Josh is a young man who had a sporting injury playing football and has been left with a life changing problem.
He first twisted his left knee playing football back in 2016 and ruptured his ACL and tore his medial meniscus. Sadly, his ACL reconstruction failed and when he came to see me in 2016 he had significant wear and tear issues on the inner side of his knee joint.
He underwent a very successful revision ACL reconstruction when we took some tissue from his other leg and rebuilt the ACL and also did a so-called anterolateral ligament reconstruction of the outer side of that knee and I am delighted to say that he flew through the surgery and had a very good recovery.
He is now reporting a normal knee in terms of how he feels and is able to do good levels of activity.
Sadly, because of the injury, which was a simple twisting injury and very common during football, he not only tore his ACL but very badly damaged his medial meniscus. This is the main shock absorbing structure on the inside of the knee and now that it has gone the forces are much higher on this side of his joint and arthritis in inevitable. Fortunately, most young people who sustain this injury don’t present with severe arthritis until they are in their fourth decade, but they can present earlier and in fact can present much earlier even within a few years of the injury.
There are lots of clever things that we can do moving forward including offloading this side of his knee with a minimally invasive osteotomy and indeed replacing the lost meniscal tissue with a meniscal transplantation. Josh may well need to undergo these procedures in the future.
He is a very good case explaining why it's important that we introduce a prevention programme to minimise the incidence of this injury, which is growing in terms of its prevalence to the point where we have seen an exponential rise.
My own daughter tore an ACL aged 11 and I have been very careful at what she has been allowed to do ever since because I have always known that ultimately there will be repercussions
Josh was referred to Professor Wilson by his previous consultant Mr Geza Kordas. He completed the first operation and did not wish to attempt a second one as he felt it was more complex than he was able to undertake - he recommended two surgeons and after looking on line at their profiles we chose Professor Wilson.
Prior to meeting Professor Wilson Josh had a ACL repair and twelve months of rehabilitation with the physiotherapy department's ACL clinic.
Before Josh had the repair surgery with Professor Wilson we had researched his work so had high expectations that he would be experienced and knowledgeable in how to deal with the surgery Josh may have needed.
We were impressed and reassured that Professor Wilson was competent and confident in his ability, he was sensitive to the previous journey which Josh had been through. At all times Josh felt he was listened to, surgery was scheduled to fit around his mock A levels so that his study was not disrupted - at a time which was crucial to him.
In terms of advice for others the GameReady machine made a huge difference in terms of pain management for Josh, knowing we had the direct telephone number to contact Professor Wilson post operatively was helpful and reassuring, being fully informed by asking lots of questions which were answered in detail.
Josh feels that he was treated as an individual during the process. He experienced significant levels of pain during his first operation and was understandably anxious about facing surgery again. He was completely reassured from the first meeting with Professor Wilson and felt that he had met someone which a wealth of experience who was capable of offering him the best option at reconstructive surgery. `Josh said he has received wonderful care with great attention to detail. All of the staff who we have met have been kind, respectful and caring towards Josh. It does feel that Josh has recovered so much quicker this time even though the surgery was far more complex. The use of a GameReady machine really helped. Weekly physiotherapy on an individual basis has allowed Josh to progress with regular reviews and he feels that this is a much more effective route than attending a class along with a group of other people who have had similar surgery. Although the surgery may be similar the individual and the recovery are unique to each person - the single biggest difference this time round is that Josh was treated as an individual at all times.