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Author Topic: MCL and retinaculum tear  (Read 815 times)

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Offline madcoder

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MCL and retinaculum tear
« on: March 17, 2015, 05:17:32 AM »
This is my first post. I'm mainly looking for any insight into what kind of recovery time I have to look forward to, and the chances of walking normally again in the next 2-6 weeks.

I slipped on a patch of ice ~3 weeks ago.  I don't think that there was any impact to the knee, I think it was just a twisting injury.  It hurt a lot and took a minute or so to stand up and walk. I walked the rest of the way to my house. Later that night as I was getting water from the refrigerator, my knee buckled and I fell -- but since then I have not had any issues with stability.  The 2nd day I mostly stayed on the couch and rested it.  The 3rd day I worked from home, still resting it, and by the 4th day I was comfortable enough with walking on it that I went back to work.  I've been walking on it since, albeit with a limp.

For about 2.5 weeks, I couldn't fully extend it -- that changed one night when I moved the pillow from under my knee to under my heel, and gravity pulled it over time to extend fully.  While standing, I now can still consciously extend it enough with a roll of my hip so that I can distribute weight on it with my feet flat, but I still can't lock my knee.  And for the first ~2 weeks, I could not flex it beyond 90 -- but for the past week, that seems to have gotten worse, where I really can't even bend it beyond 30-45.  This makes descending steps extremely annoying as I have to take them one at a time. Going up stairs is slightly more dignifying, as I can swing my hip around when I bring my bad leg up to the next step.

There really isn't any pain most of the time, even when walking.  When I do try to bend my knee, it feels like there's a lot of pressure on the top of my kneecap, where the quadriceps tendon is.  I'm afraid to try to force it through that pressure, because I'm afraid it could damage something else.

X-rays from about 2 weeks after the injury showed no fractures and good gapping.  Last week I saw an OS who drained a full syringe of fluid from the joint and ordered an MRI. Today I got the MRI results:
There is a fairly extensive contusion involving the lateral femoral condyle with findings greatest along the inferolateral aspect. There is edema in the medial patella with edematous changes about the medial retinaculum consistent with a partial tear. Findings are consistent with a patellar subluxation with associated bone contusions. There may be a very subtle subchondral fracture involving the lateral femoral condyle anteriorly.

There is a moderate effusion with a small popliteal cyst.

The menisci appear intact.

The cruciate and collateral ligaments reveal no evidence of a tear. There is edema along the medial aspect of the MCL.

The extensor tendons appear intact.

The musculature is unremarkable.

Impression:  There are contusions, especially involving the lateral femoral condyle and relatively small area of the medial patella, consistent with a patellar subluxation and return. There is a small-to-moderate effusion with a small popliteal cyst. There is no evidence of a ligamentous or meniscal injury. There is probable partial tear of the medial retinaculum. A very low-grade medial collateral ligament tear is not excluded.

I was able to see the bone contusions easily in the MRI images, though I don't really know what to look for to see the retinacular tear or the MCL.  The OS diagnosis was "Left knee injury with patellar subluxation and small MCL tear with small medial retinaculum tear," and prescribed 3-4 weeks of PT, saying that he believes none of the above requires surgery.

So, on to my questions...

1) Does anyone know if the retinaculum tear could be the cause for my lack of flexion?  My OS answered quite confidently when I asked that question that yes, it would cause that;  but from most of what I've been reading from others who talk about this type of tear, I haven't seen anyone mention a correlation to lack of flexion.

2) Is there any explanation for why there's no pain?  There's a slight "sensation" on the medial side of my knee (I guess somewhere between the MCL and medial retinaculum) when I touch it, but I wouldn't really call it pain -- the closest I can describe it as is a slight burning sensation, but it's really hard to explain.  But even on the lateral side where the bone contusions are, I don't really feel any pain.  Along the MCL, I don't feel any pain aside from that burning sensation.  And I don't even really know what the retinaculum is, to know what it should feel like.

3) Is it bad that I'm walking on it?  Today the OS gave me a J-brace, which feels odd against my kneecap, not to mention it's pretty uncomfortable where the hinge presses against the joint (on both sides, not just the medial side).  I don't know if I'm going to be able to handle wearing it all day at work.  She grabbed a large, and said that the gap in the brace is perfect, as it should be; but I'm wondering if I would have been better off getting an XL?  I also asked the lady who gave me the brace if a cane would be beneficial, and she said she didn't think it would help me.

4) What kind of recovery time am I looking at?  It's been three weeks already, and I'm just now getting a diagnosis for what happened, and just about to start PT ...  but a 0-30 ROM seems pretty bad to me :/  like I've got a lot of hard work ahead of me.

To make matters worse... I'm getting married in 6 weeks, and I definitely don't want to be hobbling on my wedding day!  Plus in just 2 weeks we're having a joint destination bachelor/ette party (stag party?), which was planned months ago, and we're expecting approximately 20 people going, all of whom have already booked flights and hotels.  So it's not like we can just cancel the party 2 weeks before...  Is it a bad idea to continue with that party?  Anything I can do to make the J-brace more comfortable to wear all day long?