Calling all injury specialists! Knee Injury for a Book

[CraigSca]

My wife is currently writing a book and her main character is going to suffer a knee injury sliding into second base during softball.

Here's what we need:

A knee injury that will not necessarily end a career, but require about 8 months of rehab.

If it requires surgery, would surgery occur right away? Would it require a trip to the emergency room?

After injury, what's the normal reaction - would the girl clutch her knee, or be in so much pain not be able to?

what's the normal rehab regimen for the injury? Would she experience a lot of pain after the trip to the hospital? What's the typical pain killer given, and for how long?

Sorry for the 50 million questions, we just want to make sure we get it right :)

[stevew]

Ping Carson Palmer?

[Eaglesfan27]

I was never good enough or interested enough in orthopedics (most of the orthopods were jerks) to answer these questions accurately. Sorry.

[miked]

I tore my ACL and meniscus playing basketball, but had a partial tear earlier from getting my foot caught turning a double play.

* I heard a nice pop when it happened and sort of went loose for a bit. I think I was more in shock as it wasn't instantly painful, but got there within a few Went to the ER as soon as I could get a ride. That night it hurt like m-f- hell. The pain goes away in a few, but it's sort of unstable, you feel like the top part of your leg is disconnected from the bottom. I had to wait a few weeks for the swelling to clear, insurance to work out, MRI's, etc. If I were Barry Bonds, I probably would've had surgery within the week but that's not real life.

* After my surgery, I went to rehab within 2 days. I was in mas pain and rehab made it worse in the short term. I was in a very bad mood because I was an athlete and struggling to lift my leg or change my socks (was in an immobilizer cast for a few days). After my stitches came out (in about a week), my doctor took away my crutches and told me to get over it. Since I was on Winter break from school, I went to rehab every day for like 2 weeks and it accelerated everything. The first few weeks feel weird and I was on a tough regimen. All in all it took about 3-4 months for me to feel like playing ball again, and my first few games were mighty timid. You get over it.

Edit: My friend had the triad, ACL, MCL, mesiscus...took about 6-8 months to recover. Very similar I think in terms of timeline, except rehab.

[wbatl1]

Sounds like a good ACL tear to me, especially since it is a female protagonist. Also, while the ACL tear is usually not contact induced, a slide can often catch the knee and cause a tear. The rehab after surgery is 6-8 months, so the time period fits in well. Yes, it requires surgery if the athlete wishes to return to most athletics. A fairly normal life can be lived without an ACL though, so that might be another part the book could incorporate. Surgery is usually scheduled for 2 weeks to a month after injury, because inflammation must go down before surgury. It would not require a trip to the emergency room if some sort of crutches or brace were availiable, but walking is usually difficult immediately after the injury. The injury is extremely painful when it first happens, but as the leg is straightened and relaxed, the pain subsides, and you are left with a lack of stabilty and nagging pain in the knee. When I tore my ACL, I clutched my knee, but could not even scream because of the pain. Rehab regimen after surgery is hard and sometimes painful, as strength of the quadriceps and hamstring muscles are being built up, and range of motion of the knee is increased. WebMD has a lot of other info if you choose to go this route, and I can always help out.

[cartman]

ping: tk

[miked]

Almost dola-

I still play baseball and partially tore my MCL sliding into second during a steal. The MCL is pretty common with the leading leg since you angle your hook slide in the MCL area.

[FrogMan]

ping: tk
I second that ping :D

FM

[JonInMiddleGA]

I second that ping :D

FM

I third it, cause that was my first thought too.

[rkmsuf]

I would have opted for a severe groin pull for this guy.

[JeeberD]

ping: tk

Knee injury, not ankle disintegration... ;)

[FrogMan]

Knee injury, not ankle disintegration... ;)
she's the master of all ligament tearing :p

FM

[CraigSca]

Thanks guys, this is great stuff!

[terpkristin]

Oh gee thanks, people, for the pages.
Yes, when I saw this thread, I expected to see at least one "ping" to me. ;)

The descriptions here of ACL tears and rehab is pretty dead-on.

ACL tears happen frequently in females, for a variety of reasons. Usually you know right away. You feel and usually hear the pop, and then you're in pain and usually you start swelling. Many people do go to the ER when they do it, especially if they don't know what they hurt. Usually at the ER, they immobilize your knee (read: entire leg) and tell you to make an appointment with an orthopaedic surgeon.

Surgeon will look at the knee, often order an MRI (not always, sometimes it's so obvious what happened that there really is no need), and then recommend surgery.

Surgery is not technically "required" for this...you CAN rehab the hell out of your knee and strengthen up all the supporting muslces (especially the hamstrings) and go back to playing competitively without surgery. That said, most athletes have the surgery, it's got a higher likeliehood of working without wasting time.

Usually they wait about a week after the injury for some of the swelling to go down before they do the surgery. If you want details on the surgery, let me know. Typically, especially for high-level athletes, they perscribe a continuous passive motion (CPM, see http://www.healthsystem.virginia.edu/internet/orthopaedics/cpmm.cfm) machine and cryo-therapy (see http://www.breg.com/products/cold_therapy/polar_care_300/default.html), in addition to starting PT almost immediately after surgery.

PT consists of range of motion for the first little bit, plus passive strengthening of your quads/hams. Usually they use a muscle stimulator to help you work on that at PT. Gradually they work you up from partial weight-bearing to full weight-bearing, then they begin really strengthening in earnest, plus working on things like balance, which is something you'd be surprised how easily you forget after an injury like that. As the patient starts going back to sports, they often use a functional knee brace for support (actually, they usually move you to one of these after they take you out of your post-surgery immobilizer and then wean you off of it for "normal" use but as you go back to sports you often start back into using it...this is the one I have: http://www.isports.com/products/cti.htm).

ACL tears often have associated meniscus cartilage tears (collateral damage), which they usually clean up when they do the ACL surgery and sometimes MCL problems.

Feel free to send me a PM if you have more questions! Or, ask here, but let me know that you have more...

/tk

[terpkristin]

Oh yeah.
Drugs.

If the person goes to the ER, they'll often perscribe 800 mg of ibuprofen.
Unfortunately, for 1 week prior to surgery, you're not allowed aspirin or ibuprofen or anything like that (they are blood thinners), so all you're allowed to have for pain is Tylenol/acetominaphen.
After surgery you're often on Percocet or some other similar opiate variant for a week, every 4-6 hours (and boy do you know when it's time to re-drug!), then pain meds as perscribed by your doc (most don't want you to be on opiates, so they try to get you to use regular OTC drugs).

Oh yes, stitches/staples usually come out 1-2 weeks after surgery, again, it varies from doctor to doctor.

/tk

[oliegirl]

If you haven't already decided...

I blew out my knee in June, found out I have "miserable female alignment syndrome" (yes, that is really what it's called) and have had it my whole life. Basically, when I fell it screwed my alignment up even more and now my knee cap doesn't sit on the center of the knee like it's supposed to. I'll need surgery at some point (I'm putting it off as long as possible), and after limping around for 5 months, developed plantar faciatis (sp?) and a huge bone spur on the bottom of my heel, so now I am in a brace and it hurts like hell pretty much all the time.

PM me if you need more details :)