TORN ACL or NOT?

[kneeProblem]

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

[MDAL]

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?

[kneeProblem]

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.

[kneeProblem]

help anyone??!

[rnm37]

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

[kneeProblem]

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.

[MDAL]

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...

[kneeProblem]

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?

[rnm37]

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

[mmrocker13]

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.

[Audice]

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.

[kneeProblem]

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.

[vickster]

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

[mmrocker13]

"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.

[kneeProblem]

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?