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The Question: I've had pain in my right knee for more than a year. After waiting five months, I had an MRI which showed two ligament tears. The specialist cannot see me for months. I have to work and care for my two children under age 10. The anti-inflammatory pills do not help, and my leg is so swollen I can hardly walk. What is my right to be treated?

The Answer: It's frustrating: You've paid into medicare for years and it's not available when you need it. Rationing and waits are endemic to our public health-care system, but that's cold comfort for you now. Across Canada, it can take months just to see an orthopaedic surgeon and more months before the operation. Hip and knee replacements have shorter waits because they have a higher priority with governments.

The surgeon will want to determine the function of the anterior cruciate ligament (ACL); it's one of two ligaments that cross in the middle of your knee, connecting your thighbone to your shinbone. The ACL helps stabilize your knee joint.

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If you are diagnosed with ACL insufficiency, you will be slotted into one of three categories. According to Emil Schemitsch, president-elect of the Canadian Orthopaedic Association, depending on the severity of the injury, you will need an operation called arthroscopic ACL reconstruction, require physiotherapy, or be told to modify your activities while wearing a brace.

With two ligament tears, your injury could be serious, depending on whether it is a complete or partial tear and which ligaments are involved. A red flag to surgeons is instability - falling - when you turn.

Dr. Schemitsch, head of orthopaedics at St. Michael's Hospital in Toronto, said two tears can also lead to a meniscus tear - the two menisci or cartilages in your knee are shock absorbers - which could cause you to develop arthritis in your knees down the road.

"The biggest impact is that the patient is going to have difficulty doing her job, perhaps doing stuff at home and looking after her children," said Dr. Schemitsch. "If you pick up your child and turn, you worry about falling down with them."

Surgeons tend to be more aggressive managing ligament tears with patients who are relatively young, such as yourself. That's because you will require those knees for much longer than elderly patients.

Here's what you should do: After that first appointment, if you find the wait for surgery excessive, see if your family doctor can refer you to another surgeon with a shorter queue. New surgeons have shorter waits.

If you want to stay where you are, tell the surgeon's office staff you can go for an operation at a moment's notice. It's not unusual for a patient to cancel surgery two days before an operation. You want to be top of mind if that opening comes up, so call the office occasionally to check in and remind people there of your availability.

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Dr. Schemitsch points out that you might not even require an operation. "The majority often don't need surgery initially," he says. "They may just need a good course of conservative treatment."



The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.

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