ACL Injuries: Should You Trust Your Doctor's Diagnosis?

Anterior cruciate ligament (ACL)

I am currently serving on an outer island, and sometimes after running or walking for a long time, I feel a clicking sensation in my left knee.
When I move my knee, it feels like something is sliding inside, and at times, the knee feels unstable, prompting me to kick it slightly to loosen it up, which produces a faint sound.
I recall that five years ago, while playing basketball (after making a turn and jumping for a shot), I landed and experienced significant pain in my knee (I didn't notice if there were any unusual sounds).
The next day, it started to swell, and I went to see a traditional Chinese medicine practitioner who diagnosed it as a ligament strain.
I underwent rehabilitation and the condition improved, but since then, my knee often feels loose.
The practitioner mentioned that my ligaments might be relatively lax.
During my recent visit to Taiwan, I went to the orthopedic outpatient clinic at the Tri-Service General Hospital.
Initially, the doctor seemed to think I was exaggerating my symptoms and sent me for an X-ray.
When reviewing the X-ray, the doctor initially said there were no major issues, but then began to ask if I had noticed anything unusual.
Suddenly, the doctor informed me that there was a height discrepancy in the bones of my knee and asked me to lie down for a physical examination.
The doctor performed several movements on my left leg, pulling and pushing my calf, and I felt a slight instability.
When examining my right leg, it felt very stable.
The doctor then informed me that I had a torn anterior cruciate ligament (ACL).
The doctor was quite certain, but mentioned that an MRI was needed for confirmation.
However, I personally feel that it might not be that serious and worry that the height discrepancy could be due to my standing position during the X-ray.
Since scheduling an MRI takes a long time (and if I pay out of pocket, it would be a significant expense), I decided to use my health insurance.
Before returning to the outer island, I consulted with the doctor again to confirm if there could be any misunderstanding.
The doctor told me that the likelihood of not having a tear was very low, and given the doctor's specialty in ACL injuries and the height discrepancy seen on the X-ray, the MRI was only to provide additional confirmation.
However, since I will be returning to the outer island in November just to get the MRI and wait for the report, I am concerned that if it turns out to be nothing, I would have wasted my time off.
Although my knee does feel uncomfortable at times, it is not as severe as described in online information, and the situation does not fully align with a torn ACL.
Should I trust the doctor's diagnosis, or should I continue to manage my symptoms?

Cai Xiansheng, 20~29 year old female. Ask Date: 2012/11/11

Dr. Shi Guozheng reply Orthopedics

If the physician suspects that you have an anterior cruciate ligament (ACL) tear, further examination using MRI can be covered by health insurance.
Based on your description, it is likely an old tear, which may present with a feeling of looseness or instability.
During the examination, if the physician stabilizes the knee joint and pulls the lower leg forward, there may be an observable forward movement of the lower leg.
In a normal knee joint, this phenomenon would not occur.
Regardless, treatment is still necessary, as long-term joint instability can lead to premature degeneration of the joint.

Reply Date: 2012/11/11

More Info

When dealing with potential ACL (anterior cruciate ligament) injuries, it is crucial to understand the nature of the injury, the diagnostic process, and the importance of following through with medical advice. Based on your description, it seems you have experienced knee discomfort and instability, which could indeed suggest an ACL injury or other knee-related issues.

Firstly, the ACL is a critical ligament that helps stabilize the knee joint. Injuries to the ACL are common in sports, particularly those involving sudden stops, jumps, or changes in direction, such as basketball. The symptoms you describe—feeling of instability, a "catching" sensation, and occasional swelling—are consistent with ACL injuries. The fact that you experienced significant pain and swelling after your basketball incident five years ago further supports the possibility of a previous injury that may have predisposed you to current issues.

Your experience with the medical professionals is also noteworthy. It is not uncommon for initial assessments, such as X-rays, to miss soft tissue injuries like ACL tears, as X-rays primarily show bone structures. The fact that your doctor suggested an MRI is a standard procedure for confirming soft tissue injuries, including ACL tears. MRI is the gold standard for diagnosing ACL injuries because it provides detailed images of both the ligaments and surrounding structures.

Regarding your concerns about the doctor's diagnosis, it is essential to trust the expertise of medical professionals, especially if they specialize in orthopedics or sports medicine. The doctor’s assessment of a potential ACL tear, combined with the physical examination findings (such as the instability you felt during the manipulation of your knee), adds weight to their diagnosis. While it is natural to question the severity of your condition, especially if you feel that your symptoms are not as severe as described, it is crucial to consider that the absence of severe pain does not necessarily rule out a significant injury.

If you are hesitant about the diagnosis or the necessity of an MRI, consider the following steps:
1. Seek a Second Opinion: If possible, consult another orthopedic specialist. A fresh perspective may provide additional insights or reassurance regarding your condition.

2. Follow Through with the MRI: While it may seem like a hassle, obtaining an MRI can clarify the situation. It will either confirm the ACL tear or rule it out, allowing you to understand the best course of action for your knee.

3. Consider Rehabilitation: Regardless of the diagnosis, engaging in physical therapy can be beneficial. A physical therapist can help strengthen the muscles around your knee, improve stability, and potentially alleviate some of your symptoms.

4. Monitor Symptoms: Keep track of your symptoms. If you notice increased instability, pain, or swelling, it may indicate that the injury is more serious than initially thought.

5. Avoid High-Impact Activities: Until you have a definitive diagnosis, it may be wise to limit activities that put stress on your knee, such as running or jumping, to prevent further injury.

In conclusion, while it is understandable to have doubts about a diagnosis, especially when symptoms do not seem to align with the severity of the injury, it is essential to trust the medical professionals who evaluate you. They have the training and experience to assess your condition accurately. Taking proactive steps, such as obtaining an MRI and possibly seeking a second opinion, will help you make informed decisions about your health and ensure that you receive the appropriate care for your knee.

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