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Old April 27th, 2009, 05:37 AM   #1
Yonah
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Unhappy Knee Injury

I wasn't sure whether to put this thread in this forum or the main forum. I actually started the train of thought in the "Training Log" thread, so I'm putting it here. I'm linking below to all the previous posts on this particular topic in order to give it context. Then I'll provide the current update.

Initial history of my knee "event"
Reassuring reply
Thoughtful sage
My replies to previous two
Another interesting reply
Reassuring history from my friend
My replies to previous two
Bill's advice -- why I started this thread

Bill privately assured me (I saved the e-mail -- I can prove it ) that this information would be of interest to a group of people large enough to warrant starting it. BTW Bill, thanks for letting me figure out the technical details on my own. I really mean it -- that's how I learn (all it took was actually reading the information kindly provided by the Forum administrators )

O.k., the drum roll please! I got the MRI report on Friday:

1. Anterior cruciate ligament (ACL) tear. I hate these reports sometimes. I don't know if the radiologist just couldn't tell the severity of the tear, or if he/she was just lazy, but there was no indication how bad it is. I have the films, and my orthopod will be able to tell me.

2. Small tear of the inferior surface of the posterior horn of the medial meniscus.

3. Grade 2 (approximately 50%) tear of the lateral collateral ligament (LCL)

4. Marrow edema at the posterior lateral aspect of the proximal tibia consistent with a bone bruise, commonly seen with ACL injuries.

5. Moderate-sized joint effusion . . . small cyctic fluid loculation at the musculotendinous junction of the popliteus muscle.

Obviously, the first three are the most serious, especially the ACL and the LCL. There is no mention of the quads, and I remain unconvinced there is no tear in there -- especially the vastus lateralis. However, I have an appointment on Thursday with the best orthopedic surgeon I have ever met -- unless there is a cancellation today and they can get me in to see him -- and he will certainly straighten me out.

It's still pretty swollen (admittedly, I could be icing it more , but I do elevate it and perform edema massage at night -- not enough pro-active intervention on my part, though), and especially painful when I've been sitting with it bent for a while and then I straighten it. The ACE compression "brace" was impeding edema flow, so I just switched today to a TEDS thigh-high compression stocking.

I'm using a "step-to" gait on stairs (up with the good, down with the bad), and I got a cane today because prolonged walking/limping makes it ache. It enabled me to go with my son & watch the Orioles beat the Rangers 8 - 5 (it was a very exciting game -- we're still Red Sox fans though).

The knee has "given out" on me a few times earlier in the week, and it's really "iffy" in full extension (straight knee) in full weight-bearing. It doesn't bend much either. I was doing some exercises earlier in the week that increased range of motion, and they enabled me to straighten the knee when it was bent to at-that-time max range of about 100 degrees flexion, with the hip at 90 degrees flexion, in supine (on my back). Before the exercises, I couldn't straighten it again from that position without assist from my other leg. However, the exercises really made it ache, and I decided to lay off for a while and let it rest as much as possible.

Meanwhile, I'm eating everything in sight and putting on pounds

More "breaking news" (G-d forbid) as it happens.
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Last edited by Yonah; April 27th, 2009 at 06:38 AM.
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Old April 27th, 2009, 02:20 PM   #2
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Thanks for the report Yonah. I think it interests a lot of us because we have been there with various injuries.
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Old May 1st, 2009, 06:01 PM   #3
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I had my appointment with my orthopedic surgeon yesterday, and I was feeling really beat up afterward. All the physical testing on the ligaments really aggravated the knee. He aspirated (with a large needle) 30 cc of blood out of the joint capsule, and the swelling dropped significantly by today to where it looks like a knee again, and not like a balloon. I'm using a Jobst compression stocking to keep the swelling down (and I will be icing often), and I have a brace on it to protect the lateral collateral ligament (LCL).

It was also pretty sore from it giving out on me a couple of times over the previous two days. I can still feel cortisol circulating through my system, so Iím still a little wiped, but I'm much better today than I was yesterday.

So, my anterior cruciate ligament (ACL) is completely ruptured; 50% tear LCL; and a small medial meniscus tear. Iím scheduled for surgery on June 23. My orthopedic surgeon is going to use an allograft (cadaver ligament) for the ACL in order to preserve my knee as much as possible. The only other way to do it is to split my patella tendon and use part of it for the ACL, but that would weaken the knee. Heís going to repair the LCL, and he thinks he can repair the meniscus, but he wonít know for sure until he gets in there and looks at it with the scope. If not, heíll trim it.

Dr. Zikria is the best orthopedic surgeon Iíve ever met Ė Iíve worked with him, and Iíve treated some of his patients. Heís very conservative, and he wonít do surgery if he can avoid it. He took X-rays of my knee to make sure itís not arthritic, which would prevent the surgery (obviously, itís not).

I asked him if Iíll be able to skate again, etc., and mentioned the extra torque at the knee that I believe occurs with DP -- especially all the more so with my low proficiency at it. He smiled, and said, ďThatís the only reason weíre doing the surgery. If you didnít want to do that, there would be no reason to do the surgery.Ē I didnít ask him about the simple fact that my knee is so unstable, wouldnít that be enough of a reason? But it was very reassuring. Dr. Zikria also has extensive sports medicine knowledge and experience. In fact, he is one of the team doctors for the Baltimore Orioles (not a coach ).

I asked him about using a sports brace so that I can return to work while waiting for my surgery. He said there is no brace available that has been proven to control for rotational movement/forces. They only control excess medial/lateral movements.

I donít know what the timeline is yet for actual return to sports. Over the next few weeks, I have to get full range of motion back in both flexion and extension, or he wonít do the surgery. I canít really work until I recover (at this point, my knee is too unstable), and Iíve cancelled my teaching trip to the San Francisco area in July (it was supposed to be New England, but we changed it). So, I will be here stretching to get full range, and strengthening only in the 0 Ė 30 degree range. Before the knee was drained I had 120 degrees of flexion. It looks like significantly more today, but I haven't measured it yet.

Dr. Zikria and his PA both complimented me on my quads, and commented on how important the quads are for keeping the tibia in place in relation to the femur. That stoked (stroked) me a bit.

I wondered how much I should worry about pain during exercise over the next few weeks (how much can I reasonably push the limits?), and he told me it will ache when I work it, but I should continue to work through that, so Iím going to be pretty aggressive with it, without overstepping the recommended protocols, of course. I want to get this show on the road. I miss skating!

Because of the lack of an ACL, the knee could give out any time with cutting/pivoting-type motions, and that giving out can further damage the meniscus, so Iím trying to be careful (not to mention how extremely painful it is when that happens, and it sometimes causes me to fall). Moving with such care and attention is a little tough sometimes during more hurried moments, especially while squeezing through tight spaces. Iím using a cane for any longer distance walking, and I can still only take the steps one at a time in a step-to gait until after the surgery, so as not to cause any shearing to the meniscus.

Iím back on track with my upper body workouts, though: high rep/low weight lifting. It feels good. Iím going to see if I can get on the Concept II rowing machine and keep the knees in the 0 Ė 30 degree range. If not, I wonít be able to do it, but if so, Iím set (I just canít get carried away).

Iím kind of glad I didnít spend the money on speed skates yet. Who knows what great new models will be available when Iím ready? Iím kind of leaning toward the Bont Jet right now (see my optimism returning?) because of what Julie wrote to me about going straight for the all-out speed configuration. Her comment was also confirmed by Bill Begg in an article that I read. Someone wrote to him asking exactly my question: Semi-race vs. Jet? He answered: The full race allows the skater to drop lower into the speed position, and the person who asked the question would be wanting to upgrade within a short time. Bill told him to save some cash, skip the Semi-Race and go straight to the Jet.

By the way, just before I injured myself, I had what I think is a brilliant insight for night skating. One Friday afternoon there was an accident on the Baltimore Beltway, and traffic was really backed up. I ended up getting on Rte. 70 to 100, and made it with [a little] time to spare. Before I knew I would be able to get to the alternative route, I was trying to think of another skating solution for that day. I thought, ďAccess roads that circle the malls!Ē Theyíre long and smooth (at least they look smooth from the car ), but I donít know how skating would fit in with traffic during the day, and I donít know if those security guys who ride around in the little carts would kick me out at night. Itís worth a look-see/try sometime.

I will keep posting progress as it happens (When news breaks, we fix it).

One more little piece of excitement: I believe that this post makes my 100th post on the skatelogforum! I think that probably 75 of them occurred in the last couple of weeks, when I've been home with way too much time on my hands!
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Old May 1st, 2009, 06:36 PM   #4
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Good luck Yonah.

I guess the somewhat long wait for surgery is normal? Would it be that long if you played for the Orioles?

If it was me I'd spend a lot of the down time in the pool.
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Old May 1st, 2009, 06:50 PM   #5
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Yonah:

Congrats on your 100th post

Sorry about the knee! I hope it gets better.

I never got the % tear on mine, they only did one X-Ray and the Doc said "Yep, MCL splint for 2 months, see me after that.

lol.

It sounds like you're in good hands!
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Old May 1st, 2009, 06:51 PM   #6
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Good luck Yonah.

I guess the somewhat long wait for surgery is normal? Would it be that long if you played for the Orioles?

If it was me I'd spend a lot of the down time in the pool.
The wait is to ensure that I have full range of motion before surgery. Less than that results in poor outcomes. I'm sure that if I were an Orioles player, I would have more resources at my disposal, and the surgery would take place as soon as I was ready. However, since the surgery has to be scheduled in advance for me, we took our best guess. Anyway, there is a lot of other prep stuff to do, like a complete medical exam/clearance, chest X-ray, EKG, and blood profile. Again, if I were worth millions to get back in the game as soon as possible, I'm sure the procedures and obtaining the results could be scheduled at the drop of a hat.

Swimming is a GREAT idea! I'm going to look into short-term memberships on Monday. Thanks for mentioning it!
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Old May 1st, 2009, 07:10 PM   #7
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If you do end up doing some swimming Yonah, I would use a pull buoy to immobilize your legs.

You stick it between your legs and let you upper body do the swimmimg.

Makes sense about the waiting period.


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The wait is to ensure that I have full range of motion before surgery. Less than that results in poor outcomes. I'm sure that if I were an Orioles player, I would have more resources at my disposal, and the surgery would take place as soon as I was ready. However, since the surgery has to be scheduled in advance for me, we took our best guess. Anyway, there is a lot of other prep stuff to do, like a complete medical exam/clearance, chest X-ray, EKG, and blood profile. Again, if I were worth millions to get back in the game as soon as possible, I'm sure the procedures and obtaining the results could be scheduled at the drop of a hat.

Swimming is a GREAT idea! I'm going to look into short-term memberships on Monday. Thanks for mentioning it!
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Old May 1st, 2009, 07:33 PM   #8
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If you do end up doing some swimming Yonah, I would use a pull buoy to immobilize your legs.

You stick it between your legs and let you upper body do the swimmimg.

Makes sense about the waiting period.
Yes, I have pull buoys, Skaterdog.

However, I don't really need to immobilize my leg, and I think there's very little chance for rotational or medial/lateral force on the tibia if I stick to the crawl, and I avoid flip-turns. In fact, I think it would be good to do some kicking, and encourage blood flow & circulation (and calorie burn). Most of the kick should come from the hip, anyway, not the knee (if I can remember that while I'm swimming).
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Old May 1st, 2009, 07:39 PM   #9
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Yonah:

Congrats on your 100th post

Sorry about the knee! I hope it gets better.

I never got the % tear on mine, they only did one X-Ray and the Doc said "Yep, MCL splint for 2 months, see me after that.

lol.

It sounds like you're in good hands!
== John ==
Thanks on all counts, John.

Don't I get some kind of skatelogforum.com pin or T-shirt, or something? Actually, your congratulations works for me.
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Old May 2nd, 2009, 01:53 AM   #10
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Yonah - we're so sorry to hear about the prognosis you received. Between the two of us, me with an MCL/PCL injury, and Kevin with a meniscus injury (he had two surgeries), we have both had our share of knee injuries and we feel for you! Sorry to hear that the ACL tear was a rupture, rather than just a tear. Hang in there!! A month or so before you know you can skate again, take the plunge and order those speedskates. Speedy recovery.

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Old May 2nd, 2009, 01:37 PM   #11
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Bummer about the knee, Yonah. It's easy to see why the medical folks call that combo of ligament tears the "unhappy triad."

It sounds like you're in good hands with your surgeon. On the bright side, it's not such a disaster to lose the peak summer months in Baltimore, as the skating season lasts so much longer. Hopefully, you'll be back on your skates before the leaves start falling.

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Old May 3rd, 2009, 04:10 AM   #12
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Yonah - we're so sorry to hear about the prognosis you received. Between the two of us, me with an MCL/PCL injury, and Kevin with a meniscus injury (he had two surgeries), we have both had our share of knee injuries and we feel for you! Sorry to hear that the ACL tear was a rupture, rather than just a tear. Hang in there!! A month or so before you know you can skate again, take the plunge and order those speedskates. Speedy recovery.

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Bummer about the knee, Yonah. It's easy to see why the medical folks call that combo of ligament tears the "unhappy triad."

It sounds like you're in good hands with your surgeon. On the bright side, it's not such a disaster to lose the peak summer months in Baltimore, as the skating season lasts so much longer. Hopefully, you'll be back on your skates before the leaves start falling.

----Scott
I appreciate all the encouragement, everyone. I'll definitely consider that suggestion about buying the speed skates -- believe me, at this point, I'm almost obsessed (maybe obvious from the recent dramatic increase in my number of posts ).

The unhappy/terrible triad actually involves the ACL, medial collateral ligament (MCL), and the medial meniscus. I just missed that group by involving my LCL instead of my MCL, but it is still an unhappy triad for me!

That terrible/unhappy/unholy triad is usually a career-ender for most professional athletes, but that seems to be changing these days. They say that Tom Brady may be coming back from it. The MCL is a much more common injury, as it is thinner & less sturdy than the LCL, and most athletes get hit at the lateral knee, forcing the knee medially (inward) -- bad news for the MCL.
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Old May 3rd, 2009, 02:08 PM   #13
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The unhappy/terrible triad actually involves the ACL, medial collateral ligament (MCL), and the medial meniscus. I just missed that group by involving my LCL instead of my MCL, but it is still an unhappy triad for me!
You're right! Maybe it deserves a name all it's own, like the "miserable triad", or "the unhappy triad's evil twin". Either way, athletes do seem to be making recoveries from the triad, and I imagine that the laterality of your collateral ligament injury would be trivial when it comes to the recovery process. Good luck!

----Scott
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Old May 4th, 2009, 03:16 AM   #14
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Well, I have to deal with knee problem of my own, but in no way near as severe as yours. Mine got a long a fancy name to it, "excessive lateral patellar compression syndrome". I'd been trying to do as much of the stretches as instructed, plus anti-inflammatory drug and kneed brace. At times it looks like it may get a bit better, but the last 2 days were almost as bad as a month ago. If things didn't get better later this month, may need to get some stuff injected into my knee......

The strange thing is, even with the knee trouble, I am actually skating faster than I did without the trouble......

Good luck to your recovery.
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Old May 5th, 2009, 02:20 AM   #15
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Quote:
Originally Posted by sk8scott View Post
You're right! Maybe it deserves a name all it's own, like the "miserable triad", or "the unhappy triad's evil twin". Either way, athletes do seem to be making recoveries from the triad, and I imagine that the laterality of your collateral ligament injury would be trivial when it comes to the recovery process. Good luck!

----Scott
Scott,

You're absolutely right -- ligament damage by any other name still really stinks!


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Well, I have to deal with knee problem of my own, but in no way near as severe as yours. Mine got a long a fancy name to it, "excessive lateral patellar compression syndrome". I'd been trying to do as much of the stretches as instructed, plus anti-inflammatory drug and kneed brace. At times it looks like it may get a bit better, but the last 2 days were almost as bad as a month ago. If things didn't get better later this month, may need to get some stuff injected into my knee......

The strange thing is, even with the knee trouble, I am actually skating faster than I did without the trouble......

Good luck to your recovery.
Thanks for your good wishes; I wish you a speedy recovery as well.

Are you just skating (faster) through the pain, or does it hurt only after you've finished?

I hope you don't end up with patellar arthritis.
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Old May 5th, 2009, 11:22 PM   #16
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New surgery date: June 9. My surgeon wanted to wait 4 weeks, not two months. I guess I've been so preoccupied that it went right by me, but my wife picked up on it. His secretary realized she made a scheduling error when I called her yesterday.

I walked on the treadmill yesterday! I was scared of my knee giving out, so I held on the whole time. I walked 3.0 miles/49:01 = 3.6 mph avg. That includes warm-up & cool down. Max speed of 4.0 mph -- 2nd mile/15:15. Max heart-rate 136 bpm, but it was mostly in the low 120's.

I stretched the left knee for about 25 minutes, and got it all the way straight; and it now bends to 140 degrees!!! I had 120 degrees right after Dr. Zikria drained the fluid; I'm very impressed with a 20 degree gain so quickly.

It was very painful for a good part of the stretch into bending, and I had to do some self-massage -- which in itself was pretty painful -- to get it to loosen up. It released well, though.

Then I iced it well. The swelling has disappeared -- I continue wearing a Jobst compression stocking on it, and a DonJoy brace. However, except for an obvious occasional medial shift of the tibia, it looks indistinguishable from the right knee.
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Old May 5th, 2009, 11:25 PM   #17
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Sounds good!

Good luck on the surgery then, it's good you're going in earlier.
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Old May 6th, 2009, 04:11 PM   #18
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Are you just skating (faster) through the pain, or does it hurt only after you've finished?

I hope you don't end up with patellar arthritis.
Well, it bothers me the most during warm-ups or when the pace is low. Once I get going, I didn't actually feel it at all. It's not really pain, but it's a discomfort that really bothers me, and also limits how low I can squat. It's getting a bit better now, but I still avoid jumping or using stairs since 2 months ago.

Other than that, I also sort of believe that the knee problem may be the reason why my sprints are really sluggish. Also, I almost damage something in my groin muscle a month ago, may be it's due to the weak knee.
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Old May 7th, 2009, 12:46 PM   #19
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Well, it bothers me the most during warm-ups or when the pace is low. Once I get going, I didn't actually feel it at all. It's not really pain, but it's a discomfort that really bothers me, and also limits how low I can squat. It's getting a bit better now, but I still avoid jumping or using stairs since 2 months ago.

Other than that, I also sort of believe that the knee problem may be the reason why my sprints are really sluggish. Also, I almost damage something in my groin muscle a month ago, may be it's due to the weak knee.
I know I start to sound like, "I got a hammer, and everything looks like a nail", but I think that before you do too much more damage to yourself, you should see a good Sports Medicine PT.
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Old May 7th, 2009, 01:13 PM   #20
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Dr. Zikria and his PA both complimented me on my quads, and commented on how important the quads are for keeping the tibia in place in relation to the femur. That stoked (stroked) me a bit.
I forgot to mention: Chris, the PA actually commented on my quads first, and Dr. Zikria responded, "Well, he's a skater."

I posted this in the Training Log thread (along with the rest of my workout for yesterday), but this is the knee-specific part:

Walk on treadmill:
3.75 miles/60:06 = avsp 3.7 mph (increasing tolerance!)
1st mi warmup 17:24
2nd mi 14:22
3rd mi 14:14
.75 cooldown 14:14

Stretch ~ :37:00
1. Long-sit hamstring stretch with towel for additional calf stretch
2. Wide legs (ABducted) long-sit with legs externally rotated for ADductor stretch:
A. Straight forward lean
B. Rotation to each side with towel calf stretch
3. Single knee to chest for knee flexion: 1st rep with self-massage because of pain; no pain on subsequent reps
4. Left heel slides
5. Left supine straight leg raise (strengthen -- not a stretch)
6. Standing "toe touch" hamstring stretch with forward/backward shift to hit upper (backward) & lower (forward) hamstrings

Ice left knee

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For every ounce of pleasure there's a pound of pain,
You gotta love it if you play this game,
'Cuz there ain't no free ride in the fast lane.
"
--Montgomery Gentry
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Yonah
http://www.oaktreept.com - http://www.themaroller.com
"Success is not the result of spontaneous combustion. You must set yourself on fire." --Arnold Glasow
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