Looking for input on Total Knee Replacement over ACL/Meniscus repair

[pleasantmeadowfarm]

Good morning! 20 year old skiing accident left me with a severed ACL. I’ve done just fine over the years without, but getting run over by a horse on Oct. 1, 2016 left me with meniscus tears on top of not having an ACL. Surgery on 12/6/16 repaired the meniscus and opted to leave the non-existent ACL alone for quicker recovery. So, 8 weeks post surgery, walking out of the high school gym I heard a snap and was in excruciating pain for weeks. Surgeon assured me it was probably the tibia remodeling, so he gave me a cortisone shot and I kept on working (I run a small boarding operation). It takes me about 8 hours to do 2 hours worth of work… Do a stall, sit down, do another… so forth, and so on.

I finally went to another ortho for a second opinion as I’m still in pain and the knee gives out on me a dozen times a day. Low and behold, a re-torn meniscus and now full thickness cartilage loss (they used the word macerated on the report) as well as a femur in sufficiency fracture. So, three months post surgery and my arthritis and degeneration of the knee has progressed rapidly. I’m a 45 year old, active farm owner and NEED to be fully functional.

Two surgeons now have suggested an ACL/meniscus repair. Neither can give me a promise I won’t still have bone on bone pain, and both are suggesting this surgery should buy me another 2-5 years.

I’m having a hard time, not pushing for a full knee replacement as neither surgeon will argue the fact that I have a crunchy old lady knee. Why would I go through an ACL recovery to buy me two years before another MAJOR surgery???

Help. What would you do???

[beaujolais]

Oooh, I am so sorry!

​​​​Can you or do you want to consult with another doctor to get yet another opinion? Sometimes a doctor explains things in a certain way or brings up a certain point and it really helps with the decision.

When you ask them this (Why would I go through an ACL recovery to buy me two years before another MAJOR surgery??? ) what is their response? Maybe they are thinking it could be more towards the 5 years and you would be relatively comfortable? Biding time in case more technological advances come out? I supposed they are suggesting the more conservative route. Are they o.k. with doing a total knee on you at this time or not so much?

Well wishes & soft hugs.

[MoonoverMississippi]

I have had major knee surgery; acl repair, meniscus repair, and medial (?) ligament reconstruction, and they actually switched bone segments to shorten/lengthen inside and outside knee ligaments (sorry, don’t remember all the names atm) about 10 years ago, and have been bone on bone for about 2 (healed improperly and kneecap isn’t tracking correctly). It does get more comfortable (or you get used to it) as time passes. And DD is on her second ACL graft and meniscus repair (1st donor graft failed, which led to more meniscus damage), so I’m familiar with the current recovery/rehab protocols.
I do know my ortho is VERY hesitant to perform a replacement on anyone under 50 without extreme extenuating circumstances. That said, I have an office job, so am not considered “unable to function normally without pain”, whereas you are having significant loss of function and it’s affecting everyday life.
I always swore after that recovery they could just chop the leg off before I repeated that again. It is a long recovery period when the meniscus is involved (they heal slowly/badly), and gave me knee arthritis at 27.

However, my BIL had total knee replacement a year ago, and while the immediate recovery was INTENSELY painful, his recovery was much shorter than mine or my daughter’s, and he was mobile faster than either of us, with dramatic reduction in pain/stiffness/discomfort compared to either of us (and not to brag, but my DD is wayyyyyy tougher than him when it comes to dealing with pain, so I truly believe his recovery after the first week was much easier).
After seeing the dramatic difference in my sample of one and the huge increase in his quality of life, I would press the doctor for the replacement, or a very good reason he won’t proceed with one when you’re looking at 4-6 months recovery in order to get another 1 1/2 years of declining comfort before then needing another major surgery.
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[EKLay]

Part of it is that joint replacements do have an expiration date of sorts. Because they can’t heal, after a certain amount of wear and tear they do need to be replaced again. Re-replacing an already replaced knee or hip replacement is exponentially more painful than the first replacement surgery, so in general, doctors try to delay replacements as long as possible in the hope that one replacement will see the person through the entire rest of their life.

I would question the doctors very specifically - making sure they honestly understand how much your day to day is impacted, and pinning them down to a more comprehensive answer in terms of recovery time vs. quality of life after surgery. Because to me, 6 months recovery for 2 years of time doesn’t make sense to put myself through. If they are required to say “2-5 years” but in almost all cases it’s 5+ years, that’s a completely different set of circumstances than saying “2-5 years” but most cases it’s barely 2 years.

[copper1]

Had my knee replaced this past October and now back to pretty much normal function. I am 67 so not as big a concern on the longevity of the new knee. glad I got it done but it has been to me, a slow process and they tell you going in that it takes pretty much ayear for all things to return to normal. I agree, depending on your age, why go thru major surgery twice in such a short amount of time.

[McGurk]

I think you need to find a surgeon, and a practice, that understands your lifestyle and needs. Sports medicine specialists, probably - they tend to understand the horseperson’s life style and desire to return to fuctionality immediately. I had my first knee replaced at 51 and had to fight for it - no one wanted to do one on someone that young. But the knee was past bone on bone, I had ground a hole in the head of the tibia it had been bone on bone so long. I had no trouble getting the second one approved at 58 when it was less pronounced wear.

My argument then and now was what’s the point of waiting if I have no quality of life/functionality now? I would rather have a functional knee now, while I’m still riding and active, then preserve the tissue and be a better mall walker at 70.

[Dance2thebeat]

I agree with what others mentioned … find a sports injury orthopedic surgeon that specializes in knees. Bring all your records and all radio-graphs (x-rays). Discuss options. Depending on your insurance coverage they may request your clinical information to determine you meet criteria for a total knee replacement. Criteria can consist of several things, here are a few that are usually looked at… findings of complete knee joint destruction, angular deformity or sever narrowing of the joint (found on radio-graphs) optimal medical management has been tried and failed, failed or not a candidate for an osteotomy. Keep in mind that there are no guarantees with a total knee replacement … there are risks with any procedure.

[pleasantmeadowfarm]

Thank you for your input. I am going to see my third surgeon (sooo very “gun shy” now) this week. So far, all are agreeing that the ACL and new meniscus repair will do the trick for several years. I’ll let the last surgeon (Hospital of Special Surgeries in NYC) be the deciding vote. They are all sports medicine ortho’s, so I know I’m asking those that understand athletes. Not sure if the fact that I’m active and on my feet ALL day handling large animals makes any difference or not… Again, thank you for the input. Crossing fingers. Pain has subsided enough, and help has arrived doing some of the heavier work, that I can now ride again, which I think will help with the strengthening the quad before the next surgery for stabilization.

[Hilary]

Given that a full recovery from just an ACL repair can be nearly a year, I would make sure the additional years you are getting from that surgery is AFTER you have fully recovered. Glad you are getting extra opinions, that was my first thought.