Knee operation: Plastic band that can make a wonky knee as good as new

By
Diana Pilkington

PUBLISHED:

19:15 EST, 22 July 2013

|

UPDATED:

04:18 EST, 23 July 2013

Every year thousands of Britons tear a knee ligament, increasing their risk of developing arthritis. Carlo Barbieri, 51, a civil servant from Bexleyheath in Kent, was given a new artificial knee ligament.

THE PATIENT

Giving him a leg up: Carlo Barbieri with his new knee

Practically every weekend since I was a child Iâ€™ve played football â€“ even in my older years I was part of an amateur league.

Then a few years ago I was playing in a charity match when two of us jumped to head the ball and as I landed on my left leg, I over-extended it and heard a big snap. It was so loud that people on the sidelines gasped.

I staggered off the pitch in pain, had a shower, and put some ice on my leg because it had swollen up.

I assumed it would get better of its own accord, but over the next few months I realised something wasnâ€™t right. My knee felt sore and weak, and would lock suddenly as I walked.

It was very depressing. Sport is very important to me â€“ for my social life as well as exercise â€“ and I had to cut right back and stop playing in the league.

Then, the following year, I was playing golf when I suddenly collapsed on the ground: my knee had just given way. I was able to drive myself to AE, where they checked me out and referred me on to David Houlihan-Burne, a knee surgeon.

At my appointment a month later, he told me Iâ€™d actually snapped two ligaments in half (I just thought Iâ€™d done a minor injury to my cartilage).

He said my only option was surgery to fix the two ligaments. Because I had bow legs, probably due to playing football for years, first I needed an operation to straighten out my left leg before they could replace the damaged ligaments.

I had this done in 2008 â€“ they cut out a wedge of bone on my lower leg to change its alignment and I had to wear a brace for three months afterwards.

The following year I had the surgery on my knee. Mr Houlihan-Burne told me he would reconstruct the torn ligament at the front of my knee with some of my own hamstring â€“ the tendon that connects the muscle and bone at the back of the thigh. This is the standard procedure for thatÂ particular ligament.

But for the other damaged ligament, on the outside of my knee, he would use an artificial one. He explained they had recently developed one made out of polyester that my body would grow into.

I was given a general anaesthetic and was asleep for a couple of hours. When I woke up, my leg was covered in bandages, but it didnâ€™t hurt much.

I stayed an extra night because of difficulty passing urine (aÂ side-effect of the anaesthetic), I was on crutches for about four weeks, but was driving again after that, and in six months IÂ was back playing some sport.Â

Mr Houlihan-Burne had warned me I might only be able to dabble in five-a-side football and a bit of golf in the future.

But a couple of years after the operation I managed to rejoin my football league, even winning a few medals. And I came third in a sprint at the Civil ServiceÂ sports day recently â€“ not bad for a man of 51.

I still have the odd twinge in my knee. There are also two scars from the surgery and my hamstring is weak fromÂ where they stripped some of the tissue. But overall Iâ€™m thrilled with the results.

THE SURGEON

David Houlihan-Burne is a consultant knee and sports injury surgeon at the HillingdonÂ Hospitalâ€™s NHS Foundation Trust, Middlesex, and at Three Rivers Clinic in Northwood, Middlesex.

Every year, thousands of Britons injure their knees by tearing the ligaments â€“ the structure which join bones together.

Aside from torn cartilage, itâ€™s probably the most common sports injury. It can happen easily in football, tennis, rugby, skiing and netball â€“ any sport where you may twist your knee. But you can also do it simply by stumbling off a kerb.

Torn: LARS, a new artificial ligament, can effectively repair damaged knee ligaments

Itâ€™s also more common in women, because during their period, hormones make the ligaments slightly more relaxed.

There are four ligaments in the knee â€“ the anterior cruciate at the front, the posterior cruciate at the back, as well as the lateralÂ and medial ones â€“ and they prevent the joint from rotating abnormally.

Without them, your leg can give way beneath you without warning when you change direction. Itâ€™s most common to damage the anterior cruciateÂ ligament, which connects the shin to thigh bone; this happens to about 18,000 people a year.

Ninety per cent of those who tear their knee ligaments will need surgery to replace them. Otherwise youâ€™re at risk of developing arthritis, because the abnormal movement in the knee leads to abnormal movement in the cartilage, which can cause it to break down.

The standard option is to rebuild the ligament using tissue taken from elsewhere on the patientâ€™s own body, typically the hamstring or kneecap tendon.

But this risks leaving you with weakness and pain in that area. And if youâ€™ve torn multiple ligaments, it means damaging more parts of the body in order to fix them â€“ itâ€™s robbing Peter to pay Paul.

We can also try to use donated tissue â€“ either tendons or ligaments â€“ from a dead person to reconstruct the ligaments. But this carries a small risk of transmitting disease, the quality of the tissue is unknown, and this tissue is hard to get hold of because it needs to be from a young person.

Itâ€™s therefore better to use an artificial ligament, but for decades every attempt at designing an effective one failed.

However, in the past few years, surgeons have been using a ligament called LARS with very good results.

LARS enhances the existing ligament and allows it to heal â€“ the existing ligament grows into it, so that the artificial ligament becomes part of the body. This means thereâ€™s less risk of the body rejecting it (unlike with a donor ligament).

Itâ€™s made from a polyester fibre, with lots of individual strands of fibres in the middle, which allow the patientâ€™s own collagen (from which ligament tissue is formed) to grow into the structure and weave around it.

We implant it using keyhole surgery. With the patient under general anaesthetic, we make two small incisions in the leg and insert a camera inside the knee.

We then drill a hole through the thigh and shin bones and thread the new ligament through the shin bone hole, into the knee and then out through the thigh bone hole. The existing damaged ligament lies alongside it. The new artificial ligament is then fixed to the bone using screws.

The procedure takes about an hour-and-a-half and carries the standard risks of infection, blood clots and stiffness in the knee.

But unlike surgery using donor tissue, where the patient has to wear a brace for three months afterwards to prevent the new tissue from over-stretching, the artificial ligament doesnâ€™t extend, so patients normally just use crutches for two weeks before walking normally.

So far in the UK weâ€™ve used LARS for all the knee ligaments except the anterior cruciate, because tissue taken from the patientâ€™s hamstring works reasonably well for reconstructing that (which is why we used Carloâ€™s hamstring to rebuild his anterior cruciate, but the artificial ligament for his damaged lateral ligament).

However, weâ€™re beginning a clinical trial to prove that LARS is the best option for the anterior cruciate ligament as well. This will save us from having to deprive a patient of any of their own hamstring.

The operation costs about Â£5,000 privately and a similar amount to the NHS.