Knee Surgery

Knee surgery is a complex field of medicine. There are so many things that can go wrong with knees, particularly where sports injuries are concerned.

Let us look at a case scenario of Richard* (*not his real name).

Richard, was 22, and playing soccer. An illegal sliding tackle brought his professional aspirations to an abrupt end. The diagnosis was a snapped anterior cruciate ligament, and damaged cartilage.

This injury occurred in 1992. 17 years ago, orthopedic surgery was advancing, but few methods were standardized and the surgeon who consulted on Richards case suggested Key Hole surgery to determine the full extent of the injury. A lengthy operation ensued to to re-attach the ACL and remove a large portion of cartilage. Plaster casts, and crutches were Richards constant companions for 10 long weeks. He was lucky at the time to have one of the best surgeons in the country, and private health care.

Never entirely free from pain, Richard continued to play competitive sport, although his knee required constant support and protection.

In 1997 disaster struck again, and whilst playing cricket in Surrey, England, he felt something 'give' and this time, being in England, for just a few months, was forced to make use of the NHS, or National Health Service.

The stark contrast between private and public health care was frightening. The 'skilled surgeon' at the NHS diagnosed that 'there didn't seem to be anything wrong' and that 'he would probably require physiotherapy.

Continuous problems with his patella popping out of place necessitated a visit to a private surgeon once again, this time one who specialised in sports injuries, at the Sports Science Institute in South Africa, a place that is becoming synonymous with top sports medicine.

A new MRI scan revealed that his ACL had disappeared (in all likelihood, snapped and retracted), and that the surgery previously performed on his was now 'old technology'.

A knee refurbishment was in order, and this time a section of hamstring tendon was removed (from the same leg) and basically recreated the ACL, as well as overhauling the knee socket by removing all the bone osteophytes, and over calcification.

The problems were not over. While knee surgery can seek to improve a condition, once you have knee issues, in all likelihood, you will have problems for life, at various intervals. Early in 2009, Richard again began experiencing problems and pain in his knee, and in fact had not been in a position to play any kind of knee stressing sport for several years.

The Sports Science Institute were again consulted, again this time with two of the best surgeons, and all the latest equipment and technology available. A brand shiny new procedure, A Meniscal Transplant, was performed.

This allows the cells of the bone to generate new cartilage, but it requires a sophisticated approach and a collagen implant that acts as a template for the regeneration of cartilage.

The surgery takes but 1.5 hours, and the patient is admitted in the morning, operated on before lunch (in most cases) and discharged in the afternoon. The regeneration is then supported by extensive icing, rest, and suportive physiotherapy.

The moral of the story remains:

• Public Health Care is not equipped to deal with complex sports injuries.
• Always get a second opinion, it could mean the difference between a sporting career, or none at all.
• Don't wait to seek out treatment. If there's pain, see a doctor. Time can really save you money and pain.
• Knee problems are in all likelihood with you for life, get the best treatment you can afford to prolong the time between inevitable future surgeries.
• Have the best healthcare insurance you can afford, even then, if you want the best of the best working on you, chances are your entire bill will not be covered by insurance, so if you know you're going to need surgery again, even if only in 20 years start an emergency fund now.