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Author Topic: What to do? Facing ACLR + HTO?  (Read 836 times)

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Offline Macu

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What to do? Facing ACLR + HTO?
« on: March 31, 2016, 04:47:44 PM »
Hello,

Iím writing here to hear your suggestions concerning my knee issue.

Before I start, let me present you with a brief history of my knee injuries, so that you can see the full context.
- 2006 Ė ACL rupture in my right knee while playing football, followed by a reconstruction.
- 2009 Ė right knee arthroscopy, the knee was cleaned. Since then, Iíve had no trouble with that knee whatsoever.
- 2012 Ė ACL rupture in my left knee while playing football, followed by a reconstruction (+ medial meniscus partial meniscectomy).
- 2013 Ė another incident with my left knee, something cracked.
- 2014 Ė left knee arthroscopy. The surgeon found a cyclops lesion on the graft and diagnosed knee impingement. He believed it was caused by the fact that the graft wasnít placed in its anatomic place. The majority of the graft was disposed of, I had another partial medial meniscectomy. 

 -2016?
Now, Iím facing a big dilemma what to do with my LEFT knee next. After my last surgery, the doctor told me that he was unable to reconstruct my ACL, because he believed that I needed to have a high tibia osteotomy first, due to varus alignement of my legs and the history of medial meniscectomies. I was quite shocked to learn that, as HTO seems to be a very complicated procedure and I was hoping that another ACLR would do the trick. As for now, I feel quite all right about my knee Ė I have no symptoms of instability, it doesnít swell, no medial pain whatsoever. It just hurts a bit from time to time, which causes some discomfort, and I have bakerís cyst at the back of the knee, which seems to grow bigger after some strenuous exercise. Iím trying to stay as active as possible, swim and take part in MTB races. Although I temporarily resigned from skiing, running and skating, I hope to get back to them in the future. MTB races are the priority though, as Iíve already given up the illusion of being able to play football again.

Having consulted the issue with a few doctors,  Iíve identified three ways of dealing with the problem:

1) Leaving the knee as it is. One of the doctors told me that my knee had suffered enough, and that was the best thing to do, bearing in mind that I had no symptoms of instability. He laughed away the suggestion that I should have a HTO and told that the other doctor had tried to tap me up for money. He even added that, having done some rehabilitation, I could go and play football.

2) Doing only ACLR. One of the doctors (the one who reconstructed my right ACL in 2006), having seen my scepticism concerning HTO (although he advocated the procedure),  told me that we could do ACLR first and then observe whether any worrying changes take place in the medial part of the knee (pain, cartilage wear, osteoarthritis etc.). If yes, weíd do the HTO as well, as a next step

3) Then, thereís the third option. To do both ACLR and HTO, at one go or as a staged procedure (HTO first). This seems to safest decision in terms of my kneeís health , nonetheless I have doubts whether it isnít too precautious. Iím worried about a few things:

- Will I feel a difference between both legs, will I walk limp-free?

- Will I be able to race on my bike

- Is my malalignment big enough? Below, you can see a radiograph which shows that the weight bearing line goes a bit more outwardly in my left knee (I drew it myself, so it might not be perfect).

Iím really in two minds (or even three) about the issue and I hope that there are some people here who had HTO and can help me. What to do?

Thanks a lot.

Cheers, Wojtek from Poland.




 
« Last Edit: April 01, 2016, 07:56:29 AM by Macu »

Offline bradyj7

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Re: What to do? Facing ACLR + HTO?
« Reply #1 on: April 02, 2016, 10:28:50 AM »

Offline Macu

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Re: What to do? Facing ACLR + HTO?
« Reply #2 on: April 09, 2016, 08:18:23 PM »
Hi,

This doctor in Poland is good.

https://www.facebook.com/ortopeda.slynarski/?fref=ts

Yeah, I had actually been considering this option before you wrote it.

It seems to be a good idea, but I was hoping that somebody had a similar dilemma in the past, so that they can describe me their personal experience.

Offline Macu

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Re: What to do? Facing ACLR + HTO?
« Reply #3 on: August 13, 2016, 10:21:55 AM »
I actually went to visit Mr. Slynarski who told me that both ACLR and HTO should be done as in my condition there's 100% certainty that If I don't undergo the operation, I'll suffer from AO.

But I still have my doubts. :/

Is there anyone who had similar problems and decided to have both procedures done?

I'm really concerned that I won't be able to race anymore.

Offline bradyj7

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Re: What to do? Facing ACLR + HTO?
« Reply #4 on: August 16, 2016, 08:19:14 PM »
He is a pretty reputable doctor. I would probably consider it giving that your 27-28 only. You'll heal quick and give your knee the best chance in long term. You've a long way to go on that knee.   

Offline dal_knee

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Re: What to do? Facing ACLR + HTO?
« Reply #5 on: August 17, 2016, 04:07:44 AM »
HTO is only good for 7-10 years and after that the only option left is TKR.  This would be the absolute last course of action when the surgery is offered as an "offloading" procedure not related to congenital abnormalities (truly bow-legged or knock-kneed at birth), and based on the description it sounds like that would be the case.  Macu, have you asked your physicians on their opinion regarding TKR at age 35??  I trust, they cannot even look into your eyes and discuss this honestly.
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.