Ligament repair, anybody had one??

[anteater]

DP has torn her ACL last week, told she would need a repair on her return to UK, anyone had this repair. Was told last night by friend that the MRI scan could take MONTHS on the NHS..??
True? If so what £ are we talking to go private??

think your frien may be misinformed, where are you coming from and what treatment/investigations has your dp had done so far?

Saw GP this morning;
On the NHS a consultation would take 6-8 weeks, an MRI scan 8 months ffs
Private, see same consultant this week (£80), MRI asap (£400)

Funny bloody NHS we have.

Bupa here we come!

I had an ACL reconstruction in 1994 -- but I was in the US so no help on NHS experience. It's a real bugger. My sympathies to your DP.

And if it makes you feel any better my MRI was $1200.

My surgeon, who was French, didn't need an MRI to determine that I had completely ruptured my ACL. He did a complete reconstruction using my hamstring tendon thru a 3cm incision plus ports for the instruments and camera. The total recovery time, however, was still an entire year until I was able to be as athletic as I was before, b/c I sustained other knee injuries as well (skiing accident).

This was in 1996-1997.

I wish your partner LOTS of luck!!

damn, anteater! that's awful.

Mine was only partially torn, but I still think the surgery was the right thing to do. The knee will never be what it once was. But, I would recommend the surgery. As it is better post op than leaving it torn.

expat that is exactly what I wass going to say. your gp should refer you to your nearest # clinic to be seen by an orthopod asap.

You could play dumb and pipe up at a and e they would refere you to ortho asap. An orthopedic dr may not have to wait on the results of an mri to confirm diagnosis. Depending on the degree of the tear they may have one done for you quicke, Ultrrasound can detect scomplete tears, Is your DP in a full leg plaster cause if not she should be in one whith a pointy toe.

slrry wrong ligament, took that to be achilies endon... silly me. Thugh she should be in a leg brace.. and thus should be being monitored by an orthopod!

You know, I have a torn ACL and have done for 10 years (tore it in a ski accident in Japan, long story!) Depending on how sporty you are, it may not be necessary to have it repaired. I do a lot of walking, cycling, and dancing, and have never had a problem. Then again I won't be able to ski ever again, or play professional basketball! The surgery and therapy afterwards is a long haul and I just didn't think it was worth it. But it depends on how much sport you like to do.

they never put people in plasters for ligament tears in the US , w/the exception od pst-op achilles tendon repairs. what is that? omg, that is soooooo outdated and unnecessary! i had my full repair done as an outpatient under spinal block and walked out - w.a full brace on. then had cpm machine at home for 4 days.

ligaments need blood for the graft to be the most successful they can be and for revascularisation. movement also decreases the risk of developing clots.

she needs to see a decent ortho surgeon asap.

Expat that is amazing, it just goes to show how outdated the nhs is. we are less likely to pop an ACL, brace and non weight bearing crutches, but everything else would be in plaster (cause its cheep I would imagine) We stilll plaster most scaphoids unnecesarily as well!

Interesting. When I had mine done, the surgeon told me about how they used to put you in a cast for 6 months and how that really wasn'a good thing cause all your muscles were very weak at the end of six months... and that was 12 years ago that he told that story. And the machine that makes your leg bend and straighten for hours on end as I recall is to help reduce the buildup of scar tissue.

I was also advised that I could probably go on and the knee would appear to be healed, but the bones and cartiledge would rub against each other and literally erode away and by the time I felt the pain the damage would be done and it would be too late to get it fixed. And that was the bit of news that clinched my descision for surgery. As my ligament was only partially torn I was borderline on whether to proceed with surgery or just try to rehab the knee. We tried rehab for a while. But when I would run I could feel the boned in my knee shifting and I didn't want unrepairable damage in my knee.

chaps i was in physio the next day! i did have a full brace for 6 weeks, and that needed to be locked when i was not in the cpm, but it saves a lot more in the long run to make a good job of it b/c the person can return to full productivity w/fewer complications.

lots of ice of course, b/c it's so important to get the swelling down so ROM can be re-established. took prescription anti-infkams as well for a week and wore surgical stocking for three weeks, but was encouraged to move as possible - is SO much better too b/c you don't get so stiff in the joint.

plasters are used far more sparingly there, and then walking ones are used when possible,

expat that is amazing,
though I get the impression you think I am advising plaster/ or brace??
Sorry if it was not clear,
Leg braces should be worn to protect acl ligament however the should not be left on indefinately as you said it is worse in the long run, That is why she should be referred to ortho ASAP and not be doing this purely through gp. once she has been seen by consultat he should arrange more hollistic care mean time ie physio etc

Your care sounded flawless, as it should be am glad it worked out for you.

No, not at all, chaps, I'm just surprised how often plasters are used here. They're great for certain types of breaks - spiral fractures, for example, although I did know several people who have spiral tibia fractures and were in walking plasters. But they do cause muscle atrophy, and that's not always good when you have a soft tissue injury, b/c you get so much muscle atrophy w/those, anyhow.

I had to lock down my brace to sleep for the first 6-8 weeks post op, which REALLY sucked b/c it's a bear to sleep like that, but miles over a plaster.

Walking sooner helps ROM, revascularisation, regaining muscle tone - which in turn helps support the joint and the graft - and decreases clot risk.

SO important!

It DOES hurt, but the surgeon also had a fab attitude towards pain relief. He felt that inadequate pain relief inhibited the body's healing properties, so I let my body be my guide and was prescribed pain meds as needed.

I totally tore my acl and partially tore my mcl about 12 years ago (another skiing accident!) and have managed without the repair - just lots of physio. Now wear a brace when skiing and am less brave (also mashed it again last year skiing but that was being over confident - had no problems this time) but it doesn't affect my day to day life. I was told they only really recommended repair for squash/rubgy players or people who had problems and that there was a real risk of infection of the joint. As skerriesmum says the long term recovery put me off. You can always have the repair later if you need it. I ended up having 'stump trimming' because the tendon had curled up in the joint and I couldn't strainghten my leg and that was painful enough - couldn't really walk and lay on a sofa for days - the actual injury was 2 days off skiing and then back on skis for another week wearing an elastic bandage. But I was younger, lighter and fitter then!

chapsmum, are you a doctor, and if so, are you an orthopod?

Actually, the treatment of ACL tears in the UK is comparable to that in the US. Plasters are rarely used, and many units do ACL reconstruction as Day/ 23 hour surgery. MRI is used, preop, to determine whether the ACL injury is complete (it is not always possible to tell by examining the patient, especially when the injury is relatively fresh), and to help plan the surgery (if meniscal repair/ resection is also required, it can add a lot of time onto the operation; if the patient is having a spinal, which can wear off in 2 hours, it is important to know). In our unit, a routine MRI will take 7 weeks, it can be requested sooner if the surgeon feels it is clinically warranted.

Some TA ruptures are treated with plaster, some with surgery (results are equivalent and complication rate is a bit lower with conservative management). Those treated with a cast are treated with a below knee cast, not above knee.

Scaphoid fractures are treated depending on the displacement, with surgery or bracing. If a cast is used, the thumb need not be included, as it does not improve healing rates. Some casualty depts still apply scaphoid casts, but most fracture clinics would remove them ASAP.

I'm rather cheesed off that you see fit to run down the NHS, when you clearly have a very outdated view of how we work!

anteater: if your dp has returned to the UK, all she needs to do is turn up at the local A+E dept with her Xrays/ letter from wherever the diagnosis was made (skiing injury? They usually are!). They will make an appointment with the fracture clinic within a week. MRI may be necessary, but can usually be done whilst the patient is waiting for surgery, so no time is wasted.

I do find it ridiculous that someone would have to wait eight months for an MRI for that type of injury, though.

If that's having a go, well, then I suppose I am.

I never had one. The day after I sustained the injury, I felt no pain and had no swelling - just hte instability. In fact the surgeon asked if it were okay for some residents to do that ligament test on me so they could feel what it was like.

The ACL was completely ruptured, I saw it myself on camera on the table a week later.

In my case, I was 25, highly athletic and wanting to return to high-level climbing, so the surgeon felt it was best for me to have it repaired.

I had it under spinal and the surgery lasted over 2 hours. I had stenosis of the notch in my femur, which was repaired then and there. My patellar tendon was also found to be too short and narrow to harvest a good graft, so the hamstring had to be used.

For me, at least, I'm pleased w/the results.

Now the other knee is the one w/the trashed meniscus and tibial platau.

expat, i wasn't accusing you of having a go, my comments were clearly aimed at chapsmum!

Unfortunately, the NHS doesn't have unlimited funding, and some units do have along wait for a scan- that's life in the UK.

Some people with ACL rupture do have pain and swelling (most, in fact). Most do not have clinical instability for weeks after the injury, as swelling and hamstring spasm can mask the symptoms/ signs.

Yes, you can make the definitive diagnosis on the table, at arthroscopy, but if additional surgery is required (and notchplasty doesn't take very long) it can add significantly to the length of the operation. Most anaesthetists would hesitate to do a spinal anaesthetic if the surgeon couldn't guarantee to have the op finished within 2 hours. An epidural can be topped up, but then the patient would need to stay at least overnight.

I don't think your experience is typical, I'm afraid; I'm glad it went so well for you, though.

No, I know it's not typical. It had been getting looser and looser throughout the ski season and I knew I was playing with fire.

When I got back up from that fall I knew I'd blown it, tho. So I sat down and packed snow around it - enough to feel it thru my snow trousers.

I'm not a big sweller, tho. I've broken several bones and had pretty minimal swelling.

I'm glad to know how it's handled here, though. It is a fairly common injury. There's been a lot of study on it in exercise physiology departments in the US, and apparently a female athelete is more prone to it b/c of her femur from her pelvis down to her knee.

I was lucky to take physio at a university experimenting w/recovery for female athletes who'd undergone ACL recon, and was a star patient who loved doing all her exercises :)

Although surgeon busted me climbing w/my short brace on at a local crag once .

doc igognito, I work in the nhs in scotland our radiological confirmed undisplaced (and some displaced scaphoid #) ~ are treated with a scaphoid cast with tumb extention. I am aware of the research that states this is not needed, but that is a decision that the lead ortho consultant will make.

Am delighted that some parts of the NHS are moving forward. I am very aware of how acl should be treated and I usually defend the NHS however am saying that you will be aware of postcode inequlities which the posters have demonstrated!

Now before you have a go please read my post again, I did suggest turning up at a and e as the referal to the # clinic would be more productive than the course of action the gp reccommended

In short, whats your problem with what I've said?

think what i should have said in that post is not
"how outdated the nhs is" but how outdated the nhs can be! Appologies for that.

Like I said doc, I usually heartily defend the nhs but at the moment my best friend has been in plaster scaphoid cast with thumb extention for a radiological scaphoid #. standards and treatments do vary within the nhs.

doc - chapsmum is a nurse and a good and caring one at that. and your condescending 'who does she think she is, i'm a doctor bow down before my expert opinion all hail me for i am the lord god your saviour' is everything i hate about bloody rotten arrogant ruddy doctors.