In August 2019, 32-year-old ski instructor, Cordelia, was teaching skiing in New Zealand when she suffered a nasty, twisting fall injuring her left knee. She saw a physiotherapist the following day and was informed that she would not be able to return to skiing for some time. She had an MRI scan and then flew back to the UK in early September to recover. The MRI scan taken in New Zealand bore out her belief that physiotherapy alone would be insufficient, showing she had suffered a full anterior cruciate ligament (ACL) rupture to her left knee. At this stage, it was also thought that she had suffered some damage to her menisci.
An online search into the leading surgeons and recent surgical developments in the field led her to Professor Gordon Mackay, but because he was based in Scotland, and she wanted to be treated in London, he referred her to Professor Adrian Wilson.
At her first appointment with Professor Wilson, he studied her MRI scan results, assessed the condition of her knee and explained the pros and cons of surgery versus non-surgical treatment. Ultimately, non-surgical treatment was rejected due to the risk of secondary damage occurring. In terms of the surgery required, Professor Wilson said that in his view, an ACL repair might be possible, instead of an ACL reconstruction, but he would need to assess the condition of Cordelia’s knee during the operation.
Using a technique that Professor Wilson has helped to pioneer and using surgical instruments that he helped to design, it is now possible to repair the ACL by stitching the torn ends of the ligaments together and creating an ‘internal brace’ of fibre tape that holds the joint in the correct position. The fibre tape is passed through tiny tunnels drilled into the bones to fix the ligament securely and is so strong that patients are able to walk normally and carry out their daily activities only a few days after surgery.
At the end of September, Cordelia underwent surgery. Professor Wilson carried out a complex reconstruction and repair of her ACL. He was able to repair one of the two fibre bundles of the ACL and reconstruct the other. Fortunately, the joint surface and menisci were found to be pristine and were not damaged as had been feared.
Starting three days after her operation with exercises in hospital, Cordelia undertook an extensive programme of rehabilitative physiotherapy for six weeks. The swelling took a long time to go down and a month to get enough flexibility for her to get on a bike, which was a depressing time. The situation improved as she was able to exercise more and the knee has gone from strength to strength.
Now, in March 2020, Cordelia is still having physiotherapy and says that although her left knee is not yet quite as strong as her right, she is able to do most things. She has run several 10K races, started trampolining, and passed her ‘Return to Sport’ test, in which a physiotherapist tests the strength of muscles and balance to assess the risk of re-rupture. She is hoping to go skiing in France in April.
She advises others with similar problems to listen to the experts and ignore advice from well-meaning but unqualified people. She cites the example of her physiotherapist saying she could run, when others advised her not to. She has been discharged only needs to contact Professor Wilson if she experiences any problems.
Cordelia adds: “My surgery has gone really well. Professor Wilson was friendly, professional and reassuring and as lovely as he has been, I hope I don’t have cause to see him again! Now in April I am running around 75km a week and have also run about 6 half marathons in the last few weeks.”
Professor Wilson adds: “I was pleased that we were able to combine ACL reconstruction and ACL repair for Cordelia’s knee. The main advantage of ACL repair is that, once the tissue has had time to heal, you can get back to your normal activities, including sports such as skiing, quicker than a traditional ACL reconstruction. Wishing Cordelia well for her planned return to skiing in April.”