In 1992 Neil had a classic twisting injury to his left knee landing awkwardly.
He underwent a bone-tendon-bone ACL reconstruction towards the end of that year. He got back to excellent activity. Sadly he had a further injury at work when his foot caught the lip of the door as he was exiting his lorry and he sustained a significant twisting injury which resulted in the failure of his ACL.
He had an arthroscopy followed by a second opinion which led to him having a revision ACL using hamstring tendons in 2011. He has not been great since. He has had pain and instability with the pain all being medial. By 2018 he had significant night symptoms and was kept awake by the knee. Twisting produces a dislocation-type pain. If he walked for more than 45 minutes he was in severe pain and had to stop. He was limping intermittently. He was able to do stairs fairly normally but went one at a time if the knee was causing him issues and he needed to hold on. He had episodes of giving way, at least 2-3 times each day but did not actually fall.
He had tried an Unloader One brace and physiotherapy and had an arthroscopy last year - and was told the next step is either revision ACL with a partial knee replacement or possibly an osteotomy.
When I recently reviewed Neil aged 50 he was fit and worked at Tesco’s petrol station with a fairly physical job although he has modified his activities and is doing less in the way of standing with this.
I found him to have a slight varus alignment (slightly bow-legged) with medial tenderness. He had lost 15 ° of flexion, perhaps even 20° on the left. His anterior drawer, Lachman and Pivot tests were all equivocal. His collaterals were intact. His PCL was intact. His plain X-rays show a metal RCI screw in the tibia consistent with the ACL surgery and he has a metal screw on the femur with a button from the previous, slightly vertical ACL. It looks as though the revision was done with the button and this position is as I say, slightly vertical and part of the issue why he has some ongoing laxity.
Putting it all together, I thought that a significant amount of his instability was coming from his pain. The arthroscopic pictures that he showed me revealed grade II (borderline grade III) disease medially with a degenerate tear of his meniscus which was tidied up. He also has a background of Fibromyalgia and Polymyalgia.
Neil underwent Lipogems, which is adipose-derived mesenchymal stem cells, as an injection to the left knee. Although initially he had really quite severe symptoms and was struggling with short distances, after 6 weeks post injection he can now walk 4 hours without pain and has had no pain almost since the moment he got off the operating table. He has had no bruising and he is absolutely delighted with the outcome as of course we are.
I had a football accident when I was 22 which led to a knee rebuild. In 2010 I had an accident at work which eventually led to another knee rebuild. In all I have had 9 arthroscopies and 2 knee rebuilds. The last arthroscopy was in 2017 which left me as I was told bone-on-bone in my knee and that I needed a knee replacement but I was too young to have this.
"I couldn't play football again and after my second rebuild I had to be more careful and to me was definitely not as successful as my first one. I was left in constant pain and was limited to how far and how long I could walk for and limited knee bend. In 2015 I had to have a staple removed as it was eating its way out from the inside.
"I visited my dentist whom asked me about my medications and why I was on them, he actually said a knee replacement may not be good for me due to my Fibromyalgia, Polymyalgia and Osteoarthritis and then told me about the Regenerative Clinic.
"After so much pain over the years I was more than happy to give anything a try especially as there was no surgery involved, the only element of risk was that it may not work and even those statistics were low.
"My expectations have been met absolutely, I walked out of the operation theatre and have not experienced any pain since. Therefore exceeded my expectations.
"To patients with similar problems, I would advise that "if you afford to do it, do not hesitate. I know it is not the same for everyone but the benefits outweigh the risk of it not working and you can not put a price on being pain free."
"From meeting the Professor to having the procedure, the care I have been shown is outstanding and I wouldn't hesitate to recommend, in fact I have already passed the details of the Regenerative Clinic on to a friend."