Meniscus :

Symptoms...not quite sure what to think... - - Posted by Run262 (Run262), 13 January 2005

Hi all, I've spent the last several days reading the archives becoming more familiar with meniscus injuries but I still have questions and I'm not quite sure if I've done something serious or not so serious. While I understand I ultimately need to see an OS, I'd like to get some feed back.

I'm an avid runner and do train for and run marathons, about 1 a year. I'm a female who's 35 years old. I injured my knee NOT running of all things.

The best way to describe this would be a sudden twisting movement while going toward complete extension extending in to hyperextension. I was standing on the ground putting my 1 year old into her car seat, which is located in the middle of the SUV. Usually I would climb in to the truck, but that day about a month ago I decided to stand there with my legs almost locked and reach over with her in my arms to put her in her seat - not a position that's good on the back. Well, she made a sudden movement to grab something so I compensated by twisting my left knee into a completely extended locked position which then went into hyperextension. Felt immediate pain through and through my entire knee - enough to verbalize the pain.  I've never felt this type of pain in my knee, it scared me. No popping but more a painful brief tearing.

Now, my knee has not felt the same sense. Walking is fine for the most part but any movement to twist or pivot the joint is painful - the more I try to twist or pivot around the joint the more painful - I kind of test it's limits to see where it hurts etc. Twisting creates pain both on the medial and lateral sides but more medial. Sitting for any period of time creates a painful stiffness when I do get up to walk. The longer I sit the more painful it is to try and walk. Squatting or complete flexion is out of the question - too painful. Forced locked extension is also painful. I can run, but after a mile or two it starts to get generally painful but it's bearable.  I haven't noticed any swelling but at times the knee feels "full" for lack of a better term. These symptoms are every day and the pain and stiffness seem to be getting a bit worse and defining themselves a bit better - if that makes sense.

I've done tests for PCL and ACL damage and I can't find any instability there. I don't have much joint line tenderness either though. I'm thinking miniscus still.  

Any thoughts?

Thanks in advance.

Posted by hmaxwell (Heather M.), 13 January 2005

The motion you describe is exactly how I tore my meniscus in the right knee (my good one) only I was lifting a heavy flat of drinks from the far back of the trunk of my car.  I tore the meniscus on my left (bad) leg by doing a similar maneuver in Yoga--downward facing dog.  Look the move up in Google...you'll see that it involves a controlled hyper-extension of the knee.

You've got to see an orthopedic surgeon, preferrably one who is a KNEE specialist (doesn't operate on other body parts).  A thorough, hands on exam by a competent knee surgeon should be able to pinpoint the problem, and x-rays & MRI will confirm this diagnosis.

To answer your question, yes--it sounds like meniscal damage.  Hyper-extension is notorious for causing meniscal injuries.  The good news is that it's usually quite a straight-forward thing to deal with.

Here's more info on meniscal damage:
http://www.steadman-hawkins.com/meniscus/overview.asp

Also, be sure to check out the meniscus section of this page by following the 'general info' link in the top center of this page.

Heather
Posted by andrewc (AndrewC), 14 January 2005

Hi Run262


Your symptoms and method of injury sound like a classical meniscus injury like Heather says. When I originally had torn my meniscus (although it was quite a serious tear as I displaced my whole lateral meniscus into the knee joint thereby causing my leg to be locked in a crooked position...for 4 weeks until I could get surgery) I couldnt possibly have walked (agony!) but the stiffness!!! About 2 weeks post injury my knee just started getting stiffer and stiffer every morning until I could barely tolerate waiting until my "emergency NHS" surgery date  

The difficulty twisting and squatting is also a classic meniscus injury sign.
I also exhibited the "full" feeling in the knee that you describe (and I still do sometimes although I have a large bakers cyst behind my knee unfortunately...which is a fluid swelling caused by an irritation in my case to the meniscus.....which my surgeon will hopefully be fixing by trimming a small part of the meniscus tear that he thinks did not heal)
Anyway, in your case the feeling could also be fluid within the knee joint itself...or swelling caused by the trauma of the injury (whatever the injury is)

Lastly...how exactly have you "diagnosed" that you have no PCL or ACL damage  ?
The Lachman Drawer test is not something even someone who knows a LOT about knees could perform on themselves!!

That said...it really doesnt sound like a ligament injury and the fact that you didnt hear a pop and don't describe swelling or instability bears that possibility out to some degree.

As Heather said....you need to see an OS as soon as poss as leaving the injury (if it is meniscus) will not help it repair or you recover one bit.

All the best

Posted by Run262 (Run262), 14 January 2005

Thank you both for your very thorough replies. I appreciate the technical talk and the advice.

One asked how I tested for ACL/PCL stability - well, it was more of a crude test so I can't really say I could rule those injuries out, but I don't have severe instability indicating that type of injury, plus there was no popping, not that you can't with a meniscus tear.

I do have an OS who is an expert in Sports Injuries with his subspeciality being knees & shoulders. Big bonus is that he's also a runner of marathons. I had surgery two years ago for exertional compartment syndrome which he performed with great success but for a nicking of the saphenous nerve which has resolved itself overtime almost completely. I have every confidence in him, but hesitate to return to him without seeing how things develop.

I don't plan on waiting too much longer, but I've had enough injuries to know that if you give something 2-4 weeks it should get better if it's just a strain/sprain/bruise and nothing too serious. With all the times I've seen him for my different running injuries I've practically subsidized his children's college education.

I do have ONE MORE question: my knee seems to "settle down" over night, meaning in the morning it's not too stiff at all, but usually withing 30 minutes it starts to act up or within the first twisting motion. One of you mentioned morning stiffness being a problem if I read it correctly....is this a must for a meniscus?

Thanks again in advance.
Posted by andrewc (AndrewC), 14 January 2005

Hi again

No...morning stiffness is not necessarily a guaranteed symptom of meniscal injury.....
My injury was unfortunately at the worst end of the scale for meniscus injuries (so my OS said) and the stiffness will have partly been caused by the fact that my leg was locked -30 degrees from extension (straight) and maxxed out at 90 degs flexion.....
This, and the fact I could not even touch my foot to the ground meant my leg was almost unused for the 4 weeks pre surgery....

Now I have had the meniscus repaired (with sutures) my leg feels great in the morning.......but starts to feel a bit stiff after a long day on my feet.

That said...I had a LOT of muscle atrophy and it has taken me nearly 7 months to get my Quads back (nearly) to the point where I can now go for a gentle run again...pain free   I am still improving however and I have good days and bad days with it.....the good oens it doesnt get stiff and feels good "most" of the time....the bad ones, where it does the opposite!

You know your own body so if your not TOO concerned to wait and see for a few weeks it is probably a good plan....just DONT let it go untreated for too long or you may worsen the injury unbeknowingly.

All the best

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