Knee Injuries: Recovery, Rehabilitation, and MRI Limitations

Knee injury

Hello, doctor.
I have a few questions.
About a month ago, I fell while playing basketball and landed on the inner side of my knee.
Since then, I have had difficulty fully extending and bending my knee, feeling somewhat limited in range of motion.
During this time, I have seen several doctors who have suggested various diagnoses, ranging from a bruise to a ligament strain (since my knee was bent inward during the fall) to a meniscus tear.
However, a few days ago, the MRI results showed everything to be normal, and I was advised to start rehabilitation.

I would like to ask if the knee joint can become completely unable to extend due to prolonged inability to straighten it? Could there be other issues that the MRI might not have detected? Is there a need for further detailed examination? Given my current condition, could rehabilitation potentially worsen the injury? Thank you for your assistance.

A-Ling, 10~19 year old female. Ask Date: 2016/04/10

Dr. Hong Ximing reply Orthopedics

Injury to the inner side of the knee for one month, with normal MRI results, is fortunate as it indicates no permanent damage.
Four weeks is clearly insufficient for recovery; therefore, light rehabilitation exercises should be initiated, along with the use of a brace for protection.
Continued follow-up consultations with the attending physician are also recommended.

Reply Date: 2016/04/10

More Info

Knee injuries can be complex and often lead to a variety of symptoms and complications. Based on your description, it sounds like you have experienced a significant injury to your knee, and the MRI results indicate that there are no major structural damages such as ligament tears or meniscal injuries. However, you are still experiencing limitations in your knee's range of motion, which is a common issue following knee injuries.

Understanding Knee Injuries and MRI Limitations
1. MRI Limitations: While MRI is a powerful imaging tool that can provide detailed images of soft tissues, ligaments, and cartilage, it is not infallible. There are certain conditions that may not be visible on an MRI, such as subtle cartilage damage, micro-tears, or certain types of inflammation. Additionally, if there is significant swelling or fluid in the joint, it may obscure the view of some structures. In your case, the MRI results showing "normal" findings suggest that there are no major tears or ruptures, but it does not completely rule out minor injuries or conditions that could be contributing to your symptoms.

2. Knee Joint Stiffness: Prolonged immobility or limited range of motion can lead to stiffness in the knee joint. This stiffness can be due to a variety of factors, including muscle tightness, joint effusion (fluid accumulation), or even scar tissue formation from the injury. If the knee is not fully extended or flexed for an extended period, it can lead to a condition known as "arthrofibrosis," where the joint becomes stiff and difficult to move.

3. Rehabilitation Concerns: Starting rehabilitation is crucial for recovery. However, it is essential to approach it cautiously, especially if you are experiencing pain or significant limitations in motion. A well-structured rehabilitation program should focus on gradually improving range of motion, strength, and stability without exacerbating the injury. It is advisable to work with a physical therapist who can tailor a program to your specific needs and monitor your progress.

4. Further Evaluation: If your symptoms persist despite rehabilitation, or if you have concerns about your knee's functionality, it may be worthwhile to seek further evaluation. This could include additional imaging studies, such as an ultrasound, which can provide real-time images of the knee structures and may reveal issues that an MRI might miss. A thorough clinical examination by an orthopedic specialist can also help identify any underlying problems.

5. Recovery Timeline: Recovery from knee injuries varies widely depending on the severity of the injury, the individual's overall health, and adherence to rehabilitation protocols. Generally, with appropriate rehabilitation, many patients can expect to see significant improvements within a few weeks to months. However, complete recovery may take longer, especially if there are underlying issues that need to be addressed.

6. Self-Care and Home Exercises: While professional rehabilitation is important, you can also engage in self-care practices at home. Gentle stretching and strengthening exercises can help maintain flexibility and muscle strength. However, it is crucial to avoid any activities that cause pain or discomfort. Always consult with your physical therapist or healthcare provider before starting any new exercise regimen.

Conclusion
In summary, while your MRI results are reassuring, it is essential to address your ongoing symptoms through a structured rehabilitation program. Pay attention to your body's signals, and do not hesitate to seek further evaluation if your condition does not improve. With the right approach, you can regain function and mobility in your knee, allowing you to return to your regular activities. Remember, recovery is a process, and patience is key.

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