2 physicians, 1 chiropractor, 2 physiotherapists, and a surgeon stumped...

[Aimless]

Hello everyone! I'm brand spanking new to this forum, and I thought I'd just delve right in!
This past May, I got kicked by my horse. I was standing behind and to the side of him, and he connected with my leg laterally, slightly superior to the joint.
The leg was fully loaded with my weight, and I didn't hear any snapping or popping that I can recall. I was very stupid and got on the horse after I got over the shock, but didn't ride long. Within an hour of the kick, weight-bearing became excruciatingly painful. Over the next few days the pain didn't subside even though I was diligent about icing it and taking anti-inflammatories. A week after the kick, I saw my GP and started seeing my chiropractor (he's also an active release specialist, which is why he was my choice; he has been my primary healthcare advisor for this injury, and has overseen my physiotherapy throughout) - my GP felt that there was nothing structurally wrong, and my chiro felt that there was something fairly major wrong. I was put on partial weight-bearing crutches for 4 weeks, I believe.
I had a MRI scan done in June - the results came back showing a meniscal edema and a strained MCL.
I progressed with my physiotherapy fairly quickly, and in late August, my chiro cleared me to ride again. I rode 3 times, with each ride being progressively worse. After my third ride, I dismounted and felt that something just wasn't right. Since then, weight-bearing has once again become painful, stairs are once again hard to do (if I've been slightly active through that day, I have to take stairs one at a time), I cannot squat without immense pain - basically, I'm back to square one, and haven't progressed at all since that last ride in September.
In mid-September, I went to see a GP in my physician's office as he was unavailable that day. The substitute physician agreed that something was likely injured in my knee, and recommended me to a surgeon - he wasn't confident giving me a guess as to what is wrong. My chiropractor works in the same office as a group of physiotherapists, so requested an opinion from one of the head physiotherapists in that group - he examined me, asked me a lot of questions about the injury and my physiotherapy to date, and was stumped as well.
My chiro asked me to get on my horse to see how it felt a month after the re-injury. I got on, walked around a bit, and got off - something didn't feel right, and being in that half-squat position was quite painful.
A month later I hadn't heard from the surgeon's office, and decided to take matters into my own hands. I made an appointment with another physiotherapist within that group (they're some of the best in the city) and he was very intrigued with my case, though stumped as well. He decided to speak directly with a surgeon colleague of his. The surgeon was intrigued as well, and I had a consultation with him a couple of weeks ago. He doesn't know what's wrong, but says it might be anything from a meniscus problem, to a femoral issue, to an osteochondral defect of the cartilage of my femur, to a recurring soft-tissue injury. In any case, he decided to send me for a bone scan, and booked me in for an exploratory scope on Feb 1, 2010. I had the bone scan last week, and will get the results on Monday.
I am very frustrated. My horse has been leased out as I can't exercise him adequately. In fact, at this point it's a struggle for me to get around the block to walk the dogs - by the end, I'm walking very slowly. I work in retail, and most of my shift is spent sitting. I am a very active person - I ride and train horses, I hike, I ski - all this has been put on hold due to this lovely injury.
My symptom list:
- palpating the joint produces extreme pain through the medial side of the joint line, worsens as you work towards the femur
- clicking while joint is put through ROM
- limited ROM - flexion is slightly limited, and painful through the top medial side of the joint; full extension is uncomfortable, hyperextension is very uncomfortable
- pain while weight-bearing
- unstable joint (I have had episodes where I've felt the joint has "slipped")
- doing stairs produces pain and clicking
- "catching" of the joint - though the joint has never fully locked
Has anyone ever been here? Any advice?
Thanks in advance!

[Heidi]

Hi

Thanks for your post. It was certainly very interesting reading!
However, I think your case is well beyond the scope of this forum.
I think all anyone here could suggest is that you wait for the results of your bone scan and then possibly the exploratory if this is still necessary.
All the symptoms to tally up with a cartilage and MCL injury, however it is the second bout of injury after apparent success with the first rehab programme that is confusing to say the least!
I take it that during those three rides you didn't feel anything specific happen in the knee and that it just got worse over a period of time?

Keep us updated with your progress and good luck!

[Aimless]

Hi Heidi!
Thank you so much for your reply!
Every time I go and see my chiro, he says "I hate your knee." It would be quite funny, except that it's true. During those rides I didn't feel anything to suggest re-injury, except for "pulling" through the anterior medial side of the joint line.


I got the results of my bone scan yesterday - it showed a mild bone contusion, but nothing that would account for all of my symptoms besides pain. My surgeon is still keen on going in and taking a look around the joint.

[Aimless]

Hello, just thought I'd throw out a quick update.... I am in for surgery tomorrow at 1:30 pm.
I guess the worst part is that we don't even know what we're going in to fix.. if it even can be fixed. He wants me to go under (which is good, I don't think I could stand watching the surgery) and seems a little concerned with recovery - apparently I'm a very a-typical case (the analogy "when I hear hoofbeats, I think horses... you're the Zebra." was used) I'm not sure I understand the entire theory, but the bottom line is he seems a bit concerned.
Here are the 4 possible outcomes he is predicting with this surgery:
1) contused, damaged meniscus, in which case he will perform a 'microfracture' surgery, where he basically roughs up the meniscus, drills into it a bit in hopes of re-injuring the meniscus enough that it repairs itself. This might include a menisectomy (sp??). If this surgery is the case, I will be non-weightbearing for 3-6 weeks.. ugh
2) osteochondral defect of the femoral cartilage, in which case he'll perform a microfracture surgery into my femur instead of my meniscus.
3) part of the "curtain" of cartilage between the patella and joint line is damaged and/or actually caught in the joint line, in which case he'll remove the cartilage.
4) damage to the fat pad surrounding the patella, possibly with necrotic tissue in there. If he is able to, he'll repair what he can, but it's not likely to be reparable.
5) he comes back out without being able to repair anything, and we try another course of treatment, which includes a pretty cool-looking brace, and some heavy-duty pain medications.