By ALICE SMELLIE |
It happened in a split second - one moment Ben Doltis was playing football with friends, the next he was prostrate, clutching his right knee in agony. The pitch was frozen and slippery, and his leg had twisted awkwardly while he ran. As he fell, he had heard a sickening - and familiar - crack.
'A year before, I tore a ligament in my left knee and had to take a month off work after surgery to repair it, so I knew it was serious,' says Ben, a managing director from London in his 30s.
A trip to A&E confirmed his fears - he had torn another ligament.
The knee is the largest joint in the body, where three leg bones meet. The thigh bone and shin bone form a hinge joint and the patella, or knee cap, sits over them and slides as the leg moves.
Crucial to this structure are the ligaments, the strong fibrous cables of tissue connecting the bones. The anterior cruciate ligament is one of the four main ligaments, which acts as a stabiliser to the leg. This is what Ben had damaged.
It is one of the most frequent ligament injuries and is usually caused by a sudden stop and twisting movement or from a blow to the front of the knee. Damage often occurs while playing sports such as football and rugby, while running for the bus or simply stepping out of the bath. The reconstructive process has historically been lengthy and more painful than the injury itself.
'I couldn't believe I'd hurt my other knee in the same way as before,' says Ben. 'I was devastated. I run my own firm of headhunters for the IT and banking industry and I needed to be at work.'
Until recently, the only repair option was replacing the ligament with tissue from either the patient's patellar tendon, which runs from the knee cap to the shin bone, or the hamstring tendon.
'There are problems associated with both techniques,' says Simon Moyes, consultant orthopaedic surgeon who specialises in arthroscopic - or keyhole - surgery on the knee, shoulder, foot and ankle.
'Using the patellar tendon leaves a large scar running down the leg, and there is a high risk of pain and sensitivity post-operation. You may also have problems kneeling.
'The hamstring is an important stabiliser of the knee and there is a risk of nerve damage when using this technique. It's like robbing Peter to pay Paul - you may suffer a great deal of pain and are effectively undergoing two operations.'
Ben was reluctant to undergo the procedure again. He says: 'The patellar tendon graft left me with a huge scar down the front of my leg and across the knee. As well as being in an extraordinary amount of pain, I had to stay off work for four weeks.'
But, as Ben's surgeon, Mr Moyes points out: 'Not only is this injury very painful, but if left untreated you risk further injury and early arthritis.'
Luckily for Ben, Mr Moyes is championing a new technique called allograft reconstruction, in which ligaments are transplanted from a deceased tissue donor.
While major organs must be taken at the time of death as they begin to decay immediately, making rejection far more likely, tissues such as skin, bone, tendons, heart valves and corneas can be safely donated up to 48 hours later.
'The public don't realise how many patients can be helped by tissue donation,' says Professor John Kearney, assistant director of NHS Blood and Transplant, the UK's major provider of human tissue for transplant. 'Age isn't a barrier to donation. Most people can be considered to be tissue donors. Disease and illness may preclude some people as there may be a risk of disease transmission. However, all potential donors are carefully screened.'
Keeping fit: An increase in active lifestyles has also led to an increase in cases of knee surgery
And unlike organ transplants, tissues such as ligaments do not need to be matched and patients do not require drugs to prevent rejection.
The donor remains anonymous - although a letter from the recipient can be forwarded to the family. Ben says he did not want to know more. 'I was very grateful, and just thrilled to be offered the operation,' he says.
The need for knee operations is increasing as more of us take up more active lifestyles - up to 25,000 people in Britain need reconstructive knee surgery each year.
' First we remove the damaged ligament via a keyhole incision,' says Mr Moyes. 'Two small tunnels are drilled into both the shin and thigh bone. Then the allograft or replacement ligament is pulled through, tightened, and fixed into place with pins or screws. Recovery time is reduced, there is less pain and bruising and the scar is much smaller. It can be done as a day case, if you're lucky.
'When performing the old procedure you may be compromised by the size of the patient's ligament, but if you are ordering from a stock, you know that the graft will be the right size. Time in surgery is reduced by about 25 minutes.'
The only potential complication is being infected by a virus from donor tissue, although the chances of this are extremely remote.
The allograft tends to be available only privately, but Moyes thinks it has so many benefits that it should be used more widely. It costs more than the standard operation because the replacement tendon has to be prepared, but savings in length of time in hospital and recovery period make it an economical option, too.
Ben is convinced that the allograft is the superior method but says it is still a very painful procedure. 'I was off work for only a week and a half, but I won't risk it again. I have given up football - just in case.'