ACL Reconstruction: Seeking Advice After New Knee Injury

Q: ACL Reconstruction: Seeking Advice After New Knee Injury

Hello Mr. <br>Tsai：<br>Q1： I recommend that you apply ice and use a bandage to protect your right knee for the next two to three days to prevent further injury. <br>Since you are responding on Thursday morning, I suggest you come to my clinic for treatment in the afternoon.<br>Q2

Dr. Lai, you previously performed an anterior cruciate ligament (ACL) reconstruction surgery on me?

Dear Dr.
Lai,
Hello.
You performed a left anterior cruciate ligament reconstruction and meniscectomy on me at Renai Hospital in May 1998.
My ID number is .
Yesterday (12/24), I twisted my right knee while running, and it feels very similar to the injury I had back then.
Since your clinic is on Thursday, and I can only bend my knee about 90 degrees now, with pain when I try to bend it further, I would like to ask you the following questions:
Q1: Which doctor would you recommend I see (on Monday or Tuesday)? Or should I wait until Thursday to see you?
Q2: Is my anterior cruciate ligament inherently weaker? Why do both of my knees seem prone to injury?
Q3: Can an X-ray determine if there is a partial tear, or is an arthroscopy necessary? I really do not want to go through the painful experience I had seven years ago.
Sincerely,
Cai

Tsai, 20~29 year old female. Ask Date: 2005/12/25

Dr. Lai Qiren reply Orthopedics

Hello Mr.
Tsai:
Q1: I recommend that you apply ice and use a bandage to protect your right knee for the next two to three days to prevent further injury.
Since you are responding on Thursday morning, I suggest you come to my clinic for treatment in the afternoon.
Q2: You need to be particularly cautious when exercising with an injured knee, especially ensuring that you warm up thoroughly and take proper protective measures.
There is no evidence to suggest that the cruciate ligaments are inherently weaker; however, the likelihood of cruciate ligament injury is related to the strength of the muscles around the knee joint, as well as the correctness of your exercise techniques and posture.
Q3: You can start with an X-ray to rule out any bone pathology.
If there is suspicion of a further tear of the cruciate ligament, an MRI can be performed.

Reply Date: 2005/12/25

More Info

Hello, 蔡先生,
Thank you for reaching out regarding your recent knee injury. I understand how concerning it can be to experience similar symptoms to your previous ACL injury. Let me address your questions one by one.

Q1: Which doctor should I see? Should I wait until Thursday to see you?
Given the nature of your injury and the fact that you are experiencing pain and limited range of motion, I would recommend that you seek medical attention as soon as possible. If you can find an orthopedic specialist who is experienced in knee injuries, it would be beneficial to see them on Monday or Tuesday. They may be able to perform an initial assessment and possibly order imaging studies like an X-ray or MRI to evaluate the extent of your injury. If you cannot get an appointment with a specialist before Thursday, then it would be best to wait and see me, as I am familiar with your medical history and can provide a comprehensive evaluation.

Q2: Is my ACL genetically weaker? Why do both knees seem prone to injury?
While some individuals may have a genetic predisposition to ligamentous laxity or weaker connective tissues, it is essential to consider other factors that could contribute to recurrent injuries. These may include biomechanics, muscle strength, and training methods. If your quadriceps and hamstring muscles are not adequately balanced or if there are issues with your gait or foot alignment, this could increase the risk of injury to both knees. Additionally, previous injuries can lead to changes in movement patterns that may predispose you to further injuries. A thorough evaluation by a physical therapist or sports medicine specialist may help identify any underlying issues that could be addressed to reduce your risk of future injuries.

Q3: Can an X-ray determine if there is a partial tear, or do I need an arthroscopy?
X-rays are excellent for assessing bone injuries, such as fractures, but they are not very effective in evaluating soft tissue injuries like ligament tears. An MRI is the preferred imaging modality for assessing the integrity of the ACL and other ligaments, as it provides detailed images of soft tissues. If there is a suspicion of a significant injury based on your symptoms and physical examination, an MRI would be warranted to determine the extent of the damage. An arthroscopy, while more invasive, is typically reserved for cases where there is a need for direct visualization and potential surgical intervention.

In summary, I recommend seeking immediate evaluation from an orthopedic specialist if possible. They can provide a timely assessment and appropriate imaging to determine the nature of your injury. Understanding the mechanics of your knee and addressing any underlying issues will be crucial in preventing future injuries.
Please take care of yourself, and I hope to see you soon for a thorough evaluation.

Best regards,
施醫生

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