Ruptured ACL and the rest.

[nick911e]

Hi

I injured my knee playing football last Saturday.

My studs got caught in the turf and my knee hyperextended. There was an almeighty crack when it hapenned. The swelling as instant.

Later that day I went up to casualty. I got an Xray. The nurse and then fructure trainee doc, both weren't happy with a bone. Turns out to be the top of my fibula. That was tender to touch.

I got sent away in a splint and on crutches and given an appointment for the orthopaedic consultant on the Monday. I returned, probably in slightly more pain, and the swelling exactly the same, which was round the whole knee, back side and front, and also in the area of the top of my fibula.

The consultant seen me, and after some rough play with my knee, he said i had ruptured my ACL. I felt when he moved my knee from left to right it went easy, whereas when he done it with my good knee, it felt elasticated kind of.

He said he would arrange an MRI scan, and I was looking at surgical repair and 3-6 Month Rehab.

I got my sick line from my doctor today. She wrote it after reading my notes and for diagnosis she has written Fracture of Fibula. Which confuses me. I know when a ligament ruptures, it can rip a bit of bone off, but is my ACL connected to my fibula?

At the moment the most severe pain i have, is in my calf and hamstring. The pain is far more severe than anything i got with my knee. Will this be from stretching the muscles when my knee hyperextended? Could they be torn?

I have big bruising on the top of my Fibula on the outside, and top of my Tibia on the inside.

I have to wait till the 3rd of March for my MRI. Its my 21st of the 6th. Bad timing indeed.

Any suggestions of what i've done, or what ligament it might be etc, would be great.

Thanks

Nick

[Heidi]

Hi Nick

No your ACL is not connected in any way to your Fibula. So unless there is something you haven't been told, then I don't know where the Doctor got this from.
It is difficult with traumatic knee injuries like this in the early stages. Often the swelling and bleeding make it difficult to properly diagnose what has happened and an instant MRI will not be conclusive either. So in that way it is good that they are waiting to do the MRI.
Unfortunately it does mean that all you can do until you get the results of that is to wait and rest as instructed. Until they get the MRI results they won't be 100% certain what the damage is and so what route is best to take.
The pain you are experiencing in the calf and hamstring could be due to damage to these muscles. Is there any bruising or swelling there? Does it hurt when you push these muscles anywhere?
If not, it could be referred pain from the knee, or it could just be that the muscles have really tightened up to protect your knee and prevent further injury. If the muscles are really tight it can be almost like cramp.
I hope this answers some of your questions, and bad luck about your birthday!
http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm

[nick911e]

[QUOTE=Heidi;3457]Hi Nick

No your ACL is not connected in any way to your Fibula. So unless there is something you haven't been told, then I don't know where the Doctor got this from.
It is difficult with traumatic knee injuries like this in the early stages. Often the swelling and bleeding make it difficult to properly diagnose what has happened and an instant MRI will not be conclusive either. So in that way it is good that they are waiting to do the MRI.
Unfortunately it does mean that all you can do until you get the results of that is to wait and rest as instructed. Until they get the MRI results they won't be 100% certain what the damage is and so what route is best to take.
The pain you are experiencing in the calf and hamstring could be due to damage to these muscles. Is there any bruising or swelling there? Does it hurt when you push these muscles anywhere?
If not, it could be referred pain from the knee, or it could just be that the muscles have really tightened up to protect your knee and prevent further injury. If the muscles are really tight it can be almost like cramp.
I hope this answers some of your questions, and bad luck about your birthday!
http://www.sportsinjuryclinic.net/cybertherapist/front/knee/anteriorcruciate.htm[/QUOTE]

Im not sure if there is any brusing to my Calf area. Theres swelling directly behind the knee. The calf is extremely tender to touch. Its a sharp pain. The pain gets worse whenever i stand up. Its by far the sorest area of the injuries i recieved at the weekend. My knee seems painless compared to the calf.

Thanks for your quick responce!

[nick911e]

Also, if they are using the fact that my ligament pulled a bit of bone off as the reason for my "fractured fibula" would that mean it was my LCL that was ruptured?

Whats the treatment and recovery time for this ligament in comparison with the ACL?

I play football at least twice a week, and ski at least 4 or 5 times a month, so I'm kinda worried I won't get back to the same activity level.

Thanks

Nick

[Heidi]

Yes, if there is an avulsion fracture of the Fibula the it is the LCL involved, not the ACL. Although there could be damage to both.
Generally, I would say healing times for an LCL rupture are quicker than ACL, although most people with an LCL rupture don't have surgery as this ligament is not quite as important to full knee stability than the ACL. It may make sense that it is the LCL as you initially said the Doctor moved the knee from side to side and there was excess movement there. This fits with LCL injury more, as ACL injury results in more movement forward/back.
Treatment for LCL is rest and getting full range of motion back, reducing swelling etc and then working on strengthening the surrounding muscles to support the joint. Similar to ACL without surgery.
http://www.sportsinjuryclinic.net/cybertherapist/front/knee/ilateralligament.html

[nick911e]

Hi again.

Its now 4 weeks since it hapenned. I'v had an MRI then seen my consulatant a week later. The MRI had stil not been reported by then though.

He put me in a cast brace and told me to come back on the 31st. He said my knee seemed to me in a state and i'd probably have to travel 20 miles to Ninewells to see a specialist.

I managed to get my hands of my MRI report which got reported a couple of days ago. I don't understand 90% of it. Can anyone help?

Here it is:

MRI Knee LT:

PD coronal fat sat, T1 sagittal, T1 DISS, T1 coronal and axial PD fat sat sequences were performed

1. There is a fracture of the head of the fibula(arcuate/avulsion) with associated bone oedema.

2. There is significant bone oedema is the medial and lateral femoral and tibial condyles with impression of a cortical breach in the lateral aspect of the lateral condyle of the tibia raising the possibility of a fracture here (not typical second type fracture)

3. there is significant high signal seen in and around the distal lateral collateral ligament and biceps femoris tendon consistant with a grade 3 injury.

4. there is also a large volume of fluid surrounding the popliteus tendon with minor irregularity and high signal at its proximal femoral attachment.

5. the anterior cruciate ligament appears heterogeneous in its signal characteristics although appears to be in continuity - consistent with partial tear.

6.there are fluid fluid levels in keeping with lipohaemarthrosis in the dependent positions of the joint.

7. normal posterior collateral ligament. menisci and patello femoral joint grossly unremarkable

oppinion: appearance are in keeping with significant posterolateral corner injury.


Thanks, Nick

[Heidi]

Hi Nick

I will try to help with your MRI findings, but there is some of it that I am not sure of either!

1. As suspected, a avulsion fracture of the LCL and fibula head - basically meaning the LCL has pulled the head of the fibula away from the rest of the bone. Bone oedema is just like swelling and bruising - as you would expect with a fracture.
2. Not really sure on this point. Think they are saying there may be another fracture at the top outside of the Tibia.
3. Tears to the LCL and Biceps temoris (hamstring) tendon on the outer/posterior knee.
4. Possible tear to the popliteus muscle - again back outer knee.
5. Probably a partial tear in the ACL.
6. Sorry - don't know!
7. No posterior cruciate or meniscus (cartilage) damage.

A posterior lateral corner knee injury consists of many of the injuries you seem to have, to the back and outside of the knee joint. You can find out some more about this here: http://www.sportsinjurybulletin.com/archive/posterolateral-corner-knee-damage