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What Causes Severe Knee Pain Post An Accident?
Question: Hi, I am a 49 yr old army officer who was very physically active regular in running/cycling . I met with an car accident in 3rd week of Nov 2016 resulting incompound communicated fracture of Left Patela and medial condyle Femur. I was operated and ORIF with CCS of Medial Condyle Femur and partial patellectomy and and extensor mechanism repair on 24 Nov 16.
Due to severe injury on the knee the healing process took lot of time and was able to commence Physiotherapy wef 20 Dec 16. Since then I have been undergoing physiotherapy but the ROM is limited to approx 60 to 70 degree, which just after physiotherapy does reaches to approx 90 degree when the knee is in warmed up condition. The process is very painful but I continued it expecting a good recovery so that I can resume physical activity. I am able to do static cycling with difficulty but unable to do cycling due to limited bending of knee. I am able to walk but with a prominent limp since I am also unable to fully extend the left leg (the physio suggested to concentrate more on bending, and thereafter to concentrate on extension)
About a month ago I felt pain in both the knees especially while coming down the staircase. Also about 20 days ago I saw some swelling in upper side of Right Petella (the leg which was OK) and the bending of right knee became stiff and painful after 100 deg bending. On showing to the doctor X ray was done and no abnormality was noticed, hence I was given tablets for 10 days. Though now there is 90 percent relief in swelling and pain in the right knee, but i was not comfortable with the same. Hence doctor recommended an MRI of right knee and following are the findings of the same :
(a) Linear hyperintense signals are seen in the posterior horn of Medial meniscus in a horizontal to
oblique morpho;ogy extending to the inferior articular surface.
(b) Synovial effusion is observed at supratatellar region.
(c) Osteophytes noted in medial and lateral condyles of tibia and femur, superior and inferior poles
(d) Osteochondral fracture seen at medial femoral condyle appearing hyperintense on FSPD/STIR images and correspondingly hypointense on T1WI
(e) The cartilage covering the patella and tibia plateau is of normal thickness and has normal signal characteristics. The cartilaginous surface is smooth.
(f) The ACL and PCL are intact and are normal in their width and signal characteristics.
(g) The collateral ligaments are intact and of normal width.
Impression : 1. Horizontal cleavage tear of posterior horn of medial meniscus
2. Osteochondral fracture medial femoral condyle.
The doctor has prescribed Omeprazole and Enflam-SR for 5 days and has asked me to use knee brace in right leg and to show after two weeks for further course of action.
I want to seek your advice on the following :
1. I have had no injuries in my right leg than what is the cause of this fracture. I was able to do a squat with my right leg when asked by doctor without any considerable pain.
2. Do I need any surgery for this fracture.
3. What kind of physiotherapy is required for left knee (to gain ROM) and for right knee.
4. Is this the standard course of action for this ailment.
5. How much time will my right leg take to fully recover from this fracture and meniscus tear.
6. WHy am I unable to get at least 100 to 110 degree ROM in my left leg even after five months
I am worried pl advice
Due to severe injury on the knee the healing process took lot of time and was able to commence Physiotherapy wef 20 Dec 16. Since then I have been undergoing physiotherapy but the ROM is limited to approx 60 to 70 degree, which just after physiotherapy does reaches to approx 90 degree when the knee is in warmed up condition. The process is very painful but I continued it expecting a good recovery so that I can resume physical activity. I am able to do static cycling with difficulty but unable to do cycling due to limited bending of knee. I am able to walk but with a prominent limp since I am also unable to fully extend the left leg (the physio suggested to concentrate more on bending, and thereafter to concentrate on extension)
About a month ago I felt pain in both the knees especially while coming down the staircase. Also about 20 days ago I saw some swelling in upper side of Right Petella (the leg which was OK) and the bending of right knee became stiff and painful after 100 deg bending. On showing to the doctor X ray was done and no abnormality was noticed, hence I was given tablets for 10 days. Though now there is 90 percent relief in swelling and pain in the right knee, but i was not comfortable with the same. Hence doctor recommended an MRI of right knee and following are the findings of the same :
(a) Linear hyperintense signals are seen in the posterior horn of Medial meniscus in a horizontal to
oblique morpho;ogy extending to the inferior articular surface.
(b) Synovial effusion is observed at supratatellar region.
(c) Osteophytes noted in medial and lateral condyles of tibia and femur, superior and inferior poles
(d) Osteochondral fracture seen at medial femoral condyle appearing hyperintense on FSPD/STIR images and correspondingly hypointense on T1WI
(e) The cartilage covering the patella and tibia plateau is of normal thickness and has normal signal characteristics. The cartilaginous surface is smooth.
(f) The ACL and PCL are intact and are normal in their width and signal characteristics.
(g) The collateral ligaments are intact and of normal width.
Impression : 1. Horizontal cleavage tear of posterior horn of medial meniscus
2. Osteochondral fracture medial femoral condyle.
The doctor has prescribed Omeprazole and Enflam-SR for 5 days and has asked me to use knee brace in right leg and to show after two weeks for further course of action.
I want to seek your advice on the following :
1. I have had no injuries in my right leg than what is the cause of this fracture. I was able to do a squat with my right leg when asked by doctor without any considerable pain.
2. Do I need any surgery for this fracture.
3. What kind of physiotherapy is required for left knee (to gain ROM) and for right knee.
4. Is this the standard course of action for this ailment.
5. How much time will my right leg take to fully recover from this fracture and meniscus tear.
6. WHy am I unable to get at least 100 to 110 degree ROM in my left leg even after five months
I am worried pl advice
Brief Answer:
Arthritis of the right knee
Detailed Answer:
Hi there
Thanks for the query
I have read your queries and understood your problems. These are your answers to your queries,
1. You have developed Osteoarthritis of your right knee because of degenerative changes like osteophytes, osteochondral defect/fracture of the femur condyle.
The cause of the fracture is spontaneous degeneration of the cartilage leading to weak point and fracture.
2. You may need an arthroscopic debridement to clear the degenerated parts like osteophytes and also remove torn part of degenerated meniscus.
3. You need to focus on Quadriceps strengthening with closed and open chain exercises as per your Physiotherapist. For the right knee strengthen the VMO and Quadriceps muscles.
4. Usually not bearing much weight on left lower limb can put too much pressure on the right limb and can cause these problems. Arthritis of the normal limb joints can occur.
5. Your right leg will not recover without surgery. Arthroscopic debridement can help to postpone knee replacement. You may need knee replacement for the right knee later on because arthritis has set in.
6. You need to work harder to get to that ROM of 110 degrees. It's possible with sheer determination only.
I hope I have answered your query.
I will be available to answer your follow up queries.
Regards,
Dr. Aashish Raghu
Arthritis of the right knee
Detailed Answer:
Hi there
Thanks for the query
I have read your queries and understood your problems. These are your answers to your queries,
1. You have developed Osteoarthritis of your right knee because of degenerative changes like osteophytes, osteochondral defect/fracture of the femur condyle.
The cause of the fracture is spontaneous degeneration of the cartilage leading to weak point and fracture.
2. You may need an arthroscopic debridement to clear the degenerated parts like osteophytes and also remove torn part of degenerated meniscus.
3. You need to focus on Quadriceps strengthening with closed and open chain exercises as per your Physiotherapist. For the right knee strengthen the VMO and Quadriceps muscles.
4. Usually not bearing much weight on left lower limb can put too much pressure on the right limb and can cause these problems. Arthritis of the normal limb joints can occur.
5. Your right leg will not recover without surgery. Arthroscopic debridement can help to postpone knee replacement. You may need knee replacement for the right knee later on because arthritis has set in.
6. You need to work harder to get to that ROM of 110 degrees. It's possible with sheer determination only.
I hope I have answered your query.
I will be available to answer your follow up queries.
Regards,
Dr. Aashish Raghu
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Answered by
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