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Knee injury. It's been a week, can't extend it...

I skateboard a lot, i have encountered an injury. About a week ago i bailed a trick over a huge barrier somebody brought into our park to mess around with. I came down awkwardly, felt a pop and instantly hit the ground and slid 10 feet. It did not hurt, but it was scary. I couldn't bare weight on it due to it being unstable.

It has been a week so far and i can walk with out it going in and out of place i guess you can say. It tends to lock up when i bend my knee all the way in, and i cannot extend my leg completely out to the point of bending inward i guess. When i stand, it looks like my bad knee is hunched compared to the other, which may be from swelling or from the Tendon/ligaments being really tight.

I can't afford a hospital visit, and i have no insurance to visit my family doctor to get an MRI. Any help would be greatly appreciated.

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replied May 5th, 2013
Unfortunately, I had the same kind if injury with gymnastics and like you at the time I had no medical insurance so I wrapped my knee in an ace bandage, and tried to go on with my life. After about two weeks I was back in gymnastics with just a Walmart knee brace. Then as I went to dismount the pads were not placed properly and I landed very awkwardly. The pop sounded like a rifle blast! My trainerran over (I was flat on my back) and told me not to try to move my leg. It was horribly dislocated. My surgeon told me the first time it happened it probably partially tore my ACL, but when I continued, and did not get it treated I ended up with my ACL, MCL, and PCL completely torn. Learn from my mistake, get it checked out And worry about paying later! There is always assistance programs!!
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replied May 5th, 2013
Especially eHealthy

As Emily stated, you probably need to see someone about this injury. Payments can be arranged, if need be, and again as Emily stated, there are some programs around which will help with payment. You may have to do some research, contact your local board of health, and ask about getting the assistance.

When a patient has a noncontact twisting injury to the knee, where there is a pop and the patient falls to the ground, it is considered an ACL injury until proven otherwise. Unfortunately, when the ACL (anterior cruciate ligament) ruptures, it is not uncommon for there to also be injury to the meniscal cartilage and/or the articular cartilage.

The "hunched appearance" you have in the knee is most likely from an effusion, which is swelling within the joint capsule (inside the knee joint). In an ACL injury this is usually due to bleeding into the joint. There is a tiny artery which runs along the surface of the ACL, and when the ACL is torn, this artery is also torn. Thus, there is bleeding into the joint. The knee joint can accomadate quite a bit of fluid, but usually the effusion will make the knee look puffy. There is also a pouch above the patella (kneecap), which can hold a lot of fluid, but it causes what looks like a water balloon sitting just above the knee. The body will eventually resorb this fluid, but it is going to take some time.

The locking is a bit concerning. The inability to fully extend the knee is usually most concerning to an orthopedic surgeon. This can be a sign of a displaced bucket handle tear of the meniscus. This locking is usually not very painful, unless the patient tried to force the knee past the point where is stops extending. It usually feels more like a chock has been stuck in the knee, preventing further extension.

True "locking" in flexion is not very common. This is usually more commonly due to pain and/or swelling, rather than an obstruction to movement. But, there are some rare cases of the stump of the ACL impinging in the joint, subluxation of the femur on the tibia, the joint catching on an articular cartilage defect, and/or a radial or parrot beak tear of the meniscus flipping into the joint, causing locking in flexion.

So, you may have some significant damage to the inside of the knee. Is it an emergency, probably not, since it has been more than a week, and you do not have any problems with circulation. But, it is something that you should have looked at, if you want to continue to participate in athletic events.

A thorough orthopedic evaluation will be needed. It is difficult to examine the knee several days after the injury, because of the swelling and patient guarding. But, usually, the orthopedic surgeon can tell from the exam if the ACL is injured. Sometimes, an MRI is also obtained, but it is not always necessary.

Usually, in ACL injuries with meniscal tears, the meniscus injury is taken care of first. It is not advisable to let a knee stay locked (cannot fully extend the knee). So, the orthopedic surgeon will address the meniscal problem with an arthroscopy, and also inspect the inside of the joint to see what the extent of the damage is.

Then the patient is placed into rehab. The goal of rehab is to get the swelling out of the knee and for the patient to regain the strength in the quads (and all of the muscles about the knee/hip) and to regain full range of motion. Most surgeons do not want to operate on an ACL injury until the knee has calmed down, and the patient has full range of motion and near normal strength.

Do all ACL injuries have to be reconstructed? Not necessarily. Some patients can rehab well enough, to the point of being able to prevent instability with strong muscles and excellent balance/agility/proprioception. The goal is to have a stable knee, which does not give way with any pivoting, because that can lead to further damage to the articular cartilage (and early degenerative joint disease - DJD). Also, there are some patients who can strengthen their knees really well, and also participate in athletics with the use of an ACL brace. But, in most cases of young patients, who want to continue playing pivoting sports, will have to have the ACL reconstructed.

The ACL cannot be repaired. It cannot just be sewn back together. Since the ACL is on the inside of the joint, it is continually bathed in synovial fluid (joint fluid). The synovial fluid prevents the ACL from healing. So, it has to be reconstructed with a graft. There are several graft options. Nowadays, most ACL reconstructions can be done with arthroscopic assistance, so the joint does not have to be completely opened up. There are several small incisions, and maybe a couple of bigger ones (if the graft is autologous and has to be harvested from the patient).

So, again, if you have true locking of the knee, that needs to be addressed sooner rather than later. Once the meniscal injury is taken care of, then you can do rehab. Most rehab can be done on your own. You can Google "ACL rehab protocols" and get an idea of what needs to be done. But, rehab/recovery does not "just happen". It takes a lot of dedication and hard work. Once the knee is rehabbed, if the patient continues to have laxity problems, then the ACL can be reconstructed.

Good luck. Wishing you the best.
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