Knee Sprains: When to Seek Further Evaluation After Injury

After a knee sprain, it is not possible to fully extend or flex the knee?

Hello, Doctor.
Five days ago, I injured myself while playing basketball.
The next day, I went to the hospital for an examination and had an X-ray taken.
Basically, there were no issues with the bones, and there were no small fractures.
The anterior and posterior ligaments were also fine.
Later, the diagnosis stated "unspecified lateral and location knee sprain." I believe it might be an injury to the medial collateral ligament (MCL) since my right knee experienced abnormal force on the outer side during the game.
After four days of rest, I feel that my knee cannot fully extend or flex.
After researching online, I am worried that the meniscus might also be injured (I heard it could be affected), and I'm concerned that it might not have been detected.
Therefore, I would like to ask you a few questions: 1.
Is it possible that the rest period has not been long enough (usually more than two weeks) to cause the swelling to persist, preventing proper extension and flexion? 2.
Could the meniscus actually be damaged, but it just didn't show up on the X-ray? 3.
Is there an urgent need to get an MRI right away? Thank you, Doctor.

Da Ren, 20~29 year old female. Ask Date: 2016/06/04

Dr. Chen Yongxue reply Orthopedics

X-rays cannot visualize ligaments or menisci.
Both of these structures can swell significantly during the acute phase of an injury, which may lead to distortion in physical examination findings.
Magnetic resonance imaging (MRI) is typically performed around two weeks post-injury when the swelling has subsided, as this timing reduces interference with the imaging results.
Thank you.

Reply Date: 2016/06/04

More Info

When it comes to knee injuries, particularly those sustained during sports activities like basketball, understanding the nature of the injury and when to seek further evaluation is crucial for proper recovery. Based on your description, it seems you have experienced a knee sprain, potentially involving the medial collateral ligament (MCL), given the mechanism of injury you described. Let’s address your concerns one by one.

1. Rest Duration and Swelling: It is common for knee sprains to take time to heal, and while rest is essential, the duration can vary depending on the severity of the injury. Typically, mild to moderate sprains may require at least 1-2 weeks of rest, ice, compression, and elevation (RICE protocol). If you are still experiencing swelling and difficulty fully extending or bending your knee after four days, it may indicate that the injury is more significant than initially assessed. Swelling can persist due to inflammation, which is a natural response to injury. If the swelling does not subside with conservative management, it may be a sign that further evaluation is necessary.

2. Meniscus Injury: You expressed concern about a possible meniscus injury. While X-rays are excellent for visualizing bone injuries, they do not show soft tissue structures like ligaments and cartilage. A meniscus tear can indeed be missed on X-ray, especially if there are no associated bone fragments. Symptoms of a meniscus injury often include pain, swelling, and a sensation of locking or instability in the knee. If you suspect a meniscus injury, it is advisable to follow up with an MRI, which provides detailed images of soft tissues and can confirm or rule out such injuries.

3. Urgency of MRI: Whether you need an MRI urgently depends on your symptoms. If you are experiencing significant pain, swelling, or functional limitations (such as inability to fully extend or flex the knee), it would be prudent to seek further evaluation sooner rather than later. An MRI can help clarify the diagnosis and guide treatment decisions. If a meniscus tear or other significant injury is confirmed, early intervention can prevent further complications and facilitate a more effective rehabilitation process.

In summary, while rest is essential, the persistence of symptoms after a few days warrants further investigation. If you continue to experience swelling and difficulty moving your knee, consider discussing the possibility of an MRI with your healthcare provider. This will help ensure that any potential injuries are accurately diagnosed and appropriately managed, allowing you to return to your sport safely and effectively. Remember, early diagnosis and treatment can significantly impact your recovery and future performance in basketball or any other physical activity.

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