TORN ACL or NOT?

[MDAL]

Yes, everything is possible. It's possible that your doctor made a mistake, and it's possible that you do have something there. Ask for a 3rd and 4th opinion... at least to get the answers in your mind.

And yes, if your lateral meniscus is totally out, and probably some cartilage has been consumed already, there will be a huge space missing (a meniscus is not that small) that might confuse tests.

About sports, you have a meniscus totally removed and maybe tears in the other... are you sure you actually want to do any sports at all? You have no meniscus, means no shock absorbing pillow, means all mechanical force going into the lateral side straight on the cartilage.

How long ago was the meniscus removed?

[vickster]

Where does he say he's had all of his lateral meniscus removed? If that's the case, and not an exaggeration, under 26, he should be seeking a transplant possibly?

After two ACL reconstructions  and meniscus removal, I wouldn't be wanting to do high impact sport either especially not without the appropriate conditioning and unloader/ACL brace., I'd be wanting to look after my knee for the next 50+ years of life. I don't know if the allografts are as strong as a well rehabbed autograft?

[MDAL]

Vickster:

In the initial post, first sentence.

And yes, I agree with you, I wouldn't go do sports that consist in jumping around too much... maybe swimming would be better.

About transplants, it's not easy to find a surgeon who does them and the current results are not always that much satisfactory... most doctors still prefer to align the bones to divide the weight... that at least would be easier to find a surgeon...

[kneeProblem]

Not sure if whole lateral was removed or if he 'trimmed' a part of it.  This was done 3-4 years ago when I got my 2nd acl surgery.  Yes I wan to continue sports, its the only reason I want the surgery or else I wouldnt do the operation if it is indeed needed.  I'm not even worried about arthiritis or anything I know how to cure it and minimize it if anything.  Im going to build up my leg with as much muscle support as possible as strong as a bodybuilder to prevent any further damage if I do get another surgery. :/

The only concern I have is with part of my meniscus removed, i heard its more likely for an ACL recon to fail, correct?  Forgot where I read this, but I heard revisions fail more not because its the second or third time, but because of the additional damage to the knee already.  So if that's true am I screwed?  I'm as depressed as I've ever been, it was just like yesterday where I was injury free and dominating my sport and thought about going pro, now I'm 3 surgeries in (2 ACLand meniscus lefy knee, 1 MCL/PCL right knee medial meniscus), PCL was never repaired buy the way as it was a partial ear and doctor said to just leave it alone it won't affect spors or heal any better with surgery.  Life really has fell apart for me

[MDAL]

I see, initial post gave the impression it was all removed... (probably my mistake in the interpretation), but if you are moving from doctor to doctor this is one piece of information that you should clear up in other to tell the exact story to the next doctor.

...and lateral meniscus already removed in the left knee.

[vickster]

Why should you be in a wheelchair?  ACL reconstructions are very frequently done and mostly successful but you do have to rehab, follow your physio and surgeon instructions and take precautions if necessary, but there's no reason why you shouldn't play whatever sport you want as long as physically and mentally ready

Are you having physio / doing proper sports conditioning as an earlier poster suggested?

[kneeProblem]

Not sure if it was a total removal of lateral meniscus or not, but i look at my knee and there is a 'gap' there, so it looks like the whole lateral meniscus is gone. 

Also I received the MRI cd and like they said before ACL is intact and its clear the whole ligament is black and connected on the MRI.  From my understanding, black on an MRI means its not torn.  There is some damage to the medial meniscus as well if I remember correctly from my doctor after reviewing the MRI. 

Will see another doctor on monday and will give him the MRI and let him decide for himself.  I'm sure I'll fail the pivot shift test again and everything else.  Did my research on this doc as well and he seems to be very good and respected and is not in it for the 'money' as some tend to be or give off that vibe making it hard to trust.  So we'll see what happens on Monday.  Also from doing research MRIs almost never give false negatives, I read a study where MRIs are 98% correct on identifying a normal ACL and 90% on identifying a torn acl.  So the statistics are on my side?

Here is the link to the study.

https://ispub.com/IJOS/5/1/4775

Here is the pasted paragraph im referring to in case you cant find it.

"Imaging for anterior cruciate tear yielded seventeen true positive, one hundred and eighteen true negatives, three false positives and two false negatives results. The sensitivity, i.e. the ability of MRI to identify correctly those who had anterior cruciate ligament tear, was 89.47%. The specificity i.e. the ability of MRI to diagnose correctly all those who had no anterior cruciate ligament tear, was 97.52%. The positive predictive value of imaging, therefore, was 85% and negative predictive value was 98.33%."

So basically the MRI was accurate in 17/20 for true acl tears and 118/120 in normal acls(no tear). I like my chances? lol

[vickster]

I don't know how you can tell that you have no lateral meniscus unless you have gone bow legged or knock kneed as a result.  The meniscus sits between the bones, it's not visible, only pain and swelling caused are palpable. You can see on an MRI or xray if the joint space is affected.  In which case, a stretched ACL wouldn't be your main issue. After 3 or 4 years of no lateral  meniscus, you would likely be suffering some degree of damage to the bone surfaces

Good luck with your apointment on Monday. Presumably you have all your notes ready, although let the surgeon examine you, look at the mri and take a history to make his own mind up

[kneeProblem]

"Imaging for anterior cruciate tear yielded seventeen true positive, one hundred and eighteen true negatives, three false positives and two false negatives results. The sensitivity, i.e. the ability of MRI to identify correctly those who had anterior cruciate ligament tear, was 89.47%. The specificity i.e. the ability of MRI to diagnose correctly all those who had no anterior cruciate ligament tear, was 97.52%. The positive predictive value of imaging, therefore, was 85% and negative predictive value was 98.33%."

[MDAL]

KneeProblem:

You are not considering one aspect, the person analyzing the MRI. Put 10 people analyzing independently the same MRI and don't be surprised that they would come up with significant discrepancies...

The stats you are quoting are about the precision of whoever analyzed them, not general MRI analysis. And considering that this was part of a study it's plausible that they put much more effort navigating the images back and forth than what is done in a busy random hospital out there.

Aside this you also need to consider the MRI machine. That study was done with a 1.5, current ones are 3.0... and let's not even go into current digital image processing modules and the definition of computer screens... that study was probably done in an old CRT monitor.

Relax, if you have no symptoms just try enjoy life and try to stop torturing yourself...

[kneeProblem]

I cant enjoy life if im not playing sports.  I have no symptoms but U can care less about no symptoms if im not active.  I need to go test out my leg once and for all and get to the bottom of this lol.

[vickster]

That sounds like a plan, but do it with a physiotherapist or a trainer.  If you've done no sport for several years. you will be somewhat out of condition, you'll need help with mental barrier you have too.

Talk to the doctor about a referral for therapy

[MDAL]

That sounds like a plan, but do it with a physiotherapist or a trainer.  If you've done no sport for several years. you will be somewhat out of condition, you'll need help with mental barrier you have too.

Talk to the doctor about a referral for therapy

This!

[mmrocker13]

Few things...
One study is just one study. So be careful making generalizations based on a single study.

Second, a total mensicectomy is rare, esp. now. They will keep as much as the possibly can, even if it's just a tiny fraction of the rim. I've had a bunch of partials, and I didn't get to sub-total until a few years ago (about 5-10% remaining--the rim of the posterior horn). My most recent surgery included a resection of the last remaining bit, which had turned to unstable fuzz So, to get from a clip to a total took me a long time and a bunch of procedures. there's almost always a piece left to salvage (well, until there isn't ).

" I'm not even worried about arthiritis or anything I know how to cure it and minimize it if anything." Well then, you should do your own journal article, b/c if you've got a cure for OA, you're poised to be a bajillionaire.

Seriously, though, OA complicates things--even if you are managing it well. Example, docs will do a meniscal transplant and an ACL repair...but add in larger cartilage defects, and they start to back away. I am a candidate for neither a transplant nor cartilage repair--they won't do cartilage work anymore, b/c i have no meniscus (well, now I have too big of OA lesions for anything to work, anyway); and they won't give me a meniscus, as I have too big of lesions (IOW, my OA is too advanced).

I would really, really, really recommend you getting into a sports specific PT and have your flexibility and strength and function assessed, and then address all of your weaknesses/imbalances, and make a safe return to sport. (And may clear up any issues you ARE having, in addition to staving off future ones).

YOu aren't having any symptoms...your life is miserable without your athletics (what sport are you involved with, again?). So get back into it. Go to a therapist and get a total eval, and work out a plan.

[kneeProblem]

Went for my second opinion today and the new doctor said my knee is stable and used the term rock solid.  He did all the tests and the pivot shift and I passed.  There was no clunk or shift this time around with the pivot shift surprisingly, but I feel as if he didn't press hard enough or maybe I was guarding a bit not sure.  He also looked at the MRI as well and probably confirmed his diagnosis that nothing is wrong.  Looking at the radiology report there was a very small tear in meniscus can't remember if he said posterior horn or what not but he said it shouldn't be a problem.

Now the question is, did he just not want to get involved in my knee seeing that the ACLwas operated on already l and didn't want to get into someone else's work because it might not turn out well? Or did he not test my knee correctly? Kind of weird getting different views from multiple doctors, I don't know who to believe and whether or not its torn still.