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Ruptured ACL, surgery at home or in Andorra?

 Poster: A snowHead
Poster: A snowHead
Hi

I have a ruptured my ACL, and damaged my LCL (not sure how badly the LCL is effected), I have the option to have surgery in Andorra, covered by the insurance with my season pass, which I know would be quicker than the UK. If I have the surgery here, does anyone know how long after surgery, it would be before I can fly. My travel insurance from home have already said they will arrange flights etc, whenever I need them.

I don’t need to worry about accommodation etc, as we have just bought an apartment here, and my son also works here, but am concerned how long I will have to stay here if I go ahead with the surgery here.

Any advice would be welcome.
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@Jja, bad luck. Ask the surgeon, can't be that long people have ACL surgery on hols all the time; you would need a fit to fly letter and they would likely give you anti coagulant jabs
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+1
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@Jja, what a shame. I suppose maybe the surgeons near a resort might have good experience with this kind of repair? Depends if you feel comfortbale, as seems you can stay.
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As above.

FYIW, they let people on flights with broken legs & in casts, so it's not a mobility thing that would stop you travelling. More likely to be recovery time from the surgery, effects of anesthetic and likelihood of thrombosis in the affected leg. Check with Surgeon.
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Its more the risk of thrombosis I’m concerned about, I’m already using the anti coagulants jabs. I’m happy to be here for a short time, but don’t really want to be here for weeks. Although there are 3 seasonaires I know in resort, that have had ACL surgery here in the last few weeks, and are doing OK.

I’m going to the hospital again tomorrow, so should know more.

Thanks for the advice.
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I’d go with local option, you can bet he sees lots more ACLs than the average UK ones. If its anything like my quads tendon repair they fill be insisting on compression tights (compression ski sock are much comfier!) and jabbing yourself every day for weeks with anti coags if they don’t think your current ones are up to the job.
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@Jja, so sorry to hear! A few pros and cons from what I've gathered over the last 10 months recovering from an ACL reconstruction:
There are two "ideal" scenarios for an ACL reconstruction- immediately (same day) before swelling and muscle wastage have set in. That's generally used by athletes for whom time is of the essence. Or-at about 6-8 weeks, after a good stint of pre-hab with a physio to get swelling down, regain range of motion and build muscles, which will put you in a better position for the post op rehab. You don't want to leave the op more than 2-3 months post injury in an ideal world, as you risk other damage to the knee in the meantime (meniscus, etc.) In that sense I can see your point about having it done quickly, as most NHS surgeons have a waiting list longer than just a few months, not to mention the time getting referred, etc.
On the other hand, against having it done abroad- I'm guessing you're later than immediately post injury, but won't wait abroad for the 6 weeks or so to regain ROM, get swelling down, etc. If you have surgery on a swollen and stiff knee, my understanding is that the results are suboptimal. The other important issue with ACLr is continuity of care. Ideally you want to start physio immediately post surgery- meaning within a day or two - tricky if you arrive in the Uk a few days post op and have to start finding a physio at that point, get an initial appointment booked, etc. You'd also want your physio to have had contact with and details from your surgeon about what was done inside your knee, any restrictions etc- a bit tricky with your surgeon in Andorra and physio in the UK. Ditto with the follow up appointments with the surgeon. I had 3 or 4, the last around 7 months.
I'll add that I wouldn't personally have been up to travelling immediately post ACLr. The focus during those early days was - on my surgeon's instructions - elevation, ice, gentle physio movements, no more than 10-15 minutes on my feet at a time, but at regular intervals (every hour or two) to get the swelling down. Getting myself in and out of a taxi and across town, leg elevated on the back seat, was challenge enough for me. But everyone is different, that was just my experience.
I don't want to put you off surgery in Andorra, because I can see why you wouldn't want to wait around for ages for the op. But worth bearing the pros and cons in mind.
Is there any way at all you could consider going private in the UK (e.g. heath insurance through work if you have it)?
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@Jja, commiserations.
As said above, I think I'd be waiting now, whether that wait is in the UK or Andorra.
There's also the LCL to consider, and how badly injured that is, if it needs surgery also. (And any other damage, or are you sure that's it?) It may be best to get that properly healed up before subjecting the leg to the ACL trauma and physical rehab regime required (my MCL was a darn sight more of an issue and restrictive pain than the ACL, I think). Probably you're looking about the right number of weeks to heal the LCL and for the ACLr to be ready to do. (Some surgeons would doubtless deal with both together, so you need to take advice on this.)
Also, you do not have to have ACLr surgery, and might want to get a surgical specialist opinion on this, or see how it goes over a period of months. Conservative treatment is a lot more accepted now, if nothing else because it avoids subjecting the knee to more trauma if it's healing well. However, not suitable for all, not a long-term solution for all. Start doing your research! And start getting opinions and options from specialists, in whatever country.
Flying wise, I would think just compression bandages or similar, anti coagulants and the ability to raise or extend the leg if necessary (post surgery might be more necessary?) When I was injured, I didn't need the 2 seats together bit, couldn't actually straighten my legs out that much, just extra legroom in front of seat (aaah, Business Class Toofy Grin )
Good luck. Smile
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Jja wrote:
Its more the risk of thrombosis I’m concerned about, I’m already using the anti coagulants jabs..

I don't think the risk of thrombosis is different whichever route you take.
Flying as such is not really a risk factor it's immobility that is the risk factor.
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If it were me and I had the choice (unlike when mine went) I'd take whatever option allowed me to get it done soonest. Everything else I'd work around.
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I’m going to ask lots of questions when I’m back at the hospital tomorrow, got to weigh up the options. The advice about physio is a good one, and as an occupational therapist I know I can get a referral to physio fast tracked where I work.

Hopefully can make a more informed decision tomorrow.

Thanks again
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Not an ACL but I shattered the ball at top of my humerus into 4 pieces last week & my initial instinct was to get home asap.
The support I have at home compared to in France is immense & like you I also have my own place but wanted home
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@Jja, good luck. I forgot to mention that the surgeon allowed me to fly at three weeks post op, without any anti coagulants etc. It was only a 50 minute flight though (family trip to Cornwall for the Bank Holiday, which we’d already booked).
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@jia , I had an ACL injury a few years ago that was revealed while snowboarding but the ruptured ACL happened a few months before I snowboarded (at that time I thought it was an average knee sprain while playing football, waited a few weeks and as it all seemed fine I kept on playing football and snowboarding).

As other people noted, it's not that important to have your surgery done straight away unless you aim for skiing the next season. I had my surgery done in France (I'm French and had access to top surgeons there) and have done my physio rehab in the UK.

This worked out for me as I was able to stay at my family's house until I recovered properly but flying back wasn't that easy. Don't understimate that your leg will feel umconfortable for a couple of weeks if all goes well (even with proper icing and exercise).

The only reason I would go for the Andorra option would depend of the type of surgery offered. While checking the options in the UK and discussing with surgeons in France, it was clear that the French option (ACL reconstruction with fascia lata) was better and offering faster recovery. I'd consider this as the main decision factor between the 2 options.

Good luck, it's quite painful at the beginning and requires a good physio to progress fast!
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 Poster: A snowHead
Poster: A snowHead
Welcome to Snowheads @spearhead93. What an extraordinarily helpful first post!
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@Jja, if you take a look at the SnowHeads ACL Rehab Club thread, there’s a very helpful explanation from Jonathan Bell, the surgeon, about the problems of doing an ACL recon too early. I’m not sure how to link to it, but if the below doesn’t work it’s on page 16 of the thread: https://snowheads.com/ski-forum/viewtopic.php?t=88075&start=600

Very much second @spearhead93 that a big trip in the first few weeks after the op wouldn’t be much fun. It wouldn’t do the swelling any good either, and the big goal in the first few weeks is to reduce the swelling as much as possible, because it shuts down the muscles you are trying to wake up and rebuild. In hindsight, I probably shouldn’t have done that Cornwall weekend three weeks in, but hey ho.
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Thanks for all the advice, I decided to return home for surgery, I have seen the consultant today (who came highly recommended by a specialist physio colleague) , and he believes I have torn my ACL, torn my meniscus and partially torn my MCL, the damage is rather more than I hoped. I now need an MRI, and then surgery.

It’s still quite swollen, and now I can understand why it was recommended to wait for surgery, and I know I can access excellent physio input here.

Thanks again, now it’s just a waiting game.
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@Jja, snap, that was me, plus a sprained LCL. Where is the meniscus tear? Are they looking at repair or removal? And are they going to let the MCL heal, or fix it surgically? Sorry, I realise you might not know that without the MRI.

In view of the MCL tear I think even more that you made the right call to wait. My understanding is that if you do an ACL reconstruction with an un-addressed MCL tear (be it by surgery at the same time, or healed beforehand) that can create extra instability in the knee when the graft is healing - not good obviously. My MCL was thankfully healed by the time of the op, six weeks post injury. I wore a simple knee support during that time to help with that.

Very best of luck with the pre-op physio. Great news about the great physio input as well - worth its weight in gold!!
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@Jja, Sad for the tragic triad of injuries, Smile for having got home and got the balls rolling. Hope you can get good physio going asap, and fingers crossed for a better set of news once you get the MRI (and for speed of getting it).
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I’ve finally got the results of my MRI, which were a little unexpected, I have a grade 3 tear to my ACL, a grade 1 to the MCL, my meniscus are fine, but I also have a fractured tibial condyle. I’m not sure if this is a better outcome or not, fortunately the fracture is not displaced.

Has anyone had this type of fracture, is it likely to cause problems in the future?

At least I now have a plan after 4 weeks in limbo, intensive physio, I’m booked in with a colleague who is very experienced in trauma, and then surgery on the ACL.
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I add this for anyone in a similar situation in the future.

The knee needs to settle down before surgery i.e. any swelling and tibial damage gone. This can take some time.
Flying shortly after surgery is very, very uncomfortable ( I flew within a week after surgery and it was an awful experience as there is not enough room to straighten your leg on short haul aircraft these days without getting hit regularly by a trolley)
You will want to have follow-up consultations and physio after the op (and you might even have complications), so the best decision will likely be to look at where you are going to be in 3-6 weeks time and for the longest period of time and get it done there.

Good luck Jja. I had the ACL rupture and tibial fracturing. The latter went on its own after about 6 weeks. The ACL is repaired and fantastic (minus a bit of flexion). I am now skiing better and more adventurously than ever. MCL's repair quicker and fully but I have no experience of it personally. The thing I fear most is a meniscus tear as that seems to give the most problems in the long term and can only be ameliorated, not fully repaired. So, in my view (and hopefully it will cheer you up a little), it could have been worse!
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22 Dropout

Thanks for the info, I thought that may be the case regarding the fracture healing prior to surgery, I was very relieved my meniscus was ok.

As for flying I was fine, being 5ft tall occasionally has its advantages!
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Jonny996 wrote:
Not an ACL but I shattered the ball at top of my humerus into 4 pieces last week & my initial instinct was to get home asap.
The support I have at home compared to in France is immense & like you I also have my own place but wanted home


How on earth could you wait? Perhaps it was higher than mine as you say the ball. They tried to immobilise me and treated it as emergency surgery so as to avoid compromising all the nerves in the arm. They would not have let me fly- but the pain was so great anyway that even the morphine hardly did the job.
Hope it's healing now. Mine was a few years ago - still get niggles that send me back to my physio exercises!
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