Lateral Knee Pain

Conclusion

 

This website has grown in length and complexity, way beyond my expectations, therefore I also need to break down the resulting conclusions.

 

With regard to my injury

 

It is my opinion that there was not only a radial tear of the lateral meniscus, but there are also 'mimickers' of a lateral meniscus tear. Or rather... an anterolateral dislocation of the proximal tibiofibular joint that, by its dislocation, has very likely resulted in subluxation of the biceps femoris tendon, the popliteus tendon via the popliteofibular ligament, and has also produced peroneal nerve compression, along with ankle pain...

 

What about extensor digitorum longus / brevis...???

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With regard to other things

 

Definitions: acute, chronic, degenerative and trauma

 

'Acute' has a simple definition... it has just happened as with cases of trauma like a car acident. Some suggest acute refers to within 3 weeks of the injury.

 

'Chronic' has a simple definition... it is a longstanding condition. However, before a condition becomes chronic, there must have been a point at which it was acute. It is important to recognise this fact otherwise the definition of 'chronic' would be that of 'degenerative'. Therefore a chronic condition may be the result of either:

• degeneration,

• trauma.

 

'Degenerative' has a simple definition... it is a result of natural 'wear and tear' on the body, or ageing. We wear out over time!

 

'Trauma' has a simple defintion... it involves an acute event, and has two aspects with regard to lateral knee pain:

• external influences, such as a car acident, or being kicked at the site of pain,

• internal influences, whereby forces within the leg, or body, are acting, perhaps, in unexpected ways because of some abnormal body movement and/or condition.

 

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Local hospital referrals

 

London hospitals should be very wary of referrals from local hospitals when years of time have elapsed since the injury. In my case, after 7 years I changed to a different NHS Trust and GP surgery, and a new GP wrote a minimal letter based on one from a local consultant, mentioning nothing but a lateral meniscus tearthat was seen on an MRI scan, and that a letter was attached. However, for whatever reason, the letter was not attached. And, coincidentally, I was offered, and took, a short notice cancellation appointment for the arthroscopy. Perhaps things happened quicker than normal... but in my opinion, it should have been most important to allow me to start the history at the beginning. Clearly, as it had taken about 7 years for my local hospital to determine a diagnosis based on an MRI scan, that diagnosis must be treated with scepticism, especially when the injury was in such a complex area of the body as the lateral side of the knee.

 

This raises a few separate issues:

Minimal documentation regarding the injury,

Length of time since injury,

Patients cannot easily get a copy of GP letters.

 

 

 

Start with the history

 

It seems to me that there is good evidence for starting all consultations with the history of an injury as is suggested in all articles involving ortheopedic trauma that I have come across. The longer the problem remains undiagnosed, the more difficult it will be to accurately determine. With the passing of time, any repair, whether surgical or theraputic, will be more difficult to perform as some confounding influences may be found such as:

 

• my good, left leg is very adept at covering up and doing the work of its failing companion,

• muscles, that were not weak at the time of the injury, may become weak due to lack of correct usage over time, and thereby may become confounding factors in diagnosis, and treatment,

• the lateral corner of the knee, and its biomechanics, are very complex, with some muscles / tendons / ligaments having dual aspects to their functionality,

• some diagnostic symptoms may be relevent to more than one problem, thereby hiding the potential cause of the problem,

• etc.

 

And, apart from the pain and discomfort to the patient, this wastes NHS resouces, not only money, but also time that could be allocated to the treatment of other patients who are also in pain...

 

 

 

Doctors can't know everything

 

Doctors, like all other people, cannot know everything! The important point to make here is that those who come across something that they are not sure about, should immediately seek advice, either by researching the problem themselves online, or by asking a more senior colleague in their establishment or elsewhere... or both. This may particularly be relevant to medical staff at local hospitals who might not get exposed to such a wide range of problems.

 

This behaviour happens regularly in the business environment / private sector, and I see no reason why it shouldn't be deemed necessary within medicine and the NHS. Of course it takes time to do research, but, unlike business where money is the be-all and end-all, within medicine and the NHS the instrument of measure is in human life...

 

So what can be done to help? I am 'winging' it here because I have only just thought so deeply into the problem. Clearly our doctors need to spend more time with patients... not sat in front of a PC screen... so it seems to me that they need a database with quick and accurate facts for comparison, perhaps using tags... or is this already available...???