Really not sure what to say after today’s consultant appointment.
Progress has been largely good over the last couple of months, I just had a few questions to raise and then I was expecting the consultant to maybe check a couple of things, advise re plate removal options down the line and then send me on my way pending final review/sign off at 12 months or so.
I had my x-ray bang on time, then went to the waiting area for my follow-up appointment, which was scheduled for 30 mins later. After just over an hour, I was finally called in. Never great to leave me ruminating that long - couldn’t really get on with any work to distract me as you never know when you’re going to be interrupted and, well, 'Doctors' was booming out from the waiting room TV (‘great’ choice, right?!).
Anyway, the x-ray confirmed that the osteotomy site is fully healed so all good on that front.
Then my consultant asked how it has been so I updated him:
HTO has been good - no worries re healing
I’m pretty much back to where I was activity wise immediately before the operation so the test comes now with pushing on beyond that
We’ve tried running and jumping, which the knee doesn’t like and is increasingly painful when attempting
I’ve had a couple of hyperextension incidents so have asked the physio to help me focus on the last 10-30 degrees of extension to hopefully get some more control there
Oh, and the knee clunks when I rotate it inwards (slight concern as the McIntosh was supposed to control the rotation)
Re the plate - yes I can feel it, and I can’t kneel on it at all presently, although it’s less painful than previously (unless whacked) so maybe that will improve with time
His responses?
It maybe a bit too soon for the running and jumping and need to get a bit more strength back there - agreed
Keep physio’ing to try to control the hyperextension - well, yeah
Plate position means there isn't much protection there - okay
And….
Well, that was basically it. Effectively signed off but told to come back if I need to or decide I want the plate out 🤷🏻♀️
Not quite what I was expecting.
While I embarked on this journey after the initial consultations with the expectation that we’d be doing the ACL again too, surgery isn’t especially a ‘hobby’ I’d recommend so, if it can be avoided, great.
But I was definitely looking for more certainty over the stability/function of my knee than I appear to have been left with. Wait and see, get confidence, then quite possibly have it blow out again is not where I wanted to be, nor where I think I really should be, if I’m honest. I’ve been here way too many times before and the thought of it giving way again (and with known vulnerabilities still present) makes me feel physically sick.
If the hyperextension is back - so not going to be part of my marginal gains - and the ACL is still lax and vertically-orientated - it would have been useful to know a) what the odds are of the alignment alone proving to be enough and b) whether the clunk on internal rotation is indicative of less-than-optimal integrity there too.
There were literally no checks of the knee itself today - just a brief conversation and then out. Maybe he was running behind, maybe there really is nothing else to say and time will tell. I’d have been more reassured if he’d at least checked it and assessed the current state of play though, e.g:
With scar tissue broken down, and a couple of post-op hyperextension incidents in the bag, is the joint more/less lax/the same as at 8 weeks post op?
Is there any other explanation for the clunking (tracking?) other than rotational instability?
Could he have called me back in at ‘x’ months to give the focused hyperextension-control physio chance to work, then review the effectiveness (or otherwise), and likelihood therefore of needing to tackle the stretched-out ACL directly (or not)?
Those kinds of details would give me a bit more clarity over likely outcomes and allow me to manage my expectations - and progression - accordingly. Instead, I’m left with the line that it's pretty much 50:50 whether I'll be back after realignment alone - ‘probably more’ - and packed off to get on with it. Oh yes, and advice not to try anything too adventurous until/unless the hyperextension is under control 🤦🏻♀️
I’ve mentioned the zipline test in previous blogs - specifically zipline 5 at our local Go Ape (where it has blown out before). At least I had enough wits about me to ask specifically re that, in an attempt to get a bit more guidance. When asked directly whether he was confident the knee would be stable enough to handle that, he was noncommittal, which gives clarity of sorts, if not confidence.
The main takeaway was that it will be a good 6-9 months still of physio before I should expect to be at the point of trying anything adventurous - so I now know it’s a beach holiday this year, not an activity one, and that the Go Ape test is going to have to wait until at least late Summer/Autumn (assuming I can kneel well enough by then to get through some of the obstacles en route to the final zipwire).
Ugh, it’s so frustrating. With a capital F. I’ll add another F to that phrase but it’s not one to type out in full.
For someone who processes stuff through writing, I’m struggling with this one. My best efforts can be summarised as:
“I just feel like I’m currently no better off than I was, although I could be, but might not be… how does that actually help? And even if it doesn’t give way again (hopefully), I’m effectively just waiting for it to happen now.” #neurotic
Or I’ll leave you with my friend’s more succinct versions:
“Ggaaaaaahhhhh that’s like the worst of both worlds 😖…
"...I mean the odds of it holding up have got to be much better than before, and there’s never a guarantee no matter how much work they do, but I think the expectation was to have a bit more assurance that normal activities could be resumed ultimately without essentially the expectation of failure.”
Not just me then.
It's safe to say that while I can see the arguments for a conservative approach, this has been going on so long that I'd really rather have gone belt and braces and just had the ACL done again too, as was the plan. That way, at least, I'd know everything that could be done to have a stable knee had been done and, while it might still blow out, I'd be more confident that there weren't known issues to make that a distinct possibility (or if there were, they'd been mitigated as much as possible).
We are where we are though. (I hate that phrase, it feels passive and I've been doing my utmost to be proactive/in control of things this time around). Now to physio the hell out of it (heard that one before too) and see where we end up. Wish me 🍀
*Oh yeah, and in case you're wondering why there's a pic of Hotel Chocolat on this post, I found them while tidying my office this afternoon - a leftover corporate Christmas gift. Always a silver lining if you care to look for one. If I trough them all in short order, that will motivate me back into the gym for more physio, even if enthusiasm for doing so is otherwise lacking right now 🐷
Next...Finding my stride
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