ASK: About 25 years ago I had a ligament repair but it soon tore again when playing badminton, which I then had to give up.
My knee feels shaky now – I can walk, but not long distances. I will soon turn 80 and feel like I may not be able to recover from major surgery. What are my other options?
Hazel Cardoza, Richmond, London.
ANSWERThe good news is that ligament repair techniques have evolved and been refined in recent years, and I urge you to reconsider the surgery.
The ligament you have torn is the anterior cruciate ligament (ACL), an important part in the knee joint that connects the thigh bone (femur) to a bone in the lower leg (the shin bone).
The operation to fix the anterior cruciate ligament (ACL), an important part in the knee joint that connects the femur (femur) to a bone in the lower leg (the shin), is known as a reconstruction. (Stock image)
The surgery to fix this, known as a reconstruction, has a success rate of over 80 percent, but sometimes the repair fails over time.
I recently saw a patient of mine undergoing such a reconstruction (using a carbon fiber implant) 30 years ago, in the early days of that kind of surgery.
He was told the repair could take 15 years, but he has only now undergone repeat surgery. This time, the surgery used a tendon of his own leg – one of many advancements that have occurred over the years.
Dr. Martin Scurr (photo) examines techniques for repairing ligaments
There are now orthopedic surgeons who focus solely on ACL repair, and this expertise improves success rates. Since your knee is shaky, I think you should have another operation to get back to the sport you enjoy.
Your age should not affect this, and I assume you are in good general health otherwise. Recovery would take about six months and you would also need physical therapy to regain muscle strength.
The procedure takes a little over an hour. It is done as keyhole surgery and is performed under a general anesthetic or under a local anesthetic known as spinal anesthesia, so you don’t feel anything.
In the latter case, although you would be awake during the surgery, you would probably also receive some light sedation to make you sleepy.
Previously, your surgery consisted of repairing the torn ligament with a synthetic one, but now surgeons use a graft – a piece of tendon removed from somewhere else in your leg, probably the back of your thigh.
It is likely that you will have to spend a night in the hospital after surgery.
I recommend that you see your doctor for a referral to a specialist knee surgeon.
QUESTION: For almost two years now, our son, 33, who is a musician, has had hearing loss and pain in his right ear and jaw. After seeing many doctors and undergoing tests, he still has no diagnosis.
Stella Brown, Farnham, Surrey.
ANSWER: The past two years have sounded challenging for your son, but I can assure you that further research on his part will be worthwhile.
In your longer letter you mention that he has had a hearing test (audiometry), which is a standard way to check for problems.
This includes a so-called pure tone audiogram, to check the degree of hearing loss, and an impedance test, which checks the function of the middle ear.
My advice is that your son ask for a referral to a consultant neurologist or neuro-otologist instead of a consultation with a maxillofacial surgeon you name. (Stock image)
This helps the specialist determine if the hearing loss is due to a structure in the ear (such as the eardrum, middle ear, or Eustachian tube, which connects the middle ear to the back of the nose), known as conductive hearing loss, or connected to the hearing process itself.
For example, this could mean problems with the nerves sending signals from the inner ear to the brain, and is known as sensorineural hearing loss.
I feel that the latter is more likely, and that research by a neurologist is needed to understand the relationship between hearing loss and pain on the same side of the face.
The ear, nose, and throat specialist you mention in your longer letter would have recognized any conductive causes.
Possible causes of the pain include stress (not unexpected in a professional musician suffering from hearing loss) and jaw clenching, which often occurs at night without the patient being aware of it.
My advice is that your son ask for a referral to a consultant neurologist or neuro-otologist instead of a consultation with a maxillofacial surgeon you name.
Once the cause of the hearing loss has been identified, another referral to a maxillofacial specialist may help explain the jaw pain.
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