Question
Hi Dr. Andrew Varadi.  I fell right before spirng break(April 2 about), and I fell at gymnastics.  I fell in the middle of two mats, left knee, and then I fell to the left, so the inside of my knee twisted.  I don't know what I did, but it was fine for awhile, but now it hurts to bend past about 110 degrees.  I now can't kneel, or do splits because it hurts so badly.  My coach suggested that it may be tendinitis or arthritis.(sorry if it's spelt wrong).  Do you by chance know what I did, and how I can make it better?

It is on my left knee, directly abovethe patella, and then just to the right.  It is on the inside of my knee.  There was minor swelling when I fell, but a little bit is left.

Thank you so much for your time Doctor.

Hope you can help,
Amelia

Answer
Hello Amelia,

Thank you for your question. I think that you are saying that your whole body weight fell directly onto your knee onto a hard floor.  I do not know how old you are, how much weight fell onto your knee, the condition of your knee before the injury or the angle that you fell at to the left. I do know it has already been a month, that it hurts past 110 degrees and that it hurts to do the splits.
Your coach suggests it may be tendonitis because it is above your knee where the tendon is that holds your knee cap. The coach also suggests that perhaps it may be arthritis. There was some swelling so chances are something holding the knee together got stretched too far or perhaps tore a bit.

Please remember that it is difficult to determine precisely what happened inside of a knee a month ago even if the patient is right in from of the doctor, nevertheless by mail. However, here are some possible ideas. Bruising (bumping) a tendon above your knee cap can hurt quite a while especially if you are walking around or using stairs. Because it hurts "inside your knee", there are also a few simple tests your own practitioner could to make sure you didn't hurt the meniscus (little pillows in your knee) which tears sometimes. This may not be the case, but it never hurts to check for it since it is one of those things that does not go away and may need future care (torn meniscus). It may also be a ligament at the side of the knee which was pulled too hard (collateral ligament sprain) which also takes a while to heal, especially if you are back at the gym. Arthritis just means "joint inflammation" but I suspect your coach means the permanent type (Osteoarthritis or worn out joint) although I don't know your age but suspect you are more young than old. It takes far more than a month to develop Osteoarthritis, so it is probably not that. Sorry about the length of this, so now I'll shorten the rest.

Have your doctor or therapist check for meniscal or inside ligament tears (drawer test, etc.) and for outside ligament sprains (valgus/varus test) and to see if the knee cap was damaged (distraction & grind, crepitus tests). That should rule out more than half of the problems common to injuries like falls. Although it was fine for a while, that 110 degree pain means something may be left over or healing slowly because you may be overusing it. Until you check this out, please do not hide the pain with some treatment and continue working out. Try to get at the remaining problem and learn what to avoid doing until you know what it is. If you have any further questions, please ask. Thanks again for writing.