Collateral Ligaments and other non-cruciate tendons & ligaments around the knee :
MCL Injury - 2nd opinion or be patient? - - Posted by cgski (cgski), 12 May 2004
I got a grade 3 MCL tear, skiing in February. Also diagnosed at the time as ACL rupture. At the time it really didn't hurt, hardly swelled and I could walk fine - just couldn't ski, so I knew I'd done something! Treatment was 3 weeks immobilisation, with crutches followed by 6 weeks in a leg brace, 24/7, with PT doing quad strengthening etc. I had an MRI - which only showed up the MCL damage, so the consultant said the MCL tear would be healed by now (9 weeks) PT discharged me. I carried on with exercises, and started cycling (exercise bike and road cycle) and hiking. Knee started to feel unstable, and more and more uncomfortable. Saw a PT privately, who sent me back to consultant (we're talking UK NHS here). Saw him today -he found lots of tenderness in the MCL area and he says I just have to be patient, and build up leg strength. (referred me back to NHS PT but not for 5 weeks!!) There's loads of things I just can't do now - cycle up hill, climb ladders, walk distance, squat - or even brace my leg straight, standing up. I have another appointment in 8 weeks with the same consultant, (who is an orthopaedic generalist) and/or the option of seeing a knee specialist, privately (££££s) in 4 weeks - with all the hassle of juggleing NHS and private - and trying to extract my (NHS) MRI scans. The wheels of the NHS grind sooo slowly - in 8 weeks the consultant may decide to refer me for anothe MRI or anthroscopy - seems to be reluctant to do either - and goodness knows what the wait list is. I just want to get on with my life - and be able to do all the things I enjoy - hiking, tennis, sailing, skiing - even just kicking a football with my boys! I'm 42.
Is it worth shelling out £££s - will I get a quicker solution, or do I just have to be patient and wati and work at the MCL tear healing properly??
Any thoughts appreciated!
Posted by ATsoccergirl (ATsoccergirl), 13 May 2004
The MCL tear is not going to heal properly unless the ACL is reconstructed. Your joint mechanics have been dramatically altered which places a higher than normal amount of stress on the MCL and other structures.
Posted by cgski (cgski), 13 May 2004
mmm -yes but...the ACL rupture diagnosis was made just after the accident (within 1/2 hour) by a doctor who clearly saw shed loads of ski knee injuries (using Lachmans and other manipulative tests) BUT on the MRI (6 weeks later) no ACL damage showed up just MCL tear. My PT thinks (today's opinion) that there is not enough laxity for an ACL tear - but there is some laxity. Brusied, tender feeling on lower medial side. Reckons there must be some other damage of some sort.
ANYWAY - The PT convinced me to get the second opinion - like, I would get a second opinion if the mechanic couldn't decide what the fault was on my car...
It's all very confusing for someone who never went near a hospital up to this point in time!
Posted by ATsoccergirl (ATsoccergirl), 15 May 2004
MRI's don't have the best track record in terms of picking up everything. A second opinion would be a good idea, but it's going to be harder for that doctor to tell. The first doctor examened you under a better situation, this is often when the best results are obtained.
Posted by KJ (KJ), 16 May 2004
If you are going to see another surgeon it would make sense for that person to be a knee specialist. It's always difficult to get a full answer on what your surgical options are if the specialist in question isn't technically able to offer some of the possible treatments. He is then more inclined not to suggest them. You will get a straight answer from a good knee surgeon.
As far as your NHS MRI is concerned - you can always ask for a copy on disc. That is easy and cheap to run off from the computer, film expenses can work out at £££ per sheet otherwise and most hospitals won't let the original films leave the hospital.
Also consider asking your GP for an NHS knee second opinion, - that way you can be patient and save money!(joking aside sometimes a delay can give the knee time to settle down and for you to build up stability)
It is certainly true that the first doctor to see you gets the best chance of assessing for an ACL tear before the swelling interferes with the assessment.
My MCL hurt for months and was probably the worst bit of the multiligament injury in terms of pain but it did eventually settle.
Posted by cgski (cgski), 16 May 2004
Thanks for your advice - my gp has been very helpful - in the first instance he referred me to the best OS consultant round here - but a)he specialises in all sorts of orthopaedic problems apart from knees, and b)I've now been passed on to his registrars - who seem to have much more limited experience. (so I suppose I could say I've had a number of opinions - every hospital appointment I've got to see someone different, doing their time on the orthopaedic clinic).
I have an appointment with someone who only does knees - his clinic is on this site, and I've heard good reports. My gp has been very supportive, and is extracting my mri scans on my behalf - but the hint about on disc sounds useful. Thanks.
It's reassuring to know your MCL did settle down eventually, KJ, but how long did it take? cgski
Posted by Beauzer (Beauzer), 16 May 2004
Sorry to hear about your knee woes. I tore my MCL (and medial meniscus and medial joint capsule)after having my ACL reconstructed. My MCL never healed and I had bad instability from it. I eventually had to have it reconstructed. My OS at the time was a knee specialist and he made me wait a year while doing extensive rehab before he would even consider fixing the MCL. They did a plication and reconstructed the joint capsule and MCL. It was a long and very painful recovery and I still don't have very good flexion on that side. You need to be patient.
Posted by cgski (cgski), 4 June 2004
Following my instincts that all was not well inside my knee proved the right thing to do - saw the knee specialist today - do have a ruptured ACL - feel very frustrated that the NHS docs were unable to pick this up, even when I went back to them complaining of instability. Now have to figure out what to do next...ckski
Updated Thu Apr 29 2010