This gentleman was referred to me by another consultant who specialises in knee surgery and who knew of my work and in particular about my interest in knee preservation surgery.
He thought quite rightly that the patient would be suitable for a distal femoral realignment procedure.
The long leg planning X-rays confirmed the valgus alignment of the patient's left leg (knock-knee) consequent on the absence of the lateral meniscus. The planning software calculated the modest re-alignment needed to correct this via a distal femoral osteotomy.
So the views on the left are before correction, and the views on the right are how things should look once the correction has been undertaken. The value of this software is that the patient can see exactly what things will look like before and after surgery, before anything has actually been undertaken, and exactly how large the wedge needs to be.
As he was so active and young (and appropriate) I also replaced his missing lateral meniscus and carried out a combined distal femoral osteotomy and meniscal allograft transplantation. This is a transplant of the lateral meniscus from a donor.
Doing a meniscal transplant is difficult enough but to have this with a distal femoral osteotomy is a very tough thing to do. Many people would just be told they are too young for anything and to wait to have the knee replaced at an appropriate age.
Nick looked into the Actifit meniscus scaffold as an option and was keen to pursue this. What I planned to do was an arthroscopy of both knees such that I could get a feel for whether it should be an Actifit or Allograft Meniscal Transplant on the right and on the left I was fairly confident that we can do an Actifit. I did explain that there is a small risk that he will not be suitable for the Actifit, in which I would get in a meniscal allograft and I would do this as a separate procedure. I explained the risks and benefits and had given him our website hipandknee.tv to look at and to download our PDFs on potential complications from knee surgery. In particular I warned about nerve damage, infection and blood clots.
Nick initially couldn't really walk and was in all sorts of trouble, but now he has a normal knee and feels as good as new!
He would be delighted to share his story which is a real testament to how well people can do with this complex but very rewarding surgery.