The Diagnostic Arthroscopy: The First Step
Before I touch your ACL, before I even think about grafts or fixation, there is a step I never skip: the diagnostic arthroscopy. This is a systematic inspection of your entire knee joint through the camera, and it happens before I begin any reconstruction or repair. It takes about ten minutes, and it tells me exactly what I am dealing with — not just what the MRI suggested, but what is actually there.
Why I Do This First
An MRI gives me a very good picture, but it is still a picture. The diagnostic arthroscopy lets me see and feel the joint directly with a probe, confirming the extent of damage and picking up anything the scan may have missed or understated. This step shapes my entire operative plan — what needs fixing, and in what order.
What I Look At, and In What Order
The patella and trochlea first. Once the camera is in, I look upward at the patella cartilage — the thickest cartilage in the body — which is very likely to be normal. I then follow it down to where the patella articulates with the femoral trochlea. Occasionally I'll see small areas of cartilage fibrillation here, but these are usually inconsequential and don't change the surgical plan.
The ACL itself. Next, I look at the ACL directly, confirming the location and pattern of the tear — commonly torn in its midsubstance.
The lateral meniscus. I apply a gentle varus force to open up the lateral compartment of the knee. This gives me a full view of the entire lateral meniscus, and I use a probe to check whether it is loose or torn anywhere along its length.
The medial meniscus. I then apply a valgus force to open the medial compartment, allowing the same careful probing and inspection of the medial meniscus.
Why This Matters to You
This isn't a formality — it's the step that determines everything else. Whether your meniscus needs repair or can be left alone, whether there's cartilage damage that changes your rehab timeline, whether the ACL tear is exactly what we expected — all of this is confirmed here, before a single graft is prepared. It's why I tell patients that the surgical plan is only truly finalised once we're inside the knee.
If you're preparing for surgery and want to understand what comes next, you can read more at /acl/start.
Whatever we find in there, I go in with the same care I'd want for my own knee — trusting that steady hands and careful preparation, under God's grace, give every patient the best possible outcome.