Is there an age limit for ACL reconstruction?

[gazkitch]

Hi, I'm a first time poster from the UK looking for advice.

I injured my knee in May whilst playing football. My MRI has suggested
that I have damage to my medial meniscus and a rupture to my ACL.

I am unable to flex my knee beyond 90 degrees and I have got a 5 degrees lag on extension. My knee cracks all the time, and I get occasional locking and have permanent inflammation of the medial meniscus area.

My OS has said that I am now at the upper age limit (I am 50 next September) for an ACL reconstruction, due to potential Arthrofibrosis problems etc.

I am totally frustrated with my situation, as he has stated that unless I have full flexion by the time of the operation he will not replace my ACL, and it will then be just a case of repairing the meniscus and removing the ruptured ACL.

Although he never specified (and I was not too informed at the time) my syptoms suggest that I have got a Bucket Handle Tear of the meniscus?! So, in all likelihood I'm never gonna achieve full flexion by the time of my op, whatever rehab I do?

[vickster]

NHS or private? I know several people in the U.K. who've had ACL recon at 50 or beyond in the U.K.

Can you get a second opinion, even if privately (from a surgeon with an NHS practice too)? Waiting lists on NHS for ACL probably 6-12 months from what I've read.

If you've had a bucket handle tear why do you think you wouldn't get full extension if you get it trimmed (unlikely they'd be able to stitch at 50 as the tissue is likely degenerate due to your age). If the meniscus tissue is stuck in the joint, surgery probably unavoidable. Leaving it may well lead to more damage.

Is your knee unstable due to the lack of ACL

Good luck

[gazkitch]

Thank you for the reply.

It was an NHS OS that I saw back in July.

The knee is a bit unstable at the moment. The current waiting time for surgery in my area is 21 weeks

[vickster]

Doesn't sound as bad as some areas. Where are you?

Can you go private perhaps if you would rather have the ACL reconstructed? If you're fit, healthy and prepared to commit to 6-12 months of rehab and have no medical conditions or pre disposition to scar tissue there shouldn't really be a reason for not going down the ACLr route...unless your local CCG won't find given your age which would be unusual. Is the surgeon an ACLr expert? How many does Ge do annually? Does he offer the op privately?

Are you working with a sports Physio to try to get some more function (usually need to go private to get solid ongoing treatment)

[gazkitch]

I live in the West Yorkshire region.

I've been undergoing rehab with an NHS physio. I have also been doing Pilates (using machines), but I usually get a reaction afterwards.

I have thought about getting a second opinion. I can't afford an ACL replacement, but maybe thought I could pay to get the meniscus damaged operated on, and let the NHS OS sort the ACL out?

[The_KNEEguru]

These people may be able to give you an opinion https://yorkshirekneeclinic.com/

[The_KNEEguru]

There is a new 'micro-arthroscopy' tool called 'Mi-Eye' where docs can look into your knee in their consulting room under local anaesthesia - just for cases like yours to check what the meniscus is doing (eg if it is the cause of the restriction in motion). Perhaps you could ask if they have one?

[Audice]

I was told back in 2005 when I, among other things, ruptured my ACL that at age 67 nobody in the USA had ever had reconstruction.

[vickster]

67 is a little different to 49/50 though in terms of likely recovery

That said, this poster had his ACL recon aged 60 on the NHS a couple of years ago (incidentally by the surgeon who manages me)

http://www.kneeguru.co.uk/KNEEtalk/inde ... ts;u=47187

[gazkitch]

I have just checked out the Yorkshire Knee Clinic website, and it turns out that my NHS Consultant works for them! A perfect example of a two tier health system?!

[vickster]

That's completely normal, most Consultant surgeons with a private practice also work within the NHS, which is good in my view as it keeps expertise within the NHS and offers choice and flexibility. For the example, I'm a contractor so it's important to me to be able to access healthcare when and where I want and I'm prepared to pay extra for the service (as I wouldn't get paid if I have to take a weekday afternoon off to attend an NHS clinic).

Is there a reason why you can't have the ACL and meniscus operated on at the same time if the meniscus trim is going to free the ROM needed for the ACL? Often operataed on at the same time, what's different about your situation?

I'm not sure you could remain on the NHS list if you choose to have partial surgery privately. Not sure it would save much either especially if you have to rehab twice, and indeed have the risk of two ops. Something to discuss with the surgeon really and hospital regarding costs. I believe a more straightforward arthrocipy is in the region of 4K and ACL, 6k although it is dependent on the hospital and surgeon (can be much more in central London for example)

[gazkitch]

When I saw my OS, he said that in order to do an ACL reconstruction, I had to have full flexion, otherwise my knee would be like concrete after the surgery. I can fully accept the logic behind this; but when I asked him how I would achieve full flexion, he just replied that I would have to work through the pain barrier. However, in my attempt to gain better flexion, I seem to be merely agrevating my medial meniscus, and this is having the reverse effect

[vickster]

Right. The problem is potentially that you are doing more damage to what is quite likely a degenerate meniscus as bending the knee might be chewibgnup trapped meniscus. I had similar with mine after initial injury. Tried to rehab for 5 months as other than a locked knee that wouldn't straighten in my case, function wasn't too bad. When it started to buckle, I had to have surgery. I have trapped meniscus now but waiting until the new year due to work/upcoming holiday.

What does the Physio think you should do? Has the surgeon put you on his list for me isvysntrim?

[gazkitch]

The physio just keeps prescribing more exercises to build up my quads and calfs. However, he has now said that I should just try to work within my ROM when it comes to knee flexion exercises.

I have now noticed that the knee is catching more; and with certain exercises, the patella sometimes does a little jump when tracking.

[BornToRun]

As Vickster said previously, it might be worth a second opinion. Certainly on the age front, a skiing forum I look at has a few members who had ACL reconstructions in their 60s and are doing well.