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Ortho Knee Surgeon...ask me anything!

 Poster: A snowHead
Poster: A snowHead
Hi Guys

I'm an ortho knee surgeon on the South Coast of England (Hampshire) Fell free to ask me any questions i might be able to help with here....happy to help out.


Last edited by Poster: A snowHead on Sat 25-11-17 20:38; 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
I am 43 and was diagnosed last year with early onset Patellofemoral Arthritis after a couple of years winding my way through the NHS system (including a wasted 3 months of physio) .

Finally got an MRI and met the consultant - showed me the shadow on the scan - surface damage ...

Nothing he would do right now. No way to fix the damage . Operating might offer relief later in life (i.e. cap replacement?) but at my age - better to ignore it as replacement cap would (possibly) relieve pain but reduce mobility.

Pain in my right knee when bending - comes on most around a 90 degree bend, sharp pain.
Hurts most when going up stairs. I can run fine though but was causing me a few niggles skiing last year.

Was consultant right ? Or is there a miracle new cure I may have missed in the last 12 months? Some kind of knee polyfilla...

Doesn't seem to be getting any worse which is good though..
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@b4d4bing, that's a very kind offer snowHead
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Thought about micro fractures? Think some footballers have had it done for arthiritis. It promotes new cartlidge growth
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well, cartilage damage is a difficult one just now, no real great solution. Some things in the pipeline. Micro fracture good, but it encourages new fibrocartilage, a bit like scar tissue to fill in rather than articular cartilage which was there originally. better than no cartilage but studies have shown its good for about 5 years then declines. Doesnt mean everyone with a little damge is going to end up with a knee replacement, but it can cause whats called post traumatic arthritis. without seeing the MRI its impossible to say, but some articular cartilage damage on your knee cap is the most difficult place to try and encourage new growth.


Last edited by Anyway, snowHeads is much more fun if you do. on Sat 25-11-17 20:38; edited 1 time in total
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Had an MRI and consultant came to the conclusion: "Some bone marrow oedema in the medial facet of the patella and some ill-definition of the medial retinaculum consistent with an episode of patella dislocation"

Puzzled What's best course of action on rehab? Is it just a case of generally strengthening the muscles around my knee?
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Any help in how to build wasted thigh muscle? I have a bucket tear miniscus, a permanent patella disloction & a torsion twist in my tibia & all sorts of ligament issues. So my knee is shot - but trying to build strength in my thigh to help with snowboarding.
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Some bracing advice appreciated. Can post some pics up of my knee if it helps
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Snoodles - the bone marrow oedema is like a bruise in the bone. Patellar dislocation if it is the first time it has ever happened is normally treated with physio to build up the quads other muscles. If it becomes a recurrent problem then seeing an ortho surgeon is a good idea as they can identify why its happening and if there is any surgery that might help it to stop happening. As always impossible to comment without seeing you and the images, but a few physio sessions would be a good idea to start.

Mr Egg - I would advise that you see your doctor and see an ortho surgeon if you haven't already. bracing is really only worth while if you have some kind of ligament instability you are trying to resist with a brace.


Last edited by You'll get to see more forums and be part of the best ski club on the net. on Sat 25-11-17 20:38; edited 1 time in total
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Quote:

Mr Egg - I would advise that you see your doctor and see an ortho surgeon if you haven't already. bracing is really only worth while if you have some kind of ligament instability you are trying to resist with a brace.

I have seen various doctors and surgeons. Going back to the early 80's when I was young (around the age of Cool, they wanted to exploration surgery, which I refused. Then when I was mid 30's my knee swelled up. Had MRI, CTScan, etc. & this is where they also diagnosed the bucket tear. - Im not to bothered about my knee (Happy for you to have access to my records for your own personal use in a messed up knee!) - but would like to try & take some of the strain off the other leg. I am waiting for a physio appointment to learn how to use a EMS/TENS machine as my muscle do no fire properly in my thigh. Also, bracing help - as if my knee bends a little, it gives way - hence my other leg does all the work in holding my body up. After 40 odd years, with my abnormal gait, its starting to take its toll on my good leg hip!
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@b4d4bing, would be interested to hear your views on regenerative treatments such as PRP or stem cell injections rather than surgery.

I've had a look at your website and, with respect, you're clearly very surgery orientated. I realise that a ruptured ACL will not re-attach itself because of the gap between the ends so surgery is the only realistic option so let's put that on one side.

What's your view on other orthopaedic issues such as meniscal or articular cartilage damage that at least in theory could repair itself with the right support?
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@b4d4bing, Welcome to the forum
We are all hypochondriacs here

I got whole lot of mileage out of my dodgy knee last season,
something to do with a medial meniscus, but that's skiing for you.

I'm whinging about plantar fasciitis or something similar now, but that's a bit blow the knee Smile
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@b4d4bing,
What's your professional views on:
a) ACL reconstruction or conservative management ( and when, why, whom...);
b) Wearing of 'serious' brace (e.g. CTi, Donjoy) for either preventative or supportive purposes whilst skiing in both ACL deficient or ACL post-reconstructive persons.
(20 marks. wink )
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You know it makes sense.
Quote:
would be interested to hear your views on regenerative treatments such as PRP or stem cell injections rather than surgery.

I've had a look at your website and, with respect, you're clearly very surgery orientated. I realise that a ruptured ACL will not re-attach itself because of the gap between the ends so surgery is the only realistic option so let's put that on one side.


I definitely am a big advocate of surgery only when its necessary. ACL recon actually isn't needed for all, your ACL wont heal but its an operation for instability and if you can manage without surgery great. The only concern with that is the next structure to take over the rotational stability of your knee is the medial meniscus, and if you have a big tear of that then you are absolutely heading for osteoarthritis in the future.

PRP and stem cell injections do look interesting something on the rise. There is very limited evidence that they have a effect on the health of your joints. With cartilage damage in another wise normal knee from trauma, I can understand why they might help the regeneration of cartilage, but the science and evidence is not there yet. In arthritis there is no evidence. These injections are not with out risk and all invasive treatments should be weighed up on a risk vs benefit.


Last edited by You know it makes sense. on Sat 25-11-17 20:37; edited 2 times in total
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Quote:
What's your professional views on:
a) ACL reconstruction or conservative management ( and when, why, whom...);
b) Wearing of 'serious' brace (e.g. CTi, Donjoy) for either preventative or supportive purposes whilst skiing in both ACL deficient or ACL post-reconstructive persons.


As i said above an ACL recon or repair is an operation for instability. If you are not unstable then you don't kneed an operation. Also the first line treatment is always physio and rehab and then progressive return to your activities. If you can achieve all you want with out it being unstable then again no op needed. If you can also have stability by using a brace then again thats the end goal whether its surgery or conservative management.

the worry is if you are unstable and just keep going, you might do more damage to other structures in your knee, and reap the consequences of that damage.

wearing a brace to prevent injury is not probably a great idea, especially if you have otherwise normal knees. the concern is that if you do fall, you might actually do your self more harm. I had a sever MCL injury and used to ski with a brace, made things manageable. so I definitely do think in the right circumstances they are great.

Injection wise there have been some good results and NICE have also given their opinion that hyaluronic acid injections (durolane) have been shown to reduce pain and increase functional ability in those with knee osteoarthritis and it is something i would absolutely try if you have OA before ever considering surgery. a replaced knee is not the same as your original and preserving your own joints for as long as possible is definitely the way to go.


Last edited by Otherwise you'll just go on seeing the one name: on Sat 25-11-17 20:37; edited 1 time in total
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 Poster: A snowHead
Poster: A snowHead
Following up on the brace, I have heard views to the effect that if you need one then you're not really ready, knee-wise, to ski. Psychologically, of course, there are other reasons to wear one, and possibly also for preventative purposes or aiding with muscle tiring. However there are negative views about the risk of transferred injury, e.g. to the femur.
There are also differing views surrounding the real benefits of the large, hinged high-end braces, as aforementioned, vs shorter and less strengthened, usually strapped neoprene (etc) ones. Others say these intermediate type braces offer no benefit.
Comments?
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Hinged braces are good for collateral ligament injury. otherwise i'm not sure they serve much purpose. Specific ACL/PCL braces if you are deficient will help to resist the forces that your absent ligament can't. Neoprene or soft knee braces I think do help people but not by supporting any structures. they give a feeling of confidence by giving the sensation of pressure around the knee and help with what we call proprioception. Proprioception is just further feedback to your brain telling it where your knee is in relation to the rest of your body. so If they help you and let you ski with less pain or more confidence, then go for it.


Last edited by Obviously A snowHead isn't a real person on Sat 25-11-17 20:39; edited 1 time in total
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Quote:

Neoprene or soft knee braces I think do help people but not by supporting any structures. they give a feeling of confidence by giving the sensation of pressure around the knee and help with what we call proprioception. Proprioception is just further feedback to your brain telling it where your knee is in relation to the rest of your body.
Ha, exactly what I've been told by the estimable Claire Robertson of Wimbledon Clinics, following the nasty bang on the knee I had a few weeks ago. I fell over twice, for no apparent reason, after that, but worked out for myself that the injury had affected my proprioception. However, happy thoughts like, 'Do I have a brain tumour?' did briefly cross my mind. Laughing
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Quote:

Quote:

Neoprene or soft knee braces I think do help people but not by supporting any structures. they give a feeling of confidence by giving the sensation of pressure around the knee and help with what we call proprioception. Proprioception is just further feedback to your brain telling it where your knee is in relation to the rest of your body.
Ha, exactly what I've been told by the estimable Claire Robertson of Wimbledon Clinics, following the nasty bang on the knee I had a few weeks ago. I fell over twice, for no apparent reason, after that, but worked out for myself that the injury had affected my proprioception. However, happy thoughts like, 'Do I have a brain tumour?' did briefly cross my mind.


I would have thought the pressure would at least aid in circulation - similar in how flight socks work to combat DVT.
Knee giving out for no apparent reason (& ending up in a bundle on the floor!) was one of the signs of my meniscus tear.
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@b4d4bing, thanks, fairly similar to what Mr Consultant said but itís nice to have reassurance.
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@b4d4bing many thanks for the response. Will sit tight for now and keep an eye on new developments...
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Hope some of this was helpful. Thanks. Good luck guys.
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@b4d4bing, Hi, we only ski once year, my husband snowboards. About 3 days into the holiday his knee swells to a giant size and becomes painful. 2 years ago he had to take a day off. Last year he wore a tight bandage from day 1 and it was a bit better. He is active and walks alot but does have problems if he overdoes it generally. Do you have any ideas what this might be and should he be seeking help? Thanks so much.
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@b4d4bing, definitely helpful, thanks very much snowHead Ironically I fell off my bike last night and bruised my dodgy knee, thankfully not too badly Very Happy
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The internet is a great thing.
Your website is very snazzy, b4d4bing, but so it should be.
You look the part:

And obviously forward looking right from your training days:
http://www.bbc.co.uk/news/uk-scotland-glasgow-west-15535438
Very reassuring Smile
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I am a bit uncomfortable with @b4d4bing suddenly appearing and obviously touting for business, putting his website link at the bottom of every post (it wasn't in his sig)
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And love to help out and answer questions and of course, read each other's snow reports.
This topic should be in Bend ze knees, shirley Confused
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@holidayloverxx, I know what you mean, though not sure what the difference is between a website link being in the body of a post, or in a sig. But, substantively, this is very different from Jonathan Bell, who has only ever weighed in if he has read a post on which he could contribute some expert advice, and he contributes other, non injury-related stuff to the forum as well.
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holidayloverxx wrote:
I am a bit uncomfortable with @b4d4bing suddenly appearing and obviously touting for business, putting his website link at the bottom of every post (it wasn't in his sig)

Well it's a topic that no doubt interests quite a few snow heads, and the advice is free. Individuals can make their own minds up whether to pay for the services advertised in the website, which is not much different to other useful posters who also advertise a service.
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@holidayloverxx, plenty of other offer advice and get business out of it, I donít see much of a problem.
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 Poster: A snowHead
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@Slippery Slope, @SnoodlesMcFlude, you're right, but this was a very stark first post. Also, I guess that some of us (certainly me, and I suspect @Jonpim - hoping I haven't attributed extra years to him unfairly!) were already around when people like doctors and solicitors weren't allowed to advertise their services at all, and the feeling of unease is therefore difficult to shake off, even if it isn't particularly rational nowadays.

Sorry, I'm rambling a bit, but it is a case of how the contribution is perceived, which is a bit woolly and subjective in itself.
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I think it is in the forum rules that links have to be in the signature
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Sorry if this has been perceived wrongly. Genuinely enjoyed Snow heads for years. Was hoping to be helpful to people. Happy to close the thread. Good luck guys.
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@b4d4bing, i just think you have been a bit pushy. Hang around, engage...where do you ski?
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@Hurtle, it wasnít a first post, was it? Heís got multiple posts and has been a member since 2011.

@holidayloverxx, how has he been pushy? Heís offered help to people. Sure heís included a link, but none of us have been forced to visit the site or asked to pay any money, and relatively few people are even in the catchment area.

Why treat this advice any different to the advice offered by Spyderjon or Jonathon Bell or CEM?
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@SnoodlesMcFlude, I've explained my thinking above.
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@SnoodlesMcFlude, 6 posts since 2011 then "look at me". I'm not that bothered about the link; spyderjon is a bit more subtle. I don't comment on CEM anymore but he has a lot of kudos and credentials from those on here that rate him.

There's just something about a medical professional touting for business, being suddenly very active and putting himself forward as the great expert. It just doesn't sit well with me.

I will need a knee replacement in the next 10 years; I have money put by and am thankful that Jonathan Bell ( the master of subtlety, with sound and well considered advice) is younger than me so can hopefully do the surgery
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I don't see the problem. The guy is offering free advice. His background can be checked via the links and the web. If some people aren't comfortable with it the should either report it to a moderator or STFU. As it is you seem to have scared off a free resource because he missed a tiny bit of small print in the forum rules.

Has he posted anything which is blatantly incorrect or blatantly selling his services? The answer is no....so why give him a hard time?

@holidayloverxx, I thought you of all people would appreciate free advice from someone who knows about knees.
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@Hurtle, agreed that they are less Ďon the noseí and obviously have offered a lot more to the forum, but the principle isnít that different and I think itís unfair to treat the OP diffferently.
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@Thornyhill, its not about tnr the small print...it just feels like spamming. His speciality isn't relevant to my knee
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