Recently, I met with an accident and the doctor diagnosed my knee with a complete ACL tear and partial MCL injury. So, I started using a knee brace. Two days later, I took a long-duration flight without taking any medication for thrombosis. However, I started taking Ibuprofen tablets (twice daily for five days) followed by 30 Paracetamol, thrice daily for 10 days. Later, I started having pain in the back of my knee and knee calf. Due to pain, I again started taking Ibuprofen once daily. Before 10 days, I had a long flight to travel again to my place. Then, I reported my pain issue to my doctor and he found muscle vein thrombosis in the gastrocnemius muscle. I have been advised to use compressions stocking (only during the day) and to take six weeks of blood thinner medicine, 15 mg for 21 days twice daily and then 20 mg once daily for the rest of the period. Earlier, the doctor said that my ACL needs an operation. However, due to thrombosis, the operation is postponed for at least six weeks. The doctor also asked me to live a normal life without any restrictions. My main concern is how should I deal with ACL tears along with MCL injury and muscle vein thrombosis. Do you think that my doctor's suggestion is right? Is it fine to live normal day-to-day life, traveling on public transport, outside walking (more than 15 minutes), and going and working at the office when I am having both ligament and thrombosis issues? What precaution is required so that this thrombosis does not expand? How should I sit and for how long? How should I sleep? How long should I walk? Should I use the knee brace now? Please help me with these questions.
I have gone through your query and would like to give replies to your queries accordingly. The issue is that you have a concomitant knee ACL (anterior cruciate ligament) and MCL (medial collateral ligament) injury for which a surgical procedure will be required as you are very young and this cannot be neglected. But right now, the main issue is to correct your DVT issue (deep vein thrombosis) and for which I guess the appropriate medications have been initiated. The advice given to you has been correct, which means management of DVT first and then your knee ligaments as ligament reconstructions are not emergency procedures and can be delayed. To live a normal lifestyle I need to see your Doppler report as to understand the extent of DVT. Precautions are taking medications on time, gentle mobilization of the affected limbs, compression stockings, especially at night, etc., so that the thrombosis does not increase. Sitting is fine and so is sleeping. But, the positions of the affected extremity have to be changed frequently to avoid blood stasis, which is the main cause of DVT. I would also like to tell you that if your thrombosis is not a big one, then you can walk small distances under the cover of medication. But, I would like to give a definite answer to this once I see your report. Also, if there is any feeling of instability, an ACL brace can be used especially while walking so as to keep the knee stable. Do not involve in any sporting activity or heavy exercises, etc. The surgical procedure can be contemplated once DVT has resolved completely.
Should I use the knee brace at home or during sleep? You mentioned wearing the compression stocking during sleep, but the doctor here suggested wearing it during the daytime only. What should I do? Which exercises do you recommend? What is your opinion about my partially injured MCL, whether it is already recovered one month is gone after the accident? Can I ride a bicycle outside or an exercise bicycle at home?
Actually, the knee brace is not required during sleep as we do not expect any activity and thus no instability. So, you should use the knee brace only during mobilization. I understand that compression stockings are required when we expect a stasis of blood, which can happen during sleep. So, it is definitely recommended during sleep when there is a relative inactivity of the affected lower limb, which is similar to the use of compression bandages at night after the joint replacement procedure. As far as I am concerned, you are a young female. So, only isometric quadriceps strengthening exercises are enough to maintain the strength of the limb. So that, postoperative rehabilitation would be faster in your case. It is not possible to actually comment on the MCL injury without physically examining you and also seeing the MRI images. But, if it is a partial tear, then it would have healed up by now, which can be clinically assessed by a physical examination test. We call it a valgus stress test to see the medial opening of the joint. Actually, you can if the thrombus is a small one. But, personally, I would recommend not to indulge in any heavy physical activity till the complete resolution of your clot as I cannot see it on the investigation.
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