Advertisement - Hide this advert





Author Topic: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision  (Read 3096 times)

0 Members and 1 Guest are viewing this topic.

Offline turkdlit

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« on: September 23, 2012, 07:00:16 PM »
Hi all,

I'm a 32 year-old physician and up until this point I haven't had any trouble in making decisions following the management of my knee. But I'm having a tough time with my current dilemma and was hoping some of you knee pros could help me out.

Long story short - patella dislocation, ruptured ACL, LCL, PLC (everything gone except hamstring tendon) and grade 2 PCL tear playing soccer a year ago. Horrific injury. Ex-collegiate soccer player. Had ACL/LCL allograft recon, and PLC recon/capsule repair. Everything was rosy, no complications, but progressive knee instability from months 6-12 after surgery. Had MRI - ACL looks stretched. Subsequent CT scan shows marked femoral and tibial ACL tunnel widening (both nearly doubled in diameter) resulting in a loose and non-functional ACL (although the graft is still attached).

Got 2 opinions (one from original orthopod, one from a multi-ligament expert who is a part of Freddie Fu's group), both agree that the only way to restore stability is a 2-stage ACL revision. 1st stage to remove non-functional ACL and do bone graft, then 4 months later they can do an bone-patellar tendon-bone autograft from the injured leg.

I have no idea what to do. I'm not able to put my full weight on the affected leg when standing as the joint will begin to feel like its "opening up". I'm able to walk w/no problem, but if I'm not paying attention the knee will buckle slightly. Able to do weights and ride bike w/out any issues. Running is ok too but usually pretty sore afterwards. Pivot sports like soccer are a no-go, and I do miss it a lot.

Any advice from those who have had a 2-stage ACLr before? I'm worried that I could potentially make things worse by having 2 surgeries (double the complication risk, etc). But at the same time, I miss playing sports dearly, and as is I would never have enough confidence in the knee to play team sports again. I'm also expecting the birth of my first child in May 2013 and I would hate to be busy with recovering and rehab at a time when my wife needs me.

Thanks guys!

Offline tez27

  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 2010
  • Liked: 8
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #1 on: September 23, 2012, 09:31:47 PM »
Hi Turkdlit
I have had the first stage of my 2 stage ACL revision and I have been told the graft will take between 6 and 9 months until its ready for the second stage, so its interesting to me that you have been told 4 months, apart from that I will be interested in whatever everyone else has to say about the whole 2 stage acl revision, I didnt get much info about it before my op, but I had decided to trust my surgeon to do the best for me and once he had a good look during the surgery he decided that the original tunnels were not correctly placed  and had widened which is the most likely  cause of the ACL failure so the 2 stage was the best way to go.
For me the decision was easy because the knee instability and pain was interfering with my work, I am a hairdresser in a busy salon so all day standing on a knee that gives out is not the most professional or pleasant way to spend the day.
Good luck with the decision, I guess it comes down to how not having the surgery will affect the rest of your life, the fact that you are missing the kind of sport that you really need 2 working knees for and.. with a baby on the way you will want to be able to run and play with the child without the constant worry of how the knee will behave leads me to think the revision should be seriously considered

Take care Tez   
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline turkdlit

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #2 on: September 23, 2012, 09:56:07 PM »
Hey Tez, thanks for the repply, I actually read your thread where you talk about your 2-stage revision and it was very helpful as well :) I do hope you're recovering well from your first stage and best of luck with the second stage when it does come around (must be torture waiting around for it!).

I've heard typically 4-6 months for the bone graft to heal adequately, next time I meet with my orthopod I am gonna ask him why some recommend a longer period. I am a physician (anesthesiologist), so while I do get some time to sit around there are many periods of the day where I am running around like crazy and the knee starts to get pissed off. I imagine being a hair dresser is really not conducive to having an unstable knee.

How far out are you from your bone graft? How long were you on crutches? Mine suggested I would be non-weight bearing for 4 weeks, and then would wear a knee brace until the 2nd stage. Are you able to get around ok with an acl deficient knee?

And finally, what kind of exercises are you permitted to do? At the moment I''m really happy with where my quad strength is and I would hate to lose all the ground I've gained due to the grafting. Thanks again!


Offline tez27

  • SuperKNEEgeek
  • *****
  • *
  • *
  • Posts: 2010
  • Liked: 8
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #3 on: September 24, 2012, 04:25:30 AM »
Hey Turkdlit
I had my first stage on the 23rd of July, I had 48 hours of bed rest right after the surgery which was a bit of a shock as I expected to be in out of hospital the next day

My OS said the original tunnels were vertical and because of that he needed the new bone to clot before I started marching around on it, after that I was never non weight baring, I used 2 crutches with weight as tolerated for a couple of weeks then went down to one for another couple of weeks which was more for stability than anything else.

 I am also waiting for an appointment to get fitted for a knee brace but I have a temprary one that I am using at work for the time being, apart from work I dont wear anything on the knee, my physio didnt want the muscles to become relient on the brace so we decided to only use it when working though I have to be careful when I dont wear it, in fact I tool a tumble down the stairs at home last week because my knee went out coming downstairs, now I make sure I hold on to the rail just in case.

As for the excersises... I use the excersise bike a lot apart from that I am doing all the stuff I did before the original acl'r to get the muscles as strong as possible, I am not really into lots of sports so I dont have to think about stuff like that I love to walk but I cant for too long at the moment because I have a fair bit of pain after a short time, and after standing at work all day I couldnt manage much at all, I have a lot of swelling in my foot ankle right up to my knee by the time I get home so its cryo cuff and elevation for me.

I am in the UK and the wonderful NHS tends to take its time to do everything, hence the wait for the proper brace and most likely the wait for the second stage of the revision.


From the sound of things with your job I would think it would be really difficult to do with an ACL deficient knee, good luck with everything and I'm glad I could help even if its just a little.

Take care
Tez     
L K injured 25th June 2008
scope Jan 5th 10
diagnosis ACL rupture
fiberous band excised from acl
ACLr July 19th 2010  scope on 24th Sept 2011
ACL has failed incorrect tunnel placement
23rd July 2012 1st stage of a 2 stage ACL revision
10th May 2013 2nd stage ACL revision

Offline Rothera

  • Regular Poster
  • ***
  • Posts: 71
  • Liked: 3
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #4 on: September 24, 2012, 06:45:03 AM »
Hello Turkdlit
I also had a 2 stage revision after my original ACL recon failed after 12 weeks! Same as you, tunnel widening in tib and femur. I had the bone grafting done in October last year. Was told to wait 6 ,onths, but I'm impatient! So had a CT scan in late Jan this year which showed excellent boen healing and I had the revision (plus MCL reconstruction) in March this year. This weekend I ran 3 miles! So I'm very happy with everything although the waiting in between surgery was a pain.

R
2011 big knee blow out! ACL rupture, lat meniscus rupture, MCL rupture 3rd degree. ACLr June plus meniscus repair. All Failed Sept 2011. Attempted ACLr and MCL Oct. bone cavitation = bone grafting. March 2012ACLr plus MCL graft with allograft. June LOAR. Clot. Wash out.
March 2013 skiing

Offline turkdlit

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #5 on: September 24, 2012, 10:55:24 PM »
Hey Tez and Rothera, thanks a lot for your responses it really helps a lot :)

Tez, it sounds like you were able to get around as well and had the same amount of activity after the bone grafting when compared to just before the bone grafting. Is that accurate? I'm just hoping that once I have the graft and acl removed that I will be able to do some decent exercise on it so that the muscles stay strong and I can minimize any instability while waiting to have the second stage.

Rothera, so happy to hear you had a good outcome. I'm just dreaming of the day I can run 3 miles (actually, I would much rather be able to sprint down the soccer field, I used to be very fast  ;D). I hope things continue to go well. Can you comment on what kind of post-op pain you had after the first stage, and whether you were able to keep your muscle strength by rehabbing in the interim waiting for the second stage?

Thanks again, if anyone else out there has any experience I would love to hear it, this place is so helpful. Cheers,
Turk

Offline Rothera

  • Regular Poster
  • ***
  • Posts: 71
  • Liked: 3
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #6 on: September 25, 2012, 07:37:29 AM »
Hi Turk
To answer your questions.....post op pain after first stage was surprising ok. Really bad for about 3 days but then rapidly got better. In fact I was back at work, driving and generally feeling fine within two weeks. I had residual bruising and pain for a few weeks from the bone harvest site but nothing major.

As for keeping fit during the waiting period it was pretty good. Because I now had no ACL or MCL I wore a brace the whole time but this meant I was pretty stable. So I went back to the gym and carried on as though I was normal! I had nothing to lose! So I actually went into the 2nd stage surgery pretty fit with good quads and calf muscles. I'm sure that's helped my speedy recovery.

Good luck.
R
2011 big knee blow out! ACL rupture, lat meniscus rupture, MCL rupture 3rd degree. ACLr June plus meniscus repair. All Failed Sept 2011. Attempted ACLr and MCL Oct. bone cavitation = bone grafting. March 2012ACLr plus MCL graft with allograft. June LOAR. Clot. Wash out.
March 2013 skiing

Offline turkdlit

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #7 on: September 28, 2012, 02:01:49 AM »
Hey Rothera, thanks a lot buddy for the reply. I imagine the pain is probably less than the original ligament reconstruction. I'm really hoping I can keep my leg nice and strong after the ACL removal and bone graft :) thanks to everyone for sharing your experiences, if anyone else out there has had a bone graft or 2 stage ACL please feel free to share your experience it would be greatly appreciated, cheers,
Turk

Offline turkdlit

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #8 on: December 27, 2012, 02:57:54 PM »
Hey all, just wanted to bump this thread up. I ended up having my 1st stage revision about a month ago. Apparently it went well. My original ACL graft was loose and partially torn, so it was removed. The femoral and tibial bone tunnels were severely widened, so my OS took bone autograft from my medial femoral condyle and proximal tibia using an OATS reamer, and mixed it with some allograft and filled in the tunnels. The operation took about 4 hours (twice as long as expected!), but he assured me that was only because he wanted to ensure it was done properly so I could have another ACLr once the bone heals.

My only issue (and hopefully some of you 2-stage ACLr experts can comment) is severe pain at the graft site. I didn't have bone taken from the iliac crest as originally planned as he felt there was enough in the femur and tibia. While I am thankful for this as I understand the iliac crest is very painful post-op, I am having severe burning pain in my medial femoral area where the majority of bone was harvested. I was non-weight bearing for the first 4 weeks, and am now partial weight bearing, but it just hurts like hell every step. This wouldn't be too much of a problem but I need to get back to work without crutches in just 5 days and don't think I'll be ableto handle it!!!

Anyways, let me know what you guys think, thanks as always!

Offline Kaputt_Knee

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • *
  • Posts: 24562
  • Liked: 75
  • [Ed: Sue sadly passed away in 2016]
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #9 on: December 27, 2012, 03:26:06 PM »
That is the same harvest site I had. The only solace I can offer is keep up with the meds as the breakthrough pain is really hard to get back under control. I actually called my sister out to look after me as I could not cope on my own. The non-weight bearing was the killer as it meant I could not prepare or carry any food once I was back home.

The routine of taking the pain control on time was not much fun for me as I hate taking any tabs. My sister worked out a schedule of every 3.75 hours and she would start to nag me so I would take the tablets. It took about 3 weeks for it to die down enough to reduce the daytime meds, but I needed the pain control at night for about 6 weeks until it died down enough for me to do without. I was back at work at about 7 weeks I think but I'm a desk jockey so did not need to move around much.

I had my revision done at the same time along with a meniscus trim, debridement and an LCL reconstruction. My surgeon was in my knee for over 6 hours in total making sure everything that needed to be done was done. He even rebroke the incorrectly healed fibula head and set it correctly so that it released all the trapped nerves which were causing me so much pain.

I like the fact that your guy, like mine, took his time to make sure that the job was done correctly. There are many excellent surgeons out there, far more than some people on here think.

Good luck with the rehab. Don't rush things as the bones have taken quite a battering and the bruises take a long time to settle down.

Sue  ;)
1989 big trauma R. knee - sorted
1990-2004 3ACL recons and 20+ arthroscopies -RK
3/06 LK ACL torn!
4/06 ACL recon, kneecap broken
09 &10/06- 2x meniscus trims
3/07 - Notch Plastic & Lateral Release
14/8/08 complete revision ACL plus LCL/PLC recon
6/2/09 returned to skiing! Whoopee

Offline turkdlit

  • MICROgeek (<20 posts)
  • *
  • Posts: 13
  • Liked: 0
Re: Need Advice - s/p ACL/LCL/PLC Recon, now need 2-stage ACL revision
« Reply #10 on: December 28, 2012, 01:30:26 AM »
Hey Sue, thanks a lot for your reply! Its comforting to know that I'm not alone in having trouble dealing with the pain. My orthopedist though gave me the impression I would be full weight bearing by 4 weeks, but I'm at that point now and when I test it out at home I can't take more than 3-4 steps and then the medial femur harvest site pain is excruciating and I need to stop. I'm seeing him tomorrow for my 1 month follow-up, so I will see what he has to say about that. Maybe my muscles are so severely atrophied that I can't support the joint with my muscles alone and am relying too heavily on the acl-deficient joint? I don't know...

Thanks again, will keep updated this thread as I go along, cheers,
Turk















support