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Author Topic: Instability + chronic ACL tear, treatment options?  (Read 5975 times)

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Offline Kathy_C

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Instability + chronic ACL tear, treatment options?
« on: December 24, 2002, 11:17:42 AM »
Hello, I'm new to this board but not new to knee problems having suffered in silence for 30 years!. I've had knee stability problems ever since damaging my left knee hurdling at school and over the years I've got pretty good at avoidance strategies (including throwing myself over to take pressure off the knee if I feel it start to go!).  I have about 5 or 6 instability episodes a year. The aftermath of the knee giving way varies according to how badly it "went" varying from feeling the knee crunch but no lasting pain, to a worst case scenario of swelling and pain lasting for 2 weeks. I like to keep fit (avoiding all ball games which are too risky) and  do running (carefully on smooth surfaces), circuit training, gym, swimming etc. but the thing most likely to cause problems is walking, particulary on on uneven surfaces, because then I can't contol the knee position so well. It actually takes very little to make the knee "go", e.g. my dog accidentally barging the side of the knee, of if he takes off after a rabbit when I have him on the lead.  On one occasion I was crossing the road and a car driver waved me across. I lost concentration and hurried in order to avoid inconveniencing the motorist, and the knee gave way. The summer before last I was walking down my garden (which is uneven and downward sloping). The knee gave way only this time  it was considerably more painful than before and it took months before it felt OK. This was when I decided I'd better have it looked at.  I'd tried twice before but due to long waiting lists I'd always moved on before getting an appointment (this is the UK!). After 18 months  (the consultant marked it urgent!). I finally had an arthroscopy a few weeks ago which showed an absent ACL (ruptured 30 years ago and mostly resorbed!), some frayed cartilage which was trimmed, and some arthritis developing. I was also told that I have extremely well developed supporting musculature. I have a follow up appointment in early January. What I'd like to know is:
1. Am I likely to be offered a reconstruction? I'm told this is physically possible).
2. Do I have any say in the matter?
3. What are the pro's and cons?
I'm very conscious that at 47 I am very fit and strong, but as I get older, I may get less steady on my feet and when muscle wastage  occurs the knee is likely to get more unstable with a greater likelihood of a fall.  Also I'm less likely to be getting my exercise at the gym and more likely to be walking, which is the very activity that poses the most risk (unless I stick to pavements which would be pretty boring!)  I'm also conscious that each episode of instability is likely to cause more damage to the knee itself.

Thanks for listening, hope you haven't all fallen asleep!

Kathy
« Last Edit: January 07, 2003, 01:29:29 PM by liga_mod »
Ruptured ACL 1973 hurdling, arthroscopy & meniscus trim November 2002. Recon 27th August 2003 (hamstring).

Offline Shazinoz

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Re: Advice please!
« Reply #1 on: December 24, 2002, 03:05:07 PM »
I know where you are coming from I have had my left ACL reconstructed twice already and looking at a possible 3rd now (this is not particularly NORMAL and I am not NORMAL I have a genetic connective tissue disorder that causes extreme flexibility in my connective tissue (ie ligamants and more) and I tend to tear and stretch my ligaments VERY VERY easily).
As to your questions You can live without a ACL if your knee is muscularly strong enough but as it seems that your instability is worse now and you have extra damage such as cartliage and arthritis a Reconstruction may be offered. You ALWAYS have a say in the matter you can say NO or you can recommend that you would prefer the reconstruction even if it isn't offered by the OSup front. It is your body and you have the right to suggest, and scream to get the treatment you need you also have the right to refuse or put off the decision. IT IS YOUR BODY it is your choice 100%.
Pro's:-  After surgery your knee should be stronger with no "giving way" ;It will or should reduce further cartliage damage and meniscal damage and also limit the amount of extra athritis (nothing can cure what you already have);It should stop the problems you mentioned as you get older (and as you know as you get older you heal more slowly (47 is better than 77);
Cons: Long Rehab and it is painful (i am not going to lie to you), you will be on crutches for a minimum of a week (normally) and may or may not be in a brace (it seems to depend on countries, doctors etc);

I hope this helps a little and lets you know you aren't alone (I am 31 and have stuffed knees (not to mention the rest of my body, OH boy wont go there).
2 ACL 'reco's', 3 'scopes', Pain, JRA, EDS, RSD, CMP, osetochondral defect & #, synovitis, adhesions, nerve damage, foot drop, MCL damage, tendonitis, fibrosis, ligament damage AGAIN, dislocations +++

Offline Tommy_the_Villan

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Re: Advice please!
« Reply #2 on: December 24, 2002, 07:09:23 PM »
 ;)
I am also from the UK and damaged my knee playing soccer on Astroturf seven years ago. I'm a 33 yr old man. At the time it swelled up and I had sports PT on it with painkillers. I was referred by my GP to a consultant OS and 12 mths later saw him in Hertfordshire, as it was weak and giving way. He performed an arthroscopy on my right knee, trimmed my meniscus and diagnosed a partially torn ACL, he advised me to play no really physical sports (golf and tiddlywinks were OK). I was mortified as I had been sporty all my life and enjoyed regular soccer games and squash matches. He told me I could build up my muscles either side to compensate and the joint should hold. Over the past five years the knee has given way when either squatting down, rolling around play fighting with my two young sons, or walking on uneven surfaces like you. Last December it gave way and locked as I was adjusting a chair under a table! After spending 6 hrs waiting in an A and E dept in Grantham only to be told by the SHO on duty to take ibuprofen and wear a tubigrip on it, I saw an osteopath who managed to manipulate the joint free later that evening. Boy did that hurt  :o, temporarily, but was a relief after! So I decided I needed something else doing and saw my GP AGAIN AT THE BEGINNING OF 2002. He referred me again to a private and different OS who was great. He booked me in for a private MRI scan of the knee, which showed damage to my ACL and he gave me three options :- do nothing, keep up the exercise and build the muscles (which had wasted after not going to the gym because of my stressful job), or have a reconstruction. I opted for the latter and had it done on 2 December in Birmingham at the Nuffield Hospital. I'm recouperating currently, but believe it was the right decision as I plan to start at the gym next week and play soccer again in August 2003, subject to my rehab going to plan. I see a PT weekly. It is painful but then I haven't had the experience of childbirth(!), and the painkillers can help with this - no pain, no gain is my motto. Get the best OS you can and go private if you have insurance or can afford to, or push your GP for the best on the NHS - GOOD LUCK. (P.S. Hope you're still awake...)
ACL recon to right knee 02/12/02 patella-tendon graft, Birmingham Nuffield Hospital.

Offline Kathy_C

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Re: Advice please!
« Reply #3 on: December 30, 2002, 02:57:38 PM »
Thanks for you replies, interesting to read of other peoples' experiences, tricky things knees aren't they! The consultant who assessed me before the arthroscopy said that reconstruction makes the knee tighter and one of the cons  is that if arthritis is present, the tightening of the knee can actually turn a knee that is unstable but mostly painless into one that is stable, but chronically painful. Has anybody any experience of this? I'm not too worried about acute postoperative pain, but I am about chronic pain, and I don't suppose there is any way of predicting the extent of this. I guess I'll just have to be guided by what is suggested to me at my follow up appointment.

Kathy
Ruptured ACL 1973 hurdling, arthroscopy & meniscus trim November 2002. Recon 27th August 2003 (hamstring).

Offline Shazinoz

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Re: Advice please!
« Reply #4 on: December 30, 2002, 04:07:57 PM »
No Kathy there is no way to predict it but seeing as how I HAVE HAD ARTHRITIS SINCE i WAS 12 AND i AM 31 NOW, AND  (OOPS sorry about the caps) I have had my ACL done twice, I dont't think I have any further problems with that.
I do suffer from not 1 but 2 chronic pain conditons (both pretty rare and even very veyr rare to have both), 1 is the result of a Genetic Disorder (HMS) and the other is the result of an injury (RSD), I am living proof that you can live with chronic pain and that where there is a will there is a way. I will never ever be rid of the HMS and my chances are very slim of ever getting a remission in my RSD now after more than 9 years. I depend (well depend isn;t the right word) I take a number of medications that help as do things like Osteopathy, massage, chiropractors (in the past, now I get severe mucle spasms after, and have had 1 whole side of my back lock in a flexed positon for 1/2 a day OUCH), PT, Hydrotherapy, hot baths etc etc
These complications are very rare but as they say with any surgery there is a risk (RSD can be caused by stubbing your toe or have a cast on to tight or a needle or something so small you don;t even remember it happening).
My thoughts on the tightening thing causing more pain would be if they over tightned it, or you had a lot of articular  or any other catrlidge damage, the ACL reco as far as I know and have read or been told just tries to reproduce the bodies natural position and stability by replacing the ligament with a "new" one thus effectively returning the knee to as near to the original position as possible.
My recommendation to you again would be to research as much as you can on the pros and cons of all of the procedues (ie reco Allograft vs reco autograft, vs doing nothing etc) and taking in all possible risks then make a fully informed decision based on YOU, your body and what you HOPE to be able to do in the future. No one can predict what will happen but to be for warned is to be forarmed (ie if you know and accept the risks (even the worst possible ones)  then go for it).
Hope this helps in some small way and doesn;t just confuse you more (which is by no means my intention).
2 ACL 'reco's', 3 'scopes', Pain, JRA, EDS, RSD, CMP, osetochondral defect & #, synovitis, adhesions, nerve damage, foot drop, MCL damage, tendonitis, fibrosis, ligament damage AGAIN, dislocations +++

Offline The KNEEguru

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Re: Advice please!
« Reply #5 on: January 01, 2003, 01:57:50 PM »
I think that Dr Cross has answered the question fairly comprehensively in this article:

http://www.kneeclinic.com.au/papers/CruciateReconstruction.html

Have a read and feel free to ask if you do not understand all the 'med-speak'.  The term 'primary repair' means repair close to the time of the original injury, while 'secondary' implies much later or after other things went wrong.

KNEEguru
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KNEEguru

Offline Shazinoz

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Re: Advice please!
« Reply #6 on: January 01, 2003, 02:31:10 PM »
This is the OS I am to see ont he 20th of Jan (WOW only 19 days and a bit to Go  ;D.
I have seen a few things that Dr. Cross has put on the web etc. Here is to hoping he is a ble to HELP ME.
Thanx Again to Knee Guru for the Big Names list and the Dr. Cross recommendation (and email of course which was my 1st contact with Dr. Cross as he is in Sydney and me in Canberra about a 1 hr flight + a couple of cab rides away).
2 ACL 'reco's', 3 'scopes', Pain, JRA, EDS, RSD, CMP, osetochondral defect & #, synovitis, adhesions, nerve damage, foot drop, MCL damage, tendonitis, fibrosis, ligament damage AGAIN, dislocations +++

Offline Kathy_C

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Re: Instability + chronic ACL tear, treatment opti
« Reply #7 on: January 08, 2003, 11:55:29 AM »
Thanks everyone for their input. Shazinoz, you are an inspiration, my problems seem very minor compared with yours! I had my follow up appointment on Monday and was told there were 2 options, physio to help stabilise the joint, or reconstruction, so I opted for reconstruction (they will use hamstring). UK waiting lists being what they are, I don't suppose it will happen soon so I asked for physio in the meantime and that was agreed on. I'll have to do lots of reading  now to see what to expect.

Kathy
Ruptured ACL 1973 hurdling, arthroscopy & meniscus trim November 2002. Recon 27th August 2003 (hamstring).

Offline Tommy_the_Villan

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Re: Instability + chronic ACL tear, treatment opti
« Reply #8 on: January 09, 2003, 03:36:00 PM »
Good luck Kathy ;),

I hope you don't have to wait too long for it. Where in UK are you from? I had mine done in Birmingham at the Nuffield Hospital. Be interested to find out where you are on the list for and how long it takes (i.e. was it worth going private?). It took two months from the time of my original consultation with the surgeon to have the operation (convenience wise) but he said I could have had it done in a couple of weeks. If you need any more advice then be in touch regarding rehab which is just as important...
Tommy
ACL recon to right knee 02/12/02 patella-tendon graft, Birmingham Nuffield Hospital.

Offline Kathy_C

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Re: Instability + chronic ACL tear, treatment opti
« Reply #9 on: January 13, 2003, 02:33:11 PM »
Hi Tommy,

I'm in the South East and will have surgery at East Surrey Hospital. I'll keep you informed of my progress but bearing in mind it took more than 18 months from seeing my GP to having an arthroscopy (op cancelled 3 times!), I'm sure nothing will be happeining in the near future! I'm sure it would be quicker going private, but I'm not sure I could afford it. Maybe I should make some enquiries as to cost.

Kathy
Ruptured ACL 1973 hurdling, arthroscopy & meniscus trim November 2002. Recon 27th August 2003 (hamstring).

Offline Kathy_C

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Re: Instability + chronic ACL tear, treatment opti
« Reply #10 on: February 25, 2003, 02:38:10 PM »
I had the shock of my life last week when the hospital phoned to ask if I was available for surgery in the next 4 weeks or so! The NHS must be improving! As it happens there's a lot going on at work at the moment so I can't make it, so they'll contact me again in  a couple of months. Anyway it looks as if I'll be having the op a lot sooner than I expected, its a bit scary! In the meantime I'm working hard in the gym to gain as much muscle strength as possible.

Kathy
Ruptured ACL 1973 hurdling, arthroscopy & meniscus trim November 2002. Recon 27th August 2003 (hamstring).

Offline Netty

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Re: Instability + chronic ACL tear, treatment opti
« Reply #11 on: February 25, 2003, 05:20:45 PM »
Hi Kathy,
I cant believe you lived with no ACL for so long.
Ive had my ACL reconned twice and the medial and lateral reconned as well. Thats 3 ops and Im told I need another ACL recon soon. What i wanted to say was that my first 2 were done by different doctors and I had hammy grafts done with both, 1 from each leg. As these have both failed I sort out and found a top of the line surgeon here in Australia and he has told me that the patella grafts are far more stronger and more successful, so thats what Im having done this time. Sorry I cant give you a comparison as yet. He says the hammy's can easily stretch but the patella ones have a small bone block on each end that they put the screws through, so this tends to keep the ligament from stretching. He has done knee surgery on an olympic gold medalist and many football and cricket players with great success, so I think he sounds like he knows what is best. Maybe you should ask your OS the differences between the 2 types of grafts and maybe even get a 2nd opinion. Our health system is good here and Ive never had to wait as yet, the longest would be 6 weeks I think. The English system seems realy slow. Well, hope all goes well, Netty
Broke the cruciate and damaged the medial and lateral ligs playing softball.Hammy ACl recon Feb 2000(failed).Hammy ACL recon Aug 01(failed).Medial repair and Lateral loop Dec 01(failed).Still unstable















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