Exam or image...
I knew that my ACL was gone, so I reached out to my village, the talented Dr. Killie, immediately. I have treated enough patients to know that the amount of force it takes to tear the ACL can also cause significant damage to other structures.
A quick x-ray in her office two days later ruled out any type of fracture. Then her manual exam proved there was damage to the ACL and MCL. This was basically what I expected, but I am often blown away by a patient's insistence on getting imaging. I didn't need an MRI to know my ACL was gone...and neither did Dr. Killie. This, in fact, is what we go to school for: to learn examination skills. Based solely on her exam findings we had a very good idea that surgery was the next step, but SHE ORDERED AN MRI!
Why?!?!? Dr. Killie is a very experienced otheropedic surgeon, with years of training, lots of practice, and I consider her an expert. The Lachman Test (the gold standard used to test for the presence or absence of an ACL) is a well studied, valid and reliable tool, especially in the hands of an expert. You can see professional athletes get this test on the field with most knee injuries.
Years ago we didn't have the technology to image our bodies as we do now, and we relied on the expertise of our providers. Now that we can "see inside" it seems that many people feel we NEED to! In my case we did NEED to look inside; not because we were unsure of the exam findings, but because my health insurance required imaging prior to approving my surgery.
The interesting thing is how long it took to get the insurance company to APPROVE the MRI! I finally had the MRI on NOV 27th...17 days after my initial injury.
Can you guess what the MRI showed? It revealed a torn ACL, torn meniscus (potentially in two places), a ruptured cyst at the back of my knee, and a lateral collateral ligament strain.