Injury Log Part I – Conservative Treatment

It was a beautiful winter day. And by beautiful I mean it was snowing – something you most appreciate when you’re a skier hungry for some white powder. We were in Poiana Brasov, going down Lamba Valley. The entry point for the valley is just below the Capra Neagra cable car station. Just keep right as you’re descending. The snow was pretty good, we had a lot of trees to ski between and later on a narrow little canyon to spice things up.

All was good until my right ski tip got caught in a snow crust and twisted my knee. Things happened very fast, although that instant seemed to stretch as my tibia and femur scraped on each other. Probably better reflexes and/or stronger muscles would have been able to protect me, as the binding was set to a meager 6 DIN.

For the first 10 minutes I just sat there, waiting for the pain to fade away. I eventually had to get up, climb to the cable car and get down on the other side of the mountain, to Poiana Brasov. Ascending on my right knee was painful, but there was no way avoiding it. Descending was surprisingly easy and I got to the car without any more incidents.

In case anybody is curious, my symptoms were:
– pain inside the knee and at the top of my tibia
– inability to completely flex the knee due to pain
– inability to completely extend the knee due to locking

I must mention I was having small problems before this knee twister. After the January 1st race and a ton of downhill stairs running with improper form, I was left with:
– crunching noise when squatting all the way
– the feeling that my kneecap would scrape my femur when climbing
– small inflammation

First thing first – I got an MRI. Here it is:

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Looking over it, you can clearly see the muscles and the bones. That’s pretty much where my expertise ends. Took the MRI to 4 orthopedic surgeons and got 4 different diagnoses + treatment plans:
– meniscus tear and tibial edema -> arthroscopic surgery to suture/trim the meniscus
– meniscus tear and a small tibial fracture -> wait a little to have the fracture heal and then come again to see if pain is still there
– meniscus tear, small tibial fracture and partially torn anterior cruciate ligament -> arthroscopic surgery to suture/trim the meniscus and to rebuild the ACL
– meniscus tear and tibial edema -> do some physical therapy and come back after a while to see if the pain is still there

I went with this last option. It seemed reasonable and the doctor recommending it has a lot of experience working with athletes. I did physical therapy for over one month, in total around 25 sessions. At the beginning they were pretty gentle, something around one hour of leg exercises with ankle weights. They however built up to over two hours each, involving warming up, strength, balance, cardio and stretching. I had to eat over 3000 kcal daily just to keep up.

Coming after a month long break, I started physical therapy with some signs of atrophy in my right leg quadriceps. But my muscles started feeling better. I was able to walk and bike normally, but the pain was still there. I could still feel it inside my knee and I was limited to steady and controlled movement. Anything fast was out of the question for my right knee. The doc also looked carefully at my kneecap again and discovered he could trigger pain just by pressing on it. So he scheduled me for surgery.

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