Diagnosis

It was now the day after Christmas and I sat in the exam room of an orthopedic doctor - a hip, knee, and shoulder specialist. He looked to be about twenty-six, but maybe, I considered, he was just unusually diligent with the moisturizer. My knee had swelled moderately overnight but I could still stand on it without any problem. My range of motion in the ER the night before was almost 100% but now it was reduced to less than half – from about 20 degrees at extension to about 70 degrees at flexion, with extreme pain and pressure on either end of the range. I explained to the doctor what had happened and he helped me onto the table where he did some very controlled tugging and pulling. Then he said, “Well, your knee’s pretty loose, boss.” A short educational discourse on the knee followed, complete with generous helpings of medical acronyms and frequent bits of Latin to describe the likely scenarios of my condition and then, just before my mind wandered off for good he gave a firm yank on the mental leash with the words “probably recommend surgery.” I quickly ran back through his dissertation trying to locate the logical transition between “pretty loose” and “surgery”. Somehow he must have recognized the frantic search in my face because he said, “I know, it’s a lot to digest all at once.” I mumbled my agreement. He would of course need an MRI to be sure, but he said he was 80% certain that I had torn at least the ACL. He recommended rest, ice, and elevation, and then he said, “I know this doesn’t sound right, but try to move it once in a while.”

An MRI comes with two parts: 1.) Films, which I received immediately after the MRI was performed, and 2.) A report of findings, which was to be prepared within a few days. Despite having never seen MRI films before, I had done just enough internet research by that point to have a vague idea of the anatomy in question. The ACL can typically be seen from the cross section that shows the profile view near the center of the knee. In my case, where I expected to see the ACL, I saw nothing but a blur of pain and debris. Nothing else looked obvious, except for a lot of thin, jagged lines in the top of the tibia and bottom of the femur (bruising of the bones I was later told), and a line in the medial meniscus, which looked to me like a possible tear. Still, I held out hope for my ACL as I talked to other people who had been through the injury and I compared their symptoms to my own. I researched the surgical options for reconstruction and none of them were good. In order to get any sleep at all for those first few nights I clung with increasing dedication to the 20% uncertainty of the doctor and my own likely inability to accurately interpret the MRI. And then the following Tuesday I had a follow-up appointment and the nurse handed me the MRI report and left me alone in the exam room. My eyes skipped down to the report summary:

1.) Complete tear of the ACL near the femoral attachment.

I stopped reading but continued to stare at the paper. The words were short and simple and impossible to misinterpret. A week’s worth of devoted optimism and wishful thinking had apparently not been enough to change reality. And the reality was that my knee had been seriously and permanently damaged in a instant on Christmas day. To my surprise, dealing with the physical aspect of the injury, at least initially, would be only half of the battle.