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Author Topic: ReConstructed ACL is now 'long' - Facing op #2.. any advice?  (Read 1326 times)

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Offline SSC

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ReConstructed ACL is now 'long' - Facing op #2.. any advice?
« on: October 10, 2011, 12:23:16 PM »
Hi all,

First time poster on these boards. Not sure if this is the right board to post in, please move if necessary. Quick summary is below and really looking for some insights, thoughts, comments etc. Anyone gone through this before? Even if you havenít, any insight would be greatly appreciated.

I tore my ACL in Feb 2008 playing football when I was 23, as I was in my final year of University I put it off until the summer. Had a hamstring graft, through private insurance with one of the best knee surgeons around.

Recover went well, I got a bit lax with my physio which was stupid but managed to get to a point where I could run around without any issues. I fell over on it the odd time but never felt my ACL go, physios never thought it had gone and playing football was fine (bar my lack of ability).

Fast forward to February this year, started a new job after getting home from travelling and wanted to get an update from a physio at work. She said it was a Ďa bit longí but was still fine and intact and advised I strengthened the muscles around the knee and it would be fine, also diagnosed a little LCL strain. I did this diligently and continued to a point where it was all great, I stopped seeing her and felt comfortable with managing the knee. Then two weeks ago I played cricket on a Friday and by the Sunday it was sore and felt quite unstable again, weight bearing wasnít great etc. I went to see her again and upon doing the normal tests her face dropped and said it was now Ďextremely long/looseí. She didnít think it had detached or ruptured but was essentially giving me no support.

Diagnosis was to either go back to my old surgeon (Iím not insured any more), or go through the NHS and get referred. She advised they might suggest I skip re-reconstruction and just manage it, but Iím 26 and donít want to give up on having a knee that works. Iím a little confused about it all and not sure where my heads at so a few bits of advice/expertise would be great.

-   Is there any way of fixing a loose hamstring graft without completely redoing it?
-   What are my options if I do get it again? Patella? Cadaver? Synthetic? More hamstring? I donít want to go into my other leg as its fine and working great, feel itís best to leave it untouched.
-   Whatís the prognosis on second time ops? Is it likely to work? Am I realistically likely to be able to play twisting sports, ski etc ever again?
-   Any other general bits of advice that I might not have thought of?

I know these threads come thick and fast but any advice you can give me would be fantastic.

Thanks.

Offline emergRN

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Re: ReConstructed ACL is now 'long' - Facing op #2.. any advice?
« Reply #1 on: October 10, 2011, 01:06:53 PM »
SSC,

I think the first thing you need to do is get a referral to an OS, whether it be private or NHS.† You really need to be assessed by an OS to determine the cause of the graft failure,

I am in the same position as you are.† I will share with you what I have learned.
1. Once the graft is stretched..it is stretched!
2. There are a bunch of graft options.† Some of them are surgeon preference, and depending on who does your revision, they may have their preferred way of doing it.† They are usually more competent at doing one particular graft.† You could use patellar tendon from either leg, central quad tendon graft(this one has a bone plug on one end). There is also your other hamstring, but from some of the literature that I have read, that is not usually a preference for revision.† Lastly, there are the allografts.† I personally don't think that I would go the synthetic route, but that is just my opinion.
3.The literature on revisions states that it is a salvage procedure.† The outcomes are not as good as a primary reconstruction.† The purpose of a revision is to give you a stable knee, and to enable you to live your life.† In saying that, I know there are people on here who have had revisions and they function at a much higher level than that.†

If you google Revision ACL surgery, you will find pretty much everything I have just written here.† There is also a good section on the KG information hub by Dr. Frank Noyes on Revision ACL surgery.† Have a look!!† I think the biggest issue is to find out what the cause of the failure was.† You stated that you had injured your LCL.† You need to have this thoroughly assessed, find out what caused your failure, and go from there.† There may be issues in your knee that will need to be resolved before a revision surgery.

Good Luck,

W

I should clarify what I have said above.  It sounded like I was including allografts with synthetic grafts.  I am sure you already know this, but an allograft is cadaver tissue.  Synthetic grafts are man made.
« Last Edit: October 11, 2011, 10:37:31 PM by emergRN »
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline Himself

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Re: ReConstructed ACL is now 'long' - Facing op #2.. any advice?
« Reply #2 on: October 11, 2011, 08:25:48 PM »
I had my revision done last December for essentially the same reason.  My new ortho told me that the graft was not inserted at the correct angle when I had it done initially in 2000.  The revision procedure was a breeze compared to the first surgery.  I took a cadaver patellar tendon this time and it seems to be doing just fine.  I , like you, rushed my PT during the first one and was, in hindsight, too quick to return to running and cutting.  I have been much more patient through this rehab and because I also had cartilage damage (from having a loose ACL for 10 years) fixed in July. The incentive to try to hurry back to sport has been greatly diminished because of this.  I know you mentioned that you had good trust in your ortho/PT, but I would recommend getting a second opinion if you can.  If there were mistakes made on your last procedure, your current team might not want to admit them.
8/2000: ACL Patellar Autograft/ Meniscectomy
8/2010: Meniscectomy
12/2010: ACL Patellar Allograft
7/2011: Allograft Articular Cartilage Transplant (Denovo NT)

Offline SSC

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Re: ReConstructed ACL is now 'long' - Facing op #2.. any advice?
« Reply #3 on: October 19, 2011, 06:08:42 PM »
Right so now im really frustrated...

Had to wait 2 weeks to see my NHS GP, just to get a referral for treatment.

I go in ready to explain everything that I said above. She asked me about how I did it the first time and then I explained my recent knee history and then what has happened in the last 6 months.

I go on to tell her about the new knee issues and then my physio's diagnosis (who is new and not associated with the group who did my first ACL recon btw). I explain there was no swelling and no one time the knee totally give way and she just becomes dismissive. I explain the logic of my NEW acl being over stretched and she become obsessed that the fibres in my knee from my old ACL being stretched may just be damaged and could take time to heal. Ignored me when I explained my physio believed my NEW ACL was totally stretched and there was no support, and that the normal tests proved I basically had no ACL.

Ultimately she says its not sounding like a serious case so no orthopaedic surgeon referral. She has booked me in for an MRI for 3-4 weeks, likely to see a surgeon a couple of months after that. I pointed out the first time I did it, A&E just booked me into see an OS within 2 weeks, she was obsessed with the fact there was no swelling or major moment it went. I chose not to explain to her that second time around ACL incidents dont necessarily swell, or have a defining moment where you feel it go as it would have just antagonised her but im left extremely frustrated.

At best it'll be 6 months before I get anywhere near a surgeon's table and I feel it would potentially be much sooner if she had taken the evidence seriously. She didnt even feel my knee, do the lumbar test or anything to see... didnt even touch it.

What options do I have? I cant complain can I? Its either follow this through or pay to go private... which = $$$

Offline Snowy

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Re: ReConstructed ACL is now 'long' - Facing op #2.. any advice?
« Reply #4 on: October 20, 2011, 04:57:27 AM »
That's awful - without doing manual tests, there's absolutely no way your doctor can assess whether or not there's laxity in your knee. A stretched ACL won't always exhibit traumatic signs or excessive instability - my knee didn't give way completely even when my ACL was completely torn. Given that a physio has already told you that the knee feels lax on testing, your doctor really should have given you a referral to an OS at the very least.

I would see another doctor if you can. Does the NHS still have walk-in clinics? That would be one option. I don't know how easy it is to see a second GP there (I'm in Canada, where it's very straightforward) but that would be another option. Otherwise you may have to file a complaint or go private, even if it's just to get the referral. If your PT is certain that the ACL is stretched, it's better not to leave it too long if you can avoid it. I guess you could always make another appointment and really push the instability and soreness with your GP, or go to A&E - but it seems all wrong that you'd have to tie up emergency resources just to get a referral to someone who can help you.

I'm so sorry that you were treated so dismissively,  and I really hope you can get a referral to an OS soon.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA















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