Lingering problems 12 weeks after an undiagnosed knee injury

Hi all,

The short of it:

I suffered a major knee injury, have no insurance, and have not sought professional care. I've made good progress in my recovery over a 12 week period, but I'm very concerned that there may be cartilage damage or something else necessitating surgery. I'm looking for information, advice, and possibly some sort of diagnostic criteria I can use to figure out what may be wrong and the best way to handle this without bankrupting myself in the process.

Thanks for anything anyone may have to offer.

The long of it:

12 weeks ago I suffered a traumatic knee injury. I was out bouldering and doing some minor free climbing with friends when I lost my grip and the unthinkable happened. I missed the crash pad by inches, and ended up suffering about a 20 foot drop onto hard packed earth.

My instincts were pretty good and I landed on my feet, but falling from that height seldom improves one's health from what I hear.

I had a rather considerable amount of pain in my left knee Meanwhile my right knee and all other joints felt 100% fine. There was no sensation of anything popping, no audible pop, and no obvious laxity. A friend with the group (though not a professional orthopedist) performed some minor manipulations and determined that at the very least no tendons or ligaments had fully torn.

In fact, immediately after the fall I got up and walked over to a mat before lying back with my lower leg elevated while my friend went to bring the car closer. We packed it in and got back to civilization, but idiot that I am I don't have health insurance so I adopted a "wait and see" attitude.

I used crutches for 2 weeks to keep my weight off of it before resorting to walking with a hinged knee brace which I've since stopped using. I believe I'm still seeing steady progress, but the length of time I've been waiting combined with some occasionally acute pain has me really worried.

I recently had a close friend perform the Apley grind test to check for a torn miniscus and felt no pain while she compressed my flexed knee and rotated it several times in both directions. Similarly I have no pain under normal walking conditions or standing on the fully extended leg.

However, while flexing or extending under load I occasionally still feel pain and I definitely feel twinges of pain when taking any impact over a short hop.

The two primary places I tend to feel pain are (1) on the lateral side of me knee just below the joint line and slightly aft (head of the fibula?) and (2) rather deep in the back of the knee also below the joint line.

On rarer occasions (though again, almost always with impact) I also feel pain on the medial side above the joint line slightly forward of the "middle" of my knee. This one honestly has me the most worried since I've heard that MCL injuries are generally associated with cartilage damage.

For its relative position: in terms of length down my leg it's exactly even with the middle of my patella when my knee is fully extended. In terms of radial position (if a cross section of my leg were a clock) it would be about 2:45 if my patella were 12:00 and the medial side of my knee were 3:00. In terms of depth it's very shallow and close to the surface.

Additionally, this knee is likely suffering from altered mechanics at this point due to muscle wasting. I lost over an inch in circumference on my left thigh, though it's still fairly strong.

I'm deeply torn over how to handle the situation.

On the one hand I really want to do everything I can to ensure a full recovery. Climbing is my life, quite literally. Avoiding training has been incredibly hard (made harder by the fact that my entire social circle revolves around it) and I've been incredibly depressed the past 2 months. However, surgery would bankrupt me and put me deep in debt. Even an MRI is only an option if absolutely necessary (it would wipe out my savings and then some).

As you can see, I'm desperately in need of any advice or insight you folks can offer. If I handle this incorrectly, my life is quite literally ruined.

For starters any way I can diagnose what's actually wrong alone or with the help of a friend would be a god send. As I said, we've already used the Apley test to (hopefully) rule out meniscus damage, but I'm not sure that was conclusive. Of course, damage to the articular cartilage would be almost as bad, but I haven't found any way to test for that without an MRI. Finally, advice or insight onto the recovery period for something that doesn't require surgery would be incredibly helpful. For example, is it normal for a bad LCL sprain to take this long to heal?

Thanks so much for any help, advice, or information you guys can offer.