Tight ligament update - revision surgery needed

Cruciate repair, allograft, autograft, synthetic ligaments. Ligament braces.
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cheekyboy_123
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Tight ligament update - revision surgery needed

Post by cheekyboy_123 »

Hi All

Happy Christmas

Went to see my consultant yesterday, after having had an MRI scan...I am around 10 month post op (patella graft) and having problems with extension which is causing all sorts of problems including walking...I have worked hard at physio to stretch the graft but to no avail...
Anyway, the consultant said that the MRI looked ok, and that there wasn't any major scaring...Just a tight ligment. He said that he was reluctant to re-do the recon and that i had another option open. He said that he could go in, and adjust the bone block, attached to the ligament (only the one above the shin) to create more slack. To do this he would carefully need to cut round the fused bone block and reposition, then secure using another screw. He said once done, he would then keep me in a straight leg brace for three weeks.

I am really confused now and don't know what to do. He said that i was a rare case and that he had only ever done this once. I will definatley get a few opinions i think but i feel that i don't have much choice. The OS did say however that this wasn't going to be as major as the original recon, but was alot more involved than an arthroscopy. I am also worried about scar tissue build up if i am left in a straight leg brace.

Just to let you know also, i recently (3 weeks ago) had the screws removed so that he could do the MRI. This wasn't a big deal but was still my 3rd op this year. The next op will make 4 in the space of a year. I think i'm his best customer. May ask for a loyality card or air miles.....

What a great start to a new year!
Last edited by cheekyboy_123 on Wed Dec 24, 2003 1:19 pm, edited 1 time in total.
ACL Recon 03/03 - Patella graft.
Arthroscopy 07/03 to clear scar tissue + Notchplasty.
Screws removed 12/03 for MRI.
Technesium bone scan 01/04.
2/3/2004 - Tight ACL removed.
Fu*$ing nightmare!
laurac
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi cheekyboy. Merry xmas! I might have mentioned this before but i was told they would try and stretch my tight ligament twice by manipulation before having a go at the bone block etc. Mind you that
could mean an extra two surgeries if that doesn't work. My knee hasn't improved so i am supposed to be having a scope/ manipulation in jan- unfortunately i can't get an appointment for another month so i am just stuck at home waiting. I am not sure if i will be put in a brace but i am also worried about creating more scar tissue if they go into my knee again in such a short space of time. Anway, I probably haven't really been much help but at least you know you aren't the only one! Let's hope that 2004 is a better knee year for us!! Take care and let me know how you get on
Laura
ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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Re: Tight ligament update - revision surgery neede

Post by cheekyboy_123 »

Hey Laura

Sorry to keep hounding you...
Has you doc ever mentioned repositioning the graft. I have never heard this before as people just tend to get the whole thing done again. I believe by repositioning then re-fastening using a screw, he hopes to create a bit of slack in the graft itself. Have you heard of this proceedure before?
Also do you know of any good doctors i could go for a second opinion...Thinking about this guy...But dunno if he's any good...

http://www.knee-surgery.co.uk/

Anyway, hope you are doing good. Have a good New Year....

Take care
ACL Recon 03/03 - Patella graft.
Arthroscopy 07/03 to clear scar tissue + Notchplasty.
Screws removed 12/03 for MRI.
Technesium bone scan 01/04.
2/3/2004 - Tight ACL removed.
Fu*$ing nightmare!
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi! I am not sure if this is the same thing as repositioning the graft but i have heard of a procedure called notchplasty. This refers to the groove in the femur through which the cruciate glides and the procedure widdens this groove. I found this on an old knee guru reply which is refering to a cyclops lesion which you don't have to have to have this surgery but it gives you an idea..-
The cruciate ligament attaches in the deep groove of the femur (thigh) bone, called the femoral notch. When an ACL repair is done, the new ligament is often too thick for the notch, and each movement of bending and straightening gradually strips the graft tissue, like stripping bark off a young tree twig.
This heaps up into a bulging lump (which looks like a cyclops's eye - hence the name) and this lump of tissue can obstruct the movement of the ligament in the notch and impair recovery of full range of movement, or perhaps lead to a reduction of the previous range of movement.
The cyclops tissue can be trimmed off, but will recur unless the notch is widened - a notchplasty.

I haven't managed to get an appointment to discuss this with my os yet. I am not sure what happens when you have dissolvable screws like mine? As for doctors I have never heard of Fergus Patterson but that doen't mean he is no good! I have been recommended Angus strover, A. Williams and J. Lavelle- i think they are all in London. I recently saw Denis Edwards at Cambridge but i am hoping to get an appointment with Mr Villars- also at Cambridge and supposedly a bit of a god in the knee world!! I could do with some godly intervention!! Only trouble is the waiting lists to see these people- v frustrating sat at home going nothing waiting for a hosiptal to ring and offer me an appointment. however, i would rather wait and see someone good rather tha being offerd more unnecessary surgery. Let me know if you find anything interesting out- I am happy to give you my phone number if you want a chat ( moan!) Hope you get some good news soon
Laura


ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi- just read your post again and realised you had a notchplasty so forget the first part of my message! Do you know what the procedure they are offering you is called? Have you had an xray which shows the ligament is in the wrong place. Mine showed mine was fine so i am a mysterious case. The real clue that my new ligament is too tight is that when I squeeze the knee cap togeether my knee bends q nicely- my osteopath says this is because i am releasing the tension in my ligament. Doesn't help with my inability to fully straighten my knee though. I am not really sure if it the prob with flexion or extension that is making it so hard to walk. When you walk does it feel like your leg bones are almost stuck together?!
ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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Re: Tight ligament update - revision surgery neede

Post by cheekyboy_123 »

Hi Laura

Yes it does. I'm not entirely sure if it is the flexion or the extension thats causing the problem. I'd bet on the extension though.
The proceedure the doc described was a 'graft revision'...He said rather than having to do the whole proceedure again (possiblily using a hamstring graft this time) he would only adjust the bone graft at the bottom of the knee and not touch the top. He said he would need to cut round the graft and make a little room at the top. He would then move the graft up a little and fasten with a screw, thus creating a little slack.
Problem is, he said he had only ever done this once but was confident that he could accomplish it. He also said i was a rare case, again! I'm not sure what that means as if the ligament was too tight - surely thats a surgical error...Dunno... :-/
Anyway - i have decided to see my physio on Mon and ask if he knows of anyone i could see for a 2nd opinion. If not - i'll see that Patterson bloke.

One thing concerns me though about the whole proceedure. He said i would need to go back into a straight leg brace for 3 weeks. Surely this would promte more scar tissue and muscle wastage. Why he promotes this when everyone else i speak to encourages movement asap, is a mystery. I will quiz him about this. He said at our last meeting that he would prefer to protect the graft and acheives better results by immobilising the knee for this period. I am however, of the opinion that it causes more problems than good (speaking from experience)...So this is where we differ... >:(

Anyway - enough of the moaning. I hope you have a great New Year. Be safe!

Take care ;)
ACL Recon 03/03 - Patella graft.
Arthroscopy 07/03 to clear scar tissue + Notchplasty.
Screws removed 12/03 for MRI.
Technesium bone scan 01/04.
2/3/2004 - Tight ACL removed.
Fu*$ing nightmare!
laurac
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi. Well I can sympathize with the feeling of not knowing what the hell to do! In theory the procedure sounds quite good as the less intervention they do the better. Not sure about the leg brace thing though. Mind you i never had one and still had problems so maybe it isn't all bad. I definitely think the aftercare you receive is as important as the surgery. It sounds llike you have found a good physio so at least thats one less thing to worry about. I haven't been to physio for 6 weeks- i have been doing stuff myself though. Are they sure the ligament is not in the right place and not just too tight? Did you find the notchplasty helpful at all? Do you think we have a legal case if the ACL recon wasn't done properly? I can't believe it has been six months since my ACL surgery- possibly the longest six months of my life. I think I will drown my sorrows tonight!!! Hope you have a good evening and that 2004 is a happier and healthier knee year!! Let me know what the phyaio says!
Laura
ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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Re: Tight ligament update - revision surgery neede

Post by koala »

Hi All,

I've been following this thread but too busy down the gym to answer.

I'd be very wary of going back to your original Os cheeky. I wouldn't want anything done by someone who'd only done it once before. Did you ask him how many ACL recons he'd done before ? (one possibly...:-(..) I've lost enough additional muscle tone from just arthroscopy. If I sat around in a brace as well it would only have been worse. What does he mean by "achieving better results by immobilising the knee". Better than what? It doesn't sound as though he's ever tried not immobilising it.

I'm not sure about Mr Paterson either. I had a look at his website and I didn't rate his FAQ on ACL recon. He said you could drive after 2 weeks which I reckon would be a sure way of causing an accident. However, it's nice to see someone who's actually got a web-site and is trying to communicate. He seems to go for hammy grafts though, so may not be the right person to look at your problem. Have you tried emailing him? Also, I was told that Andrew Williams did Laurence Dallaglio & I think that they tend to use patella tendons for footballers & rugby players so maybe he'd be more familiar with it. This is a link to more info about him:

http://www.drfoster.co.uk/consultant/co ... no=3199503

and another one you might want to look at:

http://www.kneeclinics.co.uk/

Laura - I'm really glad you've found someone who is reckoned to be a bit of a "god". How long have you got to wait?
By the way, I don't understand your osteopath saying that squeezing the kneecap is releasing the tension in the ligament. I don't see how they are connected.

In my case the notchplasty has really worked. But then my problem was always extension not flexion. I got up to 5.4 kph on the treadmill in the gym today & that's the fastest I've moved for a year. It's just a question of finding the right person to fix the problem. Keep at it - it will happen. I hope neither of you have to wait too long.

I wish you both a speedy resolution to your problems in 2004 - I'll raise a glass or two to it.

Jo
Ruptured ACL in skiing injury 11/1/03.  Hamstring recon 12/1/03 at Austrian clinic.  Rehab very slow.  Notchplasty 19/11/03.   Near full extension achieved.  Exercise and physio very regularly since.  Still a lot of pain when exercising and irregular gait.  Further arthroscopy proposed.
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi Jo- glad to hear you are making good progress. Are you able to manage stairs yet? I was hoping to get a stair lift for xmas- i hate stairs!! I am hoping to hear from the hospital next week about my appointment. I think the guy is really busy as he has operated on people such as the sultan of Brunei. Not sure where non-royals get put on the waiting list!! I know it sounds abit weird when i say about squeezing the knee cap, but apparently it relieves the force put on the ligament / gives you more glide- it was mentioned by a physio as well so i don't think he is making it up! I have another question for you both- do you have pain if you press down roughly where you screws are- the left side of my scar is really sensitive and I was wondering if it was the screws. I will keep you updated if i hear from the knee god!! take care
Laura
ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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Re: Tight ligament update - revision surgery neede

Post by koala »

Hi Laura,

Stairs - yuk! My father moved to a residential home about 2 years ago & we sold his stair-lift back to Stannah. I wish I'd kept it. At least I kept the exercise bike he got after his knee replacement. Going up has got progressively easier over the past year but I couldn't even try going down one stair at a time until after the last op. It's still pretty slow and painful now. I've learnt to think about everything that needs to go up & down before trying it. I used to smile at my Father filling up his pockets & stuffing things up his jumper before starting when he was staying with me. Boy, do I appreciate why now!

I've just tried squeezing my kneecap & it seems to take me want to straighten my leg not bend it. I guess it's hard to appreciate without having exactly the same problem.

I don't have any significant pain if I press down roughly where the screws are. The scar below my knee is above one of them & has been tender all along, but I can't tell exactly where the screw head is. I got worried when I saw my MRI as it looked as though it was proud of the bone but I think it must just be that the outer part of the bone is more transparent. I think I can feel a very small dent where the other one is but it's not painful.

I hope you get an appointment really soon. If he's good enough for the Sultan of Brunei then he should be GOOD, & probably worth waiting for. I "jumped the queue" with the second OS I saw as I'd been referred by another OS. I hope this is the case with you. Let me know how you get on.

Cheers,
Jo
Ruptured ACL in skiing injury 11/1/03.  Hamstring recon 12/1/03 at Austrian clinic.  Rehab very slow.  Notchplasty 19/11/03.   Near full extension achieved.  Exercise and physio very regularly since.  Still a lot of pain when exercising and irregular gait.  Further arthroscopy proposed.
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Re: Tight ligament update - revision surgery neede

Post by cheekyboy_123 »

Hey guys - Happy New year...

I'm gonna try be more positive this year and push my tight graft to the limits. I have decided to get a second opinion from a highly recommended doc - Mr John B King.
My physio (who is linked with Arsenal FC) doesn't think i need further surgery but just very aggresive physio for 2-3 months. He said that if after 4 weeks i hadn't noticed any difference then .....
Whilst talking about my issue (with physio), i asked who the best in the field was - he 'easy, that would be Mr King'.
I managed to get an appointment for this Monday at the London Independent Hospital...

I'll let you guys know how i get on. I'll continue the physio for a while and see what happens.

BTW - i noticed Mr King listed in this forum as 'Big names in knee surgery' - which is encouraging.......
ACL Recon 03/03 - Patella graft.
Arthroscopy 07/03 to clear scar tissue + Notchplasty.
Screws removed 12/03 for MRI.
Technesium bone scan 01/04.
2/3/2004 - Tight ACL removed.
Fu*$ing nightmare!
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Re: Tight ligament update - revision surgery neede

Post by Marek_Bowman »

Hope it all goes well for you, a minor comment about my own progress, I've just returned to work and one thing I've noticed this last week whilst I havent been doing my extension exercises as often as I was, is that I've been finding it difficult to get a good extension. However After a do my exercises I get my full extension back, I guess what I have learnt from the last couple of days is that I still need to do these exercises and often so I can retain my full extension
Complete ACL tear in left knee Feb03. Fixed using Patellor Tendon Graft Oct-23-03.
Playing soccer 3 times a week, back to enjoying my life the way I want to.
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi. i hope Mr King can help you- let me know if he is any good! I have been sat here all week waiting to hear back about my next appointment- a watched phone never rings! Just to add more complication i have just got a letter telling me to book an appointment with the pain management people(NHS) in the next month- as if I wasn't confused enough already about what to do. This has coincided with my 6 month recon anniversary and i was supposed to be off to France having already postopned about three times so hasn't been the best week!! :P Sorry to moan - let me know how you both get on
Laura
ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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Re: Tight ligament update - revision surgery neede

Post by cheekyboy_123 »

Hi All

Looks like my acl saga has taken a new twist.
I went to see a consultant on recommendation from my physiotherapist. This new consultant, Mr John B King, had a very frank discussion with me about my acl injury. He asked how i originally did it ( years of football and snowboarding) and also asked if it ever slipped/gave way after i did the injury. I said no. I told him i packed in football and it never really gave me any trouble after that. He asked why i then proceeded to have surgery (recon)..I said that i spoke to many different consultants and physios who gave me varying answers. I also said that the last consultant i spoke with (the guy who did the surgery) said that if i didn't have it done then arthritus would almost certainly kick in.
Mr kings smirked, then said that there was no evidence that this was the case. He said that if it didn't slip/give way then there was no need for surgery. Its the slipping/giving way that causes further damage...
Anyway it is done now, so i asked him what next! He looked over my MRI scans, done 3 weeks ago, and said the area above my tibia was 'hot'. He said that because the ligament was so tight it was pulling the tibia and fibia to close together, causing friction when trying to straighten. He said that if left unchecked - it would certainly lead to Arthritus. He said i had two options - first was to redo the surgery. Second option was to cut the ligament and go back to pre op state. He said that if he were in my position - he would do the latter....
He said that this was a big physicological decision to make and would effectivley mean that this whole year was for nothing...What he asked me to do is have a TE bone scan. This would involve a radio active substance being injected into me then being phtographed (similar to MRI)...The results from this would determine damage to the upper tibia.....
So now i am more confused. Mr King is based in London Independent Hospital and come highly recommended. He performs surgery on Premiership footballers including the Arsenal football team. He is apperently on the best knee guys in the country. I don't think he is a money grabber as he didn't push me to have a 2nd revised sugery. He basically said i should have it cut then asses the situation. He also said that because the ligament didn't give way before it shouldn't do now. Also as i have had numerous sugeries on the knee, scar tissue would also help to keep it in place. He said this proceedure was small and could be done via key hole.....
So what do i do..... ???

Original surgeon recognises there is a problem with a tight graft and wants to revise the graft by moving the lower graft closer together this creating slack. He said he has only performed this proceedure once, and that it was very tricky....
Physiotherapist suggests i continue working the knee and forget what original surgeon wants to do, and can understand to some extent, what new surgeon wants to do..However, his worries are that the muscles are not strong enough to cope with no ligament..He suggests that if i decide to cut it, i deveop muscles before hand. However, developing muscles before hand is causing more damage to upper tibia...
New surgeon, My King, feels if the TE bone scan confirms his suspicions, cutting graft would be the best thing. Get back to pre-op levels then see how it goes. He also said that if i decided to have the surgery again, he would need to cut out the old ligament anyway....
What a fu%$ing mess! >:(
ACL Recon 03/03 - Patella graft.
Arthroscopy 07/03 to clear scar tissue + Notchplasty.
Screws removed 12/03 for MRI.
Technesium bone scan 01/04.
2/3/2004 - Tight ACL removed.
Fu*$ing nightmare!
laurac
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Re: Tight ligament update - revision surgery neede

Post by laurac »

Hi. wow- that must have come as a bit of a shock. To be honest i have also been wondering recently if i should have had the recon. I was urged to by my original OS as he said i would be likely to develop arthritis otherwise. He even suggested having it done before my placement year in France to prevent this. I also wanted to have it done so i could get back to 'normal' activities - i have always been v sporty and active. However, like you i am now in a far worse situtation and at the moment if someone offerd to cut out the new graft i would be q tempted. Did he talk you through what the situation would be after the procedure. Having already had several procedures surely it wouldn't be so straightforward as removing it and immediately getting back to the same stage you were pre- recon? What about scar tissue, inflammation etc? My knee felt v strange without a ligament but it only gave way v occasionally or if i went downhill for some reason. I had pretty good flexion though and i was going to the gym being able to do most things before the op. However, the point is we both had it done and i think you would go mad if you thought about it all too much. I can sympathizie with you- it must be a really hard decision. I don't know anything about bone scans but if it helps you with your decision it is prob a good idea. You mentioned about needing to build up muscles- have you found your recent physio has improved your muscles? I have been doing all the right things but i seem to be fighting a losing battle with my muscles. My osteopath uses an infrarential machine on my knee and he has to turn it up so high it is practically off the scale !!! Right, just to update you on my saga! I went back to the consultant i saw 6 weeks ago as it turned out getting an appointment with the god guy was pretty impossible. It went ok- he did a brief examination and as i was expecting he wants to do a scope/ manipulation to see what is going on in my knee. He thinks it is adhesions rather than the ligament but obvisously he doesn't know till he looks. I don't understand why when i had the previous scope the os reckoned he hardly had to do anything to get my knee to flex easily and why after literaly a few days post-op the tightness and lack of flexion returned- i know scar tissue can reform quick but it doesn't all quite make sense. The thing about me being able to self-manipualte my knee also doesn't really fit in with the scar tissue theory. Obviosuly by having more surgery if it is the scar tissue causing problems i could end up worse off but i have got to the desperate stage- my lack of movement is affecting pretty much everything i do +if it doesn't improve soon i am going to have to pull out of uni till i get it fixed. I think i will be having it done in a couple of weeks. Just out of interest does your knee look v red and swollen? Has your scar faded? I have been told mine is a keloid scar and apparently it looks like i have had a knee replacement instead of an acl recon- great!! Have you thought about getting another opinion? For the sake of your sanity maybe it would be worth it?! I can't believe so many people have so many probs after what i thought was a common and fairly straight- forward operation. I 'm really sorry you are having such a crap time- keep us updated- feel free to vent!!! Take care
Laura
ruptured ACL 31/10/02, arthroscopy 01/03, ACL reconstruction 07/ 03, manipulation 10/03,
scope- chrondroplasty+ adhesion division+ MUA 28/01/04 scope- adhesion removal, manipulation 17/06/05
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