Knee Pain After Tibia and Fibula Fracture Surgery: What to Do?

After undergoing intramedullary nailing surgery for tibia and fibula fractures, there is a tearing sensation when applying force to the knee?

Hello Doctor: I suffered a tibia and fibula fracture in my right lower leg due to a car accident.
On May 9, 2016, I underwent intramedullary nailing surgery, which involved a large incision above the knee to insert a rod, and there are surgical wounds with screws on both the inner and outer sides of my lower leg.
My rehabilitation has been relatively good; I can walk with support, but I am still unable to fully bear weight.
This morning, when I attempted to stand up from bed, I suddenly exerted too much force, and I felt a tearing sensation in my knee, as if the ligaments were being pulled apart.
Previously, I had progressed to the point where I could exert force on my knee without pain, but now I am experiencing tearing pain again, and my lower leg feels even weaker.
Could I have injured the ligaments in my knee while exerting myself? Should I schedule a follow-up appointment for evaluation? Thank you, Doctor!

Amber Wu, 20~29 year old female. Ask Date: 2017/06/11

Dr. Hong Ximing reply Orthopedics

The intramedullary nail fixation has been in place for over a year, and the fracture should have healed.
If there is any pain or discomfort, you may return for a follow-up appointment to discuss the removal of the nail with your attending physician.

Reply Date: 2017/06/11

More Info

After undergoing surgery for tibia and fibula fractures, experiencing knee pain can be concerning, especially if it feels like a tearing sensation. Given your history of surgery on May 9, 2016, and your recent experience of sudden pain while trying to stand, there are several factors to consider regarding your current condition.

Firstly, it’s important to understand that after a significant injury and surgical intervention, the body goes through a complex healing process. The pain you are experiencing could be due to several reasons:
1. Muscle Strain: If you suddenly exerted yourself while trying to stand, it’s possible that you strained the muscles or tendons around the knee. This can happen if the muscles have not fully regained their strength or flexibility post-surgery. The knee joint is supported by various muscles and ligaments, and any sudden movement can lead to discomfort or pain.

2. Tendon or Ligament Injury: The sensation of tearing could indicate that you may have overstretched or injured a tendon or ligament in the knee. This is particularly relevant if you have been engaging in activities that your body is not yet ready for, especially after a significant injury.

3. Scar Tissue Formation: Post-surgical healing often involves the formation of scar tissue. If the scar tissue around the knee joint is tight or adherent, it can restrict movement and cause pain when you attempt to exert force on the knee.

4. Knee Joint Instability: If the knee joint feels unstable or if there is a sensation of giving way, it could be a sign that the ligaments have not fully healed or that there is an issue with the surgical repair. This could lead to increased pain and difficulty in bearing weight.

5. Re-injury: If you have resumed activities too quickly or without adequate support, there is a risk of re-injuring the knee or the surrounding structures.
Given these possibilities, it is advisable to take the following steps:
- Rest and Ice: Immediately after experiencing pain, it is crucial to rest the knee and apply ice to reduce swelling and inflammation. Avoid putting weight on the affected leg until you can assess the situation further.

- Consult Your Surgeon: It is essential to return to your orthopedic surgeon or healthcare provider for an evaluation. They may recommend imaging studies, such as an X-ray or MRI, to assess for any new injuries or complications related to your previous surgery.

- Physical Therapy: If you are not already engaged in a structured rehabilitation program, consider consulting a physical therapist. They can help you strengthen the muscles around the knee, improve flexibility, and ensure that you are using proper techniques during rehabilitation.

- Gradual Progression: When you do return to weight-bearing activities, ensure that you are progressing gradually. Use assistive devices like crutches or a walker if necessary, and avoid sudden movements that could strain the knee.

- Pain Management: Discuss pain management options with your healthcare provider. They may recommend medications or other therapies to help manage your discomfort.

In summary, while it is possible that you may have strained a muscle or injured a tendon or ligament, it is crucial to seek professional medical advice to accurately diagnose the issue and receive appropriate treatment. Your recovery from surgery is a process that requires careful attention to your body’s signals, and addressing any new pain promptly can help prevent further complications.

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