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ACL complete (?) rupture, MCL grade 2, with TPF

 Poster: A snowHead
Poster: A snowHead
Fellow snowHead s,

As you might have read in a couple of other threads, while away in Andorra, I sustained injuries as per thread title (plus a few more of pulled this, streched that).

I was never in any real pain though, and have completed my run down a red, followed by "another run down an easy blue", as I started to feel something wasn't quite right.

Got myself off the mountain, went to the hotel room and raised my leg. No swelling, very little pain, full ROM. Plan was to "wait & see", and if everything was OK, to go skiing the next day.
That eve though, pain and some stiffness set in. Got a couple of Ibuprofen which took care of everything. However, some bruising on the inside of my knee appeared and, having suffered a biceps tendon rupture a few years previously, I knew that the damage was more extensive.

Hobbling down to dinner that eve, I noticed laxity in my knee if I suddenly turned around or swung my leg. I remembered that "Google was my friend", so I self - diagnosed myself with a torn MCL & ACL.

Went to the hospital the next day, they applied some sorry excuse for a bandage job (I would have done it better - not joking either).
Referred me to an MRI scan, which I had the next day. I did not get results until the day after (all this while I am walking and weight bearing)!

The scan showed injuries as per thread title.
I have a couple of concerns. Are the MRI results even relevant, as I was sent around walking, without any knee support? I suspect not, and that I most likely will need to have another MRI scan.

Secondly, the diagnosis is vague (MCL rupture grade 2-3,, and ACL rupture 1-2). They are not specific.
Maybe I'm wrong, but shouldn't they be? That's the whole point of having an MRI scan - so that exact extent of injuries could be established.

Anyway, flying home tonight and will need to lean on Dr Bell's considerable skills. The good thing is that I am London based.
So If you are reading this, Jonathan, pls feel free to shoot me a PM and hopefully we can take it from there.


Last edited by Poster: A snowHead on Tue 4-04-17 21:43; edited 1 time in total
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@snowglider, @snowglider, probably best to get in touch via here http://www.wimbledonclinics.co.uk/ski-injury-clinic/ and book yourself into the next ski injury clinic.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
@snowglider,

The one thing an MRI scan will do very poorly is grade the level of ligament injury.

The only thing that is relevant is the grade when the knee is examined.

I use the scan to check joint surfaces and meniscii not diagnose the ligament injury.

Ill pm you

Jonathan Bell
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@Jonathan Bell, thank you for your super - fast reply (I did not expect to hear from you so soon)!

Received your PM and have replied - am genuinely feeling obliged.
I can make it when you said you could see me - so I shall see you then.

Best regards and thanks
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Anyway, snowHeads is much more fun if you do.
@Hells Bells, I know, I know *hangs head in shame*.

Dr @Jonathan Bell, was super prompt though and we've arranged an appointment - very relieved now that I know I'm in good hands Smile
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@snowglider, Very Happy glad to hear it.
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Then you can post your own questions or snow reports...
A brief update:

I was seen today by Dr @Jonathan Bell (I cannot thank you enough for seeing me at such a short notice, Dr Bell)!

By the way Dr Bell gave up a portion of his private time (he was preparing for a ski trip, and has gone by now) just in order to see me today.
So any snowheads reading this, and in need of medical care relating to your knees - you know who to see. Dr Bell's ethics proved to be exemplary. He will be in your corner.

The diagnosis was consistent with the MRI scan (a grade 2 MCL rupture and a non - displaced hairline fracture of my tibial plateau).
Dr Bell suspects that the ACL has ruptured completely though.This is not certain as the MRI didn't indicate that, but it's not crucial to ascertain the exact level of damage at this stage, as surgery (if needed) shouldn't be carried out so soon after the injury anyway.

So I will start physio work and see Dr Bell again in 4 weeks' time.
I'll try to provide regular updates.
So far, I have full ROM, there's little or no swelling, or pain. The bruising has faded significantly.
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After all it is free Go on u know u want to!
I hope it all goes well @snowglider

What I cant understand is how abroad you can get an MRI at the drop of your hat,
but here in the UK the hospitals & gp's seem to fight tooth and nail to avoid them.

I gave up trying to get one.
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@DrLawn, thanks for wishing me well!

True... though it might be worth noting that the MRI was paid for privately.

I'm pretty sure here in the UK GPs/hospitals wouldn't mind referring patients for an MRI either, as long as they were being payed for it privately, as opposed to relying on the NHS to fund it.

A few years ago I badly needed an MRI to rule in/out a biceps tendon rupture.
The consultant referred me for an MRI but was overruled by his manager!
I was desperate, so I saw a physio privately, who then referred me and I paid for both the appointment with the physio, and the subsequent MRI, out of my own pocket.

If you can find the time to make a trip to London, there's Vista Diagnostics clinic which does MRI scans. Their prices vary according to busy/quiet times, so if you can be flexible, the price can be as low as £200 (still not cheap, but well worth it if you really need it).
They're just by the London Bridge, so not too complicated a commute for you.

I hope that this helps and that you get better!
Btw what's troubling you, if I may ask?
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I got an MRI of my shoulder incredibly quickly after being referred - NHS, St Thomas's. I was told at the Musculoskeletal Unit that they've got much cheaper recently.
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Great news, @Hurtle!

They really ought to be. They've become almost essential, as so many high - precision surgical interventions rely on them.
Also, vice versa, they're invaluable when it comes to ruling out surgeries that are not neded - so one could potentially argue that their increased usage would actually save the NHS money.
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And love to help out and answer questions and of course, read each other's snow reports.
Speaking as an absolute non-expert, except by recent experience, like all things over here in the NHS it's mayb a case of short-term cost vs longer term benefit. Clinical opinions doubtless have a part to play too - I know that the NHS consultant surgeon who I saw said that "MRIs are for Muppets" - I think he meant that he prefers to make his judgments on the patient as they present and by means of his manual examination (Lachman, Drawer & other tests) than a grey and white image which not many people are necessarily really terribly good at interpreting (the Registrar whom I saw at the clinic certainly said straight out that he wasn't) and can present false negatives or positives and has its own inherrent limitations in varying ways. I have also read a thread where Dr Bell (Or is it Mr?) has said that they have their diagnostic limitations; though I wouldn't dare to presume his overall opinion as to their usefulness.
The reason why they're so popular and well-used abroad is simply, I believe, that many more people have private medical insurance there. It could be argued in many medical approaches that this drives things which aren't necessarily clinically necessary or even advisable; it certainly changes approaches and treatments.
I can only say that whilst the Mayrhofen Sports Clinic had its gleaming glass and state of the art machinery available on a very efficient walk-in basis (at E600 per knee for an MRI!), their clinical process overall left me very dissatisfied. No medical or drug history taken, no vital signs checked, no advice as to injury or dressings care or management pre UK return, no follow-up or warnings as to anything to look out for. "A butcher's shop" (perhaps meant a production line?) was how a local with a relative working there described them in terms of ACL reconstructions. Yes, I had my MRIs and posh and expensive (and blinking dangerous once you're moving on both legs) braces; and I could have had an operation that day if I'd wanted to pay for it (apparently the usual procedure there). Would I have had one there? Not a chance!
having said that, if there was someone offering private MRIs at £200 a shot near where I live (say in Manchester or Sheffield) then, for any musculoskeletal pain conditon I'd be paying for it myself like a shot. We don't seem to have a very good line in the UK between full NHS and full private, especailly if you have no health insuance. I, for instance, would pay for private diagnosis and physio, etc, but couldn't afford private surgery or in-patient treatments.
I'll also add that Mr G had his seriously-smashed tib/fib and 30+ piece wrist jigsaw reconstructed in an emergency, with compartment syndrome and many torn and seriously-damaged soft tissues, by a top-flight NHS surgeon 20 years ago. 9 hours of surgery and not an MRI in sight. He still has his hand and arm, he still has 95% use of it. Ditto more recently a badly-sprained foot (real ligament and tendon mess) and fibular malleolus fracture, not a problem now at all and again not an MRI, before, during or after. May be relevant, may be not. I bet in Austria they'd have whipped out the pulsating machine at some point, though...
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