NO Pain and NO Inflammation: ACL/MCL Injury ?

[Tennis-Player]

Hi,

I was playing tennis and jumped to hit my opponent's lob shot. I am not sure if it happened midair or while I came down, but I landed horribly wrong, twisted my knee and fell to the ground.

I got up in 10-15 minutes and was able to put some weight on my left leg. There was no inflammation and I hobbled back to my car and put ice on it after getting home. I was able to elevate my leg and stretch it. Whatever little pain was there seemed to reduce over the next day ot two and I was able to place weight on my left foot and walk like usual.

4 days after this happened, I went to the Orthopedic surgeon and by this time, the pain was completely gone with absolutely NO swelling/inflammation from the start. The only knee motion that I felt was restricted was bending the knee as much as I do and I could not squat. There seems to be some tenderness on the inside of my left knee. The Orhtopedic surgeon took an X-ray to rule out fracture, twisted my leg in various directions and said I may have torn my ACL. He told me to have an MRI done.

This is what confuses me. There was no inflammation, there is no pain and I have most of my leg motion back but could it be an ACL tear ? From what I gather ACL tears are accompanied by severe inflammation and intense pain. I did not experience any of these symptoms.

Well, I had my MRI done and am awaiting the report which should be out in a couple of days. I thought the group may be interested in the ongoing diagnosis and if they have any comments on this.

Comments ??

[jathib]

ACL injuries can fool you. I tore mine completely in half. There was no pop but I had intense pain for a few minutes and then I got up and walked home. I had very little swelling and was walking pretty much normal within a few days. My only problem was not being able to straighten my knee. I didn't go to the doctor because I was 15 and my parents didn't take me to the doctor since I had very little pain and no swelling. In a couple weeks I was playing volleyball and landed on my knee again. This was the worst pain I have ever felt in my life. I could not walk. The doctor said the first injury tore the ligament and my knee collapsed the second time from the instability in my knee.

So don't be fooled by your lack of symptoms. My brother didn't even know it when he tore his, he just had some nagging pain for several months and finally saw a doctor. Tendons and ligaments hurt when they tear but once they're torn there's really nothing there to hurt.

[feeny]

I had 3 out of 4 ligaments torn including acl - no instability at all and swelling went quickly.

It took 3 OS before one diagnosed me!

MRI showed it all - and people couldnt believe that this MRI belonged to my knee. But it did.
I hope all is fine and its nothing - let us know how it goes.

[Tennis-Player]

Thanks for the input...

Well the MRI results were in and the verdict --- Complete ACL Rupture...

I must comment that I just cannot tell that I had this injury 10 days back. I can walk as usual and can do Yoga exercises as usual.

So members of this forum may want to watch out. There can be complete ACL rupture without the infamous "pop", without inflammation or without pain beyond a few hours.

Well now is the time for some thinking. I have an appointment with the DOC next week so lets see what he has to say..

will keep you all posted

[feeny]

I had similar experiences to you.

One thing that ALL the OS's agreed upon was that despite no evidence of instability - it would deteriorate with time for certain.
Now, I dont know if they were or weren't right - ask the barber if you need a haircut and they always say "yes", right?

But... that, combined with their informing me that without surgery, it would not only get worse, but because the knee would be deficient it would damage other surrounding structures was alarming enough for me to decide on the surgical road.

A good OS will ask you about the activities you do - most of mine said that if my activities were gym, jogging, base line tennis, yoga etc that I definitely could live without problems with no ACL.... however if I were to continue snowboarding and playing soccer - I would have problems.

I didnt test it - I had mine recon'd 5 weeks after injury.

[jathib]

I must comment that I just cannot tell that I had this injury 10 days back. I can walk as usual and can do Yoga exercises as usual.

So members of this forum may want to watch out. There can be complete ACL rupture without the infamous "pop", without inflammation or without pain beyond a few hours.

That was pretty much exactly what I experienced. Do yourself a favor and get the reconstructive surgery. I wasn't able to because it hadn't been developed why I sustained my injury. The result was a torn meniscus less than six months later. An injury that has dogged me for 35 years and finally ended with me needing a partial knee replacement. I did have my ACL rebuilt 17 years after my injury but the damage from instability was already done. I have not had a problem with it 18 years post-op but the torn meniscus was a devastating injury.

[macygasp]

I have completely torn my right ACL and I can't even tell how I managed to do it! There was only one incident, landing kinda hard on the leg and a minor pain in the knee for about 5 minutes, afterwards.
No swelling, no popping, no knee instability, nothing... later on, a mild pain occured besides the kneecap which turned out to be a torn meniscus.
What I can tell about the popped ACL (by comparing with the good knee) is that the knee felt kinda "empty" inside, like there was something missing (perhaps this was only psychological, since I knew about the torn ACL)...

[Flowers]

I hope this thread is still alive as the "story" here is the best fit I've found for my knee situation. For the original poster or any others with the "no pain and no inflamation" case - any more news to share?

A week ago I woke up with a swollen right knee, no pain, just a weird feeling during bending. The swelling has gone down, but it kind of feels like there is swelling inside, hard to describe, but weird is the best I can do. If I try to flex it very far, it feels like it can go no further due to internal swelling, not due to pain. Can kneel but can't kneel and sit on my heels. I can walk, do leg lifts, and other normal, non-knee-stressing exercises with no pain.

The descriptions of torn ACL with no pain or real symptoms has me scared. Sure, I need to see a doctor, but I like to be armed with my own ideas about what's going on first!

[loz8]

Ok, some good points on here as lots of peoples injuries are so different - I partially tore mine and at the time it was the worst pain i have ever experienced, when it completely went some years later i tried to run it off!! So you do have different sensations - furthermore i continued to play sports and a month or to I remember chasing a ball and literally it just completlety gave way on me - a very odd sensation indeed.

What I would say is that if tennis is your sport (which it appears to be from your username) I am fairly sure that your OS will only offer one course of action if you want to continue to play reasonably even tho you feel it has some stability now. I play decent county level tennis and still find the pivoting (particularly on all weather) harder on my reconned knee than playing football!

One thing I would say is that if you are in a postion of no pain, swelling and decent stability but do still decide to have a recon then use this time well whilst you are in good shape to prepare the other muscles for the op. It stands you in excellent sted for the op and rehab. You can start that now whatever...

I hope it goes ok, let us know what you do...

Flowers, the only way you will know as feeny and others have said is an MRI, it can be many things not just a ruptured ACL so stay positive. I think the way ACL is talked about in the world of sport means we always fear the worst but it that is not always the case.
Loz

[Audice]

I had breathtaking pain initially & did hear two pops but after sitting on the ground for a short time, I got up, got back on my horse & did what I'd set out to do. By that day's end I had an enormous knee that hurt so badly I could barely walk but two weeks later when I had my OS appointment I walked in w/o a limp.

My knee, however, remained swollen for a very long time & inevitably at the end of each day for months thereafter, it was swollen. Because I've had no repairs made it'll still swell if I've been up & active all day. Just a way of life for me...Ellie

[chrislowe3231]

I do agree, people seem to react differently to the same sort of injury.

I was told by the doc i had a "badly brusied" knee after llanding on it funny, but had no pop, or nothing, but the pain was terrible. going ahead with the doc, i just rested it and played football again in two month's and then the same thing happened.

Knee was completly swollen like a mini soccer ball, and went to hospital again, and the doc said by doing a few function tests felt like a ruptured ACL.Am awaiting for my MRI results as i write this.

At the moment i have no pain, got full movement, but i have a bit of swelling still which is saying there is just something not right. so am preparing for the worst!!

But dont be too disheartend, its not the end of the world!

[Nicole43]

So glad that I found this thread as I too had little pain and only moderate swelling which went down within days. I was beginning to feel my MRI scan which shows a full tear was a mistake.

I also like to play tennis so need to think carefully about what to do next.
Nicole

[feeny]

Nicole, a good OS should be able to demonstrate to you through physical examination where the instability is in your knee.
Mine managed to do this through a pivot shift jerk test - that was better proof for me than an MRI - having someone show me on my own knee what it was no longer capable of doing on its own.

[Charliemouse]

Mine was pop, immediate pain and I knew I'd done something more than a mucle sprain. Unfortunately no one else took any notice of my concerns at A+E because of the lack of swelling and pain.
I always looked away when the consultant did his exam (after the 1st)as it always looked so wrong!

[tennis_girl]

Wow, I thought that I was the only one with little pain and no swelling!!!!
I tore my Right ACL 3 yrs. ago, and it was the hardest thing to get diagnosed. Even tore/stretched the PLC in the back of the knee.
I essentially hurt my knee one night while playing tennis. I was going fast, laterally to cut off a ball, stopped, ankle went under, knee and hip go outward. Knew something was not right, after I got my balance and composed myself. Walked on the leg to my car, it felt wobbly, but didn't hurt that much. When I went to bed, it was ok. Got up the next a.m., no swelling, but couldn't straighten it out all the way. It hurt as I tried to turn on the leg. When I pivoted, I wound up on the ground! Ok, 3 days later, I was fine. I mean that the fullness feeling in my knee was gone, I still had some trouble in the a.m. straightening the leg, but could get it straightened with some work. I really notice that something was not right when I would drive. When I would have to go from the accelerator to the brake, a sharp shooting pain would "fly" through my knee. I knew something was not right.

So.... found out through a scope that the ACL was torn and had reattached to the PCL, which gave the image of it being still attached. It was described as "non functioning."
I went for 2 yrs. thinking that maybe my knee isn't all that bad. Just couldn't believe that I messed up my knee so badly with so little pain and swelling. It took so long to finally get a diagnosis. You just have to listen to your body and find a dr. that really listens to you, and doesn't just rely on the standard tests. I know they are the reliant on MRI's and x-rays, but when they come up neg. and you still have the functional problems, it is sometimes hard to get answers, or even a dr. that takes your injury seriously.