Can't straighten my knee after a month

[Capricity]

Exactly a month ago I hurt my knee while rollerblading. I made it to my doctor a week later. Then two weeks later the orthepaedic doctor could finally get me in and so he sent me for an MRI.
By now my leg doesn't hurt at all, except if I try to straighten it. It will only straighten to about a 50 degree angle and it bends most of the way, but I can't flatten it all the way so that my foot would touch my thigh. The first week I could straighten it to almost a 60 degree angle and it seems like it got worse after that.

Because I couldn't straighten it, it was almost impossible for it to fit in an MRI casing to go in the MRI machine and even then I had to hold it tense the entire time to keep it from straightening too much and putting me in pain. Therefore there were a lot of muscle spasms and the lady who took it said afterwords "Well, I guess it was as good as we could get."
When my doctor was able to look at the MRI he said that I have a bone bruise and an MCL tear and recommended therapy 2 times a week for a month.
I have my first therapy next Wednesday and I'm just curious if there is anything they can really do for me? Can either of those problems cause the knee to be unable to straighten? For the whole month I assumed it had to have been a torn meniscus, and though it might sound crazy, was pretty much looking forward to a recommendation of surgery, seeing as most information I've read claims that after having the torn portion of the meniscus you can walk out of the surgery immediately. And now I'm looking at a month of therapy which seems like it wont be able to do much? And at the end of that I may have not improved and have to go back to the doctor again?

Also, the way i fell was that my left foot caught and dragged on the ground. There was no impact on my leg at all. And I twisted slightly to my right. Since a couple days after it happened I have been able to put my full weight on it as long as I have it bent with no pain, seeing as it doesn't straighten.

So number one, I'm worried that the MRI may not have been clear enough to see what was really wrong with my knee. And the doctor read it a week after meeting me for the first time, so he may not remember exactly how bent my leg is stuck to realize that the condition is not similar to the diagnosis he came up with? And number two, I'm really dreading a month of therapy and no improvement. Is possible that my leg is stuck for some other reason?

[TwoBadKneesUSA]

Hi there,

I'm sorry you have hurt yourself.  If you have been walking around all this time with the leg bent, it won't want to straighten out for you.  I've done that myself years ago with my first knee injury.  I waited so long the only way to get it straight was during a scope.  Therapy will help you with inflammation and getting the leg to extend properly.  It may go slow for you.  If there is no improvement you would be wise to see the OS again. The knee may be stuck for other reasons other than inhibition from pain.  It is normal to want to hold the leg in the position it's most comfortable in.  Give the therapy a shot.

Are you taking anything for pain and/or inflammation?  RICE treatment would be good for you as well.  Rest the, ice it, put an ACE wrap on it and lay down with it above your heart.  I hope your therapy goes well for you.  Hang in there and give it a chance.

Best of luck,

Milly

[jathib]

... I've read claims that after having the torn portion of the meniscus you can walk out of the surgery immediately.

You can't walk out of surgery. The hospital won't allow it for one thing. It really means that you're allowed to put as much weight on your knee as you can tolerate. Most people can't tolerate a whole lot at first and use crutches. I've had four scopes and one time I was able to limp the next day without crutches. But not any distance and I wouldn't have left the house without crutches.

That being said, MRIs are not 100% accurate. Certainly something could have been missed. When I first injured my knee my ACL was stuck in the joint which prevented me from straightening my knee. But after a few days I had very little pain and could still walk.

Your doctor is following standard protocol which is to try conservative treatment first before recommending surgery. Had your MRI been positive for a meniscus tear he may have suggested surgery. But most insurance companies require a round of physical therapy before they'll approve surgery. So give it a whirl. Sometimes it turns out to be a waste of time but you never know.

[Capricity]

Thanks for the replies.

I was taking the advil my doctor recommended for pain and inflammation for a couple weeks, but it didn't seem to have any effect on me. Afte the first two weeks the observable swelling was completely gone and I only have very slight pain and it only occurs when I bend the joint in ways it doesn't want to go. Therefore I have stopped taking any medication. There isn't any pain that bothers me. Mostly it's just the frustration of not even being able to straighten my leg a little bit and wondering if I ever will be able to.

I am very excited for my therapy appointment this week, but it is still 4 days away. I just think it will be nice to have someone working with me that I can actually speak with in person one on one, since the only actual contact I had with my doctor was the 1 to 2 minute consultation when he recommended the MRI.

[momma2boys]

Hi there,

Almost the same thing happened to me!!  Back in March I had a minor ski accident and hurt my left knee.  I elevated and iced it over the weekend and was soon unable to straighten it.  Same thing with the MRI - ouch!!!  And it was a very shaky reading.  Nothing conclusive.  I spent 2 months in pt and it was very painful.  I went to several doctors trying to get an accurate diagnosis and finally found answers!  I had excessive scar tissue - my body had gone overboard in repairing a partial MCL and ACL tear and so I needed surgery to remove the scar tissue.  I had this done a little over a month ago and am happy to report that my leg is now straight!!  I'm still in therapy to build up my thigh muscles, etc., and it still hurts... but it's so much better and I'm on the road to recovery!  So anyhow, don't know if this is what your exact situation is, but your story sure sounds similar to mine! 

[OldCoot]

You'll find good info here: http://orthoinfo.aaos.org/topic.cfm?topic=A00349
"The first week I could straighten it to almost a 60 degree angle and it seems like it got worse after that."   WHOA! 60 degrees is a looong way from straight and you have a lot of work to do lest you limp walk the rest of your life.

After my knee replacement the ligaments behind my knee were what keep my leg from straightening out lacking 15 degrees from straight and in that case the leg is shorter therefore you limp walk. Mine were so tight they felt tight like a banjo string and doing a deep massaging behind my knee hurt so good it almost made me weep. It's called achieving full ROM, range of motion which we usually do through PT and doing exercises & stretches at home. PT is a very good thing, but don't fool yourself, you have to do a lot at home every day for best results and quicker recovery.

Lay down on your tummy leg straight out as far as it will go and have someone light then deep massage behind your knee and see what it feels like and if it hurts could be your behind the knee ligaments are the problem along with the MCL.  The body protects itself and could be they tightened up to protect the MCL.  Here's another test: Sit in a chair and put your heel on the edge of another chair seat so your leg has no support from your hip to the heel. A can of soup weighs one pound, put one in a plastic bag and slide it up to your knee and sit with it hanging pulling down on the knee and see how long you can leave it there. Be careful and don't over stress it, totally relax your leg and add cans until you feel a firm downward pull or pain behind the knee, or pain wherever. I am not advising that as PT therapy but to find out where it hurts like my OS told me. My cure was stretching the ligaments out which I did in the above manner and at first I could stay two minutes and ended up with 20 minutes knee weighted downward 20 minutes periods. Once a day won't do and I did it six or eight times a day and it is by no means fun, but it worked for me and I now have full ROM and walk normally.

MY OS prescribed a Dyna-Splint I wore over 100 hours and the thing worked for me. http://www.dynasplint.com/   http://www.dynasplint.com/about/products.php
It's spring loaded and pushes the leg straight with a constant pressure which you can adjust to your particular tolerance level.  Wearing it to bed is a must because when you sleep your muscles relax and it goes to work big time. I wore it sitting in the chair like I told you and then put weight on top of my knee and it stretched as much as I could stand, then some.

Not saying you have the same problem as I, but if the PT tech knows their stuff they will quickly determine if the rear ligaments are to tight.  I say rear because I don't know what they're called. Stretch your leg out far as it will go and feel behind your knee and if the ligaments are real tight  ask your PT tech about it.   

[celinenj03]

I can only share my similar experience. I tore my knee up playing basketball, among other things I did tear the MCL too. It could be normal that with all the swelling the knee won't bend right or straighten out, BUT you have to be careful that you don't have "derangement" in the knee, which means that you could have also torn some meniscus during the twisting injury and it could have lodged itself into the joint. Can you feel anything in there when you try to bend or straighten? I could feel something like you said you feel as though it will never straighten. That is how I felt and it would have never straightened with all the PT because I had debris in there. Once the OS removed the debris, it immediately went to zero degrees and within 2 weeks I was bending it all the way. If you don't have full extension and flexion within 6 weeks of any knee injury, there is a very good chance you have debris in there and would need surgery to get it cleaning out. This did NOT show up on my MRI, but only when my surgeon went in there did he see it. What a relief afterwards! All the best,

[bella287]

hi,
 back when this fun ride started i had began to fall down because of my knee going out. My os suspected a torn meniscus and sent me for a mri it showed nothing. anywho when he went in i did have a torn meniscus plus a 6cm lesion on my rt femoral chrondoyle. so as long as you keep having problems keep insisting on more tests till they find whats wrong. but then again i dont really trust tests. when i turned 40 i had allthe tests your supposed to have at 40. at 41 i had what i thought was gas went to er who did a cath on me and found to major blockages in 2 of my main arteries. at 44 i was cathed again and another blockage was found. in between all this time i have had many cardiac tests and they always were clear.     good lluck   bella

[OldCoot]

I thought about what Celine said about the torn meniscus and she may be on to something. Years ago I had a torn meniscus and I could hardly bend my knee until he went in and cleaned it up. I don't know if he saw it on Xray or what but his diagnoses was correct, he did the Arthroscopy and in 14 days I went back to work. I remember it swelling a lot and I had to keep it iced and elevated. 

[Capricity]

Okay, well I got through my first 2 days of PT. He was able to get my leg to practically straight. For instance, now I can lay on my back and have my leg "straight" and relaxed, and although it won't lock all the way straight, I feel only slight pain staying in this position.

However, when I do the exercises he has given me I still have very sharp pain in my knee. Most of the pain has been on the inside of my knee. The straighter I was able to get it the more the pain moves to the middle of knee, like just under the knee cap. One of my stretches is laying on my stomach (as one of you suggested) and this also seems to be the stretch the helps the most. When doing that stretch I have finally begun to feel a burning stretching muscle pain like the PT has been describing to me. He keeps insisting that any pain I'm feeling is good pain and that it is merely because the muscles and ligaments are so tight, yet I the only time I feel that pain is once I get so far past the point where I begin to feel the sharp pains.

Does anyone have any idea if the sharp pains could be attributed to the MCL (if it's still sore in the spot where it tore) or if it's just the bone bruise (I hear those are quite painful, are they supposed to be sharp-type pains)? Or are those pains associated with the tightness? I'm a little frustrated, because although the physical therapist is a nice guy and most likely knows what he's doing, there is no way for him to know exactly what my pains feel like and since this is my only experience with this type of knee injury, I have nothing to compare it to.

I can't help but still be paranoid that there is a bit of torn meniscus and that I am possibly causing some harm to my knee as I work to improve my range of motion. (Especially since a few of you mentioned torn meniscus and scar tissue that went unnoticed on the MRIs and wasn't detected until surgery.) I just don't want to go through months of pain, and then finally get around to surgery if I'm gonna need it anyway, and then finally begin more PT.

One more question - The Aleeve I was recommended doesn't do anything for the pain, and I don't really notice it helping the swelling in my knee much either. (Sidenote, Advil does nothing for me ever and Tylenol occasionally helps my headaches, but not much else) Is there anything besides medication that could help relieve the swelling? I've been trying to ice it, too, just because sometimes upon waking up my knee is so stiff I feel like I lose all the progress I make the day before.
Does anyone think those IcyHot sticky pads would be a good idea? At least they shouldn't hurt anything, right?

Thanks for any ideas you may have for me!

[bella287]

ask your dr for something strong to take for pt. if you are in a lot of pain while doing pt your body will automatically fight the therapist which is thought to be a contributing factor to arthrofibrosis. if you dont like narcotics start small like darvacet and work your way up   bella

[conno11y]

Hi Capricity,

Your posts could have been written by me!  An MCL sprain in Jan left me with limited flexion and extension.  I did PT for a few months but didn't recover.  My MRI showed no meniscus tear, just the MCL spain and a bruise on the tibia.  But my OS suspected a tear anyway.  He did arthroscopic surgery and did not find a tear but did remove plica (inflamed tissue) under my kneecap.  He was "confident" that would solve my problems.  Unfortunately, it didn't.  I still have the same limited ROM and now an OS says that I have developed arthrofibrosis.  Like you, my PT can get my leg pretty straight, but I cannot lock it back.  Also like you, the Aleve does nothing for my pain.  I'm taking 4 Aleve/day for the anti-inflamatory effect, not for pain. My injured knee is larger than my healthy one and constantly warm, but it doesn't vary in size, so I don't know if it counts as "swelling".

You might mention plica to your doc.  I didn't have the normal "plica syndrome".  If the plica were my problem, they were caused by my accident.  The pain that I had was sharp - maybe a pinching pain - and it was under my knee cap in the medial side.   I wish we had tried to calm the plica down with a cortizone shot before we did the surgery.

Like you, I was worried that PT was causing further damage to a unrecognized tear, but my PT said that since the mobilizations that she does are not weight-bearing, they are OK.  We spent a couple months doing severely painful mobilizations, but now she doesn't invoke pain.  She learned some new mobilizations that are much more comfortable.  I know what you mean about the sharp pain versus the stretching pain.  I welcome the stretching pain, but the sharp pain feels like something bad is happening.  I tried taking Vicodin or Tylenol3 before PT, but it didn't help the sharp pain that is triggered by the mobilizations.

My advice is that if you do get surgery, make sure you understand EXACTLY what you should do after surgery.  Should you be on anti-inflammatories and ice?  Should you move the leg?  Exactly how should you move the leg and how much pain should you push the leg through?  How quickly should you expect to recover and when should you call if things aren't right?

I am very interested to hear about your progress.  Good luck!

[celinenj03]

Well, I'll share my thoughts here. First off, from what you are describing if it is sharp pain, almost razor like sharp inside, it could very well be a meniscal tear. I had both meniscal tear and MCL. MCL hurts pretty bad but it is more like a severely torn muscle pain, an extreme soreness. If the pain is raw and sharp, it prob. is cartilage related.

I just don't want to see you waste many months (like I did) walking around trying to rehab cartilage damage.

Also, I'm no doctor but aleve does nothing for me, however 2 motrin in the morning keeps me pretty much pain free all day long. But don't ignore this. I had to push for a scope for almost a year and when my OS finally did it, he had to admit he was wrong and I was right as I had cartilage damage and debris in my knee. Wish I would have demanded a scope sooner instead of just hinting around about it. Would have saved me a lot of pain and wasted money on rehab.

[conno11y]

I thought I would update, since I think my previous post may be incorrect now.  I went to a new OS yesterday and he said that the plica were never my problem.  He said that my MCL sprain healed too tightly and that this restricted both my extension and flexion.  Maybe your PT is right that this pain is from a very tight MCL?  My pain was sharp also - not the kind of pain that I would expect from "stretching out" a ligament.  The new OS said he never would have done surgery on me because my knee was stiff.  I think I ended up with arthrofibrosis because with a stiff knee I was unable to achieve proper ROM exercises after surgery.

[susiep]

Welcome to my world!  Fell off horse, hurt knee, GP said bit of ligament strain.  A&E said probable meniscal tear, go to physio.  Well my advice to you is don't bother....get it scoped and sorted - sounds precisely like a meniscal tear.  And what you absolutley DON'T want is a physio bending your leg about with a lump of cartilage in the way that shouldn't be there.  My knee is still locked following a meniscus tear 12 weeks on, (surgery 5 weeks ago) either because they haven't taken enough out, or because it's been bent for so long.  I paid £3.5k to have it done privately in the end because the NHS are a joke. I'm having another scope and MUA next week.  Don't put yourself through what I've been through..keep pushing if you feel that's what it is (a mechanical blockage).  Good luck..  p.s.. and if you have the cash, pay to see a decent private orthopod who will get you on the table within a week.  Trust me, the delay will mess up your life for months.