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Author Topic: ACLr and RA positive....anyone have the surgery and had healing issues?  (Read 8769 times)

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Offline xenabyte

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First, hello!  I'm a newbie here.  I posted the following in the general section (and you could hear a pin drop)...not sure how I missed the entire "RA" section!  Must be the pain pills....

Here is a snip of my post.  :)

Snip start
I ruptured my ACL in my left knee on 5/31/08.  I had an MRI a week later.  Basically total rupture, full thickness tear of the ACL, lots of bone bruising, and large joint effusion with resulting Baker's Cyst from the fluid trying to drain somewhere.

I will be seeing an Orthopedic surgeon on Friday, June June 27th.  I know I have a few options:

1.  Do nothing

2.  Do exploratory arthroscopic surgery to clean up any damage and make sure the meniscus is not also damaged. And then do nothing, except rehab and work my leg muscles to maintain support for my knee. 

(BTW, right knee is also ACL deficient, tore it out about 10 years ago, and didn't do reconstruction surgery at the time, due to being a poor student with no insurance!  I also tore the meniscus in two places and they trimmed it up.  For the most part, it's been ok for the last few years, though I had intermittant pain for the first few years after the surgery.

3.  Get a allograph - if so, would need to do both knees most likely, and I'm worried about it healing correctly.

4.  Get autograph - ditto above.

Here is the kicker.  About 4 months ago, I was diagnosed 'ANA' positive (Anti nuclear antibodies) present in blood tests, indicationg some type of auto immune response going on (doctor is strongly leaning towards RA). 

It manifested in my eyes turning beet red (usually one eye or the other at a time) and my eye doc said that it was 'Uveitis/Anterior Iritis'.  Basically white blood cells attack the iris and accumulate on the lense of the eye and cause it to 'stick' and it hurts like heck (think migraine pain focused in your eyeball).  She said it was a 'side effect' of some underlying systemic inflammatory reaction....which to date they can't narrow down, but doctor suspects early stages of Rheumatoid Arthritis considering my family's history (an Aunt and my Maternal Grandmother have it bad).

So here is my question, now that I hopefully have given enough background info.... 

Has anyone had an ACL graph repair, either auto or allo, with a 'auto immune' type disorder.  I'm thinking that it may increase my chances of tissue rejection and healing.  I've searched and can not seem to find studies that show RA or Lupus patients should not have this type proceedure or any study results.  I'm leaning towards just having the knee cleaned up, but if the doctor thinks I'd be a good candidate for ACLr, then I want to be informed.  I have been doing Tae Kwon Do for the last year (that's what I was doing when I tore out my 'good' ACL leg) and have to give it up now, that BOTH knees are ACL deficient.

Thanks for any information, helpful suggestions and comments.  I have three boys all under the age of 6, so I'm dreading the 'down time' for a having both knees undergo ACLrs if I go that route, now that I have insurance...anyone have young children and survive the rehab time with your sanity intact?   hehe

Thanks again

______________________________________________end snip

P.S.  I found one study that indicated immune compromised patients are usually difficult to heal, and if you've been on the typical suppressant meds, it can interfere with graphs and healing.  :(  But it wasn't specific to ACLr and RA, but close enough I guess! 

Offline Jaci

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Hello Heather,

First off, I don't have RA, I have a lesser-known inflammatory arthritis called ankylosing spondylitis. It is an auto-immune disease in which the body attacks places in the body where ligaments and tendons attach to bone, these attachments are called enthesis, so AS causes enthesitis/ enthesopathy which the body tries to heal by creating fibrosis and ultimately causing calcification of the tissues.  Because it's a systemic inflammatory disease, it can attack other areas of the body including internal organs and eyes. Iritis/ uveitis occurs in about 25% of people with AS, I had it frequently in the early years of battling spondylitis.

I injured my knee in Oct 2003, had a simple scope in Dec 2003 and developed a condition called arthrofibrosis where the body has an exagerated response to trauma and forms masses of scar tissue. In other words my body over-healed. Arthrofibrosis is extremely debilitating including pain and loss of joint function and is very difficult to treat. (My story and other info on arthrofibrosis is available on the Community Hub)

I know AS isn't the same as RA, however I would highly recommend that you thoroughly investigate the possible RA or other auto-immune condition before making any decision on surgery. You want to completely rule it out and if you do have it, then you'll need to work with a really good rheumatologist to make sure it is under control before having surgery. While it's true that certain arthritis drugs supress the immune system, that does not mean you cannot have surgery. There are things that can be done such as temporarily suspending drug use, this would be something a rheumy can help with. For example, I use Enbrel (one of the biologic arthritis meds, also used for RA) and was on it over a year before my rheumy felt my AS was under control enough for me to undergo a surgical procedure for scar tissue in my knee. On my rheum's guidance, I went off the Enbrel for a week before and after the procedure-- this was based on the half-life of the drug at the doseage I use and will vary for other meds.

Surgery is always something of a roll of the dice, sometimes things just don't go right. Having an autoimmune condition throws in a whole other set of unknowns that can contribute to a bad outcome. As you mentioned one of the issues with RA is that there just isn't any research on how it affects surgery outcomes, the same is true of ankylosing spondylitis. What I can tell you based on my experience is that improper healing can be far more than just taking longer to heal, it could be something that you can't even begin to imagine at this point. There is no way for anyone to predict ahead of time how the immune system will respond-- could be fine, could be slow healing, could be exaggerated healing or some other outcome. By handling the possible auto-immune condition you will improve your odds of a good outcome.

Re: allograft vs. autograft. That would be something to discuss with the rheumatologist once s/he figures out what, if anything, is going on with your body.

I wish you all the best in your search for info. All of my research was after I had already developed a severe complication following surgery. Ultimately it took a very skilled rheumatologist to finally make the connection between ankylosing spondylitis and the complication I have.


« Last Edit: June 28, 2008, 09:00:39 PM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline kimmyxs

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Hi Heather,

I have RA.  I have also had patella fracture surgery (ORIF) and eventually the hardware removal with a VMO graft and LR.  I didn't have any problems either time.  My graft healed beautifully.  Have you been referred to a rheumy?  The reason that I ask is because the RA diagnosis is a result of a RA antibody test, sometimes the ANA is high, sometimes not.  In addition, sometimes you can have a high ANA or RA test based upon drugs that you are taking.  The rheumy will do a new blood tests, xrays and a full phsycial exam.  I was a bit surprised by the depth of the physcial exam, I walked, I opened jars, I bent, he felt the major joints and spine, etc. 

He did note that had I seen a rheumy prior to my surgery, he may have been concerned, but I healed wonderfully.  If you remember, often the need for joint replacements is a result of RA, it should calm your mind a bit.  I would definately see a rheumy get a good diagnosis - a GP isn't really equiped to make that diagnosis.  The answer may be differnent basis upon what type of auto-immune disease you have.

Let us know what happens.

6/03/89 - First Knee Cap Disclocation
7/05/89 - Returned to work
6/17/06 - Tramatic Knee Cap Dislocation and Vertical Fractured Patella
6/28/06 - ORIF - Screws - no wires
8/24/06 - Ditched the brace - start PT
9/20/06 - First spinning
1/15/07 - screw removal, LR , VMO Advanc  & patella cleanupl

Offline Jenniferm

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Re: ACLr and RA positive....anyone have the surgery and had healing issues?
« Reply #3 on: September 07, 2008, 04:00:50 PM »
Hi everyone,

I have been recently diagnosed with RA - about 3 months ago.  I was devestated but then I realised that it made sense of my myriad types of pain and limitations.  I went on methotrexate but I have not been on it long enough to see if it works.  I have been on NSAIDs for almost 6 years!  Then I fell I fractured my patella and needed surgical repair which was 3 weeks ago and am in a knee immobilizer.  I am not sure about healing and RA myself but hope to see a rhematologist this week - I live in Bermuda so he only comes every few months!  I will let you know if he says there is any problems with autoimmune and healing or indeed any link between the RA and the increased possibility of softening of ligaments which can lead to injuries like my OS suggested!!  (no one told me that before, so not sure if its true!)

Take care and I hope you get some answers soon.

August 15 - broke patella vertically, knee cap in thigh - about 2 inch separation.
August 16 - surgery
Now - waiting in an immobiliser for the next 3 weeks of healing.  NWB or bending.