TORN ACL or NOT?

[vickster]

Have you been assessed by the PT yet?

[kneeProblem]

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.

[kneeProblem]

Can the scar tissue cause a false negative MRI???

[The KNEEguru]

'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.

[kneeProblem]

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.

[vickster]

Perhaps seek some help for the anxiety (e.g. sports psychology), coupled with physiotherapy, if the knee is solid

[The KNEEguru]

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.

[kneeProblem]

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.

[rnm37]

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

[kneeProblem]

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.

[kneeProblem]

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?

[Snowy]

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.

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.

[kneeProblem]

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

[kneeProblem]

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?