24-year-old architecture student, John
Consultant: Prof Adrian Wilson
Knee sports injuries and trauma
An MPFL reconstruction on both knees gives student more stability and prevents further damage
John Scammell, a 24 year old architecture student, played a lot of football and tennis when he was younger and started having problems with his knees from 16 years old.
He remembers playing football at school when a friend tackled him from behind.
John said: “I felt for the first time the ‘popping’ sensation that I was yet to become familiar with, this time in my right knee. This was followed by extensive swelling and pain. I continued to participate in tennis and football unaware of the true problem. However as the ‘popping’ sensation continued to occur, now in both knees, I was forced to give up both due to the swelling and pain.”
At 19 years old, John had an investigative arthroscopy on both knees by a local knee specialist to find out the cause of his problems. However this only resulted in the repair of mild cartilage damage leaving John none the wiser as to what the underlying issue was.
A family friend recommended a specialist who had helped with her knees, who almost immediately found the problem. His femoral groove on both sides and lack of groove in the patella was causing John instability and therefore dislocation, which was the ‘popping’ sensation that he had been feeling for so long. He was referred to Adrian, as a specialist in this area. An MRI scan found that John’s patella was also sitting too high.
Having now had two or three dislocations even when not playing sport it was decided that surgery was necessary and it was agreed John would have an MPFL (medial patellofemoral ligament) reconstruction.
Adrian said: “At age 16 John had basic arthroscopic surgery done locally and did not get a huge amount of benefit from this, so he had to avoid physical activity and was really struggling with bending and squatting by the time he got to me.
“I recommended tidying up the retropatellar damage again but also stabilising the knees with MPFL reconstructions. I did do some further investigations to make sure there was not a rotational element – and there wasn’t – so we could go for the relatively straightforward procedure of MPFL reconstruction.”
Adrian advised John not to do any physical activity which would put stress on his knees even after the surgery and to consider work which wouldn’t require him to be on his feet for a substantial amount of time.
John said: “Consequently, I didn’t expect to feel much of a change after surgery as returning to sport was off the cards and the dislocations I was getting from doing from day-to-day activities were minimal. The aim was to make the knee more stable and keep damage to a minimum to keep my knees going for as long as possible as I was only 24. We decided to proceed with my right knee first as that was the one with the most cartilage damage.”
John’s procedure was straightforward and after resting in hospital overnight he was back on his feet the next day without the need for crutches and experiencing minimal pain. He didn’t need painkillers during the day and only took a couple before bed to make it more comfortable in case he rested on the areas where the incisions had been made.
He said: “I rested well for the first week and used a Game Ready ice/compression machine, which I felt helped alot with the swelling and overall recovery post op. It was only 10 days before I was back driving and after a couple of weeks the knee was reasonably back to normal again without me feeling the need to be too careful on it.”
John had a week’s skiing holiday three months after surgery with no problems and then had an MPFL reconstruction on his left knee.
Although John still can’t play sport due to his cartilage damage, the MPFL reconstructions have made both his knees feel stable and he is more confident on them as they are less likely to dislocate.
John said: “I would say the surgery has certainly been a success. Anyone thinking of having an MPFL reconstruction can see it’s really not something to be too apprehensive about. Having read the horror stories pre op it would have done me a lot of good to read more positive post op diaries and realise the surgery/recovery isn’t too bad at all. Everyone’s recovery will inevitably be different but the overall experience certainly isn’t something to be too worried about.”
Adrian said that John did very well with the right knee, and remarkably well with the left knee.
“You can see just how well people can do following this surgery. John had no pain to speak of, and he got off his crutches on day 1 – he tells me he never really used crutches. So really very impressive,” he added.