AKIC (Acute Knee Injury Clinic) U Calgary - ACL tear follow up - appt 2

May 16 cont...
10:45

2nd AKIC U Calgary appointment (Finally)
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Wait Time has been 57 days so far,

19 days behind actual scan completion
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follow up to go over April 27 MRI results

Again, I feel reluctance to work with me, in only 2nd appointment.  When I bring up ligamys doctor does not seem familiar with it and can't answer questions.  I ask if he read the emails I sent with the information and am told they were not read.
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I inform him the surgeon responded I may be an ideal candidate for InternalBrace and am told “We don’t do that here.”  Concerned the help that could be offered on this will not be provided I said “I just need you to support which ever surgeon I end up working with by helping me get him the information he needs.” I do this to ensure consensus is established on how we’re going to proceed with expectations & responsibilities as I don’t know what may be required.
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I told him I’d send the medical journal on Internal Brace to share & discuss with the surgeons so they know what I was referring to and how they can provide this option.
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At this point I’m perplexed why they don’t know about this and am having some doubts about the Canadian Healthcare system.

1:46pm

I send the AKIC sportsmed doctor at U Calgary information on internal brace to share with the surgeons he had yet to tell me a name of, as I’ve lost faith they’re offering current practices however I don’t see why they wouldn’t be interested in learning practices with better patient outcomes.   https://www.arthrex.com/what-surgeons-are-talking-about/131FD01B-7B44-491D-B5F7-015A9474A65E

2016 article on AHS from the Calgary Herald on MRI wait times increase in Calgary – how many of these could be understood by the work from my Aug 12 post:

https://www.google.com/amp/s/calgaryherald.com/news/local-news/ahs-seeks-answers-to-the-reasons-behind-lengthy-calgary-mri-waiting-lists/amp?source=images

Still eating fresh pineapple for bromelain, found in every part of the pineapple, but most plentiful in the stem.  Seems the clot isn’t a concern anymore;  pineapple enzyme is supposed to help break up existing clots and prevent future ones from forming.  I usually blend it into a smoothie.

InternalBrace Ideal in this situation

May 16, 2018
wait time: 57 days
time remaining to avoid removal: 4.5 weeks
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Working on how I can get the MRI photos to display.
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Just after midnight I follow up on the email I sent to Dr. Mackay, they reply after 4am.  At 9am I let them know I’ll get the MRI pictures.
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4:35am

Dr Mackay replies “It would appear that the InternalBrace could be ideal in this situation. It allows the ACL and MCL to repaired simultaneously if required. 
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If the ACL cannot be fully reconstituted it can be augmented with a reduced sized graft and backed up with the internal brace, reducing the #surgical insult. This approach also supports accelerated rehabilitation.” 
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I have a window.
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I’m working in the morning so I try to get back to sleep each night as soon as I can. 

8:43am

Follow up Dr Difelice with an email.  I ended up calling at some point yesterday and they answered my questions.  USA healthcare costs are WAY higher, not sure what problem is driving this for them (more on this later). 

10am

I ask what else they need at the Mackay Clinic and what schedule provides the best possible outcome. 

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If you were like me with no prior knee injury knowledge, and read the same published articles, we'd share the foundation that an ACL regrows itself supported by multiple cases in different medical journals and other media, and over 110 surgeries; and be looking forward to your doctor going into more detail on this.
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You also might assume the specialist advising you on potential courses of action to choose from - because it’s their field of expertise - will be able to further educate you on it. 

This is the problem with assumptions and why one must validate them (beyond a Continuous Improvement event).
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I didn’t receive the impression during the 1st appt my enthusiasm was shared when asking about alternatives to avoid unnecessarily removing a ligament that’s trying to heal or damaging good tissue to harvest a graft; nor did I receive replies to my specific questions in emails.

How Close Are Scientists to Regrowing Damaged Limbs?

and the most recent thing I came across from last year:

Anterior Cruciate Ligament (ACL): Very Close To Human Trials

2017

https://www.rdmag.com/news/2017/11/how-close-are-scientists-regrowing-damaged-limbs

Dr. Cato Laurencin’s work in the previously uncharted territory of regrowing bones, tendons and ligaments.

the potential in the polymer technology for regrowing bones.

After successfully modeling how to regrow an ACL — which about 200,000 Americans injure each year — Laurencin has attempted the procedure in rabbits that he says are “running around and doing well.”

It has also been in one human patient who has had the regrown ACL for 3 years.

Laurencin says that he is now working with the U.S. Food and Drug Administration to start human trials.

Laurencin’s work regrowing ACLs was named one of the top scientific discoveries to change the world by National Geographic Magazine

  https://today.uconn.edu/2012/03/national-geographic-cites-work-by-uconns-dr-laurencin-among-%E2%80%98scientific-discoveries-that-changed-the-world%E2%80%99/#

so even if you’re a graft patient, looks like it’s only a matter of time before you can have your ACL back.

UConn scientist working on a new way to repair knees

I also came across the following

UConn scientist working on a new way to repair knees via ctmirror

Aug 22, 2013

https://ctmirror.org/2013/08/22/uconn-scientist-working-new-way-repair-knees

There’s a clinical trial underway to test a new type of ligament Laurencin invented, which has already regenerated ACL tissue in animals. If successful, the next step would likely be a large clinical trial in the U.S. and seeking approval from the FDA to put the ligament into widespread use.

It’s part of the development of a field Laurencin calls regenerative engineering

Success of the surgery is often described in terms of how common it is for patients to return to sports; studies have offered varied pictures. Some have found 90% of patients return to sports 1 year after the surgery, others show the rate is closer to 50 - 70%.

In a patient with a torn ACL, the stump that remains contains a storehouse of nutrients and stemcells, which have the potential to grow into new tissue. Laurencin’s method involves using those cells and others that are already present, by placing a specially engineered “matrix” where the ligament should be. Cells can attach to it, creating new tissue.

“In many ways, we utilize the patient’s own body as a bioreactor, if you will, to be able to make the tissue,”

It took years to create the matrix, which had to have the right mechanical and chemical properties to allow for regeneration. Laurencin worked on it with James Cooper, a former PhD student now a prof at Rensselaer Polytechnic Institute in New York.  The matrix, the L-C Ligament, is named for Laurencin and Cooper.

Research in rabbits showed that the matrix could regenerate an ACL. For the past 2 years, it was studied in sheep. The clinical trial in humans began in the Netherlands in June.

The L-C Ligament is designed to provide support for the knee as soon as it’s implanted. It takes between a year and 18 months to fully regenerate an ACL, Laurencin said.

The device was recently patented; patent-holder is Soft Tissue Regeneration, a New Haven-based co. Laurencin co-founded. The co. has received funding from the state’s Connecticut Innovations, which gives the state a share of the co. 

Grade 3 sprain explanation

I finally come across an article explaining what a grade 3 sprain is.  (May help someone else trying to decipher this)

"About ½ of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured #ligaments are considered “sprains” and are graded on a severity scale.

Grade 1 Sprains

The ligament is mildly damaged in a Grade 1 Sprain.  It has been slightly stretched, but is still able to help keep the knee joint stable.
 

Grade 2 Sprains

Stretches the ligament to the point where it becomes loose.  This is often referred to as a partial tear of the ligament.
 

Grade 3 Sprains

This type of sprain is most commonly referred to as a complete tear of the ligament.  The ligament has been split in 2 pieces, and the knee joint is unstable.

Partial tears of the ACL are rare;

More ACL injuries are complete or near complete #tears."
 

To better understand I pull out my #MRI again and reread (in Oct 6 & 7 posts).

ACL regrowth BEAR trials (bridge assisted ACL Repair)

After first finding an ACL healed itself, the 2nd thing I found were the BEAR trials run Boston Childrens in these two articles from 2016:

http://www.stack.com/a/radical-new-surgery-allows-you-to-regrow-your-acl 2016 stackmedia

https://www.bostonglobe.com/sports/2016/03/23/new-surgery-could-revolutionize-knee-repairs/BJISuh60AYKYTKWPwaYFWP/story.html Boston Globe

A safety study had been done on 10 patients, all reported “doing well, with knees working as well as knees treated with ACL reconstruction.”  The 1st patient surgery was Feb. 2015 (> 3 yrs ago), for Corey Peak, who also tore it skiing.  He concluded that it was a better option to treat a torn ACL; within 3 months post-surgery, his MRI showed that his ACL had started to naturally knit together; he was jogging on a treadmill. Soon after, cycling to work. 

Bridge Enhanced ACL Repair - How it works:

When viewed under a microscope, ACLs still have active cells and blood vessels after injury.  The ligament itself works hard to heal, however the synovial fluid — the lubricating substance that exists inside of all joints —washes away the blood clot that serves as the initial connection between torn tissue ends in other parts of the body. 

Conventional treatment for an ACL tear involves removing the torn ends of the ligament that’s trying to heal itself, & fabricating another from a tendon graft, usually done by stripping away good tissue (hamstring or patella).  Patients who had 1 injury then have to recover from 2 separate injuries—the torn ligament + the uninjured area where the graft was taken out.

Whereas a traditional reconstructions involves removing good tissue for a graft from another part of the body to fabricate an ACL, BEAR allows patients to re-grow their own ACL. This resulted in both quicker #recovery and fewer long-term complications than the traditional ACL amputation & reconstruction.

An estimated 150,000 ACL tears still occur every year in the USA. “ACL re-tear rate can be as high as 20% for teens.  Up to 80% of patients develop arthritis 15-20 years after surgery.”

Given the eligibility criteria timeline, I need to figure this out fast, as I was at 38 days, and I didn’t want unnecessary ligament removal.

Orthopedics - Intrinsic Healing of the Anterior Cruciate Ligament in an Adolescent

Apr 27-29

The majority of the weekend I spent searching anterior cruciate ligament repairs & learning what an ACL repair is, and the 1st article I found was how a 12 year old boy suffered a complete traumatic rupture of his ACL, which intrinsically healed. 

You can find the article

“Intrinsic Healing of the Anterior Cruciate Ligament in an Adolescent”

in The American Journal of Orthopedics, August 2015

https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/issues/articles/ajo04408e294.pdf

1 year MRI wait times in Alberta

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