An ACL injury 17 years earlier had led to bone-on-bone arthritis causing Paul pain and leading him to walk with a limp. He was looking for a solution to allow him to return to his active, sporty lifestyle.
Paul had a torn anterior cruciate ligament (ACL) and had also sustained significant damage to the one condyle (rounded end) of his femur. When he ruptured his ACL years before playing football he did not have reconstructive ACL surgery at the time.
When he went to see Adrian, pain was his main issue, although his knee had a tendency to give way on a daily basis. As a result he had had to give up playing squash, annual skiing trips and was walking with a limp. Even a round of golf was too much. He wanted to continue to be active and in particular to enjoy his sport.
His X-rays showed severe grade IV bone-on-bone arthritis which would have started from the earlier ACL rupture.
Adrian explains his course of action to treat Paul’s knee:
“Currently if someone presents in their 60s to an orthopaedic surgeon with this type of arthritic picture the options are often very limited in terms of what the patient is offered, and many surgeons would just suggest a total knee replacement. In Paul’s case, this would be a disaster as he wanted to continue to be active. Total knee replacement surgery really is the last option available and should only be used in appropriate patients where we can’t do joint preserving surgery.”
In Paul’s case there were two issues, one was the arthritis and the other was the lack of the ACL. To give him the best option Adrian felt partial knee replacement surgery was the way to go but because of the ACL deficiency he needed to provide him with an ACL as well. After discussions with Paul, they decided to go down the route of this combined and complicated surgery of ACL reconstruction and medial partial knee resurfacing.
“I am delighted to say that I have just signed Paul off and he is 12 months out having a really fantastic result. He walks miles without pain and has got back to a very high level of activity. He is about to book his skiing holiday and felt so strong and so good that he asked permission to return to squash which of course I granted!”
“My mantra is all about joint preservation and Paul really epitomises how far we can take that and the success that we can achieve. With modern technology and modern procedures we really can achieve a very high level of function in a situation where we have been very limited before in terms of what we can offer.“