Well, this is a weird post to write. Not quite sure where I’m at so maybe getting it down will help but apologies if it’s long and a bit scatty!
Picking up where I left off
With the knee still not right after the Go Ape incident and still having some issues with my pelvis (although much improved on where they were a few months ago), I decided to book in to see a physio about both issues with a view to taking a holistic approach. If the women’s health physio I’d seen thought some of the pelvis issues were linked to the knee and the knee was now worse again, not much point treating one without looking at the other too.
In early January, off I trotted to the physio company I saw about the PGP issues during pregnancy - and which had been recommended to me by my consultant if the RevACLr rehab wasn’t working with the second physio last time. Recommended for knees, experts in PGP, bingo, right?
Well, after listening to the history and assessing the pelvic issues, I had some acupuncture to try to relax the muscles in my glutes, lower- and mid-back (not the world’s most pleasant experience but if it works, worth a go) and was all set with exercises designed to get my glute med functioning properly again. All good. Then the physio had a quick look at the knee and I was expecting to get more quad sets/squats/lunges style exercises to go away and get stuck into. Except after doing the now-predictable Lachman Test, she gave me a look and told me I needed to go back to see the consultant again. Marvellous.
So, after another call to the the health insurance company to get the go ahead (they must seriously be regretting taking on my insurance when I transferred from the previous company), I booked in with the consultant who had done my revision surgery.
Consultant or MSK Physician?
Interestingly, after speaking to their physio line, the insurance company gave me the choice of being referred to a consultant or a MSK Physician.
A what? Exactly.
They also suggested that a consultant might be too focused on prescribing surgery and the MSK Physician might be more inclined to look at other options. A cynic may think it has something to do with money - which is a whole other blog - and frankly I don’t give a flying one about who I see so long as they can help me get this knee back to something resembling useful functionality.
In the end, I decided to go back to the consultant, not because I want to max out my health insurance but because he did the revision surgery, he knows the ins and outs of the case and I won’t have to go back over it all. Again.
The new normal and unanswered questions
Anyway, appointment made, attended, niceties said (which genuinely would be niceties in any other situation but I’m really getting a bit sick of this all by now) and yes, the graft is still loose and an MRI was booked to see if there was any other damage we should be worried about.
After going back for my follow-up appointment last week, the results are in:
In good news, there’s no new damage to the rest of the knee and the reconstructed, if loose, replacement ACL is very much still there.
In bad news, it’s clearly not stopping the rotational instability, even with the Macintosh fix on the side too and, without that, it probably would have bust completely by now.
In short, what that means is that my consultant doesn’t think there are any other options left to fix it.
If two replacement ACLs have now stretched out, it’s likely that even if we went back in to go for third-time lucky, the same would happen again. I’d love to know how much the botched initial physio and ‘bad luck’ cartilage operation on the other knee that delayed rehab further influenced the fact that it initially stretched when I slipped on ice (after all, if rehab had gone to plan, I’d have been at full strength by the time that happened) but there are some things we will never know.
The hypermobility (query) in the knee and bone positions (I can’t remember whether it was femoral head or tibial head he mentioned at my appointment) aren’t ideal and either can cause grafts to stretch out. Both of these would be potential issues for the success of any future attempts.
It all makes sense - my only issue with both of those statements is that they only seem to be identified as potential causes of failure after the event. Are these things routinely screened for before patients undergo initial and/or revision surgeries or do they just come to the fore when we’re looking for a reason for failure retrospectively?
Either way, I’ve probably got the best graft I can get at the moment (allograft, mixed with some of my own hamstring tendon) and I'm also conscious that every time we go in there, we’re potentially doing more damage to the knee, possibly bringing forward/accelerating any arthritis issues and creating a suboptimal environment if I ultimately do end up in the world of knee replacements.
(Which reminds me, the one saving grace of this consultation was the fact that after getting over the shock of seeing my milestone age in writing for the first time in my appointment confirmation letter, I was actually referred to as young during the consultation itself. Maybe there’s still some life in this ageing dog yet!)
Where to now?
Anyway, the long and short of it is that the advice I’ve been given from here is to effectively physio the hell out of the knee and consider getting a (pricey) brace if I want to do more challenging activities (ie anything not in a straight line or that involves real impact). My consultant also recommended another orthopaedic surgeon he would be happy to refer me to for a second opinion.
I am genuinely not sure what I’m going to do next. The brace angle is an option that might allow be to stop being ‘Mummy can’t’ and start being ‘Mummy can’ when it comes to being able to take the kids ice skating, swinging down zip wires, or playing football in the back garden. They don’t half look a bit ‘try hard’ though. I used to laugh about getting a t-shirt done for the gym that said ‘rehabbing, not sh1t’ but a brace would certainly tell its own story.
If that’s the route I decide to go, I just need to figure out:
how i’m going to pay for it, and
whether it makes most sense to hit the rehab first then get the brace if it still feels wobbly or get the brace to enable the rehab.
My instinct was always to rehab first but as I can’t currently do lunges or many squats without the knee reacting badly, maybe the brace would give me the support it needs to get properly off the starting line. Or maybe I can do that with taping in the first instance as physio identified that the knee cap pulls strongly to the lateral side when I bend my leg now.
As for the second opinion, my initial feeling was ‘what’s the point’ but now the ‘no stone unturned’ side of my brain has kicked in and I wonder if it’s just going to bug me indefinitely if I don’t at least check it out.
The name my consultant mentioned looks interesting but, if they know each other that well, do they basically think the same and is it just an expensive way to get confirmation of the first consultant’s opinion? The consultant I’ve seen most recently certainly suggested there isn’t anyone else in the area that he would recommend or go to himself if he had an ACL injury so how do you identify other options? And no, I don’t want a ‘scalpel happy’ consultant, I want someone who may, just may, be able to help me get to my goal of having a functional knee again.
Definitions of success
Before I went to my last appointment, I had to drop the eldest at her Grandma’s so she could take her to holiday club and she sent me off with a cheery ‘hope it goes well!’. My response? Define well.
I had in mind three different outcomes regarding what 'functionality' means to me before the appointment but in a slightly awkward moment, the consultant asked me outright if the knee was better now than when I first met him and had the revision surgery.
I would love to have been able to say yes. I know he’s very good at his job, he’s done his best to give me a stable knee and the revision surgery wasn’t exactly straightforward on the day - but the reality is that, while it doesn’t have big blow outs so often (good!), it actually feels looser day-to-day now than it did before the revision surgery and I have more discomfort (constant lateral tightness, ongoing medial soreness where there’s pretty much no cartilage left, generalised ache inside the joint, anterior knee pain and shooting pain inside the knee if I try to lunge).
I should have just said, "Yes, of course it is", in response but I’m a lousy liar. And now I feel bad that I didn’t.
Decisions, failure and coming to terms
Truth be told, it has taken me a few days to write this update as while logically, I’m okay with everything - many worse things happen at sea - I’m still pretty pi55ed off about it all.
Nine years, four operations, endless physio (and I was compliant with doing it!!!) and here I am. I don’t do failure.
The last two problems I couldn’t solve through conventional means were getting my teeth straightened as an adult (should have been done when I was a teenager but would have required a headgear, double tracks etc. and waiting lists meant timing would have been horrendous when moving to a new sixth form after four years of bullying for being class swot. Oh yeah, plus impending music college auditions - head gears and braces are no good for a flautist); and having children (not sharing details here but let's just say it was statistically unlikely).
On both occasions, I was told that the outcome I wanted wasn't likely to be possible and on both occasions, I found a way. Maybe this is the one that finally beats me?
Focusing on the positives
Anyway, in positive news, the PGP has responded well to the acupuncture/latest set of physio, even if I had to take a few days off when one set of exercises triggered SI joint problems. Where last time, any time I started working on lateral exercises, the PGP flared up big time, it seems to be almost gone now. Hoorah! What has changed between October/November, when it was pretty invasive and drove me to get it looked at, and now, I have no idea.
Maybe it was more rest. Maybe it’s the fact I no-longer do any medium-high impact exercise. Maybe the acupuncture released the muscles enough to start retraining them correctly. Maybe it’s the fact it’s over 18 months since the littlest was born and over 6 months since I stopped breastfeeding so relaxin has finally left the system (regular readers are going to think I’m obsessed with this relaxin issue but I’m genuinely just curious - there’s so little empirical evidence out there on the impact of hormones on all sorts of issues. If I had my life again, I’d push back on not being allowed to take Chemistry or Biology A-levels alongside English and Music - woah, arts and sciences can’t be allowed to mix, whatever your grades, right? - and be in a different career by now. But I digress).
I’m not sure when I’ll update this blog again other than to say that I will when I have anything new to add. I’m genuinely not sure what my next steps are going to be.
In the words of the now infamous Frozen anthem, I really should Let it go. I’m just not sure that I’m capable. Problem to be solved, problem to be solved, tick, tick, tick, tick…. Maybe Frozen II has the answer. Maybe This will all make sense when I am older? For now, I simply have to figure out what and how to Do the next right thing…
Okay, so I’m taking life advice from the lyrics of Disney films, this time I’ve officially lost it. Over and out.
Comments