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Author Topic: Acl revision and partial in one op  (Read 632 times)

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Offline Deb1966

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Acl revision and partial in one op
« on: October 20, 2018, 07:45:54 PM »
Hi all.
I had a hamstring acl reconstruction 12yrs ago which has now failed. I also have end stage osteoarthritis in the medial compartment. I have had hardwear removed and bone grafting done. My consultant is considering doing an acl review using patellar as well as a partial knee replacement in 1 operation although he has not tried this before. Does anyone have any experience of this? BTW I am a 51yr old female.

Offline The KNEEguru

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Re: Acl revision and partial in one op
« Reply #1 on: October 21, 2018, 08:00:42 AM »
Are you referring to hardware related to the ACL?

Have you researched osteotomy? Some osteotomy surgeons will do a combined osteotomy to unload the medial compartment and deal with the ACL at the same time. At your age this might delay the need for any knee replacement.
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Offline The KNEEguru

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Offline The KNEEguru

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Re: Acl revision and partial in one op
« Reply #3 on: October 21, 2018, 08:04:54 AM »
Some of the discussions here may also help http://www.osteotomyexpertgroup.com/
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Offline Deb1966

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Re: Acl revision and partial in one op
« Reply #4 on: October 21, 2018, 10:20:51 AM »
Thank you so much for your reply. It was the screws from my last acl reconstruction I had removed. My consultant did consider an osteotomy but he felt that it would only be delaying the inevitable. He is hoping that by doing the acl and partial that it should last me about 15yrs. My concern is that he said he wanted to do both ops in one go which means there will be no blood supply to the leg for much longer than is usual. Any thoughts would be appreciated.

Online Vickster

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Re: Acl revision and partial in one op
« Reply #5 on: October 21, 2018, 11:11:31 AM »
Ask him how many times heís done the two before, in what type of patient (age, gender, activity levels etc) and what outcomes achieved?
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Deb1966

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Re: Acl revision and partial in one op
« Reply #6 on: October 21, 2018, 11:45:25 AM »
He has never done it before and as there have only ever been about 20 done in the country there are no statistics for the outcome.

Online Vickster

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Re: Acl revision and partial in one op
« Reply #7 on: October 21, 2018, 12:58:17 PM »
Hmm is he a super specialist knee surgeon? Can you get a second opinion from a surgeon who has done it before?
Iíd be wary but Iíve been under a pretty conservative guy for 9 years and Iím pretty wary. Heís not even keen on partials in active patients as in his experience they loosen and need revising to tkr which isnít ideal in younger folks.
My damage is more lateral which is more unusual and tends to be more problematic  :(

No data from other countries?

Sounds like youíve done your research though so good luck  :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline Deb1966

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Re: Acl revision and partial in one op
« Reply #8 on: October 21, 2018, 04:06:29 PM »
Thanks so much for your advice. He is a very competent surgeon and although I haven't been able to find anyone that has had it done before I do trust him. I just feel that if I don't allow him to do it there will never be advancements in knee surgery that could help others in the future. It's just whether I am brave enough to take the risk without having been able to talk to someone that has had it done.


Offline Chiaretta

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Re: Acl revision and partial in one op
« Reply #10 on: October 21, 2018, 05:03:38 PM »
It's quite a rare procedure, but there is some literature on it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999376/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974734/

I think in your case an osteotomy is not the way to go, indeed. Osteotomies are usually indicated for patients with mild to moderate osteoarthritis only (or severe deformities).

Did your surgeon tell you how long the operation will take approximately? I've no experience with this specific surgery, but I had an osteotomy revision + ACL revision last year, which I guess is similar in length, and no problems with blood supply or anything like that. When it comes to anaesthesia, though, the effect of the spinal was gone after 2h, so I was in a lot of pain the last part of the surgery. I'd recommend to go for general anaesthesia, if possible.

Good luck!

Offline Deb1966

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Re: Acl revision and partial in one op
« Reply #11 on: October 21, 2018, 05:51:51 PM »
Thank you everyone for your help and information. I am certainly a lot more familiar with the procedure than I was this morning. It really is very much appreciated  :D















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