When you undergo surgery to treat an injury, how do you know you're on the same page as your medical team re target outcomes?
A random question that came into my head while pondering things over the last week or so.
On the one hand, you have to understand the purpose of a surgery - and what’s involved - to give informed consent. On the other, the medics are the specialists. While we can all ‘do our own (desk) research’ (a phrase that always makes me twitch as the signature of many a wacko conspiracy theorist), it would be arrogant beyond belief to think that as a non-medically-trained patient, I know better than those who have studied and actually seen this stuff week in, week out.
I only think about this as following my last physio session - the first since the knee gave way and swelled up again - I’m wondering what a good outcome is supposed to look like.
When I went to see the consultant for a second opinion, I was pretty much expecting to be told there was nothing doing. Then a whole world of options opened up with the news that my posterior tibial slope was steep, which can be a significant contributor to ACL failure. The plan, as I understood it, was to correct the slope, which would lay the foundations for a third (if two-stage) attempt at the reconstruction in a more favourable environment.
The issue of a varus lower leg was also brought up as something that could be corrected, and which would be an important preventative measure given my lack of medial meniscus in the injured knee.
For me, the focus of this process has always been about regaining a stable knee. The varus correction was a bonus that could also hopefully allow me to avoid osteoarthritis developing quickly, if at all.
I get the impression my surgeon’s view was more on treating the varus as the priority but with the knee stability as the bonus ball. And yes, realignment can help improve stability too, but more as part of a wider group of marginal gains, I thought?
I don’t think either goal is wrong, but I wonder if that’s why I feel a bit left in limbo (no pun intended) at the moment. Maybe our respective objectives for the surgery were, well, misaligned (pun definitely intended).
Having been back to physio, her official thoughts were that the instability episode is ‘a good thing’ and shows that the neuromuscular programming is starting to work, otherwise I’d have had a complete blow out again and ended up on the floor. When she tested the ACLs on both knees, there is a lot more movement on the injured side though, so I still have a very lax ACL - and one that wanted to give way just walking across a flat floor. We’re now working on even more proprioception to try and really push that on over the next months so my brain responds even more quickly ‘next time’ and I don’t notice any instability at all.
Nice theory.
If this was my first rodeo, I’m sure I’d have a lot more faith in that outcome but my experience has exclusively been that every time I begin to get a bit of confidence back in the knee, it lets me down, which is exactly what has just happened.
Rather than being the first step in a stability-focused plan, the HTO seems to have become some kind of (currently unsatisfactory) end game and effectively part of a rehab/physio experiment I didn’t sign up to.
Will it result in a stable knee in the end? Who knows.
What I do know is that I don’t want to find myself back facing surgery in 6-12 months time and then having to do ALL this physio again (again, again, again), if I should just be cutting to the chase now.
For now, I’ll hit the gym six times a week (gotta include a rest day) and keep on keeping on. I feel like I've said this a lot, but wish me luck. Again!
Comentários