Ankle fracture recovery and now knee injury

[atpands]

Hello, at the end of January 2013, I suffered a trimalleolar fracture dislocation with syndesmosis tear of my left ankle. I subsequently had ORIF and syndesmosis repair surgery that I am still recovering from. Recently, I started weight-bearing. My knee felt unstable every time I tried to put weight on it and the repaired ankle. I mentioned this to my doctor as well as the PT. The PT decided to do knee tests when I refused to complete certain exercises due to instability. She noted that it was very unstable and that I needed to make an appointment with my doctor. Saw the doctor and her reaction to the knee laxity was not encouraging. She ordered an MRI which I am waiting to have done. In the mean time, my PT prescription has changed as a result. I did have ACL reconstruction using allograft surgery on my left knee in 2001 as well as lateral and medial meniscus repair. All of this was revealed to both the doctor and PT both verbally and on the entrance paperwork. So my question is how am I supposed to recover from an ankle injury if there is an accompanying knee injury. Why was this never checked?? I understand that two surgeries at one time cannot be done, but it is just now being explored because of the instability. Also, my PT has changed so I may have been hurting my knee since the weight-bearing. Also, I was told to stop wearing the ankle boot as it will cause pain. But I have been on it for 8 weeks. It has already caused pain and probably done more damage. I am very frustrated by this and the doctor just blows off by saying "that's a bummer!" Is it standard protocol to investigate any accompanying injuries. Shouldn't the knee have been tested prior to weight-bearing and surgery? There is obviously a different pattern of recovery followed if there is a knee injury as well. Any input is greatly appreciated.

[atpands]

Okay, MRI results are acl is torn/missing. Exact words are no acl visualized. Just as I had feared. Surgery is recommended.

[atpands]

Thanks Dr Kaul. I am going to see the Dr who did the original ACL reconstruction to get a second opinion on the MRI results. I will see the Dr who performed the ankle surgery to discuss MRI results as well. Both will happen next week. My PT has changed completely. All ankle exercises are done with knee instability in mind, mostly using pilates methods. I will update as soon as I get the results and Dr opinions. Thanks for the quick reply. It is truly appreciated.

[S. Kaul, MD]

Hi there!

Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation; though I would agree that if a complete history was provided to the hospital/ doctor, it is essential to do atleast a physical examination to check knee stability before designing a protocol and it would be a direct/ vicarious responsibility of the treating doctor. Well, what is past cannot be undone. In the current situation, ankle physiotherapy directed while bypassing the knee in non-weight bearing position would be advisable before we have a word on the knee stability. I would suggest discussing the situation and the suggested management plan in detail with the treating orthopedician and the physiotherapist.
Hope this is helpful.

Take care!