Complex multiligament injury in an active adolescent

Max injured his knee initially back in November of 2018. He was playing rugby and landed awkwardly on a straight left knee and heard and felt a pop and it swelled.

Despite being a very high-level rugby player, since Max was only 16 he was considered a paediatric case and underwent his ACL reconstruction at the Portland​.

SAMBA procedure for ACL

The MRIs confirmed the ACL had completely ruptured and sadly it wasn’t good enough in terms of the remaining tissue for us to repair. We were, however, able to do a biological ACL, and we ran the new ACL inside the old ACL which acted as a jacket or biological container for the new ACL to run up inside it bringing blood vessels. This type of reconstruction is felt to provide quicker healing and better results. It is called a “SAMBA” or “Samba” which stands for Selective Antero Medial Bundle Augmentation!

ALL reconstruction and MCL repair

We also, because of his hyperlaxity at a young age, did an anterolateral ligament reconstruction which is a fairly new procedure and one that we always tend to do in children. For this we were able to use one of his hamstrings. We used the other hamstring for the ACL reconstruction so rather than having to use other tissue, we were able to use just the two hamstring tendons that are normally used in a traditional ACL with one being used for the ACL and the other for this new reconstruction of the ALL.

His MCL had also been injured so we did an internal brace of the MCL which again is a new technique pioneered by my good friend, Professor Gordon Mackay from Glasgow.

Ramp repair and Root repair

When we looked inside the knee, the joint surfaces were pristine but sadly both menisci were badly damaged. The medial meniscus was damaged right at the very back, a so-called RAMP lesion. This is something that we have only really been aware of in the last 5 years and we have developed new techniques to repair this and we used those during the procedure to great effect and managed to get a fantastic repair. This should allow full healing and a normal medial meniscus once the healing process has completed. When we looked into the lateral side, again the joint surfaces were perfect, but the entire lateral meniscal root was detached. So again we used a new technique to repair the root by drilling a small tunnel and passing sutures through the root and pulling it down and fixing it on the front of the shin bone.

So a very big operation - a quad graft for the ACL done biologically, an ALL done using the gracilis and my new technique, a repair of the medial meniscus, the so-called RAMP lesion using my good friend, Bertrand Sonnery-Cottet’s device. Finally, a repair of the root lesion using the exciting new equipment from Arthrex.

At 8 weeks I am delighted to say that Max has made an incredible recovery with no pain, full movement and a beautifully stable knee. It is a real triumph to the new concept and technology that we are now employing in ligament surgery and meniscal pathology.

Two physio's that we have used for treatment for Max in the past both recommended Professor Wilson. We then researched him and read through his website and some of his patient's stories on the website.
Max had visited the physio who was very concerned about the amount of swelling around his knee after the rugby injury. The physio recommended that he should have a MRI scan as soon as possible. The results clearly showed a lot of damage to the knee and the need for surgery as soon as possible.
We were completely re-assured after our first visit to Professor Wilson, he clearly explained the damage to the knee, what he could do and how he could repair it.
Our expectations have been met absolutely. Within two weeks Max was operated on by Professor Wilson. The operation was more complicated than was expected, but it went really well. Afterwards Professor Wilson clearly explained everything he had done during the operation and we were given extensive surgery notes afterwards. The service and care Max received was excellent. Max's recovery is exceeding our expectations and the help and advice we continually receive has been brilliant.

Our advice for others with similar problems is to seek advice and treatment as soon as possible and if possible get an MRI scan to give you a clear indication of any serious problems. It's too easy to let symptoms such as intermittent knee pain go untreated because it's easy to believe the knee is getting better.

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