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Author Topic: ACL torn or not?? Doctor and MRI report don't agree  (Read 11829 times)

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Offline bigtymer13

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ACL torn or not?? Doctor and MRI report don't agree
« on: August 10, 2013, 05:55:39 AM »
Hi, I am 28 year old that plays lots of sports specially soccer.  I recently injured my knee while taking a shot. At time of injury, I and a few other players around me heard a loud pop and I went straight to the ground.  The pain was not that much, it did swell for about 1-2 weeks but not major swelling and I was walking on it the same night of injury but couldn't bend it back.  I got an MRI done after 1 week and it said ACl, MCL, PCL are all intact..this is the impression of the MRI
1. Signal intensity seen within the fibers of the ACL which appear grossly intact(I underlined those words not MRI report). This may represent a Partial tear of the ACL versus a sprain.
2. Moderate joint effusion.
3. Marrow edema seen within the posterior aspect of the mid tibial plateau.

Ok so after a week I took this MRI and went to a well known orthopedic surgeon and as soon as he walked in did Lachman test and right away he said my ACL is torn and surgery is required.. He tried showing me how it's torn in the MRI but I couldn't really see what he was talking about. 
Now I have a surgery scheduled within 3 weeks but I am really scared that I don't need it because of what MRI said and how good my knee is feeling. I can jog, I can shoot a soccer ball but what I am afraid of doing is sprinting or cutting to fast because I don't really want to cause more damage if its really torn. I need help in finding out what plan to choose between surgery or going back to soccer and see the outcome because honestly I feel like I can play a 90 minute right this moment.. What concerns me about doing a surgery is how can the MRI result miss a "completely torn Acl". The injury took place on July 1st 2013, today is August 10, and surgery is August 26. So please I would appreciate anyone that can help.

Thank you ahead of time and God Bless!

Offline tez27

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #1 on: August 11, 2013, 03:14:43 AM »
If I were you I would take your Doctors word over a MRI any day, there are lots of people who have posted on this forum myself included who's MRI's have been wrong,
My first one came back saying apart from some wear and tear everything was fine with my knee but because I was still having problems a few months later my OS decided to scope the knee and found I had a complete ACL rupture which I had reconstructed...unfortunately after a few months I started having the same problems I had had pre op so was sent for another MRI which again came back fine and yet again my OS decided to scope the knee to see what was going on only to discover the graft had failed completely and was "shredded" [his words] but neither if these things showed up on the scan.
From what I can gather a lot depends on the quality of the scanner and the person reading the actual scan.
From the sound of your life style I would think having the reconstruction is for sure the way to go if you want to continue with all the things you enjoy.
Good luck with the surgery when the time comes [if you go through with it] and let us know how everything goes.
         
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline bigtymer13

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #2 on: August 11, 2013, 03:42:41 AM »
Thank You for he reply Tez27,

Can you please share with me how you originally torn your ACL? And btw my op gave me 3 options of choosing a graft. He said I can choose a graft from my own hamstring, from my patellar tendon or I can use a donor allograft. I asked him which option he would consider and he said from experience he recommends the patellar autograft but from doing my own research that choice seems like is the most strongest out of the 3 but requires more healing and physical therapy time. One more thing Tez, what did you end up doing the second time it ruptured and how long was your recovery time?

I appreciate your time

Offline Sara10

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #3 on: August 11, 2013, 02:03:34 PM »
Hey,

I haven't torn my ACL but I have patellar tendon issues.  So of course when I read you can chose one of the three to replace your ACL something screams at me "Don't use the patellar tendon!!!!"

I know two people who have torn their ACL.  One coworker said  she got her's from a donor, or a cadaver tendon. And had a 6 month recovery and she seems to be doing just fine with it.  Her surgery was 4 years ago

I have another friend who had his ACL done first with a cadaver tendon,  then he ruptured it again,  and second surgery they used his own patellar tendon.  He said it feels much stronger with using the patellar tendon vs the cadaver tendon, but has also developed now tendinosis in the patellar tendon.

So haven't heard anything about hamstring but those are my thoughts
11/2012 R patellar tendon injury, immediate quad atrophy
12/2012 MRI- tendinosis
1/2013- OS- Patellar tendinitis and Chondromalacia
3/2013 L Patellar tendon pop, no quad atrophy
7/5/13   Normal MRI, right knee tendinosis cured!

Offline Hobblescotch

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #4 on: August 11, 2013, 05:28:12 PM »
Hi Bigtymer13,

When you get an MRI done, there's a 'image-interpreting' doctor who decides what the MRI shows. It sounds like your orthopedic surgeon looked at the same images and came to a different conclusion - that your ACL appears torn. From what my surgeon told me, sometimes it's a bit tricky to tell with the ACL if it's still pretty soon after the injury - the fibres of the ligament may be frayed and it's difficult to tell if any are still attached (full vs partial tear). That's why the Lachman's test is so important, and very effective at diagnosing ACL rupture.

It would be absolutely worth talking to your surgeon about the possibility that your ACL is not (fully) torn - a very standard procedure during the op is for the surgeon to take a look inside the knee joint to assess the damage. For example, my MRI showed no meniscus damage, but my surgeon found 2 small tears during surgery! Anyway, if your ACL is intact, it's unlikely that he will perform a reconstruction, so no real need to worry about unnecessary surgery :). If it's a partial tear, that's a bit more tricky, and you might want to discuss with him what his course of action would be in that case before you go under.

However, if you have a positive Lachman's test and an experienced surgeon thinks your MRI shows a complete tear, it seems likely (though not definite) that you have a full rupture. Given your age and activity, most surgeons will recommend you go for the reconstruction, mostly because there's a very real risk that you could injure other important tissues in your knee because of lack of stability. On the other hand, a small handful of people do fine without the surgery. Personally, I didn't want to risk doing further damage, and since I hope to have decades of activity without fear of my knee giving way I opted for the surgery (I'm your age).

From what I understand, there are good outcomes from cadaver, patellar tendon and hamstring grafts. Cadaver grafts are sometimes radiated to lower the risk of infection, and this can make them more likely to fail. However, there are non-radiated allografts (I don't know as much about them, since I wasn't given the option of an allograft). I've heard some young people say that their surgeons advised them to go for an autograft because your young tissue is high-quality, whereas you don't know much about the quality of the donated tissue. The patellar tendon graft has bits of bone on each end, so that the graft incorporates into your leg bones more quickly. This can lead to faster initial healing, though the total rehab length seems to be about the same as with the other grafts. The downside with this graft is that you have a much higher likelihood of long-term anterior knee pain, so if you do a lot of kneeling this may not be the best choice. The hamstring graft is becoming more popular - it takes a bit longer for the tendon to heal into the bone and there may be a bit of a strength deficit in the hamstring afterwards. However, there is a much lower risk of anterior knee pain, and there's no difference between the functional ability of those with hamstring or patellar tendon grafts after 2 years.

Really, your surgeon's skill and comfort level with the technique will have a bigger effect on your outcome than the graft choice. If your surgeon is equally comfortable with them, then you can choose which suits you best - they all have very high success rates. I really wanted the hamstring graft, and fortunately that was what my surgeon preferred, too. I'm only 7 weeks post-op so the jury's still out, but I'm very pleased so far. :)

I found this paper very useful - it was written in 2012, and even though it's pretty 'sciency' it tells you all the latest findings on ACL FAQs, like ACL diagnoses, graft choice, surgery, etc. The 'recommendations' after each question are really handy.
http://informahealthcare.com/doi/pdf/10.3109/17453674.2012.704563

Sorry to hear about your injury, and best of luck with your decision-making!

Offline tez27

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #5 on: August 11, 2013, 06:20:58 PM »
My story is not as dramatic or exciting as most folks lol I originally ruptured mine falling down stairs :-[ as for the second time from what I have been told the tunnels were incorrectly placed during the firs reconstruction which caused the graft to fail, first time round they used my hamstring which was my surgeons graft of choice and apart from the fact it failed everything went well post op, I'm pretty sure if the tunnels were in the right place I wouldn't have had any problems with it.

The revision was done using an patella tendon allograft, the reasons my surgeon gave me for wanting to use the allograft instead of my own patella tendon was... first  me being 52 my own tendons  might not  be of as good quality as a younger cadaver one and second because he had tried a bone graft 9 months previously to fill in the holes in the bone which  also failed he needed to use pretty large bone blocks so that he could drill out the oringinal tunnels more and change the position of them so he had a bigger hole to fill, and he felt to take the amount of bone he needed might have been too much for my old bones ;).

As for the recovery I would say both were pretty much alike the revision surgery was by far the most painful which was a surprise because there wasn't a donor site to contend with, but I think it had more to do with the fact the leg had already had such a lot of work done to it that caused more pain.

I work as a hairdresser so stand all day and needed to take 9 weeks off work after the first op 6 weeks off after the bone graft and 10 weeks off after the revision surgery, though depending on what sort of work you do you most likely wont need as long off work I would think, having a good physio is very important its worth while getting someone who knows all about ACL rehab ect.
Any other questions you have please ask, I had so much help and support from this forum so anything I can do to help someone else going through this sort of thing makes me feel better.
Take care Tez
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline Snowy

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #6 on: August 12, 2013, 06:58:04 AM »
I had a hamstring autograft, and have been super happy with it. I wasn't a candidate for a patellar tendon graft as I already have some maltracking issues and a history of PFS, and I was prepared to accept the slightly tougher early rehab of an autograft (which involves healing of the harvest site as well as the knee itself) in return for the faster overall recovery than an allograft. My hamstring graft healed well and relatively quickly (I was released to full activity after 7 months) and has stood up to some pretty ridiculous demands including backcountry skiing and obstacle racing.

Really, though, the differences between the major graft types are relatively small - increased risk of anterior knee pain vs. faster healing with a patellar graft; slightly slower healing time vs. less risk of long-term side effects with a hamstring graft; no donor site to heal vs. longer overall rehab time with an allograft - and unless you have very strong feelings about one of these elements, something to keep in mind is that it's definitely better to have a surgeon who has lots of experience with the graft type that you choose.

Good luck! And definitely keep asking questions if you have them. We're not medical experts here, but we're always happy to share our own experiences if it will help.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline bigtymer13

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #7 on: August 12, 2013, 07:20:48 AM »
Hey everyone,

Thank you all for replying and it is very helpful and calming to read what you guys went through and the results afterward, it's  a good heads up to the situation I am in.  Sara the reason I might go with using my pettellar tendon is the fact I want the strongest one possible because I am not ready to give up the sport that I love.  I will talk to the op more about the options that are before me..Hobblescotch Thank you for that link I will definatly go through it tonight and btw I made an appointment with another doctor for Tommorrow as a second opinion just to see if he concurres with the first doc.
Tez I'm sorry for what happened to you, falling off of stairs is no joke as it has happened to me but thank god I got up in one piece.
Snowy thank you for your insight regarding your experience and the reason I can't go with the hamstring autograft is the recovery time, from what the doctor and the articles been saying, it sometimes need 2 years to be fully stable and the truth is I can't be away from soccer for that long. If I do go with the surgery I'm actually going to try to push my self really hard in physical therapy if the doctor permits just in order to be back ahead of expected recovery time.

Again thank u guys for replying and I will keep u updated with how the second openion  goes

Offline Snowy

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #8 on: August 12, 2013, 11:35:34 PM »
Quote
the reason I can't go with the hamstring autograft is the recovery time, from what the doctor and the articles been saying, it sometimes need 2 years to be fully stable

This doesn't match anything I've read or been told by medical professionals. The hamstring autograft heals faster than an allograft, which takes longer to regain strength because of the treatment it goes through to eliminate the risk of disease transmission. Typical return to full, unrestricted activity after a hamstring autograft is around 8-9 months (mine was 7 months, a little ahead of schedule); for an allograft it's about a year. I've never heard of any graft type that required restricted activity for two full years following a successful surgery/rehab.

That said, you will have a faster return to soccer with a patellar graft than either a hamstring or allograft because the bony healing is quicker, so if that's your main concern then it makes sense to go with this option.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline bigtymer13

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #9 on: August 13, 2013, 05:26:32 AM »
Hey ppl,

I am more confused but excited today than I have for the past month and a half.
I went for my second opinion and this op totally disagreed with the surgery option, matter of fact he said its a very small tear if there is one at all.  He advised me not to go with a surgery and just to be cautious, he wrote me up for a month worth of therapy 3 days a week. 
Why I am confused is how the first op was so confident in saying that I have a full tear, how the MRI said only a few torn fibers but acl grossly intact, and how this OP made it seem like nothing is wrong.
But to be honest, I agree with this op because like I said before, my knee feels fine just some minor pain here and there but nothing to serious.  Swelling is totally gone and I never had it give away or buckle or lock at any instance past the incident. 
Snowy, I am sorry I mistyped what I was trying to say, from what I been reading and understood from medical experts is that a cadaver allograft takes about 2 years to fully attach it self to the bones and binds as any other ligament in the body. Healing time is in fact similar between all three choices.  Strength wise, I would choose the pettellar tendon even though it has a few dangerous risks but at the same time they all do.

Now i will make an appointment with a University of Michigan OP to get another and final Opinion.  I would of went to this OP ahead of anyone but I read that he prefers using cadavers more than patients own tendons so I will just get his expert opinion on whether its actually torn or not and if surgery is required.. I am so sorry for making this a very long essay but you guys have no idea how excited I been since today's appointment :)

Thank you all

       

Offline bigtymer13

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #10 on: November 10, 2013, 06:58:22 AM »
I did the surgery and I ended up going with the hamstring autograft. It's been 4 days and its been really painful.  Just wanted to let you guys know just incase you stop by.  I chose the hamstring over the patteler tendon because I do lots of kneeling and I was advised not to go with patteler tendon due to that reason.  Thank u n God bless everyone

Offline IHMK

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #11 on: November 10, 2013, 12:18:05 PM »
What did the U of Michigan doctor say, back in August? I assume your ACL was in fact completely torn? Which doctor did you go with?  Was any other damage found in your knee? It sounds like you had a bit of a roller coaster ride and I'm so glad you're past that one and on to the next ride!

Things should start to feel better very soon. In the meantime I hope you have a Netflix subscription ;) Also you have some great diaries available in the post-op diaries section of this board, like those of Snowy, Hobblescotch and virtual_me who all had hamstring autografts. Since you said your plan is to push the rehab, Snowy's your gal for inspiration on crazy intense post-op exercise  :D

Best of luck to you.
My knee story: http://www.ihurtmyknee.org

28 March 2013: tore right ACL (also meniscus tear, MCL tear ["Unhappy Triad"!!], tibial plateau fracture & condylar bruise)
28 June 2013: surgery to reconstruct ACL (allograft)

Offline Audice

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #12 on: November 10, 2013, 12:35:58 PM »
At the time I saw the orthopedic surgeon after my knee injury, the very first thing the doctor said was, "The MRI indicates a few remaining strands of the ACL but I can assure you the ACL is ruptured." I, too, would go with what the doctor says. Even a few strands remaining aren't going to give you the stability you'll need for sports & ultimately you will most likely end up having reconstruction. Wishing you well.
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 Snowy

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #13 on: November 10, 2013, 08:51:44 PM »
Good to see you - I'm glad you were able to come to a decision that you were happy with. The first week or so after surgery is definitely the worst time. Stay on top of your pain meds, and don't try and do too much right away. The good news is that once the pain starts to improve, it does so relatively quickly. When will you be starting PT?

Good luck with your recovery and rehab!
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline bigtymer13

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Re: ACL torn or not?? Doctor and MRI report don't agree
« Reply #14 on: August 14, 2014, 07:24:25 AM »
Hello,
November 6th 2013 is when I did the surgery and today is Aug 14th so almost a complete year and still not doing so well.  I did intense therapy for the first 4 months and completely stopped after that due to family reasons.  My acl feels great and the knee is stable but my problem is the Quad muscle and my Calv muscle.  They completely dissapered and for the past month I been working out with heavy weights trying to target those two muscles but it doesn't seem like its working.  I wanted to ask you guys if it will be a permanent problem with those muscles since I disregarded them for about 5
Months.  Is it too late now? I gave up on soccer and all of sports I just want to have a normal whole around leg that actually looks similar to the other knw because right now my legs look like they belong to two completely differnt humans.  Any suggestions is much appreciated.  I am attaching a photo of the calves.
Thank You















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