Cruciate ligaments :

Unhappy triad/ O'Donoghues syndrome? - - Posted by wazza (wazza), 5 December 2004

I am a sports active 30 yr old male in the UK and I injured my knee( first knee injury)  playing rugby 7 days ago. I hurt it in a tackle I did not hear any popping or feel any major pain but when I tried to run it felt like my leg was locking. I did not get any swelling of note and pain was minimal I decided to go to the A&E the following day as it felt like it wanted to lock and made loud click noises if I staightened it. They X rayed my knee no MRI scan and diagnosed it as O'donahues syndrome I researched on the net and found this to also be called an unhappy triad. They have put me in plaster ankle to top of my thigh for 5 weeks. I have ben told by a physio that this is very long and would make my leg very weak one of my worries is that I am using the NHS ( National Health Service)  and I wonder if the consultant did this as the OS I next see is only back in January, and from what I have heard from a friend who did his ACL I could wait 8 months or more until surgery. If this was the case would waiting that long for surgery be detrimental for my knee and prospets of recovery? I am prepared to pay for private treatment if it means I have better chance of recovery by having treatment/ surgery now. My friend who waited so long for surgery still limps now 18 months after surgery I am not worried about playing rugby again just want to be able to lead an active lifestle again. Any advice would be most welcome.  
 
 

Posted by libertynm (libertynm), 13 December 2004

Hi,

Can you get a second opinion?
The plaster might have been to allow your MCL to heal (for some reason MCLs can do this while ACLs rarely do).  As you are aware, you will lose some muscle mass because of the immobilization.  You can build it back, though.

I did wait 8 months for my ACL reconstruction.  The decision to wait was a mixture of balancing life/school demands and having my surgeon agree that we should go ahead with the surgery.  

It would be probably be best to be careful with you knee if you do decide to wait (ie not to do cutting/twisting/turning activities, contact sports, etc).  That way you can prevent further damage to the knee.  I spent 6 of my 8 months of waiting building up my leg muscles through physiotherapy exercises.  I have to say that my knee was giving me a lot more trouble in the last three months before the surgery.  My physiotherapist ended up letting me borrow an old hinged locking brace that he had on hand (that relieved a bunch of the pain as I could no longer hyperextend the knee).

If private treatment is an option, you may want to go that route to get it done with sooner.  I was about wits end by the time I had the surgery from being away from the activities I loved so much.  Having your surgery 8 months earlier would mean that you could return to your activities sooner. . .

Good luck with your decision and all the best to you. . .

Sincerely,
Nesanet
Posted by wazza (wazza), 13 December 2004

Hi Nesanet

Thanks for the advice, I went to a private OS and it turns out that I had the wrong diagnosis. Copy and paste the link below to read the full story.

Cheers

Warren

http://www.kneeguru.co.uk/cgi-bin/KNEEtalk/YaBB.pl?board=1;action=display;num=1102274446
Posted by KJ (KJ), 15 December 2004

I'm sorry to disagree with your management but plaster casting of knee ligament injuries is certainly not standard practice amongst knee surgeons. (It was many years ago)
Even with complete ACL and MCL tears  you would normally be put in a brace allowing you to keep a reasonable range of motion - otherwise your leg is going to get extremely stiff and you may have difficulty getting flexion and extension back.

Its true that an ACL reconstruction may take months on the NHS but that doesn't necessarily matter. It is more important that you get the right Rx now and let the knee settle down and recover full movement.  Ask your GP or A&E doctor if you can see a knee surgeon. It is quite a reasonable request, it should also be possible to have an NHS MRI scan.

Where are you based?

I have had a multiligament injury (ACL, MCL, PCL etc) treated on the NHS so have come to know quite a lot about how the system works, (I am also a GP)
I used to worry about upsetting people and so didn't query my original treatment, 3 years on I wish I had been more questioning and then my recovery might have been easier.

I absolutely agree with your physio - 8 weeks in plaster is not common treatment. Ask her who you should go and see)
Good luck
Jane

(PS you could message me if you want to discuss local details!

Posted by andrewc (AndrewC), 16 December 2004

Hi there KJ

If you click on the Link highlighted in blue above you will see the conclusion of this topic which the individual posted in both the "general" and "cruciates" section of this board!

Fortunately for him the situation was resolved with a Private Consultation with a specialist knee surgeon at a top London Clinic....it makes an interesting read!

Seems it was an SHO in casualty or similiar who decided he had an unhappy triad injury and prescribed such an innapropriate course of treatment....eg/ cast etc


Posted by Elly (Elly), 29 December 2004

A little word of advice...

Just be careful what kind of activities you do whilst you wait for surgery.

Regardless of whether you are definately having surgery, try and get a physio referal from GP, Ortho consultant, or even pay for a private session if you can afford it.

Anything involving twisting/direction change/high impact may run the risk of re-spraining the joint and causing more meniscal damage.

For a number of reasons it's nearly been 3 years since I tore my acl and I'm only just going in for the surgery, but my knee has slowly got worse due to many many many mild-moderate re-sprainings!

I actually invested in a hinges knee brace for protection of the joint on high activity which helped, but even with that there was an element of minor re-spraining.

Best wishes,
Elly  x
Posted by wazza (wazza), 30 December 2004

Thanks for the advice, I have been @ physio and have been taking it easy on the knee I have just started cycling @ the gym. Will be staying away from the pivitol/ high impact  type sports for  @ least 6 -9 months.

Cheers

Warren

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