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??

all i know is, if someone tried to put me in plaster - or my kids - they'd better have a damn good reason.

ant, keep us posted about your partner.

it's a long road to recovery, but it CAN and WILL happen if she's persistent w/the physio.

at times, it can be really depressing, especially if your partner is really athletic and loves to exercise. i was like a rat in a cage - doing chin ups off the edge of a table, in the gym training my upper body and abs as soon as i could get in, etc.

there's a lot of muscle atrophy right afterwards, but it's not the end! things will improve.

p.s. - times like now, tho, when it's there's a really, really wet cold on, i can still feel the pin in the femur. rarely - it has to be super damp and cold, but i can. i don't feel the one in my tibia, tho, or the staples in there.

I had an arthroscopy after a partial rupture of my acl last May. Consultant didn't see the need for a recon despite my high level of physical activity and love of netball. His viewpoint was that if my knee was good enough to get me by on a day-to-day basis then I should be happy with that and preserve it for the next 50 years. I still had a gruelling 6 months rehab with 3 times a week physio after 2 months on crutches.

I have got to the point now where my knee still inhibits me too much for my liking - and I am none too happy that I can never take part in high impact physical activity - it's just not me to be like that. I am seriously considering asking for a reconstruction at my next appt with the consultant.

All you experts on acl's - would you consider that was the right way to go? Or should I be happy that I can walk about and go swimming a couple of times aw eek? Would having the recon mean I could return to a higher level of sporting activity?

QE2
I'm with you. If you really find you miss the high impact sports, then I'd say go for the recon. I'm not going to lie, it does hurt. For a long time. At first you may think, 'What the hell have I done?' It's major surgery, don't be fooled.

But you sound like you'd be a physio's dream w/regard to being proactive about the recovery, doing your exercises and making the surgery work for you.

I needed to use a support brace for sport until about a year after the surgery.

But I have been able to do what I wish since then and my knee feels SO strong. It was well worth the year-long recovery process IME.

For me, I love the 'freedom of the hills' as the books go. I enjoy the challenge of peak climbing and climing rocks and cliffs as well. There's just nothing like a good walk, IMO.

mtp,I'm quite insulted by what you wrote, but I'm sure that was your intention.

From what chapsmum has written, I would guess that she works either in A+E or in an ortho/ fracture clinic. The NHS needs caring and well-informed nurses, but what I was complaining about was the fact that she was slagging off the NHS (which, until she corrected herself later on she seemed to be). We have very limited resources, and for the money we spend on health, we have an excellent service. I've seen what can happen in an Insurance-based service (such as in the USA), and it's not pretty. If you've got a good policy- fine, if not well you're stuffed!

FWIW- orthopaedic surgeons don't just use the cheapest treatment available- we do some of the most expensive operations the NHS offers. Conservative management (which often does involve POP) has the advantage of being relatively complication free (and more of the complications that happen are easily rectifiable, unlike surgery). Some surgeons tend to be on the conservative side, some more knife-happy, but the NHS as a whole is NOT "outdated", just as the American service is NOT "gold standard" in a lot of ways. Wasn't there a thread recently about how bad obstetrician-led maternity services in the USA can be?

QE2, I would say that expat's advice is good. If you go into ACL reconstruction with your eyes open, expecting it to be a long slog, then you won't be disappointed .

Got to go and replace a hip!

doc, tanhks for coming back to me, I do work in a and e and roate through a # clinic, so I do know a bit about bones!

I agree that the NHS is not always out dated, I think it is a fabulous system that works well for the people who come through a an e.

But the NHS can be let down by individual GP's of drs. as was the case by this pster. I do still feel that in the trust i work in some practises like scaphoid cast are unnessisary and it is well know to us that that really is cost incentive...£25 for wrist splint vs few pence for pop.

I wish you had been around when I was trying to defend the NHS re: vaccinations.

I wonder why have you changed your name for this post?

I would definitely go for the reconstruction. If you can feel any shifting in your knee when you set it to the ground forcefully (say when running)then you are at risk for the bones and meniscus taking wear and tear. It will hurt later in life. And when it does, it will be too late to prevent the erosion. I am no doctor, but this is what I was told by my surgeon. And it was the primary reason I opted for the surgery. Mine was also only a partial tear. I could have gotten by with it as it was. But, I didn't want to. I wanted it fixed.

I must say I am generally skeptical in the NHS if they are giving me theit honest unbiased medical opinion, or if they are forced to alter it to get in line with their budget (i.e. discourage things because they aren't in the budget).

BTW, my US ecperiance is a bit different from Expat's. My surgery was done under a general and I was in the hospital for a couple of days. The knee hurt a lot to stand up (weight on other leg) for a week or so, then many months of rehab to get it back up to normal funtioning. But, definitely, I'm glad I had the surgery.

And one more thing, I do really believe that the quality of medical care in the US is far superior to the medical service I have experienced here in the UK. I do not believe this is due to better doctors, but rather I think the limitations of a nationalised health service limits the doctors in the UK. It is all about money and national guidelines and if you want anything outside of their usual recommendation, then the private option cost a fortune -- so much more than private insurance in the states.

The matters probably closed now doc, and I think Mypw was simply sticking up for me cause she knows how much I support the NHS.( or I would have moved to private.)

Additionally I never try to put people down, I do ask them to clarify on points I dont agree with but I never use owrds like "am cheesed at."

I feel that more than an orhthopod, I see how well the NHS works in resus, and also see how fatally flawed it is when there are no medical admitting beds and the 84 year old granny develops unhealable pressure sores from a 48 hour trolley wait. (oh and when I ge my wages at the end of the month only to realise that I will be working above my grade again because there is no funding for my promotion)

The NHS has and does offer the most expensive treatments in the world free at the point tof use, but it has to save somewhere...
Additionally it will only offer highly expensive treatment like a knee replacement once in a life time (if at all possible)

I never once said the US treatment was gold standard but the treatment expat had, like you admited yourself, was!

I am rather hurt that you chose to have a go on this specific subject without having a clue where I worked or what I belived in or the lengths that i go to in my job to make the nhs work.

Hope your hip op goes well, I should get back to wiping bums and making cups of tea, its what the NHS needs, right?

I completely severed my ACL and I had an arthroscope then had full reconstruction. I could play all types of sport etc. afterwards but as previously said the recovery takes a while as long as she follows what the physio tells her and does the exercises she will be fine..

20 odd years ago I ruptured my medial and anterior cruciate ligaments, I spent 1 week in hospital, had alengthy operation to repair them, spent 6 weeks in a long leg plaster and a further 4 months on crutches and 6 months in daily physio. I eventually returned to work a year later (had a very phsyical job)

I am so glad to read fgrom this thread that management of this type of injury has change for the better. I would not wish this type of injury on anybody else as it is truly horrendous.

I also had a smiths fracture to the opposite wrist (made the use of crutches very interesting!!)just in case anybody was wondering why I was in physio for so long.

Thank you for your points. We tried the crutches at A&E, simply refered back to GP. Yes the accident was skiing. Dp is very active, horses etc.

One accepts risk with any sport but the time scale offered by the NHS is not acceptable.

She will have to go private, no insurance unfortunatly, so skiing may not be an option for a while anyway!

We saw a Doctor in Zermatt, who obviously spends his life thinking knees! Neoprine brace over knee and crutches. Swelling reduced in 3 days. He was sure the ACL was 'gone' and would need surgery. Also possible support ligament damage.
Advised against an MRI there as UK would not accept them. Had x rays which were fine.

Having been thro this myself, I know the rough time scales, but for those who do not have the choice to go private, the NHS delay is a complete joke..

I tore my ACL in a major smash 26 years ago. Spent 6 months in Stanmore OH in Plaster and didnt ride for 18 month (Jockey) Always wear a knee brace when skiing and have to say it feels every bit as strong as the good one.

chapsmum- we do need people to wipe bums and make tea as well, though, and I do see on the wards that some of the more "unskilled" aspects of nursing go by the board in favour of form-filling. Not the nurses' fault, I know, but there are corners cut, because the amount of admin required is so vast.

You did say ,"how outdated the NHS is" and my reply was before you corrected yourself. I used "cheesed off" to mean "mildly irritated" rather than anything more forceful.

As for my name change- well I have used this name change several times. If I stated in my usual persona what I do, and where I work, I could easily be identified. In addition, I occasionally give advice in my other persona on things that I feel qualified to comment on, however, I NEVER say, "I am a doctor, believe me". (Just as you said "I work in the NHS", not "I am a nurse").We had enough trouble with JF claiming to be a lawyer and giving dodgy advice- if people want to listen to me, that's their lookout.

As for knee replacements- Once per lifetime? No, we will do revisions if required. Yes, people do have to wait for the primary op, but the main reason is that the complications, if they do happen can be devastating- you need to really need a TKR. Many people come to me and want a TKR "because they don't like taking painkillers". I kid you not.A major op, with a risk of fatal PE, infection (which could lead to amputation) and a 20 year lifespan if successful. Better to wait (if possible) till the twenty year lifespan will last the rest of your life.

Doc when you say we, you rally mean I. THe same mistake I made.

Health care is not provided all at the one level and different trust have different policies. "National guidelines implamented at local levels" gives a lot of scope for differences in treatment.

If you knew about what nurses in a and e really did you would see that the more essential tasks are missed due to staff shortages and not beurocracy, there is actually very little paper work in a and e. There is however a high volume of patienst requiring skillied medical and nursing care.

I think the last post from anteater says everything that I was talking about. Appologies if I was generalising about the NHS but you appear to be doing so yourself.

And I am perfectaly aware of the risk factors involed in surgery, you dont need to point them out, I am glad that you seem to everything in your power to give your patients gold standard treatment, but this has not helped anteaters dp!!

Great, the treatment you are talking about is avaliable, but it is not avaliable to all due to flawed areas of the system!!!!

and just for fun, when was the last time you wiped a bum, it actually takes a lot of skill and practise!

sorry to post so many the wee chap is not weel today and requires playtime.

But I would like to point out that any advice i give, I give as a mother and not as a nurse. I have said manytimes the "internet triage" is dangerous. Medical advise should only be given by a qulified person who is there to do a physical examination.

Guidlies are only that, guidlines, they are not universally transferable, evryone onlie will have hidden circumstances and symptoms that you are no awarre of which is why I feel it is important to share experince rather than give definative advice.

anteater I hope things work out for you and your dp

wow - can't believe so many people have had ligament problems, must be very common.

Thanks for the advice re my knee - food for thought, that's for sure. I have 5 kids, 2 of them 3 and under so if/when I do have recon then it will impact greatly on dh who would have to take quite some time off work to care for them.

I would be more than prepared for the long haul recovery - I have spent the best part of last year hobbling about. Last night I did an hour's hard swim and my knee actually aches from doing that today. I really think recon is the way to go for me.

Does anyone know:

1. How long on crutches after recon?
2. Plaster for how long?
3. How long until able to weight bear on recon'd leg?

chapsmum, when I said "we" I really meant "we" not "I". I don't need people to wipe bums, at all, but we as members of the healthcare consuming public do. When I had prolonged block after my c section, and temporarily lost control, I rang the buzzer for assistance, and a MW came along. When apprised of the problem, she said, "I'll get an auxiliary to help you", and off she went. The auxiliary arrived half an hour later. Yes, I'm sure they were over-stretched, but it wouldn't have taken the MW a few seconds to help me herself. I don't often encounter a dirty bottom in my line of work, but I am not above helping when it's needed.

"If you knew about what nurses in a and e really did you would see that the more essential tasks are missed due to staff shortages and not beurocracy, there is actually very little paper work in a and e." Well, I do see what happens in a+E, and agree that there is less paperwork there than on most wards. I also agree that you have a high volume of sick patients requiring expert attention, and not enough staff. I specifically referred, however, to wards, where beaurocracy has gone wild.

I have worked in the NHS for 25 years, and, I must admit, recall fondly the days when it was the nurses responsibility to look after the whole patient. Now that "personal care" and "housekeeping" tasks are done by other people, it is far easier for someone to say, "it's not my fault that should have been done by someone else". The reason why it bothers me so much at the moment is that I recently had a patient who was left without fluid of any kind for over 24 hours. The "named nurses" (all 3 of them) who were supposed to be looking after that patient, all carefully and dutifully filled in the observation charts, and noted that her urine output had fallen to nil. The fact that she was NBM, was recorded (she had had a minor stroke and was awaiting SALT). The junior doctor was hauled over the coals for failing to put up a drip at the time of the diagnosis, but I was amazed that not one member of the nursing staff seemed to question the fact that she had had no fluid going in, at all.

Ooh, and, when you said , "But the NHS can be let down by individual GP's of drs. as was the case by this pster" were you referring to anteater's dp? Because the wait for an MRI scan is nothing to do with any individual group of doctors, neither is the wait for an OP appointment. I can assure you that I have NO influence whatsoever over the MRI times, except where I can beg the radiologists to queue jump people for me. It's not even the radiologists' fault; they don't have enough staffed sessions to cope with the number of requests.

As for OP appointments, if a GP sends in a letter labelled "routine" and doesn't give a clue as to why this pt should be treated any quicker, then their letter goes to the bottom of the pile, but if a GP can call and explain, or write a bit more detail in the letter, then we try our best to squeeze the patient in.

I think you are the one thats genralsing now, I have never left a patient who has neede basic nursing care. I hope you are not implying that all nurses are incompetant. If you want to have a go at nurses your barking up the wrong thread as I would never be that incompetant. I am able to cannulate and prescibe fluids and do so regularly.

I really feel that consultants and clinical managers must take the lead in educating new staff, all to oftern girls who are 1 year out of collage are left in charge, there mistakes are not made due to incompitance but lack of experience.

I really am having difficulty following your argument, one minute you are saying that the NHS is second to none, the next complaining about the ability of the nurses. If you really are saying we (No, we will do revisions if required.) meaning the whole of the nhs will do this as and when neccisary, then why do I not agree with what you are saying from personal experience?

I feel that it is a shame because we really could have fought the same corner for the NHS but you have taken it to a level of aportioning blame, and unneccisarily in the context of this thread.

I'm sure the origional poster will appreciate the time you have taken to answer her question, but regardless of your claims of equality and quick treatment this has not happend for her.

and the reason that individual drs let the system down is the same reason that nurses do. Some do not know how the system works or how to get the best out of it and a few (and far between) are incompetant on both sides!

No, I'm not complaining about the ability of the nurses, as such, what I'm complaining about is abdication of responsibility for caring for the patient. I have been on the receiving end of the "it's not my job" attitude- and I didn't like it. I'm very glad that you can cannulate and prescribe fluids, and that is a role that is entirely appropriate in an experienced A+E nurse. It is not universal on the wards, however.

Were you really implying that I should take some responsibility for educating new nurses? .That idea would go down like a lead balloon around here. FWIW, the nurses I was referring to were all experienced, one of them an F grade,and even their managers couldn't see why no-one had said anything. What happened to "the nurse as the patient's advocate"? -Protecting patients from the nasty doctors whose job it is to maim them?

I never said the NHS is second to none, but what I did say is that for what we spend on it, it's not bad. Many people compare us unfavourably with much richer healthcare systems, yet wouldn't vote for a political party that wanted to increase taxes to pay for an improvement.

the fact that anyone has to wait for an MRI is another example of how flawed the NHS can be! I really dont think your helping your own argument!

Please dont feel that I am blaming anyone specific or slaggin the nhs, Fundametally it is a great system that sometime can work really well for you other times you have to work it.

If you go around with blinkers on and feel the need to blame rather than taking some responsibility and educating then the NHS will never move on.

I acknowledge the presence of some nurses like the one you have mentioned equally I have met drs from all specialities including gp's who are incompitant. There is fault on both sides and with the the system.

The real question is what will the nhs workers do about it??
(but that is a whole other thread)