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Author Topic: Climbing accident  (Read 1537 times)

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Offline John Bloodgood

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Climbing accident
« on: February 19, 2005, 01:01:50 AM »
Around 1988 I suffered about a 30 foot fall in a rock climbing accident.  The exact details of how my knee injury occured are a bit fuzzy, but it appeared that I had impacted with my knee bent, into the rock face.  The point of impact was the lower portion of the kneecap and the tendon that goes to the front of the shin, but I did not impact on the shin itself.  I immediately developed fluid build up around my knee and for several weeks afterwards I had a pocket of fluid that I could push from one side of my knee to the other.  Subsequently, anything which required my knee to flex front to back or keeping my knee bent for even short periods of time caused pain.  About three years after the accident, I finally convinced a doctor that there was something not correct with my knee.  Though I had almost no problem with strength or stability, in part to having muscular legs, I had developed a small knot on the lower front of my kneecap.  He ordered a bone-scan which revealed a lot of activity in that spot.  Over the years I have periodically gone in to get my knee looked at and I get told a variety of things from chondromalacia and improper tracking to there being nothing wrong.  Though I can now sit for longer periods of time, my knee hurts when I get up from sitting.  I still have a good deal of pain when flexing my knee through its normal range of movement and the knot on the lower front of my patella has slowly gotten bigger.  I have tried just about every knee brace there is with no luck.  The docs swear this knot is scar tissue (if so, it is they hardest damn tissue I have ever felt) and that there is no damage to my soft tissues.  An MRI was not conclusive of any problem.  Based on the nature of my injury, is there something in particular the docs should be looking for?  Any advice?

John Bloodgood
« Last Edit: February 19, 2005, 01:04:23 AM by John Bloodgood »

Offline rozzzie

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Re: Climbing accident
« Reply #1 on: February 19, 2005, 04:32:16 PM »
Hi John and welcom to our little group.

The Dr your seeing is he a Orthopedic Dr(OS) or a GP?  If it's your GP get a referal to a OS that specializes in knees, if he's an OS get a second opinion.  Sounds like you've been bothered by this for 16 or so years and have not gotten any treatment?  The thing I can't stress enough is to see a OS that specializes in knees.  There are many listed on this site, if you can get to one of them great, but you need a new set of eyes looking at this problem.

Good Luck

Hugs
Rozzzie
OA of knees since 85 
93 scrambled ankle - PE
98 PE
99 anlke fusion
04 hit by car broken leg, ribs AC joint seperation
RTKR  Dec 1 2005
LTKR. IM rod removal March 16, 2006

Offline John Bloodgood

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Re: Climbing accident
« Reply #2 on: February 20, 2005, 10:02:58 PM »
Hi,

Most of the time I have to settle for seeing a Physician's Assistant.  I don't think I have ever been able to get a referral to an actual OS. 

What problems specifically should we be looking for given the impact war on the lower patella and tendon?  They don't seem to think I have any soft tissue damage and the last time I was seen, they seemed convinced I have a tracking problem, despite the pain not being along the sides, it is in the lower front.  I am starting to think that any tracking problem is due to favoring the leg because of the older injury.  Additionally, last year I turned wrong and all of the sudden, for the first time ever, I had a sharp pain along the outside of my knee.  In other words, I think my root problem from the fall is now starting to show up as other problems and these folks only seem to be focusing on the newest developments. 

Offline Heather M.

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Re: Climbing accident
« Reply #3 on: February 20, 2005, 11:00:59 PM »
John,

It's amazing that you survived the fall with relatively few injuries!

If you look around this site and others on the net, you will find a lot on impact injuries of the patella.  There are a couple of possibilities in your case--a patellar fracture or another fracture around the joint.  Since you're so far post-injury, the trick would be to see if you did have a break in the past and if it healed correctly.  It's an unfortunate reality that our bodies don't heal perfectly in all cases; when you break a bone that is part of a joint, you sometimes also create a break in the articular cartilage that coats the bone.  This cartilage is meant provide a smooth and frictionless glide; when there has been a healed break, this smoothness is broken up to a certain extent, and this can create catching and grinding sensations.  Sometimes these are just noisy or annoying, but in the worst case they can be painful.

This is called, in general, a chondral defect--chondro being the layer of articular cartilage that coats the bone.  If the defect goes into the underlying bone, it's often referred to as osteochondral.  This is arthritis, pure and simple, and you can get it the old-fashioned way or due to trauma like the one you experienced.  Even if you didn't break the bone, you can actually have an impact that gouges out a divot of the chondral or even osteochondral layers.  This is called a focal defect, because it is very deep but with a fairly small diameter.  Usually, when you have chondromalacia (damaged or softened cartilage) or osteoarthritis (damage going through the cartilage into the underlying bone) develop as a result of simply getting older (wear and tear), the damage is widespread or found in multiple areas.  When you have a person with an impact injury, it's highly localized.  This is good news!  It means that your underlying knee mechanics are okay, and that you may well be a candidate for cartilage restoration.  There are a couple of different procedures to restore focal cartilage defects:  OATS, ACI/Carticel, and Microfracture.

Another possibility to consider is whether you have developed a severe muscle imbalance as a result of your injury.  This can happen for a lot of reasons:  an underlying genetic condition that was pain-free up until the accident triggered/worsened things, severe post-op pain that caused muscle inhibition and led to your body guarding the injured area and compensating with other muscle groups (especially the lateral quads and the hip), patellar mal-tracking the developed following the trauma due to ongoing muscle imbalance (strong lateral quad and weak inner thigh or VMO muscles), or even soft tissue damage or scarring that has created serious mechanical change in your joint.  In general, you can call this catch-all group of problems PFS or patello-femoral syndrome.  This is actually a crummy name, and it means different things to different doctors.  Someone can have PFS and be dealing with thickened plica (folds of tissue that get irritated and snap around, leading to chronic pain and irritation) or they can have PFS and be dealing with a kneecap that tracks laterally and causes damage to the cartilage on the back of the kneecap.  These patients both can be said to have PFS (a syndrome relating to poor knee mechanics) but their symptoms and treatment plans could be different. 

So you may want to look at whether you have PFS or problems with the mechanics of your knee joint...and to further confuse things, after having PFS for long enough, you can even begin to experience serious damage to the articular cartilage in your knees....so you can be said to have chondral defects, just like someone who has a serious impact injury to the knee.  *Usually* someone with PFS will have widespread chondral damage or multiple defects, whereas someone with an impact injury has a highly localized single defect.  This is most common, but with knees we learn never to say never.

So anyway, you might want to research chondral defects (aka chondromalacia, articular cartilage damage, osteochondral lesions, osteoarthritis, etc.) and PFS in general.

Here are a couple of good places to start:

http://www.kneehippain.com/patient/for_patients.html  (Great overview of the knee and issues with cartilage and ligaments)

http://www.steadman-hawkins.com/knee_chondral/overview.asp  (overview of chondral defects and treatments)

http://www.steadman-hawkins.com/pate/overview.asp  (Overview of PFS)

http://www.steadman-hawkins.com/knee_microfracture/overview.asp (on microfracture, one of the cartilage restoration techniques).

http://www.kneeguru.co.uk/html/steps/step_05_patella/mechanics.html  (Overview of patellar mechanics, PFS)

http://www.kneeguru.co.uk/html/steps/step_06_arthritis/pathway.html  (Understanding arthritis)

http://www.kneeguru.co.uk/html/steps/step_07_arthritis/diet.html  (Managing arthritis overview)

Broad overviews of the techniques out there:
http://www.cartilagedoc.org/
http://www.rush.edu/rumc/page-1099918806726.html
http://www.cartilagerestoration.org/news/news3.html

Hope this information helps.  Keep in mind that you can also have problems with the meniscus or ligaments, too.  Knees are tricky little monkeys!  You need a great diagnostician who truly understands the knee joint on your side.  A PA is not trained to diagnose knee problems.  In a case like yours, where pain and disability have continued and multiple diagnostic tests are not helpful, a diagnostic arthroscopy might be called for.  However, I think the first step is to be seen by an orthopedic surgeon--and a darned good one.  Do not accept assistants and fellows.  It's ridiculous to me that you have yet to see a real surgeon since the onset of your issues.  This well could be the root of your problems.  I don't know about where you are, but here in the US a person can be certified as a PA after doing a college course and a specialized ONE TO TWO YEAR program.  That's it.  This is not who you want to have looking at your knee!!  Just my opinion, but you have been treated terribly.  There is no reason you should still be having problems of an unknown nature YEARS after your injury.

Heather
« Last Edit: February 20, 2005, 11:04:43 PM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline John Bloodgood

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Re: Climbing accident
« Reply #4 on: February 22, 2005, 06:02:31 AM »
Well, I did have a rope and harness on.  Still, I bruised both heel bones, was pretty scraped up, and by the time I got to the ground I was unable to bend my leg and my knee had swollen an incredible amount. 

I don't really have any scraping or grinding and I never really noticed any loss of stability or power on the knee--just pain.  It used to be for several years after the accident that I could not sit for more than about 20 minutes.  This made driving any distance a hassle.  Plus any exercise that required simple straight back and forth flexing hurt, making even stationary bikes a painful experience.  Running became an exercise in pain management, which is a big blow because I like to run. 

Because of the pain, I am sure I have now developed some muscle imbalance.  The bad thing is that is the only thing these quacks seem to focus on.  Getting to an actual OS is difficult.  I use the military health care system and getting past a PA takes an act of Congress.  And of course all they do is give me some Vitamin M (Motrin--military docs use it for everything from migraines to head amputations).  Once, and only once, in all these years they have tried some physical therapy; not that it did much good as they were still treating what they saw as a tracking problem. 

The last time I saw anyone about the knee, I about went off on the PA who came to see me.  He came in with the tone, "So you want to get out of running and PT."  After setting the young Captain straight and making it clear if he tried that tone with me again that he would need some reconstructive surgery to fix 206 broken bones and the local paper would carry a story about an old Master Sergeant whupping up on a snot-nosed, teat-sucking PA, he relented to an MRI, not that it found anything. 

Thanks for all the info.  I will be burning a lot of it to CD and trying to educate who ever it is they decide to saddle me with next time.  I would love to get this at least diagnosed properly before I retire (I made them keep a copy of the bone scan in my records--normally it would be destroyed/recycled).