MRI

MRI following primary repair of the anterior cruciate ligament

Primary repair of the anterior cruciate ligament (ACL) is being performed increasingly in the treatment of acute proximal ACL ruptures. Advantages of ACL repair over surgical reconstruction with a tendon graft include preservation of the anatomy and proprioceptive function of the native ACL, and therefore, faster rehabilitation. The addition of an internal brace protects the repair during ACL healing and can increase the success rate of the procedure.

Given this evolution of ACL surgical treatment, radiologists should be familiar with the new repair techniques and their appearances on postoperative imaging.

In this article, we describe two different surgical techniques for primary ACL repair, dynamic intraligamentary stabilisation and internal brace ligament augmentation, and provide an overview of the normal and abnormal appearances after this type of repair at magnetic resonance imaging (MRI) follow-up.

May 06, 2019

https://www.clinicalradiologyonline.net/article/S0009-9260%2819%2930157-6/fulltext

Although Canada is about a decade behind adopting current orthopedics with respect to these types regenerative medicine procedures, radiologists can prepare in advance. 

The Canadian radiologist who interpreted my regrown ACL MRI did so incorrectly, however when reviewed by those familiar with current procedures it was exactly the mottled appearance expected for that period of time.

Follow up MRI 1 - InternalBrace ACL Regrowth

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Aug. 24, 2019 - 1 year, 3 months post surgery

Follow up MRI completed at Foothills Medical Center, Richmond Road Diagnostic, AHS, Calgary Alberta

Radiologist interpretation influenced by lack of exposure to this type of repair and therefore may not accurately reflect actual condition in tissue remodeling.

This is a general problem, despite ACL regrowth being practiced for 10 years most orthopedic surgeons are not practicing current method, and as a result radiologists do not have exposure they otherwise would have.

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MRI results wait time: 16 days

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April 30, 2018

I received the following email:

“We have received your MRI results and Dr. _____ would like to see you back in the AKIC to go over those results on:

Wednesday, May 16th at 10:45am.  (16 day wait time)

We are happy to report that there are no urgent surgical findings in your #knee. Please continue with rehab exercises (ie. physiotherapy, athletic therapy, or home strengthening/flexibility program) and activities as tolerated.  Please remain in linear activity only (no pivoting or twisting) and no impact exercise (no running or jumping).

Please reply to this email confirming the above appointment”

 

 

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To which I promptly replied:

“Are there any non-urgent surgical findings?

It really blows my mind I know 2 people who had MRI's scheduled, results provided and in 1 case surgery conducted in less than 2 weeks, and I have to wait over 2 weeks just to review them.  A phone call would be great to give me an idea of what's going on. 

Also wondering if I am better to have results sent to my previous sports medicine doctor in Toronto and fly their to speed receipt of diagnosis.  I understand from my healthcare background this is due to the medical care system setup, not individual people.  If you would like to reduce your turn around times, I would be happy to help.

As for your recommendation not to run or jump, I can barely walk.

Evening prior to MRI I stepped off a curb and bent my knee more than it wanted, and it has been quite challenging since then.
Confirming the appointment in half a month.”

 

The step off the curb 3 days prior brought the inflammation back to where it started. 

 

Received call from AKIC doctor at U Calgary next day, who provided some clarification.  Very grateful for this.

 

*even though the radiologist completed their report promptly, & the doctor received it, there’s still a 16 day wait time for results instead of scheduling them within 24 hours of actual availability.  Go back 4 & 7 posts to see examples how wait times are reduced with lean healthcare in the emergency room and MRI, which can be done

 

Total Wait Time so far for diagnosis: 40 days

Plus the additional 16 days now.

 

MRI - Richmond Road Diagnostic - Alberta Health Services

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I want to mention how grateful I am we actually have access to healthcare.

Just the fact that it is available at all in a world where many don't have the option.

A lot of people complain without offering a solution or appreciating the fact that despite the imperfections, we're lucky to be in this part of the world.

 

Last 2 weeks I'm starting to walk (limp?) a bit better despite limited range of motion; has it improved slightly?  for straightening I have gotten it a cm or two closer to the ground, not sure if that translates to a degree or more.

Still very slow, just to & from parking lot for work & necessities, which has been treacherous at times.

Lucky snow & ice is gone in the city; would not have been able to walk on ice.

 

Apr 26

- evening before MRI

stepped off curb; it must have been a bit lower than I expected, likely I was going a bit too fast as I feel things are improving - bending beyond the comfort zone and couldn't stay up, naturally caught myself with the other leg & hands on the road.  Push through the pain to straighten it again, stood up and assessed.  Sat on my bumper for a few minutes while it settled down.  Hopefully it didn't make anything worse; happy the MRI is tomorrow and we can finally get a diagnosis. 

Surprised no one stopped to ask if everything's alright; there's a fair bit of traffic in this area - it wouldn't have help me, but what if it was someone else that actually needed help?

After this I decide to start keeping detailed notes regarding #injury progress & how it feels.

 

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Apr 27

- MRI scan

- 37 days after injury

- surprisingly long walk from front door to the MRI lab, a great exercise in patience for me.

wait time of 37.4 days for 15-30 minute scan Alberta Health Services

 

*side note

- within the week I waited, my friend requested & received and MRI at a private clinic in Calgary

- so the problem at Alberta Health is not a shortage of access to equipment or capacity.  Had my appointment not been moved up I would have done the same, as the doctor explained there is a window to treat these injuries for a positive outcome

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HOW TO REDUCE MRI TIMES

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Here's an example

HOW TO REDUCE MRI TIMES:  

https://pubs.rsna.org/doi/full/10.1148/rg.347140025

This was done at Department of Diagnostic Radiology, Henry Ford Hospital,

2799 W Grand Blvd, Detroit, MI.

It is more complex than most I would expect, and the team did not quit, they followed through their learning. 

 

I've been implementing Lean for 10 years, part of that in healthcare, if you have questions or a hospital CEO interested in leading your facility to obtain these results.

It works. 

The question is are you learning how to apply it Alberta Health Services?

1 year MRI wait times in Alberta

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I receive a call saying MRI appointment is for March 2019

- 1 year away. 

 

Cannot straighten leg or bend it near 90 degrees.

 

*Would be 3 weeks post op in US and recovering; being told I have to wait a year now here. 

 

Consider that other people have families, children or their elders to take care of; or may not be in a financial situation that allows a 1 year pause due to pending injury diagnosis - 1 year is unacceptable for MRI wait times.

It can impact their quality of life, #recovery potential & ability to economically contribute or support dependents. 

 

This situation supports unnecessary ACL amputation & ACL reconstruction when diagnosis & #treatment is not achieved within the time frame for natural ACL regrowth  - more explanation to follow.

 

Is MRI magnet time at 100% ?

If so, are we executing Lean Healthcare reducing costs in other areas to free up the available funding to purchase new equipment like so many other hospitals? 

 

For example, Lean has been used to improve hospital utilization, improving patient outcomes while reducing the need to add entire proposed #hospital WINGS.

When properly applied the CEO frees up $$, space & resources which can be redeployed for additional healthcare services (or MRI suites).

 

One way to learn a solution Alberta Health Services

- in the same way emergency wait times are consistently reduced through 3-5 day Rapid Improvement events, MRI wait times are reduced the same way.

 

see how it's done in next post