Mar
31
Newbie POST ATR Day5 POST-OP DAY5
March 31, 2011 | |
Thanx for this site. I am 43 y/o/ male neuroanesthesiologist and I ruptured my right AT on Saturday March 26 while playing soccer (with 21 neurosurgeons). Although I had gastroc and soleus injuries 6-8 weeks prior after a tennis match, I never had tendon soreness and my muscle soreness on the right had long resolved.
The actual rupture was unusal as it happened not during a period of acceleration, pushing-off, jumping or twisting, but as I was walking into a good throw-in position when I heard the "pop" and dropped like a rock. It did not hurt much, maybe a 2 or 3 out of 10, but my foot was floppy and even the neurosurgeons present could diagnose my injury.
I called ahead to the ER, where they simply confirmed what I already knew. They had an OR ready for me immediately, but I had eaten and the ortho wanted an MRI. After that waiting I was in the OR by 7PM, less than 9 hours after my injury.
I did not know the on-call ortho doc, who is a trauma orthopedic surgeon. He said he would not be offended if I waited to have a sports guy do my surgery later in the week. But I have seen the mangled bodies that come through the trauma service, and I figured a single, isolated ruptured tendon repair in a healthy male was easy for him.
I was out 1.5 hours later with not much pain and home the next day. I only take vicodin at night. I am being pretty extreme about my leg elevation, spending hours watching movies with my hip flexed at 90 degress. My follow-up appointment is ten days post-op. He said we will decide at that appointment whether he will be more liberal or conservative with mobilization versus casting.
Will update after my 10 day day appt.
I have some good operative pictures, but I am having trouble posting them. Never been part of a blog before and all this stuff about HTML, Visual, Media, Plugins is way over the top of my head.
Comments
6 Comments so far
Well . . . you are off with a fast start to recovery. Good healing. pk
Dr. P., there are a number of recent posts (and one very old one by a ‘chocolata’) that give successful procedures on posting photos. ‘Janet’ and ‘gailbuddy’ are the recent experts, I think.
Interesting decisions coming for you, about “more liberal or conservative with mobilization versus casting”. Most ortho surgeons are still attached to the logical notion that going slower promotes more complete healing and lower re-rupture rates. I haven’t seen a single study that gives a shred of support for that logical notion, and I’ve seen a bunch that seem to disprove it — either in favor of the opposite relationship (that faster is actually safer), or that there’s no strong relationship either way.
For sure, staying immobilized and on crutches longer is a pain in the lifestyle, and also a pain in the rest of the body. Risky, too, since none of us is as safe from falls on crutches as we are on our own two feet.
The new studies that compared surgical and non-op — especially refs 4 & 7 in the Wikipedia article on ATR, bit.ly/Wiki-ATR — went very fast and got very good results (with and w/o surgery). With boots, not casts, facilitating early exercise and PT.
Ref 7 was done near here (in London, ON, Canada), and may be why the two Ontario medical students I’ve heard of who tore their ATs recently, both skipped the surgery (and happily so, last i heard). But there are still enormous variations in treatment between regions, countries, and individual hospitals and surgeons.
There’s always been a bias toward quick surgery (like yours). Me, I wish the authors of those studies would analyze their data to see if very quick immobilization also improves outcomes for non-op patients. I’ve suggested it to one of the co-authors of Ref 7, but I’m just a patient, and haven’t even heard back. The fancy sports-med surgeon who talked me out of surgery for my 2001 ATR (my second), told me he always preferred repairing ATs that had “ripened” for around 2 weeks. He said the torn ends were neater by then. But by the time I’d come along, he’d stopped doing ATR surgery, so it became academic. And his preference is unusual.
Good Luck, and Good Healing, and keep posting!
I have two posts waiting for moderation. Please delete one of them since they’re identical. I thought I could beat the system by being logged in but no such luck.
Trying to upload some pics.
http://achillesblog.com/pboltonmd/files/2011/03/imag00471.jpg
pboltonmd - I’ve added your picture to your post. The image upload feature is still a bit buggy so you basically have to add the html code manually in the html mode of the post editor. If you have other images that you want to add to your posts, just mention that you uploaded the image and say where the image is, as you have done. I can then add it for you if you like. happy healing!
Well, best of luck with your recovery. I ruptured my LAT on Feb 21 and didn’t have surgery until Mar 9. It’s gone flawless and I’m going to be officially 100% WB this upcoming Wednesday. I’ve been doing PT twice a week for three weeks now and have been walking in my boot full WB for the past 24 hours. PT guy had me walk across the room yesterday when he saw how I was walking with one crutch. Last wedge comes out Wed too. Then, two weeks of FWB in boot, then into shoes.