Surgery on a previously unknown ligament can make the recovery of the knee stronger. David Walton, 31, a director of a snow sports company from Surrey, told Carol Davis his story
While skiing in the French Alps in March 2016, my left ski caught heavy snow and I fell, turning as I descended the slope.
David Walton, 31, director of a snow sports company from Surrey
I heard a thud in my left knee and felt a throbbing pain, so I covered it with snow to numb it. Only, I had to ski down to get help and put my weight on my right leg.
After X-rays at the local clinic, doctors told me that I had torn my anterior cruciate ligament (ACL), the tissue band that connects the femur with the tibia, keeping the knee stable. An MRI scan confirmed this and showed other damage.
I was wearing a knee brace, taking painkillers, and resting, but doctors said the only option was surgical repair if I wanted to stay active as an enthusiastic skier and an army reserve.
I did research on private surgeons and when I saw Professor Adrian Wilson six weeks later, he explained that, in addition to reconstructing the ACL, he would be repairing the anterolateral ligament on the side of my knee.
Professor Wilson said that doctors only discovered this ligament eight years ago. It is not easy to see in images or even during surgery unless you know exactly where to look, and it was likely that it was damaged in my fall. Repairing it as well as my ACL would make my knee stronger.
While skiing in the French Alps in March 2016, my left ski caught heavy snow and I fell, turning as I descended the slope (file image)
I had the three-hour operation under general anesthesia. The next day my partner, Lauren, took me home, still on crutches. In the following months I received weekly physiotherapy and I did exercises three times a day to build muscle strength. By the end of June I was on crutches and I could cycle and walk our puppies.
Now – two and a half years after fall – I am fit and ready for a new ski season.
Professor Adrian Wilson is a knee surgeon consultant at Wellington Hospital in London and treats patients on the NHS at BMI London Independent Hospital.
Every year around 25,000 Britons tear their ACL, a central band of connective tissue that runs diagonally through the knee. Although 20 percent of people can continue without adjusting their activity, more active people can struggle.
Repairing used to mean an 8 cm incision at the front of the knee, but now we are reconstructing it through three & # 39; keyhole & # 39; incisions, 1 cm in diameter, below and on either side of the knee. Traditionally, we then fix it in place with two hamstring tendons taken off the bone.
With the hamstrings we can bend our knees, but scar tissue grows and plays the same role.
About 5 percent of ACL repairs fail due to further injury, poor healing or technical problems during the operation, so the knee becomes unstable again.
With hamstrings we can bend our knees, but scar tissue grows and plays the same role (file image)
But the discovery by a Belgian researcher in 2011 of another, thin ligament (4 cm long, 5 mm wide), which is located in tissues along the outside of the knee, helps to improve this pace.
This "new" anterolateral ligament (ALL) plays a crucial role in keeping the knee stable and we now know that in 80 percent of ACL injuries, ALL is also damaged.
We have results for five years after the operation showing that when we perform an ALL procedure in addition to an ACL reconstruction, the failure rate can be reduced to 1 percent.
During the operation I make two small incisions on either side of the knee and I place a camera to inspect the damage. I then master an incision and dissect the hamstring tendons. To reconstruct the ACL, I only need one hamstring tendon, but if the ALL also needs to be reconstructed, I take two from the leg on which I operate. These are prepared on a back table in the theater, where we double and compress them to make them smaller and stronger and reinforce them with fiber tape.
We also soak them in an antibiotic solution to reduce the risk of infection, which is approximately 1 in 500.
Then I identify ALL, drill holes in the thigh and shone and attach the graft over the ligament to strengthen it. I drill a small bag into the bone and secure the graft in place with a plastic screw.
I reconstruct the ACL in a similar way. Immediately afterwards we place the patient in a cryotherapy device – a cooling knee support – that delivers ice-cold fluid and pressure to stop the swelling.
Patients only need painkillers for two weeks, have no crutches within three to four weeks, and are back to work within four to six weeks.
- The procedure costs the NHS £ 7,000 and £ 10,000 privately.
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