Me and my operation: The donor cartilage that banished my knee pain for good

THE PATIENT

As a teenager, football was a massive part of my life. Then, when I was 22, I badly injured my knee during a match.

I tried to turn, but my right foot was wedged one way, while my right knee twisted and there was a ‘pop’ — it was so loud that my friends on the sidelines could hear it.

I collapsed in agony and was taken to hospital. There, an X-ray showed my knee wasn’t broken.

The doctor advised me to take a month off work to rest it and to carry on taking painkillers and said I should be OK after that.

But, by December 2008, a month after my injury, my knee kept locking. If I bent it when sat on the sofa, it would ‘jam’ and I’d be unable to move my leg.

I was referred to a specialist, who told me I had torn the meniscus — a piece of cartilage that provides a ‘cushion’ between the thigh bone and shin bone.

My best option was to have the damaged cartilage removed — I had this done in March 2009.

While this stopped my knee from locking, I was still in constant pain. An MRI scan revealed that bone was rubbing on bone, as I had no meniscus to act as a cushion — but I was told nothing more could be done.

Then, in 2013, my wife Sadie and I moved to Ipswich with our two children, Macie, now nine, and Amelia, six. By then, I was limping when I walked and sport was out of the question. I couldn’t even run around after my children.

My new GP referred me to Ipswich Hospital, where I saw Mark Bowditch, a knee surgeon.

At an appointment in March 2015, Mr Bowditch said I would be a good candidate for a meniscal transplant. He explained that he would use a piece of cartilage from a donor, exactly the same size as my meniscus, and implant it into my knee.

I hadn’t heard about this type of transplant before, but didn’t have any reservations, as it meant I would lead a pain-free life.

My knee was measured and I went on the donor register. Unfortunately, it took more than two years to find a donor.

Finally, last September, a match was found in the U.S. — I had the two-hour operation in December under general anaesthetic.

When I came round, I was in a lot of pain. Mr Bowditch said this was normal. I took morphine for three weeks, then switched to paracetamol and ibuprofen once the pain started to lessen.

After one night in hospital, I was sent home with crutches.

Because it had been so long between my initial injury and my transplant, my thigh muscles are very weak, so I’ve needed crutches for longer than most people.

But I’m now down to just one and should be rid of the other in the next few weeks.

While my football days are over, I’m going to try cycling and golf. I can’t wait to be able to play with the kids and do ‘dad’ things.

THE SURGEON

Mark Bowditch is a consultant orthopaedic surgeon at Ipswich Hospital.

There are many ways to tear the cartilage in the meniscus — the tissue sits between the shin bone (tibia) and thigh bone (femur), so is prone to getting caught.

Squatting or turning quickly can do it and high-impact sports such as football can also be a risk factor. As people get older, the meniscus can get weaker and less elastic, causing degenerative tears.

There are various treatments, depending on age and the type of tear. Some patients will be able to avoid surgery by resting the knee and bringing down the swelling and pain with ice and anti-inflammatory painkillers.

Physiotherapy can also help build the muscles so that they support the joint.

If the knee keeps locking, as in Dan’s case, the patient will be offered surgery to remove part — or all — of the damaged meniscus, or repair the torn cartilage by stitching it back together.

While most people will be able to get on with their lives, some will be left with persistent pain, especially if they have had the whole meniscus removed, as there is nothing to cushion the bones.

A good option in this case is a meniscal transplant, especially for those left with severe, disabling pain who have exhausted all other options. Pioneered in Belgium, meniscal transplants have become popular in Europe and the U.S., but remain uncommon in the UK.

Dan is the first of my patients to have this operation on the NHS (stock image)

Until we started offering it at Ipswich, Coventry was the only NHS hospital doing it — more than 200 of these transplants have been performed there.

Dan is the first of my patients to have this operation on the NHS.

In terms of donor cartilage, you need to find an exact match in size and shape — cutting a piece down to size can damage it.

While the NHS has an excellent tissue bank, Dan’s cartilage came from the U.S., as he needed a large outer right meniscus, of which there is a worldwide shortage.

The tissue is stored frozen, from a deceased donor, without a blood supply and still works years later.

Unlike with other organ transplants, there’s no need for anti-rejection medication. The keyhole operation, which takes two hours (it used to be four, but techniques are improving all the time) involves positioning the meniscus in between the thigh bone and shin bone. It can be very fiddly.

We use several sutures, using a long needle to stitch the outer side of the meniscus on to the outer lining of the knee joint and anchor it through the bone.

It’s normal for the knee to be painful afterwards. It will be kept in a brace for a few weeks. We ask patients to avoid putting weight on it, but, after four weeks, they will start to move it, with weight bearing at six to eight weeks.

The transplant is complete when blood vessels start to grow into the donor meniscus — this usually takes six months.

Within three months, the patient should comfortably be walking around without crutches.

The operation is not yet being widely performed, but it’s clear this surgery has a real place for people with persistent pain following a meniscus tear.

• The procedure costs £10,000-12,000 on the NHS and privately.