Knee Injury :(

A snowHead

I fell on my knee on hard pavement 9 weeks ago. Didnt think it was anything serious as could get up immediately and go home. When going down the stairs on train station the same day I noticed it was sharp pain when I was bending my knee. Apart from that just slight pain from fall and large bruise. So didn't go to A&E. Over the next couple of days swelling massively developed. I dont remember if it started on next day or took several days but i was unable to walk though could weight bear. Went to GP 10 days after the fall and he referred me to XRAY and to physio assessment. Physio did assessment and said it looks alright, could possible annoy meniscus but need to wait to see what XRAY says. XRAY came clean so GP says no further actions and see how it goes.

Another 10 days later I went to private physio as I wasn't getting better. Physio inquired about XRAY, did assessment and said he cant feel any damage and he thinks t is bursitis that causes inflammation and my inability to bend my knee past 120 degree. I can extend fully from the beginning. We did approx 4-5 physio sessions across next month and physio got concerned that he doesn't see much improvement. Flexion improved to 125 but knee is still very swollen and on some days i have loss of extension by 5 degree. He now recommends MRI to see whats going on, he suspects xray could have missed some bone fracture as by now 9 weeks into injury swelling from damaged meniscus and ligament damage would have settled by now.

I have skking trip planned at the Easter which will be 5 months post initial injury, but i am doubt and so is my private physio that I will be able to go. Not to say that i am extemely exhausted from being unable to walk normally for 2 months now. Just wondering what to do. I dont have private insurance but happy to pay for MRI if it allows me to skip wait on NHS. Should I then see a consultant with results?

A snowHead

My GP was happy to refer me based on a self funded MRI. Check beforehand, but private MRI can be found for around £200 - worth checking locally if you are close to a university! Otherwise can be done in the back of a truck in a supermarket car park!
I got as far as sharp pain when bending & thought you may have a torn meniscus. Meniscus tear don't really show up on xray.
Meniscus rarely heals, it either ‘beds’ down after a few months, or it will continue to catch & give you jip… which probably means surgery.

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Can your physio or anyone he can recommend do an MRI referral for you?

There are some places doing private MRIs that can do the referral 'in-house' as it were, but that increases the cost, as it's effectively another private physio appointment.

I've just had an MRI on my knee, but arranged through my health insurance - but I'm paying for a rehab program separately through my gym. The Head of Rehab there could have referred me for an MRI if I wanted (and self funded - was told £250). I wish I had, as it took a few weeks to jump through my health insurance hoops rolling eyes

I should get the results back to a physio through the insurance, and then can hopefully give them myself to the rehab coach too. If self-funding, I've been told they get given to the person who did the referral, so if your current physio can do it, it's simple.

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I live in London so plenty of choice here and physio happy to do a referral to MRI at one of the centres in central London, they provide results within 1-2 working days and use 3T machine which I think is more precise. Results will go to physio and he said I dont need an appointment he will give me a call once he receives the result and discuss finding and actions. MRI would cost £250 with appointments and results available within couple of days, I feel like it will be money well spent.

I am self employed so thats why no insurance unfortunately, probably will arrange one for myself going forward. But I am happy to pay to MRI and physio and consultations (not that I have lots of free money, I am just so exhausted from pain and lack of mobility. Sad

The only thing I would probably would not be able to pay myself is private surgery. If required will try to get on cancellation list, as self employed can go there any time with 1 hour notice.

Can injured meniscus give swelling for two months? I am okay with surgery as long as it will resolve the problem, though I am aware UK specialists prefer conservative treatment first. I guess by the time I will be on NHS list a good 4 months will pass so it would be easier judgment call to go ahead for surgery or not. I also suspect the meniscus myself, though extremely worried if it is ACL Sad

(which physio thinks is not, he did tests couple of times and thinks it is intact) or missed bone fracture indeed and I have been walking on it for 2 months Sad

((

I am so surprised that it tooks weeks to get it through your insurance fixx. In times of my employemnt days I had private insurance via my employer, actually very good one as it also included pre conditions, was a matter of couple of hours to get approval and for them to arrange appointments for me. But it was very large employer so I guess they forked lots of money to cover all their multiple thousands employees.

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@Markisa, my injury doesn't sound anywhere near as bad as yours. I was offered a full course of physio very quickly, it's just arranging the MRI that has taken a while, but I don't think it was ever seen as something horribly urgent, which I agree with.

It sounds like you have a very helpful physio - I hope you have a quick recovery from here on in!

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@Markisa, my consultant said I needed physio to help get the swelling down and wouldn't operate until it was and I had regained full Range of Movement. This was for an ACL reconstruction

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@Markisa,

No physio. I was referred straight to a knee specialist who sent me for MRI & bone scans. Results that came back was a big tear. From ear to ear the specialist told me & it was flapping around which was causing it to catch in the joint. I seem to remember I could bend the knee pain free in a hot bath. I think I used to go to the swimming pool & just done leg/knee movements. Trying to crouch, stand on tip-toes & all the other kind of stretches you would do warming up!
My theory was my body weight crushing down on the knee, but in a pool I would have buoyancy of the water to cause less downward weight on the joint...
I still have a tear, it just managed to work its way in to a position that is not causing pain or a daily issues. I wanted to avoid surgery, as I know some people it can cause more issues than it solves!

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I can only sympathise you guys & gals with your menisci.
I've been there too, it takes a long time to heal.

@Markisa, are you taking prescription level anti-inflammatories? It does sound a lot like a meniscus tear.

I had a similar issue many years ago. Literally woke up one day whilst on a skiing holiday, got out of bed and fell over from the intense pain in my knee. No obvious cause, hadn't had a fall whilst out skiing - nothing. Caused me problems for years, not least of which were bone contusions on the inside of my patella from the grinding. I couldn't walk downhill for about 5 years. Had Xrays and MRIs which showed a frayed ACL but no obvious tears.

A few years years later I had a baker's cyst in the same knee whilst skiing which sounds like what you currently have? A baker's cyst is not an injury in itself, rather a symptom and reaction to some underlying issue. My knee was extremely swollen and the cyst burst as I was straining to put on my ski boot, and went down the back of my calf. I skied that day but as soon as the boot came off, my calf looked like a rugby ball and that was that. MRI showed the cyst as 7cm x 2.5cm in my calf and a possible tear in the medial meniscus. However, it was likely an old tear that had partially healed (maybe damaged at the same time as the ACL?) so the surgeon did keyhole exploratory surgery. When he went in, the ACL and medial meniscus were both intact but he found a tear in the lateral meniscus that had not shown up anywhere and trimmed it.

It helped a lot but I believe my medial meniscus was damaged again not long after the surgery and it became very clicky with mild swelling. I had PRP injections which were very new at the time and they were very effective in both stopping the swelling and settling the pain. The clicking has reduced over the years, presumably as the torn part of the meniscus wears away but the most important thing is that the knee has never significantly swelled since I had PRP.

I think for sure you need the MRI and then if it doesn't show anything, consider a keyhole examination. IME if the swelling hasn't gone down within a few weeks after you've stopped any aggressive activity, there's definitely something still wrong.

You know it makes sense.

@Je suis un Skieur,

No, i took ibuprofen for first month but then stopped as physio advised me. I think I will get MRI privately and then if needed go to GP and ask for prescription level anti inflammatory along with referral to Orthopedic. I googled baker cyst but I dont have swelling at back on my knee, or at least it is not noticeable, all the swelling is in the front, in the place where my knee hit the ground. I think it could be a reason why physio suspects missed fracture. I can walk for uphill and downhill it is instabiity that bothers me and also when i walk swelling gets worse below the kneecap(place where I landed on the ground), could be severe bone bruise as well? Lots of guessing at the moment, so i think MRI next week is a way forward.
So sorry to hear that you went through so much suffering, it sounds awful. How are you doing now? are you functioning normally including sport? Physio also mentioned potentially steroid injection, again based on MRI results.

Otherwise you'll just go on seeing the one name:

@DrLawn, what is your experience with swelling and healing times? How long did it take for swelling to go down?

A snowHead

@Markisa,

If you had sustained a fracture it would be unusual to be able to walk and weight bear, also the swelling would have appeared immediately. Not impossible but unlikely. If you fell on front of the knee and had bruising at the front with discomfort at the back of the knee then PCL would be more likely. Unfortunately a fall can significantly upset the patella and tear a meniscus. If you had osteoarthritis it may trigger a significant flare up. You really need someone to see you and make a diagnosis. You may get lucky and get a clear diagnosis from a scan alone but if someone hasn't asked questions of the reporting radiologist the scan can be unhelpful. If your knee remains very swollen at a couple of months then physiotherapy alone probably not going to be that helpful. Any good physio is going to want to know what the diagnosis is. I used to run a fast track knee injury clinic when i was in NHS. Have you asked your GP if your local centre has one? It may be worth checking as if they do they may also have fast track scans.

A snowHead

@Markisa, in my experience of a bone contusion/hairline fracture (in my elbow) it would indeed swell up for some time but the whole area would also be black and yellow.

I am fine for skiing with my knee, I have far more concerns about my shoulders. Laughing

A steroid injection might work as a short term fix but you can only have so many before they become ineffective. So you need to find the underlying problem. PRP is better for long term results if it's at all arthritis related IME.

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@Jonathan Bell,
I googled PCL and sounds very likely indeed. I dont have osteoarthritis (at least never had symptoms). I am in my 30ies and never had problems with knees (well until now).
GP initially sent me to FCP for assessment. I will give them a call again next week and inquire about knee injury clinic. Hopefully having symptoms ongoing for 2 months should be enough for referral.

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@Jonathan Bell, thank you Jonathan, will try to get a gp appointment and ask for referral to knee clinic or consultant. Not sure if physio considered PCL tear but read that they are tricky to diagnose just by examination itself.

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Hi @Markisa, Its about 4 or 5 years ago since I had that meniscus problem, and it has faded into the mists of time now.
Probably because it has been eclipsed by other injuries Sad

That one was on my left knee due to having a crash trying to avoid someone in Hemmel Fridge
Then I had another embarassing fall hurting my Right Knee in Crans Montana last February.
Then in July last year I got taken out by an airbourne snowboarder in Hemmel again.
This put an almighty torque on my arthritic left ankle which was still suffering from a pots fracture caused by riding my BSA Bantam back in 1966. I don't think I'll ever recover fully from this and I'm still hobbling on it.

We are so lucky that @Jonathan Bell, pops in now and then offering top advice for us decrepid SnowHeads Smile

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My been half has been having physio for 3 months. She had been struggling, big fat knee and very sore. She had a scan and Doc said there was degenerative meniscus damage and water in the bone ( Puzzled

) and that all of the bodies emergency services had descended on the knee and they just needed to f*** Off (in his words)

It has been gradual, but lots of physio and some drugs saw her ski wonderfully a fortnight ago. The whole thing is improving, just took some time and hard work

I had a call with GP, they cannot refer to the acute knee clinic now as injury is more than 3 weeks old and knee clinic only accepts within 3 weeks. It is a sad really that GP didn't refer me there when I initially came to see them second week after injury, choosing FCP instead and they just decided to wait and see how it goes. Bad luck I guess. Now 10 weeks later I have still lots of pain and mobility issues, he can only refer me back to FCP to second assessment, he said FCP can do referral to MRI. GP said that he will refer to MSK team but it will take like 3 months to be seen and MSK team is also run by physios? So he suggest FCP first which will be a bit quicker. Alternatively he said I can see someone privately, seems a common practice now that people choose to pay a couple of hundreds to be seen earlier than 3 months. Which is shame really what healthcare has become nowadays...

So I have appointment with FCP on Tuesday and will see what he says, though have little hope as it will be the third physio who will try to access me. I guess I will just end up paying for consultant appointment with zero waiting time.

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who is FCP?

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@boardiac, First Contact Physio

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I visited FCP, who are now third physio who examined me. Like previous two, she doesn't think there is any ligament tear following tests and examination. She thinks could be either small piece of bone or meniscus resulting from a fall floating in a joint and causing inflammation and lack of movement. Got referral for MRI, she said I will be contacted within 2-3 weeks. MRI is outsourced, so hopefully wait wont be too long. Based on results of MRI, she said she will either refer to surgeon to remove the piece if MRI confirms her suspicion or if results are clean, she will refer for physiotherapy.
I am just wondering if anyone has swelling that long and got a clean MRI? Not sure if inflammation/bursitis can lasts for 2-3 months without other issues in the knee?
Thats my biggest fear, if MRI is not clean then at least I will have diagnosis, but if it is clean then no idea.... I have also small lump on inner side on top of my lower leg, the place where i landed after the fall. I am still limping because it is painful in this place when i put all weight on straight leg when making step.
Maybe I should have asked for shin bone xray as well as we did knee only.
I am 2 and a half month in and extremely tired. My mental health went down the drain. Not yet cancelled the skiing trip but deadline is looming and another bump to my mental state. Crying or Very sad

In the meantime I returned to the gym on advise of private physio. Mainly for cycling, swimming and sauna. Physio says it could help to bring swelling down.
Started Naproxen as well, on my 5th day, haven't noticed any difference so far, but i guess it may take time. Physio mentioned i can ask GP for steroid injection that would help bring inflammation down, I guess i will wait for MRI first to see if surgery is required.

MRI results came back and I need to say I am very impressed by efficiency of process. I visited FCP on Tuesday, received invitation to book appointment on Friday evening, got a slot for Monday morning and now results a week later. In total 2 weeks from FCP visit to MRI results and from GP referral waiting for FCP appointment only 3 days. Maybe I am lucky because it is election year though:-D

Anyway, MRI came clean, no damage to knee, the only thing they noticed is small joint effusion and mild semimembranosus bursitis (which is my understanding is at the back of knee ie baker cyst). I am not sure what to do. Waiting for an GP appointment for further actions. I think the plan is to refer me back to physiotherapy. FCP said will refer to specialist only if smth found on MRI... if nothing then back to physio.

Now I am a bit puzzled what to do. Knee is still quite sore and stiff in the mornings especially. I still don't have full range of motion. Though I see quite a good improvement over past 2 weeks. Upon physio advice I returned to gym for stationary bike, swimming and sauna. Knee seems to be better but far from being normal and I am 3 months in. Still have a lump on medial side of knee (where I landed upon:( with ongoing swelling inflammation.

I read that MRI can miss certain things and though it is unlikely that it miss ligaments damage, it can miss meniscus damage. I am wondering if MRI can miss just small tears or also more complex ones that prevent full ROM such as bucket handle tear on when piece of meniscus floating in the joint.

Anyway I am thinking if I should pay for orthopedic consultation now. Maybe specialist picks something that MRI and physios missed? Can someone recommend knee specialist in London? I am in the north but happy to travel south the river, ideally i need someone who has both NHS and private practice. I am happy to pay for consults but if need surgeries or something more complex would need to go to NHS list. Shall I also wait with consult till swelling goes away fully? Physio struggled to do some meniscus tests because I couldn't bend the knee past 125 degree. Now I maybe have 135

My ski trip is in two months. I still have till last week of february to cancel. Still having small hope that I can make it especially as there is only swelling and soreness and no structural damage at least according to MRI.

You know it makes sense.

@Markisa, MRI wont miss anything, but the interpretation by whoever is reading it could miss something. Ie they could be looking a pre-suspect issue & miss the actual problem.
Not sure if you could get a copy of your MRI & pay for a private interpretation who does not know why the MRI was done. I would follow Jon Bell advice - he is more qualified than anyone else's opinion on here Smile

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A snowHead

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Thanks everyone. I think I just have anxiety that MRI didnt find anything, I am just struggling to believe that given ongoing symptoms for 3 months i didnt damage anything and swelling is caused just by impact from a fall on pavement. Physios were doing some tests like rotating and bending the knee, tests for ligaments tears as well to see if there is a pain but nothing, only when bending the knee all the way through the pain was deep inside, they said likely due to swelling as i have this lump. I also didnt hear any pops or cracks when fallen. Got up normally a minute later but had sharp pain when going down the stairs at train station to get back home. I have MRI images though as was done in private center just paid by NHS.

Not sure if anyone was in similar situation and it took such a long time to heal but no damage to meniscus/ligaments not even bone bruising etc Feel like it would be easier if they found some sprain or tear and at least i would have known what to expect.. On top on that I strained my foot a couple of days ago by overstretching from exercises, now dealing with that as well. I hope at least this one will be of short duration rolling eyes

I know that Jonathan Bell is highly regarded on this forum, but I think he has only private practice? No problem with paying for consult even though Wimbledon is like 50 minutes drive from me (London distances wink

), just worried that I will not be able to transfer to NHS surgeon if needed later on as FCP will not refer now due to clean MRI and GP said they cannot refer themselves, MSK triage is needed, which they referred me in mid Jan to but said will be couple of months wait.

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@Markisa,

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@Hurtle, thats a long time!! When were you be able to return to skiing?

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@Markisa, have you just been having NHS physio? Might be worth paying for a few sessions of private physio, so make sure you are building up right muscles etc. They should give you loads to work on.

In my experience, when you get an injury half the challenge is getting your body to stop avoiding the injury. You other muscles kind of take over and get stronger to avoid injury and rehab is about building back up those which were being avoided once the initial injury has healed.

My Pilates instructor is also really good at this.

Help!!

Knee Injury :(

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