Chronic swelling around knee cap and subsequent splaying foot

[HeatherDee]

Over five weeks ago I was opening the car door and to prevent my dog escaping took my foot off the car sill to quickly plant my foot and secure the runaway dog lead. No pain at this point. Within 10 mins after bending down to clean up after the dog, my knee seemed to pop as I stood up. It swelled up the following day and after seeing my osteopath twice, whose diagnostic was vague as there was quite a bit of resistance due to the swelling, I’m left with limited mobility.

Due to the Covid lockdown I have been RICE-ing and cycling, but can seek no expert advice. The foot of the offending leg is now splaying outward as I’m overcompensating for non weight bearing movement. Ironically I’m not in pain, though when I get over-confident and try and walk normally up and down stairs, I’m quickly reminded that I have to take a step at a time. I’m beyond frustrated and not clear if I should rest or be active...I walked daily after the incident for three weeks (dog-walking) but have rested it for two, with zero improvement.

Any ideas? I’m told that it probably isn’t Cruciate-based as I’d probably be in agony. It is fine in the morning after bed rest but very stiff each and every time I rise from being seated. I’m a fit and active 52 year old female but feel ancient.

Any suggestions or words of wisdom will go a long way.

Thanks in advance,

[Vickster]

Can you bend and straighten same as the other knee? Pain along the joint line between the thigh and shin bones?

Are you icing regularly? Does it help?

Taking any sort of anti inflammatory or using a topical one like Voltaren?

Got a compression sleeve?

[HeatherDee]

Thanks for the reply...makes me feel less insane...

In answer, I’m struggling to use weight bearing ligament to straighten leg...about 30 degree incline at best compared to full extension in opposite leg. Am icing and heat packing in a ‘where does it hurt/block today’ frenzy, so it’s not consistently applied, but does reduce rigidity, yes.

I’m trying to visualise the point where the thigh and shin bone meet...seems that yes, certainly the side knee tendon is bearing the strain currently.

No more anti inflammatories and used Voltarol til Friday for 1 week (just gone).

* scratches head *

I do have a compression sleeve...not too brace like but satisfactory and keeps all in check...don’t wanna be too reliant...what do you suggest?

[Vickster]

Have you seen a doctor at all?
Did the osteopath mention anything about the meniscus (cartilage that sits between the thigh and shin bones?
Does it hurt on the inside or outside on the knee or middle?
I don’t really know what you mean by weight bearing ligament?

This will explain the knee anatomy
https://www.kneeguru.co.uk/KNEEnotes/primers/knee-anatomy
And common knee problems
https://www.kneeguru.co.uk/KNEEnotes/primers/common-knee-disorders

[HeatherDee]

I have seen a doctor who quickly suggested it could be Cruciate-based because of the ‘pop’ I explained to him. I requested that we book in an MRI which he dissuaded me from as it was only three weeks in, at that stage continuing to explain that there is a danger to having knee work done too early when it isn’t necessary and can heal by itself. So I’m a tad frustrated.

The osteo has since ‘locked down’, but wasn’t clear upon initial investigation as there was too much swelling to detect much.

Thanks again for you reply and the very useful links...I’m now thinking it’s an MCL tear or patella tendon too, since these are the problem areas.

[Vickster]

Meniscus tear another possibility and this can happen rather easily as we get older (the tissue starts to degenerate from age 30 onwards). You need a physio or a specialist ideally to examine the knee thoroughly, meniscus tears are identifiable with certain manual tests (MRI useful to confirm but not full proof).

RICE the best way to manage, use a neoprene support to provide compression.

If it is meniscus or MCL, 3-6 months or more to recover would not be unusual.
What country are you in?
Can you get a video consult with a private physio to get a basic rehab programme organised?

[HeatherDee]

Hi again Vickster, thanks for your comments once more.

I live in UK, was in London (were GP and Osteo are) but moved to countryside prior to ‘lockdown’.

I wonder whether a meniscus tear is a Grade II level injury, ie. doesn’t need surgery but can mend over a longer period of time. Since your last post, I’ve discovered a kind of bench press motion using the arm rest of the sofa while seated helps to realign the limb and knee and pushing into the heel helps to stabilise things for a while...who knows?

Will certainly look at video consultation as a starting point though sadly I can’t afford to do this privately...will see what other avenues are available too.

Thanks once more,

HeatherDee

[Vickster]

Whether a meniscus tear will heal depends on loads of factors, where it is and blood supply, how big it is, the state of the tissue, whether lateral (outer side of knee) or medial (inner side of knee), the state of the knee Cartilage in general (arthritis)

There’s a good primer here
https://www.kneeguru.co.uk/KNEEnotes/primers/meniscus

In terms of surgery, the evidence for meniscus removal isn’t good if there are no specific mechanical issues to fix (locking, buckling due to the torn tissue being caught in the joint) and the aim is really just pain relief.

Better to manage swelling and rehab with an experienced physio to get strong if the knee is otherwise good

[HeatherDee]

Belated thanks for your reply. The articles within this forum offer interesting reading, so thanks for the direction. I contacted my local NHS musculoskeletal help group and hopefully I will qualify for physio, though I’m not sure quite how urgent my case is.

Just wanted to offer my thanks for your reassuring presence when it often felt like there was none especially because of the lockdown.

Thanks again

HD

[Vickster]

No worries.

There’s a comprehensive list of knee rehab exercises you could try. If the knee is stiff, try warning it up with a wheat pack or hot water bottle before starting. If it’s swollen, give it an ice afterwards
https://www.kneeguru.co.uk/KNEEnotes/primers/a-z-rehabilitation-exercises
I’d avoid anything that involves squatting, lunging, hopping, jumping etc and try the ones lying down