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Author Topic: Confused by differing answers by Drs regarding very unstable knee  (Read 1230 times)

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Offline SacredPetra

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Sorry if this is really long, its been a very confusing proccess.  For those who don't want to read the whole story, there is a tl:dr recap at the bottom.

A little over a month ago I was bucked off a horse (I train horses for a living) and felt something happen to my right knee.  There wasn't much pain at the time, but I came off head first and was much more concerned at the time with not breaking my neck. I knew immediately something was wrong with my knee, but I figured it was just bruised and swollen, so after taking the rest of the day off, I continued working despite the pain/instability in my knee. 

After about 2 weeks, the pain and instability got much worse, so I went to an orthopedic specialist, who was very concerned about my pcl/lcl, and joint capsule, so he ordered an mri.  He thought my acl felt alright, but was able to rotate my lower leg independently from my upper leg.

My insurance company and that doctors office gave me the run around for a week, during which my knee continued to get worse, despite wearing the brace prescribed by the first Dr, so I went to the ER to get an MRI.  The radiologist who read my MRI at the ER said that it showed masive bone bruising and feathering and edema in my acl and I would likely need my acl replaced.   They reffered me to an orthopedic surgeon who I was able to see the next day.  The surgeon said that all my ligaments feel fine and they don't know why my knee feels unstable to me, but prescribed a rigid frame brace (a donjoy defiance) so I could walk comfortably (I leave for Germany on Sunday and will be spending two weeks on vacation there).  There were quality issues with the MRI, but neither doctor seemed concerned.

At this point I was only able to ride 2 horses per day before I reached my pain tolerence limit, as well as still being unable to walk without the rigid frame brace, so I went to a second orthopedic surgeon a week later.  He also said that me ligaments feel stable and he doesn't know why my knee feels so unstable to me.  He also said that given the amount of bone bruising I should have ruptured my acl and he can't explain why I did it.

I was willing to believe that maybe with was just the bone bruising causing the instability and began phyisical therapy that week.  The physical therapist was examining my knee and found the same instability as the first doctor, and was quite alaramed.  He says I test positive for laxity in my acl, but that it can be hard to tell in my knee because I'm protecting the joint so much with my other leg muscles.  I know that its been difficult for me to let the doctors tug on my knee ligaments as when the first doctor and the physical therapist managed to find the laxity, it feels like my joint is about to dislocate and nearly makes me throw up.  I've been in physical therapy for two weeks now, and still feel major instablitliy in my knee.

The tl:dr recap: I have major, persistant, instability in my knee.  Two Drs and my physical therapist say I have ligament damage, the two orthopedic surgeons say my ligaments are fine but can't explain why my knee is unstable.  The only thing everyone agrees on is that I have massive bone bruising, and hyperextended my knee badly enough that the front of my tibia collided with the back of my femur.  I am curently wearing a rigid frame brace during the day in order to be weight bearing and sleep in a hinged neoprene brace because the feeling of my knee joint opening in whichever direction is unsupported keeps me awake.

I'm only 24 years old, and a very active person; I train horses for a living (and am currently unable to work due to pain), I play ice hockey, I camp, backpack, ski in the winter, and was just getting back into running.  Right now I can shuffle around without a brace, but I have to plan for which way my knee is going to give on each step and can't step more than a few inches in front of my other foot.  Like I told my physical therapist, I can't live my life like this.

Has anyone else had surgeons (well respected ones at that) miss ligament injuries, or does anyone have and idea why my knee would be this unstable without ligament damage?

Offline dm

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Re: Confused by differing answers by Drs regarding very unstable knee
« Reply #1 on: July 24, 2013, 04:38:02 AM »
I would suspect that you have the acl damage, and would pursue finding out what's wrong.

1. I'd follow up on the crappy MRI and see if you can get the original physician to request a redo based on bad quality, so maybe you can get out of paying for another scan.

2. I'd see if you can take a max dose of painkiller 1-2 hours before you have another appointment to have the knee looked at, so you're not guarding quite so bad when they look at it.

3. When you do have an appointment, do this - do NOT look at them or your knee when they examine it, it makes you tense up, anticipating some kind of pain. Ask the doctor to work with you so he can examine it correctly and completely, I always try some "guided mental imagery" - take a deep breath, hold a couple seconds, and exhale fully, imagining tension flowing out to the floor. Do this a couple times, and see if you can lower your overall physical tension/strain level. If it helps, bring a friend and have them talk to you as well as be your advocate about how you have problems functioning.

My knee hurts all the time... having them bend, flex, twist it is not comfortable... and I KNOW my acl is trash.... but they do the "usual" acl type tests to gage how much slop the knee has so they can track it. No point in putting in an acl when I'm in line for titanium anyway. The breath technique, and not looking helps me, as does pre-medicating. I know it hurts anyway - this way it's just not so bad.

I compensate about the painkillers for the exam by again communicating with the doctor about why. haven't yet had one complain.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline SacredPetra

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Re: Confused by differing answers by Drs regarding very unstable knee
« Reply #2 on: July 25, 2013, 11:31:34 PM »
I hadn't considered taking a stronger pain killer before my appts,  but I'll definitely talk to my Dr about it for my next appt ( unfortunately not until mid-august as I'll be spending the next two weeks hobbling around Germany).  My physical therapist also said he'd speak to my Dr,  so hopefully they'll look at my knee more thoroughly after that.

I should have lots of time to practice some  guided imagery relaxation while on my flights,  so hopefully I'll be able to put that into practice at my appt as well.