Warning: I wound up writing a novel here, but feel free to just look at the pics. The album contains some gross pictures, including what my knee looked like immediately after the injury as well as some pics of the inside of my knee during surgery. The surgery pics are actually so abstract that they're not that gross, but in case you don't have a strong stomach you've been warned.
https://imgur.com/a/G97Dd7E The Injury I'm a 28 year old male (27 when the injury occurred). My initial injury happened in September of 2017. I was running towards a ball flying over my head during a soccer game, and mistimed my control of the ball - rather than get my foot under it, I stepped on the ball as it was landing. My right leg was planted when I did this, and since I was sprinting full speed I slipped, causing my whole body to move except my leg. It immediately twisted and dislocated, and I'm told people heard the pop from 40-50 yards away. An ambulance was called, but the refs were afraid to move me so the game was called off while we waited. I didn't have the guts to look down at my leg (and moving even slightly was unimaginably painful so I didn't wanna try) but I knew I would be curious about what it looked like so I had my girlfriend take pictures (pics #1 and 2 in the album).
Initial Treatment Everyone was fascinated with my knee in the emergency department. It was a university hospital, so all sorts of residents and students came by to look at it and ask questions. Most knee dislocations reduce themselves, but mine was stuck. An orthopedic surgeon with decades of experience would later take a picture of the X-ray they took while it was still dislocated because of how bad it looked. I had to wait a couple hours for the orthopedics resident on call to make his way to me and get approval from a full doctor to reduce my knee, and during this time the adrenaline wore off. I could feel my bones pushing into the skin (I came very close to having an open dislocation, which results in amputation about 50% of the time because infections are difficult to manage), and this was probably the worst pain I've felt in my life. Some of the doctors were talking about emergency surgery to reduce my knee, since it didn't look like it would respond to manual reduction. At this point, my hero arrived - the orthopedics resident came in, looked at my knee, and said we were popping it back into place right now. They shot me up with some dilaudid and four doctors did the deed: one resident grabbed my leg around the knee and held it up while the other three grabbed around my ankle and
twisted. When I say twisted, I mean three adults pulling as hard as they could. Four incredible pops later, my knee was back in alignment and the pain was immediately resolved.
They kept me in the hospital for two days for observation because they were concerned my popliteal artery might have been damaged (see Zach Miller's recent knee dislocation for what happens, emergency surgery is needed to save the leg). The artery was fine, so eventually they released me. They took MRIs while I was in the hospital, and based on the MRI and X-ray reports it initially looked like the following were torn: ACL, PCL, MCL, LCL, lateral and medial menisci, patellar tendon, knee capsule, and quadriceps, with avulsion fractures in the tibia and femur. It later turned out there was so much blood in my knee that some of the structures (mainly my menisci and LCL) looked damaged in the MRI but were actually fine. My patellar tendon was only partially torn. Everything else was completely torn (MCL off the bone, ACL and PCL in the middle), including my quad having been basically sliced by my kneecap.
I saw my sports medicine surgeon about a week after the injury (picture #3 in the album, the bruising actually got
much worse after this and about 3/4 of my leg was purple) and he did the manual tests - Lachman, drawer, valgus, and varus. My ACL and PCL were definitely torn, and in the valgus test my knee was giving way like it was made of rubber. The varus test looked surprisingly stable though. I was scheduled for surgery just a few days later, and they would basically figure out how much they could do in that surgery (and whether my LCL and menisci were still in good shape) after cutting me open.
Surgery 1 The first surgery was in the end of September. There was so much edema, blood, and swelling that they were only able to repair my MCL, reattaching the original ligament to the bone. My LCL and menisci were confirmed to be healthy though, and they stitched my knee capsule and quad back together. My doctor showed me a picture (unfortunately I don't have a copy) immediately after the procedure of what the inside of my knee looked like - he described it as looking like a grenade had gone off inside my knee, and that the giant hole was not something they had done, but what my knee already looked like when they went in to look. A femoral nerve block meant that I felt absolutely no pain post-op, and I stopped taking my prescribed painkillers at the same time the nerve block wore off. The surgery also immediately cleared up a four day calf cramp I had been experiencing, which my surgeon theorized was being caused by blood flowing from the knee down my leg.
A week after, I saw my surgeon again (pic #4). The swelling had decreased significantly and I was cleared to start PT, but I was non-weight bearing for the first 4-6 weeks post-op. Surgeon wanted me to get to 120 degrees of flexion before he would operate on the ACL and PCL to avoid permanent stiffness - he seemed to think I'd get that back in about a month or so. My physical therapist was awesome, but flexion came very slowly. I was walking without crutches around December, but it wound up taking until January 2018 for me to hit 115 degrees, which my surgeon deemed good enough.
Surgery 2 Surgery #2 was in February 2018. I had been having back of knee pain so they looked at my lateral meniscus again just to verify, but it turned out to be healthy - the pain was probably just a hamstring strain. I received single bundle allografts (hamstring tissue) for both my ACL and PCL, affixed using a button rather than screw (as I understand it, the screw is more beneficial when using patellar grafts that include some bone, but for hamstring grafts the button allows the grafts to be tighter). Autografts were not an option since my knee was so damaged that the doctor didn't feel comfortable harvesting anything else. The nerve block this time was botched so it was only partially effective, but even then pain post-op was minimal. The images labeled 001-009 are of the surgery itself: 001-003 are my medial and lateral meniscus looking good, 004-005 are the drill creating the tunnel in my bones for the grafts, 006-008 are the new ACL and PCL grafts, and 009 is of where my kneecap meets the rest of my knee. After the surgery, I was told that my knee injury was part of an annual presentation by the residents at the university - a dubious honor, but pretty cool.
I was allowed to partially weight bear immediately this time, but I had some weird lumpy swelling (see pic #5) that felt pretty uncomfortable when I would put weight on the leg. I was also put on a CPM machine immediately after the surgery, and hit around 85 degrees of flexion (120 on the CPM, but it does not reflect real flexion very well) within a week. After a PCL reconstruction, however, you're not allowed to bend your own knee for the first four weeks - when the hamstring activates during flexion and pulls back the tibia, it puts stress on the PCL graft which can cause it to loosen. I was on strictly PT-assisted or CPM flexion for the first month, and after that I was given a custom-fit PCL brace made by Ossur that applied a force at my tibia during flexion to counteract the stress on the graft.
The hamstring strain actually got a lot worse during this period, and started to hurt incredibly while doing heel slides. Between lots of hamstring stretching and slowly working on heel slides, however, it eventually faded. The swelling went down, flexion improved, and I was told to drop the crutches as soon as my PCL brace arrived.
Present Day I had my three month followup earlier this week, and my doctor said all of the repaired/reconstructed ligaments felt incredibly stable. I was expecting to be on the PCL brace for 6 months, but got the all-clear to drop the brace immediately. I was so happy to be done with the brace (which was the 5th knee brace I had gotten for this injury) that I went out and tried riding a real bike for the first time - I was a little shaky, but eventually I got comfortable riding. Stationary bikes are nice, but I had been so excited to finally feel the wind on my face while riding.
I'm not sure that I'll ever actually want to play soccer again, but my goal for PT is to recover to the point that I
could play if I felt like it. Not there yet, but I'm told in 6 weeks I might be able to start jogging. Slow progress, but any progress is awesome considering 6 months ago it felt like I would never be close to normal again. Thanks for reading, and feel free to ask any questions!
Overview of LCL Pathology In patients who have a complete
lateral or fibular collateral ligament (LCL) tear and noticeable side-to-side instability with activities, a lateral collateral ligament surgery is recommended. The term fibular collateral ligament (FCL) is more anatomically correct, but is more commonly referred to as lateral collateral ligament (LCL).
LCL surgery is very effective in restoring side-to-side stability to the knee and preventing varus gapping. During a clinical exam and varus stress radiographs, we will be able to confirm whether or not there is a complete LCL tear. It is important to note that an MRI scan can be inaccurate – especially in cases of a chronic situation where the LCL heals improperly – that is why it is important to properly analyze the pathology.
Treatment for LCL Injury The severity of the
LCL injury will determine the treatment method. In less severe cases, a remedy of rest, ice, compression, and elevation (RICE) along with the use of anti-inflammatory medications (NSAIDs) and pain relievers can alleviate discomfort and help diminish swelling. Increasing strength and range-of-motion can be achieved through physical therapy, and ultimately restore the knee back to a healthy state.
Typically, patients who have a complete LCL tear will require surgical treatment. This surgical procedure is typically done as an open procedure in conjunct with arthroscopy.
Dr. Miten Sheth from
The Knee Clinic will replace the torn lateral collateral ligament with a tissue graft. The graft is passed through the bone tunnels and attached to the femur and fibula bone using screws.
We prefer an anatomic technique for surgical reconstruction. With this technique, we use either autograft hamstring tendon to reconstruct the lateral collateral ligament between its native course. First, a tunnel is reamed at the femoral attachment site, slightly proximal and posterior to the lateral epicondyle. We then secure the graft at this location with an interference screw in the prepared tunnel. The graft is then passed under the superficial layer of the iliotibial band and the lateral aponeurosis of the long head of the biceps femoris. Next, a tunnel is reamed through the fibular head, starting laterally at the exact attachment site of the LCL on the fibular head, and exits on the medial aspect of the fibular styloid just distal to the popliteofibular ligament. The graft is then passed through this. The graft is placed under tension, the knee is flexed to 20 degrees and a valgus reduction force is applied. A screw is then used to attach the graft in the fibular head. Once one confirms on exam under anesthesia that the varus gapping is eliminated, the procedure can then be ended.
Are you a candidate for LCL Reconstruction? There are two ways to initiate a consultation with Dr. Sheth: 1. You can provide X-rays and/or MRIs for a clinical case review with Dr. Sheth. 2. You can schedule an OPD consultation. REQUEST CASE REVIEW OR OPD CONSULTATION (Please keep reading below for more information on this treatment.) Post-Operative Protocol for LCL Surgery Rehabilitation for
LCL surgery involves early range of motion of the knee, starting at a minimum of 0 to 90 degrees the first day, and then after 2 weeks progressing further. Isolated hamstring exercises should be avoided for the first 4 months post-operatively. Patients should not place weight on the injured leg for 6 weeks and then may progress to crutches and start the use of a stationary bike starting at week 6. They should avoid side-to-side activities, or step-up activities, until varus stress X-rays are obtained at 5 months post-operatively verify that there is sufficient healing of the reconstruction graft to allow further activities. For athletes, we usually recommend the use of a secure brace to allow them to initiate these activities and request that they wear it through the first year after surgery to maximize graft healing.
submitted by What Are Common Symptoms Seen in Knee Varus ? Bow-leg in knee joint; Knee pain; Difficulty in walking. Osteoarthritis changes in knee joint. Swelling around knee joint. DIAGNOSIS:-→ Radiological examination : x-ray taken form AP and Lateral view → Varus stress test by physiotherapist. PHYSIOTHERAPY TREATMENT:-→ Gradual knee mobilization ... Stress radiographs have been used for several years to detect the amount of varus/valgus knee laxity and to evaluate the degree of compartmental involvement in degenerative osteoarthritis. However, the popularity of these radiographic methods has been affected by their technical limits due to the x-ray exposure for the personnel involved and the variability of the stress forces applied. A device was developed with the aim to create a constant varus or valgus stress force to the knee with the ... Vector illustration. Anatomy, front x-ray of an arthritic knee joint and a knee after total knee replacement. Pediatric orthopedics. valgus and varus. Vector illustration of pediatric orthopedics. valgus and varus . Valgus varus and normal. Vector medical illustration types of curvatures human feet. Plastic surgery, treatment diseases leg bones, toe alignment valgus varus. Meniscus _Arthritic ... Therefore, in our primary definition, a knee was recorded as varus when alignment was >0° in the varus direction, neutral when alignment was 0°, and valgus when alignment was >0° in the valgus direction. However, it is not clear whether a knee within a small range of neutral differs from a knee that is 0°, in terms of either in vivo function or outcomes. Within 2° of 0° has been applied previously as a definition for neutral That’s why it’s so important for surgeons to address varus or valgus deformity during the index surgery, Matthew P. Abdel, MD, told attendees at ICJR’s inaugural course for senior residents and fellows, Advanced Techniques in Total Hip & Knee Arthroplasty, whether they use cruciate retaining or posterior stabilized implants. [4,5] Otherwise, the patient has a strong chance of requiring ... Objective: To investigate the impact of knee varus and valgus in varying degrees on the alignment in lower extremities of patients who received the total knee arthroplasty (TKA). Patients and methods: We retrospectively analyzed the condition of varus and valgus deformity in full-length X-ray films of double lower extremities in weight-bearing position of 120 patients before and after they ... Stress views are additional X-ray projections that demonstrate indirectly the amount of joint cartilage left. They are to be taken with the knee bent 15 degrees, the thigh supported by a thigh rest. The beam is angled parallel to the jointline, while either a valgus or varus stress is produced, either by an assistant or by the patient, using an ankle strap around a post or pulley. The terms valgus and varus refer to angulation (or bowing) within the shaft of a bone or at a joint. It is determined by the distal part being more medial or lateral than it should be. Whenever the distal part is more lateral, it is called valgus. Whenever the distal part is more medial, it is called varus. Therefore, when the apex of a joint points medially, the deformity, if any, would be called valgus, as the distal part points laterally. X-ray images at the age of 18 at an initial visit to our department showed severe valgus deformity with mechanical lateral distal femoral angle (mLDFA) of 71 degrees in contrast to left mLDFA which was 87 degrees. We performed a biplane-cut distal femoral varus osteotomy (DFO). Postoperative X-ray images showed an improvement of 86 degrees in ... Orthopedics; OBJECTIVE: To investigate the impact of knee varus and valgus in varying degrees on the alignment in lower extremities of patients who received the total knee arthroplasty (TKA). PATIENTS AND METHODS: We retrospectively analyzed the condition of varus and valgus deformity in full-length X-ray films of double lower extremities in weight-bearing position of 120 patients before and ...
Varus Stress Test:1. Lie supine 2. Abduct hip such that leg lies over edge of exam table3. Flex knee 30 degrees 4. Examiner stabilizes lateral distal distal ... Dr. Ebraheim’s educational animated video describes the Q - angle of the knee. Follow me on twitter:https://twitter.com/#!/DrEbraheim_UTMCQ Angle of the Knee... In this episode of eOrthoodTV, orthopaedic surgeon Randale Sechrest, MD narrates an animated tutorial on the anatomy of the knee. Dan Smith, DO performs the valgus stress test on a patient as part of a full knee examination. Enroll in our online course: http://bit.ly/PTMSK DOWNLOAD OUR APP:📱 iPhone/iPad: https://goo.gl/eUuF7w🤖 Android: https://goo.gl/3NKzJX GET OUR ASSESSMENT B... Knock knee or bowleg deformity of the lower leg creates abnormal stress on knee, hip and ankle. This alignment problem impacts walking, appearance, wear, and...
