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Author Topic: decision for drastic surgery? - anthroscopy help decide extent of damage?  (Read 2777 times)

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Offline sb22678

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Hello guys,

Put in a message a while ago about my persitent anteversion only corrected through a derotational osteotomy. Obviously not too keen on this idea, though ive resorted to every other measure with unsuccessful results. Thing is, i dont get dislocations (like some of the other guys with this porblem seem to experience :(), i just have the horrible pain.

I was told by a pain specialist that if i had the operation, i might still get the pain since ive had it for over a decade and it might remain there as someone who has an amputation gets phantom pain?!

To help me decide whether its worth me having the op, im trying to get an idea what my knees might be like say in 10 years time.....will i be totally incapacitated or still able to walk (just not up/down hills/stairs and kneel/bend etc).

Is the fact that my leg bones are wonky causing friction? In which case the knee is likely to be worn and continue to be increasingly worn over the years.

Is there a procedure to find out the extent of the damage to my knee so far, so as i can decide how this might worsen? Would an anthroscopy tell this?

Sorry about all the questions, Thanks for listening and hope you are also recieving the support you need,

Communal hug!

Stephanie




Offline tanyap

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I was told by a pain specialist that if i had the operation, i might still get the pain since ive had it for over a decade and it might remain there as someone who has an amputation gets phantom pain?!

Yikes - dont like the sounds of that - perhaps this is worth looking to with a second opinion?

To help me decide whether its worth me having the op, im trying to get an idea what my knees might be like say in 10 years time.....will i be totally incapacitated or still able to walk (just not up/down hills/stairs and kneel/bend etc).

I dont know the answer, everyone is different, and no one can say for sure how much your damage will accelerate and how much physio might correct the problem.

Is the fact that my leg bones are wonky causing friction? In which case the knee is likely to be worn and continue to be increasingly worn over the years.

Yes. Quite possibly. It all depends on how much damage is actually being caused by the way you walk now.


Is there a procedure to find out the extent of the damage to my knee so far, so as i can decide how this might worsen? Would an anthroscopy tell this?

I would be inclined to think x-rays, MRI and CT scans would be enough to determine whats going on - as you say you dont have instability, just pain. That is definitely a question worth asking your OS.

Also you need to ask will the femoral anteversion get worse? And what can be done NOW to control your pain without surgery.

And as always - the famous second opinion is always worth a shot.
Tanya
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline sb22678

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Tanya,

Thank you.

Ive had an MRI scan on both knees but was just told it was normal?

My low back pain has got increasingly worse in line with my knees pain - Im wandering if this is part of the anteversion too?

healthy wishes,

Stephanie


Offline tanyap

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Well if you have pain and its not showing on MRI perhaps there is some kind of cartilage or meniscus damage that is not visible? Sometimes that can happen, I would persist looking for answers before agreeing to the derotation. Yes, your lower back could be affected from compensation. You could also consider getting orthotics to help improve the way you walk?

What have you got lined up in terms of appointments, tests or are you at stasis for now?
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline sb22678

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Yes ive got another appt for august. Maybe i should ask him why the MRI showed nothing. So would an anthroscopy show up any other damage (like the cartilage and meniscus you were referring to?). I kind of had the feeling i might be compensating knees for back pain - so thanks for pointing it out.

Sounds like you're OS hasnt been very helpful either - sorry Tan,


Offline tanyap

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Well sometimes damage can 'hide' in an MRI, or just not be visible. For example, Ive just had a scope and the surgeon told me I had a worn patch of cartilage behind my kneecap medially - that did not show on MRI.
Also it depends on the radiologist reading it - they can miss things.
Arthroscopy would show everything, but its an invasive procedure so they wont do it lightly - and you wouldnt want it done lightly either.

But they might be able to tell more with CT scans?

August is far away - can you go for a second opinion before then?

1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline sb22678

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What's a scope then? - does it put you out for a few wks then? I had always thought an anthroscopy was an in and out thing, without very much in the way of invasion....not so then?!

Youre right august is a way away - how can i go about getting a second opinion? I assumed i had to stick with this OS because he covers my local area - sounds a good idea to get another opinion though (is this allowed on the NHS or do i have to go private?)



Offline tanyap

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well they have to cut you open and stick a camera in so its invasive as opposed to scanning from the outside. any surgery carries risk and they would only do it when other avenues had been exhausted.

i dont know how the NHS works - youd need to ask someone in the UK. Im in Ireland and my only choice would be to get my GP to refer me to someone else publically (like the NHS) or pay privately myself. But I dont think we have the local area thing like you do.
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Plumb

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I just like to add. A scope is a same day surgery but you may be rehabbing for six months and might be worse off afterwards. 

Take it slow.. Try to see a few doctors.  If even for a consult spend the money to see them.  Get copies of all your MRI's and Xrays. 


My first MRI only showed a small posterior horn tear.  When he scoped it .. it was a war zone with OA and shreded cartlidge.  My knee pain was very bad going in to surgery and well worth a look see to get the pain levels down. I had cartlidge jamming in my joint and couldnt weight bear properly.  Well worth a look see since I was out of options.  I had PT to try to strengthen the leg.  I had cortizone to take down inflamation. I was on NSAIDs. ~~~ a year after TKR~~~ a long year of pain.





Offline sb22678

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Hey Plumb!

So you think a scope might be a good idea? Rehab of 6months?!! Sounds bad - just for an investigation?!
Sounds like they found out alot that they missed on the scans though - Tanya had mentioned cartilage damage doesnt always get picked up on MRI. Ive had X-rays and MRI but nothing seems to have shown anything - just been told i got persistent anteversion.

So i am entitled to copies of my imaging? What, so if i ask the hospital, they will actually send me these?  Sounds good, but is this really possible?! trying to get anything out of the NHS seems a long journey!

Hope something can be done for your pain...constant pain can be really draining cannot it...im constantly on a tens machine for my back because of my compensating my knee pain...unfortunately doenst work on my knees, but could be something that might work for you?






Offline JoniF

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sb,

When I had my x-rays, etc.  everything "looked" fiine; however, when I had the scope done, OS found a tear int he lateral and medial meniscus, ACL tear and had to perform a LR.  Things aren't always as they appear on film, even though any surgery is invasive, it might be worthwhile to get a visual as to what is actually going on within your knee.  Many people heal fairly quickly with a scope.  I was advised by my OS that each time a scope is performed it can weaken your quads, etc.  Ultimately you need to be your own advocate and decide what is best for your knee.  Hope you find the answers you're looking for.

Take care,
Joni
1989 Lateral Release, debridement, and arthroscopic surgery - lk
1996 TTT, Elmslie-trillat procedure, lateral release and debridement - lk
1997 Debridement and hardware removal - lk
2006 Lateral Release, 2 meniscus tears repaired, & acl repair - lk
2008 Sev Patella Effusion - rt knee

Offline Plumb

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my MRI did not show what was going on in my knee.  When he scoped it I had bone on bone spots and crab like bits of cartlidge floating around plus the tiny tear the MRI picked up.

I am getting visco supplements in my left knee now.  The right knee was replaced.  When he wanted to scope my left knee I had him take standing xrays which showed my joint space was too narrow and could wind up in the same boat again.  I have moments of pain when I over do it and when I get a floater locked up in the joint but .. compared to the hell i been threw I am choosing no surgery until I cant bear the pain .

Offline lis1

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You can always ask for a second opinion even on the NHS but would probably have to go through your GP again to get a referal and explain why you wanted one.  They would be more likely to be your stumbling block rather than the surgeon himself.

I have had two arthroscopies and recovered very quickly from both of those, and had meniscus removed from the first and cartliage tears repaired from the second.  I work in leisure and have to be activly fit to do my job and was able to return to work 1 week afterwards.  We do all recover at different rates though and a lot depends on what was happening with your knee and how much pain you were in before the 'scope' was done.

However if your knee is giving you problems and you cannot find out what is causing it by the less invasive actions and you need to know and sort it out then keep persisting with your GP and the NHS route to find out, as i am a prime example of what happens if things are left too long as further problems can develop.

I am in the UK, but have the advantage of private medical insurance, but still have to get referred from the GP and that is still sometimes a problem even with private cover.

Good luck in what you decide.

Lisa
remidial meniscemtomy 1994
scope and tidy up july 2006
acl reconstruction and microfractures oct 2006 (failed on both counts)
oats june 2008 - very successful
acl revision patella tendon - oct 09

Offline Caroline109

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I had torn mensicus surgery (left knee) in February. The tear was seen in the MRI. However, my OS also found a nice hole in my articular cartilage too and said I'd need OATs eventually there. Articular tears, from what I read somewhere, aren't visible in MRIs. Going myself on Tuesday back to the OS because I've had a pain issue, ever increasing in my right knee , for about a month now now that he thought was bursitis. DId the icing as told. He said he'd send me for another MRI if necessary to see what is going on.
Caroline
Chronic low platelet count
Men. surgery, both knees 2003,2007,2008
R PKR Sept. 17, 2008 - Biomet Oxford Partial
LK-TKR 4/21/2010 Biomet Vanguard Signature Knee
Scar tissue issue next to TKR knee
March 2, 2011: PKR to be revised to a TKR

Offline sb22678

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Meniscus? That's being mentioned alot - sounds painful :( Thing is, my femoral and tibial anteversion is the cause of my knee pain...what could be the damage from this? Is the pain just a byproduct of my wonky legs, or is it a sign that my wonky legs are damaging the insides of my knee? In which case i suppose a scope (is that short for anthroscope then?!) is the way to find out what damage?