Diary of a Banjaxed Knee - diagnosis

Following on from above

18th?October: Trip to Accident & Emergency at Stockport

I’d been told at Blackpool that if I just rang up and explained the situation I’d be able to bypass Accident and Emergency, have x rays and get a referral to an orthopaedic surgeon at my local hospital. I did call but was told that because Stepping Hill hadn’t seen me I’d need to start over and sit in A&E, which was frustrating given we were still mid pandemic AND I’d already sat in an A&E exposed to goodness knows whatever for several hours.

Anyone that’s sat in A&E for any period of time will know why I think that the chairs are blatantly designed to deter people and are very uncomfortable at the best of times. I was sat in a full length knee brace which was supposed to be elevated – the chairs had immovable arm rests plus Perspex screen separators because the pandemic was raging on, so there was no option to elevate. The height of the seats combined with the brace and the swelling was putting pressure on me in all the wrong places so I ended up sitting on the floor for a chunk of the four hours I was there.?

Having seen various people and had my x rays I finally got what I needed – the slip of paper to refer me to orthopaedics. Honestly, the senior nurse I saw actually said to me “basically all you’re here for today is this slip of paper. Go and put it in the box over there on your way out”. This was after I’d cried at the pain of him man handling my leg and after I’d had to show him photo proof that my patella had dislocated in order for him to believe me. Frustrating day. Went home and cried. Again. Not for the last time.

Right: Difference in my knees on day three.

Over the next few days the most incredible swelling and colouring came out, not to mention tears multiple times a day as I realised how little I could do, how long I’d be out of hockey, how I am not built for watching TV all day. I couldn’t weight bear at all so I couldn’t get myself a brew or a snack, waiting for Mike to get up if I needed something because I’m still super crap at asking for help and he was working from home. I did click that if I wore hoodies with pockets I could grab a piece of fruit or a snack in a packet and make myself a bottle of juice. Apart from that, the only thing I didn’t need help with was going to the toilet. Thank goodness for small mercies. Washing, however, was a different story – I needed Mike to lift my leg in and out of the bath and keep it straight. It was stressful for both of us - the last thing I wanted was to do more damage and I was very keen to avoid experiencing that pain again.

Getting dressed and undressed was genuinely exhausting even with Mike helping me with socks, trousers and shoes, although the shoe bit was reminiscent of when I put my daughter's shoes on when she was really little - I couldn't wiggle so I was no help at all :D . Getting up the stairs was frightening as two or three steps from the top I’d feel knackered and disoriented, then feel like I was going to fall backwards. Coming down was easy - I could bum shuffle or I could throw my left crutch down the stairs and lean heavily on the bannister. I turned this into a game because *bored* - I'd sail the crutch down the stairs and see if I could make it to the bottom without actually throwing it - the sticky out arm bits were a challenge because they'd stop progress if the caught a step. If I actually threw it, poor Mike thought I'd fallen down the stairs and I was in the bad books more than once. I could only get in the back of the car as my seats didn’t move back enough but I wasn’t really up to being up and about so that wasn’t such a biggie but Mike took me out for lunch a couple of days to get me out of the house. I think my constant crying was getting to him as much as me.?

?I was also very fortunate to have some lovely visitors. My friend and team mate Emma sent me flowers – her partner and daughter were watching the game and her two year old was very worried about “aunt Caz”. Emma then borrowed her partner’s car one day and took me for a really lovely dinner where we people watched and caught up. It was really nice. More team mates came to spend an evening at ours – we just got a take away and talked rubbish for a few hours which was a lovely escape again. I wasn’t ever really in pain unless the brace moved and I pushed my knee back too far. I slept absolutely loads and I’d called work to take some time sick – I wasn’t sure how I’d feel in the first few days but was surprisingly pain free for the most part. If I put my leg down without thinking I was in pain but the first few weeks were pretty painless, just uncomfortable as the leg was held rigidly in place. I sleep on my side in the foetal position so had to learn to sleep on my back which is harder than you'd think.?

After a few days I called work because I was bored – I asked if I could work part time and build up once I knew what appointments and rehab I’d need and they agreed, stressing that I should take as many breaks as I needed and to call if anything changed. Over the next few weeks I was reminded a few times to take it easy and called when I was doing too many hours. It was really appreciated – the laptop kicks out a bunch of heat (I have two at the moment) and I needed to ice my leg for chunks of the day to get some of the swelling down, had loads of physio to do etc. I felt seen and understood. I even got a call from Wolfgang, our CEO, checking in and offering to help if he could.

28th?October: Appointment with consultant, first MRI scan, first physio appointment.

I went into the trauma unit to see the consultant. He was running nearly an hour late which was frustrating and again uncomfortable but by now the swelling had come down considerably and I felt that the brace was more of a danger to me than a help. The lady that had fitted it had cut some of the strapping off the brace, which meant that once the swelling was reducing I couldn’t tie the brace tight enough to keep it in one place. As I was moving about it was shifting but ultimately the plus side was that the swelling was starting to come down and I was more comfortable in the waiting room this time.

The consultant asked me a bunch of questions and again I had to get the photo out to prove that my knee had been dislocated. He was much more gentle in his manipulation than they’d been in A&E and simply said “We’ve got to get that knee moving. I want you to see physio today, change your brace and let’s see if MRI can see you today”. A nurse came out with some pieces of paper and gave me some directions to the various departments I needed to visit. First stop, plaster room – swap the brace to one that allowed my leg to hinge at the knee but prevented any lateral movement.?

I was delighted with my new toy – I figured I could even get in the front of the car with it. I immediately sent my partner and mum videos of my knee bending in the new brace, genuinely starting to think the damage might not be so bad after all. MRI had a free slot so I jumped in the noisy machine for approximately nineteen years, then had to ask the nurse to put my shoe on for me and tie my laces.

It was quite late by this point so I went back to the trauma unit to see if the physio was still around and got called straight in, last patient of the day. The physio wanted to see what I could do in the new brace (not much) and explained that I’d need to continue to wear the brace 24/7 and that rest, ice, elevation was still really important. My early physio exercises were ridiculous. Straighten the leg. Bend the knee. Lift the leg two inches off the floor. When I say the exercises were “ridiculous” I mean I couldn’t do them. I’d gone from deadlifting 95kg to not being able to left my own leg off the ground in the space of 12 days. I could already physically see the muscle wastage. Andrew, my physio, told me that a week of bed rest is reversed by six weeks work in the gym. I’d been almost two weeks and when I went home and measured the difference in my thigh circumference I’d lost 2cm. Meanwhile my knee was 3cm larger in the bad knee.?

?I was determined to fix myself asap so I religiously did all my physio and rehab work, quickly working out hacks to be able to put my shoe on myself, even if I couldn't fasten it for a few more days.

4th?November. Phone consultation with consultant

?The damage to my knee is fairly hefty – I have a history of doing things properly, a perfectionist, if you will. It appears I’ve extended this to my hockey ways now: Scans revealed that split second decision to slap instead of hit the ball left me with an MCL torn off the bone at the bottom and torn at the top, plus a sprained ACL. Where the MCL had come away from bone it had retracted – it was sat higher than it should have been so if it reattached it would likely not attach at the right point. I was told that surgery could only be done if there was a good anchor point at one end of the ligament or the other. Cracking.

The knee joint is made up of three bones – the thigh bone (femur), the shin bone (tibia) and the knee cap (patella). The knee cap sits at the front of the joint providing protection. These bones are connected via four primary ligaments.?

A ligament is a tough, flexible band that holds bone and cartilage together. The MCL, or medial collateral ligament, is the ligament on the inside of the knee and it connects the bottom of the thigh bone the top of the shin bone. It’s job is to stop the knee from moving side to side. You’d be surprised how much you use and need this little elastic band type thing and it’s only really now I’m starting my prehab (preparation for surgery) that I realise how much I’ve taken it for granted previously. The ACL, or the anterior cruciate ligament, prevents the shin bone from sliding in front of the thigh bone and gives stability to be able to rotate the knee.?The x rays I’d had in A&E had revealed a piece of floating bone at the back of the knee but this was not a new injury, likely there for some years and not causing me any problems. The consultant told me to keep working with the physio and he’d see me in a month.

Source of diagram: orthoinfo.aaos.org ?