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The first clinic visit
Orthopedic surgeons who specialize in sports medicine are an excellent
medical resource for diagnosing and treating knee injuries. Whereas it
is often it is your primary care doctor who arranges your first consultation
with an orthopedic sports medicine surgeon. Many surgeons do see new patients
without a referral. Your first clinic visit to a sports medicine doctor
is a good time to learn more about what has happened to your knee and
what can be done about it. This is the best time to begin the process
of deciding how your injury will be treated.
The first clinic visit to a
sports medicine doctor after you have injured your knee often begins with
a careful evaluation and a set of x-rays of the knee. Your history and
physical examination are essential for making a correct diagnosis of the
type of injury you have sustained. One of the classic signs that you have
torn your ACL is called a positive "Lachman's test." This test demonstrates
that your knee has too much motion from front-to-back, indicating that
you have torn your ACL. While you may be very apprehensive about having
a doctor move your knee in order to examine it, this test usually does
not hurt, and is performed in the following way:
 A
routine set of x-rays of the knee is also an important part of the first
clinic visit. X-rays are used to estimate how much wear and tear you have
had to your knee before your injury, and they are also used to exclude
the possibility of a fracture of either the thigh bone (femur) or a part
of the shinbone (called the tibial plateau). Ligaments cannot be seen
on the x-ray, but in some cases, the X-rays can be very suggestive of
an ACL injury. Sometimes the ACL tears lose a piece of bone from a part
of the shinbone (called the tibial spine) where the ligament is normally
attached to the bone, and this is called an avulsion fracture. A "second"
fracture, where a tiny piece of bone is pulled away from the lateral side
of the knee, is also considered to be a definite sign of an ACL injury.
Although these fractures can occur when the ACL is injured, they are relative
rare.
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