Almost a year ago, I tore my meniscus. I was told no surgery needed and did PT for severe muscle atrophy for 12 weeks. Everything was going well. Then quarantine happened and leg started getting weaker due to lack of normal physical activity. Now my knee hurts, feels weak sometimes when I walk and can no longer perform a straight leg exercise (I am able to do it even with injury). I try to continue to do the PT exercises at home but to no immediate avail. Should I be worried? Should I get a second opinion in light of circumstances or just continue with exercises at home?
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Well, there is a loss of bulk and muscle atrophy due to reflex inhibition in patients with injuries of the knee. Exercises and rehab usually prevent it.
You need to elaborate on certain details. Do you take a high protein diet? Did your back hurt as well? What is the difference between girth of your thigh as compared to the normal thigh (at 15 cm from knee joint line)? Any vitamin D3 supplements taken? Revert back with the details.
Thank you doctor,
Yes, to high protein, and no to back pain but slight hip pain on the side of the injured leg. I have not taken any vitamin supplements. Attached is the injured leg (left one) in comparison the right is exactly 17 cm all throughout the lower knee, mid knee, and upper thigh both sitting and standing. The injury is almost always 16.5 cm in the same areas while sitting or standing.
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I have seen the picture (attachment removed to protect patient identity).
The quadriceps muscles on the injured side have slightly less bulk (0.5 cm) which is not something to worry about. Performing straight leg raise requires good core strength and quadriceps strength so if you are having difficulty in performing that either of the two scenarios are possible. Your meniscus is further injured or not healed leading to pain and not able to do the physiotherapy hence the weakness.
Other reason is that the femoral nerve which supplies the quadriceps has also been pinched and the muscle loss is more of due to femoral nerve irritation.
Start with basic core exercises (you tube them includes planks, gluteal bridges, straight leg raise), back extension exercises, quadriceps and vmo strengthening (start with isometrics), ice packs and continue with high protein diets.
Take vitamin D3 supplements 60k per week for 10 weeks and Methylcobalamin 1500 mcg daily for three months. If there is pain, you can have Naproxen or Ibuprofen.
Is there any catching sensation or locking of your knee? Is there any episode of instability (feeling of giving away in the knee especially during twisty movements of the knee and walking on uneven surfaces)? Also what kind of meniscal tear was it (peripheral or central)? Type longitudinal, radial, flap, etc?
Thank you doctor,
As for injury type, I think it was peripheral but by the time MRI was taken it was mostly healed. Now when it hurts (where I sent the picture) with any type of straight leg exercises, It will hurt/pinch in the middle of knee right under the patella joint. The only instability I feel is when I start walking immediately after sitting or lying down maybe for about 10 minutes and then if feels better. Also, when climbing stairs but not so much on uneven surfaces. I have used KT tape to help but only helps for a little bit. Also, you can get an idea of the muscle loss, whenever I take a step with the injured knee, you can visibly see the patella joint go inward while the good leg you cannot see.
Welcome back to icliniq.com.
The area you have pointed (attachment removed to protect patient identity) marks the medial joint line where the medial meniscus and the medial collateral ligament is and also insertional area of vastus medialis oblique muscle. Peripheral tears usually heal by 8-10 weeks, and does not appear to be the cause of your symptoms.
The symptoms you have described are consistent with patellofemoral overload syndrome which is very common in females. Also, the patella being visible going inward is due to the wasted vmo muscle (once you get muscle bulk back, it will become similar to the uninjured knee). So you have to concentrate on vmo strengthening exercises (youtube the exercises) starting from very basics and then increase the intensity.
Also, do not sit cross legged. Avoid climbing upstairs. Do not squat. Avoid wearing heels.
Also, continue your exercises and the supplementations as advised (especially vitamin D3). You can skip Methylcobalamin (nerve cause seems to be ruled out). Initially, the exercises for vmo and quadriceps strengthening will hurt and it will appear that the problem has exaggerated but slowly you will feel better.
You can have a follow up via video consult if that is fine in three or four days or through text query whichever is convenient.
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