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Dr. Andrew Rynne

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Suggest remedy for ligament injury

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Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5172 Questions

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Posted on Sat, 24 Oct 2015 in Back Pain
Question: I have been told there is a chance I have a tiny fracture in the top of my tibia and that if I continue to use my leg for weight bearing activity, the tibia may spread apart causing permanent damage requiring surgery and 6 months in a cast. This information was provided by a family medicine practitioner, who suggested I should consult with an orthopedic surgeon who would be better equipped to determine if this is the case or not. I have xray images (dcm files). Can you review these and determine if I do or do not have a fracture which warrants keeping weight off the leg for some time period. I ask because i am traveling and it will be extremely inconvenient for me to avoid weight bearing activities but if I do have a tibia fracture then I can see I must do that, however if I don't have a fracture, then I see no reason to discontinue my travel.

The family med Dr. also suggested the patella is out of place, possibly due to the lower patella tendons being ruptured and that I may require some level of surgery to restore the patella to the proper position. I do plan to consult an orthopedic physician for both aspects of the injury when I return to my home. I am mainly trying to determine if I need to avoid putting weight on my knee.
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Answered by Dr. Aashish Raghu 41 minutes later
Brief Answer:
Possibility of ligament injury. No major fracture in the tibia is seen. You

Detailed Answer:
Hi there.

Welcome to Healthcare Magic.

Thanks for the query.

Kindly answer a few questions for me to be in a better position to help you.

Are you able to walk around bearing weight normally on the left lower limb ?

While lying in bed, are you able to lift your left lower limb straight upwards ?

Do you feel your knee slipping forwards on walking downstairs or downhill on a slope ?

Have you ever felt your knee cap move to the left when you bend your knee ?

I have reviewed your Xray and studied it very carefully. I don't see a reason for you to not bear weight on your limb.

In my opinion you do not have a major fracture of the tibia, but there is a possibility of mild avulsion injury which can indicate ligament injuries inside your knee. This can manifest with slipping sensation in the knee while walking downhill, increased apprehension on attempting to jump over large area due to fear of slipping etc. The knee swelling is due to collection of blood which will resolve in 3 weeks. An MRI Scan will better help delineate the structure of the knee ligaments and if any are torn, as these won't show up in an Xray.

You can bear weight of you do not have pain. I would advise you to wear a long knee hinged brace. Keep the limb elevated upto 6 inches over pillows. Apply ice. After 3 weeks you can get an MRI of the knee to look at the structure of the ligaments.

Avoid flexing the knee especially if it hurts.

I hope I have answered your query.

I will be available to answer your follow up queries.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Aashish Raghu 9 hours later
Reply to questions.

Question 1: Are you able to walk around bearing weight normally on the left lower limb ?

Reply 1: Yes. I have very little if any pain due to putting weight on the leg. The pain I experience is when bending of the knee beyond about 30degrees. This seems to be primarily due to the swelling. I have some tender areas below the knee which feel more like a bruise than soft tissue damage. I have a small but very tender area just above the knee cap which feels more like a fibrous mass than fluid swelling. Pressing on this yields acute pain. Bending the leg at the knee more than 30 deg while standing also seems to activate pain in this spot.

Question 2: While lying in bed, are you able to lift your left lower limb straight upwards ?

Reply 2: If you mean lying on my stomach and lifting the lower leg by bending at the knee the yes but I cannot bend it more than 30 degrees as I noted in the reply to question 1. If you mean lying on my back then I have no issues or pain lifting the entire leg bending at the hip.

Question 3: Do you feel your knee slipping forwards on walking downstairs or downhill on a slope ?

Reply 3: My knee feels quite stable. I am a long time athlete and have had many injuries to ankles, shoulders, elbows which involved ligament or tendon damage so believe me I know what such injuries feel like. My knee feels like it would support jumping, running etc except for the issues I noted in the reply to question 1.

Question 4: Have you ever felt your knee cap move to the left when you bend your knee ?

Reply 4: No. Kneecap seems to be solidly in the same place though possibly higher up towards the thigh than before the injury.

Thank you for your reply.

doctor
Answered by Dr. Aashish Raghu 1 hour later
Brief Answer:
Possible Quadriceps muscle injury. Needs rest, ice, elevation, MRI

Detailed Answer:
Hi there.

Thanks for the reply to my questions. They were very informative.

The symptoms you are experiencing are possibly due to the massive blood collection which may have occurred into your knee joint and suprapatellar pouch.

I would advise you to wait for 3 weeks for the swelling to come down. It is possible you may have a small tear and haematoma in your Quadriceps muscle as it is common in your age group. After 3 weeks you may get an MRI Scan of the knee and Quadriceps muscle especially if the symptoms do not subside.

Till then, avoid bending the knee. Ice it. Keep it elevated to about 6 inches. Wear a long hinged knee brace to allow stability.

Kindly follow up with me henceforth.

I hope I have answered your query.

Regards,

Dr. Aashish Raghu


Above answer was peer-reviewed by : Dr. Raju A.T
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