Saturday, July 21, 2018

My Patient Was Told He "Just" Tore His Lateral Meniscus

Maybe it's not so obvious from just the picture above. But when I looked at my patient's legs, they were the first clue I received that perhaps there was something more than meets the eye.

He had gone on a skiing holiday in Whistler in March earlier this year and suffered a fall. After being brought to the physiotherapy clinic on site, they just gave him a knee brace and told him that he tore his lateral meniscus and that it will recover in a month or two. He actually felt fine after a few days of resting and thought he recovered fully after returning to New York where he's studying.

Two months later, when he tried to play tennis once, his right knee "gave way" and he had a very sharp pain for a few seconds. That actually subsided quite quickly too. Similarly on another occasion when he had a kick around game of football with his friends, his knee collapsed again.

He then mentioned that he wasn't confident about running, playing sport with his knee since even it seems to him that he'd recovered.

From what he told me, I immediately suspected he'd tore his Anterior Cruciate Ligament (ACL). Not wanting to "scare" him at first, I didn't say anything to my patient I went through all the ligament and joint testing thoroughly.

After checking his patellofemoral and tibia femoral joints, I did the Lachman's test, Reverse Pivot Shift test and the Anterior Drawer Test for the knee and they were all positive. (I seldom get a positive result for the Anterior Drawer Test but for him there was pain and a big difference in laxity compared to his other leg).

My patient was very shocked when I told him that he'd torn his ACL based on my assessment findings. He wasn't very convinced at first until I explained to him what I found based on his history, the positive orthopedic tests (and the fact that the physiotherapist in Whistler didn't actually examine him). Later he added that no wonder his knee never felt quite right after the skiing trip and now he knew the reason for it.
From my patient
He later went to see his general practitioner doctor and got a referral for a MRI scan and he later messaged me the result as you can see in the picture above.

After some consideration, he decided to do his ACL reconstruction yesterday in Singapore instead doing it elsewhere. Here's the picture he sent me upon discharge from hospital today.
Picture from my patient
It's not the the first time I have a patient who tore his ACL but the previous doctor/ medical practitioner/ physiotherapist they went to first missed it.

Please make sure whoever you see for your knee pain assesses your knee thoroughly.

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