After putting it off for three years and trying to convince myself I could live with the chronic ACL deficiency and the associated knee instability, or mitigate it by bracing my leg, the Easter incident finally gave me the kick I needed to explore the option of second opinions for this dastardly ACL. As soon as I was back home, I looked up the surgeon recommended to me by my RevACLr consultant, ran the usual gauntlet of health insurance telephone lines to get authorisation for an appointment, and then got myself booked in for the middle of May.
When I booked the appointment, I added a note explaining it was for a second opinion and mentioning that I was happy to send over previous notes if useful. The Friday before the appointment, I had a call from the consultant’s secretary, checking who the previous consultant was and confirming my permission to call that hospital for the info. Apparently there can be professional sensitivities when it comes to second opinions (I guess it’s a competitive field and professional pride etc etc) but a) surely it’s what the patient needs that should be front and centre of these circumstances, which you'd think would include access to a full case history, and b) I was confident it wouldn’t be an issue, seeing as I was planning to see the exact same consultant my previous consultant had suggested.
Anyway, I spent much of the week running up to the appointment mithering over what I wanted out of it and making notes of any questions I wanted to ask so that, if the answer was as expected ("No, there’s nothing doing, sorry"), I could at least try to let my mind reconcile with that fact knowing I’d explored all the options and didn’t have any lingering questions that could change the outcome. I also spent some time re-reading this blog to remind myself of the chronology so I could give an accurate case history. I had completely forgotten some of it. What a convoluted journey it has been!
Luckily I had a morning appointment so when the date rolled round, I dropped the kids off at school, popped back to my desk for a quick client call and then headed straight off to the hospital.
The consultation was pretty much as expected - case history (where to start?!), physical examination of the knee/s and then a discussion, which basically confirmed that there isn’t any ACL function in the injured knee, even despite the 'belt and braces' RevACLr plus MacIntosh fix 🤦🏻♀️. If nothing else, it proved I’m not just mad and imagining it all and thankfully the consultant seemed to have the notes from my most recent surgery so no need to go through all that again.
What he did pick up on, which the previous consultant had mentioned during my ‘end of the road’ consultation, was that it looks like my posterior tibial slope is relatively steep and that this can have a pretty significant impact on the success (or otherwise) of ACL reconstructions. Over simplifying the figures, if the failure rate for ACLr is roughly 1 in 10, some papers suggest it goes up to between 5 or 6 in 10 for people with a steeper tibial slope. Wow, that's some difference and would go a long way to explaining why I’ve now effectively worn/blown out three of the blighters!
Rather than telling me what I expected, that it was a shame but there was nothing further that could be done, the consultant instead sent me off with imaging requests for an MRI and a couple of standing leg x-rays, with a view to establishing the actual slope measurements to see if it was steep enough for a surgical correction. That could potentially make it worthwhile having another whirl at an ACLr once it's 'corrected'. The magic PTS measurement for surgery is 12 degrees. ‘Normal’ is between 5 and 7 degrees.
Luckily, I was able to get both sets of images done same day, so booked in for a follow-up appointment two weeks later and off I went, a) trying not to get my hopes up that maybe, just maybe, there might be a solution that will finally give me a functioning knee again, but b) without completely smothering the little flame of hope that had been kindled.
How people wait two weeks for information when they’re dealing with a situation that’s life threatening rather than simply being an elective scenario is beyond me (and not one I truly want to explore) but it was going to feel like a long two weeks.... Patience, even six years later it seems, is still not one of my virtues.
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