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Author Topic: Root Ligament Avulsion and MCL 3  (Read 993 times)

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Offline K9Sport

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Root Ligament Avulsion and MCL 3
« on: December 16, 2014, 04:34:18 PM »
Hi all..

New here...

Back in May 2014 I had injured my knee.  MRI report said there was a Posterior Horn Medial Meniscus Root Ligament Avulsion.  I did a cortisone injection and 6 weeks of PT, as per my first OS.  For obvious reasons this didn't help (ligament was totally ruptured).  OS#1 offered me to remove my whole meniscus.  For which I politely declined as my meniscus was intact. Why would I want to remove an intact meniscus??  I'm 47 years old, very active, mountain climber, avid skier, and I train police dogs (which is a contact sport!  Believe me!  That's how I injured my knee to being with) This led me to OS#2.  I decided to seek expert care and went to one of the best knee OS in the eastern US.  I made the trip to the Hospital for Special Surgery, met with OS#2 who said 100% the root ligament needed repaired, but the OS also felt that I had a patellofemoral component and prescribed 8 more weeks of PT and high dose antiinflammatory to try to quiet the knee down (large effusions on MRI).  She described the surgery required to fix the MMRT which would be a pull out suture repair through a tibial bone tunnel with a bone anchor.  I went home, did the PT, took the antiinflammatories and the knee did start to feel better.  While going through round two of PT, I was referred to an OS in my area who was "excellent" with knees.  So I went to see him.  All else being equal, it would be nice to do the surgery in my own area where I wouldn't have to drive 4+ hours one way for postop appts.  I met with OS#3, who agreed with OS#2 and said he would do the same repair (pull out/transtibial bone tunnel/anchor), in fact he pulled up the same surgery he had just done on another patient and he showed me exactly what the repair was (watched the arthroscopic video).  OK.. good so this guy had obviously done this surgery before and had a good outcome AND he came highly recommended from other doctors in my area, so I chose to use him.  Day of surgery I got an epidural and a femoral block.  I asked to not be sedated as I wanted to watch the surgery (I'm an RN), so as soon as he placed his portals and started to run the knee there was a loud pop!  His valgus pressure to open the knee space ruptured my MCL!  He said to me right there... "Did you hear that?  That was your MCL giving way.  But don't worry about it, it will heal on its own and it actually allows me to better visualize the posterior horn."  OK..  didn't think to much of it... MCL's do heal and the posterior horn is a very difficult place to get to. Can't cry over spilled milk right?  He finished the surgery and gets a VERY NICE approximation of the root ligament to its anatomical footprint.  Sews me up and sends me home, with 100% NWB, in an immobilizer at full extension.  Day 2 I have a post op appointment.  Appointment goes well, swelling is only moderate, pain is pretty well controlled.  As I'm trying to crutch up the ONE step into my house, I slip on the ice, fall and land HARD on the heel of my bad leg, I hear and feel another pop and immediately have burning up the lateral side of my leg.  Call the OS, he said, don't worry to much about it, we can't go back in now anyway, just RICE.  Fast forward to 4 weeks post-op.  Still 100% NWB in an immobilizer/full extension and still having pretty significant medial joint line pain, and posterolateral pain (right behind my knee).  Pretty constant throbbing, and numbness on the lateral aspect of my calf and my foot. And also having persistant patellar pain, especially with any type of dorsiflexion.  It also feels like my knee is in constant hyperextension which is quite uncomfortable.  OS orders a second MRI.
Moderate joint effusion
No definite tear in the medial meniscus - but MM shows moderate extrusion
Proximal half of MCL shows severe MCL grade 3
Moderately severe superficial and deep soft tissue inflammation/edema overlying all
regions of the right knee
ACL intact.

Followed up with him a few days later (now 5 weeks post op) and he said everything should be fine, go ahead and start to use the leg.  Took me out of the immobilizer, told me to wear the hinged knee brace I got pre-surgey, and to start to wean off the crutches.  He wants me to start PT this week as well.  So I try to do what he says., 25% PWB, and start to bend the knee...  and it immediately swells back up, pain increases, and every time I put my heel on the ground (lightly) it send a shock (like pins and needles) up my heel, up the back of my leg, to the back of my knee.  Is this normal?  Has anyone else experienced this with an MCL injury? I'm 5 weeks post repair and post MCL rupture and any little pressure that gives me even a little  pressure is very painful (like my big toe catching on my pant leg as I'm trying to put my pants on), is this normal? 


« Last Edit: August 25, 2016, 09:53:27 PM by K9Sport »
11/2014 - PHMM Root Ligament Repair (failed)
6/2015 - revision of PHMM Root ligament repair, LOA, Chondroplasty

Offline KyAuz

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Re: Root Ligament Avulsion and MCL 3
« Reply #1 on: December 23, 2014, 10:02:40 AM »
Oh my goodness, you have been in the wars, haven't you! Your third OS sounds like a bit of a dill. I have a grade 3 MCL tear that happened 12 weeks ago along with a completely ruptured acl. I still haven't put weight on it! My OS wanted me to be at least 8 weeks in with the healing of the MCL before he would do the ACL recon. So, I think putting weight on your leg so soon is a bad idea. A second opinion may be in order. I still, even 12 weeks on get pain and a weird stretchy feeling in my MCL. So frustrating because you can't see if it's healing the way it should. I'm sorry I can't really help you but just know you're not alone. This torn ligament business is a nightmare. Take care and Merry Christmas x

Offline K9Sport

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Re: Root Ligament Avulsion and MCL 3
« Reply #2 on: December 24, 2014, 01:19:07 AM »
Thanks KyAuz!  I guess I expected that the MCL would feel fine after 6 weeks or so...  I'm 6 weeks post op today and PT started last week.  I'm still only PWB and since the physio started the knee is quite painful again.  I can range with passive motion from 5 to 45, with active motion (bands) I can get to 70, but it is very painful.  My OS said that I should try to wean off the crutches all together in the next 3-4 weeks.  I am pushing hard with the physio as I really want to be back on my feet soon and I guess I'm a little discouraged that the range isn't coming back quicker...

Have you had your ACL recon yet?

Merry Christmas!   
11/2014 - PHMM Root Ligament Repair (failed)
6/2015 - revision of PHMM Root ligament repair, LOA, Chondroplasty