Today is the day that I tell the story of a knee meniscus. I have been a physiotherapist for 22 years and sometimes I think that I have jinxed my kids as I can’t seem to keep them out of the orthopaedic surgeon’s office! Today I experienced an “easy peasy” knee scope for a meniscal clean up from the eyes of a mom. Let me tell you the perspective is different.
Its also important to point out that I am telling the story of a 19 year old athletic young man with a traumatic meniscal tear, and thankfully not a story about a middle aged woman going for a knee “clean up scope”….that is another blog as we know that there is a new thinking process for people like me.
I have heard stories like that of my son’s 100 times before. He was in his Junior B practice, as he puts it, “he was in stick battle.” There wasn’t a body checked involved, it was a simply a “caving in of his knee”. He tells the same story, “I felt a pop and I couldn’t put weight on my leg without pain”. I got the call to drive over to arena to pick him up.
In the clinic he presented the way 90% of knees do – swollen. The challenge with assessing and diagnosing a knee injury lies in the fact that there are several structures within the actual knee joint – we call those structures intra-articular. Once one of those structures are compromised the whole knee responds with swelling. The best way to diagnose a knee once its swollen is through carefully listening to his story. Remember, his knee went inwards and he felt a pop.
Fortunately, within 3 days his swelling went down and he quickly regained his range of motion. Through his Sports Medicine assessment with Dr Mountjoy, her primary diagnosis was a grade one tear of his medial collateral ligament (MCL). A reminder of the MCL anatomy forces us to consider the medial meniscus otherwise known as the inside cartilage of the knee. The MCL sends an anchor to the meniscus, and with any MCL strain or tear we need to be able to rule out any damage to the medial meniscus as well.
Sometimes, ruling out the menisci (there are two, one on the inside of your knee and one on the outside) is not easy. The menisci by nature are the shock absorbers that decrease friction between our thigh bone (or femur), and our leg bone (or tibia). They slide forwards when we straighten and backwards when we bend our leg. Often when the MCL pulls hard enough it can cause a tear in the medial meniscus or commonly the meniscus flips over on itself. In the early stages of rehabilitation, the medial meniscus can progress along quite nicely, sliding backwards and forwards as it should, BUT the meniscus can also be a bit unpredictable. A small fray in its edges, or that flip, can be functional 90% of the time, but a simple typically nonpainful movement can suddenly pinch the meniscus if it catches it at the right angle and compression.
In clinic we do have some decently reliable tests to detect these injuries, but it is not uncommon to see some clients progressing well with range of motion and strength, and then suddenly regress with symptoms like swelling after activity, locking or catching. Most clients can continue to progress without any flare ups and be back to their normal activity within approximately 6 weeks. Unfortunately, my son’s story was the first scenario. He successfully pushed himself with high level exercises in the clinic, progressing to jumping, ladder work, pivoting around cones and simulated hockey drills. During these drills, he did report intermittent and inconsistent catching or clicking in his knee but overall had no pain or increase in swelling with exercise.
He returned to noncontact, then contact practices and was thrilled to be back in the game. After 2 games over the weekend, at the following practice, again without any contact he felt a more piercing pain at the back of his knee and was not able to weight bear. I knew then that his meniscus was rearing its ugly head.
I had a disappointed hockey player waiting on his MRI and surgical consult. The MRI did confirm that he did in fact have a meniscal flap and he also had some “floating pieces”. Floating pieces in the knee are not helpful! They can float around and find a comfy spot, and then they float into a smaller place in your knee joint and you know it with symptoms of locking or sharp pinching pain.
With his surgical date booked, I transferred his care to the skillful surgical hands of Dr Stamp. I have seen Dr Stamp’s patients over my 22 years and I knew my son was in good hands. But it was still a stressful morning as I waited in the waiting room trying not to think of all the complications that I also know about – yes, they are rare and that is what I continued to remind myself of.
That brings us to 8 hours post op. We are doing the necessary basics: rest, elevation, compression and ice. He likely doesn’t have much of a choice, but we are also doing our early necessary bending and straightening of the knee and ankle pumping. Things are going well 😊. He is being waited on and getting caught up with Sports Line!
Our focus for the next 3 days will be on the basics and then he will be back in the clinic – using our team at the Health and Performance Centre. Thank you to Lisa our Physiotherapist and Marco our Chiropractor for taking him on, with both Dr Mountjoy and Dr Stamp monitoring his care. He was committed to his strengthening pre-surgery and we know from research that this pre-surgery strength and range of motion will set the foundation for post operative success.
If you want to know where his rehab is going stay tuned!