MCL, Meniscus tear, subluxing patella

by Teresa
(Honolulu, Hawaii, USA)

Please help me, I am in tears over this on going issue.


I live in Hawaii - and the doctors keep telling me that they can't help me.

They tell me that I can't ever dance, weight lift, jog or do yoga ever again. I am only 25 years old as of July.

When I was 21 or 22 I played softball for a city team for fun and injured myself - I was running back from 3rd to 2nd base and planted my foot hard -half on and half off the base - i twisted my knee and fell to the ground in extreme pain - one of the doctors I went to suggested that I may have torn my MCL in this injury.

I recovered from this within weeks - at the time thought little of it because my doctor only had me do an xray.

About a year and a half later I was doing aerobic dancing in my living room and my knee "popped" and twisted and i fell to the ground in agonizing pain. The swelling subsided after a few weeks on crutches and while the recovery took longer I did recover.

This time on March 25, 2008 I was dancing and another "pop" and twist and intense pain. the swelling happened immediately and I couldn't walk on it for well over a month. This time I got an MRI and a xray.
This revealed a small tear in the lateral meniscus and only one of the other opinions I got told me that I had a torn MCL - but no one else said that- not even the MRI report - she said that "Most of those guys dont know how to read those things" - which bothered me. They also said that my patella is "subluxing".

When I tell these doctors how upsetting this is - and how important especially dance and weight lifting is to me they say that it really isn't that important and that i need to focus on doing the things I can- which is basically small physical therapy stretches and "swimming straight-legged".

I am so frustrated because I've been weight lifting again for the last four weeks and my body was starting to feel like my body again and during my knee press and lunges I can feel "crackling" in my knee - which i thought was scar tissue being broken up - but my doctor says it is a sign that these exercises are ensuring a life of arthritic pain.

Comments for MCL, Meniscus tear, subluxing patella

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Aug 21, 2008
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My question is..
by: teresa roberts

this is my question - do you think my doctor is full of it and doesn't know what he is talking about? what should i do to be able to do the things i love to do? and WHY WON'T ANYONE DO SURGERY ON ME?!?!?!!
-Teresa

Aug 23, 2008
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Frustration
by: Bart - SII

I can understand your frustration, especially when there are doctors who brush aside your wishes to be able to return to activities that are very much a part of your life. Because for you, your quality of life is dependent upon being able to do what you enjoy doing - a pain free knee is important, but not being able to do the things you want to do is also important - and when you can't do them, your quality of life decreases - I don't think that physicians or clinicians take this into consideration enough.

From what you describe in your post, and please remember that this is only my opinion based on the information you presented, I think that your number one problem is the patella subluxation. The popping with a twist, the pain, swelling - all of these things are common symptoms of patella subluxation. And once it happens, it is likely to recur.

MCL tears generally do not involve a pop (although sometimes they do), and they usually don't recur as often as you are describing.

The MRI you had didn't show an MCL tear - which if that was what you had would have shown up - MRI's are sensitive enough that they would show a tear, and at the very least, fluid and inflammation around the ligament. The fact that it didn't show damage to the patellar ligament from the subluxation is probably due to the fact that it was possibly your third subluxation - the tissue is already stretched out, so now, subluxations create inflammation and swelling, but not necessarily more damage to the patellar ligament or retinaculum.

With that said, there are some things that you can do to try to improve this situation. You said your self that when you work out, you start to feel better, more like youself. Working on improving your hip strength could help to keep your knee in a better position and reduce the recurrence of the subluxations. Hip strengthening is essential to keeping the patella femoral joint stable. Also, avoiding activities, for the meantime, that put your knee into a twisting type position can help. This is important as you work to improve your hip strength.

Balancing exercises that involve rotation of the body are a good way to improve patella femoral stability and to strengthen the hips. It also improve muscle control, which is ultimately what is needed to prevent further subluxations.

You may also consider trying a patella stabilizer brace, which could be beneficial during activities.

continued...

Aug 23, 2008
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continued...
by: Bart - SII

The cracking you are getting with leg press and lunges may be due to chondromalacia - a softening of the articular cartilage on the back of the patella. This can be treated surgically - and is not necessarily an indicator of lifelong arthritis, but it does suggest wear of the articular cartilage.

Surgical options for you based on what you have described would include an arthroscopy to treat the small meniscus tear - if that is truly what is causing the problems, a patella stabilization procedure where they tighten down or reconstruct the patellar ligaments to reduce subluxation, or an arthroscopy to "clean up" the patella femoral joint and smooth out the articular surfaces.

I would recommend trying physical therapy prior to any surgical options - and that therapy must focus on improving hip strength and muscle function.

I hope to have more information on the site within the next couple months regarding specifics of hip strengthening exercises for patella femoral syndrome.

Hope this helps - sorry for the delay in my response. Comment back with other questions.

Bart

Oct 01, 2008
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Better late than never
by: Anonymous

Don't know if you'll get this but I feel for you. I recently dislocated my left patella for the second time in nearly 6 years. This time though I also tore my MCL.

There is a surgery I am considering but probably won't get unless I dislocate my patella a third time. It involves realigning your leg so your patella rests more firmly in the groove it is supposed to rest in.

I was recently doing some research on surgeries and couldn't find anything involving reconstructing ligaments to make them tighter, which would be great because what it happening is the ligaments on one side of your knee are stretched out and on the other side they are not. The result is that the good tight ligaments are pulling on the patella more than the loosened ligaments throwing your patella out of alignment and making subluxing occur more often. A procedure I read about involved loosening your good ligaments so that they didn't pull as hard on the patella. It wasn't presented to me as an option during my surgical consult though so I am not certain how legitimate of a procedure it is.

I would recommend taking it easy if you are still in pain. When you start feeling better ease yourself back into a routine. I would start with low impact first like an eliptical or swimming. Another good strengthening exercise is to put all of your weight on one leg then slowly crouch on it while sticking your other leg, knee locked out with your heel touching the ground. See how low you can get with your good knee then try and match it with your bad one. As soon as you feel instability, stop and come back up. It was an exercise my PT had me do the first time I dislocated my patella.

Always where a knee brace when you do any sort of physical activity. You can usually find a good knee brace with side stabilizers at any sporting goods store. The stabilizers will help keep your patella from moving too far.

The grinding noise you are experiencing could also be cartilage and bone that has flaked off from the subluxions. An Xray can locate any small bone fragments usually and an MRI can find cartilage tears and pieces. That can be surgically removed and any rouch spots can be smoothed out.

Apr 14, 2009
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Knee injury...
by: Anonymous

Hi there,
Firstly, let me say I sympathise with you (and share your frustration!)...I am a 29-year-old professional dancer who injured my knee around 6 months ago. After being told it was a ligament sprain/strain, I had 2 days off and persisted with dancing on it. However, 4 months down the track I was still having pain during certain movements (usually involving twisting, jumping or bending the knee fully) & felt something was not right, so I ended up having an MRI & X-Ray. The doctor in the US told me I had a meniscus tear & should fly straight home to get it operated on. Once I arrived home, I saw a doctor who specialises in dancers & knees, who advised that the joint was stable, and surgery would be unecessary for now, as the risks outweigh the benefits. I am now having intensive physio in the hope of starting rehearsals for a show in 2 weeks. My point is...get a second opinion. If sport & dancing is what you love to do (& your life isn't the same without it...6 weeks of rest was bad enough for me!), then go and see a doctor who specialises in sportspeople/dancers, and the same with the physiotherapist (mine are great, and actually treat one of the Australian women's netball teams). Yes, they might lay it out to you that, if you want a knee that you can still walk around on & do normal stuff on in 10 years' time, you might have to consider giving up the sport. But at least they will be sympathetic to the fact that you love what you do and they will have greater knowledge of the increased demands placed on your body by what you do. Also, make sure they explain everything to you properly (in layman's terms!) so you understand exactly what you're dealing with, and ask questions about exactly what you can and can't do if they tell you to rest/do minimal exercise for a period of time. The last thing is...if it is something which requires physio (either instead of or after surgery), really stick to your physio plan & do exactly what you're told...I've seen dancers who have torn achilles tendons, had knee & all sorts of other injuries, and made it back by being disciplined with their recovery programme. The last piece of advice I can offer...glucosamine supplements!! All the dancers I know take them and they're great for joints if you do a lot of physical exercise.
I'm not a doctor, but I hope this helps...

May 03, 2010
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mcl
by: Anonymous

try prolotherpy or p.r.p

Oct 13, 2010
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Heal your knees
by: Anonymous

I also have a complicated knee issue and live on Maui. I got no help here and ultimately was helped by a book written by the head of orthopedics at seders in LA, called heal your knees. You can get it through amazon. It has a complete water and land rehab program that is top notch and achievable by the average person. Ultimately I ended up seeing Dr. Klapper as well when he visited his home in Diamond Head. He didn't even charge me. He is a gem and one of the top guys in the US for knees and hips. His book is both to prevent surgery and for after surgery.

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