CASE STUDY

Teenage girl is now pain free and getting back to daily life following MPFL reconstruction and osteotomy to ongoing knee dislocations and knee pain

17-year-old Mollie was referred to Professor Adrian Wilson by her Orthopaedic Consultant following many years of knee problems.

Mollie had been a keen sports person and had competed at a national level for girl’s rugby. Mollie’s knee problems began six years ago when she fell when climbing on benches in school. After several weeks of pain following the incident, an MRI scan showed a growth in her knee which was subsequently removed.

After this operation she continually had unexplained bruising around her leg with extreme heat radiating from the area. Mollie’s parents decided to get a second opinion, which resulted in an arteriovenous malformation (AVM) being diagnosed and removed by her Consultant Orthopaedic Surgeon at the time, Mr Duncan Whitwell.

Following this, Mollie’s knee continued to be painful when walking and her kneecaps began dislocating on activity. After several months of dislocations, Mr Whitwell referred Mollie to Professor Adrian Wilson who then completed an MPFL reconstruction in March 2017, which successfully stopped the dislocations.

The operation unfortunately failed to cure the pain in Mollie’s knee. Adrian reviewed her torsional profile and found her to have abnormal torsion in the femur (thigh bone) which lead Adrian to conclude that this was the primary problem with Mollie’s knee.To rectify this, Adrian carried out a femoral osteotomy in December 2017 in order to realign Mollie’s leg.

Mollie was relieved to have the problem finally identified. She explains: “Prior to this operation I was hoping for the majority of my pain to go away, be able to resume normal activities (such as walking up stairs properly, be able to cycle/run) and for my leg to look straighter.”

She continues: “I was nervous about the op because I appreciated the risks involved. However I was pleasantly surprised when I came back from theatre – the pain was well managed by a variety of pain reliefs and a spinal block.”

Mollie was discharged from hospital a few days later and started physiotherapy at home. Within 6 weeks of physio she was off her crutches and a further 6 weeks later she could walk up and down the stairs normally. The pain had significantly reduced and by 5 months she was able to resume cycling and all every day activities.

Mollie concludes: “My advice to others would be to make sure you persevere to get the medical treatment that you need and don’t be too scared of the operation you may have to have as ultimately you should be left pain free and able to participate in activities that you previously wouldn’t have been able to do and that is worth a little bit of pain and discomfort for a short while after an operation. My life has definitely improved for the better by having this op, without seeing Professor Wilson I wouldn’t have been offered this opportunity and would probably still be in significant daily pain and unable to do the normal activities teenagers do without even giving it any thought. I’m grateful we were able to find out about Professor Wilson’s work, and experience first- hand the beneficial results of such treatment.”

Adrian comments: “Mollie has done really well with her femoral osteotomy. We plan to follow with a derotation osteotomy of her left distal tibia for external torsion. Her knee pain is now significantly improved but it has left her with an externally rotated foot. So the final procedure will be to bring her foot back into appropriate rotation and we plan to do this at the end of the year. A complex problem but the torsional issues always are…”

August 2018

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