Advice on probable ACL injury

[Monomial]

I need advice.

I am a 45 year old American male who had a full reconstruction of the ACL on my left knee when I blew it out playing football at 18. A few days ago, I stepped off a 70 cm wall and my left knee buckled when I hit the ground. The pain was extreme, and after 5 days the swelling has not gone away, I can not put any kind of a side load on the knee and I can not get extension beyond about 20 degrees. I am currently walking with a crutch.

Unfortunately, since this was a disclosed pre-existing condition, I also have no insurance coverage on it. This makes me extremely cost sensitive, and as an American I don't even have the option of returning home and getting it done there. Family obligations wouldn't let me do that in any case.

I have not yet seen a doctor, mostly due to cost. My gut tells me the ACL is completely ruptured again. Even though it was 25 years ago, I still remember how it felt. I have scheduled an MRI with Prachachuen MRI Center next Friday. This more than 10 days since the injury, and the swelling should have gone down enough by that time to get a reasonable image. I saw no point in paying a doctor just to tell me I had to pay more for an MRI through the hospital to confirm a diagnosis. I might as well combine the initial visit and the analysis and only be charged once.

My question is, who should I see once I have the MRI in hand? Remember, I need to keep costs on this very low. I live in Rangsit, so going all the way downtown to Bangkok is going to be a serious challenge. I could probably do it for surgery, but followups and physiotherapy down there would be unrealistic.

Locally, there are really only 3 choices I can think of. For private hospitals, there is Pat Rangsit and the newly opened Paolo at Future Park. There is really only 1 government hospital of any quality in the area, and that is at Thammasat University. Does anyone know any good orthopedic surgeons that work in these hospitals? Alternatively, is there somewhere else I should consider?

Does anyone have any other advice about orthopedic surgeons?

Another question:

Assuming the ACL is completely torn, does it make sense for a 45 year old, overweight male to attempt a reconstruction? I really do need to stay somewhat mobile so I can chase after my 5 year old children. There has been more than once I've needed to go sprinting through the store to stop my daughter from doing something. My inclination is to do the surgery unless there is a very compelling reason not to.

On a more technical note, since I have already had a pateller tendon graft, I don't think that option is available to me again. In another country an allograft would be the likely choice, but is that a possibility in Thailand, or am I looking at using the hamstring?

Any advice is appreciated.

[Sheryl]

Offhand I am not familiar with orthos at any of those hospitals and as my ToT connection is down I am not really able to search their websites. Note that in the case of a govt hospital, unless they have a private channel you cannot chose your own doctor and most of the care (including the surgery) will be done by interns and residents in training. Not something I would want to risk with a problem of this type.

If I were you I would take the scan to Dr. Panya at Bumrungrad first for consultation and advice as he is pretty much the best knee specialist around. Consultation will be under 2000 baht. Address your various questions above to him.

If it turns put surgery is advised, and once you have his opinion as to type of surgery etc, you could tell him frankly that you cannot afford it at Bumrungrad and ask if he can recommend someone at Chulalingkhorn Hosp whom he would recommend for the specific approach advised. Chula is a govt hospital but has a private channel, also some of the professors there also have privileges at St Louis and Bangkok Christian, nonprofit hospitals that are much less expensive than Bumrungrad (but still much more than govt hosp).

They don't do much by way of PT here, not like in the west and anyhow could always get the PT (such as it will be) at a different and closer hospital than the surgery.

[macleans]

Thammasat university hospital has a not-so-good website and everything's in Thai. There's list of ortho doctors and the outpatient schedules. However, there's no info regarding doctors' qualifications.

So, I did a bit of google search for you using the names on that list. It turns out that there are 2 doctors who are knee specialists and 1 doctor who maybe less so (there are maybe more knee specialists but the following are the only names I got as far as google search is concerned):

1. Assoc. Prof. Dr. Nattapol Tammachote

profile: http://zeekdoc.com/en/doctor/assoc-prof-dr-nattapol-tammachote-276

schedule: http://www.hospital.tu.ac.th/SearchDoctor/Detail_Doctor.php?data_search=1&docID=ORTHO019&Page=1&select_major=3&txtName=&txtSurName=

2. Dr. Boonchana Pongcharoen

profile: https://www.bumrungrad.com/doctors/Boonchana-Pongcharoen

schedule: http://www.hospital.tu.ac.th/SearchDoctor/Detail_Doctor.php?data_search=1&docID=ORTHO013&Page=1&select_major=3&txtName=&txtSurName=

3. Dr. Prakasit Sanguanjit (more of a shoulder expert but he appears in the local press talking about torn knee ligaments)

profile: https://www.samitivejhospitals.com/en/doctors/prakasit-sanguanjit/

schedule: http://www.hospital.tu.ac.th/SearchDoctor/Detail_Doctor.php?data_search=1&docID=ORTHO017&Page=2&select_major=3&txtName=&txtSurName=

My guess is that all of them have after-hours schedules as indicated by the word "VIP" located after some of their hours.

These are the room rates:

http://www.hospital.tu.ac.th/pt_room.html

This is the after-hours channel:

http://www.hospital.tu.ac.th/flow-overtime.html

I assume your wife is Thai. So, she maybe able to help you navigate through all these.

good luck