 Poster: A snowHead
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@@ryancartiers, A lot of stuff to read there!
One day, this has got to be the way to go, surely. The DIS looks interesting too.
I note from your last quoted paper (tbf, the only one which I seriously skim read) that all the interventions were on patients with detachment and avulsion ligament injuries. I saw a reference in another post above about this too. Any reason for this as opposed to mid ligament, latitudinal, non-avulsion tears to ruptures? Are there different outcomes & prognoses, and why?
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@@grizzler Research on repairs going back to the early '90s has found that proximal avulsion (and the rarer distal avulsion) tears have better outcomes for repair than other types. I'm not a doctor, so I cannot explain the exact mechanism (it may not be fully understood...), but the native ACL can heal/scar into the femoral (or distal) footprint when attached sufficiently, while it does not seem able to heal/scar into itself. I also believe that tissue quality may be retained better in extreme proximal and distal tears than in midsubstance and other types of tears. This article has more info/references
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124221/
I am very happy with my repair at almost 3.5 months post-op, but still waiting for the long-term outcome studies. Also not going to rush back to activity just because everything feels better.
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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?
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@EastCoastUS, Interesting. Seems that the "midsubstance" tears are those crying out for some kind of brace, ladder, framework, stitching, etc etc, then.
I wonder if there's ever been any research into those people who have ACL ruptures and 'cope' without surgery. Where are their injuries? I was told by various doctors and physios that my (bilateral, apparently midsubstance) ruptured ligaments may (stress may) have reattached themselves either to themselves or to the PCL or some other internal structures. I have heard this suggestion in others in a similar situation to me. This suggests that a mid-ligament rupture can indeed - and spontaneously and unsupported - heal itself to something; yet surgically it seems not to want to. 
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@Grizzler,
When my consultants and physio have compared the Lachman test on both my knees, they stated that on my injured leg (which MRI showed a fully ruptured ACL and classed as deficient amongst all the other injuries) there was a very solid end point, and that the amount of movement compared to my good leg, was only slightly more. Telling me verbally that as the end point was so solid, and not what they generally encounter when there is no ACL, that either my good knee was also ACL deficient by comparison or that the ACL on my injured leg had somehow repaired, or re attached to something or somewhere else within my knee.
I did mention to both of them that I would look forward to reading their report, neither of them included that in their reports though, and just noted either a subtle pivot shift - that on test I was not aware of - or that there was no pivot shift problem.
Fingers crossed, 10 month since accident and no instabilities in my knee, and having just had 1st session snowploughing on plastic, which highlighted very tight hips, my knee was fine  SO Im going to treat myself as being a person who's ACL is healing, and take it easy and wear some kind of strapped knee support or brace when skiing.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@grizzler,
From what I have heard/read, copers (people with torn or no ACL but stable knees) usually have a ton of muscle strength that provides stability in the absence of the ACL. But muscle strength alone isn't enough, and it just comes down to anatomical differences. I haven't heard anything about the nature of the tears themselves because I think true "copers" are people who's knees are somehow stable while lacking a working ACL, not people who's ACLs still function (though I have read at least one case study about a full ACL tear spontaneously healing). There are copers who have no ACL tissue left at all. At the time of my injury my legs were about as strong as they have ever been, and yet my knee became very unstable and had instability incidents months post-injury just walking across the room despite having full range of motion.
My ACL tissue scarred onto my PCL, which is what enabled me to have a repair 3 months post-injury. Most repairs can only be performed closer to the injury unless the tissue quality is maintained by scarring to the PCL. In terms of surgically repairing midsubstance tears, I think that because the ACL is made up of bundles of long fibers that are constantly "flexing", it is difficult to patch it when it torn across itself, while in extreme proximal and distal tears the bundles are more likely to remain relatively whole.
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I can highly recommend@AndAnotherThing.., as someone to trust with your journey back to skiing after a knee injury, he has been through the hamstring graft ACL repair and recovery, and as a qualified alpine ski instructor he can ease you back in to the sliding game! Sorry mate, didn't think that a shout out in the acl internal brace repair thread was good practice, but what the heck
I had the all clear from my physio, who simply stated that "although my quads are 'massively weak' on the injured leg, my functional strength is good, and that it's clear I have worked hard on developing hamstring and glute strength, with a bit of imbalance, but to go and ski on plastic or indoors as I will be pleasantly surprised".
(I have skiid with @AndAnotherThing.. variable conditions off-piste in North Wales a few times, socially rather than a coaching role, we are both mountain professionals, him as a ski instructor and me as a winter mountaineering instructor, he seemed to put up with my blunt humour, and we have been comparing acl injury for most of the year)
I left it for another 4 weeks of gym work before stepping back in to a pair of bindings.
So after some warm ups and some very gentle drills, including an unplanned emergency right hand turn, injured knee taking the lead role, all was good and as was mentioned to me a few times; "we are all standing upright at the end of the night!" which is always good.
I see my physic next week and will get input on hip mobility/range of movement and come up with a plan for the next progression step.
I love it when a plan comes together, it makes all the diversions and set backs turn in to stages of learning about how to manage my recovery, as all of us should now know the mantra 'everyones knee recovery journey is different"
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| EastCoastUS wrote: |
@@grizzler
Also not going to rush back to activity just because everything feels better. |
Smart. I'm proceeding in the same manner.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| EastCoastUS wrote: |
@grizzler,
(though I have read at least one case study about a full ACL tear spontaneously healing). There are copers who have no ACL tissue left at all. At the time of my injury my legs were about as strong as they have ever been, and yet my knee became very unstable and had instability incidents months post-injury just walking across the room despite having full range of motion.
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I posted 2 links to case studies on full ACL tears spontaneously healing.
Also met a guy a few months ago who seemed to be operating fine and said he had no ACL anymore.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| Grizzler wrote: |
@@ryancartiers,
I note from your last quoted paper (tbf, the only one which I seriously skim read) that all the interventions were on patients with detachment and avulsion ligament injuries. I saw a reference in another post above about this too. Any reason for this as opposed to mid ligament, latitudinal, non-avulsion tears to ruptures? Are there different outcomes & prognoses, and why? |
The research (see Difelice articles I posted) says that the original research back in the day showed overall success for ACL repair was not good - however they did not look at the type of tears. Reviewing the stats again shows certain types of tears had excellent success, other not - so the type of tear determines one eligibility for ACL repair.
There's other research that repeats this, although I haven't looked at the stats.
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| Markhandford wrote: |
@Grizzler,
I did mention to both of them that I would look forward to reading their report, neither of them included that in their reports though, and just noted either a subtle pivot shift - that on test I was not aware of - or that there was no pivot shift problem.
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My physio said there's something called an Arthrometer to test ligament laxity - I plan on finding someone who has one to test me in a bit - maybe something that could help you assess also
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You know it makes sense.
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| Grizzler wrote: |
@Markhandford,
Having both ACLs out at the same time,
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wow, dude how did you injure yourself - only ACL's or other sprains?
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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I posted more info on #internalbrace primary repair #surgical technique @ryancartiers today, here's the link:
https://www.arthrex.com/what-surgeons-are-talking-about/131FD01B-7B44-491D-B5F7-015A9474A65E
Lot's of info, looks like they've added a bit since May.
Prof. Mackay's website has also been updated.
I'm 6 months post op on Christmas day.
(and I plan to do my rehab exercises that day like every other)
Still working on trying to post a photo here...
[img]https://www.facebook.com/RyanCartiers/photos/pcb.2209118539416014/2209118099416058/?type=3&theater[/img]
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Poster: A snowHead
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| @ryancartiers wrote: |
| Grizzler wrote: |
@Markhandford,
Having both ACLs out at the same time,
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wow, dude how did you injure yourself - only ACL's or other sprains? |
If that's addressed to me, it's a Dudette  but, hey, no matter.
Took out both ACLs as complete mid ruptures, I'm told, plus both MCLs as bad but not complete tears. Lots of swelling, haemarthrosis, etc. Feels to me that there was lateral involvement and bone bruising too, also possible mild meniscus/cartilage, particularly on 1 knee, but nothing else ever formally diagnosed.
Got hit at speed from diagonal rear and landed an apparent aerial 720 on my splayed legs and chest  Don't do things the easy way, me...
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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In case it helps anyone, I came across an article explaining what a grade 3 sprain is. May help someone else trying to decipher this - helped me reread my MRI (in Oct 6 & 7 posts) & understand it:
"About ½ of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.
Injured ligaments are considered “sprains” and are graded on a severity scale.
Grade 1 Sprains
The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains
Stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains
This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split in 2 pieces, and the knee joint is unstable.
Partial tears of the ACL are rare;
More ACL injuries are complete or near complete tears."
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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?
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Anyone looked into Dr. Stone work in San Fran? He uses piggies for parts.
I have a complete messed up knee & was shown his work about a decade ago when I was diagnosed with a meniscus bucket tear to go along with all the other knee issues I have!
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Here is recent article about it (albeit from the same group of authors representing the company that makes the suture tape): https://www.ncbi.nlm.nih.gov/pubmed/30612165
At mean 3.2 year follow-up, the failure rate for primary repair without internal brace was 13.8% versus 7.4% with internal brace in an overall sample of 56 patients with proximal tears and good tissue quality. The failure rate still seems pretty high to me, and the mean follow-up for internal brace was only 2.4 years, so that hardly qualifies as long-term. But, while the sample size is small, a 7.4% failure rate would be comparable or better than reconstruction. But the 5-year follow-up data will be a lot more meaningful than what we have so far.
Here's a scarier article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083779/
It was written by a bunch of research assistants, rather than an orthopedic surgeon. The reported failure rate for internal brace within 2 years was 52.6%. However, this was defined as revision surgery or internal brace failure, and I am not sure that internal brace failure necessarily indicates failure of the ACL repair because the internal brace is intended as a secondary support during healing of the native ACL, not as a permanent aid to the native ACL. They do not differentiate between the need for revision surgery and internal brace failure (which may not require revision surgery). They also say that laxity is greater for repair with internal brace versus a quadriceps reconstruction, but the mean laxity for repair with internal brace was only 2.5mm, which is lower than most given clinical thresholds for laxity (3mm or 5mm). My healthy knee is more lax than my repaired knee, so laxity itself is not meaningful if it's sub-clinical level. The study was also conducted on an adolescent cohort (mean age 14.1 years), and it does not discuss patient selection (which is absolutely critical in studying ACL repair). We do not know if the participants had midsubstance tears, secondary injuries, or other contraindicated factors that would rule them out as viable candidates for ACL repair with internal brace. The results in this study are certainly anxiety-provoking for someone like myself who is 5 months out from having this surgery, but they are not conclusive. It looks like a bunch of new findings are starting to come out about this procedure, but it will be another couple of years before longer-term data are released.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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A paper published on october 2018 also by prof mackay shows good results after 2 years follow up.
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Hi everyone! I am a new member of the ruptured ACL club  Happened in Sestriere in January.... (on the last day so I can't really complain!) I have also stumbled across the various articles on the Internal Brace system and would be open to this option for surgery if my tear and other knee injuries put me in to the group of 20% who display the correct characteristics (proximal tear, good quality tissue etc). I had a knee arthroscopy on the NHS last week and have left a few messages asking if I can see the results, but have heard nothing back from them. Am I overstepping the line asking for this info or is it mine to have anyway??
I have spoken to Mackay clinic but like a few of you have mentioned, they want me to arrange a consultation (and no doubt hand over some money) before telling me if I am a suitable candidate. I do understand this but I am of the feeling I would rather know where the tear in my ACL is before taking the 20 hr round trip to Glasgow! I'm no medic but surely there is no point in the consultation if I am in the 80% of people who aren't 'suitable' candidates and where the standard ACL reconstruction is the better option (which I am already on the NHS waiting list for). Do you think this is a reasonable request? Has anyone else been able to get arthroscopy results from the NHS? Sorry if this is off topic....
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The answer may lie in the reason you had an arthroscopy.
An arthroscopy isn't usually required to diagnose an ACL rupture.
What was the stated objective of the arthroscopy?
Jonathan Bell
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Thanks Jonathan, funnily enough I met a patient of yours at an event at the weekend and she couldn't talk highly enough of you - she was a very happy customer!
I was told I needed the arthroscopy because I couldn't straighten my leg and they thought I may have some loose cartilage wedged under the knee cap. They said the arthroscopy would also enable them to assess the extent of the damage (MRI had already diagnosed a ruptured ACL, MCL and torn meniscus though)....after the procedure, the consultant just said that they were able to remove some 'nasty stuff' and that the damage to the meniscus would mean that I did need the ACL reconstruction.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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I am 7.5 months post-op now, with ACL primary repair plus internal brace. I plan to ski again next winter, sticking to easier slopes at least initially. My knee is stable, and everything feels normal (apart from that last bit of strengthening).
The advice provided by Jonathon Bell is very helpful and informative (albeit scary for me...). I had a high grade partial tear where (judging by the arthroscopy photos from my surgery) my ACL was about half still attached, with a bundle pretty cleanly torn from the proximal end with the tissue in good shape 3 months post injury. Though I had agreed to a repair if it were possible, I didn't realize until after my surgery that the internal brace would be used and was non-absorbable.
I share Dr. Bell's conclusion that polyethylene cannot survive the forces to which the ACL is subjected, but I am hopeful that the internal brace really only serves the secondary role for which it is intended and does not absorb all of that force. It is 2mm wide, not 6mm like the Kennedy Ligament, which leaves less material in the knee joint if it ruptures, but still a lot more than I would like... I am happy to have the opportunity to preserve my ACL tissue, especially given the difficulties resulting from reconstruction (despite the low re-rupture rate of reconstruction). The old ACL repairs from the 70s, 80s and 90s created stability over the long term for ~40% of patients (here is an example, https://link.springer.com/article/10.1007/s00402-004-0766-2). That is an unacceptable outcome, but it does appear that repair can work for a subset of patients. If I had it to do over, I would still have the repair, but without the internal brace. Anyway, just some thoughts for those who may be thinking about this option.
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| Gigiski wrote: |
Thanks Jonathan, funnily enough I met a patient of yours at an event at the weekend and she couldn't talk highly enough of you - she was a very happy customer!
I was told I needed the arthroscopy because I couldn't straighten my leg and they thought I may have some loose cartilage wedged under the knee cap. They said the arthroscopy would also enable them to assess the extent of the damage (MRI had already diagnosed a ruptured ACL, MCL and torn meniscus though)....after the procedure, the consultant just said that they were able to remove some 'nasty stuff' and that the damage to the meniscus would mean that I did need the ACL reconstruction. |
Pleased to hear of a happy customer!!
If the knee didn't go straight after an ACL rupture a number of things could have been blocking it: a minor MCL which gets too tight, a displaced meniscus but also the ACL stump blocking the movement.
The latter is the most common. I think you will need to ask your consultant if the cruciate tear was in a suitable position for repair and if he/she removed any of the ACL stump to help get the knee straight.
If they did have to remove ACL tissue it almost certainly not a reparable tear.
Jonatha Bell
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Oh wow ok, he certainly didn't go into anything like this amount of detail so I have no idea what was preventing me straightening it. Whatever they did worked as I can now straighten the leg but I think I need to find out a bit more. Thanks again for your advice.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| Tiredoldskibum wrote: |
My son, who is 20, had ACL and ALL repair last Tuesday (6 days ago) using the internal brace technique.
Early days but he can currently extend the knee fully and bend it more than 90 degrees. He is using crutches but can put some weight on it without pain. Since yesterday he has not needed to take any painkillers.
Hospital physio told him that because he doesn't need to protect his hamstrings (since no graft required) his rehab should be easier. He starts rehab physio this week.
Surgeon was Prof. Adrian Wilson of Hampshire Knee. He will only use this technique where he deems it appropriate. The plan, in my sons case, was to use hamstring grafts, but having got into the knee, he decided that he was a perfect candidate for IB repair (this was previously explained and discussed).
I will update with his progress if there's interest here. |
3 year update for anyone interested.
My son, now 23, had internal brace repair for ACL & ALL as detailed above. 3 years on (just over) all is well. Skiing better than ever and learning to snowboard. He did have a couple of minor issues with the ALL (possibly overtight) but that seems to have resolved itself with no further intervention.
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I've had InternalBrace and am coming up on 2 years since. It has been around for a decade and out of the 3 options to regrow an ACL it doesn't have hard ware to remove after like Ligamys, not require a 6 week cast like BEAR. However BEAR is in trials so if you can get it paid for it may be worth the 6 week cast. If you do your homework you'll find the medical journal publications on InternalBrace. I've also posted everything I found prior to making a decision to avoid unnecessary ACL ligament/organ removal on my insta, fcbk and website, as I'm skeptical and did my homework. I strongly suggest you do yours as well. There have been several publications in the last 2 years on InternalBrace, progression in ALL, and any orthopedic surgeon or sports med doc up to speed with current practices will have seen this at one of several conferences on orthopedic technology over the last 2 years. It is practiced in Europe, the USA and South America.
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You know it makes sense.
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Update: a lot of people have been asking when I plan to ski again. I skied at the beginning of March for 3 days.
Prior to that I also went back and did testing as part of PhD research on InternalBrace, not sure when you'll see that report will be after the summer for sure.
And last year in August had a follow up MRI to see how the ACL regrowth was remodeling. If you do this and the radiologist is not familiar with what an ACL repair looks like during remodeling, he will present a different picture to one that is exposed to current orthopedic practices. I've posted it online if you want to see.
The real test was in the clinic (and on the hill).
I have a few things I want to further strengthen, stretch & push ROM in, however results are very good so far, and would not have been achievable with ACL reconstruction.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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No idea about the internal brace but after having both ACL’s reconstructed in my 40’s first with hamstring graft in (2016) and the second with patellar tendon graft in (2018) both knees feel stronger than ever and skiing not impacted at all. The 6 month rehab was tiresome though. If you can get the same result without that would be interesting...
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Poster: A snowHead
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@Jonathan Bell,
Hey Dr. Bell! Appreciate you responding to all of our concerns. I will keep it short and to the point.
Partially tore acl 8 years ago, decided not do surgery as I was able to go back to sports after a few months. Manged to stay out of trouble for 8 years until last month ( March 2021). Was playing sand volleyball, heard loud pop, to the ground! MRI confirmed ACL (full) Tear.
Ortho pointed out that the tear happened close to the femur so I am a good candidate for the internal brace procedure. I started to read about this procedure and this is how I ended up here
Curiously, lots lots lots of pro IB surgery (Arthryx, McKay, DiFelice, etc) Sounds like it may work given the right conditions. On the other hand, only a handful of Drs actually challenge the effectiveness of IB.
* Has your opinion on IB change since 2017? Is this a procedure recommended for pivot/rotation sports like skiing?
* Even if I am a good candidate for it (32yo, tear close to bone,active/good shape), shouldn't the surgeon assess the ligament tear via arthroscopy before he/she makes final decision?
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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sorry to intervene..
"shouldn't the surgeon assess the ligament tear via arthroscopy before he/she makes final decision"? they assess the MRI and if it looks good for repair than they book the procedure, and the final decision is made during the procedure. very few surgeons have a micro camera niddle that could be used in their office before booking the procedure.
please note that the repair should be done very quickly, my surgeon said that the most ideal time is 2-4 weeks after the injury (the earlier the better).
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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?
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@elpepe8989, Welcome to the forum -- Just be aware, Jonathan is not always present on the forum and may not see your post... ::
Please do not be too disappointed if he does not reply...
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You need to Login to know who's really who.
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| aaaa1234 wrote: |
sorry to intervene..
"shouldn't the surgeon assess the ligament tear via arthroscopy before he/she makes final decision"? they assess the MRI and if it looks good for repair than they book the procedure, and the final decision is made during the procedure. very few surgeons have a micro camera niddle that could be used in their office before booking the procedure.
please note that the repair should be done very quickly, my surgeon said that the most ideal time is 2-4 weeks after the injury (the earlier the better). |
No worries, appreciate your comment! I agree with you that the final decision should be made during the procedure. One of the papers (McKay perhaps?) mentioned that the final decision was made during the surgery after further inspections of the remaining ligament.
I posed the same question to my surgeon and waiting on a response now. Right now, the primary plan is to do patella graft but could decide for IB up to 2 days before the surgery.
My general take on IB is that Arthrex is funding a lot of the research and promoting the use of their product. My surgeon did say this was a "controversial" topic and that there is not a consensus yet, mainly cause you dont see a lot of close-to-bone tears so hard to find statiscally significant results.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| albob wrote: |
@elpepe8989, Welcome to the forum -- Just be aware, Jonathan is not always present on the forum and may not see your post... ::
Please do not be too disappointed if he does not reply... |
Thanks @albob! appreciate the welcoming comments. Will wait patiently, started to follow him on Twitter too lol!
Speaking of twitter, lots of surgeons promoting IB, gives me a salesmen-vibe... very rare to find surgeons opposed to IB, would like to hear what the opposing arguments are.
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You'll need to Register first of course.
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@elpepe8989
Apologies such a snow free year means I have not been checking out Chamonix conditions as faithfully as I usually do.
The literature is starting to tell us a lot mire about repair of ACL.
There is agreement that only a very small number are suitable. ( roughly 10%) You are correct that the tear has to be right off the femur with minimal damage to the ligament otherwise.
I have now out of a mainly adult practice found a handful (15) that I believe were suitable. They must accept a that final decision is made once the ligament is viewed. Nearly all the ones I have done have been kids( 10 to 15). Over 3 years even with being very picky 2 have failed but that is not especially high given they are nearly all kids / young as failure rate for reco is at least 20% in this age group. My view is that approx 80%!have their own ligament which is holding up. One of my failures had had a significant MCL injury aswell which may have increased risk of failure.
I would not offer repair if some had a ligament scarred form previous injury as I just believe there is isn’t enough healing capacity in an already scarred ligament .
There are some quite scary published complication rates for some repair techniques with high rates of repeat surgery and or stiffness (stiffness for me means osteoarthritis will develope)
I think I can now identify which knees will be suitable from the examination and description of the injury mechanism. I believe that hyperextension injuries will be much
More likely appropriate than other mechanisms of injury.
Hope that helps a bit
Jonathan Bell
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| elpepe8989 wrote: |
@Jonathan Bell,
Curiously, lots lots lots of pro IB surgery (Arthryx, McKay, DiFelice, etc) Sounds like it may work given the right conditions. On the other hand, only a handful of Drs actually challenge the effectiveness of IB.
Is this a procedure recommended for pivot/rotation sports like skiing?
* shouldn't the surgeon assess the ligament tear via arthroscopy before he/she makes final decision? |
- Great to hear more orthopedic surgeons are updating their skills and offering current othopedic techniques.
- Procedure is not sport dependent, it is dependent on the ligament tear location, tissue condition - characteristics of the tear. Think about it from another perspective: a cast to heal a broken arm is not recommended dependent on the sport you were engaged in - it's whether the procedure meets the needs of the injury regardless.
- The surgeon will base their recommendation on the MRI and will tell you during the consult it is not until they are inside that they can confirm that the condition, and they may opt for something else depending on what they find at that point - which means they do assess via arthroscopy before they make the final decision during the surgery.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| aaaa1234 wrote: |
sorry to intervene..
"shouldn't the surgeon assess the ligament tear via arthroscopy before he/she makes final decision"? they assess the MRI and if it looks good for repair than they book the procedure, and the final decision is made during the procedure. very few surgeons have a micro camera niddle that could be used in their office before booking the procedure.
please note that the repair should be done very quickly, my surgeon said that the most ideal time is 2-4 weeks after the injury (the earlier the better). |
- agreed, and even with the arthroscopy option prior to booking the procedure it may be overkill to do this twice
- ideal time is as early as possible due to tissue attenuation (think of it dissolving over time in the synovial fluid). 90 days (12 weeks) is the maximum amount of time, however the longer you wait, the more ROM and muscle atrophy that occurs, increasing your recovery time.
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| elpepe8989 wrote: |
My surgeon did say this was a "controversial" topic and that there is not a consensus yet, mainly cause you dont see a lot of close-to-bone tears so hard to find statiscally significant results. |
There's actually a decade of results you can find online, as the first InternalBrace procedure was done around 2011. Also, Ligamys has a long tenure, results available online as well, however the tool if often requested to be removed and therefore slightly disadvantageous compared to IB. I highly recommend you do your own research, there is a lot available. You can also look at where InternalBrace is being used for ankle, shoulder and hand surgeries to get a better idea how ligaments have been regrown over the last decade.
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FAQ
Anatomical difference may be. I guess I don't care as long as they keep on holding together and don't hurt or ache too much.
