They say time flies when you’re having fun so, with a whole two weeks to wait for my follow up (I know, that’s nothing), I threw myself into final plans for my children’s birthday celebrations and ploughed on with work and the usual chaos of family life. I’m not going to say the two weeks went quickly - they didn’t - or that I wasn’t more than a little distracted - I was - but the days eventually rolled round and it was time for a progress report soon enough.
Obviously I did quite a bit of reading during that time - and it’s pretty weird to be hoping that images qualify you for something that’s likely to be unpleasant - but if that unpleasantness is part of a path to better times, it’s something I think I can deal with.
I was trying really hard to keep the hope under control and, by the time I pulled up at the hospital, I’d pretty much convinced myself the angle would be wrong and it would all be a waste of time (even if my heart rate suggested that hope hadn’t entirely left the building). Even that negative mindset was a semi-conscious ploy though - if I’m going to use a sporting analogy, whenever I’m confident WBA will win a football match, we lose but, if I’m convinced we’re going to have a bad day, that’s when they surprise me - so for all I can’t control any of the above, if I can get my head in the relevant 'don't expect anything' state, it might actually help 😂
Having been called in from the waiting room, I sat down and the consultant logged into the computer and started bringing up various images, drawing lines across them, thinking, checking a journal article(?) on his phone and repeating. Eventually he broke the silence and confirmed that some of the ACL graft is still there but not doing anything, there’s no medial meniscus left (which I didn’t know, even though some had been removed during each surgery to date), that my lower leg is ‘in varus’, and that the posterior tibial slope looks to be between 13 and 14 degrees, so within the range that is worth correcting to make a positive difference to any future ACL surgery.
That set of info opens up a number of possibilities that were not on my radar when I first decided to get a second opinion:
HTO to correct tibial slope is a viable option that could improve the odds of a third ACL reconstruction actually working 🎉
Varus lower leg means HTO would be advised anyway to reduce/slow/avoid arthritis issues 😬
Complete lack of meniscus combined with no overt osteoarthritis in the joint (yet) also makes me a potential candidate for meniscus transplant (although I may be considered too old), which could also stave off need for knee replacement while improving joint stability 🤔
Lots of options, either on their own or in combination, which is great position to be in following the dead end of the last few years but also, as he rightly advised, “there’s always something you can do, the question is whether or not you should do it.”
We talked through some of the possibilities and implications, as well as the challenges of extracting clear data from research papers to pick the best course. My consultant’s view is that alignment should be our priority, with the rest following behind. In true ‘me’ style though, even that’s not a straight forward option as his preference would be for an opening wedge HTO (“Always better to add bone, not take it away”), but that doesn’t correct tibial slope, so closing wedge may be the better option, or maybe there's another way of performing a bi-planar correction. If we do that first, he can have a proper look inside the knee and maybe bone graft the tunnels from my previous ACL surgeries then, with a view to doing another ACL reconstruction once that’s healed, plus or minus the meniscus transplant (either combined or as two separate surgeries).
Quite a lot to get your head around.
The big priority for me is, will it actually work? If the odds are good, I can wind myself up to give it another whirl; if the odds are not good, is it really worth putting myself (and my family) through it again, even if I’m finding the current state of affairs really limiting, annoying and, at times, painful? This could go on for another 12-18 months so it’s something I have to consider, even if I really just want to crack on with it.
Also, is this primarily about solving the problem I went with or staving off a different issue at the pass, and maybe also solving the initial issue as a 'bonus'?
Anyway, after a scratched nose incident that turned the rest of the consultation/day into something of a farce, he sent me off with yet another imaging form - this time for a CT scan to aid HTO planning - and will be back in touch once that’s done to discuss further/look at dates.
The wheels are turning and I’m a mixture of hope, excitement, anticipation and anxiety all at once.
Yet more promise, more uncertainty and unknown timescales mean I’m balancing health planning with work planning (running the business means I need to make sure I have the right cover in place for various accounts as and when anything happens, not helped by live pitch and re-tender processes at the moment) and, of course, managing the kids’ movements and activities as we head into the extended summer break.
From a work perspective, the summer holidays is probably the best time to be out of action for a week or so (how long will I actually need to be completely off?) but that also has implications for booking the kids’ holiday clubs, ease of getting the right cover in the office and, oh yes, figuring out whether or not we can actually book a family holiday when we were hoping too. We haven’t been overseas since before Covid, our trips to Cornwall and Dorset were scuppered by dodgy knees (one me, one my husband) and we’ve had just a week off work since Christmas and it’s beginning to show.
Either way, I’m thankful that there are options.
I mentioned in an earlier blog that I don’t do failure and that this was looking like it might be the one thing to finally beat me but maybe not after all…. Just waiting for the call following my CT now and hopefully then we’ll have a plan. Fingers firmly crossed! As a friend so neatly put it: "Hooray for a knee that’s deformed but deformed enough that hopefully something can be done?" Hmmmmmm!
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