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Anterior cruciate ligament repair

Discussion in 'Health and wellbeing' started by deliasmithbook, Apr 14, 2012.

  1. I'm waiting to hear from my consultant - I tore mine in a fall in which my foot skidded sideways across the wet floor as I went down and my knee made a kind of right angle with my thigh. He mentioned "grafting" but I will know more when he has all the scan results etc. I have physio exercises to do (AGONY) which i thought were to strengthen it before the operation. I hope it's not instead of an operation! Good luck with yours.
     
  2. Gardening Leaves

    Gardening Leaves New commenter

    Thanks and goodluck with yours, too. Mine went the same way! I found a v good website belonging to Simon Roberts in oswestry that's worth a look. He is a cruciate specialist and it explains in detail all the options and the relative advantages of each. I have a new MRI scan on Tuesday, because the consultant didn't rate my Austrian one and then another appt at the end of the week. I have impressed upon him that I want to continue to be very active.
     
  3. Being active longterm wont be a problem depending on the activities you want to do.
    I think if you search for Windsor knee clinic you will find some useful info.
     
  4. Gardening Leaves

    Gardening Leaves New commenter

    Thanks - skiing, tap dancing and ballet!!! So I need it to be 100%.
     
  5. Thanks for the link. I'm not what you'd call a sporty type - i just want to be able to walk and climb stairs!
     
  6. Tigger1962

    Tigger1962 New commenter

    Cruciate ligaments are a long job whatever treatment option you chose - usually longer if you have surgery as there is a longer recovery afor the muscle such as your hamstring etc that is used for the tendon graft
    unless you are an international athlete they normally don't operate in the acute phase unless the swelling and inflammation has subsided as operating during inflammation carried a higher risk of developing osteoarthritis - sometimes this can take several months and then the recovery time from ACL surgery is 4-6 months - perhaps longer for skiing so with surgery probably 9-15 months before back to all activities like skiing
    Usually conservative treatment is worth a go for a partial tear and even some compete tears - it is good preparation for surgery to strengthen all of the muscles and ligaments around the joint as it will make the recovery from surgery quicker - you will need a good physio with experience of knees to get you doing the right exercises and training - and you will need the ability to tough out the pain of doing them
    A relative of mine ruptured her ACL skiing last year and she is a nig club distance runner - she started conservative and was starting to feel that she would need surgery as she went months with no improvement - however after a change to a knee physio she made more rapid progress and was able to get back to running after around 8 months
    I suffered a catastrophic knee injury in 2010 that was thought at first to be an ACL and turned out to be much more complicated more serious - the plan was for conservative treatment but it hasn't worked and I have no knee stability am now looking at the prospect of a knee replacement but am considered too young
     
  7. Gardening Leaves

    Gardening Leaves New commenter

    Thank you so much for taking the time to write at such length. Your experience (and that of your relative) is extremely helpful to me.
    I have read widely and my daughter is a doctor, but not an orthopaedic specialist. The difficulty I am encountering is that there seems to be so much conflicting information. I am an active person, not only skiing but still taking challenging ballet classes. I want to be able to continue to do that, so it is important for me that I get the treatment option right.
    The Austrian specialist told me that I must insist on having it 'properly repaired' or face osteo-arthritis. My reading led me to believe that leaving it unrepaired would keep it permanently unstable, pre-dispose osteo-arthritis and I would be unable to be very active on it again.
    Other information suggests that 100% repairs result in osteo-arthritis within 10 years because the common surgical technique is to screw the graft in a slightly abnormal position (for access reasons). There is one surgeon, in the Bournemeouth area, who claims to have developed a new technique to be able to attach the graft in a more natural postion which will lessen the risk.
    My specialist now believes that potential arthritis damage is caused by the original injury and not by subsequent treatment choice. I just don't know what to believe. I can certainly feel hard surfaces rubbing together now in a way they never used to. His suggestion is to treat it conservatively, with physio, at first and then consider surgery if it doesn't improve. He does use physios with specialist knee rehabilitation experience.
    I have had a second MRI scan, after the specialist 'dissed' my Austrian one and I shall know more when I see him again this evening.
     
  8. Vampyria

    Vampyria New commenter

    Apart from wishing you the very best with the scan, I've nothing very constructive to add GL. My only prior experience of this is seeing animals with it in the surgery some years back, which invariably required the surgical option, owing to diffculties with cage rest etc .
    You appear to have a very good handle on things already, I have to say. Hope you manage to discover the best treatment option for you. I don't envy you having to decide.
     
  9. Plenty of things to raise at my next appointment from this thread, thank you! Mainly: I dont understand the osteoarthritis connection - I thought OA was caused by cartilage wearing away and causing bare bones to grate against each other? I don't see why ACL repair would make that any more or less likely. My mum's only 58 and she's already had a knee replacement for OA so think I might be genetically doomed anyway!
    Can I just ask you how long it is since your injury and what your level of mobility and pain is right now? Mines not really feeling a lot better for weeks and is always worst after physio. I've been trying to knock the painkillers off as I got awful constipation (sorry if TMI!) and I don't think not moving about much helped with that either.
     
  10. Tigger1962

    Tigger1962 New commenter

    I think that a lot depends on what the original igury was like and how it occured
    I suffered a knee dislocation slipping on ice - however the fact that the knee bent backwards in the wrong direction at 45 degrees meant that the knee crushed together at the front causing a meniscus compression, full/partial ruptures to all 4 ligaments (ACL, PCL, and , a leg fracture where my thigh bone (unattached by the ruptured ligament) slid over the top and fractured the lower leg and nerve damage etc
    However what the issue was for my injury was that the surface of the bone within the knee joint was crushed that the cartillage is attached to with bone fragments within the knee joint from the crush injury ( a chondral fracture) and I think the concern was that digging about within the knee joint to repair cruciate ligaments would create a higher risk that the crushed bone and cartillage would become permanently detached and create osteoarthritis.
    So this is why they often prefer to wait for a certain level of healing swelling to subside to give surgery the best chance. Also it gives you the chance to do the pre surgical training for the muscles etc to improve strength. Some people also have steroid injections to reduce inflammation and swelling
    I read a lot of the research and there is no clearcut answer to whether conservative or surgical repair is better as it is often individual from case to case - this is why they often encourage you to start with conservative to see which level you can reach just with training and physio - although this is a painful option you will have to start from zero again after surgery anyway. A lot depends on the individual circumstances and what you level you want to get to
    I know someone who runs ½ marathons with 2 ruptured cruiciates and it seems to work for her
     
  11. Tigger1962

    Tigger1962 New commenter

    oops that should read ACL PCL MCL LCL
     
  12. Thanks for the info! What an accident-prone lot we are!
     
  13. Good luck with it.Timescales vary from person to person so it might not take as long.
    Mine wasn't as bad as your's and seems to have healed itself - it did take a while for the muscles to balance up again though. It's just the rest of me that's fallen to bits now.

     
  14. Tigger1962

    Tigger1962 New commenter

    Did you have your surgery? How did it go?
    Getting the knee straight can be a big problem if you have been in a cast for a while - it was a year after my accident before I could fully straighten mine and that was doing 100-200 sets of straightening exercises each day
     
  15. Gardening Leaves

    Gardening Leaves New commenter

    Thank you for remembering and asking :)

    I haven't had the surgery yet. I've scheduled it for mid September because we'd already booked a big holiday to Canada in August and I wouldn't have been able to walk properly or drive.

    Knee's improved a lot but is far from right. Can bend it well but it still wont straighten properly. I can't walk long distances or on uneven ground and can't do anything high impact. Tried a tap class gently on Tuesday, just to try it out but I don't have stability or sideways movement. Feels like someone has filled up my knee with expanded foam!
     
  16. Gardening Leaves

    Gardening Leaves New commenter

    Saw consultant on Saturday morning. He's doing a hamstring graft taken from the same leg and can apparently do it with key-hole surgery. He doesn't brace adults though sometimes braces irresponsible teenagers. I have negotiated with him to do it as a day case, as I hate staying in hospitals. I never sleep, end up watching the middle of the night repeat of Countdown in desperation, don't usually need the pain relief and always just want to go home to sleep in my own bed.
    Post-op, he says, I'll be weight-bearing immediately and on crutches for 3 to 4 weeks. Need to rest it to let it heal, with first only gentle physio. Needs to be 'quiet' again after 8 to 10 weeks as that's when grafts can break down, but he reckons he can have me gently running in a straight line after 12 weeks. 9 - 12 months altogether until it's functioning in the way I want to be able to ski and do ballet on it again.
     
  17. You will have a small incision with stitches from the hamstring "harvest". That is the most painful bit of the operation and you will need pain relief for that and ibuprofen to help the inflamation and swelling for several weeks.
    Good luck with your op.
     
  18. Tigger1962

    Tigger1962 New commenter

    Glad to know that things are progressing Gardening Leaves and that you will get your surgery soon - even though it is a long slog to get back to the high level of activity
    You are lucky that you have managed to negotiate day surgery - it is the bit than I am dreading for my knee replacement - I hated every minute of the time spent in hospital with the original injury. I was the youngest patient on the ward by 30 years and didn't get a wink of sleep owing to several dementia patients - but was unable to go home until adaptations had been carried out.
     
  19. Gardening Leaves

    Gardening Leaves New commenter

    It's the main reason I have private health care. I can't bear not being in control of my surroundings. This way I can choose when and where to have surgery and which consultant to use. I have a private room with en suite and can .negotiate for the surgeon to do me first at 7.30am, so I can go home the same evening. I don't sleep even in a single room. I'd be climbing the walls on a ward.
     
  20. rosievoice

    rosievoice Star commenter

    Excellent news, Gardening Leaves. I hope the surgery goes smoothly. xx
     

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