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Author Topic: ACL torn or not??  (Read 6952 times)

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Offline brady004

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ACL torn or not??
« on: August 12, 2009, 09:06:47 PM »
Hello,
In November of 2008 I landed wrong after a flying kick in Tae Kwon Do and and hyperextended my knee.  I went down immediately and it swelled.  I saw an experienced sports medicine OS 2 days later who did a Lachman test and confirmed an ACL tear.  The MRI the same day confirmed an ACL tear with no additional injuries to meniscus or other ligaments. 

I got fitted for a custom brace for TKD and started PT to regain range of motion and strength.  The knee still crackles when I bend it and swells with activity.  Pivoting and hard landings I try to avoid. 

As I prepare for ACL reconstruction this fall (one year after the injury) I saw another experienced sports medicine OS and PA who both, separately confirmed torn ACL with the Lachman test and ordered a second MRI to check for damage that I might have done in the 8 months in the meantime (I haven't stopped TKD ;)).  The second MRI showed an intact ACL and a "full thickness cartilage fissure of the medial patellar facet" and some joint effusion.   

So, I am scheduled to see the second OS on August 26th.  With 3 positive Lachmans and 1 MRI showing a tear and the second not, what are the chances that I don't actually have a tear?  I read that chronic ACL tears may be difficult to interpret on MRI, but what are the chances?  Or are the acute and swollen ACL tears harder to interpret and less accurate? Anyone else have a similar situation?
11/08: complete ACL tear during Tae Kwon Do
3/2/2010:  hamstring autograft ACLr

Offline Lizn8r

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Re: ACL torn or not??
« Reply #1 on: August 13, 2009, 01:45:11 AM »
Hi there,

Wow, hard to know for sure what's up with those results, huh? 

I had my first MRI 3 or 4 days after I injured my knee 10 years ago and the report read "inconclusive".  Literally ... "inconclusive".  I also had a PA attempt to do the Lachman test (he didn't really know how to do it and I didn't know any better at the time) which he said I passed, whatever that meant, so the insurance company wouldn't authorize another MRI.  My knee was ridiculously swollen and I don't think King Kong could have shifted anything in there.  10 years later my PCP (who knew what she was doing) does the Lachman ... seemed like my tibia could've held a cup of coffee on the plateau!!  And the report from my latest MRI said my ACL was "not present"! As in gone! So from my experience, I have to believe that imaging equipment has a harder time reading through edema/swelling.

While the way you describe your accident ... hyperextending your knee upon landing ...is definitely something that could tear your ACL, I'm just wondering if you maybe have joint hypermobility in your knees.  When I was younger, everyone called it "being double-jointed".  Anyway, that could explain the positive Lachmans.  Google it to find out more about it.

Good luck ... I hope that you can get resolution on your knee problems in some way other than surgery. 

Liz
Sep '99: Tore left ACL (football) - misdiagnosed
Sep '99-Apr '09: Lived with pain and buckling
Apr '09: New PCP (who listened), MRI and OS consult - proper dx
May '09: LK ACL Allograft and 25% medial meniscus removal
Sep '09: Released from PT and OS ... back to things I haven't done in 10 years!

Offline Ferris

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Re: ACL torn or not??
« Reply #2 on: August 13, 2009, 08:16:42 AM »
MRIs are not conclusive.  I had a partial ACL tear in my left knee caused by a fall while skiing in December 2002 and rehabbed conservatively at first, after an arthroscopy when I returned to the UK from France confirmed the diagnosis after a positive Lachmans test (once the surgeon got me to relax the knee enough as I had severe muscle guarding) but inconclusive MRI.  The surgeon clearered out the knee but felt that there was enough stability left not to justify the reconstruction.

Fastforward two years and after another positive Lachmans test (and others), I had another MRI which appeared to show that the ACL was still attached in part but when the surgeon saw it during surgery it was only attached by a few strands and was actually functionally useless and so my surgeon went ahead with the ACLr in January 2005.

Rachel

Offline brady004

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Re: ACL torn or not??
« Reply #3 on: August 13, 2009, 01:05:25 PM »
Thank you for the interesting and informative stories.  I seems that the word "inconclusive" comes up in the MRI report and then there is confusion until surgery when a tear- partial or full- is confirmed.  I am just curious with my 2 MR reports 8 months apart that say definitively torn in one and intact in the second.  I know that the ACL is not capable of healing itself, so maybe the first report was misread and was only a partial tear.  I am curious as to what the OS will recommend at this point, especially since I do have a chronic effusion.
11/08: complete ACL tear during Tae Kwon Do
3/2/2010:  hamstring autograft ACLr

Offline mollyc

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Re: ACL torn or not??
« Reply #4 on: August 13, 2009, 06:23:37 PM »
MRI machines vary in quality as well. Did you get the MRIs done at the same place? Apparently, older machines in particular are often of such poor quality that radiologists can't always read them.  There actually was a story on just this issue in the New York Times in February or so. (I took special notice having just had my first MRI after my knee surgery.)

In my case, MRI suggested complete tear. ACL wasn't present at all on the MRI.  When they went in, ACL was holding on by just a few threads.  Functionally useless, though, so I still needed the ACLr anyway.
Ski accident 2/14/09
Ruptured ACL, MCL sprain, bone bruise
ACLr allograft 5/27/09
Knee now 100% fine...skiing and playing tennis regularly

Offline Audice

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Re: ACL torn or not??
« Reply #5 on: August 13, 2009, 06:58:42 PM »
My OS looked at the MRI report, did an x-ray right there at the practice & informed me that although the MRI indicated there "might" be a few strands left, he was quite emphatic that it was completely ruptured. But then he was also perfectly certain I'd done all the damage with that one injury & wouldn't hear about past injuries, one of which was at least as awful as this last one. I think we might well be at the mercy of our doctor's interpretation.

I've heard often enough how MRIs miss some meniscal tears but wasn't aware they were as capable of not seeing what was going on with an ACL. Hope you get something definitive at your August appointment...Ellie
April, 2005 - ACL rupture, medial meniscus tear within posterior horn to articular surface, abnormal signal within lateral meniscus, partial tear MCL, bone contusions tibia/fibula, Baker's cyst.
No repairs.

Offline dianna

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Re: ACL torn or not??
« Reply #6 on: August 14, 2009, 02:22:30 AM »
I have been diagnosed with a completely torn acl that has attached or scarred to the pcl.  My mri looks totally normal even though I have a complete acl tear?!  I was diagnosed with arthroscopic surgery.  I have also had a shoulder mri that misdiagnosed a partial supraspinatus tendon tear and a labrum tear.  Mri has proved to be very inaccurate on my injuries.

Offline brady004

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Re: ACL torn or not??
« Reply #7 on: August 23, 2009, 03:31:25 AM »
The first MRI report (right after the injury) reported a "grade 3 mid substance disruption".  I wonder if and how this is any different from a "torn ACL"? I am beginning to wonder if the ACL has scarred somehow to make it look intact still, 8 months later.  Anyone else experienced with a 'mid substance disruption" of the ACL?   I will update after my OS appointment on the 26th.
11/08: complete ACL tear during Tae Kwon Do
3/2/2010:  hamstring autograft ACLr

Offline mollyc

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Re: ACL torn or not??
« Reply #8 on: August 23, 2009, 05:11:44 PM »
My understanding is that a grade 3 tear is a full rupture. I had a grade 1 MCL tear and a grade 3 ACL tear.  Basically, the ACL was completely gone.  I don't know what "mid substance disruption" is.
Ski accident 2/14/09
Ruptured ACL, MCL sprain, bone bruise
ACLr allograft 5/27/09
Knee now 100% fine...skiing and playing tennis regularly

Offline nkbond

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Re: ACL torn or not??
« Reply #9 on: August 23, 2009, 07:18:24 PM »
I had multiple positive Lachman results over a 12-yr period and inconclusive MRIs.  It got to the point where the Lachman result was so significant that the docs said they didn't have to see the MRI.  The pics from my surgery show a totally torn ACL but at the very top at the femoral attachment point.  It looked normal until the surgeon pulled it down with an instrument.

Just my personal experience, but I think the physical exams, if you don't have any significant swelling at the time, are the best indicator of a problem.
Medial Meniscus Repair
BPTB autograft ACLr
July 31, 2009
Medial Meniscectomy
February 24, 2010

Offline luvmy4girls

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Re: ACL torn or not??
« Reply #10 on: August 24, 2009, 02:36:08 PM »
I can totally understand how you feel.  I am 8 months post op from ACL reconstruction revision.  I had re-injured my knee playing basketball with my daughter, but was unsure of the extent of injury.  So I went back to the original surgeon who performed my first ACL reconstruction years ago, he told me that I had re-injured my ACL after he performed Lachman's test.  He is an excellent surgeon who has been a team physician to a major college for many, many years. He told me that he does not do MRI's often b/c the results are often not reliable.  My original surgeon is now retired from doing surgery so he sent me to another excellent surgeon in the same group...this dr wanted to do a MRI just to see if anything could be found.  Well, the MRI did not show anything, but I still had positive Lachman's.  So, both surgeon's still recommended surgery and that is when he found my old ACL graft badly stretched which made in not functional.  The MRI showed it intact.....so in my case it makes sense b/c mine was not ruptured. I still had the same symptoms though..... I guess my original surgeon who has been a doctor for many years was right about the MRI......he just don't do them very often b/c he has seen them wrong so many times.

If your knee is still swelling and unstable, then you should go ahead with ACLr.  I am glad that I trusted my dr's and went ahead with mine. 

Good Luck! :)

Kim
2/1991 -  Rt knee torn ACL & MCL
3/12/1991 - Rt knee ACL reconstruction
6/2008 - Rt knee re-injured ACL
12/17/2008 - Rt knee ACL Reconstruction Revison

Offline brady004

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Re: ACL torn or not??
« Reply #11 on: August 26, 2009, 06:12:39 PM »
Well, the verdict is in.  I guess my ACL is scarring on itself and the second MRI, though not normal, was read as intact.  The original MRI was definately a full tear. Today my OS showed me the central scar that it is forming, but it does not have the same strength or integrity as a normal ACL, so I will have it reconstructed in November.  The good news is that there is minimal damage to my meniscus ( no repair needed) and a fissure in my patella that they will smooth out when they are in there.  Now I will continue with my pre-hab so my hamstring will be ready to harvest. ;)
11/08: complete ACL tear during Tae Kwon Do
3/2/2010:  hamstring autograft ACLr

Offline luvmy4girls

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Re: ACL torn or not??
« Reply #12 on: August 26, 2009, 09:39:55 PM »
I am glad you finally got some answers and can move forward.....good luck with your upcoming surgery!! ;)

Kim
2/1991 -  Rt knee torn ACL & MCL
3/12/1991 - Rt knee ACL reconstruction
6/2008 - Rt knee re-injured ACL
12/17/2008 - Rt knee ACL Reconstruction Revison















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