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Suspected ACL rupture, where to start?

 Poster: A snowHead
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Morning lovelies over in this board, I've not been here before so please be gentle.

Morning of day 6 of the EoSB and a few of us pootle out from the Oxalys down to the Plein Sud chair, 2 kids in front and I turn to look uphill to check the followers and catch an inside edge on my left ski, leg stretches to rebalance and I feel it's gone to far immediately. I come to a stop in a few metres and have to pause a good few minutes to get my breath back to even think about moving. Husband was with me and saw me bent over my ski poles and thought something was up with my bindings, another basher in our little group realised something was up as in sliding to a stop, I effectively cut her up. Anyhow, with some side skipping / falling leaf I get to Cairn and back to hotel.

I manage to hobble out and meet up at the Chalet Caron for lunch but get encouraged to get checked out. Dr at med centre couldn't fathom out much from exam as I was too tense and the xray showed no broken bones but sees me shuffling hence the suspected rupture. I have some sizeable swelling (discernable even on my mahoosive thighs) around the top, rear and left of the knee and limited movement, without the brace I can't bear weight for more than 1 shuffle and feel as if I can't lift my foot up off the floor at all.

I have the xrays - do I just go to my GP in the morning to get the suggested MRI referral or can I go direct to a private place? I also got told to go for a blood test to check platelets for the anticoagulant my husband is stabbing me with - is that a GP job too? I am SW London so the obvious place privately is Wimbledon. How do I start this process? Thank you x
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Morning knee LOLs... Always29 just removed her truss and said "Ooh my knee doesn't feel so hot today - thats good!"... reminded her she also just removed her breakfast icepack... does ACL have connection to brain at all as normally she's quite smart.
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Get a definitive diagnosis. Knee injuries are generally difficult to assess, diagnose in the acute stage. If you can be seen privately and have the MRI scan done privately that would speed up your diagnosis. Would be a much longer process via your GP I would imagine. The blood test for checking your platelets should probably have been done before prescribing the injections however it is unlikely to cause you any problems.
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Richard_Sideways wrote:
does ACL have connection to brain at all as normally she's quite smart.

Yes, bggrd female knee = bggrd brain, at least in acute and healing phase. Patient will require 24/7 pampering on long term basis Little Angel
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@always29, bad luck, my sympathies. May not be ACL of course... My lost ACLs were/are not painful at all; MCLs on the other hand... Evil or Very Mad
If you can go private, Jonathan Bell @ Wimbledon seems a good bet from what I read on here.
If not, I was advised to proceed via A& E to get into system quickly. I went to a drop-in acute knee/fracture clinic at a local city hospital and got quick referral to Ortho from there - but I did already have MRIs done in resort. Maybe do a search on what local hospitals offer, or phone and ask? GP is not the fastest route usually.
There are references on this forum to a place in London that does private MRI - can't remember offhand but you should be able to search for it.
In absence of medics, a specialist or good lower limb physio should be able to assist.
Do see GP re the medication, though.
Best wishes, hope it isn't too serious.
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@always29, First stage - call in and see the GP, but you need a referral to an orthopaedic specialist.

The French love the heparin injections. The UK GP will probably discontinue them immediately. They have with both me and my wife in the past.

I am not sure about the MRI referral. My GP just refused to beleive it was damaged, and I had to harrangue him to get me an appointment. (It was of those crazy NHS times when hospital referals came out of the GP's budget so they avoided doing it). In the end it was diagnosed under a general anaesthetic, and then operated on some months later.

The GP seems to have changed their procedures; the last two injuries (both shoulders) have resulted in hospital referrals within a week and operations as soon as medically appropriate.
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Private MRI in London: Vista diagnostics

@Weathercam used them

http://snowheads.com/ski-forum/viewtopic.php?p=1780873&highlight=vista#1780873

He has a good blog write up too.

http://www.anotherharddayattheoffice.co.uk/aclknee.html
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@always29, I'm so sorry to hear this, but you are in the right place wink

http://www.wimbledonclinics.co.uk/

3 years ago Jonathan Bell reconstructed my ACL & I have never regretted it. I would ring the Wimbledon Clinic advice line - I think they do a sports injury clinic on a Tuesday, or you may be able to get a direct referral to JB. I wouldn't bother getting an independent MRI - if they feel you need one, they will organise it for you. I wish you a speedy recovery, anyway
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@always29, I hope that the "medication" that we passed on to @Richard_Sideways will be of benefit! Very Happy Hopefully we'll see you back in form in a couple of months.
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@genepi, sound advice.
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@always29, it all depends on whether you can afford to go private in which case it's not a problem for you to go to Wimbledon etc

However if you're a bit cash strapped then there are ways to go down the NHS route - I did a mixture, went to GP to get a referral for a private MRI then paid for a Consultant appointment who then put me into the NHS there-bye saving a fair amount of time.

There is a rather nasty procedure that a good physio can do to determine if it's an ACL basically pulling your lower leg from your thigh, couple of secs of pain but will tell if your ACL is ruptured, but you'll still need the MRI.

Try and keep mobile and if it is an ACL then building up the knee prior to an op is just as important as post op rehab.
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This is what JB said about MRI.

Quote:
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.
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Hells Bells wrote:
This is what JB said about MRI.

Quote:
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.


However it is very common to do other damage along side an ACL injury - though first time I did my ACL it was just that in isolation, which is why (I believe) it is always done even when the consultation is quite sure the ACL is ruptured.
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@Hells Bells, I've had three ops, one ACL and two clean-ups.

The knee consultant on the initial consultation will have a good idea but will then use an MRI prior to operating to determine what the exact and other issues could be.

That said it's during the operation that the surgeon can really see the degree of the damage and what else is missing rolling eyes

This mini bombshell happened to me - around 05:10 into it !


http://youtube.com/v/Km3iF8wOCQk
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@Weathercam, I'm not saying it isn't necessary, just repeating what JB said in another thread, that he would use examination to diagnose and MRI to check for other damage. So get a consultation first.
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@Hells Bells, but that's if you're fortunate to go private, if you have to go down the NHS route the process is obviously far longer, each one of the stages below is around 2-3 weeks

NHS Route --> see local GP --> refers to Hospital Muscular / Skeletal --> refers for MRI --> back to Muscular Skeletal for assessment --> Op scheduled
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@always29, did the doc in resort (or anyone else for that matter) done the lachman test (https://en.wikipedia.org/wiki/Lachman_test) on your knee yet? It's a good first indicator of ligament damage and pretty much standard procedure, as far as I'm aware. Was the first thing the doc did to me in Val d'sere.
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@Dr John, that's what I was alluding to above but could not remember the name......

"There is a rather nasty procedure that a good physio can do to determine if it's an ACL basically pulling your lower leg from your thigh, couple of secs of pain but will tell if your ACL is ruptured, but you'll still need the MRI"

I'd had around 5 pints by the time I'd let this physio near me - and yes it was done in the bar in front of everyone about eight hours after I did mine and was back from the hospital etc


Last edited by Well, the person's real but it's just a made up name, see? on Mon 24-04-17 10:26; edited 1 time in total
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Thanks for all your help folks - catching up while waiting at GP! The Dr in resort did Lachman test but google translate tells me it was "doubtful muscle contraction ++", I was very uptight it would seem. I am feeling very positive this morning, the usual 15 min school run only took 40 mins and top of knee swelling has gone down hugely, my knee is clicking painlessly & I can almost circle my ankle when brace is on.

I don't have private medical but am willing to get a private assessment done if it will help speed things up and definitely will call Wimbledon depending what gp says.
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alangibson73 wrote:
The blood test for checking your platelets should probably have been done before prescribing the injections however it is unlikely to cause you any problems.

I suspect it has been requested because falling platelets are a rare side effect of the injections, so need to be checked after the course has started.
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@Weathercam, it's uncomfortable, but I didn't find it painful, and it's quick if the doc is good.

Warning though, it very much depends on the doc knowing what they're doing. The sainted Dr Griffiths diagnosed mine, about a hour after I did it which was the time I took to hobble to the lift and download. Immediately diagnosed as ACL complete rupture. Went to see a specialist in London and was examined by a junior lacky while waiting for the the main chap, Jnr did the same test and said nope, not an ACL tear. I protested. Chief Doc came in, did the same test again (was getting tedious by this point) and said yep, definite ACL rupture, to be confirmed by MRI. The test is a good one, but only as good as the doc doing the test.

Ps. I had a hammy graft 5 weeks after the rupture (private medi through work), many months hobbling around and physio/gym work, was skiing 9 months later, albeit tentatively. That was 6 years ago and I'm a better skier now than I ever was due to better fitness and concentrating more on technique rather just flinging myself downhill as fast as possible.
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And for any knee related injury this is money well spent - both for post injury as well as the all important post op - to reduce swelling - I've lost count of the friends I've lent it to - it now travels with me - and after I strained my knee badly earlier in the season (pinned to a tree in an avalanche) it again helped tremendously - CryoCuff Knee - Ebay / Amazon etc basically fill the container up with water and ice and that feeds into the brace and lasts along time, then when it's no longer cold via gravity water from brace goes back into the container, wait ten mins and then place container above brace and gravity fills the brace back up with ice cold water.

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Grizzler wrote:
...Patient will require 24/7 pampering on long term basis Little Angel


Hmm, better go get some adult size Pampers then... suppose its to be expected as the bog is upstairs normally and you can't move too quick on a bum knee.
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@Richard_Sideways, jokest thee not! Try even getting on, never mind off the damn things when both knees are fixed, immobile and damn painful wink Another one of those little things in life which you just don't appreciate until you can't do it...
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@Grizzler, Masque was regaling the kids with tails from when he busted his coccyx while teaching them to fall properly on a snowboard and the related traumatic pooping. Moral of that story, prevention is better than cure!
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@Richard_Sideways, I always claim that the huge increase in the size of my posterior & thighs when snowboarding is just very well-padded impact shorts. Honest Smile
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Fancy you snowboarders derailing my poorly knee tale into schoolboy toilet humour.

After GP telling me there's a two week wait for local fracture clinic referral, I'm having a trip to the famed Wimbledon Clinic this morning. Things are feeling a LOT less sore so very hopeful it's not anything sinister at all and can get on with lots of physio and back to normal.
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Possibly... However by the time I got the swelling down and was in a position to have the reconstruction my knee was feeling almost normal and I must admit I did have a few second thoughts with going ahead. However given the damage I caused when it collapsed under me when I was unknowingly sprinting with only half the reconstruction left, it really is worth doing if you intend to carry on skiing etc.

Best of luck this morning.
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Good news this morning - MRI shows only some fraying of ACL and a undisplaced tibial plateau fracture which is better than initially anticipated, couple of weeks on crutches, some physio and should be all reet Smile My knee apparently , injury and surrounding subcutaneous fat allowed for, is in good shape Smile More horrifying than pain of injury and medical bill was seeing all the fat !!
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@always29, Good news indeed. I prescribe snowboarding to keep the knee safe. wink
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cad99uk wrote:
@always29, Good news indeed. I prescribe snowboarding to keep the knee safe. wink


Hmmm, I think that treatment is far too extreme Very Happy
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Excellent news!
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@always29, excellent news!
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cad99uk wrote:
@always29, Good news indeed. I prescribe snowboarding to keep the knee safe. wink


^ This.
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@always29, excellent result! See you in a few weeks.
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She's off shopping for a new, sexier knee-truss now...
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@Richard_Sideways, I got mine from firstaid4sport.
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I've persuaded her to hold off clicking 'Buy' until she's spoken to the physio about what the best buttress to apply.
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@Richard_Sideways, yes, wait before spending lots of pennies. Get physio and Ortho advice and try to try on if poss, though these days that seems very difficult. For everyday use while recuperating from my own ligament injuries I've so far found a really cheap (£5 each) spring-sided neoprene wraparound velcro-strapped thing by far the best; hinged version hurts inner &outer knee much more & doesn't feel half as comfy or supportive. Seems to be helping me surprisingly fine for walking uneven or sloping ground as far as I can so far manage that. But whilst thinking to the future and a return to skiing & boarding I will seriously be considering a pair of £500+ Cti or Donjoy rigids just for the protection, never mind if I end up needing support or not. But I will wait a lot longer until I work out how well I've healed and how much stability I have.
Can get very expensive, this injury thing... Sad
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Richard_Sideways wrote:
cad99uk wrote:
@always29, Good news indeed. I prescribe snowboarding to keep the knee safe. wink


^ This.


And lots and lots of aforesaid padding. Everywhere Very Happy
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