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Suspected ACL injury. Others' input welcome!

post #1 of 4
Thread Starter 

I've read some other posts about ACL tears/partial tears, and I want to get input from others who have sustained this injury.  Here's my story:


About a year ago, I was playing basketball when another player who is much larger than I am plowed into me from the side.  My foot was firmly planted at the time (I've read cases where this scenario is common in ACL tears).  I felt something wrong occur in my knee, and I fell over.  I got back up after a moment and tried to continue playing, but something just didn't feel right.  The next day, I got on a plane back home.  The injury occurred while I was out of town for Spring Break.  When I got off the plane, my leg was really stiff.  I figured the plane ride made my knee situation worse, but I wasn't too worried about it because I wasn't in a lot of pain.  At first, I couldn't fully extend my injured leg, but the difference between leg extension in my injured and uninjured legs was very slight in my opinion. 


Still, I felt something was off, so I ended up going to my university's health clinic for diagnosis.  My doctor performed the Lachman test and suspected I had a torn ACL.  He referred me to the sports medicine doctor.  In the meantime, he gave me a knee immobilizer and told me to keep off my leg as much as possible & ice the knee for the next few days.  When I saw the sports medicine doctor, he also performed the Lachman test and confirmed I had torn my ACL.  He also said I had muscle atrophy from the injury.  The difference in muscle between my right & left leg muscles was very significant.  I was used to my leg muscles bulging out; after injury, my left muscle looked like it was completely gone. 


I was able to participate in "prehab"--physical therapy before surgery.  Since I was uninsured and since the dr said I could technically live without my ACL, I decided to postpone surgery until I had insurance.  At PT, my therapist took regular measurements of my knee so he could track the rate of swelling.  Some of the exercises I was completely unable to do right after injury--specifically, standing on the injured leg and bending at the knee to touch the ground (or edge of the bed in my case, but I couldn't even bend that far).  With hard work, I was eventually able to successfully perform that exercise and still do it on a regular basis now.


I haven't been the best at keeping up with my PT exercises, which I am supposed to do daily.  My muscle has recovered to an extent, but it still isn't as big as the one on my uninjured leg.  I basically have NO pain at all.  Recently, after finally getting health insurance through my employer, I decided to follow-up on my knee.  My general practitioner referred me to an orthopedic specialist.  Unfortunately, the guy I ended up seeing is primarily a foot/ankle dr, not a knee dr.  He ordered an MRI.  I just met with him this morning, and he said the MRI showed a normal ACL, and the only abnormal thing is some swelling.  The printout of the results says "Normal MRI of the left knee except for small joint effusion." 


I know I should be happy, but I can't help but think the MRI was wrong in light of all the information I was given at the initial time of injury.  Keep in mind that the MRI was just taken--about a year post-injury.  Even though the MRI says I'm "normal," the current dr. says my knee is still loose when performing the Lachman test.  However, he thinks I can safely go back to playing high-impact sports.


My question is, could my ACL possibly be intact?  My gut says to get a second opinion. 


I don't look forward to having knee surgery, but I DO want to go back to playing sports.  For the past year, all I've been doing is walking, biking, and using an elliptical machine.  The sports medicine dr. warned me not to play high-impact sports until I had knee surgery, for fear of causing greater injury to my knee (tearing the meniscus, etc.).


I wish there was a way to test my knee's stability without potentially causing greater damage to it. 


By the way, I have no pain, which from what I've read is common with only an ACL tear (unlike the MCL).  Also, I've not had any problem of my knee giving out on me, but again, I haven't been playing high-impact sports since the injury. 


What do you folks think?  Is it safe for me to play?  Should I trust the MRI?  Thanks in advance for your responses.

post #2 of 4

Get a copy of the MRI films. The films not the report. You can usually get them on a cd. Find a doc who specializes in knees and take the MRI film to him.  The peace of mind will be worth the price of the 2nd opinion.

post #3 of 4

It's quite possible that your original tear was misdiagnosed, but it's also possible that the MRI was wrong. A friend of mine just had the opposite experience, with the MRI showing a complete tear only to have the doctor find an intact ACL once she was inside his knee. Your symptoms are borderline, so it really could go either way.


I agree with skier31 - get a knee specialist to review the MRI, and repeat the manual tests on your leg. Even if the ACL is intact, if the tests show laxity you'll want to work on building up the muscle to provide extra stability for the knee before you go back to high impact sports. 


Good luck - I hope the MRI is right!

post #4 of 4

Your story sounds almost identical to mine. I hyperextended my knee playing basketball. It happened when I went for a lay up and was fouled hard and landed on my left foot sooner than expected. I knew very little about knee or acl injuries and had slightly hyperextended my knee before and thought since I could still walk it would just get better in a few weeks. I had major instability and it would easily "give out" for the first month or so after it happened. I was in school and had major medical insurance with a high deductible and didn't want to pay the money to get it checked out. After about 5 weeks it wasn't getting any better and I decided to get it checked out. I worked for the University of TN football program while in school though and their team doctors, physical therapists, and trainers checked me out for free. The physical therapist and OS were both very confident it was a torn acl. The trainers even used me as a guinea pig to let the student trainers perform the lachmann test to see what a torn acl feels like. They apparently don't often let them touch the players when they get these types of injuries. I held off on surgery because I knew I would be graduating soon and getting a job with better insurance. The PT gave me a prehab program which worked very well for me to regain my range of motion and a lot of my strength.


I now have a job and good insurance and finally went to see an OS where I live now and to see about getting surgery. I explained the whole situation to them and they performed the lachmann test and other stability tests and agreed that they were confident the acl was torn. You can feel and see a huge difference when they compare the bad knee to the good knee with the lachmann test. They tentatively scheduled me for surgery and ordered an mri. The radiologist report came back saying acl and all other ligaments fully intact but a partial meniscus tear. This was quite shocking since I have none of the symptoms of a meniscus tear. I've always heard from people with meiscus tears that they are quite painful all the time. I really haven't had any pain since immediately after the injury occured. I still have noticable instability but most of my daily functionality has been restored. I can even jog slowly (about 5 mph) on a treadmill now. I go back to see the OS this Thursday and I'm very anxious to see what he has to say. I'll post what I find out after then.


Have you done anything else about your knee since your post? You should definitely get another opinion. No matter what the radiologist and mri say I know 100% my knee is screwed up and I couldn't ski with it or play a high impact sport like basketball.

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