The Mystery of the Locked Knee
Sometimes I fill in as an emergency doctor when we are short staffed in the medical center. This happened a lot in 2020 due to the coronavirus. One Saturday in April a patient was wheeled in with an injured knee.
Dr. Tanaka: Hello, Mr. Johannson. Looking at the admission notes. I see you injured your knee. Can you please tell me what happened.
Mr. Johannson: We were playing doubles tennis this morning. I stopped and pivoted to hit a return shot, and twisted my knee. My knee feels like it is locked, like something is stuck behind my kneecap. I can't move it.
Dr. Tanaka: Do you feel any pain?
Mr. Johannson: A little now, but not too bad. At the time it happened it did hurt a lot.
Dr. Tanaka: By any chance did you hear a pop when it happened? The reason I ask is because if you did, it might indicate a torn ligament.
Mr. Johannson: Well, I heard something, but not sure I would call it a pop. More like a crack.
Dr. Tanaka: Ok, let's do a simple X-RAY to make sure there are no fractures or meniscus tears. At some point we'll do an MRI to see if you have any ligament damage, but because your knee is swollen now we'll wait until the swelling subsides. I will refer you to a sports injury specialist, who will take over your care after you leave here today. I'll also send a note to your primary doctor.
Mr. Johannson: Thanks doctor. Do you think I'll need surgery? This is really scary if it is my ACL.
Dr. Tanaka: Well, I'm not sure yet. Let's see the X-RAYS first and take it from there.
The X-RAY results came back within the hour.
Dr. Tanaka: So, it looks like you have some meniscus damage, but no bone fracture. We still don't know about whether there is ligament damage, so I am going to give you a brace to wear around your knee until you see a specialist. It will keep the knee immobilized and hopefully prevent any further damage. In the end, you'll need surgery to minimally clean up the meniscus tear, and depending on the MRI, um, well, let's just wait on that part.
Mr. Johannson: How long will the swelling take to go down?
Dr. Tanaka: At least a few days. When you get home apply some icepacks to the area. That will help. I'll prescribe Tylenol with Codeine for the pain.
An MRI was scheduled for the following week. The results were good. No ligament damage was found. A surgery date was set, and eventually Mr. Jenkins had arthroscopic knee surgery to repair the meniscus tear. Two weeks after surgery he began physical therapy. Three months later he was back on the tennis court!
Flash Card Drill
- Although he was prescribed Tylenol with Codeine for his pain, he declined to take it. Instead, he drank whisky to relieve his pain!
- I took Tylenol to relieve my pain, despite the fact that it has some serious effects with long term use.
- Jane had arthroscopic knee surgery to repair her knee following her bicycle accident.
- His right kneecap is misaligned because of a weak muscle.
- He wore a brace on his neck to keep it immobilized for weeks after the car accident.
- I had both knees scoped after the football season to repair torn meniscus.
- In the final game of the season, Jack Peters suffered significant ligament injuries to his elbow and forearm.
- It took Jack Peters a full nine months to recover from his ACL injury. We all wonder if he will ever be the same player he was before this serious injury.
- I had an MRI on my knee a few days after I fell down the stairs.
