Had my 8-week post HTO surgery consultant appointment and x-rays today and (whispers) all looking good so far 🎉
The fracture line is almost invisible in the AP x-rays but you can still see it in the other set so some healing still to do but all on track.
The x-rays also show that the posterior tibial slope has reduced to 'less than 12 degrees' - most likely somewhere around 8-10 degrees, which is less of a reduction than the consultant usually aims for (usual goal is 'normal' so 5-7 degrees) but, given we were trying to realign the varus 'deformity' too (due to lack of medial mensicus), that apparently is about as good as we could wish for.
I hadn't realised that trying to do more with the tibial slope would have pushed the varus even more into valgus so I'm happy with that compromise. I'd already noticed that I am in valgus (rather than neutral) post surgery so it gave me a neat segue into asking about it and yes, the slightly valgus knee is deliberate. Not being able to put my feet and ankles together when my legs are straight (there's about a 2-3 inch gap) is the new me. It's a special look!
Having tested the ACL and compared it with my other knee, my consultant advised it is still a bit lax but not dissimilar to my 'good knee' (which doesn't give way - touch wood).
I'm not wild about that. I've heard almost those exact words before and it didn't end well but, in the wider context, I'm marking it in the positives box for now. So long as it does turn out to be part of a bigger picture that gives me a knee that is functionally 'better than the sum of its parts'.
What I mean by that is:
The ACL is still lax but can do something controlling anterior/posterior movement
The consultant is not sure if the lateral tenodesis I'd had as part of my RevACLr surgery previously is still controlling rotational movement but...
If the posterior tibial slope has been reduced, that should improve stability in its own right
As should the varus to slight valgus realignment (taking weight-bearing line away from the area with no stabilising meniscus)
As should reducing hyperextension in the knee (which is why I was in a brace post surgery, to try to encourage scar tissue to reduce this a bit)
PLUS, getting older should tighten the joint too ('There aren't many benefits to getting older', he said, 'but that is one of them'. Rude 😂! I should have replied that as I'm guessing he's closer to 50 than I am, I wouldn't know and will have to take his word for that...)
A new explanation to add to what feels like an ever-expanding mix, was also discussed; in this case a working theory that much of the instability I've experienced might not be true ligament instability at all but, instead, could be a muscle inhibition response, triggered by pain, possibly arising from the previous varus alignment and lack of medial meniscus. That in itself can cause instability apparently... 🤔 Change that trigger and you potentially add another 'marginal gain' to the list of ingredients for a better functioning knee.
An interesting theory that could hold water given how long there has been a problem with the knee and the knock-on effect that - and all the surgeries - could have on nerves, muscle response, neural pathways etc. I just wonder whether it's really the case if pain has never noticeably been the problem here. If it is, and shifting the weight-bearing line helps reduce that trigger, great. I guess the muscle inhibition could also be caused by the initial injury, repeated giving way or surgery responses but I remain to be convinced...
Anyway, finishing up this post with a bit of fun...
Taking the line that I'm now basically hoping (that word again 😠) that the knee as a whole will perform better than the sum of its parts, it occurs to me that its basically like the Albion promotion teams of 2001-2 and 2007-8. Not the greatest raw ingredients to work with but an end result that delivered more than we could have righfully expected (in those cases, promotion to the Premier League).
Growing up watching the Albion undoubtedly means coming to terms with disappointment on a pretty regular basis but I've also learned that, quite often, the most successful team is not the one with all the perfect ingredients (big names and egos) but the one that balances different talents and personalities, and simply works more effectively as a whole.
This was certainly true in 2006-7 when we had a team of (relatively) big names who never seemed to gel and ultimately failed to get promoted back to the Premier League. Come 2007-8, a summer clear out saw some of those bigger names leave the club, some lesser-known names come in, and culminated in a Championship-winning season and promotion back to the so-called (financially-at-least) Promised Land.
So, taking inspiration from that squad, I figure I'm basically aiming for a 'Baggies promotion' knee now - and what better way to illustrate that than by picking a five-a-side team, made up of players from that Championship-winning season, who represent the performance characteristics I need (solidity, multi-directional stability, reliability, some quality, good balance etc) to deliver a positive end result. I give you:
Dean Keily - a solid, reliable stopper
Paul Robinson - whole-hearted player who could withstand (and dish out) a 'strong' challenge
Zoltan Gera - attacking flare midfielder who made the magic happen (I'm ignoring his injury-prone knees 🙈)
Jonno Greening - midfielder who primarily seemed to take care of sideways and backwards movement, with occasional drive towards goal
Kevin Phillips - ageing but legendary striker who still knew how to hit the target
Let's hope the end result of this surgery is more along this team's lines than the one I came up with from the 2001-2 promotion season. A certain football pundit harshly described a new acquisition to that team as like putting lipstick on a pig. While I'll happily admit this whole theme is a pretty tortured analogy, if I'm working with less than ideal resources, the 2007-8 team is almost certainly the better option.
Hard work trumps talent when talent doesn't work hard but, by heck, a little bit of quality along the way doesn't half make life easier.
Next - Three month update
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