and was told by the surgeon in the UK that he was 'too old' to have them operated on. He was absolutely furious - the physio showed him some exercises to do, and he followed the advice rigorously. A year later he was skiing again, with a knee support. He also started playing squash again twice a week, about 6 months later. The next year he skiied again with a knee support - and has been skiing and doing squash without since then.

He now agrees that operating is not always the best option- and has no regrets. In his mid 60s, he still skis without problems. Keeping the muscles around the knee with specific exercises can truly be a solution that works long term.

20
I snapped my ACL six years ago and had successful surgery which has allowed me to return to skiing and telemarking, ski touring, 2 day mountain hikes, mountain biking etc.

Yesterday I went for a 3 hour walk and last night my knee had swelled considerably and is still swollen now. Small amount of pain but guess that is due to the swelling.

Never had anything like this happen in the last 6 years. Any ideas anyone? Thanks.