Question - MCL Injury

by Sherri
(Manitoba, Canada)

I injured my right knee while snowboarding on Feb 22, 2007. I heard a snap and it felt like something let go, and my knee began to give way.

The initial diagnosis was an MCL tear. Following and MRI that was negative, I rehabilitated my knee with physiotherapy as per doctor's orders. By June 1, I obtained a doctor's note to return to work on June 11, 2007.

On June 8, 2007 I re-injured my knee by stepping in an unseen hole. This injury was much worse than the initial injury. My doctor was 90% certain I would need surgery due to the click heard in my knee on assessment, as well as the laxity noted over the MCL, and also over the ACL. However, the MRI also came back negative, and he said I would not need surgery. This was in September 2007.

Now, in December, I am still unable to return to work, my knee is not healing, it interferes with normal ADL's, I wear a brace all the time, must use a cane for outdoors, my knee is in pain most of the time, and it clicks alot. It also threatens to give way if it gets too sore.

My physiotherapist said there is nothing more she can do for me. At this point, my nursing career is on the line. I just turned 21 a few weeks ago, I graduated 1 year ago as a nurse, and only worked for 8 weeks before I was injured.

I am not ready to resign to having a knee like this the rest of my life. My doctor said there wasn't anything else for him to do, so he's referring me to another doctor.

Do you have any input on this situation? It will be 10 months next week...there has got to be some answer with the medical technology we have these days.

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Question - MCL Injury

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Dec 11, 2007
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You need a second opinion
by: Bart - SII

You are absolutely right, with the technology we have today, there is no reason for you to be living with a bum knee at 21 years of age.

MRI's are great tools, however, sometimes I think that we rely too heavily on them, and throw out a strong clinical exam. What did we do in the days before MRI's? Physicians and athletic trainers relied on their physical exams.

While both of your MRI's came back negative, that obviously doesn't solve the problem of your knee pain and symptoms of clicking and giving away. Standard course of treatment would be conservative rehabilitation. As long as that works, all is well. But when it doesn't, then the next prudent step is either another MRI, or a diagnostic arthroscopy. No one wants to have surgery unless it is needed, but MRI's can be mis-read, or not show pathology that is there. They can go the other way too, showing a tear that isn't really there. An arthroscopy would allow the surgeon to actually see what is going on inside your knee, and know for sure that either there is something damaged, or not.

You should explore your options for a second opinion. Your physical symptoms alone warrant further evaluation. You are right not to want to just resign to having a knee that is painful and gives away. Hopefully this physician referral will be able to take care of your problems.

Hope this helps. Feel free to comment back with any more questions.

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Dec 11, 2007
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Submitted by: Bart - SII

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You are absolutely right, with the technology we have today, there is no reason for you to be living with a bum knee at 21 years of age. MRI's are great tools, however, sometimes I think that we rely too heavily on them, and throw out a strong clinical exam. What did we do in the days before MRI's? Physicians and athletic trainers relied on their physical exams. While both of your MRI's came back negative, that obviously doesn't solve the problem of your knee pain and symptoms of clicking and giving away. Standard course of treatment would be conservative rehabilitation. As long as that works, all is well. But when it doesn't, then the next prudent step is either another MRI, or a diagnostic arthroscopy. No one wants to have surgery unless it is needed, but MRI's can be mis-read, or not show pathology that is there. They can go the other way too, showing a tear that isn't really there. An arthroscopy would allow the surgeon to actually see what is going on inside your knee, and know for sure that either there is something damaged, or not. You should explore your options for a second opinion. Your physical symptoms alone warrant further evaluation. You are right not to want to just resign to having a knee that is painful and gives away. Hopefully this physician referral will be able to take care of your problems. Hope this helps. Feel free to comment back with any more questions.

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