KNEEtalk

The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: kneeProblem on January 18, 2015, 08:43:05 PM

Title: TORN ACL or NOT?
Post by: kneeProblem on January 18, 2015, 08:43:05 PM
To start off, I've had two previous knee acl reconstructions on my left knee and lateral meniscus already removed in the left knee.  First acl recon was with the patella tendon from same knee and then a cadaver.  About 2.5 years ago I hurt the knee again playing soccer, where I felt a pop but can't remember if it actually gave out or not.  I never got it taken care because my knee always felt stable and I was busy with other things in my life.  Now with the whole Obamacare insurance ending when you turn age 26, im having my knee looked at again by the doctors to see what actually happened 2.5 years ago during my knee incident. 

I have gotten an MRI and it shows the ACL is INTACT and there's a small tear with the medial meniscus.  The weird thing is, from an evaluation standpoint, my doctor said my acl felt loose to him and that it might be 'stretched' or partially torn.  My knee has never given out or anything and have multiple times where I slipped hard with my bad knee and knee didnt give out, one time was on mud going up a hill and the second time recently on ice unexpectedly where my knee should've given out if my acl was torn, no?  That's what worries me about this whole thing, these were all 'unexpected' slips so my musclles were not activated and my knee still did not give out?  I also played a basketball game where it never gave out, but did feel a possible sensation of it giving out when jumping up very quickly but could've just been because of the meniscus.  I really believe all I have is a meniscus tear. 

Anyone else have a similar experience?  I really hope my acl is not torn.  Me and my doctor have an arthroscopic surgery scheduled to see what's actually torn or not, but I'm thinking of not going through with it just yet.

Are there any self tests I can do to see if my ACL is indeed there.  I'm willing to risk my knee giving out to see if its torn
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 18, 2015, 09:16:22 PM
There is no 100% sure method. Imaging such as MRI can be tricky and manual testing depends a lot on interpretation and "experience"...

Also note that if you had your entire lateral meniscus removed there is some extra space there confusing the mechanics of the whole thing...

I am not sure if I understood. It seems that you don't really have any bad symptoms, only a medical opinion who says maybe and wants to do an exploratory surgery to check out, is that it?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 18, 2015, 09:36:18 PM
Yes he is not sure but said that it felt 'loose' to him.  MRI showed an INTACT ACL and a small tear on medial meniscus.  Can it be the removal of the lateral meniscus and a tear in medial meniscus threw off the ACL diagnosis?  I have no instability problems and like I have said I have slipped multiple times unexpectedly where knee shouldve given out and my knee was rock solid.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 19, 2015, 02:52:25 AM
help anyone??!
Title: Re: TORN ACL or NOT?
Post by: rnm37 on January 19, 2015, 07:17:37 AM
I have also had 2 ACL surgeries and my knee in its current state also appears to be a tad loose - I think when a knee has the history that yours or mine has we need to accept that things arent going to be "normal" ever again. If the doc says the ACL feels loose and an MRI has come up clear, its possible it may have stretched out a bit. I am pretty sure being meniscus deficient is also known to skew some physical laxity tests. The question is if what you are experiencing is a hindrance on your daily life.
If you are determined to get to the bottom of this then I would say go get the arthroscopy. But the main thing I took from your post is that you say your knee feels stable and is not giving you any issues currently - that suggests the knee is doing its job one way or another. All the best!

Ross
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 20, 2015, 01:02:14 AM
I'm going to get a second opinion and bring in the MRI that has been read as negative and ACL intact with me.  I will give it to the new doctor and see what he says and let him evaluate me as well.  My knee feels great.  I can kick my leg out like a karate kick and my knee doesn't even give a feeling of any type of giving out.  Doesn't that mean my ACL is intact if im able to kick my leg out with force and it feeling completely stable?  I can throw a football as well and drag the back knee while doing the throwing motion which I heard many acl deficient knees cant do.  It doesn't give out in the football throwing motion, all I hear is a clunk probably because of damage to the medial meniscus and the previous removal of the lateral meniscus?  Any other self tests I can do?

Thanks for the advice.
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 20, 2015, 07:19:25 PM
I'm going to get a second opinion and bring in the MRI that has been read as negative and ACL intact with me.  I will give it to the new doctor and see what he says and let him evaluate me as well.  My knee feels great.  I can kick my leg out like a karate kick and my knee doesn't even give a feeling of any type of giving out.  Doesn't that mean my ACL is intact if im able to kick my leg out with force and it feeling completely stable?  I can throw a football as well and drag the back knee while doing the throwing motion which I heard many acl deficient knees cant do.  It doesn't give out in the football throwing motion, all I hear is a clunk probably because of damage to the medial meniscus and the previous removal of the lateral meniscus?  Any other self tests I can do?

Thanks for the advice.

If you feel that great, I would risk to say skip the surgery... or ask as many "opinions" as you can before adventuring into "exploratory" surgery.

About self-tests, yes you can google them... issue is, in the end you will know the same as you know now - nothing... those tests are tricky even for experienced professionals, done as a self test, it may be just as good as flipping a coin and see what you get...
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 20, 2015, 10:23:03 PM
Appreciate the advice. But isn't it not normal for someone with a suppsed ACL tear to kick out their leg and it not hurt or give out?  You would think even a partial tear would yield some discomfort or instability.  I can do a high kick as a martial artist would do with no problem, but yet my doctor said my knee felt 'loose'?  Im getting a second opinion on Monday and Ill let you know what the second doctor says.  Thanks again. 

By the way I can't find any 'self tests' on google.  Any ideas on what I can try besides playing in a pickup basketball game or soccer game to test the stability?
Title: Re: TORN ACL or NOT?
Post by: rnm37 on January 21, 2015, 10:26:50 AM
I very nearly drove myself crazy trying to "self test" as you describe. I would be jumping side to side in my room, trying to perform laxity tests on myself, trying to mimic slipping motions to see how stable it was. All that happened was my mental state deteriorated and my knowledge of what was going on in my knee stayed exactly the same. From my experience, I believe it is very easy to develop a mental issue after so many knee injuries and surgeries - you expect the worst every time you feel a twinge or wobble.
As MDAL says, these tests are best performed by a doctor who knows what they're doing. From what you describe, you have a functional knee which gives you no issues during a variety of difficult movements. Wasn't that the reason you had the surgery in the first place?

All the very best,

Ross
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on January 21, 2015, 02:17:35 PM
So, it doesn't hurt, doesn't impact your activities, and doesn't affect your quality of life. It's stable, asymptomatic, and "rock solid."

You've done your self-tests, right there.

My suggestion would be save your money, stop sending bills to the insurance company, and quit looking for trouble. The human body isn't a perfect machine--we've each got oddities, and chances are if you look long enough, you'll find something that "shouldn't be working" correctly, but is doing just fine in everyone. There really is no such thing as "normal."

Keep your records and your reports, and go about whatever it is you do. If and when you have problems down the road, bring  your records to your doc and discuss these past findings as something that may or may not have played a role.
Title: Re: TORN ACL or NOT?
Post by: Audice on January 22, 2015, 12:13:32 PM
I have to agree with what mmrocker13 says. ACLr is an elective surgery. If, indeed, you're not finding the knee to be problematic there doesn't seem to be a valid reason for reconstruction.

I've owned & been involved with horses most of my life & for 8 years following the damage to my knee I rode my horse daily. (Now I'm just too old.)  But almost 10 years out, I'm still functioning just fine w/o an ACL in my right knee.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 22, 2015, 01:17:16 PM
Why do I care so much to find out if its torn or not.  Because I want to return to sports again and everyone knows its nearly impossible to play without an ACL even though we have heard stodies of people playing without an ACL.  That is the reason I've had prior acl surgeries and its the reason I'm thinking about it again, if it is indeed torn.  It is affecting my life because its not letting me do the sporting activities that I want to do, although I haven't tried to play yet in fear that my leg will give out, which is why I'm asking about all these self tests that I can do.  By the way when I run it just doesn't feel right, but that could be becauae of the meniscus tear.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 22, 2015, 01:26:36 PM
Ultimately it's your choice but you did ask for advice.

Have you exhausted all the other options, physio, a brace?

I personally wouldn't rush into invasive exploratory surgery because the clock is ticking on insurance (but then that's not an issue in the uk if there's a clear medical need for an operation). Few surgeons here would even consider reconstructing a functional acl, even if partially torn except maybe for large sums in a pro sportsperson!

Get the second opinion first and all the tests done by a specialist. As a young person you should also be seeking to preserve your meniscus so as to reduce the risk of arthritis later. I'm due to have a meniscectomy soon without mechanical issues but I do have constant pain. If i didn't, then I wouldn't go ahead. You say there's no pain, it just feels funny? Perhaps back to basics physio to sort all the muscle groups would be advisable

Good luck whatever you decide :)
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on January 22, 2015, 03:03:27 PM
"everyone knows its nearly impossible to play without an ACL even though we have heard stodies of people playing without an ACL. "

I don't know who this "everyone" is.

I know that a SYMPTOMATIC knee can cause problems and make playing football/soccer/basketball, etc. a issue. And of course you stories of people playing sport lack an ACL or have other significant defects. They are usually people who are either asymptomatic and/or are managing their symptoms successfully.

" It is affecting my life because its not letting me do the sporting activities that I want to do, although I haven't tried to play yet in fear that my leg will give out"

From everything you've said, it isn't your leg holding you back at this point--it's your mindset. You say you've recovered from previous surgeries, can do all the exercises for your sport (high kicking, throwing, foot dragging, etc.), and otherwise feel no instability or issues with the acl. You've slipped and fallen, and done any other of things that "should" cause you issues if you had a tear,, yet they do not. And then you admit to not having actually tried returning to sport yet.

In your initial post, you even say that since your free insurance coverage ends at age 26 (I am assuming you are on your parents' plan), you are reopening this case before your coverage runs out. I'm sorry to be frank here, but it really sounds liek what you are doing is having an exploratory surgery for something that is not bothering you--and is not indicated on an MRI, and will be using your surgeon's time and resources, and your insurance company's money...because it's free.

Surgery--even a simple diagnostic scope--is NEVER without risks. That's the most important thing to remember. Not to be doom and gloom, but what if, god forbid some horrible complication makes you code on the table, or you throw a clot later, or develop an infection, or he knicks something while he's in there, and actually makes your issues worse? Are the risks small? Sure. But do you really want to roll those dice for a problem you are not even having?

I'm sure there's more to the story, b/c I find it hard to believe a surgeon would agree to open you up to check on your acl when your MRI shows no tear, and your knee is stable (even though you are worried someday it might not be). I'd sort of wonder about his judgement, if that were the case.

Personally, I'd say if you really want to get back into sport, and you want to spend that insurance money... go to a really good sport-specific therapy clinic. Get totally evaluated--strength, conditioning, gait, imbalances, weaknesses, etc. Do a return to sport program with them, and THEN if you are in pain/unstable/unable to maintain your fitness with non-surgical measures (PT--and continuing PT maintenance, bracing, whathave you). THEN go looking for the cause/solution surgically.

Good luck to you. I have been an athlete my entire life, and I understand the competitive drive and the need to be active.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 22, 2015, 08:20:20 PM
Thank you all for the great responses and advice.  My sport doesn't involve high kicking, I was just making a point that if I can do something like that with no problem, then I must have at the most a partial tear or stretched out acl.  The question is, will it hold up playing sports where I'm cutting and jumping very quickly?  That's what I need to find out and I'm having a lot of trouble coming to a conclusion.  The MRI coming back negative on the ACL and me slipping on ice really hard and knee being rock solid on such a freak slip really threw a monkey wrench into this whole thing and has me doubting my doctors evaluation. 

The thing is, 2.5 years ago when I reinjures this knee I got evaluated by my doctor who did that surgery and he also said it was torn again.  Now I get evaluated by this other doctor and he also says its torn ororpossibly stretched, but yet I feel very stable, the only thing I haven't tried was playing soccer at a moderate level to test out the knee, but I don't think that's very advisable because I can reallh end up damaging the knee.  I have no pain in the knee, only after I run I get a bit sore and MRI said I do have small damage to the the other meniscus, so maybe that's where the pain is coming from and not the ACL?

I really don't know what to do at this point, but as of now I'm going in for my second opinion (technically third opinion) and we will see what happens.  I almost want to just go ahead and try to play soccer to finally get to the bottom of this.  If not an arthroscopy is next in line

Something to note as well is that I tested positive on the pivot shift test twice now.  The first time was with my original doctor 2.5 years ago when I first reinjured the knee and now with my new doctor.  Both times there was a 'shift' and a 'clunk' during the pivot shift and both doctors stopped the evaluation right there and confirmed that it was an acl tear.  Now my question is, is it possible to still not have an ACL tear even if testing positive on a pivot shift test?  Could it have been the lack of a lateral meniscus and damage to the medial meniscus causing the 'shift' and 'clunk' on the test?
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 23, 2015, 05:36:59 PM
Yes, everything is possible. It's possible that your doctor made a mistake, and it's possible that you do have something there. Ask for a 3rd and 4th opinion... at least to get the answers in your mind.

And yes, if your lateral meniscus is totally out, and probably some cartilage has been consumed already, there will be a huge space missing (a meniscus is not that small) that might confuse tests.

About sports, you have a meniscus totally removed and maybe tears in the other... are you sure you actually want to do any sports at all? You have no meniscus, means no shock absorbing pillow, means all mechanical force going into the lateral side straight on the cartilage.

How long ago was the meniscus removed?
Title: Re: TORN ACL or NOT?
Post by: vickster on January 23, 2015, 06:28:26 PM
Where does he say he's had all of his lateral meniscus removed? If that's the case, and not an exaggeration, under 26, he should be seeking a transplant possibly?

After two ACL reconstructions  and meniscus removal, I wouldn't be wanting to do high impact sport either especially not without the appropriate conditioning and unloader/ACL brace., I'd be wanting to look after my knee for the next 50+ years of life. I don't know if the allografts are as strong as a well rehabbed autograft?
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 23, 2015, 09:14:57 PM
Vickster:

In the initial post, first sentence.

And yes, I agree with you, I wouldn't go do sports that consist in jumping around too much... maybe swimming would be better.

About transplants, it's not easy to find a surgeon who does them and the current results are not always that much satisfactory... most doctors still prefer to align the bones to divide the weight... that at least would be easier to find a surgeon...
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 23, 2015, 09:27:53 PM
Not sure if whole lateral was removed or if he 'trimmed' a part of it.  This was done 3-4 years ago when I got my 2nd acl surgery.  Yes I wan to continue sports, its the only reason I want the surgery or else I wouldnt do the operation if it is indeed needed.  I'm not even worried about arthiritis or anything I know how to cure it and minimize it if anything.  Im going to build up my leg with as much muscle support as possible as strong as a bodybuilder to prevent any further damage if I do get another surgery. :/

The only concern I have is with part of my meniscus removed, i heard its more likely for an ACL recon to fail, correct?  Forgot where I read this, but I heard revisions fail more not because its the second or third time, but because of the additional damage to the knee already.  So if that's true am I screwed?  I'm as depressed as I've ever been, it was just like yesterday where I was injury free and dominating my sport and thought about going pro, now I'm 3 surgeries in (2 ACLand meniscus lefy knee, 1 MCL/PCL right knee medial meniscus), PCL was never repaired buy the way as it was a partial ear and doctor said to just leave it alone it won't affect spors or heal any better with surgery.  Life really has fell apart for me
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 23, 2015, 09:32:15 PM
I see, initial post gave the impression it was all removed... (probably my mistake in the interpretation), but if you are moving from doctor to doctor this is one piece of information that you should clear up in other to tell the exact story to the next doctor.

Quote
...and lateral meniscus already removed in the left knee.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 23, 2015, 09:37:21 PM
Why should you be in a wheelchair?  ACL reconstructions are very frequently done and mostly successful but you do have to rehab, follow your physio and surgeon instructions and take precautions if necessary, but there's no reason why you shouldn't play whatever sport you want as long as physically and mentally ready

Are you having physio / doing proper sports conditioning as an earlier poster suggested?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 24, 2015, 12:41:33 AM
Not sure if it was a total removal of lateral meniscus or not, but i look at my knee and there is a 'gap' there, so it looks like the whole lateral meniscus is gone. 

Also I received the MRI cd and like they said before ACL is intact and its clear the whole ligament is black and connected on the MRI.  From my understanding, black on an MRI means its not torn.  There is some damage to the medial meniscus as well if I remember correctly from my doctor after reviewing the MRI. 

Will see another doctor on monday and will give him the MRI and let him decide for himself.  I'm sure I'll fail the pivot shift test again and everything else.  Did my research on this doc as well and he seems to be very good and respected and is not in it for the 'money' as some tend to be or give off that vibe making it hard to trust.  So we'll see what happens on Monday.  Also from doing research MRIs almost never give false negatives, I read a study where MRIs are 98% correct on identifying a normal ACL and 90% on identifying a torn acl.  So the statistics are on my side?

Here is the link to the study.

https://ispub.com/IJOS/5/1/4775

Here is the pasted paragraph im referring to in case you cant find it.

"Imaging for anterior cruciate tear yielded seventeen true positive, one hundred and eighteen true negatives, three false positives and two false negatives results. The sensitivity, i.e. the ability of MRI to identify correctly those who had anterior cruciate ligament tear, was 89.47%. The specificity i.e. the ability of MRI to diagnose correctly all those who had no anterior cruciate ligament tear, was 97.52%. The positive predictive value of imaging, therefore, was 85% and negative predictive value was 98.33%."

So basically the MRI was accurate in 17/20 for true acl tears and 118/120 in normal acls(no tear). I like my chances? lol
Title: Re: TORN ACL or NOT?
Post by: vickster on January 24, 2015, 08:35:59 AM
I don't know how you can tell that you have no lateral meniscus unless you have gone bow legged or knock kneed as a result.  The meniscus sits between the bones, it's not visible, only pain and swelling caused are palpable. You can see on an MRI or xray if the joint space is affected.  In which case, a stretched ACL wouldn't be your main issue. After 3 or 4 years of no lateral  meniscus, you would likely be suffering some degree of damage to the bone surfaces

Good luck with your apointment on Monday. Presumably you have all your notes ready, although let the surgeon examine you, look at the mri and take a history to make his own mind up
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 25, 2015, 04:13:32 PM
"Imaging for anterior cruciate tear yielded seventeen true positive, one hundred and eighteen true negatives, three false positives and two false negatives results. The sensitivity, i.e. the ability of MRI to identify correctly those who had anterior cruciate ligament tear, was 89.47%. The specificity i.e. the ability of MRI to diagnose correctly all those who had no anterior cruciate ligament tear, was 97.52%. The positive predictive value of imaging, therefore, was 85% and negative predictive value was 98.33%."
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 25, 2015, 08:30:00 PM
KneeProblem:

You are not considering one aspect, the person analyzing the MRI. Put 10 people analyzing independently the same MRI and don't be surprised that they would come up with significant discrepancies...

The stats you are quoting are about the precision of whoever analyzed them, not general MRI analysis. And considering that this was part of a study it's plausible that they put much more effort navigating the images back and forth than what is done in a busy random hospital out there.

Aside this you also need to consider the MRI machine. That study was done with a 1.5, current ones are 3.0... and let's not even go into current digital image processing modules and the definition of computer screens... that study was probably done in an old CRT monitor.

Relax, if you have no symptoms just try enjoy life and try to stop torturing yourself...
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 26, 2015, 05:45:27 AM
I cant enjoy life if im not playing sports.  I have no symptoms but U can care less about no symptoms if im not active.  I need to go test out my leg once and for all and get to the bottom of this lol.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 26, 2015, 08:26:02 AM
That sounds like a plan, but do it with a physiotherapist or a trainer.  If you've done no sport for several years. you will be somewhat out of condition, you'll need help with mental barrier you have too.

Talk to the doctor about a referral for therapy
Title: Re: TORN ACL or NOT?
Post by: MDAL on January 26, 2015, 02:50:25 PM
That sounds like a plan, but do it with a physiotherapist or a trainer.  If you've done no sport for several years. you will be somewhat out of condition, you'll need help with mental barrier you have too.

Talk to the doctor about a referral for therapy

This!
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on January 26, 2015, 03:39:38 PM
Few things...
One study is just one study. So be careful making generalizations based on a single study.

Second, a total mensicectomy is rare, esp. now. They will keep as much as the possibly can, even if it's just a tiny fraction of the rim. I've had a bunch of partials, and I didn't get to sub-total until a few years ago (about 5-10% remaining--the rim of the posterior horn). My most recent surgery included a resection of the last remaining bit, which had turned to unstable fuzz :D So, to get from a clip to a total took me a long time and a bunch of procedures. there's almost always a piece left to salvage (well, until there isn't :D).

" I'm not even worried about arthiritis or anything I know how to cure it and minimize it if anything." Well then, you should do your own journal article, b/c if you've got a cure for OA, you're poised to be a bajillionaire. :D

Seriously, though, OA complicates things--even if you are managing it well. Example, docs will do a meniscal transplant and an ACL repair...but add in larger cartilage defects, and they start to back away. I am a candidate for neither a transplant nor cartilage repair--they won't do cartilage work anymore, b/c i have no meniscus (well, now I have too big of OA lesions for anything to work, anyway); and they won't give me a meniscus, as I have too big of lesions (IOW, my OA is too advanced).

I would really, really, really recommend you getting into a sports specific PT and have your flexibility and strength and function assessed, and then address all of your weaknesses/imbalances, and make a safe return to sport. (And may clear up any issues you ARE having, in addition to staving off future ones).

YOu aren't having any symptoms...your life is miserable without your athletics (what sport are you involved with, again?). So get back into it. Go to a therapist and get a total eval, and work out a plan.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 26, 2015, 07:01:43 PM
Went for my second opinion today and the new doctor said my knee is stable and used the term rock solid.  He did all the tests and the pivot shift and I passed.  There was no clunk or shift this time around with the pivot shift surprisingly, but I feel as if he didn't press hard enough or maybe I was guarding a bit not sure.  He also looked at the MRI as well and probably confirmed his diagnosis that nothing is wrong.  Looking at the radiology report there was a very small tear in meniscus can't remember if he said posterior horn or what not but he said it shouldn't be a problem.

Now the question is, did he just not want to get involved in my knee seeing that the ACLwas operated on already l and didn't want to get into someone else's work because it might not turn out well? Or did he not test my knee correctly? Kind of weird getting different views from multiple doctors, I don't know who to believe and whether or not its torn still.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 26, 2015, 07:10:39 PM
Sounds like excellent news (why do you think the surgeon is wrong when all the evidence supports what he is saying?)

As mmrocker, get PT, get fit and get back to your sport.  You're young, don't spend the best years of your life worrying about something that isn't there

Maybe a (sports/health) psychologist would be of help too?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 05:23:01 AM
Well why did the other 2 doctors say it was torn? My first doc 2.5 years ago who did the surgery and another one recently saying it was also torn.  But now this third doctor says its not torn?  That's what is confusing me.  The MRI is also on my side it seems unless it was read wrong by the radiologist and the surgeons but from my understanding and looking at it myself it looks intact in most if not all of the images.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 27, 2015, 07:16:49 AM
Your first post said the doctor said "it might be 'stretched' or partially torn" - doesn't sound like he was at all sure, hence the MRI?  I didn't see any mention of a second doctor saying it is torn.  Why if you were examined several years ago, have you done nothing surgical or physio wise (as far as I can recall) and now despite a negative MRI, are you now only thinking it needs fixing? 
Maybe muscle weakness is the issue here?  Why not take mmrocker's advice and get physio (do you have to pay for that unlike surgery, I don't fully know how the US system works)?

What are the three doctors advising? I and everyone else who has responded are not doctors, we've not seen your knee...these three surgeons are and have, so you should go with what they advise (usually surgeons are conservative initially).  Or get further opinions if not happy (I'd see a sports physio now and not another surgeon, especially given sport is your aim)
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 07:25:32 AM
well my very first doctor who originally did the surgery, evaluated me when I came into his office 2.5 years ago when I thought I hurt it again.  He said I tore it but never saw an MRI and I never got the MRI done at that time as I wasnt even thinking about surgery at that time in my life.  So I put off surgery up until now because my insurance ends in a couple of months so I got it looked at again.  Saw another doctor and he said it was torn but said it might be stretched because I dont have any symptoms and ordered to get an MRI.  Once he saw the MRI he advised not to get surgery unless I was symptomatic.  I then went for another opinion my most recent one today and he said it is not torn and everything feels solid and stable.  That is where I'm at now.  I have no symptoms of giving way or no pain unless I run, I start to feel sore.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 27, 2015, 07:33:52 AM
If there's no pain, no mechanical issues, I certainly wouldn't go through the potential risks of surgery (as mmrocker previously) and post op pain.  I don't think an asymptomatic stretched ACL needs surgery.  Rehab and train to get back to sport if that's the main thing and see how you go.  The doctors all sound wise.  Have they referred you for physio?  Do you do physio at home if not structured?

Can't you get insurance through work or something after the age of 26?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 07:39:29 AM
Yes I can but I currently don't have a job that gives me full benefits such as surgery because I work two jobs on a part time basis.  I guess later down the road If I need coverage Ill have a job that can cover me.

No, the doctors have no prescribed physio, but the last one said maybe Im getting sore due to my running stance.  He did say I have a small tear in the meniscus and I believe that is what's causing me to get sore when I run.  I just don't know though about this whole thing because last time before my revision ACL I got an MRI and it also came back negative even though my knee gave out during some light basketball activity coming down from a rebound.  Cant remember if I got that MRI after the knee gave out or before, either way the MRI was negative and knee clearly had a torn acl.  That being said, Ive become skeptical of MRIs and also doctors.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 27, 2015, 07:52:03 AM
Have you had a gait analysis done to assess your running?  I didn't think you were doing any sport?  Or just not playing soccer?  I didn't think you had any giving way and all the tests for stability are negative, so I don't really follow on the basketball?  When did the knee have a clear torn ACL - before the last reconstruction?

When is the op? If you have the op and then need another to redo the ACL again and your insurance runs out, how will you do all the physio that will be needed after?

It sounds like you have made up your mind and want the operation, so best start the pre-hab asap.

Good luck :)

Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 07:59:25 AM
NO. The giving out of the knee in basketball was before my last surgery about 5 years ago. I already got that taken care of.  My knee has not given out since my last surgery, perhaps on my last incident 2.5 years ago can't really remember what happened.  That's when I decided to go back in and see if tore anything.  Since then I have gotten 3 opinions on my knee.  The first was right after the incident and went to my original doctor and he said acl was torn, then I waited up until now and went to my second doctor, he also said it was torn, but ordered an MRI to make sure, once he saw MRI he said lets no operate unless you're symptomatic.  Then I got my third opinion today and he said its NOT torn and everything looks stable. So idk what to do as of yet. My knee feels great just a bit sore when I run.  And like I said when I initially hurt it again I cant remember if it actually gave out or I was in panic mode and thought it did.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 27, 2015, 08:17:18 AM
Knees can give out, for no specific reason, or due to muscle weakness or specific types of meniscus years. Mine can feel a bit wobbly, my ligaments are fine but I have meniscus tears in both knees. Those in the left don't give me much bother except some pain at night when I turn over. The right is painful all the time despite painkillers so it's due to be scoped next week. I lt sometimes feels wobbly especially on stairs but that could be pain inhibition, I don't know. If it didn't hurt, I certainly would be putting it and myself through the stress of surgery

Have you thought to get some counselling to help with the worry as this is clearly a big thing for you? Knee issues are a funny thing and it's all too easy to overthink every little twinge, and to obsess (I've been there often over the last 5 or so)! As mentioned, the mental barriers after injury and surgery are much harder to fix than the physical. There's even a sub forum on here for that reason.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 08:37:15 AM
Well like I said my knee has not given out since my last surgery and it feels very stable and like Ive said before I can do high power kicks like a martial artist and knee doesnt move.  The only time it mightve given out but cant really recall was when I believe I injured it 2.5 years ago.  Ever since then I stopped playing sports in fear that it was indeed my acl.  But i seem to have no symptoms and my knee feels a lot more stable than previous tears in the past so we'll see how it goes.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 27, 2015, 08:41:32 AM
Sounds good and can work towards sport. Or is martial arts what you do? Might want to talk with physio or coach about a support short term, if just as a mental crutch while you get back into it all :)
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 02:55:36 PM
No i do soccer lol, i was jsut making an example of my knee being stable
Title: Re: TORN ACL or NOT?
Post by: vickster on January 27, 2015, 03:17:08 PM
So did your physio not clear you to play again after the ACLR rehab?  Why would you things like high kicks while concerned about the integrity of your knee, unless cleared to do so?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 27, 2015, 07:21:09 PM
The reason I did the high kicks was to self test my knee and see if I was able to do a tough movement such as a high kick and if I could, I could try to come to a conclusion that my knee is fine.

He didn't specifically clear me or recomend me for physical therapy, he just simply saud nothing is wrong with me.

I'm really concerned about my knee still, last thing I want is to think I'm healthy only for me to blow out the rest of the knee on aquicj cut or jump and the acl not being there.  Everytime I run or use the knee vigorously, I get sore.  Walking and standing on it all day though I dont get sore, just when I really try to use the knee if that makes sense, running, etc.  I'm wondering if thatvsore feeling is me just not being active for almost 3 years now or its because something is wrong
Title: Re: TORN ACL or NOT?
Post by: Snowy on January 28, 2015, 03:30:18 PM
Quote
The reason I did the high kicks was to self test my knee and see if I was able to do a tough movement such as a high kick and if I could, I could try to come to a conclusion that my knee is fine.

I don't think you can really tell anything from this kind of self-testing. When I tore my ACL, once I'd recovered from the initial injury and regained strength in my leg I had no day-to-day instability at all and was able to ski, run and kick without any problems or discomfort. Only the testing done by the doctor showed laxity in the leg. All that self-testing can tell you is that you're not experiencing symptoms from these particular actions; it can't tell you whether the ACL is intact, stretched, or torn.

You've had some excellent advice from other people on this thread. It seems your choice at this point is to go for the exploratory scope, which will mean another surgery but is the only thing that can give you the concrete answer you're looking for on the state of the ACL, or you return to sports (with the aid of a physiotherapist would be a good idea) based on the stable feel of the leg and the last doctor's advice. It sounds as though the thing you're really struggling with is the idea that you may not have absolute certainty on the condition of the ACL if you go the latter route. Is getting that certainty worth an exploratory scope?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 28, 2015, 03:59:59 PM
The thing that concerns me is the pivot shift test.  I thinm the last doctor really did a poor job in evaluating the pivot shift and even when I heard a small click he tried to brush it off and kind of just gave off the vibe that he didn't want to operate on me. Also when I pivot I sometimes more often than not hear a clunk, which is a bad sign and that my acl is most likely torn as the tibia is not tracking correctly anymore with the loss of the acl
Title: Re: TORN ACL or NOT?
Post by: vickster on January 28, 2015, 04:15:02 PM
Which surgeon is willing to operate?  The one who has operated before?  If happy with their previous management, go back to them again and ask for more tests, explaining all your worries and concerns
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 28, 2015, 04:35:37 PM
Is a clunk when pivoting an almost definite sign of a torn acl even if it doesn't give out?  Because most of the time I go to pivot my knee clunks.  I think I'm going to just get the acl surgery
Title: Re: TORN ACL or NOT?
Post by: vickster on January 28, 2015, 04:38:03 PM
Have you read the ACL primer in the info hub, should provide insight into clinical signs

I've no ACL history, but does it matter if there is a clunk if there's no pain, swelling, instability?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 28, 2015, 04:46:50 PM
Of course it matters, its the same clunk in a positive pivot shift that two of the doctors found when evaluating my knee.  And from doing my research, according to doctors, it is said that patients claim they hear that same clunk from a positive pivot shift as when pivoting or normal activities and that its a sign of an acl tear :(
Title: Re: TORN ACL or NOT?
Post by: rnm37 on January 28, 2015, 06:11:44 PM
I've had 2 ACL recons and it would seem strange to me that this clunking you describe when pivoting is related to being ACL deficient. When I tried to pivot on my knee pre surgeries, it was the feeling of absolutely nothing being there (no clunk or anything, just total giving way) that worried me! Currently, my knee is a bit loose but stable and I NOW experience clunking when pivoting, which both my physio and I agree is patello-femoral related - this area of the joint takes a bit of strain during intensive ACL rehab exercises and wear and tear can occur, especially considering the knee is already compromised.
I totally understand your frustrations and feelings of uncertainty with your knee, I have gone through exactly the same thing but I do think its important to keep things in perspective - after 2 major surgeries a knee is never going to behave exactly like it did before, thats the unfortunate reality of this type of injury.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 28, 2015, 07:19:10 PM
Appreciate the advice mm, its good to hear clunking can be normal and I'm trying to remember now if I had clunking before this supposed reinjury.  I also like many have said already probably have become a little psycholgically damaged with all these injuries and perhaps I'm just overthinking everything, but with differing opinions amongst doctors, its kind of normal to doubt if it is indeed torn. 

I'm going to most likely skip surgery for now and concentrate on getting a lot stronger before even attempting to touch any sporting activity.  Once I feel I've gained lots of strength in my legs and core I will attempt to test out this acl of mine and the moment of truth will be realized.
Title: Re: TORN ACL or NOT?
Post by: Snowy on January 29, 2015, 06:40:29 AM
Quote
I'm going to most likely skip surgery for now and concentrate on getting a lot stronger before even attempting to touch any sporting activity.  Once I feel I've gained lots of strength in my legs and core I will attempt to test out this acl of mine and the moment of truth will be realized.

That's a really good approach. Look at it as another self-test, but a more definitive one - if the knee does have laxity, and it's exposed when you return to sports, then you'll know that it's time to explore the surgical options. And the strengthening won't have been wasted either way - either it'll get you ready for a safe and steady return to sports, or it'll put you in a really good place going into surgery if the worst happens.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 30, 2015, 11:10:45 PM
Lets just hope that when I go back to play and my knee ends up giving out, lets just hope it doesnt tear anything else when it gives out. :-X
Title: Re: TORN ACL or NOT?
Post by: vickster on January 30, 2015, 11:17:26 PM
Talk to your physiotherapist about bracing for sport, and certainly don't go,out expecting to get hurt!
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 31, 2015, 03:09:15 AM
I probably need a psychiatrist the most at this point lol.  Thanks again guys for all the support and advice.
Title: Re: TORN ACL or NOT?
Post by: vickster on January 31, 2015, 09:02:03 AM
Joking aside, a sports psychologist (not psychiatrist) might be able to help you get over the mental barrier and back to sport :)  Ask your physiotherapist for advice
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on January 31, 2015, 11:04:35 PM
I don't have a physiotherapist, rather not go to one anyway and pay co-pays each visit.  I will just workout alone as I have a great understanding of how to strengthen the lower body I just never have done it consistently
Title: Re: TORN ACL or NOT?
Post by: vickster on January 31, 2015, 11:08:53 PM
What would you do about rehab then if you go ahead with surgery? Doesn't the insurance you have at the moment cover physiotherapy? You really should work with someone if return to sport is your aim, not least a trained professional should sign off on you doing so. Is this why you've not returned to football?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 01, 2015, 08:27:00 PM
Yea after surgery my insurance covers my local physiotherapist, but right now I'm not sure I want to get insurance involved just for physio when it all really comes down to just strengthening. I can do that at the gym and I know what exercises are needed.
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on February 02, 2015, 03:27:32 PM
Even just an eval by a PT would be a good thing to have done; you'd probably be surprised at where you've got weaknesses and imbalances--often in places you don't even realize. Chances are you've done a lot of totally unconscious compensatory shifting. If you're really serious about returning at a high level, invest in the PT. A good done is worth his/her weight in gold for an athlete.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 07, 2015, 12:11:00 AM
Going to get a 4th opinion actually.  Got fired from my job the other day and now have more free time.  This will be my last opinion and go from there once and for all
Title: Re: TORN ACL or NOT?
Post by: vickster on February 07, 2015, 08:14:45 AM
Make sure you get this opinion from a surgeon who is highly experienced and expert in ACL reconstructions rather than someone more general or who claims to be the best because he works with a football team or some such. Where are you in the us? Look through the surgeon database in the info hub or see if anyone in the ACL forum has any recommendations

Good luck :)
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 07, 2015, 02:47:38 PM
New Jersey.  I tried to do thar last time through my insurance and search for the best knee doctor with the best reviews and awards.  But I will also try the surgeon database on here as well, thanks.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 08, 2015, 11:24:29 PM
Looking over my MRI, yes it does have a clear black strand signifying a healthy acl.  But then there's one image that gets me a little worried it could be partially torn.  It's a real close up of the fibers and on top portion connecting to the femur there seems to be a white area along with the black, and im thinking to myself it could be partially torn now.
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on February 09, 2015, 07:35:37 PM
MRIs are tricky to interpret--even for medical professionals. That's why a radiologist looks at it and gives his/her findings.

And it's not just a matter of black/white=torn not torn, etc. What dark/light signifies depends on the type of image, etc.

Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 09, 2015, 09:15:54 PM
Ive come to the conclusion for good and we can close this thread.  Im hitting the gym hard and trying out my leg in a sport in 2-3 months and possibly join a sports clinic beforehand.  I think it really is mental at this point. 

What really gets me thinking is the time 2.5 years ago when I thought I had reinjured it again if the knee gave out or not, because if it did, shouldn't the ACL be torn, I remember I was stressed because I thought it gave out, could I have just over reacted and it never in fact gave out and perhaps just a little nudge from the patella making a clunk sound?  Because my patella does clunk easily and doesnt seem to sit in the groove like normal.

Plus, why am I getting sore so quickly after jogging? Can it just be inactivity after 3 years of doing no physical activity?  I mean that makes sense, but my first instinct from so many injuries is that maybe I have a meniscus tear or partial acl tear or complete tear.
Title: Re: TORN ACL or NOT?
Post by: vickster on February 09, 2015, 09:24:13 PM
I believe patella maltracking is often caused by muscle weakness or imbalance, you'd be best to get this assessed by a physio and get a tailored programme to address the issue. I am sure that's what any good surgeon would suggest
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 09, 2015, 09:37:35 PM
Yes and it's the same clunk in the pivot shift test from two doctors.  Can they be confusing maltracking with the clunk in the pivot shift test thereby giving a false positive?  Because my knee clunks just by touching my kneecap side to side with my fingers.  Kneecap seems to be a bit loose?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 12, 2015, 06:29:09 PM
Also I dont know if anyone has ever experienced this, but after revision acl surgery, I've always been able to see the outline of my acl through my leg but I still wondered if my acl was still torn or not because there could still be a tear in the middle somewhere. I dont know if this was due to loss of bone from the surgery, but looking at my leg in the mirror I can see the actual ACL ligament lining!  The more I think about it now, I really think its not torn. 

Is this normal? Being able to see the actual lining of the ACL by just looking at the knee through a mirror?  Or is it what Im seeing just the tunnel? The lining is seen much better when I flex my quad and will provide a link here to the pictures so you can see what im talking about.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 12, 2015, 06:46:04 PM
Here are the pictures of my left knee.  First one is standing with quad flexed.  And the second one is my leg extended in the air.  Is this normal to see the lining of the ACL? lol, I guess I've lost a lot of bone through the surgeries.  Or what exactly am I looking at?  Is the lining in those pics just the tunnel or is it safe to say it's the ACL?

http://tinypic.com/r/2rp67np/8

http://tinypic.com/r/28v3toy/8

Title: Re: TORN ACL or NOT?
Post by: The KNEEguru on February 12, 2015, 08:20:34 PM
I wonder if what you are seeing in the 'mirror' is hypertrophy (overgrowth) of the original harvest site in the patellar tendon?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 12, 2015, 08:41:49 PM
How can it be the patellar tendon, if it's clear you can see the diagonal line where the ACL should be.  Connecting from the lateral femoral condyle to the tibia
Title: Re: TORN ACL or NOT?
Post by: The KNEEguru on February 12, 2015, 09:37:36 PM
I see two raised areas in your picture - one central and one oblique as you say. I was referring to the central one.

The ACL is passed inside the bone and not visible from outside. Unless maybe you had some other procedure at the same time?
Title: Re: TORN ACL or NOT?
Post by: The KNEEguru on February 12, 2015, 09:43:11 PM
Like a Mackintosh procedure - http://www.ncbi.nlm.nih.gov/pubmed/16103958
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 12, 2015, 11:11:51 PM
No i did not have another procedure.  But that diganoal line in my knee is where the ACL should be.
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on February 13, 2015, 02:17:00 PM
No--your ACL is posterior to your patellar tendon. It does originate from the distal femoral condyle, but  deep in the intracondylar notch. It's attaching on your LFC--on the medial wall. The distal attachment is on the tib plateau, yes, but again...it's internal. It basically blends on the anterior portion of the medial meniscus. Just like you can't see your meniscus, you can't see your ACL.
Title: Re: TORN ACL or NOT?
Post by: rnm37 on February 13, 2015, 02:19:30 PM
No i did not have another procedure.  But that diganoal line in my knee is where the ACL should be.

On a 2-Dimensional image of your knee, yes, but there is no way on Earth an ACL would show on the surface of the joint. The graft is placed inside the knee joint BEHIND the knee cap. What you are most likely seeing is residual swelling/scar tissue from the injury/surgery (yes it can last for a very long time).



Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 14, 2015, 12:08:58 AM
Did you look at the two pictures? The one with the knee extended in the air is more noticeable.  Can it really be just scar tissue from the the top attachment to the bottom attachment of where the ACL sits?  Its the same exact length of an ACL After my first acl surgery I never had that but ever since my revision I noticed it from the very beginning I had that weird lining in my knee where the ACL would be.  Here is the picture again if you didn't see.

http://tinypic.com/view.php?pic=28v3toy&s=8#.VN6UNi7VnIU

What if this scar tissue is what threw off the whole MRI and gave it a false negative??  Is that possible?

Title: Re: TORN ACL or NOT?
Post by: vickster on February 14, 2015, 03:23:00 AM
Why not go nd discuss this with the surgeon rather than speculating and being concerned, get your. Mind. Put at rest by the specialist who did the operations? Only knee guru is a trained medic, the rest of us are patients :)
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 16, 2015, 11:44:03 PM
I have and every surgeon says something different.
Title: Re: TORN ACL or NOT?
Post by: vickster on February 17, 2015, 07:17:09 AM
I think you'd be best listening to the one who did your last surgery as he is most familiar with the inside of your knee in its most recent state

Did you see a physio yet?
Title: Re: TORN ACL or NOT?
Post by: mmrocker13 on February 17, 2015, 03:36:20 PM
I bet they would all agree you can't see your internal structures on the outside, though.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 17, 2015, 03:46:57 PM
Sure looks like an ACL from the outstide lol.  So I guess my next question would be, could this scar tissue cause a false negative on the MRI?  Tricking the MRI to think something was there when it actually wasnt?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 26, 2015, 03:44:12 PM
Could the scar tissue seen in mirror cause the false negative in my MRI results?  Maybe I do have a tear?
Title: Re: TORN ACL or NOT?
Post by: vickster on February 26, 2015, 04:19:41 PM
I think surgical screws used for ACLr can affect the quality of an MRI.  Might be worth asking the specialist (did you get your nth opinion?)
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on February 26, 2015, 11:23:16 PM
No, but I do remember having a negative MRI on my second time injury and my ACL was indeed torn and i had my revision after, which is why Im so skeptical
Title: Re: TORN ACL or NOT?
Post by: Snowy on February 28, 2015, 04:41:22 AM
Quote
Sure looks like an ACL from the outstide lol.

Except that it's on the outside, so it can't be an ACL. ;)

On a more serious note, it's almost impossible for an untrained layperson to identify an ACL on an MRI, never mind any potential disruption to it. You'll drive yourself crazy trying to read the scans, and convincing yourself that every weird pattern you see is a tear or something that shouldn't be there. Trying to self-diagnose via MRI interpretation is an exercise in futility.
Title: Re: TORN ACL or NOT?
Post by: zigmude on March 02, 2015, 01:28:03 PM
Not sure if this has been resolved but just wondering if you had any new scans?
Sometimes imaging like MRI's can be a bit tricky and relies a lot on interpretation and the experience of the doctor. Did you get a second or third opinion? also, Did you have your lateral meniscus removed before?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 02, 2015, 04:43:50 PM
I have had no new scans.  According to the radiologist and orthopedist, the ACL is intact on my MRI and sure looks like it when I see the images myself after looking through youtube to read a knee Mri from every angle.  My only suspicion is that before my last surgery, i also had an intact MRI for my ACL and the surgeon said it was torn and I believed him because my knee gave out playing light basketball. So im real skeptical with MRIs these days.

And just to clarify my knee has not given out since my last surgery.  The basketball incident was 5 years ago before my 2nd ACL surgery.  Ever since my last operation my knee has been fine until I felt something weird playing soccer and not sure if it gave out, too long to remember and since then I haven't played in the last 2-3 years and am now wondering if I tore it again, which is why all these posts in this thread.
Title: Re: TORN ACL or NOT?
Post by: vickster on March 02, 2015, 05:21:06 PM
Have you been assessed by the PT yet?
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 02, 2015, 10:01:22 PM
No I have not, don't want to get insurance involved yet. Parents insurance so they still have the say in it and they wont want to get insurance involved for something they think that im fine as it is.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 08, 2015, 05:49:42 AM
Can the scar tissue cause a false negative MRI???
Title: Re: TORN ACL or NOT?
Post by: The KNEEguru on March 08, 2015, 09:15:52 AM
'kneeProblem', I think that you have had pretty good answers to your questions so far, but we cannot tell you what to do.

You have already had a revision ACL procedure, and know you have damaged the meniscus as well.

I understand that you are a young person, since you are on your parents' insurance, and that you are concerned about anything happening to the knee in the future because of changes that are going to happen to your insurance cover. I understand also that you have been reassured that there is adequate stability, but you are uncertain if it is safe to return to the sporting level you desire in case the ligament snaps again.

I believe it is time to be realistic. So much damage in a young knee is a recipe for arthritis later in life. Each operation may also cause issues with your growth plate in the bone. Why push for the sort of stability you desire so that you can go back to higher level sport and risk the ligament yet again. A young knee that has had two ACL procedures and some meniscus work is not a normal knee, even in the best of hands. It is a damaged knee, and an ongoing rehab programme to strengthen the quads and hams and the hips and lower back will allow you to get on with life, but it would be wise not to push for increased sporting levels at the risk of yet further surgery.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 10, 2015, 05:58:53 AM
Well the question Im having is not whether I should to return to sports or not, the question is, is my ACL retorn right now or not.  I appreciate the advice on not going back to sports, but I wont be playing competitively anymore I dont think, what I want to do is just go back to recreational activity, playing soccer with friends in a pick up game etc.  I need to find out if my ACL is retorn and not even a doctor can decide.  An MRI came back negative as well.  My original doc who did the previous surgery said it was retorn back when I visitied him 3 years ago when I thought I reinjured it again.  Then I waited 2 more years to get a look on it and another doc says its possibly torm but lets order an MRI first.  MRI came back negative and he said lets NOT do surgery.  Went for another opinion and did my research to find the best doctor, and this doctor said my knee is rock solid. 

With all that being said, im lost about what I want to do and the only real way to test this is going out in the fire and testing it once and for all in a sporting activity at moderate intensity because I cant take this anxiety anymore and want to just get on with my life.
Title: Re: TORN ACL or NOT?
Post by: vickster on March 10, 2015, 08:47:44 AM
Perhaps seek some help for the anxiety (e.g. sports psychology), coupled with physiotherapy, if the knee is solid :)
Title: Re: TORN ACL or NOT?
Post by: The KNEEguru on March 10, 2015, 09:13:23 AM
In medicine, not everything is black and white. It is not simply 'is the ACL torn?' or 'is the ACL not torn?'. The issues from the doctor's perspective is -

1. IS THE PATIENT EXPERIENCING INSTABILITY? - people can be very distressed because the knee gives out during normal activities, feels wobbly, cannot be trusted. This might be because of ligaments, or because of a torn or absent meniscus, or because of muscle weakness.
2. IS THERE OBJECTIVE EVIDENCE OF LAXITY - is the knee lax on hands-on testing by the doctor, or using a measuring instrument like a KT2000?
3. IS THERE VISUAL EVIDENCE OF DISRUPTION - an obviously frank tear on MRI, an obvious meniscal tear or absence?

All of these will be taken into consideration, and obviously the doctors are not convinced that there are enough pointers to justify taking you back to surgery. If you insist on an answer to "is my ACL retorn right now or not" then you need to go back to the doctors and ask again, armed as you are with a greater understanding of the issues.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 10, 2015, 05:39:14 PM
The thing about the MRI, is that before my last surgery(revision) my MRI also came back negative, so I take MRIs with a grain of salt these days.  Im going to just go out in the fire, going to the doctors has left me knowing what I have known previously, NOTHING.
Title: Re: TORN ACL or NOT?
Post by: rnm37 on March 10, 2015, 11:52:43 PM
Why do you want to go "out in the fire" and test it so badly? What will you do if your knee does actually give way beneath you the first time you play football (soccer) again?
Why not be pragmatic and go back to basics with your rehab, and properly build back up to playing sports? See what stage you are at with regards to cutting, jumping, sprinting drills etc. Try to build up confidence in your knee again (which you clearly lack) in a safe environment before going back into a proper game.
Progressing with sport-specific exercises on an incremental basis will give you a better idea of the state of your knee, and you are less likely to stress it in a manner it cant currently cope with. With your knee history, to go straight into a football game (even a pick up game) after 2/3 years of little/none sport specific training seems rather daft to me. Sorry to be blunt
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 12, 2015, 05:14:24 PM
The point is to not go hard, its along the lines that you mention, progressing slowly to see where my knee is at.  But I will progress slowly by doing some light cutting in a football match, whats the difference?  You can't get an idea of knee stability through rehab.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 13, 2015, 07:23:29 AM
I found an interesting self test to test my ACL.  Was looking through youtube and i came across the Lelli's Test.  I think KNEEGURU is familiar with it, because he actually commented on the youtube video coincidentally lol.  Here is the link.

https://www.youtube.com/watch?v=eEhpwTU3KXg

EDIT** Just tried it on myself and I dont know if i did it wrong but both of my feet didn't pop up.  When I flexed my quad slightly both feet popped up.  But im sure anyone who flexes their quads with knee in 30 degree angle would have their foot popping up though?
KNEEGURU can you please elaborate on this test?

Title: Re: TORN ACL or NOT?
Post by: Snowy on March 14, 2015, 04:41:09 AM
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the ACL is intact on my MRI and sure looks like it when I see the images myself after looking through youtube to read a knee Mri from every angle

I know this is just a reiteration of my last post, but you can't read your own MRI. Radiology training is not a simple thing, and YouTube is not a substitute. As you also note MRIs aren't infallible, but a radiologist's interpretation of an MRI is an awful lot more accurate than anything you can accomplish with YouTube videos. I understand what led you there because I did exactly the same thing with my own MRI, but as soon as a radiologist explained what I should have been looking for I understood that there was no way I ever would have seen it regardless of how many images I looked at or videos I watched.

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I found an interesting self test to test my ACL

I would be wary of this. Even testing under the guidance of a medical practitioner can be thrown off by overly tense muscles - self-testing, where psychology is also at play, is dubious at best.

KneeGURU offered some very solid advice here - it might be time to think about that route rather than continuing to obsess over what's going on inside your knee. If you're truly unable to live without an answer to that question then yes, you're looking at a scope to determine for certain whether the ACL is torn. MRIs are not infallible. Physical tests are not infallible. In your case both seem to point to a particular conclusion, but if you're really not happy with that then the only answer is a scope - and the consequences of another surgery on a knee that's already damaged.
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on March 14, 2015, 02:32:00 PM
Snowy, thanks for the advice as well, but what do you think of the Lelli test, is it reliable?  Not much info on it yet because of it being such a new test, but there has been some anectodal evidence has been positive.  Also, while I agree it might be hard to do it as a self test, what if I got someone to help me, I mean it doesn't look that hard to imitate the test.  But I do think doing it by yourself is possible as well if you put your other leg under your knee and then follow through with the push on quad with hand
Title: Re: TORN ACL or NOT?
Post by: kneeProblem on April 02, 2015, 10:38:20 PM
Also is it normal to have a tingle(pins and needles) type feeling in the area around the scar when pressing against the skin?  I believe that only happens after a re tear of the ACL because of the scar tissue build up?  Am i right?