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Offline Lewisdg

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2nd opinions
« on: August 01, 2005, 02:56:07 PM »
Hi fellow knee suffers,

about 18 months ago I had my knee bent sideways (from inside out) playing rugby - after a long time waitng I had keyhole surgery the docs cleaned it all out and said I had small tears in the meniscus and a partial tear in my ACL.....they said to me to continue on as normal and basically see what happens - so after awhile I got back up to full fitness and my knee felt solid again. I Then during some tackle bag work I had my leg slip in the mud and then grip this then forced my knee to bend in the same way as it did the first time. That was months ago and I have not played rugby since as I did not want to risk it until i got the results back from the MRI, but I went to a couple of physios to see what the thought while I waited for the results, they both said that my 'bad knees' ACL felt more solid than my good knee and that I might have just stretched my lateral oc-lateral ligi.....but the doc said that the MRI is showing my ACL to be completely ruptured and has booked me in for a re-construction using my hamstrings. Can the MRI be this wrong or are the tests that physios do reliable? any help would be great



Offline RN2BNVA

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Re: 2nd opinions
« Reply #1 on: August 01, 2005, 04:08:24 PM »
Hi Lewis!

There are many different factors that play into testing. From my personal experience I found that mechanical testing/machines as well has physical exams can all be inaccurate.

I hurt my knee last April (again) and the first MRI showed that I still only had the partial ACL tear that I got almost 10 years earlier. My OS and PT both did lachman's testing and said that my ACL would give but not like it was a full tear... I had a KT1000 done that showed partial tear... and on one reading the give was significant but because it only occured once it was thought to be an error. Second MRI done in Aug of the same year (with no major trauma or activity during the time frame) showed a total rupture.

ACL reconstruction scheduled. Once I was completely sedated I had an extremely positive lachman test and once they got into my knee they could see that the ACL was still attached but it was so stretched and torn that it was useless. Reconstruction went about as planned...

Point being that I had one MRI that showed it partially torn at about what it was 10 years before (slightly over 75%), the next showed complete rupture... but it was still intact with about a 90% tear... OS (actually 3 different OS) and 2 PTs all told me partial tear but not enough to reconstruct... KT1000 showed partial tear but stable... all may have been partially correct but considering the ACL was useless it really did need reconstruction. Your muscle strength, swelling, and apprehensions can all make a difference in your physical exam. If you are uncomfortable you tend not to relax, great muscle strength can counteract several ACL tears, and if the knee is swollen it doesnt move the way it should.

If you have increased instablility and fail the lachmans and/or pivot shift testing then it is reason to believe the ACL is torn and reconstruction would be the next step.
*May 95-- Roux-Goldthwait & lateral release
*Dec 95-- Chondroplasty, Synovial tissue removal,partial ACL tear
*Sept 04-ACL reconstruction w/allograft
*Mar 05-Chondroplasty of kneecap/Chondromalacia
*Saphenous neuroma
*Chronic PFS
*Aug 2nd 2005 Fulkerson TTT