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Author Topic: MCL injury after arthroscopic surgery  (Read 4084 times)

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Offline K9Sport

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MCL injury after arthroscopic surgery
« on: December 18, 2014, 06:53:31 PM »
Hi all..


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  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
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 valgus 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? 

Initial PT eval was this morning.  I can range 0-45.  Quad strength was excellent as per PT.  Hamstrings were very tight as was the ITB.  She gave me my "homework" to so twice a day and I'll be doing physio 3x/week for the next month. 
« Last Edit: August 25, 2016, 09:37:28 PM by K9Sport, Reason: correction typo »
11/2014 - PHMM Root Ligament Repair (failed)
6/2015 - revision of PHMM Root ligament repair, LOA, Chondroplasty

Offline K9Sport

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Re: MCL grade 3 after arthroscopic surgery
« Reply #1 on: January 02, 2015, 12:22:46 AM »
Thought I would update...  2 weeks into PT and my ROM has increased to 0-83, I can weight bear with a single crutch, the constant throbbing is gone, I definitely have significantly increased flexibility in the knee (quads, ITB, and hamstrings are much more flexible)  When weight bearing I might take 30 steps that are virtually pain free and then on the 31st step I have a sharp pain deep within the knee.  Weird!  I still have crepitus under the patella which is quite painful on extension, and the MCL area is still very sore, but I am happy to report that it feels like I am moving in the right direction. I hope to be totally off the crutches in the next week or two!

(7.5 weeks s/p repair of MMRT - with MCL g3)
11/2014 - PHMM Root Ligament Repair (failed)
6/2015 - revision of PHMM Root ligament repair, LOA, Chondroplasty

Offline healingup

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Re: MCL injury after arthroscopic surgery
« Reply #2 on: April 26, 2016, 08:01:11 AM »
Hey k9sport,

I was wondering how your rehab is doing.

I susstained a grade 3 mcl, acl and flipedn lateral menical tear. 6w post accedent everything had been stiched bank. The mcl with internal brace and the acl with lars.

One weem post opp. The mcl hurst most. I cannot bend further then 50 degrees. I am looking into stem cell treatment as well just to "reinforce" the meniscal tear, even thought it is stiched back. I hear many stories of meniscus that fail after surgery... how are u doing? Thx