Athroscopic Knee Surgery Complications.

[pluto_manibo]

I had Knee acl recconstruction and meniscus trimming after a sports injury one year ago, in a reputable Bangkok hospital. I now have one year later, an ACL graft impingement. This is where, the graft catches on the newly drilled tunnel and prevents a smooth flexion/movement. On top of this I have new meniscal tears(the issue was adressed during stated surgey but there are new ones). Has anyone dealt with ACL complications? Can anyone recommend a doctor for a second opinion in the Pattaya/Bangkok area(Please do keep in mind that I am coming from the suggested Doctors in previous related topics, in Bangkok area). Thank you for sharing your experiences.

[Sheryl]

I know this is not what you want to hear, but you really would be best served by returning to the doc who did the original surgery.

If you are determined to go elsewhere and in the Pattaya area, could try this doctor at BPH:

http://www.bangkokpattayahospital.com/doctors/view_profile.aspx?v_id=174&depid=22

Be warned though that BPH tends to be more expensive than top end Bkk hosps. This same doc is also at Bumrungrad so if you decide to have surgery with him aftyer consulting hiom at BPH you should investigate whether it woudl cost less to have him do it at Bumrungrad.

You could also try your luck at Queen Sirikit Sattahip or Phyathai Sri Racha. have no idea whether either of these has a doctor of appropriate expertise as neither has a website showing doctor qualifications. However military hospitals usually do have some good ortho docs as one would expect.

ACL reconstruction is a very difficult procedure and you really need someone with extensive expertise in exactly that, which will usually be a specialist in sport's medicine.

The complications you have experienced do occur in 5-10% of all ACL reconstructions, and while this rate may be a little lower among the best surgeons it does sometimes occur to all of them. You will probably require an ACL revision procedure.

Again, the surgeon who did the procedure is best placed to determine how to go about the revision.

[pinfold]

Had the tear,had the op,smooth as silk....but not in Thailand,went to India,a fraction of here Going in two weeks time again,bowel cancer,prostate scans,plus eye surgery .

All the surgeons I used are NHS trained,sorry no help to your specific Q

[jrtmedic]

As Sheryl as indicated ACL repair is associated with a 5-10% "failure" rate.

Research suggests that surgeons who undertake ACL reconstructions on an infrequent basis are more likely to experience complications.

In your own case the original ACL injury was compounded by meniscal damage. Such an association is also related to an increased risk of "failure"

You are now aware that you have further problems.

So what advise can I give ?

In my opinion you need to seek out a surgeon who undertakes , routinely, a high volume of ACL repairs and who is also experienced in ACL revision surgery. As your problem is complicated by further meniscal damage it is , in my opinion, vital that you ask the "right" questions of your chosen surgeon.

You may find that you will need to seek advise outside Thailand in somewhere like Singapore, Hong Kong, the USA or the UK,

Whilst it is entirely possible for your knee to be returned to good health your days of indulging in vigorous sports may be over !

Best wishes

[pluto_manibo]

@jrtmedic-Thanks for the input. Surgery was done by a Sports medicine Orthopaedic specialist in arthroscopic knee and shoulder injury. I am aware that my trampoline career and long jumping days are over! Just wondering how succesful these ACL inpingement revision surgeries are? Going through surgery and rehab again, is a blow, in more ways then one.

[jrtmedic]

As Sheryl has already implied primary ACL reconstruction is complex.

Revision surgery for a "failed" procedure is even more complex and in my opinion should only be undertaken by a surgeon with significant experience of the challenges a revision procedure presents.

The decision to proceed with a revision procedure should be based on

1. Your level of disability ( ie your knee might not be 100% but can you manage to "live" with it ?)

2. Comprehensive clinical and radiological (including MRI studies) evaluation of your knee by someone experienced in revision surgery.

3. An open and honest discussion with the surgeon as to the likely outcome of further surgery based on his/her experience (Remember there can and should not be any guarantees of a 100% successful outcome)

4. Before committing to any treatment a second opinion should be sought ! ( The x-rays and MRI scans if of adequate quality need not be repeated but it may be advisable to secure a second Radiologists interpretation of the films)

http://www.healio.com/orthopedics/journals/ortho/%7Bed721369-edd4-4b10-a665-c0a8906eef52%7D/vertical-grafts-a-common-reason-for-functional-failure-after-acl-reconstruction

Whilst highly technical and full of jargon this article may give you some insight into the complexities of your problem.

[pluto_manibo]

@jrtmedic-Very sound advice. I have covered all the points you mentioned already. I have also read a lot of litterature on the matter as well and the outlook is not so good. The MRI's from last week, show slight graft impingement and meniscal tears. Can I live with it? If it doesn't get any worse, yes. Was I told of these issues before surgery and promised a less then favourable outcome?No.

[jrtmedic]

pluto_manibo

Don't despair !

Whilst statistically revision surgery has poorer outcomes than primary ACL reconstructions undertaken by experienced surgeons, it is entirely possible for a "failed" procedure to be rescued !

Be aware that In some parts of the world it is possible for someone to label themselves as a "sports injury specialist" or indeed any type of specialist but lack training and expertise.

Ideally you should be seeking an American Board Certified surgeon (or a person with equivalent Western European, UK or Australian/New Zealand qualifications) Claims of an "Associate or Affiliate" membership of one of these "boards" indicates that the individual has not met the full training requirements for a "Fellowship" indicated by an FACS (America), FRCS (UK) , FRACS (Australia/New Zealand), EBOT (Western Europe) Those who specialise in orthopaedics will often have a (Orth) appended to their primary surgical qualification.

As you have already researched your problem I won't bore you with yet more links to academic papers. However, the papers you have read will provide a big hint as to where you might go to seek advise.

Any Western trained surgeon should be willing to discuss the likely outcome of revision surgery and even be willing to refer you onwards if they believe a colleagues skill and expertise is more appropriate to your case.

I do speak from experience ! I recently underwent major orthopaedic surgery in Australia --- the first surgeon I spoke to referred me to one of his colleagues who possessed a skill set (combined with impressive outcome stats ) which were ideally suited to my needs.

I do indeed wish you well for the future

[Sheryl]

The surgeon he is seeing is US Board certified and has all the qualifications you mention. That is not the problem. And is also highly experienced in ACL repair.

I think he was simply in that unlucky 5-10%. It happens.

[jrtmedic]

Interesting !

Medical School:
- M.D., Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand, 1994
Board Certifications:
- Diploma of The Thai Board of Orthopaedic Surgery, 1999
Fellowships:
- AO, BG Unfallklinik, Technical University Munich, Germany, 2002
- Orthopaedic Shoulder Surgery, Harvard Medical School, Massachusetts General Hospital, USA, 2003
- Sports Medicine & Shoulder Surgery, Harvard Shoulder Service, Massachusetts General Hospital, Harvard University, USA, 2004
Special Clinical Trainings:
- Sports Medicine, Knee and Shoulder Surgery, Techniche Universtat of Munchen, Germany, 2002
Special Clinical Interests:
- Arthroscopic Surgery
- Shoulder Pain, Shoulder Instability, Shoulder Stiffness
- Sport Injuries (Ligament, Cartilage, Meniscus Injuries)

Nothing claimed about having a FACS or equivalent ! The only board certification claimed is the Thai Diploma ! A Western Surgical Fellowship is not gained in a year or less !

I have of course not identified the surgeon but I am aware of who he is

[pinfold]

Feel sorry for this guy,probably do not want to hear from me again about where I get my ops done ,but their motto is " If bone we perform miracles" KLES Hospital kanatra state,just over the border from Goa ,brilliant hopspital,about 30 orthopedic surgeons attached to it., all on the go

Worth a try with your problem Skype them ,once past switchboard their English picks up considerably,ask one of the surgeons specialising in your field

[smokie36]

Interesting !

Medical School:

- M.D., Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand, 1994

Board Certifications:

- Diploma of The Thai Board of Orthopaedic Surgery, 1999

Fellowships:

- AO, BG Unfallklinik, Technical University Munich, Germany, 2002

- Orthopaedic Shoulder Surgery, Harvard Medical School, Massachusetts General Hospital, USA, 2003

- Sports Medicine & Shoulder Surgery, Harvard Shoulder Service, Massachusetts General Hospital, Harvard University, USA, 2004

Special Clinical Trainings:

- Sports Medicine, Knee and Shoulder Surgery, Techniche Universtat of Munchen, Germany, 2002

Special Clinical Interests:

- Arthroscopic Surgery

- Shoulder Pain, Shoulder Instability, Shoulder Stiffness

- Sport Injuries (Ligament, Cartilage, Meniscus Injuries)

Nothing claimed about having a FACS or equivalent ! The only board certification claimed is the Thai Diploma ! A Western Surgical Fellowship is not gained in a year or less !

I have of course not identified the surgeon but I am aware of who he is

From what I see here I would say he's more of a shoulder surgeon.

If I needed an ACL reconstruction I would use a surgeon who does only that operation. No idea if such exists in Thailand however.

[pluto_manibo]

Thank you for all the responses! To clarify things, after having done some research, I need a notchplasty (widening of the opening of the graft tunnel) as well as some meniscal tears attended to again(trimmed). From the vast amount of information out there, I gather this is not so complicated and not a full ACL Revision. No guarantees are given, and the main idea seems to be to leave it alone if it is not too troublesome. This is what I gathered, however I could be completely mistaken.

[jrtmedic]

pluto_manibo

I am retired now so may be well out of date ! ----

However from memory a "notchplasty" is a procedure undertaken at the time of reconstruction if the surgeon considers the femoral intra-condylar notch too narrow to accommodate the ACL graft without the risk of impingement.

I have never heard of the procedure being undertaken in isolation either with an intact ACL or a grafted ACL repair.

​I guess you have undertaken some extensive research and or received clinical advise which you are pleased with.

If you have any references I would be pleased if you would pass them on and hopefully I can update myself !

As before I wish you well and hope that your knee problem can soon be remedied.