Hi lads and ladettes,

as has been rambled about by moi, I have stuffed my Medial ligament on my knee and am just finding out the extent this week (did it 10 days ago).

Does anyone have any advice (specifically for medial ligament damage) as to physio, training and possibly support equipment?

I have been told the Medial usually repairs itself (unless completely torn) but am waiting results of this morning's MRI to know if there is any other damage in there.

I don't think i will need a rigid knee brace as shown here http://www.gallbrosmedical.com.au/index.html but rather a firm (but fair) neoprene style that is gonna stand up to salt water use etc?

I should be full bottle on the damage and process after the weekend, but would like some info to help decide the course of action.

Cheers all.

for when i had PCl and MCL damage i just used a standard hinged neoprene brace after a fair bit of physio work..

the physio's name was Adam I THINK, if you go up shenton ave and you get to the roundabout next to the medical centre you turn right and its on your left next to the british shop thing, was recommended to me by orthopedic surgeon and he was really really good

hey dude good too see you got the mri booked. that really will tell you extent of your damage much better than clinical assesment.

go see dr gerard taylor as sports med subiaco, its actually part of the hospital, Brilliant sports doctor, he will be able to tell you if you need surgery or not. Hope you did get the refferal from a specialist because it saves youa lot of money for the mri.

I got a really good neoprine brace from the place next to windsurfing perth i cant remember the name. It has full lateral movement support plus changeable extention and flexion it cost about $300 but i had surgery for a medial meniscus tear only 2 weeks ago and i wore it last thursday to kite and it was awsome i dont think you really need the full hardcore brace unless you really have torn the complete thing and cant get the surgery yet.


i fyou find a good physio let me know because they are bloody hard to find :)

Done my medial collatoral ligament in my right knee twice now. Both times I have gone straight to these guys in the city (www.centralcityphysio.com.au/). I always ask for Salem (www.centralcityphysio.com.au/meet_the_team.html) as he seems to understand sports injury very well and the desire to get back out there ASAP.

Your best course of action, as always, is "RICE" as any temptation to get back too soon will risk longer term damage. After the second tear I started taking Glucosamine/Condroitin/MSM formula as well as Omega-3 as my knee used to lock up from time-to-time. After taking this stuff continuously for over 12 months my knee was back to normal but that could have been just the passage of time helping also!

For rehab I did, and still do, a lot of cycling. Never bothered with a knee brace as both times that I injured my knee it was at the back end of the season so had plenty of time off for rest.

Bottom line I would say is stay away from kiting for a good 8-12 weeks at least

Hey mate, ignore the specific advice from other people on here, as individually the impact of a grade I, II or III MCL tear will be totally different for each person. I've seen grade II tears confirmed on MRI with huge swelling, lots of pain, unable to weight bear without taping etc, and I have also seen the exact same appearance on a different knee with full range, no pain and no loss of function just 1 week after the incident. What I'm trying to convey is that there is a lot of variance between presentations for this type of injury.

When you get the MRI results, copy them word-for-word in here and I might be able to give you some advice, but overall the best thing to do is;

RICE initially for 72 hours or more
Take the MR results to a good sports physio and explain to him the situation. If there is meniscal or ACL damage or a grade III MCL injury then surgery could be indicated.
Ask about braces - a hinged knee brace would be good in almost all circumstances

Good luck with it.

Oh and rehab is all about quads and hamstrings - go nuts and build them up. Especially the quads.

Great so far fellas.

Have been icing it everyday (almost) since, although wasn't able to for the first 48 hrs or so (Doh!).

Not wrong about physios. Costs will lead me to extract the info from them and go solo asap too. Will check out the couple listed ta fellas as they should be handy locations.

The MRI will show if I've got PCL damage - hoping not as though. There is a bit too much movement but no pain in that area.

Swelling and pain is still big-time in the medial area. Sleeping is awful as every movement tweaks it and so i wake up. Although, I have found poking wifey in the ribs and telling her to stop snoring therapudic! Karmic returns right there..

I usually take a low dose of fish oil and Glucosamine anyhoo but hadn't heard of Chondratin until the weekend. Will investigate.

Anybody got a link to the sort of non or semi-rigid braces? Brand/models?

Geez i feel a bit of a sook compared to some of you guys with multiple injuries. My 1st knee damage though and have always been paraniod of feking my knees and kissing goodbye to sweet boosty-time!

Many thanks fellas.

When grovelling favor the other knee.

No doubt a fair bit of "Awww honey pweez." contributed to the wear n tear initially.

Must get one of those ol' codger garden kneelers for future begging.

I'd ask for a loan of yours Slacko, but am pretty sure it will be completely worn out.

Funkster I use my begging mat as often as you use your kites, hence after 20 years it still looks brand new.

So I would be loathed to lend it to someone like you that will wear it out in a matter of weeks.

Have just done the same and spent about 10 weeks off the water. Kiting again and wearing this on the water.

www.djoglobal.com/our-brands/donjoy?ip=168.1.133.126

Of course you get what you pay for in terms of quality and this was on the cheaper side of the market at just over $200. I wear it on the water kiting and seems to be doing the job nicely, it ceratinly increases the confidence.

I would recommend staying away from kiting until it heals. Certainly harder said than done when your mates are on the water having a great time!

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getfunky said...

Great so far fellas.

Have been icing it everyday (almost) since, although wasn't able to for the first 48 hrs or so (Doh!).

Not wrong about physios. Costs will lead me to extract the info from them and go solo asap too. Will check out the couple listed ta fellas as they should be handy locations.

The MRI will show if I've got PCL damage - hoping not as though. There is a bit too much movement but no pain in that area.

Swelling and pain is still big-time in the medial area. Sleeping is awful as every movement tweaks it and so i wake up. Although, I have found poking wifey in the ribs and telling her to stop snoring therapudic! Karmic returns right there..

I usually take a low dose of fish oil and Glucosamine anyhoo but hadn't heard of Chondratin until the weekend. Will investigate.

Anybody got a link to the sort of non or semi-rigid braces? Brand/models?

Geez i feel a bit of a sook compared to some of you guys with multiple injuries. My 1st knee damage though and have always been paraniod of feking my knees and kissing goodbye to sweet boosty-time!

Many thanks fellas.

ok my papers say high grade partial thickness of acl pcl mcl and lcl. short oblique tear in posterior horn of medial meniscus, short oblique instrasubstance tear of junction of mid and posterior horn of lateral meniscus, grade 2 possible 3 MCL (few visible intact fibers but no significant retraction) marked oedema and expansion of the pcl and acl in keeping with partial thickness tears. (crap annotation i made from the long list)

i got away with no surgery, just rehab work and came back just as strong, no discomforts or anything, had a neoprene hinged brace for about a month when i first got back into it. dad contacted some hell high up orthopedic surgeon guy in england cos he lives there and he said to me they avoid surgery as much as possible, so did my orthopedic surgeon whom i was referred to by ANOTHER orthopedic as being the only trust worthy person in perth for PCL work. his name is Benjamin Hewitt and his practice is near kings park.

so anyway dont worry dude you'll be right, i just suggest going to see Ben with your MRI results (get a referal from a gp) and he will point you int he right direction, he was totally good with me like real friendly and helpful.. i was with dr lim b4 that or something n he was a bit of a ball bag to talk to but recommended hewitt.

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Charl dv said...
. his name is Benjamin Hewitt and his practice is near kings park.

so anyway dont worry dude you'll be right, i just suggest going to see Ben with your MRI results (get a referal from a gp) and he will point you int he right direction, he was totally good with me like real friendly and helpful.

Totally agree with charl. I have used the services of Ben in the past he is a (ex?) windsurfer and great bloke.
If he can fix it he will if he cant he knows someone who will.

that brace in the link above is pretty much what you want for an MCL injury. However i would go to a physio and get them to measure you up (to get the right size) and order one from AusMedic or SportsMed, they usually come in at less than a hundred bucks - last one i ordered was $78 or so.

Awesome - I already saw Ben on Mondee (co-inkydinks!) and got an MRI report last night - very similar to Charlie's - grade1-2 tear on MCL, possible slight tear to the moniscus and large oedeama. PCL and ACL are fine (phew!).

Ben is good awright. Am seeing him again on Fridee so will know what to do after that. Glad to hear slice n dice is unlikely. Pity I haven't cycled or swum this winter as I will be needing to do more work to get back i guess. Bloody happy it's not December at the mo and will be chuffed to get back on a board in 6 weeks (hopefully less) or so.

Slacko has suggested joining a gym. I loathe gyms but gotta do what i gotta do. Was thinking maybe a home gym but exxy (and cr@p?). Anybody know a good (but in-exxy) gym around the city? I work in East Perf and take the squids to Beatty Park every other weekend but live around Churchlands.

Ta for the links to the knee braces. Would be keen for any other suggestions on braces also? The cheapies are probably worth skipping but some of the recomended ones are around $140, so that isn't too tuff. I would assume neoprene ones are fine for salt water but haven't found anything specifically yet?

Bloody sore today (gone down hill a bit this week) and will finally be taking a day off work tomoz as have been too busy to so far - not they they give a stuff about my work ethics .

Once again - many thanks fellas (and fellettes in case I mnissed a feminine opine) good to know the SB crew are handy and helpful at such times.



Rawk orn fellas (and watch out for the knee-braced gumby around late Nov!)

If the meniscus is badly torn then you should consider an arthroscope to clean it out, but if it's not clear on the scan then leave it and wait. lucky your MCL isn't ruptured, it should heal up reasonably well if you rehab it well. usually what i do with these is tape the knee into varus (force it into a slightly bow-legged position) which allows the MCL to be unloaded for 4-5 days and the collagen that is laid down as the healing progresses is then nice and tight - the ligament heals without too much laxity. Ask your physio if he's going to tape it, it will help a bucketload if he does it the right way.

Cheers

yep i was told the same about the meniscus^ he said it didnt look like it was displaced or anything so leave it and if it stayed uncomfortable come back and have another look. but even with that its only 6 weeks off i think...

i feel the same about the gym i hate going there but i just grabbed 2 months membership and pumped it out at the gym to make sure im good to ride when i could. great idea is asking your physio for a copy of a good gym routine to help you out.

just get a pair of crutches if you havn't already, good to keep the pressure off for first couple weeks and hit the anti inflams haha i ate that sheit like candy..

i just used a standard neoprene brace, just rinse out the hinges after ur sesh so they dont build up with crap and seize, neoprene holds up fine in salt water provided you let it dry.

Tops advice.

Alas I have not been kind to myself and have been on it (er.. my knee that is) constantly.

Neil are you an ortho dude? Great advice - will book a physio for tomoz/fri and ask for what you described.

Final question (ha ha - hopefully) are any of the knee braces ok to sleep in I seem to do a bit of jogging or sumpin in my sleep as I have woken in poor state and increased pain - especially the last few days.

EDIT: Oh Neil i forgot to whack in the MRI results exactly but will try to do so on Fridee. Mate - it is super cool to get an informed opinion here. Your rates are very reasonable too!

i'm a sports physio mate, i saw three knees just like yours in the last 2 weeks


the brace won't help whilst you are sleeping. it's designed to stop you injuring the MCL even more by resisting lateral displacement/angulation of the joint. The reason it's hurting more in the morning is that the inflammation around the joint proliferates while you sleep, and lack of movement means your vascular and lymphatic systems aren't draining it away as quickly. The only thing you can do there is take some anti-inflams and wait for it to settle. you can either get some prescription ones from the doctor or just duck into the chemist and ask for some voltaren 25mg tablets - these seem to be plenty strong enough for most people.

Yo Neill,

Unfortunately i have an intolerance to salycilates (naturally occuring asprins essentially) and had a backlash (joint swelling, majot itchiness etc) a week before this due to taking too much ibuprofen and voltaren (voltaren 50mg is the biz tho). I have had to avoid anit-inflams and savoury (curries with the combo of spices are my fav but the worst by far for this) foods like the plague for a while to get back below the 'threshold'. Bloody awkward timing but i have been good for a fortnight now so will give the volt another jolt.

Great to know the casue tho.

Is there any chance you could PM me a link to the knee brace you recomend? I have been looking but find a $40 - $300 variance. Sumpin around $80 would be sweet.

umm i used to sleep with injured leg on top slightly infront and put a pillow underneath, does wonders for the pain.. couldnt sleep some nights until i figured that one out... lol

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Charl dv said...

umm i used to sleep with injured leg on top slightly infront and put a pillow underneath, does wonders for the pain.. couldnt sleep some nights until i figured that one out... lol

Hah, experienced exactly that. Often woke with pain when lying on my side, muscles relaxed and placing lateral pressure on the knee.

Get on the bike as much as possible. I have been (but not as much as I should) and it has done wonders.

For those in the know, I was recommended to avoid walking up hills or stairs (when I was able to walk comfortably again) during rehab, any reason for that?

Cheers

righto Funkster since slack is still getting into you at every opportunity
the missus tore her medial lig soem time ago an dwe have one flash looking knee brace which supportsthe knee and only allows you bend so far ( adjustable 0 to 90)
you will look like a real gimp wearing it , but it will get you back onthe water i think
let me know if you want to try it out

Hey Charle dv

I am a GP but also I am a part time operating assistant for the oft mentioned Benjamin Hewitt, who specialises in knee reconstructive surgery.

The amount of posts on the subject points to just how common knee injuries have become amongst kitesurfers. If the ACL or PCL have ruptured self repair will not occur and a good reconstruction [hopefully first time] is essential to your future continuation of the sport.

A couple of points:

your MRI report states 'high grade partial thickness of acl pcl mcl and lcl. short oblique tear in posterior horn of medial meniscus, short oblique instrasubstance tear of junction of mid and posterior horn of lateral meniscus, grade 2 possible 3 MCL (few visible intact fibers but no significant retraction) marked oedema and expansion of the pcl and acl in keeping with partial thickness tears'.

This means major disruption of virtually every structure in your knee!

Now i dont fully trust MRIs as they are just pictures and pictures can fool you. Unfortunately I dont think your 'out of the woods' yet and delaying proper diagnosis will ultimately delay your full recovery.

There is no substitute for physically testing the stability of the structures.

I know that quite often Ben Hewitt picks up ACL tears clinically that have not been reported by the MRI. This is because the torn end of the ligament will drift back into its normal anchor point and looks OK but unfortunately although it looks OK it will not repair and has no strength. The report suggests just that has occurred.

My advice [and this is not advertising]would be to get a referral to him anyway from your sports physician or GP and get him to look the at the MRI and examine your knee. I think he will suggest an arthroscopy [look inside] at the very least

On another point apart from being one of the few doing PCL reconstructions in Perth, Ben has been quitely doing LARS [synthetic ligament augmentation] knee reconstructions for in Perth for a few years now and has done more than anyone in Australia I think, including lots of SAS soldiers and AFL guys [where time off is money]. This is a more technically complex operation than the standard knee reconstruction [but costs the patient no more]. It involves sleeving the reconstruction with high tensile dyneema type stuff. and it offers athletes rapid recovery. The repair is bomb proof within weeks instead of the nine months it usually takes. That means early mobilisation and back on the water this season not next. Not everyone is suitable [and you may not be if your PCL requires repair too], but if you are seeing him, you should ask him.

If I blew my ACL that would be the operation I would have him do on me because being told not to kite for 9 months would nearly kill me.

Good Luck

Once again - awesome input folks. Great points Niall etc.

Tried a towel but a pillow might well be the G.O. fellas. Ha ha - packed wifey orf to Bali yestredee so there is more room to 'customise my sleeping posi' More doona too. Also took the day off yesterdee (breathing space at the salt mines at last) and put my feet up after scoffing some 50mg Voltaren (finally able to get some into me - salycilate intolerance is painful and awkward). Sweet relief. Feel 100% better today but still being cautious.

Got the post-MRI follow up with BH after lunch toady so feeling optimistic.


Hey BTW Niall - you will obviously befar wiser on this - I thought the synthetic ligamanet replacement was the GO for AFL etc as it meant immediated results but that down the track (a decade or thereabouts) it needs to be replaced - unlike the slower recovery of the real ligament? Any ideas? BTW -not relevent to me I think (but hey I am a nerd and curious too).

Wayy chuffed with responses here folks.

Ian

have you got the results of the MR yet mate? type the report in here when you do.

In brief:

I had a follow (post MRI) appointment with my ortho this arvo.

These things can only be completely certain from invasive investigation but as far as the pics show there is a grade 2 tear on the medial ligament (looked very swollen and 'frothy/wiry' on the pic) and a slight tear/rip on the moniscus.

His only concern is potential for the slight damage on my moniscus to be a problem but believes it unlikely and will wait to hear from me if any agitation occurs/continues.

So i got a great result really. He recomended 6-8 weeks off the water but the possibility of less is there if the knee improves rapidly.

I finally bit the bullet (ha ha - literally) and scoffed some 50mg voltaren yesterdee. Man - that is better!! I almost feel like I could kite in a couple of days.

Am hoping to see a physio and get fitted for a brace on the weekend then lots of water resitance, some light cycling and a gradual ramp up to get back on the water asap.

The ortho was happy for me to go for the lighter/cheaper end of the brace spectrum (had a print out of a dozen or so braces from one supplier ranging from around $70 - $200) as long as it is braced and impeded medial movement.

Interestingly he didn't think it neccesary to go for gym work etc, just light (to start with) cycling, water resistance etc. Might go the gym junkie avenue for future prevention (and a bit of buffo for the ladies too) though.

Awesome outcome so far.

Tres happy.

Just wish i had been a bit less fick in he 1st place.

Yes Get Funky

you are completely right about entirely synthetic grafts in knee reconstruction, they always fail eventually and are no longer used, but the LARS knee reconstruction is a new procedure standing for 'ligament augment'.

Essentally Hamstring or patellar tendon grafts are harvested and placed in the normal fashion but augmented by a sleeve of a high tensile synthetic material that just gives it immediate strength and does not interfere with the normal assimilation of the graft into the bone, and actually forms only a small part of the graft.

As a caveat it is not known whether this may increase the risk of failure a long way down the track as the 'LARS' has only been out a few years, but results thus far are really good with a zero failure rate [at least as regards graft rupture] in BHs's hands to my knowledge

^^ Interesting. I'd probably be exploring that option if in that situation. Seems like a bit from column A and a bit from column B.

Amazing what is out there thses days.

Feel sorry for the (long term) strain on sports people's bods though.

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niall barrett said...

Hey Charle dv

I am a GP but also I am a part time operating assistant for the oft mentioned Benjamin Hewitt, who specialises in knee reconstructive surgery.

The amount of posts on the subject points to just how common knee injuries have become amongst kitesurfers. If the ACL or PCL have ruptured self repair will not occur and a good reconstruction [hopefully first time] is essential to your future continuation of the sport.

A couple of points:

your MRI report states 'high grade partial thickness of acl pcl mcl and lcl. short oblique tear in posterior horn of medial meniscus, short oblique instrasubstance tear of junction of mid and posterior horn of lateral meniscus, grade 2 possible 3 MCL (few visible intact fibers but no significant retraction) marked oedema and expansion of the pcl and acl in keeping with partial thickness tears'.

This means major disruption of virtually every structure in your knee!

Now i dont fully trust MRIs as they are just pictures and pictures can fool you. Unfortunately I dont think your 'out of the woods' yet and delaying proper diagnosis will ultimately delay your full recovery.

There is no substitute for physically testing the stability of the structures.

I know that quite often Ben Hewitt picks up ACL tears clinically that have not been reported by the MRI. This is because the torn end of the ligament will drift back into its normal anchor point and looks OK but unfortunately although it looks OK it will not repair and has no strength. The report suggests just that has occurred.

My advice [and this is not advertising]would be to get a referral to him anyway from your sports physician or GP and get him to look the at the MRI and examine your knee. I think he will suggest an arthroscopy [look inside] at the very least

On another point apart from being one of the few doing PCL reconstructions in Perth, Ben has been quitely doing LARS [synthetic ligament augmentation] knee reconstructions for in Perth for a few years now and has done more than anyone in Australia I think, including lots of SAS soldiers and AFL guys [where time off is money]. This is a more technically complex operation than the standard knee reconstruction [but costs the patient no more]. It involves sleeving the reconstruction with high tensile dyneema type stuff. and it offers athletes rapid recovery. The repair is bomb proof within weeks instead of the nine months it usually takes. That means early mobilisation and back on the water this season not next. Not everyone is suitable [and you may not be if your PCL requires repair too], but if you are seeing him, you should ask him.

If I blew my ACL that would be the operation I would have him do on me because being told not to kite for 9 months would nearly kill me.

Good Luck

thanks but dont think u quite followed what i said

I saw ben about 3 or 4 times and he was the one who gave me the all clear... i also saw my physio Adam about once a week for a month n half and he also gave me the good to go...

ben was also the one who said leave it and if i get pains in the joint id get a arthroscopy clean up thingo for the meniscus'

Hey Guys,

What specific exercises are recommended to strengthen the knees for kitesurfing?

My right knee tends to feel like it wants to turn inside out at the tail end of a session - especially after my botched, hard landings & pinaroo chop! Any suggestions for exercise to keep the knees strong?


Thanks.