UKC

I was bouldering last night and as I attempted to rock over onto a heel hook there was a fairly loud pop (loud enough for 3 or 4 people to hear and look at me rather worried) from my left knee. It was sore but not agony, enough that I did not want to put to much weight on it. Iced when i was home and thought it might be ok this morning. It wasn't.

Was in a fair bit of pain this morning and didn't want to weight it.
Spoke to a few friends who mentioned ACL and other suspected things and told me to go get it looked at.
Went to hospital and explained. They did an X-ray told me nothing was broken and said you will be fine, take some pain killers and rest.

It seemed a pointless trip. I could have told them it was not broken. Unless i am wrong Xray will not show ligament or tendon damage?

Still sore now, very little swelling and no bruising.
I would love it to be nothing but the pop it made worries me.

Advice welcome.

Cheers,
Ben

In reply to Ben_Climber:

I don't know but will an x ray reliably show a soft tissue injury such as an ACL tear? For medial ligaments I needed an MRI scan.

In reply to Ben_Climber:

Can you work out what makes the knee hurt? With your foot free-hanging, does it hurt when you push the foot outward, inward or is that ok? Does it hurt when you straighten your knee or when you bend it? These things will help localise the injury. I made my lateral collateral go 'pop' this time last year, heel-hooking. I thought my days of steep-plastic jug pulling were over but it got better with rest much quicker than i though (about 5-6 weeks). I think cruciate tears generally provide fairly drastic joint swelling - given your knee isn't swollen the day after then hopefully you've swerved this injury. I think meniscal injury usually occurs during rock-over type moves. Given that it occurred last night, i'd remain optimistic but make sure to give adequate rest and when you start re-exercising, be sure to listen to tell-tale signs of pain. Good luck.

In reply to Skyfall:

That was my thought. I was surprised when I explained what had happened and the noise it made that they X-ray it and not a MRI or CT. That said, I am no doctor and could be talking rubbish.

In reply to Ben_Climber:

Did the doctor examine your knee?

In reply to Ben_Climber:

X-rays have limited capacity to diagnose soft tissue injury, but because the cruciate ligament is inside the joint, the possibility of cruciate ligament damage is made more likely if the x-ray reveals swelling within the joint. Same goes for meniscal damage, though extra tests (physical examination.....MRI) would be needed to differentiate the two, or indeed diagnose both problems together. Collaterals exist outside the joint, hence would not 'show up' on x-ray, but would hurt when pushing the foot left or right.

In reply to Ben_Climber:

Head to see your GP and request either Physio or Orthopaedic referral. Your GP may even order imaging themselves depending on where in the country you are and what policy they have. Here in North Wales we can self refer to physio which is handy as certain physios are able to order imaging as they are Non medical Referrers. The red flags for your knee are crunching, locking or giving way and to a lesser extent clicking and a feeling of instability. If you have any of these then yes you will likely require further imaging and investigation. In the meantime the old acronym RICE still stands, Rest Ice Compression Elevation.
Best of Luck
Chris

In reply to Ben_Climber:
>"I was bouldering last night and as
I attempted to rock over onto a heel hook
there was a fairly loud pop
(loud enough for 3 or 4 people to hear and look at me rather worried) from my left knee. It was sore but not agony, enough that I did not want to put to much weight on it. Iced when i was home and thought it might be ok this morning. It wasn't."


The knee and it's joint is'nt ( really, if at all) designed for both Flexion* and certainly much if any Lateral* ( i.e sidey-ways) movement, So that if you hips are not esp. flexible(i.e tight), the knee on a weight-bearing leg can be the weakest anatomical link - If that makes any sense.

These (above) things usually sort themselves out over time and the knee pops back into place- it's usual alignment.

What is the solution? - well With that said bear in mind not to do that kind of movement in future if that is the case.Flexion(as opposed to extension) is when the foot touches your buttocks.Lateral movement is when the foot turns inwards or outside.In my case I did'nt understand how the knee joint works (anatomically-speaking of course) and my hips were not that flexible or rather on the tight side....which means the knee takes alot of the strain and it's not designed to do that.

It seems to be a unique joint you really have to look after....if it is out of alignement or injured you really need to be careful with it.In my case rest, time and just going easy with it- it sorted itself out, maximum a month.I did it quite a few times after finally learnt my (own) lesson(s).I suspect it is one of the less/least forgiving joints if there is something up with it and it wants or needs healing.

In reply to Ben_Climber:

As others have stated... soft ligaments (like meniscus and ACL) will not show on X-ray.

Generally the load pop comes from ACL... but not always, I had it when my meniscus toar.

Best course of action, is to see a (sport oriented) orthopedist, preferably one that specializes in knees... They can do a stability test to see id the ACL is gone, but most likely will order and MRI. At least that's how it has been with me (twice, I might add ).

If it is ACL... well, luckily fixing it is quite straight forward, but healing will take time. Meniscus is either easier or a lot worse.... if just a small tear on the meniscus, a small operation is needed... how ever, if the tear is big or would mean removing a lot of the meniscus, well trying a meniscus faxation (ie. sow it back together) is highly advised... Because meniscus is really there for a reason... recovery from meniscus fixation is rather long...

In reply to Ben_Climber:


Sounds almost exactly like what happened to me about 4 weeks ago so I'll relate my experience. I'm sure you appreciate the usual disclaimer that any superficial similarities in the cause don't imply the same injury/prognosis.

Mine was a high heel hook on a steep (~45') sport route on a trip, left knee made a loud pop and I fell off. It didn't really hurt, but did feel a bit 'tingly' around the outside (i.e. left) side of my left knee. No swelling, no pain when bearing load, but something felt 'not quite right' when walking down hill, and I wouldn't have fancied attempting the same heel hook again!

When I got back from the trip (so more than a week later) it had improved a bit but still didn't feel quite right so I saw a physio (no climbing specific knowledge but experience treating football and rugby teams). He inspected the knee and found a bit of swelling around the back/outside. Likely some damage to the lateral collateral and possibly posterior ligaments, but nothing serious. Recommendation was (as I had been doing already) to avoid heel hooks and drop knees, and sports like squash/football that might twist it) for a week or two and it would probably clear up.

I'm back to normal with climbing now.

In reply to Ben_Climber: I think kness are one of those things: it would not be financially sensible to MRI everyone who hurts their knee, when most will get better with rest. Ideally you want to be taking a few weeks sensible rest, antiinflammatories, then physio if not improving after a couple of weeks, then if not getting better go for the MRI. Don't be fobbed off if it doesn't get better though, took me a year to get my torn meniscus referred.

In reply to Ben_Climber:

if your worried I would go and see a sports physio and get them to check it out

Davey

In reply to Ben_Climber:

From my limited experience, the movement and load you describe sound like a classic cause of meniscus tear, definitely much more likely than ACL rupture (although mine did a loud, cracking sound when it went....).

Standard X-ray would not help with the diagnosis, but if the NHS is reluctant to do an MRI, you can most likely get a reliable diagnosis from a good physio.

A full ACL tear can often be diagnosed by pulling the lower leg forward and getting a sliding motion in the knee (again, not always, mine was missed as the knee was still too stable and only showed up when they were looking for meniscus damage by MRI). Partial rupture would probably not make much of a sound. Meniscus tears often result in the knee locking up when bent to a certain degree.

CB

In reply to cb294:


Rather than "often", the correct wordin' is can.

I've had my meniscus now fixed twice (no lockin' up) and so has a few of my pals (again, feelin' odd but not lockin' up).

But yeah, a good sports oriented orthopedic doc and most likely an MRI are the way to go...

In reply to Ben_Climber:

This reminds me of my first knee injury about 5yrs ago. I basically had my knee cap 3" higher up my leg and a big dint in the place where my kneecap should have been. Got wheeled into A & E (Ambulance job) and the 'consultant' came and inspected me. I had zero control over the bottom part of my leg. He grabbed the bottom part of my leg and attempted to bend it. I screamed. I then went for xrays.

The same guy looked at the xray, saw that there was some 'unknown to him' bit that had snapped and there was bits of bone attached to it. EVEN I COULD SEE THAT!!.

Sent me home with a stretch bandage on and a set of crutches to be seen again on the monday by a proper consultant. When i got in on the monday the same idiot was in the hospital and while examining me again by trying to bend the leg (Me shouting again) the proper consultant came in. Demanded the idiot take his hands off me and immediately diagnosed a ruptured patella tendon (They snap with about 17times your body weight and its not pleasant). A big smile on his face when he told me he hardly ever sees them and would love to sort it. 2hrs later they had taxi'd a special new splint from Leeds to the hospital and i was on the operating table.

The patella tendon is about 1" thick and mine had bits of bone still attached and the 'Idiot' still couldnt tell me what had happened to me. If you think something is wrong, ask for a second opinion because you usually get seen by these juniors and they report back to the guys who actually know what they are doing.

I have other unbelievable stories.

In reply to Ben_Climber:

A&E departments usually just have access to x-ray machines and not MRI so I don't think you were hard done by. MRI results are not as quick to obtain as x-ray and I've never seen them used in an A&E environment in the uk or abroad.

Speak to your GP. I would imagine they would refer you first for scans if they thought partial tear or rupture. A physio (and probably quite a few GPs) can physically test for cruciate laxity relating to full tear and probably predict with with a good level of confidence whether torn but a scan is going to be needed to properly confirm, particularly if surgical repair is needed. Therefore start with your GP but consider assessment by a private physio if worried you are not going to get a diagnosis quick enough.

In reply to Ben_Climber:

I'd go straight to a physio experienced with such climbing injuries. Ask for recommendations here or on the other channel (UKB). Waiting for a GP referral all too often just delays recovery and might get you someone who is less experienced with the injury.

In reply to HeMa:

I have seen a lot of these injuries in the course of my judo career, and would stick with "often", but as you say, clearly not always.

CB

In reply to Ben_Climber:

Honest answer is that your G.P probably has no more of an idea than the collective advice here, regarding your knee. If it were mine, i would rest, contrast ice/heat and try to return to activity.

If in 7 - 10 days no better. Then Push for referral and the good old waiting list. Reality is the G.P typically will not request an MRI.

Sport Physio is good idea. They will have far more of a clue and may avoid above hassle.

Steve

In reply to Ben_Climber:

Many thanks for the advice guys.
It seems there have been a fair few dodgy knees among us!

My guy feeling is that it is not anything serious (ACL) as i just don't seem to be in enough pain.
Nick Russell, you account seems similar to mine.

I will continue to rest and ice over the weekend and see what it's like then. If it needs to be checked i will no doubt be back with physio recommendations.

Cheers,
Ben

In reply to Ben_Climber:

I've got dodgy knees I've had a lateral release on both knees and then a more major op on my left one to remove a floating bone and quarter of my knee cap.
Before the ops I had MRI scans which showed nothing up it was the xray that showed up my worn knees from years of misalignment damage that I had done.
I've been told popping and crunching is ok it's a problem when you get pain.
I'm no Dr so this is just from my experience.
On the bright side I'm climbing and doing other exercise (apart from heal hooking but that's because I'm a rubbish climber)
I hope you have a speedy recovery

In reply to Ben_Climber:

Is it badly swollen ?

I concur with the above, sports physio is the way to go, i did mine skiing and the doctor was predicting all sorts of doom and gloom from torn ligaments and meniscus tears.

Sports physio twisted and tweaked and compressed and proded, basically i had just strained them badly enough to swell up like a swine and make it hard to bear weight, 5 weeks of exercises and 3 physio sessions and its ready to go again now

Current thinking is POLICE instead of RICE now, Protection, Optimal Loading, Ice, Compression, Elevation.

In reply to Ben_Climber:

If it hurts, rest, ice and elevate. If you've done something grim it will probably swell, the pain won't get any better and then you can make an appointment with your GP and possible referral onto an appropriate consultant. You will find them much more accommodating if you go and say, I did this, it hurt, I've spent a week icing and resting but the pain's getting worse and I feel a bit unstable, rather than, I did this last night and it hurts a bit.

I wouldn't dream of attending hospital for a joint injury unless I thought it was broken or I couldn't put weight on it, or use it at all, especially if I'd managed to survive 24 hours already.

HTH

In reply to HeMa:

meniscus can also heal its self.

In reply to Dark-Cloud:


Can you explain the Optimal Loading bit?

In reply to CurlyStevo:


Parts of the meniscus can. But most of it has no blood supply and cannot.

http://orthoinfo.aaos.org/topic.cfm?topic=a00358

In reply to Simon Caldwell:
Sure its smaller tears to the outer region of the meniscus that tend to heal better and generally younger patients self heal better than older ones.

There is also growing evidence that trimming the meniscus is being over used as an operation.

http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-litt...

etc

In reply to CurlyStevo:

Yes,


Menusectomy ist night gut...

But meniscus fixation, where they sutturate the tear (i.e. sew it back to one piece) is the preferred method these days... Unfortunately not all docs have heard about that.

In reply to HeMa:
I believe that the inner portion (which makes up the majority) of the meniscus on most adults doesn't have enough blood supply to be sewn back together.

In reply to CurlyStevo:


It's a 50/50 or so thing... luckily the classic bucket handle tear is on the outside of the meniscus. Which is also more important than the inside of menisci.

The operation from 10 years ago has seemed to work ok, and the one from a few months back, the doc said something in the lines of 60 change of it working or so...

In reply to Ben_Climber:

You should get an X-ray if you meet these criteria. http://www.emottawa.ca/assets/documents/research/cdr_knee_card.pdf

Obvious limits to doing anything beyond X-ray in ED have been mentioned.

Most orthopods would suggest trying a period of rest and analgesia before a graduated return to activity and any ongoing pain, limit to movement, locking or giveing way then seek further advice. Depends on area but NHS physio with access to imaging referral is the best bet.

In reply to Ben_Climber:
You have not done your ACL or PCL , there would be severe swelling and worse pain. Likely you have a partial tear to either a meniscus , a collateral ligament or both . Partial tears to the collateral ligaments ( at the sides of the knee ) heal well as the blood supply is good. . As do small peripheral radial tears ( outer bits) to the meniscus or knee cartilage , again they
Have a good blood supply. Large meniscal tears will cause more problems but often with locking of the knee ( a block to extending it) from what you say I think you have a minor ( grade 1 or 2) injury and will recover fast in. 3 to 6 weeks. Keep active as best you can and if it persists you need an MRI . I am both a doc who deals with a lot of this stuff and a climber / runner who did the same as you. . Get a knee brace on the inter net ( I use mine for all climbing except ice !) avoid sit starts and over bending it and don't worry, it will get better !

In reply to Allovesclimbin:

Cheers for the info.
4 days on from the injury and still very little swelling.
Some pain in the knee joint still and a bit of a twinge when I twist it or fully extend.

What you have said seems promising. I've got a brace on it and been icing it when I can. Off on holiday for a fortnight to put my feet up so will check in with a physio when back if its not better.

Ben

In reply to Ben_Climber:

Not to scare ya, nor anyone else... more to just remind you...


That if you have damaged your meniscus, while it can come almost or even completely pain free... it's there for a reason.

And meniscus damage (which might be fixable) often leads to knee arthrosis... which currently isn't fixable.

Disclaimer: I am an Orthopaedic Registrar, Working in Hip & Knee

I'd advise you go and see your GP or A&E and get a referral to either fracture clinic or acute knee clinic so you can be investigated and treated properly

You need a proper examination and probably an MRI scan, your surgeon will then explain what your treatment options are and counsel you appropriately

I hate trying to remote diagnose over the internet but it does sound suspicious for a meniscal tear

If you have any questions feel free to PM me!
Get well soon!
Mike