Knee problems

[dori2o]

I have had problems with my right knee for approx 12 years. It used to dislocate often up until I was around 19, then it stopped, there was no explanation for this and couldn't be explained from the results of an Arthroscopy.

 

In March last year I started getting severe pain in my knee, I again has an Arthroscopy and it was found that I had a torn cartlidge and also a very large tear of the Anterior Cruciate ligament (ACL). The Cartlidge was done during the Arthroscopy, and when I saw the consultant a few weeks later he explained about the ACL. He said it was unlikely to heal and so I should prepare for replacement surgury by having intensive physiotherapy for 3 months, then the situation will be reviewed.

 

That was 4 months ago, I have just had an appointment to see the consultant again, only I saw his regstrar not him.

 

The guy didn't have a clue, misread the notes and said that I would have to have an MRI scan, another 6 months waiting. He also stated that he didn't feel the tear would necessarily need surgury, complately contradicting the consultants origional diagnosis. The pain is still severe, but I put up wit it in the hope that following this appointment I would have an idea as to when I would be having surgury.

 

I said that this was unnaceptable and wanted to see my consultant, the guy went away and came back and said that the consultant was very busy, but agreed with him.

 

The problem is I have already had 16 weeks sick leave from work, and they are being OK about t at the moment, but, it seems now I will have to wait another 6 months, taking 1/2 a day off sick every week for physio, plus more sick leave for the MRI etc.

 

I feel as though I am just being fobbed off, made to wait longer, surely the results of the MRI will be the same as the last Arthroscopy.

 

How easy is it to get a 2nd opinion, will it cost anything, can I write to my consultant/NHS Trust to complain. Or is it just a waste of time?

[feefofum]

Hi.

 

I'll try and answer your questions thoroughly as a person with knee problems and also a health professional. First of al the following site is very useful for info, and to find others who can offer you support and advice KNEEguru - knees, knee pain, knee injury, knee surgery, knee rehabilitation, knee surgeon

 

1. Recurrent dislocation of the patella often stops as your bones age. This has NOTHING to do with your other problems. Recurrent patella dislocation is due to a number of factors including wide hips (hence more common in females), weak vastus medialis oblique (VMO) muscle (this is part of your quadriceps muscle on the inner part of your thigh), Flat feet/low arches (have you also got bunions without really wearing high heals)? and a tendency to walk 'knock kneed' (called pronation). All of these can first be dealt with by wearing insoles in your shoes that cause your heels to tip outwards (Pronation and Excess Over Pronation) and good physiotherapy/chiropractic care (not just excercises, but re-educating your whole body how to move correctly). An arthroscopy will never be able to diagnose recurrent patella dislocation, though may find other associated problems such as torn cartilage. It's the patient's history and gait that diagnoses this.

 

2. The ACL has little or no blood supply so doesn't heal from tears. However the rest of the knee as a joint is often able to cope with ACL tears (depending on your level of activity). Bear in mind an ACL reconstruction is a VERY big and painful operation and takes a lot of effort to recover from. Many people live good lifes with complete ACL tears as the trauma of an operation and recovery is not worth it (again not the case if you're a professional sports person/very active. But your surgeon would have taken your age and weight and level of activity into account when deciding whether you should have the ACL repair).

 

It's not worth doing another arthroscopy, they're invasive and they're an infection risk. If your ACL is torn, then it's torn! simple as. Another arthroscopy won't tell you anything you don't already know. For this same reason, it's almost not worth having another MRI either, same deal, you know your ACl is torn, you'll gain no extra info from the MRI (have you had one already)?

 

You say you're having 1/2 day a week off sick to have physio. What excercises are the physio's prescibing that you can't do at home AFTER work? - Physio is an ongoing process that you should put into everyday life and activity, as opposed to going off to a certain place for 30 mins each week (which will be doing you no good at all unless you also do the excercises during the day. It's little and often that counts here),

 

What's your job? (Your employers should be able to modify your activities so you are able to work if you're off sick for such a long time).

 

In terms of your treatment from the NHS, it does sound as though you've had shoddy treatment, the least they can do is explain to you what's happening and why. I would phone the consultants secretary in the first instance and speak to her about WHY your having (another)? an MRI when you've already had one arthroscopy and the problem has already being diagnosed. She can then put this to the consultant and he can call you back to explain. (Save you the long long wait for a useless test for you in this case).

 

You can go back to your GP for a second referral. Beware this may put you at the bottom of the list though. How are your relations with your GP? You could make an appointment with him and explain this to him. If he's good at his job he'll be able to explain the whole procedure to you, and get you out of 'the system'.

 

Also, which trust have you being referred to? If your trust is in huge debt they may be 'stalling' in terms of who they offer operations to or not. Speak to your GP about this, and perhaps be referred to another consultant at another trust (with less debt).

 

Finally, just top give you a little bit of hope... my own situation is that my ACl is completely gone, but I still horse-ride, play badminton and cycle (cycling is the best excercise for strengthening your VMO as long as you don;t allow your knees to move inwards or to go beyond your toes). When I have periods of rest from being active (3 weeks or more) not only do I loose my fitness levels but my knee becomes incredibly unstable and weak. It's the regular excercise that keeps the sorrounding muscles strong and allows them to take the strain the my ACL would otherwise take.

 

Hope the above is helpful, anymore questions fire away!

[feefofum]

........and if you know anything about reclaiming from Yorkshire bank, would you mind taking a look at my new thread there please? ;-)

[Sandy483]

Feefofum what an informative reply so interesting even with out having a bad leg:D

 

Dori it looks like you have the right partner in crime here;) i hope you get something sorted for your knee sooner rather then later, i have found with my mum if you don't push you don't get.

 

Good Luck:)

[maybelline]

hello, I posted about my knee problem ages ago as sports injury, this thread is really interesting and helpful - can I just reiterate my problem in the hope there is another suggestion.

 

I started a womens jogging club and all was well for about three weeks, I was also going out twice a week for about half an hour. then both my knees swelled up and I used the 'rice' programme and all seemed fine, but every time I ran after that one of my knees swelled up again. it now gives me continual problems and is feels unstable. I have seen my GP and been to A&E twice but always same response, take anti inflamatory drugs and rest. I feel I need a physio programme but my PCT is heavily in debt and have also looked at knee guru (doctors advice) - I am not looking for surgery, I have a book on knees also but without an expert look at the problem I dont know what exercise to do and to avoid?

 

maybe if I pester my GP some more I will get a referral but this has now been going on for 18 months.

[feefofum]

Hi Mabelline.

 

It's v difficult to answer your questions without further info. (Which you may not want to provide for all and sundry to see here on t'net).

 

1. Are you overweight?

2. How old are you?

3. Do/did you excercise regularly and was/is it weight bearing excercise (i.e. not swimming).

4. Does this problem occur during other excercise? (i.e. cycling/cross training at the gym)?

5. Do you have correct shoes specifically designed to absorb the impact of running?

 

In general, without knowing your exact situation, ... Running and jogging puts a heap of constant, regular pounding pressure on your lower limbs, and it's the ankles and knees that suffer the most. It's really a sport that needs to be worked up to gradually, especially if you're not used to being so athletic. Walking/cross training and cycling are all just as good in terms of a cardiovascular workout and burning calories, without the associated regular and prolonged impact on your lower joints.

 

My general advice to you would be:

a) Do you HAVE to run? if it doesn't suit you then how about another exercise? (I know this can be hard, I too used to love running but had to give it up due to knee problems).

b)I would recommend seeing a sports physio/chiropractor/Osteopath that specialises in sports medicine and get them to assess your biomechanics. They may be able to recommend insoles, and specific exercises depending on what part of your physiology/anatomy needs rectifying. (You will have to pay privately for this, but if you're serious about running it may be the only option. Physio's in the NHS have enough on their plate treating acute problems (including ppl in ITU and on the wards, a lot of people don't realise the huge workload and responsibility they have within a hospital, as well as seeing outpatients to prescibe a regime of exercise and advice which won't be followed anyway) However if you live near a college of osteopathy or chiropractic you may be able to get cheaper treatment from their training clinics).

c)Have your gait assessed and choose the most appropriate shoes for running if you decide to continue.

 

You're doing the right thing by following the RICE regime when the injury occurs, make sure you don';t return to training too soon afterwards either. Give it chance to heal and rest.

 

Good luck!

[tractordriver]

Hi there people with knee problems

 

All NHS hospitals have an independant complaints service called PALS (Patient Advice & Liason Service). This department is there to help you resolve issues you may have with your treatment or staff at your NHS Hospital. The are obliged to follow your concerns through, keep you informed of their progress and provide a suitable solution to your issues. Try them!

 

Running on Tarmac and footpaths plays havoc with hips, knees, ankles and feet. If you run on roads that have a camber to them and you run in a circuit format regularly reverse your route as this can stop repetive strain that is cause from running at the same angle continually.

 

Don't run to get fit.

Get fit and then start running

 

tractordriver

[maybelline]

thanks tractordriver and others, gave up running a while ago, but the advice here is all gratefully acknowledged. thanks.

[dori2o]

Hi,

 

I'm not sure if I have mentioned this before but here goes.

 

I have a torn Anterior Cruciate Ligament, this was diagnosed in August 2006, and my consultant said that although it is not ruptured, there is no chance of it healing itself and so surgery is the only option.

 

I started having problems with my knee when I was 13, but it got really bad in May last year, to the point where I could not walk. I had an Arthroscopy in August, and was then told I would have to have 3 months physio in order to build up the muscles aroiund the knee ready for the op.

 

we are now in July 2007, I am on a final warning at work as I have had 150 days sickness abscence (including half days for physio) since May 2006.

 

I was told in April this year by the consultant who did the arthroscopy that I would now be puit on the waiting list for the op and could expect to have it done soon. He then advisedd that he did not want to do the op as he is not as skilled at knees as one of his colleagues, and prefers to deal with hips?

 

So I get passed to a new consultant. Had an appointment with him in April where he examines the knee, usual stuff bending, twisting, pulling, causing severe pain in the knee. He feels the ACL does need repairing but feels there may be other things wrong, especially with the Medial ligaments and medial capsule?

 

I now have to have another Arthroscopy...Grrrrr

 

I have written the following letter to my new consultant.

 

Dear Mr Asumu.

 

As you will be aware, I am a patient under your care at the Royal Oldham Hospital, currently suffering from what is believed to be a torn/ruptured Anterior Cruciate Ligament (ACL).

 

This problem, as you can see from my notes, has been ongoing for some time, but has become a real problem since around May 2006.

 

In this time I have has to take sickness absence from work totalling 150 days since May 2006. Until recently my employer has been giving me a lot of discretion in respect of the time I have had off. Unfortunately now this discretion has ended and I am on a period of Formal Review. This basically means that my attendance at work will be monitored, and also the situation with my knee problem will be looked at.

 

There is also a problem with the fact that I have to take half a day per week off work to attend Physiotherapy.

 

When the physio first started back in October, I was told it would be for a period of 3 months, and if there was no improvement then I would have to have an ACL Reconstruction. The Physiotherapy is now still ongoing 9 months later, and I am no closer to an operation as I was in May 2006.

 

If at the end of this 6 month review there is no change in either the absence, or the situation regarding getting a clear diagnosis and idea of further treatment including timescales etc, it is likely I will have my employment terminated.

 

I have included in this letter a copy of my written warning, so you can see how desperate I am to get this situation moving. I have been told the only time off that will be acceptable is for recovery from operations. Hopefully these can be done as soon as possible.

 

I have had a Pre-Op assessment on 9th July, in preparation for the Arthroscopy that you have scheduled for me. It is now extremely important that this procedure is carried out as soon as possible, and the true diagnosis of the problems I have with my knee confirmed as soon as possible.

 

Following this, again, it will be imperative, that if further surgery is needed, as was suggested by my former consultant, Mr Chougle, that this is also done as soon as possible.

I am sure you will agree that this has now gone on long enough, and it should now be time to start the ball rolling in trying to get my knee into the best possible shape. Simply to allow me to get on with my life, as normally as possible.

 

Please, I ask that you do all that you can to help resolve this situation. I appreciate the problems with waiting lists etc, but I have now been waiting over 12 months, and I personally feel that is unacceptable.

 

I look forward to your reply in the hope I can give some good news to my employer.

 

As you can see I have had a Pre Op assessment about 2 weeks ago, but whilst others who were attending the assessment clinic already had dates for their ops, I still have not.

 

Is it true what they say with the NHS, the more you shout and stand your ground the quicker you get seen to, or am I just going to have to wait forever.

[poppynurse]

Hopefully the consultant will take your comments on board and get you sorted

I would also be in touch with ACAS/your union to ensure that your company follow correct procedures.

[dori2o]

Sent the letter 2 weeks ago but have had no reply:(

 

Phoned the booking department at the Hospital and they said I should be in sometime after the 27th September.

 

Will keep you informed.

[dori2o]

Got this letter from the consultant today.

 

I write further to your letter dated 25th July 2007

 

I have looked through your case records and your case is somewhat complex. You have had a few arthroscopies (2 actually) which seem to imply that there might be a problem with your anterior cruciate ligament but there has been no definate diagnosis of an anterior cruciate ligament tear. (Not according to the last consultant who diagnosed a large tear to the ACL, my doctor has a letter to prove this) The magnetic resonance scan, which you had on the 10th May 2007, does not show a tear in your anterior cruciate ligament.(I was told the scan was inconclusive as the quality of the scans stops from making a diagnosis)

 

None of these investigations can be 100% accurate and this is in part why you have been referred to see me.

 

I plan to carry out a further arthroscopy (Yet another)on your knee and not an anterior cruciate ligament reconstruction (I am fully aware of this following our last appointment)as we have no conclusive evidence that this is the problem. (The last consultant did and referred me to you for the reconstruction)

 

If at arthroscopy your anterior cruciate ligament is found to be down I will schedule an ACL reconstruction at a later date. I would, however, point out to you that an rupture on its own does not cause the knee to be painful(So why not get the arthroscopy done asap to find out what is causing it.). It is therefore extreemly unlikely that when I reconstruct the acl any pain which you have in your knee will be improved.(Again you have already advised me of this) I will try to tackle any ongoing sources of knee pain at your knee arthroscopy.

 

It is not certain to me why there have been problems with your work attendances. in my experience, and have a specific interest in knee injuries, an acl rupture does not interfere in a significant manner with carrying out duties of a clerical nature. It does interfere with sporting activities or heavier jobs. (It's not a problem doing the work, it's getting there. The knee swells up sometimes so badly, and the pain getts so bad that i cannot put any wight on it, sometimes for days at a time.)

 

I will see you when you come into hospital for the arthroscopy of your knee, but having gone through your records I can not as yet tell you that I am offering a curative procedure.

 

If you have eny enquiries..........

 

[dori2o]

any help appreciated

[poppynurse]

Sounds like a wise man - if he is not convinced your ACL is the cause of the problems he obviously needs to find out what is so that he can fix it, there's no point in scheduling ACL repair surgery if that isn't going to solve the problem.

[ScarletPimpernel]

I agree with Poppy. It would be a poor surgeon who simply schedules surgery without seeing the patient for himself.

[mazzab]

Hi Dori2o,

 

It sounds like you have hit an impasse. Your knee pain sounds disproportionate to the apparent scan / scope findings, and it's obviously this rather than the possible ACL rupture that is limiting your ability to work. It may be worth discussing other pain management strategies (Neuromodulators, Cognitive Behavioural Therapy, Complimentary Therapies ect.) with your GP to see if your overal functional state rather than just the level of pain, could be improved.

 

Function is the key, and although surgery may play a part in improving function, relying on this alone can be slow and of limited value (I speak as an ex orthopaedic surgeon turned GP). The orthopods are buggering you about, so seek help elsewhere too (repeat after me "multidisciplinary team care" - that'll scare your GP!)

 

Hope this helps!

[dori2o]

Many thanks.

[jansus]

only a thought as obviously your employers have been quite patient so far - would it help if they organised a lift for you to and from work - and then if you were not putting weight on it while sitting down - would that help you ? You dont want to loose your job after all this stress you have had - just trying to think of what would help in that respect?

 

Jan

[tiglet]

Do you have a HR department at work with occupational health? If so, they may well be able to assist you with your issues.

 

I agree that the consultant has to make sure he's giving you the best treatment - your other consultant did refer you as he is a specialist, so I think you just have to wait this one out, I'm afraid.

[Surfer01]

I have the same issue. I do clerical work but sometimes the pain is so severe that ypu cannot concentrate. other times due to being kept awake at night one is in no fit state to go to work. I am a little bit luckier in that i can log into work from home and do my work but I cannot always do a full day's work. I am at the stage where I am waiting for a MRI scan. I have even offered to travel any distance to get it done sooner but even if I have it done tomorrow the consultant who can hardly speak any English cannot see me for 5 weeks. At that point I will probably have to wait another several months for the op. So much for the Labour Government reducing waiting times. It took nearly 12 weeks to get an appointment with the consultant although I am in agony constantly.

[patrickq1]

ive been today for a pre op and back in hospital on the 4 th oct for a twin bypass,i am amazed my self at the speed but they did not offer any alternative it was operate now or amputate...but saying that i crushed one of my testicules in 1986 and it has never been healed so i get terrible pains every day only for a minit or so but they say they cannot operate all they want to do is cut all nerves,,,no thanks...ive since been told that if they cut open the sack it is unlikely ever to heal over proper so i just put up with the momentary pain,because i have tried to read up on anything concerning crushed but nothing ever comes up..weird huh

still pointless complaining because the service i am getting now is second to none

[Bigbearuk]

Surfer01

 

The governments targets have been changed it's 18 weeks now from first seeing your GP to being treated in hospital and that time span includes your Out patients appointment.

[poppynurse]

Didn't think that had come in yet?

[Bigbearuk]

The official date is Jan 2008 but most trust are trying to implement it now but they are failing most of them are only achieving just under 23%

[witchiepoo]

Hi

Yes its true to say that it is supposed to be 18 weeks BUT that date applies to seeing a consultant for the first time. For the last few years the NHS have worked to what they call "Breach Dates" (the time taken from the date of the ref letter to seeing a consultant), but if that consultant decided they could not offer the care they would write to another consultant who in their opinion could. That letter would then be treated as a new referral and guess what, the government guidelines do not apply to consultant to consultant referrals.

Regards

Witchiepoo